The vision in his right eye had been blurry for several days. It had worsened over the weekend and when he awoke Monday morning only a sliver of the vision remained. Worried, he walked into the office without an appointment, hoping he I could see him. My office staff quickly brought him back into an exam room.
I didn't even need to examine him. His story told the story. I was near certain that he was having a retinal detachment, a true medical emergency. As it had been progressing for several days I knew his vision was in severe jeopardy. He needed to see a specialist immediately.
Without leaving the exam room I logged into the HMO website to process the referral. He was a member of a new network in town, with a limited number of specialists available. I called the office of the only general ophthalmologist on the list. My heart sank when the staff told me the doctor was not seeing patients in the office that day. Who could I find to see him?
Worried, I called the medical group. After several minutes on hold I asked the staff to call so I could move on to my other waiting patients. When I came out of the next room my heart sank a little further. I learned that my nurse had not been able to get a referral but that we needed to wait for a return call from the assistant medical director. Not wanting to wait I searched my email for the number for the Medical Director, deciding to go higher up the chain as it was nearing the lunch hour when reaching a specialist would be near impossible. She gave verbal approval for the patient to be seen by a specialist in an affiliated group. Before I could hang up the phone my receptionist had that office on the phone.
More heart sinking. The receptionist at that refused to even get a doctor on the phone. As the patient was not officially a part of that group and they were not on call, she told me there was nothing she could do. I lost my cool for a moment, saying, “I guess we should just let him go blind!” as I hung up the phone.
The assistant medical director called me back a few minutes later. I quickly briefed him on the case and he promised to arrange a referral to a UCLA affiliated specialist a few miles away. Things started to move. That office called within 15 minutes, offering to see the patient on their lunch break. It had taken over 30 minutes of effort but he was going to be seen within the hour.
I went to lunch thinking that the problem had been solved but I was mistaken. Later that afternoon the eye doctor’s office called back with an update. It was a severe retinal detachment and the patient was at high risk for permanent vision loss in his eye. Emergency surgery was needed but the surgeon did not know if it could be done on time at the local hospital. He recommended that the procedure be done at UCLA first thing in the morning. The problem was that UCLA was over an hour drive away and the patient could not get to and from the hospital. They wanted my input.
My input was that the surgery had to be done locally, even if they had to transfer care to another surgeon. The doctor reconsidered, ultimately finding an assistant surgeon and getting time in the operating room of the nearby hospital for the next morning. I agreed to add the patient to the end of my day for the pre-operative medical exam and clearance.
One more glitch remained that day. After scheduling the procedure, the eye doctor was informed that the hospital did not have an operating room scrub technician available. His office called me again asking again about doing the procedure at UCLA! I was firm, "No! We have been over this, that is not possible!”
I looked at my watch. It was 3:45. If referral to another doctor was going to be necessary, we were running out of time. I pointed this out to the surgical scheduler. “We are running out of time to get help if we need it. I do not want to be rude, but this is ridiculous. This is an emergency surgery, and this is a hospital, someone needs to make this happen. If we cannot get a scrub tech in the next 15 minutes, we are going to need to call another doctor for help.”
They found a scrub tech.
He was back in my office within the hour for the pre-operative visit.
He was frightened. Everything had happened so fast and his world had been turned upside down. He was facing not only the loss of vision, he was also facing 7 days of immobility and weeks of work. It was hard for him to wrap his mind around it all. Worse, he was alone in town and had no support system.
I completed the clearance form and faxed it to the eye doctor’s office. When 30 minutes passed without any further glitches or delays I breathed a sigh of relief.
After the patient left I realized how drained I was from the day. While there was nothing medically challenging about the diagnosis getting the appropriate treatment had taken an incredible amount of effort. Between my staff and I over 20 phone calls had been exchanged in a period of 5 hours.
It wasn't over.
We called the eye surgeon in the morning to check on the patient's status. The surgery had gone well, but there was a new obstacle. To preserve the sight in the eye, he would need to lie face down on a special table twenty-four hours a day for 7 days, with only one 10 minute break each hour. The table rental was $300 for a week and was not covered by insurance. As he was out of work and already poor, he could not afford it. The secretary at the eye doctor's office said, "This is sad because if he cannot get the table he will likely lose his sight." She acted as if there was nothing anyone could do. I could not believe that we could not step up and cover $300 to save the man's sight. Hadn't thousands already been spend on the surgery?
Multiple more phone calls later, we got the table paid for. That left us with another more basic need. How would he eat? He lived alone and could not cook or shop. Who could help him with meals and basic survival? Desperate again, I called a Calvary Chapel Church near his home. He had told me he had a friend there. I was forwarded to the staff member who oversaw the church's compassion ministry. She was immediately receptive. Two men in their church had experienced similar issues in the last year and she understood what the man needed. She committed to making sure that meals would be provided.
Tears came to my eyes as I hung up the phone. I did not know if we were going to be able to save his sight, but I knew we had done all we could. I was proud of my office staff, and especially grateful to the church. His case reminded me of why we all do what we do. We are here to help people in need, because we can.
I pray his vision will be saved. I ask that you pray as well.
- Bart
Thanks for reading, and a special thanks to those who share posts with others. It matters! Readers can subscribe to the blog by clicking on the subscribe button (upper right on desktop, bottom page on mobile devices). I can also be followed on Twitter @bartbarrettmd