Thursday, May 1, 2008

Fast Friends and Close Colleagues: The Professor and Me

Professor Lalzoi waits patiently for me to leave his office.

This week I visited the National Military Hospital’s ophthalmology department and met Professor Lalzoi, a 74 year-old Pashtun Afghan who claims he is the oldest physician at the facility. He speaks no English but is fluent in Russian as he trained for ophthalmology in the Soviet Union at least twice in the past. The Professor appeared to barely tolerate my presence. He’s a reticent man by nature, apparently, and when I tried to engage him on topics outside of medicine, such as the Afghan military and politics, he gave curt answers loaded with subtextual emphasis on the corrupt nature of many things Afghan and my unbelievable temerity for broaching the topics. He didn't exactly cotton to my suggestion that he run for president in the upcoming election, even when I reassured him that at least one 70-something candidate is de riguer in American presidential elections these days. I’m sure we will be good friends before my departure from Afghanistan.

A few patients arrived to break the uncomfortable silence between the Professor and me. The young boy in this photograph has strabismus, or crossed eyes, because he is far-sighted (hyperopic) and exerts such vigorous focusing power (accommodation) that one eye turns in. His father, an officer in the Afghan Army, explained that his son had lost his glasses. (Kids around the world are all the same.) The father then had his son come shake my hand. I know enough Dari to ask “What’s your name?” and the boy seemed so surprised when he heard Naame taan chees? from me that he couldn’t respond. (Then again, he might have understood nothing from my stab at Dari, leaving him to wonder what language I was speaking.) The father was happy to join us for a photograph, and then a technician put dilating drops in the boy’s eyes for the upcoming exam. That medication stings when it hits the eye, and most children I have treated start shrieking after the first drop and thrash about trying to stop the dose destined for the second eye. This boy simply put his head down and rubbed his eyes a bit. These Afghans are tough.

The Professor wanted to confirm the child’s spectacle prescription before writing an order for glasses, and when the boy’s eyes were dilated Prof performed a skiascopy examination in a dark room with a lamp using a few tools I have never seen before; but he was able to determine from the reflection of light off the boy’s retina the refractive error of the eyes and, thus, the proper prescription. I watched and thought the position of the boy with his father next to the lamp in that otherwise dark room might make for a great photograph. They both agreed to pose for me, and I took the photograph below.

The other two patients I saw with the Professor were both severe eye trauma cases. A boy who appeared to be nine years old earlier in the day had taken a pellet to his right eye after a friend of his fired a gun near his face. He had no pain in the eye, but no vision either. His cornea had a laceration visible upon simple inspection, and an x-ray showed a small metal object lodged in the socket behind his eye. He needed surgery later that morning to seal the eye, but it likely will never regain vision. His blindness is due to the negligent discharge of a firearm. Many Afghans have told me that thirty years ago very few people owned guns and Afghanistan was much safer than today, as it seems every family owns a weapon.

I also saw a soldier who had suffered severe facial and torso trauma from an explosive device that detonated near him recently. He was groaning and grimacing the entire examination (which was mercifully brief), but I was able to see that the iris of his right eye was incarcerated (i.e. stuck) in a laceration of his cornea. He, too, needed surgery to release the iris fibers and sew the eye shut. I went by the operating room when another ophthalmologist, Dr. Abdulmanan, was preparing the soldier for surgery. I’m not sure what type of anesthesia they use for eye surgery here, but he needed more of whatever he was getting as when I peeked into the operating room he was writhing on the table and kicking his feet into the air. Maybe he wasn’t fully sedated yet. I hope that was the case. There’s no way Dr. Abdulmanan could have done surgery with the soldier moving so much.
Thankfully, I had to leave the hospital about then. I find that I don’t really enjoy the company of patients in agony. That’s the milieu of other surgical specialties, such as orthopedics. You may know that the definition of an orthopedic surgeon is "someone who has a high tolerance for other people’s pain. "


sandra said...

so, anesthesia types back here in the US aren't so bad after all! much less kicking and screaming over here

Joseph said...

where can I get me an awesome vest like the father of the child had?