Question

William Davis is 62 years old. He was employed as a postal worker until his declining eyesight forced him into early retirement a few months ago. His wife, Mildred, died last year of complications from diabetes after a prolonged and expensive hospitalization. Mr. Davis does not trust the medical community, and because of this distrust, he has not been to a doctor since his wife’s death.

Mr. Davis is not considered legally blind, but his presbyopia and an advancing cataract in his right eye are starting to interfere with his ability to take care of himself. He still drives to the market once a week, but other drivers get angry and honk at him. He pays for his groceries with a credit card because he is afraid the cashier will cheat him if he accidentally gives her the wrong bills. He complains that the cleaning lady hides things from him and deliberately leaves the furniture out of place. When she leaves, he can’t find his slippers or an ashtray. Yesterday, he put his lit pipe down in a wooden bowl by accident.

His son insists on taking him to see the ophthalmologist who treated his wife’s diabetic retinopathy. Dr. Hsing believes Mr. Davis’s sight can be improved in the right eye by performing cataract surgery. Mr. Davis listens in fear as the doctor explains. “Without this procedure, your sight will only get worse.”

Mr. Davis thinks about all the medical procedures that were tried on Mildred, and she died any-way. He doesn’t want to go into the hospital, and he doesn’t want any operations. But his son is talking about taking away his car if he doesn’t do something about his failing sight. “What more can be taken away from me?” he thinks bitterly. “First my wife, then my job, and now my independence.”

1. Discuss how Mr. Davis’s loss of sight is affecting the way he treats others and is treated by them.

2. Mr. Davis is a patient at the clinic where you work. Discuss the ways you would adjust your usual routine to accommodate his needs.

Answer 1

1. Mr. Davis is suffering from progressing cataract and presbyopia. Mr. Davis first needs to know what condition he is suffering from . We need to make him understand that cataract is a condition where his eye lens is progressively becoming cloudy and hence his decreased vision. Also presbyopia is a aged related condition that disables him from focusing on nearby objects. Also this is leading him to reduced eyesight.
We need to emphasise that his inability to see properly is putting him in distress, which is leading to his irritable behaviour towards others and a sense of helplessness.

With a reduced eyesight when is trying to drive, there is a high chance of meeting an accident. Also he is somehow putting others on the road in danger too. While shopping for groceries also he facing problems with bills which is otherwise can easily be tackled if he undergoes cataract surgery. He is putting himself in danger too. With his son taking away his car it is natural for him to feel trapped, but he cannot drive with such reduced eyesight. Also his son has to worry for him a lot. He even lost his job due to this condition which is making him feel insecure.

In an avoidable complication his wife died, but that doesn't mean there are such deadly consequences for his surgery too. If he agrees for the surgery he would be independent, would no longer be irritable in his behaviour, most importantly he would be able to get his eyesight back and that would be great for him. Without this surgery, he would land up in many other social and health problems .

2. Ways to accommodate Mr. Davis' needs :

• As he is already anxious and irritable, it would be of primary concern to make him calm and relaxed.
• He should be made aware of the surgery and it's procedure that he will be going through.
• He should be provided with the required medications and also take history of medications to avoid complications. He should be given proper pre operative and post operative care.
• He may have disturbed visual sensory perception, for which necessary help should be provided.
• With reduced vision and decreased hand eye coordination,there is a risk for trauma . Hence safety measures should be taken.
• Also his nutrition and his washroom needs are to be taken care of.