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Teaching and Learning Moments

Clarity of Vision

Federman, Daniel G. MD

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doi: 10.1097/ACM.0000000000001112
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I was already running behind that afternoon. I hustled out to the crowded, chaotic VA primary care waiting room, shouted my next patient’s name, and was relieved to see a middle-aged man in sunglasses stand and turn his head in my direction. At least he was not one of those arthritic octogenarians, I thought, expecting him to follow me quickly back to my office. But he didn’t move; he just stood there as if frozen.

Then I noticed his folded white and red walking stick tucked neatly beneath his armpit, and I felt foolish. I had never cared for a patient who was blind. I had no idea if I should stand on his left or right, whether I was supposed to describe everything I was seeing as we walked. I wondered how to get him through the door jamb, into a chair, and onto the exam table.

We were to be an odd couple—he the slow-talking, soft-spoken, tall, sweet, African American gentleman with an accent I placed somewhere in the rich farmland between Georgia and the Carolinas, and me the short, Jewish, fast-paced, cynical New Yorker. He told me that he had lost his eyesight after a mortar explosion in the jungles of Vietnam when he was only 19. Thanks to much training provided by the VA blind center, he was able to be mostly independent, marry, and raise a loving family. I thought about what my life would be like if I couldn’t experience the grandeur of another colorful sunset, wake up to the pristine beauty of a fresh New England snowfall, or experience another piece of art at a museum on a lazy Sunday afternoon. I anticipated that over time, the veneer would crumble and I would learn the true despair that must have been lurking underneath his pleasant demeanor.

It has been two decades since that first visit, and we have remained patient and primary care physician, two people whose lives became intertwined only by happenstance. I owe my good fortune to the serendipity of the scheduling clerks.

At a recent visit, I asked him why his health is important to him, and not unexpectedly, he informed me that he didn’t necessarily want to live as long as I could keep him alive but, rather, live as independently as possible for as long as possible. Enjoying family, cooking for himself, self-toileting, and ambulating with his cane meant much more to him than his creeping PSA, a low-salt diet, or whether he should have a vaccination against the flu or shingles. He has taught me that controlling a patient’s blood pressure and cholesterol and providing cancer screening and immunizations do not make you a great doctor or meet every patient’s true needs.

“How were you different before the injury?” I asked at another recent visit. “Were you always this pleasant, wonderful guy?” I was surprised by his response. “Before, I used to get into some trouble. That’s why I went into the service. I used to like the ladies … you know, really like the ladies. I used to really enjoy the way they looked.” After a brief pause, he continued: “Now things are totally different. I don’t care what you look like. In a way, I’m freer. I don’t need my sight to feel the goodness and kindness of those I’m with. I don’t judge people by what they look like, the color of their skin, whether they’re skinny or fat, just who they are.”

He said this not only with the conviction of someone relaying a self-evident truth but also with apparent pride at being liberated from the vicissitudes and shackles that either consciously or unconsciously bind those of us with sight. He could not see the rivulets of tears slowly rolling down my cheeks, although I’m sure he sensed them. His sight might have been stolen from him at an early age, but he not only gained true clarity of vision but also improved my ability to see my patients better.

Acknowledgments: The author would like to acknowledge Drs. Anna Reisman and Beth Heuzey for their thoughtful editing of this essay.

Daniel G. Federman, MD

D.G. Federman is professor of medicine, Yale School of Medicine, New Haven, Connecticut, and associate chief of medicine, VA Connecticut Health Care System, West Haven, Connecticut; e-mail: [email protected]

© 2016 by the Association of American Medical Colleges