And the Blind Shall See

Dr. Rommel Fuerste is an ophthalmologist from Iowa who has made prior trips to Haiti to help the less fortunate. On his most recent trip, Bon Nouvèl asked him if he wouldn’t please write out a story of a previous Haitian patient that stood out in his mind. The following night, he typed us out the following.

My most memorable patient to date was a little 80 year old Haitian named Jacque. Haitians are very supportive of fellow family members, so Jacque was brought down the mountain by his sons and daughters. Haitians are also very proud, so even though this family may have all come out of a single room hut with a dirt floor, the whole group looked like they had just walked out of church on a Sunday morning in Topeka. The clothes were crisp and clean. The hair was washed, nary a strand out of place. And each family member had on his or her only pair of shoes. Those shoes were only worn when it was time to impress.

I distinctly remember the moment Jacque entered my clinic. I happened to be busy with other patients, but a stir at the door caught my attention. It was Jacque shuffling in the room directly behind his daughter. Shuffle may not properly describe poor Jacque’s movement. The elderly man was obviously blind, and scared to move either foot more than three inches forward. He had each of his hands firmly placed on his daughter’s shoulders, somewhat trusting her lead. She sympathetically was moving at a snail’s pace.

Although busy with other patients, I would periodically keep an eye on the 80 year old while he was seated in line on the waiting bench. He stoically sat with a straight back, chin high, gaze straight ahead. In spite of a room full of chaos, Jacque had the stare of a blind man; no head movement right or left, and no facial expression.

After the elderly Haitian had finally gotten to the end of the waiting bench and was sitting in front of me, I learned he had been hit with a stick in his left eye at the age of twenty. Evidence of that trauma was a mass of old scar tissue where the left eye was supposed to be. Jacque had lived most of his life using the vision out of just the right eye. His luck had run out a decade earlier when the right eye developed a cataract. The cataract had continued to advance until the little man sitting in front of me no longer had a run of the mill cataract. He had what ophthalmologists refer to as a “moonstone” cataract.

In the human eye there is a lens which focuses light to the back of the eye. The human lens is exactly like a lens in a camera. Both are clear, and shaped like a thick flying saucer. The lens in the human eye is directly behind the round blue part of the eye, which is called the iris. In the middle of the iris there is a black hole, called the pupil. When you “look somebody in the eye” you are staring at the black pupil. When somebody gets a cataract, the lens becomes milky or foggy. If you “look someone in the eye” who has a cataract, you will see some cloudy white where the black pupil should be.

When I looked through Monsieur Jacque’s pupil, it was like looking at a white opaque rock; thus the term “moonstone” cataract. I couldn’t see in the eye, and the unfortunate patient couldn’t see out. Jacque’s vision was “light perception”, meaning he couldn’t count my fingers in front of his nose, nor could he see my hand move in front of his nose. He could only note a change when I would shine a bright light into his eye; he was trying to look through a rock.

Monsieur Jacque needed a cataract surgery. This idea initially struck fear into my heart. In the United States I had never operated on such a dense hard cataract. On top of that, I would be operating on the Haitian’s only eye; if things went sour during the surgery, this man didn’t have another eye to fall back on.

On the other hand, my new patient wasn’t exactly seeing well in his current state. I thought about the situation long and hard, took a deep breath, and explained the possible risks and complications of a cataract surgery. Jacque and his family didn’t have to think long about the predicament. They wanted to go ahead with the surgery; he didn’t want to continue living this way.

That afternoon the elderly Haitian and I were in the operating room together. Fortunately things seemed to go smoothly. At the end of the surgery, I patched his only eye shut, and sent him to the recovery room for the night.

I don’t know how the patient slept that evening, but I didn’t. Before heading to the operating room, all I was worried about was the fact that I was operating on his only eye, and it was going to be a difficult case. After the surgery was over, I started worrying about what was behind the rock I couldn’t see through.

Behind the lens of the eye is the retina. What if he had had a retinal detachment years ago? Removing the cataract would have been a waste of the poor man’s time. Many Haitians have glaucoma. What if the glaucoma had choked off the nerve long ago? Again, the time in the operating room would have been for nothing.

When you take a patch off a patient’s eye, the facial expression of the patient will often telegraph the success or failure of your surgery long before the patient speaks. In the morning, when Jacque’s patch came off, his face remained deadpan; no elation, no smile, not even a raising of an eyebrow. Nothing. That was not a good sign. My stomach sank.

I suggested to my translator that he inquire about the patient’s vision. The interpreter seemed to phrase a long question. The patient gave a short reply. The translator turned to me and said: blurry. Devastation took my breath away. I was so upset about my new friend. Again and again I asked the interpreter to rearticulate the question. The response from the deadpan patient was always reported to me the same: blurry.

In despair I realize there was nothing I could do but dilate the eye so I could look in the back and see what disaster existed to ruin this Haitian’s only hope for vision. I put the drops in the eye and set the patient back out on the waiting bench.

As with the day before, as I went about my business, I always seemed to catch a glimpse of the patient out of the corner of my eye. However, today’s glimpses were not like those of the previous day. Monsieur Jacque’s head was moving. The door to the clinic would open, and Jacque seemed to turn his head in that direction.

A nurse would call for a patient, and Jacque seemed to look around to see who would stand up. My brain was trying to comprehend these head movements from this man who was not impressed with his surgical results.

I couldn’t take it anymore when, as I was holding up two bottles of drops and explaining their use to another patient, I distinctly noted Jacque stretching his neck over the shoulder of the patient next to him to look at my bottles. At that point I had to stop everything in the clinic and march the interpreter in front of the 80 year old post-op. I demanded interpreter again inquire about the vision. The question was asked, and without facial expression the response was given. I heard the translator report back to me: blurry.

With a whine in my voice I asked: “Well isn’t it better than before the surgery?” The translator related the question. The deadpan patient sat a minute, looked up at the questioner, and shrugged. The interpreter turned and looked at me, and shrugged.

Come on, Monsieur Jacque, throw me a bone here. I’m a pathetic American who needs a little positive reinforcement. I was stumped. Was the vision really still bad, or was the patient too stoic to let an ounce of emotion permeate through his square little jawbone?

Both the retina and the optic nerve looked perfectly normal though the dilated pupil.

Bewildered, I stared at the patient with my brows furrowed and my jaw on the floor. Exhausted from the workload and the Haitian heat, my brain couldn’t catch a gear. A blink brought me back to reality. I had to move on. There were other patients to see. I told Jacque and his clan it was time to head home.

As the family stood to leave, they positioned Jacque into his place behind his daughter. The family raised his two hands to her shoulders. I watched with keen and questioning eyes as they started their march to the door. Within three steps, one of his hands dropped off a shoulder. Another four steps and the second hand came down.

Half way to the door and Jacque’s stride was at least eight inches long.

And then finally, finally, I saw it. Two steps before the door, the patient patted his daughter on the back, and a small smile cracked the rock hard face.

And I’ve been happy since.

Three days later Jacque returned to the clinic for a post-op check. Without glasses, and without emotion, he read down to the 20/40 line. In America, 20/40 vision gets you a driver’s license. Through the commotion of translation, the family seemed to imply Jacque had been in a slightly better mood around the hut since the surgery. I knew that was all the positive reinforcement I was going to get, so I took it.

I think of Jacque often. My imagination always seems to put a twinkle in his eye.

Dr. Fuerste back home in Iowa with his loyal companion.

 


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