(Two ophthalmology interns and a nurse wait for trauma to arrive. The ophthalmology attending walks in wearing dress clothes)
ATTENDING: What do we have coming in?
INTERN 1: Gunshot wound
ATTENDING: To the eye?
INTERN 1: No, roughly 40 eyeball lengths below the head, give or take
(Attending adjusts bow tie as he looks at his interns tightly gripping their ophthalmoscopes)
ATTENDING: You'll be fine. Remember your training! Vision! Pupils! Pressure! Drops!
INTERNS (in unison): VISION! PUPILS! PRESSURE! DROPS!
INTERN 1: Patient is unconscious. He's wearing glasses
ATTENDING: Ok, we need to expose the eyes
(Intern uses glasses shears to remove glasses from face)
INTERN 1: I don’t see an RAPD, but pupils are unequal. Sir, there appears to be anisocoria
ATTENDING: DON'T PANIC. Nurse, please mark PRRLA in the chart
NURSE: Got it! PERRLA noted.
ATTENDING: No, PRRLA
NURSE: Yes, I have it written as PERRLA
ATTENDING: No it’s P-R-R—You know what, nevermind. I’ll have my trauma scribe do it.
NURSE: Sir, there's no such thing as a tr—
ATTENDING: There's no time. Now, what’s the eye pressure?
INTERN 1: 15 OU
ATTENDING: Excellent! Now, we can’t check vision or get him up to the slit lamp, so John, get the portable.
(Intern 2 breaks emergency glass, grabs portable slit lamp)
INTERN 2: Anterior chamber is formed, lens intact, no scleral lacerations, there is a pterygium extending into the visual axis. He may need excision with a conjunctival autograft.
ATTENDING: Good catch, we’ll get him on the surgery schedule for pterygium excision once he recovers from his gunshot wound. Go ahead and check his other body parts.
INTERN 2: Looks like the ophthalmoscope holders and cataract surgery pedal steppers are intact
(Nurse rolls eyes, types “extremities normal”)
INTERN 2: There’s a bullet hole in the wall of the organ container. Also, there’s blood. Oh my God. There’s so much blood.
(Intern 2 rolls up sleeves of dress shirt and applies 2x2 gauze with small forceps)
ATTENDING: We’ll deal with the bleeding in a second. First we need to do an ultrasound to look at the organs inside the organ container.
(Intern 2 grabs ocular ultrasound probe and places it on the patient’s abdomen)
INTERN 2: The patient has subcutaneous tissue. It appears intact.
ATTENDING: That’s reassuring. Call the ICU. Tell them we have an unconscious male of pre-cataract age with anisocoria and a pterygium that is probably visually significant. He also has a bullet hole in the organ container with blood present and intact subcutaneous tissue on ultrasound.
INTERN 2: Got it!
ATTENDING: When you’re done, meet me in the cafeteria for second lunch. It’s deluxe chicken sandwich day.