Chapter 2: Doctors
Dr. Myers - Ophthalmologist
First thing the next morning, Susan called Dr. Hobby, Pearl’s pediatrician. Dr. Hobby suggested Susan make an appointment with Dr. Myers, an ophthalmologist that had been practicing for over 15 years in the area. Susan was on the phone trying to schedule a time for Dr. Myers’ office to see Pearl today. The office manager informed Susan that Dr. Myers was booked solid for today; nevertheless, Susan persisted. She shared what Mr. Wyatt had told her regarding Pearl and what she had seen on Pearl’s schoolwork. The office manager put Susan on hold to confer with the doctor. Returning to the line, she told Susan that Dr. Myers agreed to see Pearl at 12:30 p.m. during his scheduled lunch hour.
Susan called her boss and took the day off to be with Pearl for her appointment. Generally, Grandma is the one who takes Pearl to any doctor appointments and after-school functions. But both Susan and Pearl knew this appointment was something different, something bigger.
“Cover your left eye with this stick and read the third line of the chart from left to right using only your right eye,” Dr. Myers instructed Pearl.
Pearl sat nervously in the blue chair covered with a thick plastic coating. She had never had an eye test before. No one in her family wears glasses, not even Grandma. She did not know what to expect and so far thought the testing was boring and elementary.
Dr. Myers performed numerous tests on Pearl ranging from a basic acuity test to a color test. He offered no feedback to Pearl during the testing, but during the verbal questionnaire Dr. Myers repeated several questions more than once. This made Pearl uneasy, and she wondered if the doctor did not believe her. Or worse, did he know something she did not want to know? Pearl would rather be labeled a trouble-making, exaggerating teenage liar than being told she had a serious eye condition. After all, a teenage drama queen who exaggerates would be more common than a teenager with a major eye problem.
Pearl continued to follow Dr. Myers’ instructions until he told her to sit back and relax while he went and got her mom from the waiting room. He patted her shoulder on the way out of the room. It was a heavy pat: one that implied, “I’m so sorry” instead of “everything’s okay,” and Pearl felt the difference immediately. The stress of the visit made her sleepy, and Pearl closed her eyes and rested until the doctor reappeared with her mom.
“As I was explaining to you in the waiting room, Ms. Winters, Pearl’s central vision is normal. Her acuity test results fall within the range we like to see. Unfortunately, it is Pearl’s answers to the questionnaire that have me thinking we need to explore this further. I would like to refer you to a retinal specialist. My assistant up front can help you with getting the necessary contact information.”
“What are you thinking is wrong, Dr. Myers? Is it something serious, or something that may require surgery?” Susan asked.
“Have a seat, Ms. Winters.” Dr. Myers wheeled a small brown chair next to where she was standing and motioned for Susan to sit down. “I do think we may have a serious issue here; still, I don’t want to be presumptuous in stating what I think it might be. I have had enough experience to realize I do not know everything regarding the mysteries of the eye. I think you should follow up with a consultation with Dr. Holt, a top retinal specialist here in the Dallas area and well known nationwide. Dr. Holt will be able to give you some definite answers and a good picture as to Pearl’s condition now and what she might be dealing with in the future.”
While Susan was checking out, Dr. Myers’ assistant gave her the telephone number to Dr. Holt’s office. On the way home, Susan used her cell phone to make Pearl’s appointment with Dr. Holt. He would see her tomorrow, Friday, at 9:00 a.m.
Dr. Holt – Retinal Specialist
The next morning, both Pearl and Susan were up early. Susan had taken a second day off from work and was annoyed with her boss’s reaction when she told him she wouldn’t be back until Monday. Susan was also very nervous about this morning’s appointment with Dr. Holt. She was pacing back and forth in the kitchen while holding her cup of coffee. Her mug was still full, and the coffee had not yet been sipped. Her hands wrapped around the mug like a child holding a magic lamp wishing for the genie to come out. Yet, Susan knew no amount of wishes could change what was going on with her daughter’s eyes. The uncertainty created a suffocating atmosphere, and Susan stepped onto the back porch to catch her breath.
Pearl had already been up for hours. She tried to fluff her pillow as she made her bed, but it felt heavy from all the worries it had absorbed from her tossing and turning the night before. Pearl wished she were someplace else - someone else, just like everyone else her age that was already enjoying the joys of summer. She missed parties, hanging out at the mall, the pool, and going to movies. All those things Pearl had gradually stopped doing over the last months because of her failing eyesight. She stopped returning her friends’ phone calls, and they had eventually stopped calling.
Pearl felt more alone this particular morning than ever before. She sank onto her bed and gathered her pink quilt around her. She felt too young to have to think about such a potentially big problem and too old to be as scared as she was. Having cried herself to sleep for the second night in a row, Pearl’s head pounded like an aching sore. This morning she was simply too tired to cry, and she knew she must get up and get ready, both physically and mentally.
