Fighting for a Patient's Sight

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

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14 year-old mom survives a delivery room emergency- An Amazing Childbirth Story

The young mother was not at all prepared for what was about to happen to her. Unfortunately, neither were her doctors.


It was my first time in the delivery room at the University Hospital. The doctor “training” me was an intern with 3 weeks experience. Our combined knowledge and experience would have filled a page and a half in a medical textbook. But there we were, attending the delivery of a 14 year old girl. That is not a typo. The mom had gotten pregnant as an 8th grader. She was from Mexico and spoke no English at all.

The birth of the baby was routine, and the intern performed the delivery of the baby without any difficulty. The umbilical cord was quickly cut and clamped and the baby handed off to the nurse.

The intern then turned to me, “Want to deliver the placenta?” It wasn't a hugely difficult medical procedure, but third year medical students take what they can get.


I switched positions with the intern and grabbed hold of the clamped umbilical cord. I gently pulled downward. Nothing happened. I continued to pull for a few minutes. Seeing no progress, the intern instructed, “Pull harder.” So I did. Still no progress. The intern repeated the instruction. A few minutes more, still no progress. I thought I as pulling pretty hard, but according to the intern I wasn't as she instructed me to increase the downward traction even more.

Finally the amount of visible cord began to lengthen, indicating the placenta was on its way out. But what appeared between the mother's legs did not look to me like a placenta at all. It was big and round and purple, with lots of veins. It looked like a martian head. (If martian heads actually existed and came out in delivery rooms!)

“Oh my God! What is that?” exclaimed the intern who was watching me. As she verbalized the question the answer came to me, the words came out of my mouth simultaneously with the realization of what it was-

“It's the whole d--- uterus!”, I said as quietly as I could.

I had pulled the cord so hard that the girl's uterus had turned inside out and come out with the placenta still attached. The uterus was now located outside of her body. I lacked experience, but I was pretty sure that this was NOT a good thing. (I later learned how bad it actually was. If the placenta detached while the uterus was out, the uterus could not contract down to stop the bleeding and the mother could bleed to death. If the uterus contracted with the placenta still attached, it would take a lot of medication and skill to safely put it back. It was a race against time.)

“What do we do now?” I whispered.

“I don't know!” was the intern's non- reassuring reply.

The nurse, who actually had experience, reacted quickly and called for the senior doctor on the OB unit. The doctor arrived quickly, and surprised me by rapidly pushing the intern aside. She then used her balled fist to forcefully shove the uterus back inside. I vividly remember repeatedly seeing the outline of the doctor's fist through the mother's abdomen as the doctor worked to make certain that the entire uterus had completely returned to its correct position, and would stay there.

I also remember wondering- what is this young mother thinking? She was alone. There were no family members with her in the room. She was in a foreign place surrounded by doctors and students she did not know, speaking a language she did not understand. She had to have felt significant pain given the pounding pressure of the doctor's hand inside her body, and she did not even know why. Things happened so quickly no one had taken the time to explain. And- she was only 14 years old.

14 years old... about the same age that Mary was when she gave birth to Jesus. We have sanitized the Christmas story and ignored the pain of childbirth, the bleeding after the placenta released, the cramping that came as she nursed her baby, and the vulnerability of that young family. Mary was in an unfamiliar city, alone except for Joseph, her young husband. Shortly after the birth shepherds arrived, strangers intruding on her first moments with her son, relating an incredible story of an angelic announcement. What was Mary thinking?

The story of the young girl in the delivery room reminds me that Mary's experience was not all halos and choirs. Childbirth, especially to a young woman in a strange place, can be a frightening experience!

- Bart

This is the 4th of Six Amazing childbirth stories. you can read the previous ones in our archives, and subscribe to the blog to have coming posts delivered straight to your inbox. 

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