A former comedian, Dr. Sparkle now works in the Emergency Room of a major American city. No, her name isn’t really Dr. Sparkle, but everything else you’re about to read is absolutely true.
EYE SEE YOU
One truly becomes accustomed to seeing gruesome things in most areas of medicine but especially in the Emergency Department, where people enter with knives sticking out of their heads and wrought-iron fences piercing their legs. If I stop to look around, I often feel like I’m walking backstage through the music video Thriller. I can usually refocus my senses on problem solving, and usually most things become less disgusting. Other things still do not.
Working in a trauma center, I have become skilled at stifling the gag reflex. Certain smells regularly trigger nausea, like vomit for instance, and foul vagina and other various purulent effluvia. But even these I’ve been able to stifle the gag reflex and casually hide my disgust. One occasion, however, I was defeated. A young man came to the ER with complaint of “eye irritation.” He was a pleasant 20-something year old man with a cane who spoke like a white rapper and looked like the good guy in a movie who you find out later was the one who molested all of the children. He held one hand over his left eye, stating that it was very “itchy” and “didn’t feel right.” His right eye was normal in appearance and I asked him how long his current problem had been bothering him and he said “a minute,” which is ghetto-slang for “a long time.”
After gaining little other pertinent history about the eye, I asked him to please remove his left hand so that I could examine the eye. He said it hurt to open it, but he would try. He then proceeded to open his left eye and then did something I’ll never forget. Like a scene out of Indiana Jones (I’m talkin’ Crystal Skull shit), he inserted his fingers around his open eye and pulled out his eyeball revealing an eye socket that oozed pus. Aghast, I had to quickly figure out how to both control the appearance of my shock and repress the words “What the fuck did you just do?!” from escaping my mouth. I must have looked somewhat startled as he said, “Oh, it was shot out a few years ago.”
Somewhere between complaining of “my eye is irritated” and saying, “It hurts to open my eye,” one would assume that he might have mentioned that his eyeball was previously shot out of his head, and that the “eye” that was in his skull was not in fact an “eye,” but a spherical prosthesis that had worn out its welcome in the native socket. But there are many poor historians in the wilderness of urban medicine, and this is not something he imagined I might want to know before watching him remove his pus-covered “eyeball.”
After catching my breath, I pardoned myself as any gentle-lady might do, and proceeded to relieve some nausea by gagging myself in the women’s room. Afterwards, I re-entered the room and called for an ophthalmology consult, some IV antibiotics, and advised the patient that in the future, best to let the healthcare practitioner know about his injury. He was admitted to the hospital for further intervention.
His discharge diagnosis was something like, “Post-traumatic orbital abscess” though it will always be referenced in the catalog of my memory as “The nastiest thing I have ever seen in my life.” As in many instances in a career in the ER, you never know what’s going to walk in the door. People don’t always tell me everything I need to know, so I don’t judge a book by its cover.
I think about this patient often, and now I will sometimes ask my eye patients, “…And you’ve never had your eyeballs shot out or anything?” Most patients look at me askance when asked this, but at least I’m prepared if they look at me askance with one eye and pull the other eye out of their head.