Saturday, we picked up our rental car and headed down the Pacific Coast Highway toward Monterey. It was pretty foggy; for her first week in California Anna got no day without constant drizzle.
The fog was a perfect 18% gray, and I noticed some unsettling things: there were lots of “floaters” in my field of vision, and they were different from the usual ones. These were sharply defined black points with white haloes. But that wasn’t what bothered me: it was the large “jelly fish” thing in the lower right of my field of vision. I switched eyes and verified that it was unique to one eye (i.e.: it wasn’t something in my brain) then observed that it tracked with my eye: something was wrong with my eye. By now some of you already know where this story goes.
Back in 2002 or so, one guy I knew in the security industry (he has since died) had a retina completely detach, rather suddenly. He said he saw “floaters” and then a black curtain drew across his eye and he never saw with that eye, again. I was trying to play the situation reasonably cool, which means that I was not screeching like a scared chimpanzee and flinging poo around like a congressman. When we got to the hotel in Monterrey, I checked around a bit and found a local hospital with an ER that had an opthamologist (but it was Saturday late in the afternoon) and a local opthamologist who listed an emergency contact number. Since I had it in my mind that this was an emergency, I left a message on that number and started to sort out my plans for getting to the ER. But, lo! A nice-sounding opthamologist called me back on my phone and said “this is nothing to mess with” and suggested I could meet him at his office in 15 minutes.
15 minutes after that, I was having bright lights shining in my dilating pupils, and all sorts of close examination from various angles with magnifying lenses. My assumption was that I was going to probably lose an eye, at worst, or have some kind of surgery, at best. But, no: it turns out (as he explained to me, very clearly) the gooey stuff in our eyes sometimes dries out, and if our eyes are particularly egg-shaped – as those of us with nearsightedness’ are – it detaches from the back of the retina and doesn’t really hurt anything but it’s a problem to keep tabs on. Sometimes it can pull the whole retina away with it and then it’s a bad, bad day.
I’ve been walking around all week with a “jellyfish” in the lower right of my field of vision and it may be a new part of my reality – it sounds to me like one of those “If it doesn’t get worse it’ll probably get better but maybe not much” kind of situations.
It’s good to know the symptoms of these sorts of things, and to understand what is an emergency and what is not. I don’t recall at any point of my life being taught, “here is when you walk, and here is when you run.” I suppose the list of things that can go wrong is too big to pre-load us with sensible responses, until we’re at the point where they become obvious.
I’m 57 and my joints are falling apart, my eyes are not so hot, my brain is definitely not what it used to be, etc. I know that Making Marcus Great Again is not an option; I suppose I should just be glad that the wheels haven’t come off with a bang yet.
A big tip ‘of the eyeball to Dr Leland Rosenblum, MD., who dropped what he was doing (he said something about “it being a boring meeting, anyway…”) and came to poke around at my head and diagnose a scary situation. I hope that doctors like Dr Rosenblum periodically remember how much comfort they can bring when the situation is scary; their calm and professionalism is the best of what modern medicine offers.
Someone needs to write a book like: “Now that you’re at the age where you are falling apart…” – it should have a list of things you absolutely must know, and then a big indexed load of “things that are emergencies” and “things that are very expensive” and “things that will probably be OK if you don’t pick at them.” I guess medicine is too much of a moving target (that’s a good thing: I remember when they taught us a version of CPR that didn’t work very well) I’m just super glad that people like Dr Rosenblum are there for us when we need them. He’s way better than a whole fleet of F-35s.
Hope and wishes.
I am resigned to the joint failure and cognitive lapses, but I will rage against the dying of the light.
Yeah, that’s scary.
As a child, I had perfect eyesight. It started gradually and slowly deteriorating when I was about 12. That was an uncomfortable experience. At first, I tried to deny that it was happening. Then I had to get eyeglasses. Then, by the time I was 18, I needed a new pair of much stronger eyeglasses. It was scary to think about how much worse it was going to get. At least by now my eyesight hasn’t worsened for the last few years. As long as it’s not getting worse, I’m not freaking out. My eyesight is really bad, but at least it’s not worsening.
