Weird Things Happen At Quiet Calls
It was one of those peaceful nights that weird stuffs happened.
At 6 or 7 in the evening, I received a page from the emergency department of another hospital which was also covered by us during call hours. I returned my call promptly, and a Dr W picked up the line,
‘Hi, this is Dr W from Accident & Emergency, are you ophthalmology?’
‘Yes it is’
‘right, we have a woman in her 50s who complained of seeing a curtain like shadow from her left eye for one day, and we think she’s having a macula-on retinal detachment (an ophthalmic emergency where the retina is being ripped off but yet the most important part- the macula is still attached ‘ON’, often requiring early surgical intervention), we need your assessment.’
‘Alright, so what’s her VA (visual acuity) like?’ I asked.
At that point I was actually thinking to myself, oh my god this guy certainly knew some stuff, for god’s sake he knew the term macula-on RD! As excited as nobody else would be, I was all ready to receive this patient.
’20/15.’ said he in a calm voice, ‘My SMO also saw the patient and he thinks it’s definitely a macula on RD.’
See that line 20/15? she's seeing pretty well!
‘Alright then, could you please send the patient over here asap, and before you do please dilate her eyes okay?’
‘I’m sorry? But.. what? how do you dilate her eyes?’
Oh my GOD! They could tell a macula on RD without dilating an eye! Did their SMO use to work in our department? I don’t think I could tell a RD if the pupil isn’t wide open enough but apparently these two brilliant guys can! How amazing are they!
So I told him, ‘Mydrin P 1 drop every 5 minutes x 3, or you could use mydriacyl if you don’t have mydrin P.’
‘What? ..Sorry i don’t hear you, my- my- what? How do you spell it?’
‘…M-Y-D-R-I-N – P..’
‘alright thanks’ and he hung up.
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A few minutes later, he paged a second time, this time he asked,
‘Hi, it’s Dr. W again. By the way, emm where should we transfer our patient to? I mean, which ward?’
I was in disbelief. ‘No, No, NO NO you don’t transfer her to our ward, you transfer her to our Accident and Emergency Department, and then WE would come down to see her at A&E.’
‘Alright, but we don’t want you to miss her, because this is a case of macula on RD.’
‘Ok..fine, I’ll take her ID number and go pick her up as soon as she arrives.’
So I took the woman’s ID number and continued to wait – it usually takes these people HOURS to transfer someone from one place to another, even though that hospital is actually a 15 minute drive away.
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An hour later, my call partner and I were seeing other patients at the A&E, and she asked,
‘Hey did you get the call from Dr. W?’
‘Yes I did, of course.’
‘Well he said nobody returned his page.’
‘WHAT?’
‘Yea, he was telling me this lady with macula on RD and that his SMO also saw the patient and thought the same, he then asked for my last name, I told him, and then he asked, “so what’s the last name of the other guy who called earlier on?” So weird.’
‘Oh god for sure, that guy is totally weird…first he is all so committed about the diagnosis, yet he doesn’t know how to dilate a pupil, he does not know where to transfer his patient and now he was lying about me not returning any of his calls, so who the hell taught him how to dilate a pupil!’ I just didn’t see what’s going on in his mind.
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Finally the patient came, after an hour and half, and her retina was all attached and fine. No sign of whatsoever RD.
We thought of calling them back just to tell them they were wrong about the diagnosis, but soon enough we dropped that idea. Because we were worried about them taking a revenge on us – by sending all floaters to us throughout the rest of the night. Thank goodness neither of us received any of his calls after that.
Well, what I want to say about this is, false alarms are not embarrassing – these things do happen to us all the time. You have all the right to misdiagnose a condition because you are an outsider, and we do have a role in correcting the diagnosis being an ophthalmologist-to-be. But this was perhaps the weirdest false alarm that ever happened to me since I worked here – the communication was just weird – how they bragged about the urgency of their own diagnosis, and the denial of my returning calls. I still don’t get it, why did he have to lie about this? Was he trying to get a fresh second opinion from my call partner? Or did he not like the way I told him how to send over the patient? Or did I not spell Mydrin P right for him so he lost faith in me and turned to my colleague? No, none of this made any sense..it IS weird.
Oh but you think that was it? No… something weirder happened later that night…
