Like all of my fellow earthlings, I live in a country with many flawed political leaders. Unlike a large percentage of those who share my planet, however, I live in a country in which I feel free to express my dissatisfaction with those rascals. Many countries forbid criticism or insults directed at their leaders, through formal laws or informal sanctions (“Care for a little more polonium in your tea, sir?”).

People in my country of birth are even legally permitted to burn our flag if they care to do so, although I will be prosecuted and fined if I burn a pile of leaves that I raked in my backyard. All of which brings to mind a patient from years ago. I was a young assistant professor and he, a healthy-appearing man in his early 70s, was brought to see me by his son and daughter.

Cataract diagnosis on top of Alzheimer’s 

Their father, they explained, was diagnosed two years previously with Alzheimer’s disease. He had 24-hour nursing care, seemed outwardly happy but had severe dementia, and a judge had appointed the two children as his legal guardians. The son and daughter and his nurses could tell that the father no longer could see. He had a history of dense amblyopia in one eye but had previously enjoyed excellent sight in his other “good” eye.

But for the last year, he seemed not to see. He would sit all day and listen to a radio, but not show any interest in reading or looking at things and didn’t get up to walk without someone guiding him.

His local ophthalmologist diagnosed cataract and recommended they bring their functionally one-eyed father to see me. My examination showed advanced brunescent cataracts but otherwise apparently healthy eyes. The man could not read the eye chart, but clearly had some low level of visual function.

The son, daughter, and I discussed the situation at length while their father sat childlike in the exam chair, seemingly unable to pay any attention. I explained why we are generally reluctant to proceed with surgery in patients with comorbidities that might keep them from experiencing an improved quality of life. Also, his severe dementia would mean that he would need general anesthesia.

The son and daughter strongly wished to take the chance to improve their father’s vision, and a week later he had the surgery. Everything went well and I saw him once postoperatively. Because it was hard to transport their father the long distance to see me, they arranged for their local ophthalmologist to check him afterward. I never saw him again.

Two years later, I received a letter in the mail. The son and daughter had written to let me know that their father had died.

They described how during the weeks and months after the surgery, their father progressively interacted more and more with them and others. He began reading the newspaper again every morning and discussed with them what he had read.

“When he began to complain bitterly about the idiotic decisions being made by the government, we realized that you had given our father back to us for the last two years of his life,” they wrote.

I have always been grateful that my patient’s children took the time to let me know what happened to their father. Plus, it drove home to me that for at least some of us Americans, being fully human includes our exercising our fundamental right to remonstrate about our politicians.


	E: pmcdonn1@jhmi.edu; P: 443/287-1511
	

Dr. McDonnell is the director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical 

Ophthalmology Times, January 1 2019

A renewed vision