At school I had a physics teacher who told us that you only need to exercise your eyes, and that will prevent bad eyesight and even fix existing problems. She had excellent eyesight despite her somewhat old age, and she firmly believed that it was thanks to whatever eye exercises she was doing. Back then, I didn’t expect my teachers to misinform me. I also heard from some other sources that you need to take some vitamins and that will improve bad eyesight. Damn snake oil salesmen. I didn’t give these kinds of snake oil salesman any of my money, but their false promises still hurt me, they gave me false hope. I certainly dislike alternative medicine salesmen, but most of them don’t actually make me angry. Those who sell remedies intended to improve eyesight actually do invoke some emotions in me—this one’s personal.
It’s interesting how some medical problems don’t scare me much, but others freak me out. I’m not afraid of getting killed, because, once I’m dead, I’ll no longer care. As long as it’s quick and painless, the prospect doesn’t scare me. However worsening eyesight or injuring my right hand scares me immensely. I’m scared of my body getting stuck in that state where I could become indecisive about killing myself and spend some years living in misery. I know that if my health got bad enough, I would have to commit a suicide (after all, a natural death at an old age is extremely unpleasant with most illnesses). But how bad is bad enough to warrant killing myself?
Damn.
I think Ieva covered most of what I would have commented on, so I don’t really have much else to add.
I’m impressed by your hasty off-the-cuff analysis as to whether it was neurological or… (I don’t think “eyeballish” is the right term…), and I suspect that helped with the doctor’s official diagnosis.
I’ve got pretty decent vision, and have taken it for granted most of my life, and the idea of suddenly loosing a significant portion of that sense is a bit scary.
Sorry I don’t really have anything substantive to ad, but I admire your analysis of your situation, and am wishing you the best possible recovery.
Somewhere between 42 and 44, my ability to read things close up started to go away. Now I’m 57 and need cheaters to read anything within six feet of my nose. The upside is that I’ve lived to enjoy my presbyopia, which I much prefer to the alternative.
Horrid start to the experience, great finish, huge kudos to Dr Rosenblum. I’m very glad you ‘only’ have a jellyfish in your vision, not an actual detached retina, but uff that will take a while for your brain to adjust to – it will in time, but it must be disconcerting at the moment. I hope it’s stable.
I’ve been myopic since I was a child, but I vividly remember realising my vision had deteriorated so much that I had to wear glasses all of the time. I was cycling down Headington Hill in Oxford, you can get a jolly good speed up, and I had done so when I realised I couldn’t see the surface of the road clearly enough to avoid the potholes -yikes! I’m not sure exactly when my near vision started to go, at least fifteen years ago so I’ve been wearing varifocals for years. The last check up I had the nice young opthamolagist said I had the earliest signs of cataracts, so now I have lenses that darken in response to light too. I’m 58, which feels too young to be developing cataracts, but having glasses that are automatically sunglasses when I need them isn’t a bad thing, it’s just the idea of cataracts is associated with being old for me and I don’t feel that old. Oh I also have dry eyes so have to use drops several times a day, but that’s likely a side effect of one or more of the drugs I’m on; I discovered that by waking up one morning with my right eye feeling odd, when I looked in the mirror there was what looked like a blister in the inner corner of my eyeball. Phoned the opthamolagists, they triaged me and said I needed to come in to get it seen within three days, which was reassuring. The drops keep the dry eye under control and feel especially wonderful when the pollen count is high enough to overcome the anti-histamine I take for hayfever, so I count the dry eye as a win overall.
There was a fad/cult going around about that.
Bates method
Glad to see you were able to get help. Mine are bilateral. Two big floaters, like a pair of Cheerios.*
Dunno if you’re presbyopic, yet, like efogoto, but I sure am – and probably more myopic than most – 20/400.
I’ve been wearing trifocals for about 30 years, now; otherwise I look like a bobble-head doll when doing computer stuff.
fusilier
James 2:24
*’Murican breakfast cereal, made of an oat paste baked into small, circular toruses.
That would be really scary; glad you could get to a doctor so quickly.
Also, good for you for being willing to go to the ER. A lot of people won’t go, even when they’re reasonably sure they are in serious trouble. We’ve had the experience of desperately trying to talk several of our neighbors into going to the ER when they were having a heart attack, and yes, while they were actually experiencing it. On the other hand… the Partner tells me they have people come in to the ER because they have sore muscles. Hard to find that middle ground I guess.
Undesirable excitement, indeed.
What to do with all that adrenaline with no point in hitting or running?
I’m sorry this has happened to you, Marcus. Your brain will adjust in time, but it’s a kick in the ass.
