Rust Ring

Last Saturday morning one of our local mechanics presented to the ER complaining of a foreign body sensation in his left eye. Apparently on Friday afternoon he had been grinding without safety goggles. Hmm. Never seen that before. Our slit lamp was out of commission, so I had him recline on the stretcher in the ophthalmology room and used a magnifying glass to locate the piece of metal embedded in his cornea. I then took one of the single-use topical anaesthetic tubes from the appropriate box in the eye tray and squeezed two drops of tetracaine into the affected eye.

After waiting the customary five or six seconds for the freezing to take effect, I began scraping the surface of his eye with a miniature Alger brush to remove the offending particle. He immediately did a whole-body flinch and bellowed, “Ouch!” I had never seen anyone react like that before. Geez, what a wimp, I thought. I added another couple of drops and continued working. This time he sat bolt upright on the stretcher and started rubbing his eye vigorously. “Ow, doc! I can still feel that!”

“Four drops of tetracaine is more than enough to numb the surface of the eye,” I sniffed. Just to be on the safe side, I opened a new tube and put another two or three drops in. “Now please rest your head on the pillow and hold still so I can get this thing out.”

Braveheart lay back down reluctantly. After a couple of minutes of scraping I was able to get the metal fragment and its accompanying rust ring off his cornea. It wasn’t easy, though – his eye kept watering and he wouldn’t stop blinking and squirming around.

Boy, they sure don’t make mechanics tough like they used to, I groused to myself when he finally left the department.

At 10:15 on Saturday night I was sitting at the ER desk when the phone rang.

“Hello?”

“Hi doc, it’s me, Mike the mechanic.”

“Hey, Mike. What’s up?”

“I was just wondering how long it’ll be before I can see normally again.”

“What do you mean?”

“My eye’s not as sore as it was before you took that piece of metal out of it, but now everything looks pretty blurry.”

“Well, it usually takes a couple of days for the scratch on the surface of the eye to heal.”

“Oh, that’s good to know. Thanks a million, doc. One last thing – about how long will it be before that black circle in the middle of my eye goes back down to normal size?”

“What?”

“Right now it’s way bigger than the one in my right eye. Is that okay?”

“Your pupil is dilated? That doesn’t make any sense. Maybe you should come back so I can have another look at you.”

Mike returned to the hospital. The ophthalmology room had just been used and needed to be cleaned, so I took a quick look at him out at the ER desk. Sure enough, he had a hugely dilated left pupil. There was no good explanation for it, unless… . I went back into the eye room, pulled on a pair of gloves and did the wastepaper basket equivalent of dumpster diving. After a brief search I found the discarded tetracaine tubes I had used on him that morning. Unfortunately, a closer inspection of the labels revealed they weren’t tetracaine at all - they were homatropine. Homatropine is used for dilating pupils. It has no topical anaesthetic properties whatsoever. I sifted through the tetracaine box in the cupboard and was only mildly surprised to discover both tetracaine and homatropine tubes in it. True to Murphy’s Law, the tubes are almost identical in appearance. My best guess is that the last person to stock the medication cupboard accidentally tossed a handful of homatropine tubes into the tetracaine box. No wonder he’d had such a hard time staying still – he’d been feeling every single scrape and scratch as I worked on the inordinately sensitive surface layer of his eye! The mere thought of it made me want to ralph. I squared my shoulders and went out to face the music.

“Um, Mike, there’s something I have to tell you… .”

655: Dead, But Dreaming

(Trapped on Jacob’s Ladder)

"As I lay dying, the woman with the dog's eyes would not close my eyes as I descended into Hades."

 

- The spirit of Agamemnon speaking to Odysseus in Homer's Odyssey

 

* * *

 

“Is all that we see or seem

but a dream within a dream?"

 

- Edgar Allan Poe, A Dream Within a Dream

 

The highways of northern Ontario can extinguish your life in the blink of an eye. One minute you’re humming along with the pop star on the radio; the next you’re an ugly red smear across a rock cut. Graffiti in flesh and blood. Carrion for the haruspex and obit scavengers. Did you hear about that horrible accident on 655 last night? What a shame, he was such a nice man… .

Highway 655 is a 60-kilometre strip of desolation that runs between Timmins and the northern branch of the Trans-Canada Highway. Due to chronic staffing shortages, the provincial police have pretty much given up on trying to rigorously enforce the speed limit on it. As a result, 655 has become immensely popular amongst the 18-wheeler crowd. Some days the endless convoys of transports blasting by can make keeping your car out of the ditch a real white-knuckle adventure.

Oddly enough, some nights on 655 you can drive forever and not encounter a single soul. Whenever that happens, my mind has a tendency to wander off and leave my vacant shell steering the car. Although this state bears some resemblance to the automatism that sometimes manifests during minor medical procedures, one key difference is that zombie-driving isn't nearly as closely monitored. As I autopilot down the highway at well over 100 kilometres per hour, a host of half-forgotten memories drift around aimlessly inside my head. Sooner or later my primordial fugue is interrupted by an urgent message from the sector of my neural network tasked with keeping me alive: Wake up! When’s the last time you checked the road? I usually awaken from my drooling stupor just in time to cringe as a semi passes within a few millimetres of my car. You’d think close calls like that would make me more vigilant, but they don’t. Most times I decay back into a torpid, near-REM haze within minutes. It’s not that I have a death wish or anything sinister like that – it’s just that I’m so tired I can barely keep my eyes open. Sometimes it almost feels as if there are pennies resting on my eyelids.

Strange thoughts seep into my mind at night when I’m in a daze and there’s no one else on the highway. Am I really here right now? How can I be certain I didn’t fall asleep at the wheel and wrap my car around a tree a few klicks back? Maybe I’m actually pinned under a filigree of twisted metal, coughing up blood and imagining I’m still cruising along a chimeric 655. Could my current existence be nothing more than the terminal hallucinations of a dying brain? Can anoxic neurons spin threads of life out of fear and hope?

Do the dead dream?

Time Flies When You’re Having Fun!

Mrs. Charon is in for a routine checkup. I’m running through a review of systems with her.

“Any change in your bowel habits?”

“No.”

“Any chest pain?”

“No.”

“Shortness of breath?”

“Yes.”

“How long have you had that?”

“For a while.”

“How long is ‘a while’?”

“Oh, a few months, maybe. You did a test on my lungs around the time it started. I had to blow into a machine.”

“That was probably a pulmonary function test. When did you do that?”