Thursday, September 1, 2016

The examination

Here is the story so far:
August 22, 2007: Something about his eyes
August 23, 2007: Whispers and gut feelings
August 23, 2007: Homecoming
August 24, 2007: Boston

August 24, 2007- The boy with the cloudy eyes is 3 days old, and we have brought him to a doctor in Boston to confirm the diagnosis of pediatric glaucoma and to start on the road to management. We have filled out the paperwork in Dr. Walton's little Boston office, and he has asked us to please come sit in the examination room.

The examination area is a big room with a small office off to the side. A pocket door separates the tiny office from the big exam room. Papers and books are stacked on the desk in the tiny office. Crayon pictures adorn the walls of the room, and a photograph of a large sailboat hangs above 4 chairs along the near wall. Dr. Walton's desk - a table cluttered with handheld instruments of ocular examination, pens, and a box of tissues - sits beyond the chairs. To the right of his desk is a wooden cabinet filled with lenses and switches, and a black swivel chair is situated in front of that. A small sink is attached to the far wall, and a few rolling carts with various instruments are lined up in succession next to the sink.

There are no windows in the exam room, and the fluorescent light gives everything a bright tan look. The doctor asks us to sit down. My wife holds the boy while he asks us questions about his birth, his eyes, and our family. He then explains how the examination will go: my wife will sit in the exam chair and hold the baby during the exam.

Dr. Walton begins checking our son's eyes. He is careful, calculated, and sure in all of his motions and decisions. He visually inspects the boy's eyes. Other instruments are used to gather information. The doctor is a scientist, gathering data and mulling over ideas as he works.

A drop of fluid is applied to each eye, and a device is used to check the boy's eye pressure - a handheld tool with a small tip and a blue light shining from its end. The doctor looks through a lens, and makes some adjustments. He writes. He gets up, gathers something, and returns to the task. Both eyes are checked. The doctor is explaining the ins and outs of glaucoma as he works. He rises and is walking out of the room and says, "His eye pressures are really good. His eyes look good." He leaves the room to get something.

I look at my wife, holding the boy in the exam chair, and I can tell she is thinking what I'm thinking. The pressures are fine.

This has all been a big mistake!

He is fine. Joy! Relief!

When Dr. Walton returns, one of us asks, "So the pressures are fine? He doesn't have glaucoma?"

"Oh no. He has glaucoma. There is typically a honeymoon period shortly after birth where the pressures go down a bit. He has glaucoma."

Crashing back down to reality.

The doctor explains that the boy's eyes are cloudy when his pressures are up as his corneas are stretched and this changes their opacity. His real eye color is dark, dark blue - almost black - since his irises are so thin. This thinning of the iris is typical in children with glaucoma, and it makes these children highly sensitive to light. When eye pressures rise, it damages the insertion of the optic nerve in the back of the eyeball, and this causes blindness.

The exam concludes, and my wife and I sit in the chairs next to the doctor's desk.

The boy has glaucoma, and the newborn presentation is the most severe. He will require surgery and careful monitoring of his eyes and his eye pressure.

"This is not a sprint. It's a marathon," the doctor says. The doctor explains that we will be seen in his office regularly to have pressure checks, and if (when) the pressures rise, the boy will need surgery. The most effective surgery for eyes with newborn glaucoma is a tube shunt placement. Fluid can get into his eyes, but it cannot get out, and a valve with a small tube attached will be surgically placed in his eyes to drain the fluid.

Jesus. You've got to be kidding me. We ask questions. We're nervous. He takes time to answer our questions. Two hours we've been in the office for an appointment that wasn't even on the schedule for that day. Dr. Walton explains it all to us. We make an appointment for the middle of the next week.

We have a plan. We have hope. As we finish up, I asked the doctor, "If we do everything right, will he be able to see?"

"Yes. He'll be able to see."

We have a plan. Monitor the pressures with the doctor in Boston, watch for signs of increased pressure, like cloudiness. Keep the boy healthy. Surgery will be needed, and the boy can't be sick. That's our plan.

We have hope, and we head for home.

No comments:

Post a Comment