I think by the time we get to this age (I’m 58) we’re supposed to have seen all the things that go wrong with our parent’s generation to know most of the things that can go wrong with ourselves. I think having a doomsday book of bad body mojo might make me paranoid.
OK, that last bit is a lie. I’m a nurse so the paranoia set in years ago. My simple rules are see your Dr. regularly and do all the tests recommended for your age group, don’t ignore pain, and if anything gets suddenly weird (like eyes or balance or breathing) have it checked out quickly.
Also, I’m sorry Anna hasn’t had any sunshine on this trip. If I went to California in winter I’d feel cheated.
Jazzlet,
I had bilateral cataracts fixed when I was in my early 30’s from rubbing my eyes. It was a habit because of allergies plus a likely genetic component. It made me feel old, but it’s a very simple surgery now and 20+ years on I still see well. (When I started nursing cataract surgery meant lying flat with sandbags on either side of your head to limit movement for 48 hours. No sitting or standing at all. Now, you go home a couple of hours after surgery.)
Reginald Selkirk @#6
Yes, I know. When I realized that I have been misinformed as a child by my school teacher, I did the obligatory research.
kestrel @#8
This one’s tricky. How do you find the middle ground? A lot of things that go wrong with human bodies are temporary and disappear on their own if you wait for a day or two. How can the average person without medical education correctly decide when to go to a doctor and how urgently it must be done? Personally, I’m wondering about this question whenever something seems odd with my body. It’s hard for me to tell how serious something is.
I have no qualms about going to doctors and complaining about everything that feels wrong. After all, I’m paying doctors for listening to my whining. So, hopefully, I’m not being too badly influenced by toxic masculinity. But, in some ways, the “boys don’t cry” mantra has profoundly affected me.
I feel uncomfortable with letting my friends find out that I’m in pain. On some occasions, I have even lied just to hide that there’s something wrong with my body. For example, a few years ago I lost some blood and became temporary unable to handle any physical exertion. When hanging out with friends, I lied and said that I don’t like rushing just to hide the fact that I was unable to walk at a fast pace. On another occasion at that time, I was going to a museum with a friend and at one point I was forced to admit that I wasn’t feeling well and I needed to spend a moment resting on a park bench. I finally told my friend what was going on only when my head started spinning and I realized that otherwise I’d just collapse if I kept pushing myself forward (and that would have looked even worse than explaining the problem).
Even when I verbally admit that I’m in pain, I still feel the need to not show it. The worse something hurts, the more I feel compelled to keep up the poker face. I just cannot stand other people seeing me cry. When I’m not feeling well, I just hide at home in my room and make sure nobody sees me until I have gotten better.
This behavior of mine is definitely influenced by the society, which insists that guys aren’t supposed to cry or admit any form of weakness. Then there’s also my desire not to be perceived as weak or feminine. Having the wrong body already makes people see me in ways that I dislike, so I feel compelled to be tougher than any cis guy just to overcompensate. Then there’s also the fact that as a child I learned that being tough was a very effective way how to deal with wannabe bullies. If I refused to show any visible signs of pain, people would leave me alone and abort any attempts to abuse me. And it wasn’t just kids. A few adults attempted to spank me, but stopped it immediately when instead of crying I fought back and refused to show any signs of even acknowledging that I was in pain. If I refused to cry or show any other signs of being hurt or vulnerable, people were a lot less likely to try to abuse me.
The end result is that this behavior is deeply ingrained in me, even if logically I can understand that it is toxic masculinity and it is not rational. I know that my friends wouldn’t turn their coats and start abusing me if I allowed them to find out that I was in pain. Nor would they even perceive that as a sign of weakness. That friend to whom I was so reluctant to admit that I needed to spend a moment resting on a park bench has told me about his chronic shoulder pain and a bunch of other health problems he has. He wouldn’t be telling me about his own health issues if he believed that doing so is a sign of weakness.
Society’s gender expectations sure can mess with one’s head in shitty ways. Even if I logically understand that toxic masculinity is stupid, it still influences me.
I’d buy that in the blink of a (failing) eye.
@Ieva, #11: I think you are so right, that toxic masculinity plays in to this. But one of the people was a woman! Women too can feel invincible I guess. Or like they “don’t want to bother anyone.” As we pointed out to one of these persons (wasting our breath) if he did not go in to the ER, he was going to impose on all kinds of people to take care of him instead – and that’s exactly what happened, including us having to drive about 200 miles out of our way to go pick up his car at the ER because he waited DAYS to go, and they had to fly him out to the heart hospital… Really, people: if you’re sick GO TO THE DOCTOR. It really is easier if you go yourself! I really think when all is said and done the people at the ER would far rather try and help you when symptoms first occur, instead of you waiting until you’re so bad you can hardly get there, and then they are behind the 8 ball and have to work extra hard to try and save you. Not to mention being flown out by helicopter is super expensive!
