From the Other Side the Patients Viewpoint

Gabor Kocsis

* This chapter was written by a patient who sustained a very serious eye injury. It is an "eye opener" even for an experienced ocular traumatologist to be confronted with the description of the entire management process as seen from the other side.

I am 41 years old, 180 cm tall, and I weigh 100 kg1. I love sports and the outdoors, and work out with my friends every week, even playing some mild contact sports occasionally.

This is what we had on our mind on that day, 3 May 2005. We had just finished our warm-up and I leaned forward to adjust my clothing as my friend, who was standing next to me, raised his hand. His finger somehow hit my left eye, I felt sudden pain and my vision was gone. My lid immediately became swollen and I could not open my eye.

My friends, visibly scared, quickly took me to the county hospital. Here the chief of ophthalmology told me that I needed surgery instantly to save my eyeball. I did not even have time to truly realize what was happening to me as I was taken for emergency surgery, which lasted several hours. When I woke up I had no idea about my eye's condition, but I was somehow hopeful that all was well and one day I would be able to see again.

The next day, my ophthalmologist told me that the operation was successful but that I needed further surgery or surgeries. These surgeries would require special equipment, which this hospital could not offer. He promised to find for me an ophthalmologist who specialized in ocular trauma and who would hopefully be able to help me.

This promise did give me some encouragement initially, but with time I was getting more and more desperate. I had absolutely no vision in my eye, and although I had no pain, it slowly started to sink in that I was going to

1 6 feet, 220 lbs lose my eye. It was getting increasingly difficult to sleep at night, I just kept on rolling in bed, thinking about what the future was going to bring.

I understood that my ophthalmologist did everything he could to keep my eyeball alive, but the pressure in the eye was falling and the vision was not coming back. I had been a healthy young man, with so many plans for my life - and this was all gone forever in a split of a second. I became a patient, a sick man, who was at the mercy of the disease and the physicians. It was impossible for me to comprehend and accept this.

After a few weeks, I was finally given some good news. My hometown ophthalmologist was able to reach a specialist who split his work between two countries and was thus not always available. The specialist agreed to immediately see me. As I said thank you and good-bye to my physician, he encouraged me not to lose hope and to believe in miracles and miracle doctors. To this day, I remember his words.

I was taken to a hospital in another city. The specialist examined my eye and told me that he was going to be honest and straightforward with me. The eye's condition was very severe and required immediate surgery, he said, and he could not promise anything except that he would do everything he could to help. His words were truly shocking to me; up until then, I had not truly realized how serious the situation was. All I could think about was how my life was going to change. "What will happen to me?" I kept thinking. How can I keep on living under such conditions? Will I be able to continue my work? Will I be able to earn enough money to support my family? Can I play with my children? Can I ever go back to playing sports again?

I was hundreds of kilometers from family and friends, with the phone as the only way of communicating with them. It was my wife who had kept the hope alive so that I did not give up but rather continue fighting for my eye. I needed all her encouragement, because what followed was a series of tests and operations, and a lot of inconvenience.

During the next year I underwent no less than five surgeries; the injured eye's overall condition has improved, but I am increasingly overwhelmed by what's happening to me. My blood pressure is now high and I have to take medication. It is difficult to wake up in the morning to face the real world. I have become mentally imbalanced, and I have to take tranquillizers so that I can sleep at night. I was able to keep my job, but between periods of work I spend a lot of time at home, recuperating. I was hopeful that going back to work would help keep my mind occupied with work-related issues. Thanks to my co-workers, this indeed helps a little, but my anxiety has only subsided, never disappeared. It is difficult for me to accept what has happened to me. I often fight myself over it, even though I know I have to accept it. I, who had spent so much time with my family building our home, gardening, cooking, now cannot find my place in society. Nothing can keep my mind occupied enough. I am impatient with those who are close to me. I gave up sports and the outdoors, which has further reduced my spirits. I am afraid that any physical strain will make my condition worse, even though I was informed that this is not the case. Now all I want is to live a simple, uneventful life.

I am a religious person, and I often turn to God to guide me, to give my sight back, and to allow me to live in peace with myself. I know that the healing process takes a long time, and I appreciate the honesty coming from my eye trauma specialist. I know that I still may have several surgeries ahead of me, and I know that the outcome is uncertain. I may have some vision left when this is all over, or I may lose not only my vision but also my eyeball. I am grateful for the treatment I have been given, but I wish that my country had not a single - but several - specialists available at any time to intervene without delay if somebody were to have an injury like mine.

It was difficult for me to put my thoughts on paper, as this forced my mind to again focus on what has happened to me. But I do hope that those who read my story will benefit from it.2

2 The patient suffered a posterior scleral rupture with extensive tissue extrusion, total vitreous hemorrhage, and retinal incarceration; his initial vision was NLP. The eye's comprehensive reconstruction was delayed because the only surgeon who agreed to attempt secondary reconstruction was unavailable for almost 3 weeks. When the eye finally underwent vitrectomy and chorioretinectomy, PVR was already present. Several reoperations were performed, the eye is prephthysical, and the recurring PVR-retinal detachment keeps pushing the silicone oil against the cornea, causing zonular opacity. Visual acuity improved to CF, and additional surgeries are planned as needed.

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