What a difference a year makes

In his shortlisted essay for the 2021 John Henahan Prize, Dr Stuart Guthrie says the changes that are lasting and beneficial in daily clinical practice will help to improve patient care, safety and ophthalmology training.

Colin Kerr

Posted: Sunday, May 9, 2021

Lifting the next set of case notes from an ever-expanding pile I look up at a sea of faces gazing at me in anticipation. A moment later I am responsible for a reverberation of disappointment as I call the “wrong” name. Sighs, groans and at times the occasional quietly muttered expletive lilt in the warm clammy afternoon air. Even the soothing tones of Marvin Gaye’s “Sexual healing” from Smooth FM do little to abate the growing sense of frustration from the tightly packed ocularly challenged throng.
The lucky chosen one lifts themselves from their hard plastic chair slowly, joints stiffened and gluteus maximus numbed by hours of stasis. A quick rub of the knees and a shake of the legs and the assault course to my consultation room begins. Prams, hurried medical personnel and small sugar laden children attempt to scupper the poor chap’s attempt at his quest for a resolution in his ophthalmic complaint.
He makes it to my door physically unscathed but clearly in a degree of psychological distress. “Thank you so much for waiting today sir, it’s a been terribly busy clinic, please take a seat.” Comes my unconscious response for nearly every patient seen.
“What has brought you to the emergency clinic today Mr. Anderson?”. The gentleman opens his mouth to begin when there is a knock at the door. A nurse pops her head in “Sorry to interrupt, I can’t cannulate the patient you requested an FFA on”. I attempt a reply but my mobile beginnings to loudly ring the classically awful Motorola ringtone. I nod apologetically to both nurse and patient.
“Hello, Dr Guthrie on call ophthalmology, how can I help?” another automated response comes.
“Afternoon, this is Dr Rashid, I’ve got a lady down in ED with fixed pupil, cloudy cornea and nausea and vomiting….I think it may be angle closure. Would you be able to take a look?”
Like watching the nucleus sink down through the posterior capsule into the ever welcoming vitreous, an impending sense of doom enters my already fragile mind.
“Yes, of course.” I say weakly.
I hang up and smile maintaining my professional façade. However, it is broken shortly when a most unwelcome guest makes his feelings known “grrrrrrrrrrr….gggrrrrr”. Ah but of course, the familiar low growl of peristalsis attempting to evacuate an empty gastrointestinal tract. Thoughts of a missed lunch must be pushed to one side or alas, these patients, and I, will never leave this department.
“Stuart…..Stuart? wakey wakey!”
I suddenly find myself in the same clinic, gazing absent mindedly out into the empty waiting area.
“That’s your first patient in, Room 2. And put your mask over your nose you dafty”
I turn back to my computer and finish replying to the email of a local optician who had sent in some photos for review of Mr. Anderson. Marginal keratitis I think. “barn door” I mutter under my breath. I provide an appropriate management plan and click reply.
I rise shake my stiff legs and enter my new automated routine. Wash hands, don gloves and apron, and take lens.
At that point, a text message alert pings from my phone requesting a video consultation from ED. Frustratingly, having just “donned”, I must, as they now say in common medical vernacular “doff”.
I accept the invitation and a familiar face now engulfs my display in crystal clear pixelated form.
“Dr Rashid! how can I help you today?”
“Good afternoon, I have a patient here with an abrasion, but the pupil looks a bit funny. He had a nasty fall yesterday”
Dr Rashid mounts the tablet on to the slit lamp adapter and focuses on the area of interest.
“I am afraid that’s a penetrating eye injury, Dr Rashid. The iris is peaking out of a small corneal wound”
I then immediately coordinate an appropriate management plan with ED and liaise with theatre staff and my seniors.
My concentration is temporarily broken by the TV blaring to the patient-less waiting room. Statistics flash upon the screen dramatically “Death count 25,345, Tested positive 50,678” accompanied by aerial footage of mass graves outside New York. Sometimes I think I am in some awful dream. Not being able to see friends or family. Loved ones passing away with no one to comfort them. How life can seemingly change so quickly.
However, I take great hope in how we humans do what we have always done in response to crises. Adapt and become more creative, finding new solutions to new problems.
There is no doubt daily clinical practice has changed and will continue to change. But the changes which are lasting and beneficial will stay with us improving patient care, safety, and ophthalmology training for the future….and hopefully allow me to finally enjoy lunch.

Stuart Guthrie is an ST4 Ophthalmology specialist registrar at Queen Margaret Hospital, Dunfermline, Scotland

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