On a stray bullet

About five appointments into my first day of outpatient ophthalmology, a succession of quick 10min follow-up visits, we walked into her room. She was quickly folding up her hand-held radio and apologizing. She likes to listen while waiting.

At first, I didn’t really note her big sunglasses. A lot of patients were following up after cataract surgery. My dad has a big pair of sunglasses, too. I call them his Kim Jong Il shades.

The attending initiated the encounter warmly, like she did for the other patients of the morning. The patient, let’s call her Susan, was a slim woman in her early fifties. Susan told us how she had started to blink her left eye, that she had done something the physician said that she wouldn’t be able to do. The attending smiled, laughed, and congratulated her.

When the patient took off her large sunglasses, her eyes were sunken into the socket. Like someone had scooped out her eyeballs but left the lids intact. It shocked me because I had assumed that she was a post-op patient. I had forgotten that you might see actual pathology on an easy week of shadowing in outpatient ophthalmology.

The attending asked Susan to tell me her story. Periodically, throughout the tale, the attending would look at me and give a “can you believe it?” raise of the eyebrows. For this case alone, the week of ophthalmology follow-up and post-op visits became worthwhile.

About a year ago, Susan was sitting in her living room with her niece nearby. The late October night was dark and stormy. Without much notice, a .357 magnum round barreled its way into the small apartment, inches behind the back of the niece, and into the skull of this patient. The bullet entered her right temple and exited her left, destroying her eyes in the process but leaving her brain intact.

She was rushed to a nearby hospital, where they began treating her. They quickly realized that the scope of injuries were beyond their ability to treat, so they transported her via ambulance to Philadelphia. They would’ve helicoptered her over, but the rain and thunder precluded that possibility.

When in Philly, she spent about a dozen hours in the OR and had about as many surgeons work on her, ranging from plastics to ophtho to ENT. She lost her vision, but miraculously survived her injuries. They never caught the individual that fired the round. No one knew why someone would be shooting a gun during a storm and in that neighborhood. Just bad luck.

She had asked her mother, who I would assume to be in the ballpark of her seventies or early eighties, to wait outside the room during the appointment. Susan wanted to talk frankly with the physician and she felt that her mother would be too emotional during the encounter to hear the truth, even one year after the event.

Susan wanted to know if there was any chance of a surgery or transplant that could give her sight back. The physician smiled. She said, “I am the type of person to believe in miracles.” Susan smiled and nodded in understanding.

Considering her age at the time of this major life change, she seemed to handle the transition well. Susan didn’t seem to hold any anger or rage at the hand she had been dealt. Her mother probably had more trouble, watching her adult daughter suffer an unimaginably rare accident.

Afterwards, the attending took a moment to tell me that this was the kind of case you see once in your career. In a day of dull follow-up visits and routine post-op checks, a single case reminded me that you never really know what lies behind that door. We knock, introduce ourselves, and buckle up for the ride.


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