There are a lot of wonderful things about general medical practice, but like anything else it occasionally gets, well, tiring. A fourth worried-well general physical exam at the end of a long afternoon is not something most doctors look forward to, hesitating with one hand on the examining room doorknob. The poor person shivering on the examining table is often ready with something like, “I feel lightheaded”, “I seem to be tired all the time”, or, “My legs don’t feel right”.
One of the vague complaints I dreaded but heard quite often in my office was, “My eyes are tired.” Eyes? Tired? Eyes don’t get tired. Sore, dry, runny, blurred, independent of one another sure. But nowhere in medical school or in any ophthalmology book had I run into real causes of tired eyes. People with tired eyes always seemed to have other kinds of trouble. Not enough money, lonely, can’t lose weight, taken advantage of at work. I would examine the eyes, find nothing, do a general physical going-over with blood tests: nothing. Healthy as a horse. Eye specialists must have felt tired themselves facing my tired-eyes referrals.
I wondered what was the matter with these people. The specialist report always confirmed a normal eye examination including 20:20 vision, and blinking at me between the lines was the specialist’s message, “Where’s your common sense Sloan? There’s no such thing as tired eyes.” I didn’t make much of an effort to avoid patronizing my patient in the summing-up appointment.
Well, for the last six months I have had tired eyes.
After 20 or 30 minutes, no matter how interesting the book, the print on the page starts to blur, I have to work at keeping my eyelids wide open, and I end up struggling just to see the lines of print. I’ve got to tell you my eyesight is near-perfect. My progressive bifocal close-up readers have been recently updated. I don’t see double. I don’t have early Lou Gehrig’s disease or multiple sclerosis (I’ve been to a neurologist). And I’m not falling asleep when this happens, I’m wide awake. My eyes just get tired.
It’s like my experience of patienthood as my father-in-law was taken to a nursing home, or when my daughter was born. It doesn’t make a damn bit of difference to me whether the trouble I’m having has a name, is the subject of a textbook chapter, or is obviously “psychosocial” and not the business of some professional trying to end his appointment and get on to somebody who has acne or heart failure that he can fix. Doesn’t matter. My tired eyes are real, even if they’re a product of my perverse imagination.
So how do I get rid of my problem? Could there be a magic answer? I believe in magic but not in the abracadabra kind. Changing large chunks of the physical world by waving a magic wand would make an enormous difference in many ways, but because medicine’s understanding is the best materialist version we have of the part of the physical world our bodies occupy and tired eyes isn’t in the textbook (to say nothing of the common-sense unlikelihood of abracadabra magic) I’m not expecting a fairy godmother to fix my tired eyes. What about the magic most simply referred to as belief? “Placebo effect” if you like. I don’t care that medical students in a hospital hallway titter among themselves over a patient’s miraculous response to a sugar pill. That patient really got better.
I don’t care that courage in tribal warfare following eating the heart of a lion is superstitious silliness, the battle was still won. And it doesn’t bother me a bit that for such magic to fix my tired eyes the complaint would have to be “psychological” to some extent. I’m “psychological” to some extent.
I do worry that belief works its magic best when it is engendered by authority. That would be pretty much by definition something or someone outside our self. Or would it? Could someone talk themselves into a placebo effect that worked? Maybe the wind changing some afternoon will carry enough authority to wake my vision up.
What I know for certain is that I see more and more human troubles to which my increasingly technocratic profession is blind. Or maybe our eyes are just tired. I see those troubles best when they belong to me or people close to me, when I’m potentially on the receiving end of professional help. Fewer and fewer of these troubles appear amenable to health technology. I want to take medicine by the lapels of its white coat and tell it as clearly as I can that refusing to address weird individual problems creatively is hurting our effectiveness. Technologic medicine has its own case of tired eyes, which maybe ought to be evidence enough that such things exist and that they need a different kind of cure.
I’m a 4th year medical student at UBC, planning to go into Family Practice. Your name was mentioned by one of our lecturers today and I luckily stumbled upon your blog. I am so happy to see your site and all of the work you are doing to help people live with dignity until the end. I particularly liked this post, as it is something I struggle with in medicine already. I’m looking forward to following you and your adventures!!