WHEN DOCTOR TURNS PATIENT

As the front tire of my mountain bike slipped off the trail and I soared over the handlebars and into the bushes, I thought, “That was weird. I totally misjudged the height of that drop-off. There’s something wrong with my depth perception.†I got back onto my bike and continued the descent. Niels was waiting for me at the bottom of the course. “Wow, your right eye is pretty red. Did you get some dirt in there when you fell?†he asked. “No, I don’t think so. I’ll be fine,†I replied. There’s an unwritten rule that we don’t complain when we’re out there on the course. Niels, my colleague in our ophthalmology residency, is the only other person I know who is crazy enough to be out there at sunrise on a freezing Sunday morning. Neither of us wants to hear the other whine about anything at all. I didn’t feel any foreign body sensation when falling off my bike. What I did recall was the unilateral epiphora that started the moment I left my house that morning on my way to the trails. At the time, I didn’t think anything of it. Freezing wind will make any eye tear relentlessly. Only its unilaterality was unusual, but I didn’t give it much thought at the time. When I got back home, I looked in the mirror. The right eye was clearly redder, but the hyperemia was primarily nasal and interpalpebral. I took a picture of both eyes with my iPhone and forwarded it to Niels. “It looks like episcleritis,†he replied. Indeed it did, so I stopped thinking about my eye for the rest of the evening. The next morning, my eyelids were stuck together. I couldn’t open my eye until I rinsed it. I saw a wet, very hyperemic eye with crusty eyelashes in the mirror, looking back at me. At that point, it became a different story. I went to the Rotterdam Eye Hospital’s emergency room and signed myself in as a new patient. There is an official “red-eye examination room†in the emergency room, a sort of conjunctivitis quarantine. It helps prevent transmission from one patient to the next. Karin, another resident, carefully examined me, avoiding any chance of contamination. “Whoa, that’s obviously an adenovirus. Bummer. I’ll take a sample for PCR, just to make it official, and prescribe you some iodine drops,†she said. Dr Wefers Bettink, the emergency room staff physician, confirmed Karin’s clinical diagnosis. “I’m sorry, but you’ll have to go home. We don’t want to start an adenoviral epidemic here in the eye hospital. We’re not taking any chances. I’ll contact the chairman of our infection prevention committee and we’ll keep in touch via email. Don’t come back to the hospital until your PCR is negative and you’re cleared by the committee.†It’s an odd feeling to come to work on a Monday morning and to be sent home for an indeterminate length of time. In a moment I was transformed from ophthalmologist-in-training to ophthalmology patient. I must say, I prefer being the doctor than the patient. The next day, I received a phone call saying that my PCR was positive for adenovirus. I would remain at home, as a patient, for three weeks, taking care of myself instead of treating others. I tried to see it as a surprise vacation, but I had nothing planned! No travel, no week-long visits from friends or family, no interesting activities to look forward to. If my wife and I were not the parents of two very young children, we would have booked a last-minute flight to Portugal for a few weeks of warm-weather fun. After all, she was on maternity leave. But that’s not so simple to organise with a 16-month-old daughter and a 7-week-old son. Plus, my eye didn’t look or feel so fantastic, and using iodine drops, which had to be stored in the refrigerator, six times per day isn’t exactly a joyful experience. Fortunately, my infection was relatively mild. But I was contagious! I was welcome neither at home nor at work. My wife has a deep distrust of viruses and has always hated the sight of a red, hyperemic eye. As a dermatologist, she treats some rather nastylooking diseases, but a red eye is just one of those things she can’t stand. “Just be happy the PCR wasn’t positive for chlamydia,†said Peter, another resident. “Then you’d really know what it’s like not to be welcome at home.†True, but having any highly communicable disease is an unpleasant experience. It must have been terrible to have had leprosy in ancient times, or the plague in the middle ages. You’re not really welcome anywhere. Everything I touched seemed tainted. I didn’t take any risks. I placed bottles of 70 per cent hand alcohol in various locations at home and used them until my skin started cracking. “Maybe you should consider using moisturising lotion,†my wife suggested when the skin over my knuckle started to bleed. Despite what I know about the virus, and about how easily it is transmitted from patient to doctor, I felt a little bit ashamed that I had become infected. Had I not been careful enough? Could I have prevented it? Now my colleagues had to work extra to cover for me, my wife was anxious, and my children were at risk for an unpleasant ordeal. But hey, it can happen to anyone – even an ophthalmologist.