Eye Sage

The original vitreous haemorrhage I had on New Year’s Day decided it was time for a sequel. It hit the box office Friday before last with a vengeance. Only the day before I had had a follow-up to my A&E visit early in the New Year. I was seen, eventually, and told that the damage should clear up within a few weeks, that the blood should be re-absorbed, eventually. Mr. Park told me to return if things got worse. That didn’t sound too conclusive. I wasn’t mightily re-assured.

The very next evening, Friday 12th January, it was as if there had been a Sony Bravia-like explosion of red in my eye. The bleeding continued until the end of that evening by which time I was blind. I called A&E and they told me to come in first thing, so that they could do an ultrasound, presumably to check on the state of the retina. I waited until Monday. It’s a long story, but nothing more was going to be done on the NHS before then anyway.

I have to say, the NHS is not very consistent. Every person you see gives a different and conflicting view. You generally want to see the person at the top. The others are frankly, guessing. I was surprised that I had to explain the phenomenon of re-entry to them. Whilst I am normally wary of google as a means of fast-tracking one’s medical knowledge, on this occasion, I did feel better prepared.

My first A&E visit resulted in my being seen by every opthalmologist in the hospital (too many opthalmologists spoil the sight?), it seemed as if they were using it as a training exercise. (My eyes often provoke that kind of response - and if you saw the laser scarring, especially in my hitherto weaker left eye, you would see why). The guy I saw eventually, after a three hour wait was very courteous. He got my name right, having a Muslim name himself helped. He even offered salaam!

What he didn’t offer was good news. After looking me over quickly, he said I would need laser surgery pronto and that my retinopathy had returned with a vengeance. He asked if I had medical insurance. When I affirmed, he suggested, quietly, that I should make use of it. He wasn’t proud to say this, but the urgency in his voice suggested that waiting around for the NHS might have unpalatable consequences.

I went home in a daze, half blind, eyes both blurred as well from the dilating drops, every usually forgettable light its down dazzling, static fireworks display. Reds, whites and blues everywhere. Starburst City - I felt like I’d walked into a cheap videography commercial.

Let’s rephrase that. I felt fucking awful. I know this sounds dreadfully ungrateful, but a man like me could manage without his legs. God forbid, God forbid, God forbid. But not my eyes.

The next day I arranged to see the same consultant who has looked after my eyes for the last 15 years on the NHS. Except he has not seen me once on the NHS. If I’d wanted to see him now, the wait might have been over 3 months, I’d be blind, depressed and still might not actually get to see him.

With my medical insurance, I was able to see him in his private clinic, in the same hospital, for an extended one-on-one session, with no trainees, within 48 hours.

And what a blessed relief. He confirmed one of my fears, that if the second haemmorhage, which has blinded me in the right eye after traction on the retina, doesn’t clear up within a few months, vitrectomy is a foregone conclusion. However, if I take it very easy, very, very, very easy, that I should be OK and that my eyesight will recover eventually, even if the double bleed and the tractional damage might have marginally affected the quality of vision I have. Hell, I can live with that after experiencing no vision at all for reading purposes for the last week.

At the top of this page you can see a picture of my retina. As you can see, blood obscures the centre. Right at the centre is a small disc that represents your crucial central vision, called the macula. It is obscured by blood. I can seethe periphery, but I cannot read shit. It’s very strange. Text elusively appears clearly at the edges of my vision, but as I chase it with my macula, mirage-like, it is gone in a haze of blood. (The bright disc you see is not the macula, it is the optic disc, which is the retinal interface of the optic nerve).

The detritus of course floats around and obscures different parts of the macula depending on my orientation and momentum, like ink squirted into a glass of oil. And like measuring a quantum particle, I could never tell you when and what I will be able to read or see centrally at any given time with any precision.

My right eye was previously my good eye. The retinopathy in my left was very bad and it looks like the surface of the moon. I’m not sharing that picture with you because some unscrupulous sod might use it for nefarious identification purposes. With the blood in the picture of my right eye, you don’t get a clear and full shot of my retina, so nothing to worry about there.
The good news is that it’s not retinopathy. The NHS guy was wrong. The bad news is that the bleeding was aggravated by the new medication given to me to handle my two TIAs from last autumn. And although I’m meant to exercise gently after my knee surgery, I’m now being told that I can’t, in case I haemmorhage agein and completely fuck up the eye. So I get to choose - risk of blindness - or risk of stroke. I decided I’d risk the stroke.
Some morals from this tale?

• Don’t get diabetes
• If you get diabetes, look after yourself fucking well, or you will die horribly over years
• In either case, get private health insurance

I am off work for a while now. I have been very worried. I can type, because I have great muscle memory from 25 years of typing. I can’t read very fast though - I used to be a voracious reader. My left eye was my weak eye, as it had been lasered right around and even on the macula. Now it is my only working eye for reading, until hopefully, the right eye clears and hopefully, there is no more traction on the retina at the point where it has bled twice already.

My NHS diabetologist is a hero, a wonderful doctor, but having been a hardcore NHS and private customer for the last six months, I can say this:

With private health insurance, all the members of my medical support team treat me like the client, the patient, the person who needs to be helped and supported and guided and informed. The first time in 22 years of retinopathy I ever got to see the back of my eyes was being given a print-out after my private photograph taken by the same person who took an NHS photograph only 48 hours earlier. The same man who now talked me through the whole process, invited my children into the room, allowed them to see the screen and gave me a colour print-out was the same man who 48 hours earlier got me in and out in moments without a smile, a hello or a bye-your-leave.

With the NHS, I am nothing more than a number that has to be put through the system as quickly as possible. One never feels less like a patient and more like a wasteful burden than when one is being treated on the NHS.

That’s it in essence: To the private sector in health care, I am a client and a patient. To the NHS, I am a statistic and an inconvenience. We truly have a two-tier system. The more money one has, the better the treatment.
I simply don’t understand why.