I’m back in the world of Medicine after my year-long psychology hiatus. Not going to lie: I’ve missed it. Maybe that makes me a masochist, slightly strange, or both, but at least I know I’m going into the right career…
So it was with a pinch of trepidation and a healthy dose of excitement that I found myself sitting in a GP’s consultation room face-to-face with a patient for the first time in over a year. We were practicing the cranial nerve exam, a long-winded series of tests to make sure the nerves which control the head and neck are working properly.
Four other medical students were crammed into every available square inch of space, whilst the supervising GP perched on the bed behind me. Mrs Williams (not her real name) sat in a chair in facing me, having been interrogated about her general health by the nervous bunch of students. The GP had warned us that the results of her exam will probably be normal since patients with a cranial nerve abnormality are few and far between.
So the cranial nerve exam is a bit of a strange one. It involves the patient doing things like sticking their tongue out at the examiner and making faces at them. Having gone through the first few tests, the time came for me to test Mrs Williams’ field of vision. Mrs Williams had her left eye covered by her hand, whilst I had my right eye covered for comparison and was waving my other arm about like I was hailing a taxi. I explained that I will move my hand into different locations and all Mrs Williams needs to do is to say “yes” when she can see my fingers move within her field of vision.
I stuck my arm out to the edge of my peripheral vision and wiggled my fingers.
“Can you see my fingers move, Mrs Williams?” I asked.
“No,” Mrs Williams replied. Hardly a cause for concern at the moment, since it could be my positioning rather than her eye that was causing the problem. After all, I’m a little rusty on the examinations. I moved my arm further into my field of vision.
“How about now, Mrs Williams?” I repeated.
“Nope,” Mrs Williams said again. My hand was definitely within my peripheral vision. Perhaps Mrs Williams had tunnel vision? Does Mrs Williams know she has tunnel vision? Would I have to explain to Mrs Williams that she has tunnel vision? Does the GP know she has tunnel vision? But the GP said her exam will be normal! I moved my hand right in front of her eye and tried one last time.
“Can you see my fingers wiggle?” I asked for the third time.
“Nope,” Mrs Williams said.
Okay, this is way worse than tunnel vision. Mrs Williams couldn’t see my fingers which is directly in front of her face. Will I have to explain to her that the vision in her right eye was seriously impaired? Does she know that her vision is seriously impaired? Was she having me on? She didn’t seem too concerned about her predicament. Dampening down my own sense of panic, I looked into her bright green eye with flecks of hazel strewn across its iris-
“Do you have a glass eye, Mrs Williams?”
The corners of Mrs Williams’ mouth twitched up in amusement. I imagined the light bulbs flickering on above the fellow medical students’ face. The GP was probably giggling to himself behind me.
“Yes,” she said. “I lost it in the car accident.”
We’d established that Mrs Williams had been in a serious car accident in the past, but it turned out that our supervising GP specifically told her to refrain from mentioning the completely trivial fact that she has a glass eye. My annoyance mingled with amusement at the sheer ridiculousness of my situation.
I’d just attempted to test the vision in a patient’s glass eye. The GP set us a little trap and, like a complete rookie, I blundered straight into it. After we got over the shock of Mrs Williams’ revelation (and had a good laugh at me) Mrs Williams completed her cranial nerve examination which, I was happy to say, she passed with flying colours.
You’ll be glad to know that I have three more years of training before I’m let loose in the NHS.