Thursday 12th January 1989  Morning surgery 10:20

“Hang on, Mrs Vaughan! Can I stop you, there?”
Mrs Vaughan gave my Dad a stern look.
“I would like to bring the medical students in.” He turned to Zoe and Chloe. “Here, we have a 73 year old lady who noticed a shower of floaters affecting her left eye. She’s never had anything similar previously. Now, what would be your main worry in a patient with these symptoms?”
“A detach . . .”
“Mrs Vaughan! Give Zoe and Chloe a chance.”
“A detached retina, Dr Dennis.” Zoe and Chloe answered simultaneously. Mrs Vaughan raised her eyebrows disdainfully.
“Excellent! Excellent! Now, in a situation like this, there are three questions that I usually like to ask the patient. We will go through them one at a time. Let’s see if we can get them all. Zoe, what would you like to ask Mrs Vaughan?”
“Have you had a knock on the head, Mrs Vaughan?”
“No, I haven’t.”
“Excellent, Zoe! Excellent!” My Dad nodded enthusiastically. “ What about you, Chloe? What would you like to ask?”
“Were there flashing lights when you had the floaters, Mrs Vaughan?”
“No, there weren’t.”
“Excellent, Chloe! Excellent! That’s very good. What about you, Dennis? What question would you like to ask?”
“Errm . . .  errm . . .  did you see . . . like a shadow . . . something like a grey shadow or a curtain across your eyes, Mrs Vaughan?”
“No, Dennis, that’s very, very good but I didn’t see anything like that.”
“Well done, Dennis. What about you, Mrs Vaughan?” My Dad continued. “What would you like to know? Are there any supplementary questions that you would like to ask our patient?”
“Yes, Dr Dennis, yes, there are. I would want to know if the patient was extremely short sighted or if she was suffering from diabetes.”
“Yes, that’s exactly what I would have asked, Mrs Vaughan. And are you?”
“Am I what, doctor?”
“Are you very short sighted or are you suffering from diabetes?”
“No . . .  No . . .  of course not, Dr Dennis. You know that.”

“Right . . . to sum up then,” my Dad took a deep breath. “A retinal detachment can be caused by a knock on the head. The patient’s symptoms usually consist of flashing lights, floaters and, sometimes, the appearance of a grey curtain. Retinal detachment is, as Mrs Vaughan has pointed out, more common in patients with severe short sight or diabetes.

Now, we need to look into Mrs Vaughan’s eyes with the ophthalmoscope. I am afraid this is a tricky business, even for a GP like myself with years of experience. The detachment usually occurs at the edge of the retina. Where the retina has been lifted up it is usually a pale grey rather than a nice pink colour which is why we see Dennis’ grey curtain.

Trying to look into the back of Mrs Vaughan’s eyes was a difficult and time consuming process. By the time all four of us had attempted to do this, she was in a distressed and dazzled state. Fortunately, she did not have a detached retina.

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