How Do Patients See You?


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Orion Magazine is a visual feast for the eyes, featuring nature, culture, and place.  The May-June 2016 issue contains an article by Sharman Apt Russell, a gifted nature and science writer, entitled Ordinary Miracles.

Sharman Apt Russell

Here is an excerpt from the section on Light:

My optometrist wouldn’t know a bedside manner if he had just put his book and reading glasses on it. He looks at one of my test results, does a double take, and says, “Oh. Okay! You have myasthenia gravis, an autoimmune disease. This is serious. People die.” He goes on to explain how nerve cells release the molecule acetylcholine which opens a protein called an acetylcholine receptor (another sodium channel) in a nearby muscle cell which then starts a biochemical process that signals the muscle to contract. In myasthenia gravis, the body’s immune system has mistakenly produced antibodies that interfere with this process — specifically with the acetylcholine receptor. Typically, the disease affects muscles that control the eye and eyelid, face, and throat. My symptom is double vision. But I might also start having trouble swallowing or eating or breathing.

Time in this small brightly lit office has become a kind of clear gel, viscous and slowing down movement. Slowly, I think: this is it. From now on, my life will be divided in two: before this moment, and after. Simultaneously, a part of me is distracted by amazement. All that acetylcholine being released right now, all that opening and closing, opening and closing, muscles contracting, eyes seeing, throat swallowing, heart beating. So many trillions of molecules doing just what they are supposed to do.

Later I learn that myasthenia gravis, “once a uniformly disabling and even fatal disorder,” can now be managed effectively with drugs. Likely I have ocular myasthenia gravis, confined to the muscles in my eyes, and maybe — in any case — the symptoms will continue to be mild or even disappear. I push this to the bottom of things I worry about in the middle of the night, and since that kind of night worry is tediously repetitive, I never get beyond the top two items.

I do occasionally find myself in conversation with protein receptors in my left eyelid. In response to acetylcholine, these bulbous shapes allow positively charged sodium ions to enter cells, triggering the internal release of calcium ions which in turn creates an electric current which results in movement. I have become the acetylcholine whisperer. Go, go, go, go, I say to the sodium ions. Sweetheart, I encourage that receptor. You’re doing great. Pay no attention to those antibodies.

Diplopic Chairs

2 thoughts on “How Do Patients See You?

  1. Tis it possible the doctor was an O.M.D.? Then again, Dr. James and others have reported that what you think and believe and say with you tongue seems to change attitude and maybe changes physical i.e. body results. James 3
    August

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