And if you’re thinking people don’t go because they can’t afford it… and you are stuck living in the USA like I am… the ER can not turn you down. They have to take you in and treat you.
Ieva @ #11:
How can the average person without medical education correctly decide when to go to a doctor and how urgently it must be done?
The UK have a service that attempts to answers exactly that question. After a disappointing start in 2014, with all-too-usual technical mishaps and woefully inadequate capacity, we are now able to call 111 to speak to a triage nurse for “urgent but not life-threatening” health issues at any time of day or night. They go through a very annoying script at the beginning to rule out arterial bleeding, stroke, heart attack and anaphylactic shock, but once past that, they listen, ask reasonable questions, and tell you what to do or what service to use. They can summon an ambulance for you, they might tell you to make your own way to A&E*, get an urgent or routine appointment with your GP, talk to a pharmacist, take an ibuprofen and get some sleep, and so on.
It’s far from perfect — for one thing, it’s too blindly algorithmic. Mention chest pain in any context (“I have had a cold for a week now. I cough so much my chest hurts. Do I go to a doctor, or should I take more cough syrup and stay in bed?”) and they might send an ambulance, because chest pain = heart attack. It’s also not uniform across the UK: it’s not yet available in Northern Ireland, the number has not yet changed to 111 across all of Wales, and only in England they can dispatch ambulances (in Scotland and Wales, they get you to call 999, the emergency number**, instead). As with many of these services, I’m pretty sure they forgot to close the loop: they don’t follow patients, don’t have access to outcomes, and don’t get feedback, so it’s much harder for them to learn and improve. There are also complaints that it’s expensive, and quite a number of GPs think it’s largely useless.
Still, it is a good first step in answering that question.
* ER
** 112, the Europe-wide emergency number, works too
@Marcus:
Eeeeek! Glad it wasn’t as bad as you feared! Are you ok to fly back home?
Sunday Afternoon@#15:
Glad it wasn’t as bad as you feared! Are you ok to fly back home?
Doc Rosenblum said that it’s probably OK but that I need to (so to speak) keep an eye out for it getting worse.
How can the average person without medical education correctly decide when to go to a doctor and how urgently it must be done?
There are three algorithms I think are appropriate. Since I don’t know real names for them, let’s just call them: “increasing pain” and “awareness of end-state” as well as “squirting blood.”
Increasing pain is pretty straightforward. When I had my kidney stone I switched pretty quickly (about 1 hr) from “wow, this sucks” to “I may have to shoot myself.” The pain was going up and off the scale. That’s different from something like gout (which also sucks a lot) but which does not threaten to ramp up to mind-blowing pain. So there are some pains where the increase-rate is such that you just know you’re going to be checked out in pain in a few hours, or it’s going to suck a lot but you have time to do some research online and get some idea of what may be wrong. I don’t make a distinction between slow and fast pain increase; I just use the time for a bit of research. For example, if I were experiencing slowly worsening pain in my stomach, I would get to a doctor after it was clear that was what was happening. Pain is a signalling mechanism that indicates that something is probably wrong. Ignoring increasing pain signals is like driving your car blithely along as more and more warning lights come on the dashboard, and it starts to wobble and smoke.
“Awareness of end-state” is where you have a particular end-state you expect to achieve in a certain time. If you don’t hit that end-state, you go for help. For example, I once had a flu: a really nasty one. Usually a flu follows a predictable cycle: it sucks for 2-3 days then transitions to spitting up green goo and having a running nose. If I have a flu and 3 days into it, my fever is still going like crazy and I’m throwing up, I start to worry about pneumonia. By the way, I have had the experience of waking up with pneumonia so bad that it felt like I was breathing through a straw; I let that one go a bit too long and was in an oxygen tent for 2 days and had permanent lung damage. But you should have an idea of the progress that is likely to happen with something and run for help if it does not follow that progression. You need to know these things. If you cut yourself and tape it up but it keeps bleeding, starts to smell, and you get feverish – oh, well, you should have gotten to the doctor at the point where the wound didn’t appear to be cleanly knitting back together. You needed a tetanus shot and better cleaning procedures because you may be in serious trouble. It’s important to have a model of the progression for how things will evolve and what the end-state is and you run for help if that’s not what is happening.
