Note: I wrote the following piece in 2009 about an afternoon in 1983. It offers insight into the heart of a confused young medical student who fell in love with the human eye.
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The four of us, a tired but curious crew in crisp white lab coats, had started medical school in San Francisco six months earlier. Through an entire sunny autumn and most of the not-much-different winter, we had spent eight hours a day, four days a week, locked in lecture halls learning about the human body. I had long been a career student, so the hours in school did not trouble me. In fact, nothing had ever fascinated me more than learning the details of the Homo sapiens organism.
Finding such adventure in studying the body came as a surprise. Up to this point in my life, I had never considered myself a âpeople person.â A few years earlier I had felt quite comfortable in solitude, studying nocturnal crustaceans on a moonlit beach. My plan had been to become a naturalist and work more or less alone in nature. A therapist I consulted in the throes of profound depression convinced me to enter medicine because it offered higher pay and status andâas a bonusâwould counteract my tendency toward isolation. Confused and anxious to please, I acquiesced to his conviction that he knew what was best for me. Although that choice was misguided in key ways, it did offer the supreme gift of teaching me about the human body.
The therapist was correct that medical education immersed me in the human drama. At first, this was difficult because I felt uncomfortable around strangers. Since early childhood my vicious and domineering stepmother had punished me whenever I dared look her in the eye, and I now had great difficulty making eye contact. In due time meeting patients became a source of satisfaction; rather than avoiding strangers as before, and looking at the ground, I began to meet new people with pleasure. But first I had to overcome my discomfort with locking eyes. That unease began to melt one afternoon when our gang of four visited the eye clinic at Letterman Army Hospital.
As everyone knows, you canât go to medical school without memorizing, which sometimes felt like a boring chore. We tried various techniques to learn by rote every piece of the skeleton, from the curved plates of the skull that fit together like pieces of a giantâs jigsaw puzzle, to the surprising number of chunky dice-like bones that it takes to make a foot. Without a background in Latin, the names sounded foreign and meaningless: navicular, talus, cuneiform, etc. But we learned them anyway.
We developed skill at identifying microscopic clusters of cells, such as those in a testicle, which churn out tens of millions of sperm every day, or the ever-vigilant gangs of immune cells that prowl the body like well-trained Doberman pincers. Chemical structures never seen by the naked eye had to be memorized, as well as how they fit in the labyrinthine chains of reactions that form the fundaments of life. We poured over lecture summaries and textbooks, and spent hours in the anatomy lab with our cadavers.
Although it sometimes seemed like med school had me trapped in an endless vocabulary lesson, I felt enthralled by the challenge of mentally exploring every corner of the human body. My mind traveled in time from our first hours as dot-like globs of cells, to the decay that follows mortal existence, after our life-sustaining chemical orchestra loses its battle with the mixing blades of entropy.
The intellectual journey pleased me more than a trip around the world, but on some level everything I was learning about human biology remained abstract. My internal model of the Homo sapiens animal came mostly from books and auditoriums. Yes, we peered through microscopes at tissue mounted on glass slides. And the school lent us each a box of real human bones to take home and manipulate. Of course, we spent untold hours picking away at the insides of actual dead people. But despite the privilege of learning from all these teaching aids, there was no actual life in view. Everything I looked at, with only a couple of exceptions, had died long before it came to me.
That changed one sunny but chilly winter day in the Presidio, which in the early 1980âs was a run down and largely abandoned military base. It happened to stand on one of the most spectacular pieces of urban real estate in America. We drove to the eye clinic along a curving road that led from the affluent neighborhood where Diane Feinstein lived, down a eucalyptus-forested slope that every once in a while offered an awesome view of the Golden Gate Bridge and the shining waters of the Bay. We rolled past imposing officerâs houses separated by large tracts of land: homes that most San Franciscans would have donated a body part to possess.
I studied the scenery as if it were a painting in a museum; it seemed to glow in the gentle sunlight of winter. Looking out the window as we passed the vintage houses and pulled into the parking lot behind the hospitalâa giant cube of concrete that seemed out-of-place in these surroundingsâI gathered my confidence to enter the world of clinical medicine.
