Note to readers: this is the second post in a series.
My initial experience in trying to get Akhtar, the blind-in-one-eye refugee from Afghanistan, an appointment with someone at the Wilmer Eye Clinic was not encouraging. I assumed that I needed a referral from an eye doctor in the health system where he was enrolled. I struck out with the ophthalmologist he was referred to in that system because she would not accept Medicaid. I was not hopeful that any other eye doctor there would accept a Medicaid patient. I could try to find a list of eye doctors and start calling, but instead I decided I would give it a try and call the Wilmer Eye Clinic myself.
Brilliant idea. Much to my astonishment, after getting all the information about Akhtar’s condition and Medicaid insurance, the kind person on the line at the Wilmer Eye Clinic said that Akhtar could in fact see one of the Wilmer eye doctors.
“But there is one thing you must know,” she said. “As you know, the Wilmer Eye Clinic has to be selective regarding the patients we see. We will see Mr. Akhtar and will diagnose his problem. But given his insurance, we will not be able to actually do any procedures or operations to fix it.”
I replied, “Well, that is terrific news that you will see Mr. Akhtar, and for this I am very grateful. But just to be clear, Wilmer will tell him what is wrong but won’t actually fix it, is that right?”
“That is correct.”
“So to take this a step further, you guys are the best in the world when it comes to eyes, right.”
“That is our reputation. Our doctors are very good.”
“So it is possible that you could identify a problem which you could fix but few if any other eye clinics could fix?”
“That is possible.”
“But you won’t fix it?”
“We can provide a referral.”
“But, say, there is no one else who can fix it.”
“All we can do is provide a referral. It has to do with Maryland Medicaid. We only accept it for the diagnosis procedures.”
Okay, I thought, let’s take what we can get. You have got to start somewhere, and just getting an appointment with one of the best eye doctors in the world was a lucky break.
Six weeks later when the date of Akhtar’s appointment arrived, I drove him to Johns Hopkins Hospital in Baltimore with both excitement and apprehension.
There are several things you need to know about Akhtar. I have already mentioned that he is totally blind in one eye and a welder. He is also illiterate, not only in English but in any language. When he was growing up, the Taliban was in charge, and all schools were closed. Also while Akhtar is fluent in Dari, Farsi and Turkish, his English skills are very poor. It is almost impossible for me to understand a word he says. For this reason I was a bit nervous as to how things would go at the Wilmer Eye Clinic.
I had been to the Wilmer Eye Clinic about ten years before with Embry, who had an eye operation there. The John Hopkins Hospital was located in a tough area of Baltimore, and the clinic was in a pretty rundown condition. They may have had the best doctors, but the surroundings felt like a third world country. This is not the case any more. The new hospital is more like a massive palace with sparkling, wide hallways, original art on the walls, lots of glass, healthy plants everywhere, and a main interior “highway” system that connects all the departments, all of which are named after people who I presume gave them lots of money.
After walking what seemed like at least half a mile, we came to the Wilmer Eye Clinic, which it turns out consists of several clinics and individual waiting rooms. We were directed by one of six or seven receptionists to what was called something like the “general clinic.” There were ten or twelve people seated in an attractive waiting room area, and after a wait of only about fifteen minutes we were whisked away into a small exam room with all sorts of eye testing machinery. Professionals in white coats of varying sizes were running about in the hallways, focused and engaged, just what you would expect in the world’s greatest eye hospital.
What kind of doctor would we get? Would he or she really be the best in the world? Could the Wilmer doctor give us any hope of restoring sight to someone who had no vision in one eye?
Well, we actually got two doctors, one in his forties, slim and athletic looking, the other man, white haired, and close to retirement age. The younger one called in the older one about 20 minutes into the testing, I presume for a second opinion. These two doctors ended up spending over one and a half hours with Akhtar, assisted by several technicians wearing red, Wilmer Eye Clinic golf shirts. I could not determine if having two doctors was standard protocol or because restoring sight from a blind eye was such a formidable task. Whatever the reason, I was impressed. They were polite, engaged and obviously skilled. We had come to the right place.
What made the examination particularly interesting was the communication challenge. I had alerted the person whom I had talked to on the phone that Mr. Akhtar did not speak much English; and when we checked in, I made the same comment to the receptionist, who assured me that this was no problem and that they routinely used translators. The challenge was addressed by dialing up a Farsi-speaking translator on the phone. Akhtar would make a comment or respond to a question, and the translator would repeat what he said in English using the same tone and emphasis. When speaking in Farsi, Akhtar was quite animated, waving his arms and speaking loudly. Just after the second doctor entered the room, as the doctors were asking him to tell them what letters and numbers he could see on the screen while looking through one of the devices, Akhtar suddenly appeared annoyed and seemed to make a definitive statement. Over the phone from the translator came this in a very loud voice suggesting exasperation: ”Look, I came to the U.S. to get a new eye. They told me in Afghanistan and in Turkey that when I got here, I could get a new eye. I want a new eye!”
The exam room suddenly became quiet as both doctors abruptly paused what they were doing and looked at each other in disbelief. The younger one answered calmly, “You are not going to get a new eye. Not here or anywhere else. There is no such thing as an eye transplant. Maybe in 10 or 15 years, but not now.”
Akhtar immediately waived his arms and said something in loud voice, which was repeated by the translator, “But they told me I could get one in America.”
The doctors ignored the comment and plunged back into testing his eyesight with the various machines and devices.
There was also a peculiar situation where Akhtar was able to read the numbers on the screen but not the letters. When I pointed out that he could not read English, they switched entirely to numbers, which solved the problem. The good news was that as the exercises continued, it became apparent to me that Akhtar could actually begin see some things in his blind eye.
Toward the end of the examination, Akhtar made one more plea about the new eye and questioned whether the doctors really knew what they were doing. The two doctors paused again and looked at each other, frowning. The older of the two replied harshly to the translator, “Tell this guy again that there is no such thing as an eye transplant and if he brings this up again, we are not able to help him.” That was the end of that.
The two doctors conferred briefly and then left the room. In about fifteen minutes the younger one returned and presented the findings:
“Look, Mr. Akhtar, we can’t give you a new eye, but we believe your eyesight can be mostly restored in your blind eye. You have a scratched cornea and you have no lens. We believe that this can be addressed by using a special contact lens, but it is not guaranteed. It certainly is worth a try, however, and we will give you a referral to one of the Wilmer contact lens doctors.”
Akhtar responded with what I feared was something like, “I still do not see why you guys can’t give me a new eye” but was gently translated by the Farsi translator on the phone as “thank you very much for your time and effort.”
Three cheers for the Wilmer Eye Clinic. Reputation well deserved.
So on to the next step: off to the contact lens specialist. It would be about two months before we could get an appointment. But would it work? Could a special contact lens correct blindness? Stay tuned for the next installment.