The Eyes Have It

"Let her have Harvey," suggested one of the nurses, smiling.

I had been talking to the attending physician about which patient I should take next.

"Oh yes," the attending said. "You'll love Harvey. He's a doll."

As a second-year emergency medicine resident, I rotated through several hospitals --which meant that it took me much longer to get to know the regulars.

Harvey was a thin, pale, white man in his mid-forties. He was clean but still somehow looked disheveled. The only remarkable feature about Harvey was his eyes, which were astonishingly clear and blue.

"I'll take him to the eye room," the nurse said to me, and Harvey followed her, quiet and obedient.

"What's the story that everyone but me knows about this fellow?" I asked.

"Take a look at his file in the computer," the attending said. "You'll see."

Harvey had been in the emergency department a total of seventy-seven times within twenty-three months. Every chief complaint was ocular - "painful eye," "scratched eye," "reported burn to right eye." It went on and on.

"This is incredible. This guy's been here over seventy times in two years, all for eye issues."

The attending smiled. "Just wait til you meet him."

When I walked into the opthalmology room, I saw Harvey in his seat by the ocular lamp, wringing his hands.

"I'm Dr. Finkel. What brings you here today?"

Harvey looked anxious.

"I have paint in my right eye," he said. "I brought the paint brushes to show you."

"When did this happen?" I asked.

"An hour ago. I brought the brushes to show you."

"I see," I continued. "And how do you know that you got paint in your eye?"

"I could feel it immediately!" he exclaimed defensively. Harvey seemed irritated, and crossed and re-crossed his legs several times. "I brought the paint brushes to show you."

I decided I'd better look at the paintbrushes.

He reenacted five or six times how he accidentally turned the paintbrush toward himself momentarily and how, consequently, the paint was hurled into his right eye.

"Let's take a look then," I said. I didn't want to offend him again in any way.

Harvey knew the eye exam as well as I did, and he sat remarkably still throughout, something most patients find uncomfortable.

"Where do you live, sir?" I asked as I worked.

"A few miles away. I work at the supermarket on the corner. I work forty-six hours a week. I like my job. I like to paint even better but I can't make money doing that." Harvey barely moved his mouth as he spoke, never once interfering with my exam. "I feel some of that paint in my right eye for sure."

"Do you live alone?"

"Yeah, but my sister lives next door. She has two children. I paint their faces," Harvey said. "I can still feel that paint in my eye."

I reached for the opthalmoscope attached to the wall.

"How old are your sister's kids?" I asked as I looked through the scope.

"They're five and seven. I hope that paint isn't going to hurt my eye," he said. "I like to paint their faces and other people's faces too."

Harvey continued to talk, and as the exam proceeded, I concluded that there was absolutely nothing I could detect wrong with either eye.

I was afraid to tell him the good news.

"Well Harvey," I started, "The paint in your eye has dissolved without causing any damage. Both of your eyes look fine now. What do you think?"

"Okay," he sighed. "I'll just use those eye-wetting drops like usual then."

"Do you have a way home?" I was surprised at how well he was taking the news of his good ocular health.

"Yeah. My sister's outside. I brought some new pictures. I gave them to the nurse, Marci. Thank you doctor." And with that, Harvey left.

Around 4:30 in the morning, when things had quieted down, I went to see Marci in triage.

"Harvey was here today...he told me he had brought some pictures he made. Do you know where they are?"

"Yeah. I put them in there with all the others." She pointed toward the drawer behind her.

When I opened the drawer, I found a stack of portraits - some were painted, some sketched. One was drawn in crayon. The subjects in Harvey's portraits were men, women and children of all ages, and each was unique. There was only one thing that all of Harvey's subjects had in common. None of them had eyes.

Dr. Michelle Finkel is an attending in the Emergency Department of the Massachusetts General Hospital.