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: Holding it together

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.

Boston

In case you missed the story so far:

August 22, 2007: Something about his eyes
August 23, 2007: Whispers and gut feelings

August 23, 2007: Holding it together

August 23, 2007: Homecoming

August 24, 2007: It's 5:30 am on Friday. It's still dark, but the first rays of sun are trying to peek out over the houses in our little neighborhood. I'm sitting on the floor in the living room with my back leaning against the couch, holding the boy with the big, beautiful, cloudy eyes. I'm crying, but feeling hopeful that our son, who was just diagnosed with pediatric glaucoma, will meet the doctor today who will help him see. It all feels like a big mistake.

My wife is making her tea, and we are preparing to leave for Boston in a couple hours. Plans have been made. My wife's parents have taken the day off work to stay in Albany with our 2 year-old daughter, and we would take the 3 day-old boy with the cloudy eyes to Boston.

The sun comes up, the in-laws arrive, my daughter is fed, and we fasten the boy into his car seat. I drive, and my wife, who is still moving a bit gingerly from the birth 3 days earlier, rides next to me. As we drive, my wife makes a few calls to our insurance company and the boy's pediatrician. We need letters of medical necessity. Of course.

After one call to the pediatrician, she flips her phone closed. "What'd he say?" I ask.

She replies, shaking her head, "Glaucoma. What a drag." What a drag. We chuckle a bit at this statement. The pediatrician is a great guy, and an awesome doctor. He takes incredible care of our children. But at that time, at that moment in his professional career, he must have been at a loss for words. What a drag. To this day, my wife and I sometimes mutter, "Glaucoma. What a drag." It's true. The boy got a shit deal so far in his young life. It's a drag.

We drive and stop to nurse, and we stop to change diapers, and we drive. We arrive in Boston, and we find the building where Dr. Walton practices pediatric ophthalmology. It's a high rise apartment complex with professional offices in the lobby and mezzanine. We ask the guy at the front desk in the lobby where we're going. He directs us to the second floor. Suite 201. We walk down the hall to a basic tan door with a name placard next to it. "Dr. David Walton." We turn the handle.

It's locked.

The doctor who is to save our son's sight is not there. We wait. We return to the lobby and ask the man what is going on. He makes a few calls. We sit in the lobby. The boy nurses. We change his diaper. We do what normal young parents do.

We wait.

Finally, after an hour or so we are told the doctor has arrived. We head back up to suite 201 and walk in. Dr. Walton is the only one there. He is a tall man, early 70's. Nothing flashy. Simple solid shirt, tie, dark pants. Belt matches the shoes. Slightly unkempt, but he is not the doctor who worries about his appearance. In time we learn he worries about his patients.

He asks what we are doing there, a confused look on his face. There's been a mistake. It's all a big mistake. When the appointment was made, my wife thought it was for Friday, and Dr. Walton thought it was for Saturday. Someone made a mistake, but it doesn't matter who. We learn that Dr. Walton performs surgery on Friday mornings, and that's where he was. He was not expecting us, but he invites us in and we fill out the paperwork that goes with any medical visit.

The office is small. A 10-foot hallway leads to a reception area on the right and then opens up to a waiting area with a few doctor's office-type chairs in it. There is a shelf with toys. Books with New England themes sit on the table. Blueberries for Sal and Make Way for Ducklings. Mike Mulligan and His Steam Shovel. The walls are adorned with snapshots of children who have glasses, patches, and smiles. Papers with crayon drawings are taped next to the photos. These children are Dr. Walton's patients. Dr. Walton's children. We sit and write while the doctor is at the reception desk managing things that doctors manage.

The office is atypical of a medical office. Usually there are receptionists and medical technicians and mid level providers buzzing around. Not here. No receptionist. The phone rings, and the doctor answers it. Nothing flashy. No extra personnel. Just the doctor and us. We finish the paperwork and Dr. Walton invites us to join him in a room just off the waiting area.

The doctor will see you now.