Squirting blood is also pretty straightforward. I know what bone and tendon look like and if I see any sign of those in a wound, it’s off to the ER! I also know how most of the parts of my body function and if I take an impact (like the time I broke my jaw) it’s time to run for help if something is mechanically wrong: a joint no longer moves, or something that isn’t a joint is acting like a joint – or your jaw is hanging an inch lower on one side and the bone of your chin is protruding through your mustache on one side and you have cerebrospinal fluid leaking from your ear. Bleeding should stop with some wrapping and pressure. If the blood keeps soaking through bandages, it’s time for a trip to the ER for some stitches unless you are absolutely sure the wound is clean, didn’t hit any major blood supply, and no tendons or bone are involved. If you’re pretty sure it’s clean and the bleeding is slowing down, you can crazy glue a piece of paper towel across the wound and be prepared to go to the ER tomorrow if it’s not looking better. Also, the crazy glue trick doesn’t heal very prettily, if that matters. It’s OK for your hand if you’re a shop-dog but not good on your face if you’re a model.
There is a more serious thing which is that, if you’re thinking of doing something dangerous, you need to have a vague idea of those dangers and be prepared to confront them. If you don’t know how to stabilize a broken leg, don’t ride a motorcycle. If you’re working with yellow-hot steel, you should have burn packs and fire extinguisher blankets handy and you need to think about how to use them. A buddy of mine who is head of security for a major (FORTUNE500) company hosted a “safety day” in which they had firepeople come and start fires in 50-gal oil tanks and fire pits, and the staff got to use real fire extinguishers to put out real fires. It turns out very few people had any idea how to do that! In computer security we call this “risk modeling” – you think about what you are likely to encounter and you are prepared to a necessary degree for it. If you’re skiiing you should know how to handle a neck injury and stabilize a break, and if you’re forging you should know how to put out your shoe if it is on fire. If you’re working with a table-saw in a wood shop you should know where the nearest ER is. (table saws and lathes have two classes of injury: ohmygodohmygodohmygod and “that sucks but no big deal”) That kind of thing.
kestrel@#13:
I really think when all is said and done the people at the ER would far rather try and help you when symptoms first occur, instead of you waiting until you’re so bad you can hardly get there
Doctor Rosenblum specifically said “I am much happier to interrupt my afternoon and come spend 20 minutes to tell you its OK than to interrupt my whole day trying to arrange a surgery for a completely detached retina.” And I agreed with him!
My algorithm for going to the ER has changed in the last few years, thanks to two people I know who went to hospitals for one thing and wound up getting seriously messed up by antibiotic resistant bacterial infections. That is going to be an increasing concern for humanity going forward: do you want to risk letting the doctors get their hands on you? Actually, it’s more like that your fellow patients will infect you with something horrible; the doctors and nurses understand sterile protocols and are just as scared of bacteria as you are (perhaps more)
kestrel @#13
Now that’s a sentiment I have never had towards doctors. I’m paying them to deal with my medical problems. When I pay somebody else to deal with a problem I have, I’m not “bothering” this person, instead I’m hiring them. (Even when some medical service is free, I’m still paying for it with my taxes.)
However whenever I’m not paying some other person to deal with my problems, then I really do feel that I shouldn’t be bothering them.
Cvoinescu @#14
What you described sounds pretty good.
In Latvia it’s a lot worse. If you call the ambulance and they arrive and conclude that it really was an emergency and your life or health really was in danger, then you don’t have to pay anything. However, if they arrive and conclude that your medical problem wasn’t urgent, then you will have to pay a 56 euro fine for calling an ambulance unnecessarily. I can imagine poorer people being afraid to call an ambulance unless they are absolutely certain that whatever is wrong with their bodies truly is urgent and they won’t be told to pay the fine. This fine was instituted some years ago in order to discourage people from using ambulance as a free taxi to a hospital.
Marcus @#17
That sounds reasonable. It also made me realize that I don’t have any similar reasonable criteria. For me it’s more like asking the question, “Do I feel really shitty without having a clue why?” If yes, contact a doctor, the urgency depends on how “shitty” it feels, after all there are degrees of “feeling shitty” ranging from “something feels odd and I don’t like it” to “OMFG it hurts like hell.”