Pearl and her mom had never seen an office like Dr. Holt’s: gadgets, literature, and posters of the eye surrounded the entire lobby. Pearl felt as if she had just stepped into some freaky scientist convention. But, more accurately, Pearl and her mom had just entered one of the most recognized retinal research facilities in the nation, The Retina Foundation of Texas.
With her mom’s help, Pearl had to fill out seven pages worth of paperwork ranging from background information on her relatives’ health to specific questions regarding issues with her vision. While filling out the paperwork, Pearl had to force herself to be completely honest as to what was going on with her sight. For the last several months, Pearl kept her vision problems hidden from her mom because she did not want to worry her. But on the doctor’s paperwork, Pearl needed to divulge the truth.
As she wrote, she felt her mom’s warmth next to her. Her mom remained silent; yet, Pearl could hear her breathing getting deeper. When she finished the questionnaire, Pearl glanced up at her mom who had tears welling up in her eyes. She placed her arm on Pearl’s shoulder and rubbed her back softly. Her mom had no idea the extent of her daughter’s eye troubles, and she was both upset and frightened after reading what Pearl had written. What Susan thought was just a typical teenage phase of ignoring her mom was something much more intense and unimaginable.
Pearl got up and returned the paperwork to the front desk. The assistant told her to take a seat, and the nurse would be out to get her shortly. Pearl couldn’t help but notice the toddler coming in through the lobby door with his mother. Pearl guessed the boy was around three, maybe four, years old. He had on the coolest Converse hi-tops, orange, and blue tie-dye. But what stood out more than his shoes were the extra thick glasses he was wearing and the walking stick he depended on to navigate his path. While his mom was filling out paperwork, the boy comfortably made his way around the room several times. He laughed once when his stick got caught behind a chair leg, and he didn’t seem discouraged when his foot slipped on a magazine someone had left on the floor next to the end table.
Pearl was amazed at the mobility of this boy, despite his obvious challenges. After the mom turned in the paperwork, the boy eventually settled onto her lap as she read him stories from a Highlights magazine. The mom not only read the stories, but she also described the illustrations in such an imaginative way that Pearl found herself captivated by both the magnificence of the boy and the mother.
“Pearl Winters,” the nurse called out while holding a new manila folder in her hand.
“That’s me,” Pearl said as she and her mom stood up and followed the nurse down the hall to the last room on the right.
“Dr. Holt will be with you shortly,” the nurse said. “Take a seat and make yourself comfortable.” As she left, Pearl heard the nurse slide Pearl’s folder into the plastic tray hanging outside the door.
It was official, Pearl thought. She was in line to see the retinal specialist. All her anxieties over the last several months regarding her sight were exposed within the manila folder resting in the plastic tray. Strings of inked words arranged on the paper like evidence that would help solve a mystery. This was the first of many moments Pearl would feel like a victim. Her attacker was about to be identified.
To say he was attractive would be too obvious to mention. Dr. Holt had the darkest blue eyes Pearl had ever seen. They reminded Pearl of the color of her favorite pair of jeans. He was tall, much taller than she expected. And when he shook Pearl’s hand, she noticed immediately that his handshake was confident and his smile was sincere. Pearl was instantly set at ease by Dr. Holt’s presence.
“Let’s get to know one another a little bit before we decide which tests to run, Pearl,” Dr. Holt began. “We have set aside a block of a little over three hours for you today. While you are here, we want you to be as comfortable as possible. A small kitchen is just down the hall to the right, and you and your mom are welcome to stop in and grab snacks or drinks anytime between the tests. The restroom is the door directly across from the kitchen. I will be with you at the start of each test, and one of my research assistants will continue the test to completion. You will have an approximate 20 to 25-minute break between each test while I review the results to see if the test needs to be repeated or if additional testing is deemed necessary. Do you have any questions so far, Pearl?”
“No, sir,” Pearl replied.
“How about you, Ms. Winters, anything I can answer for you before we get rolling?”
“Not at this time. I am sure my head will be swimming with questions once this is over,” Susan replied nervously.
“Please make sure you take one of my cards before you leave. You can certainly call or email me with questions as well,” Dr. Holt said with a pleasant smile. Pearl noticed her mom smiling back in a way that she had not seen in a long time. In just one smile her mom looked five years younger.
After about fifteen minutes of questioning, Pearl was ready to bolt. With every question, she felt more and more squeezed. Dr. Holt had pressed just hard enough to uncover a good starting point for testing.
“Pearl, from what I am gathering by your comments, you are telling me that you feel you have the most difficulty seeing in dark or low light. Is this correct?” Dr. Holt asked as he leaned both elbows on his knees and stared directly at Pearl.
“I guess. I never really put it all together like that; but yes, that is correct,” Pearl said as she shifted her eyes downward to the far corner of the room.
“Okay, Pearl. Listen, don’t be nervous. I am just trying to figure out where we should start. No one is trying to make you feel uncomfortable. I know this is not easy for you, but my job is to provide you the best possible care. The only way I can do that completely is with your honesty. So, we both have an important job to do, okay?” Dr. Holt said with another one of his sincere smiles.
