Thursday, March 31, 2016


Not long ago I visited my eye doctor. I like him much better than the one who preceded him, though that doctor had a reputation as a miracle worker when it came to cataract surgery. I complained to that doc and also to the present one about my eyes being bloodshot, itchy, and “tired.” I thought it was from being on the computer so much. Last summer my eyes were such a bother that I went back on an emergency basis. That time the farmers were burning fields and I decided that was the problem.
I worried that I might have damage from my diabetes, because I slip off my compliance regime sometimes. I’m having increasing trouble with forgetfulness and bad temper. It’s a symptom of age. I’m 76. But also I’m reading about atrial fibrillation — arrhythmia of the heart and how it can make the blood turbulent enough to throw off tiny clots. The clots could mimic transient ischemic attacks, or maybe they ARE transient ischemic attacks, which are little pinches in brain function. I had interpreted my diaphragm as fluttering. This has nothing direct to do with my eyes, but if I’m too forgetful to take my pills in spite of sticky notes here and there, then the eyes suffer. It’s the beginning of the final unraveling.
Prince Harry of England -- Rosecea?

The anger comes from impatience but also from losing my temper over the doctor situation, even with my well-liked eye doc. More and more a visit means some teenager goes down a checklist and not much more. Then at the end of the last examination, the Doc asked if the pink cheeks and scaliness in one spot might be rosacea. Sure, it is. I know the diagnosis because a few years ago the GF Clinic’s one-time dermatologist diagnosed it, but he didn’t explain or prescribe.  Never mentioned eyes.  He was a very weird bald guy who left in months because patients complained. I’m beginning to suspect that Montana is a dumping ground or refuge for docs who’ve been in trouble. Rosacea is so obvious that even a teenager could see it.
My cousin also has pink cheeks — we’re Scots and it’s hereditary in part, though no one really understands rosacea. In all the checkups I’ve had, including the one that was double-teamed Physician Assistants, billed as a “free” Medicare checkup (which it wasn’t because I had to pay for lab tests — not announced in advance), neither really looked at my face. They just looked at the lab printouts, which they didn’t have during the physical exam. They never met my eyes.

The treatment for ocular rosacea is hot washcloth compresses with baby shampoo washing immediately afterwards. But the docs have always acted like tap water would kill me. I’m allergic to one of the eye exam chemicals and keep my eyes from swelling shut by splashing them with tap water, but they insist on using squeeze bottles of sterile saline — and billing me, no doubt. (There’s also an over-the-counter equivalent for rosacea washes.) It never quite does the job, but instead of arguing, I just go down the hall afterwards and wash my eyes in the bathroom. (It’s Unisex, incidentally, and so is the one in the supermarket.) But what do street people do?
Anyway, I didn’t know that rosacea affects eyes until the doc told me and he simply pressed me to try the new dermatologist at the clinic. He didn’t explain in detail. Thinking it was like the brilliant idea of selling glasses in spite of the new cheap internet competition from China, and also because my insurance now requires a co-pay of $45 which would buy three cases of cat food, I put off the idea of making an appointment. Even with low cost gas, it’s a long drive to Great Falls and the ancient pickup makes funny noises.

It's got Clinton by the nose.

Yesterday I was trying to restore order around here and realized I should learn more about rosacea, so I googled. Holy catfish. This is serious. In the advanced stages it’s like Bob Scriver’herpes keratitis in 1962 that just about blinded him and pulled us into a close relationship very quickly because he really needed help. The treatment for ocular rosacea is very simple in the beginning: using a warm compress to loosen whatever is crusted on the eyes and then using baby shampoo to wash the outsides thoroughly. Artificial tears up to four times a day. As things get worse, the tear ducts might be blocked to divert the tears across the eyeball. The same meds that miraculously saved Bob’s eyes is used for advanced rosacea and the often accompanying eyelid inflammation: dioxiuridine.
If the rosacea increases and maybe leads to the inflammation of the eyelids (called blepharitis — I knew “itis” means inflammation but not that my eyelids were “blephs”), then things get more serious. Around here eyes suffer already because of bright prairie light with a high ultraviolet component and the wind carrying particles. Maybe we should all wear goggles. The Blackfeet at one time early in the 20th century had a terrible plague of trachoma, which is a chlamydia infection of the eyelids, rather easily cured if you know what it is and what to do. But people did NOT know what to do and there was a lot of blindness. Other tribes called them the “one-eyed people.”

It was the notorious Doug Gold who had an eye doc friend back in Pennsylvania and brought him to the rez. The doc diagnosed the problem, taught the Golds and a few other responsible men how to diagnose and treat it, and resolved the epidemic. What would they have done about ocular rosacea or were they genetically immune? Do trading posts carry baby shampoo?
Folks love villains and manipulate information in order to control the public reputation of their competitors so that everyone agrees with them. A person with the prominence and control of a doctor is always vulnerable to rumour and accusation. In the early days Doug himself was considered absent-minded, the proverbial professor, but his father James Gold, the Presbyterian missionary in Browning in those days, struggled hard with depression and finally had to be sent to Warm Springs.
So far, attacking Doug, who started the school system in Browning, is based on his mistaking culture for intelligence and drawing the conclusion that tribal people were genetically dumb, accepted wisdom in those times. If one culture accrues information and then tests another culture on their knowledge of it, naturally the second culture (which has its own information and world view) will not score well. Yet people cannot get it through their heads that an IQ test only measures how well one does on IQ tests, all about things valued by people who design IQ tests. They are PRINT culture, never ORAL culture. The more assimilated the Blackfeet become, the better they do on the tests.
If a doc is a little overambitious, a little careless, a little pressed for time, the consequences might be pretty serious. But it begins to look as though the culture of many doctors has left idealism behind and gone to greed. How do we pick our way through the problem? Since public perception always has a political element and is rarely self-correcting, any dynamic of suspicion and resentment can be exploited. Reputation counts large. GF Clinic needs to think about theirs. By withdrawing proper support staff from their doctors and adding boutique profit-makers, they are diminishing their professional standards.

I AM print cultured. I’m also hip to journalistic sensationalism about greedy doctors and the rather scandalous manner in which they have delegated their management and ethical self-policing to managers expected only to increase profit. I can defend myself in part through this mechanism of the internet, but also I’m old enough to remember doctors who used to take my hands, look into my face, and try to get a sense of who I am. It’s not impossible, even now. I recently saw a vid of a doc gently interviewing a squirming pre-adolescent boy who had been living on the street, doing sexwork. It was quiet, respectful, and revealing — even healing. That man was a true doctor.

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