One of the great joys of retinal screening is the relationship you develop with each patient. It might only last for twenty minutes, but by today's standards that's verging on a long-term commitment, so as it's Valentine's Day, I thought I'd share the love by passing on a true story which was told to me by a friend and colleague from another screening programme.
Obviously it's rude to reveal a lady's age, so I can't tell you that she's 52, but what I can tell you is that in addition to being a fine retinal screener, she has the figure of a woman half her age, and resembles a young Julia Roberts. At least in her own mind. To those around her, the phrase 'drop dead gorgeous' refers more to her risk of dying from a heart attack, but either way, she's a respected member of the screening team, and much-loved by patients and colleagues alike. Or so she tells me.
Interestingly, however, whilst being a well-rounded human being in more ways than one, the weight of this mystery screener is distributed mostly around her middle. She might have the spare tyre of a minibus, but she has the elegant wrists and pert bosom of a twenty-one-year-old. And I don't mean Adele.
Personally I'm inclined to believe that all retinal screeners should be a few pounds overweight. I think it shows solidarity with the patients. Let's face it, you can't empathise effectively with a type 2 diabetic unless you've struggled with cake yourself. It gives you a more personal connection and makes you less judgemental. The patients see themselves in you, and feel you're one of them, facing the same challenges in life and going through a similar experience.
Unfortunately that can sometimes lead to problems. Frankly you don't want the patients thinking you're too much like them...
So this friend of mine was doing a screening clinic, and one of her patients was a lady in her forties, who arrived with a child of about four. When it came to putting in the eye drops, the patient said "This is my second time with the drops. I was ok last year, but this time I know what's coming..."
Being an empathic person with a strong sense of sisterhood, my colleague replied "Yes, it's a bit like childbirth - the first time you're naïve and have no idea what's coming. The second time - oh s***, you do!"
You'll have to excuse the language. In the rough and tumble of a screening clinic, people don't always choose the right words. I know a patient who once referred to his bifocals as bisexuals. I'm not here to judge.
Anyway, there are various responses you might expect to that analogy from my colleague, but the one she got was a little unexpected. The patient replied with these four little words:
"Is this your first?"
My friend might be well-fed and fifty, but the patient presumed she was pregnant. It was something of a body blow, but with all that padding around her middle, she didn't feel it. She did, however, set the record straight immediately by responding "Gosh, I've got grown up children!", which was the perfect comeback. Except that it didn't contain the words 'I'm not pregnant'.
The patient, who was still under the impression that she'd met her eye screening soulmate, replied "Me too. I have twenty-year-old twins". And with that, she went back to the waiting room.
Naturally my colleague hoped that was the end of the story, but sadly for her, it wasn't. When the patient returned for the photographs, she sat down at the camera with her four-year-old child, and said "So you're like me - starting again. How long have you got to go?"
It was at this point that my friend knew she was in trouble. In front of her was a well-meaning patient showing a genuine interest in her non-existent baby. By responding "I'm not pregnant, I'm fat", she would risk embarrassing the lady to such an extent that she could be mortified beyond belief and might never return to screening. What was needed was a way of letting the lady down gently, in a caring, considerate, perhaps light-hearted manner which would absolve her of any guilt and embarrassment, and allow them both to move on with the screening appointment without any feelings of awkwardness. It's one of those delicate situations where the screener needs to choose her words carefully in order to extricate herself from an extremely sticky situation, whilst maintaining her self-respect, her dignity and above all, her professionalism.
So she considered the question for a moment, and said this:
"Three months."
At which point the patient wished her good luck for the birth, and settled down for the photos.
That might sound like the end of the story, but of course it's anything but. The patient's on an annual rescreen, so she'll be back next year expecting a blow-by-blow account of the labour. My friend has twelve months to lose weight and fake some baby photos, otherwise she'll have to look the lady in the eye and tell her that motherhood's so great the second time around, she's already expecting another.
This is the VA chart we use in the screening room at one of our hospitals...
I was using it this morning to test the vision of an older patient, who started reading confidently at the top, only to stop abruptly after 'X-U-A'.
When she failed to continue, I asked her "Can you see anything below that?"
She replied "Yes."
I said "What?"
She said "A sink."
The same word accurately describes what my heart did. I wouldn't mind, but she was deadly serious.
