Polite Dissent

I was sitting at my table in the hospital tent early one Wednesday evening, typing on my laptop, and trying not to think about the 120 degree heat we were experiencing on our deployment in the Arabian Peninsula.

The tent door opened, and Gene, one of the vehicle maintenance sergeants, came in.

“Doc,” he said. “Something funny’s going on with my right eye.”

“What’s that?”

“I haven’t been able to see well out of it for the last couple of days. There’s one spot where I can’t see at all.”

I beckoned him over to sit down on the cot and looked closely at his eye.

“Did you injure your eye? Or get anything in it?”

“I don’t think so.”

I did a quick exam, and both eyes moved and responded normally. I got out my ophthalmoscope, and looked at his retinas. This is a difficult exam to do under the best of circumstances, and in a bright hot tent it was particularly difficult. Both retinas looked pretty normal, though there seemed to be a slightly pale spot on the right.

I did a confrontation exam, which revealed that he had a fairly significant blind spot in the upper outer quadrant of his right eye.

Finally, I took some fluoroscein stain, and applied it to his eye. If there is any injury to the cornea, this stain will fluoresce bright green under a black light. With all the blowing sand in the camp, and metal shavings in his shop, I figured there was a good chance he had a corneal scratch. The exam was negative, however.

It now seemed most likely that he had some retinal injury, probably a detached retina. He needed to be seen by an ophthalmologist quickly. Thursday and Friday are the Muslim weekend, so there was little available to me on Wednesday night. I could send him down to the local Arab military hospital emergency room in Abu Dhabi, but I’d been warned that the ophthalmologists there were worthless.

There was a better hospital about two hours away in Dubai, but their emergency room would be closed before we could get there. They did have specialty clinics, and I might be able to get him in to see an eye doctor the next day.

I didn’t want to take any chances with his eyesight, but I didn’t trust the local ophthalmologists. Gene had already had this blind spot for three days, so I gambled that one more night wouldn’t make any difference.

I got up early the next morning, and called the information desk at the hospital in Dubai. Luckily, most of the people there spoke English, so I was able to explain what I needed. I was transferred to the appointment desk, where I was told the next ophthalmologist appointment was in ten days. This would not do at all! I thanked the appointment clerk, made the appointment (just in case), and then hung up.

I dialed the hospital information desk again, and asked for the direct number to the eye clinic. I dialed the clinic directly, and explained my situation to the receptionist. She transferred me to another receptionist, who transferred me to a third, and then a fourth receptionist. After a half-hour of phone tag, I was finally transferred to the nurse. I explained the situation to her.

“Well, the doctor is very busy today,” she said, slowly enunciating each word. “He has no open appointments until next week.”

“I understand that,” I said calmly. “But I have a patient who can’t wait that long.”

“Well,” she said slowly. “I’ll let you talk to the doctor.”

A minute later, a masculine voice with a slight English accent got on the phone. “This is Dr. D-”, he said.

I explained that I was an US Air Force physician two hours from Dubai who had a patient with a sudden blind spot.

“It sounds like his retina. He needs to be seen right away,” Dr. D- said.

“Can you help?” I asked politely.

“I’m not a retinal specialist, but I’ll be happy to take look at him. Send him right over and I’ll see him when he gets here.”

I thanked him profusely, woke up the patient and my medic, and sent them both to Dubai.

Two hours later, Dr. D- called me back. “He has a small area of detached retina.

It needs to be reattached, but you’ll need a retinal specialist for that?”

“Are there any in the country?”

“There’s one in Abu Dhabi, so I suggest he go there. The doctor doesn’t usually see foreigners, but I talked to him, and he’ll take a look at your patient.”

I thanked him again, and sent Gene and my medic back to Abu Dhabi.

Three hours later, Gene and the medic walked in the tent. The medic handed me a Big Mac (“We stopped off because we were hungry,” he said sheepishly. Mmmm, American food!) and the specialist’s report. I skimmed it while I listened to Gene.

“The retinal specialist said that I need an operation. He said I can have it done here or back in the United States.”

“Did he say it was safe to wait?”

“He said the operation needed to be done in the two to three weeks.”

“Is it safe for you to fly?”

“He said so.”

“Do you want the operation here, or back in the US?” I asked. “Either way, you’re going to have to return home on convalescent leave.”

“I’d rather go back to Nellis.”

I went to talk to the Colonel, and we arranged for Gene to fly home on the next flight in two days. I called my old partner back at Nellis AFB, and had him arrange an appointment with the ophthalmologist on base there.

Gene flew home, had the operation at UNLV, and had no complications. After several weeks of recovery, he was able to return to the Middle-East and finish the mission with the rest of us.