Outdated Equipment

Friday noon, in typical fashion, I seemed to have an emergency on my hands. This time, it was an ocular one.

Philip Brown had driven 35 miles in a steady snowfall to see me. Four days earlier he had been to the Cityside Emergency Room for modest pain and a couple of small blisters on the right side of his forehead. They diagnosed him with shingles and put him on an antiviral. Now he had 48 hours of severe, burning pain in his forehead, where at first there had been only mild discomfort, as well as a new, piercing pain and profuse tearing in that eye.

“Well, we’ve got two things to take care of”, I began. “The pain can be managed with the same medication you took when you had that pinched nerve in your back last year, but we have to figure out exactly what’s going on with your eye.”

He grimaced and struggled to open his eye. With his left eye he could see 20/30 but with his right only 20/200. His squinting eye had a mixed injection – redness that extended all the way to the limbus, or corneal margin.

“Let me get some more equipment to examine your eye with”, I said and headed to the procedure room for the Wood’s light and some fluorescein strips to look for signs of zoster ophthalmicus, the dreaded dendritic fluorescence you can see when the virus attacks the cornea.

I reached for the eye tray on the top shelf in the cabinet over the large stainless steel sink. My heart sank as I fumbled around among its contents. The fluorescein strips were gone.

I knew exactly what had happened. The half full box had December of last year printed as the expiration date. I remember thinking the last time I used them that we needed to order new ones. The ordering of supplies is done by one of the younger nurses at the other end of the clinic.

“Autumn, have you seen the box of fluorescein strips?” I asked, but she hadn’t.

I returned to Philip with the bad news: “I’m going to have to refer you to an eye doctor today, because we ran out of the stuff to look for shingles in the eye. Who do you usually see?”

“Dr. Pomeroy.”

I looked at my watch.

“An hour from here, in good weather.”

“With good eyesight”, Philip added.

Just then, there was a knock and the door opened. A triumphant Autumn handed me the box of fluorescein strips.

“They were on Sally’s desk, ready to be thrown out”, Autumn said. “I left a note for her not to get rid of the old box until the new one comes in.”

Moments later, I knew that Philip didn’t have shingles of his cornea. What he had was a peripheral superficial corneal abrasion at twelve o’clock, caused by a curled eyelash. With the eyelash out of the way, his eye stopped tearing and his pain was instantly reduced by half. On his second trip to the eye chart, he scored 20/25 with his right eye.

With prescriptions and instructions taken care of, I went back to my office, opened my thermos and ate my sandwich.

Just then, Sally, back from her lunch, came in.

“What’s this about the fluorescein?”

I swiveled around and looked up at her.

“Let me tell you a story about how, with outdated equipment, I saved a man from pain and agony and a dangerous two hour round trip in a snow storm…”

3 Responses to “Outdated Equipment”

  1. 1 meyati January 17, 2015 at 5:41 am

    I’m glad that Autumn had the initiative to do some extra searching and found the box of fluorescein strips. I’m glad that you have a staff with good memories. They make a good team. I also enjoyed the story.

    Thank you

  2. 2 Levin January 24, 2015 at 10:33 am

    What about the eruption and zoster-form rash? H.Zoster may not have dendrites and a non-specific stain. SLE needed to r/o uveitis. Patch would work. How is he doing?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



Error: Twitter did not respond. Please wait a few minutes and refresh this page.

Top 25 Doctor Blogs Award

Doctor Blogs

Enter your email address to subscribe to this blog and receive notifications of new posts by email.


contact @ acountrydoctorwrites.com
Bookmark and Share
© A Country Doctor Writes, LLC 2008-2022 Unauthorized use and/or duplication of this material without express and written permission is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given.

%d bloggers like this: