Viewpoint FROM THE CHIEF MEDICAL EDITOR

It's an Emergency… Eventually!

Larry E. Patterson, M.D.

I recently recalled the true story of a very nice man who, through no fault of his own, experienced an intraoperative complication that we handled rather nicely. It was the story with the Hudson river analogy described in the March issue. This month, I will tell you another true tale that happened just a few weeks after the prior event.

Chris was a nice 20-year-old man 2 months out from a very successful bilateral LASIK procedure. He came in to see us one Monday morning complaining of decreased vision and pain in his right eye. This began 2 days earlier while being hit by a tree branch in the eye… while driving a jeep. Apparently, the window was open and the branch swooped in and got him.

His previous 20/20 vision was down to 20/400. The slit-lamp exam revealed the typical wrinkling of a displaced and decentered flap. He needed immediate surgery, I explained. What I didn't mention to him was that I was 4 days post open hernia surgery repair myself, and had scheduled a light day at the office since I was still in quite a bit of pain. But I digress. I explained that even in the best circumstances I can't guarantee a restoration of the perfect vision he had prior to the accident, and that the prognosis for 100% success in his case was diminished somewhat due to his waiting 2 days to come in.

We took him straight down to the ASC. These are the times when it's really, really nice to have your own in-house surgery center! We floated the flap, ironed it out, and hoped for the best.

The second day postop, Chris was seeing 20/20 uncorrected. Feeling pleased with our better-than-expected results, we presented this case at one of our weekly meetings with the doctors and techs. One of my doctors asked the question, "If he was the driver, how did the tree branch strike his right eye through the open window? Shouldn't it have been his left eye?"

We all stopped to think. A tech answered, "I bet I know what happened — he had his head out the window." This seemed unlikely, but we asked Chris at the next follow-up exam. Sure enough, the patient confirmed that while driving he stuck his head out of the window to check on something involving his front tire. I politely told him, and his very embarrassed mother, that once everything healed I'd schedule him a consultation for a possible brain transplant. He took the ribbing in good humor.

Oh, one more thing. Remember the patient's 48-hour delay in seeking care? I found out the reason. Turns out he had a motocross race the next day, on Sunday. He was afraid that if he told anyone he had injured his eye, they wouldn't let him race.

He won.