I had been accepted to medical school on the strength of a strong science background that included graduate study in biophysics. Unlike most of my classmates, I had zero experience with the world of doctors, nurses, and patients. So every time we went to a new clinic, I had to steel myself for the stress of entering a foreign land. My profound introversion also complicated my debut as a clinician. Meeting new people distressed me, and I always had trouble meeting their gaze. Screwing up my courage that afternoon, I marched into the ophthalmology department with no hint that this day would change my life.
The introduction of medical students to living patients happens differently depending on where and when you train. In my case, not long after we started classes that first year we were granted occasional afternoons to spend in outpatient units. Our little group of four dallied a few hours with a cardiologist, listening with spanking new stethoscopes to abnormalities in the heartbeats of patients who agreed to let greenhorns struggle with cold instruments on their chests. We attempted to detect heart murmurs, trying to differentiate the normal âlub-dubâ from the âlub-whooshâ of aortic valve backflow, or the âlub-rumble-dubâ of aortic constriction, and so on.
We went to other specialists in like manner, always meeting very kind and usually elderly persons who offered their medical problems for our instruction. We listened to high-pitched wheezes in the chests of chronic smokers, felt ominous breast tumors as solid as stone, and saw the angry rash and vesicles of shingles. These brief sojourns in the clinics were meant to put living flesh on the bare bones of factual information we were being force-fed.
Nothing so far had brought things to life for me, however. One of my classmates had a terrific ear, and could describe a symphony of living sounds listening to the human heart. I had to strain just to hear the most obvious murmurs. Someone else could feel the margin of an enlarged liver with little effort, while in the same afternoon I came away with little more than the memory of pushing my fingers into one belly after another.
But then we went to the eye clinic. When we arrived Dr. Kearny greeted us. He stood a few inches above me, and looked a bit like a college professor despite military garb. He wore a not-too-sharply creased army uniform covered by a well-worn lab coat that reached to his knees. He seemed amused to meet our band of neophytes, each wearing blinding-white lab jackets that looked like theyâd just been unfolded from their box.
âWhat rank are you, Dr. Kearny?â One of my classmates must have come from a military background, where such a question made sense. âYouâre a colonel?â the student guffawed when he got his answer, âno, I mean really. What rank?â Dr. Kearny only smiled, until my companionâs face blazed with embarrassment as he realized the good doctor had not been joking. I did not know the difference between a captain, a colonel, or a lieutenant, but I was pleased to watch Dr. Kearny brush off the gaffe in good humor.
We each carried a brand new ophthalmoscope. The university had permitted instrument salespeople to display their gleaming wares in a large conference room, where they pitched the necessity of spending hundreds of dollars on the tools of the doctorâs trade. No one told us that most of these things were already on hand in the clinics; ophthalmoscopes are typically mounted on the wall of every examining room. Naively holding our shiny and expensive toys, we sat politely while Doctor/Colonel Kearny gave us his introductory talk about eye exams.
Like every examination of every part of the body, an eye exam proceeds in an organized way. First, the clinician directs the patient to look in different directions; next s/he examines the pupils for normal shrinking reactions to light, and then measures the internal eye pressure. After that, the physician inspects the front of the eye with the specialized microscope used by eye doctors, called a slit-lamp. Deeper parts of the globe are looked at next, in front-to-back sequence. Dr. Kearnyâs lecture covered this basic material efficiently, and then he led us to the exam suite.
He guided into the room an attractive woman of about forty who was nearly as tall as me. She may have had glaucoma, or some other eye disease, or she might have been there for a routine check-up. Iâll have to admit that some of this information slipped by me, as I took in her erect posture, slender frame, and dark gray dress that clung tightly enough to highlight her figure, without in any way looking provocative. She seemed like a woman of genuine elegance, and she distracted me momentarily. What really got my attention was the forest-green color of her irises. She had intense and intelligent eyes, made even more captivating by their unusual hue. Despite my interest, in my shyness I avoided her gaze when she swept it my way. While my classmates were busy demonstrating their clinical knowledge to our mentor for the afternoon, I got lost in a brief erotic fantasy. Having recently married my first wife against my better judgment, I often got sidetracked by intriguing women. I knew attraction to patients was terribly inappropriate for a physician, and I made a note to myself to work on keeping such feelings at bay.