“Yes, Doctor. Thanks.” Pearl managed a small smile back.
“Okay, one other point. You seem to have had a fairly significant change in your peripheral vision over the last year. I want to look into that further today while you are here. My goal is that when we are finished with the testing, you will have a much better idea as to what is going on with your sight and some options as to how to proceed further.”
Both Pearl and her mom replied at the same time, “Thank you, Doctor.”
Dr. Holt touched Pearl on the arm and said, “Well, let’s get started. Follow me.”
Just as the doctor had told her, between each test, Pearl waited about twenty minutes. The testing and the waiting made for a very long and exhausting day.
In addition to a similar acuity and color test like she had with Dr. Myers, Pearl was subjected to a much more rigorous testing of each, as well as a visual field test, dark adaptation test, and an ERG (electrophysiological test). Each test served a distinct purpose. The acuity test measured Pearl’s central vision. The color test helped to determine the health of Pearl’s cone cells (the ones that decipher color). The visual field test determined the amount of Pearl’s peripheral vision, and the dark adaptation test showed how well Pearl’s eyes adjusted to varying changes in lighting. At this point, Pearl was ready to be anywhere but in Dr. Holt’s office – but no quitting yet. One more test had to be done: the worst one was saved for last.
Dr. Holt decided to administer the ERG test on Pearl as the final test of the afternoon. He told Susan that this can be an uncomfortable test and that it would be best to take Pearl home afterward. He recommended coming back on Monday to discuss the results. Susan told Dr. Holt that she could not afford to take off another day of work and that her boss had not been very gracious with her taking off two days this week. Dr. Holt agreed to meet Pearl and her mom tomorrow morning at 9:30 a.m. at his office.
Dr. Holt normally does not make Saturday appointments; however, he knew Susan was desperately seeking answers as to what was happening with her daughter’s sight. He also knew from the results he had reviewed thus far that Pearl would need to get answers quickly as time was not on her side.
Pearl was nervous during all the tests, but it was the ERG test that made her nearly come unglued. The ERG test is used to measure the electrical activity in the retina. Pearl had no idea what that meant and was in no way mentally prepared for how vastly this test differed from the rest she had already taken. This test contained a series of steps, each more bizarre and uncomfortable to Pearl as they progressed.
First, Dr. Holt put eye drops in both of Pearl’s eyes to dilate her pupils. After waiting for the black part of her eyes to get really big, the assistant placed patches over both of Pearl’s eyes. The patches remained in position for thirty minutes, so Pearl’s eyes could get accustomed to the darkness.
Next, the assistant guided Pearl into a dark room and positioned her in a chair. The assistant wore a strap around her head (like a coal miner) that held a tiny red lamp in the middle of her forehead. The small light enabled the assistant to carefully administer the test while Pearl remained in darkness.
The assistant removed the patch covering Pearl’s left eye. Afterward, she cleaned Pearl’s forehead with a solution and attached an electrode to the cleansed spot while holding the sensor in place with a pasty gel and tape. At this point, Pearl felt like she had been kidnapped and was in a torture chamber ready to be a victim of experimental testing. Pearl’s mind raced wildly as her imagination lit up the darkness with thoughts of people lurking in the corners of the heavily shadowed room and mental images of rats scurrying around her feet. None of this was true, of course; regardless, the oddity of what was happening to Pearl made her less able to shake off the silly thoughts.
Next, the assistant put another type of eye drop in Pearl’s left eye. This drop stung, and she closed her eyelids together tightly in pain. The drop made her eye numb. Before Pearl could adjust to the burning sensation, the assistant separated Pearl’s eyelids and placed an immensely thick contact lens on the front of her left eye. The lens was very large, and forced Pearl’s eye open for the entire test: her eyelids were unable to close. The assistant held the lens on Pearl’s eye in place with several strips of tape. The tape tugged on her brow and pulled her skin downward from the weight and shape of the lens. Pearl was miserable.
Pearl was instructed to put her head on what looked like a very large volleyball cut with an opening for her head. Her chin rested awkwardly on a leather strap. Pearl was told to look straight ahead at the flashing lights and stay completely still. She could feel her heart pounding, and drops of sweat began to trickle down her spine.
“Pow…Pop!!” The white light flashed. The lights reminded her of extremely bright camera flashes. They burst into Pearl’s forced-open eye like an enemy on the attack. The intensity of the light increased as the exam continued, and Pearl wondered if she would make it through.
After the testing was complete for the left eye, the process was repeated for Pearl’s right eye. This time it was worse because Pearl knew what to expect. Her stomach wrenched, and she rubbed her palms against her knees to distract herself.
This was her final test of the day, and it took Pearl the remaining part of the day to fully get her focus back to where it was before the ERG. Her head never hurt so badly, mostly from stress and the insanity of the test. She was emotionally and physically drained; and yet, she knew nothing of the results. That would have to wait until the next morning. Today would be her last day without a medical label: without a fancy word to describe her symptoms. This was truly her last day to be labeled “normal.”