22/06/2015 13:21 BST | Updated 22/06/2016 06:59 BST

A Lesson in Patients

As a retinal screener for people with diabetes, I am in the fortunate position of seeing a new person approximately every ten minutes throughout my working day, running mobile clinics around my county. It's not a job for everyone - the required level of person-to-person skill is necessarily high, and each new person needs a lightning-quick assessment of their personality and adaptation in my professional manner, in order to get the best from them, and make the appointment go as smoothly as possible for both of us.

Thankfully my extroverted nature means that this is the kind of thing I view as an exciting challenge, and I pride myself on my ability to interact with each person on a meaningful, as well as a functional level.

The point of retinal screening is simple - it acts to safeguard the vision of people with diabetes, who are at risk of developing sight-threatening retinopathy (which can occur when blood glucose levels are not well managed) - and involves a simple sight test, the administration of dilating eye-drops, and them having a couple of photographs taken of the back of each eye.

That's all.

Except it's not, because somehow this position and its close contact with people from all walks of life results in me often being viewed as far more than the person who takes retinal images; thrusting me into the role of a listening ear, (mistakenly) source of information about eye conditions in general, a source of reassurance, a new recipient for old stories, but primarily a fount of knowledge about 'all things diabetes'.

That said, though it would utterly transgress the bounds of professionalism to step beyond my remit of photographer and educator, there are nonetheless many valuable lessons my patients can teach me, if I am open to learning.


There was the Old Soldier, who had been on the beaches at Normandy as a teenager - who saw his compatriots mown down by German machine guns, and who was considering his first return to that harrowed seafront on the 70th anniversary of D-Day. He taught me how much I take for granted about life in England as it stands, and how much I owe to this gentleman and others like him, for my freedom.

There was the Old Lady, who shuffled painfully through to the back of the van and lowered herself agonisingly into the chair for her photographs to be taken, before fixing me with a very beady-eyed look and telling me "Getting old isn't for wimps!" and in that one statement instilled in me an understanding of the manner in which ageing can strip a person of their faculties and the ease with which they've been used to living, and gradually drag them into a constant uphill battle just to achieve the everyday things. It also imbued me with huge respect for her, and for my other elderly patients.

A man with Down Syndrome visited once, with his carer; who explained that the man was not able to communicate well, and that they knew little about him and his visual capabilities and needs, seeing as they'd only taken charge of him recently. We did our best, but the thing I most remember is the two wonderful, giant hugs I got from my smiling patient, and how I didn't mind having to wipe his spittle off my jacket, because the thing he was communicating most excellently was care towards a fellow human.

There are the children (who we see for screening from the age of 12) who come in all moods - embarrassed, chilled out, defiant, moody, anxious - and who sit, dwarfed by the equipment, always with an air of hopefulness that things will be alright for them, and very keen to leave as quickly as possible. They remind me that even young lives can be fragile and blighted by conditions and stigmas which tend to be thought of as belonging to an older generation, and to never make assumptions about 'youngsters', because with a condition like diabetes, there's just no way of knowing.

Too-busy professionals or harangued offspring-carers bring aged parents in wheelchairs and roll their eyes at the wait, the lack of understanding of their elderly relative and their inability to engage effectively, and the way there is no way to hurry things along, but that the capture of adequate images for appropriate assessment is important. Sometimes they break and pour out bitter words of siblings' abdication of responsibility, or just how hard it is to be in charge of a once-capable human. I am reminded that diabetes, where it exists, can have almost as great an impact on family, and whilst I am eager to encourage them in the importance of their role in safeguarding their relative's sight, it is poignant and stilling to think just how much the burden of care is increased.

People for whom English is not their first language come to see me with a relative in tow to translate for them. The way the three-way communication which inevitably detracts some detail from the episode, often leaves me feeling thankful that they have someone invested enough to attend with them (even if they spend the duration of the appointment plugged into their mobile phone) and convey the essentials, maintaining that vital link which safeguards my patient's sight. Afterwards I find myself wondering how many people slip through the net for lack of ability to communicate without help, or for whom the immersion into an arguably technical appointment in another language causes anxiety or concern.

Each person I see reminds me that they face at least one daily challenge I am spared. Each cheerful face and expression of gratitude for the job I do reminds me of the amount of grace and fortitude which can reside in the human spirit. Even those who are having an 'off' day provide me with an exercise in compassion and patience.

I am lucky, because every clinic, in spite of my role being the professional one, I encounter as many lessons as people, and each individual has something slightly different to teach me.

I should make sure I pay heed.