A Country Doctor Writes:

Sweden, Saturday night: 

Sitting in my aunt’s living room on the eleventh floor as the late summer sun set and the sky turned dark, the conversation over after-dinner-coffee and cognac turned to her recent stroke and emergency carotid artery surgery. My mother had a small stroke a couple of years ago, which fortunately only affected her peripheral vision to her right. My aunt’s sequelae are less specific, affecting a few fingers, her balance and some parts of her memory. I let my gaze wander to my right from the coffee table to her windowsill with several blooming orchids and the city lights below.

“How funny”, I thought to myself, “there’s a spider web between those two orchids”.

A perfect, round spider web sat between the two orchids with a distant light source illuminating it from behind. I tilted my head to make sure; my aunt was always a good housekeeper and it seemed unlikely she would have cobwebs on her orchids. “Maybe the stroke did even more things to her”, I thought to myself.

With my head tilted I saw another spider web of the exact same size and appearance, between the next two orchids on the windowsill, also illuminated by a bright light in the distance. “No way she would have two cobwebs”, I decided. “It must be my eyes”.

As the conversation continued I drifted off with my own project. Closing one eye at a time and discretely tilting and turning my head, I determined the spider webs were only visible with my right eye. Sudden cataract of one eye seemed an unlikely diagnosis, so I figured it must be something else, probably a vitreous detachment. I saw no flashing lights, which can be a symptom of either a vitreous or a retinal detachment, and there certainly was no curtain over any part of my visual field or any loss of peripheral vision.

With no ominous diagnosis immediately apparent to me, and not wanting to ruin the evening, I beamed myself back to the conversation and finished out the evening without saying a word about my vision.

Driving back to the hotel, I knew for the first time what people mean when they describe the difficulties of night driving with cataracts. The spider webs seemed more like small haloes around streetlights and headlights of oncoming cars. This is a classic symptom of cataracts, but this was too sudden. Squinting with my right eye allowed me to drive comfortably.

After parking the car outside the hotel I continued my exploration. What looked like a halo with a spider web configuration was also a circle filled with a swirl of movement, like water circling a drain. Inside this swirl of water were squiggly, small worm-like shapes, similar to the small, unobtrusive floaters I have had for years.

I went up to my room and pondered my fate. I wanted to be a doctor from about the age of four, ever since as a sickly child I had our general practitioner come for house calls. When I became severely and progressively nearsighted starting at age seven, I became fascinated with ophthalmology. My first eye doctor was a thin, old man with an office in an ancient apartment building with marble stairs, oak doors and a musty smell. As he leaned into me with his bright lights, he spoke with great concern about my worsening eyes. Every year I would get new, thicker lenses, and every year he would seem more concerned. After puberty, things seemed to slow down, and the old doctor seemed to be more content with my situation. He was so wise and kind. I wanted to be just like him.

In medical school I flirted with the idea of becoming an ophthalmologist; I learned everything I could about refraction, and as an avid photographer and dark room enthusiast, it seemed like a natural fit. I took electives in ophthalmology and thought this would be my life’s work.

Then one thought, one factoid, stopped me in my tracks: As a severe myopic, I might be at increased risk for suffering a retinal detachment – then where would I be as an eye doctor who couldn’t see well? The rest, as they say, is history. I decided to become the kind of general practitioner I first identified with as a young child. 

Fast forward to 2008, a middle aged Family Practitioner, sitting in a hotel room with a self-diagnosis of a vitreous detachment in a country where I no longer have any medical connections – do I have a harmless condition with no need for intervention? Do I trust what I think I know about ophthalmology beyond my own specialty training? Do I trust whoever is on duty at the small hospital nearby? Or do I call my wife back home in the States and ask her to pull some strings and get me an appointment Wednesday with the best ophthalmologist I know back home?