Chagrined at my lapse, I returned my attention to Dr. Kearnyâs discussion of this patientâs eyes. He guided her into the exam chair and had each of us check her pupils. Then he rotated the slit lamp into position, and I stood back as the others took turns looking at this ladyâs eyes with the microscope. She glanced up at me when my turn came to settle down on the rolling stool, with its circular black cushion and stainless steel legs. She flashed me a kind, accommodating smile, and I noticed how the leafy color of her eyes contrasted nicely with her auburn hair. I felt awkward, and wondered if she had noticed me checking her out. I darted my eyes away.
She moved back into the head frame, her well-sculpted chin resting on the little tray covered with a stack of rectangular pieces of tissue paper, designed so that a fresh sheet could be uncovered for each patient. Dr. Kearny helped me get the hang of the joy stick that moved the microscope forward and back, and side to side, in order to adjust the focus and look at different parts of the eye. I felt clumsy, and had difficulty getting everything working.
Then IÂ saw. Looking at her right eye, what had seemed like an interesting green from a distance blossomed into the most multifaceted jewel I had ever seen. In front there was a crystalline dome, shiny and perfect, and as clear as spring water. Behind the cornea I encountered an empty space that looked like a miniature aquarium. This magnified void drew me in as if I were an explorer entering a newly discovered cavern. After that came the iris, which gave this woman the glimmer of green that caught my attention when she first stepped into the room. Under the microscope it looked like the surface of a fertile alien planet. The experience felt a bit like flying a glider over a foreign landscape. There were so many specks of color, so many ridges and valleys, so much texture, that I could have explored for hours. I watched the subtle twitching of the muscles at the iris margin as light shined deeper inside the eye, stimulating the pupil to contract and then expand again as the beam moved on.
I had to force myself to pull back and stand up. My heart pounded, and I tried to figure out why this excitement felt familiar. Then I remembered how each summer in junior high, a schoolmate and I spent two weeks scuba diving off the leeward shores of Catalina Island. After a whole day spent sailing from the Los Angeles mainland in a dilapidated 26-foot-sloop, we spent two weeks sleeping in its cramped quarters while moored in a bay the size of a large parking lot, diving once or twice a day. Todayâs view of the eye through a microscope took me back to those summers; it reminded me of swimming above submerged reefs overgrown with kelp. The giant marine algae formed forests of what looked like knotted vertical ropes the color of roasted grain. The stalks swayed to and fro, extending from root-like attachments on the rocky bottom, soaring upward to form dense mats of golden-brown leaves that drifted on the surface. In that unfamiliar space I often felt like I was flying, watching fish as shiny as silver spoons dart among the rust-colored rocks below. Amber-tinted sunlight sparkled down through the kelp-blanketed ocean swells, twenty-five feet above. I swam in those underwater groves day after day, and never tired of the scenery.
That image flashed before me as I regained my composure after my first magnified view of the human eye. I had stumbled into a whole new universe. I had looked into the organ of sight and lost myself in its living magic. The fluids, the tremors, the intelligence and perfection of the eye animated everything Iâd been studying. No longer did medical facts seem abstract, or tissues dead. I had seen it all in action, in living flesh. This was Life itself.
Fascinated by the miracle of her eye, I had completely forgotten about that womanâs allure. In fact, my relationship with people shifted in a fundamental way. From then on, every time I looked into anyoneâs eyes, male or female, youthful or wizened, I saw something new. My timidity about locking stares with people vanished, and instead I had to be careful to not gaze so intently that I made others uncomfortable. If the eye is the window to the soul, I thought, then the soul is more magnificent than I had ever imagined.
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