Half of my time as a pediatric ophthalmology fellow is spent being an ophthalmologist, and the other half is spent being a magician, distracting and dazzling children with finger puppets and spinning light toys in order to examine their eyes. I pretend to be looking into their mouth with a flashlight when in fact I’m checking their pupils, and I have them count the beeps on the automatic Tono-Pen rather than have them focus on this instrument tapping on their corneas.
I flatter myself to believe I have many tricks in my armamentarium to examine a child’s eyes. However, what’s most evident to me in my hundreds of hours of pediatric ophthalmology training is that children can outsmart adults. Rather than complain, children will adapt with a head posture or frequent eye rubbing or squinting.
Hunkering down next to a 7-year-old girl with a blind right eye with a right exotropia (where the eye turns outward), I quietly asked her whether anyone asked her questions about her eye.
She whispered back, “They ask too many questions. They ask, ‘Why do your eyes go that way? What are you looking at?’” After a pause she confided, “So that’s why I walk like this,” and she cupped her right hand protectively near her right eye and ducked her head. “Or sometimes I just close my eyes like this,” demonstrating as she raised her chin and closed both of her eyes so she was just looking through a couple of millimeters of opening in each eye. She never told her mother these things. After a discussion with mom, we planned to perform a strabismus surgery to improve alignment of her eyes. The fact that such a lovely young girl has ridicule built into her everyday life is heart wrenching, however the adaptations she made show her resourcefulness.
The adaptations children and their families make are also inspiring. When a young boy lost his vision in both eyes, going from 20/30 vision to “count fingers vision” over a matter of months, his response was to learn braille. I found this out when I received a handmade holiday card with a lovely note typed in braille (and with written words below) wishing me a happy holiday.
I was so touched, that I went to our Little Rock Foundation Family Resource Room, housed in the Children’s Seashore House at CHOP. The Little Rock Room is a special area for people who are visual—and/or hearing—impaired. With the patient assistance of family relations coordinator Sandra Huwie there, I typed and had embossed a 3-page reply to the thank-you card and popped it off into the mail before realizing that I did not include a written translation!
As I leave CHOP with memories of gaining a child’s trust and confidence, the gifts of spontaneous hugs and thank-you cards in braille, I know that the physical and emotional energy I try to pour into every day is worth it. I will leave as an inspired, humbled, and hopeful ophthal-magician.