The Strabismus Institute
Part 8 - The Nerve Stimulator Test
Jim turned to me and said, “Jack, lets go get this test over with.”
I followed him to still another room. This one had a recliner chair, and arm chair and some kind of machine with something that looked like earphones.
“Have a seat Jack while I explain this test. Have you ever had a nerve stimulator test?”
“No.”
“Let me show you how one works. This is a small unit that is used for stimulating nerves in the extremities. I am going to place this band on your forearm, where the muscles that operate your fingers are located. Now, when I turn it on, you may feel a slight tingling under the band and when I activate it, your finger muscles will contract and make a fist.”
“Hey, that does tingle. My fingers are trying to close and I can’t do anything about it.”
“Now, when I turn it off, your fingers will relax”
“OK, now I have control of them again. What is that thing used for.”
“Most often it is used for physical therapy when a person has has nerve or muscle trauma. Muscles need to be exercised to keep them from becoming weak.”
“What does this have to do with me?”
“This larger unit is set up to exercise eye muscles. In your case, we would like to try stimulating the nerves that control your Lateral Rectus muscles that are one of the 6 muscles on each eye that control movement. The muscles work in pairs. The ones we are concerned about in your case are the Medial Rectus muscles that move your eyes inward and the Lateral Rectus muscles that move your eyes outward. For you eyes to move inward, or converge toward your nose, the Medial Rectus muscle has to contract and the Lateral Rectus muscle has to relax. The eye muscles provide the motion and your brain is the control system. It controls the complex contractions and relaxations that can move your eyes in almost any combination of directions.”
“Is this test painful?”
“Not painful, but it can cause some mild nausea as it forces your eyes to move around. If you wear this mask over your eyes you won’t see the images moving around and you should have no problems or discomfort.”
I looked at Jim with a frown, “Jim, are you guys a bunch of sadists?”
“Jack, it may seem that way, but we have a very good reason for the test. We think that your problem may be either in your muscle control system or in the nerves that run from there to the muscles. This machine actually does two things. One is nerve stimulation, the other is monitoring the nerve impulses from your brain and measuring their amplitude. The last item causes no discomfort at all. I will be right here with you during the test and anytime you want me to stop, just say so.”
Reluctantly, I decided that we were back to that situation where ‘knowing’ was better than ’not knowing’.
“OK, Jim, I’ll do it, but if I say stop, I insist you stop instantly and disconnect me from the machine.”
“I agree Jack. If you will, sit down and recline the chair to make yourself comfortable.”
I sat down with some apprehension and reclined the chair. Jim removed my glasses and placed the “headphones” that weren’t headphones on my head. Actually, they were also real headphones.
“Jack, I am going to do a couple of preliminary tests to make sure the sensors and stimulators are in the correct positions. For this you can keep your eyes open. I want you to move your eyes around so I can be sure the nerve impulses are being detected.”
I moved my eyes left, right, up, and down in kind of a circular motion, but without my glasses, I saw double.
“That’s fine Jack, I can see the nerve impulses on the screen. Now, I am going to try mild stimulation to the Lateral Rectus muscle in your right eye. Tell me what you see and feel.”
“I felt a little tingle on the right side of my head and the image from my right eye started getting closer to the image from my left eye.”
“Excellent! Let’s do the Left eye.”
“Pretty much the same, except this time the tingle was on the left and the left image started moving closer to the right.”
“Now, JIm I want you to put on this sleep mask, it is like the ones they give you on long overnight flights to help you sleep. I am going to let you feel the tingle of the maximum stimulation before we start the real test so you won’t be surprised.”
“Oh! That was obviouly stronger, but not all that bad. I could feel my eyes being pulled outward. How long is this test going to take?”
“About an hour, but after a few minutes, you may find that the test is not all that uncomfortable. Many patients have fallen asleep during the test. To help you pass the time, we can provide almost any musical program you would enjoy listening to.”
“I’ll believe THAT, if I fall asleep. How about some easy listening light jazz instrumentals.”
“Here we go Jack, the test will start with mild stimulation and gradually increase to the maximum level over the hour. Relax and just let the machine do the test.”
I felt the mild tingle and my eyes moving behind closed eyes and the sleep mask. The music program started with Dave Brubeck’s ‘Take Five’ and continued with Duke Ellington’s ‘Take the A Train’. Before long I was enjoying the music and soon, Jim was shaking me."
“OK, Jack, wake up. The test is over”
I took off the sleep mask and the headset. Jim handed me my glasses and I put them on.
“Well, what do you think of the test?”
“That turned out to be a rather nice test. I feel pretty relaxed but curiously, my eye muscles feel a little tense.”
“That is to be expected, Jack. They have had a lot of exercise. How is your vision, any doubling?”
“No, everything seems like it was before the test.”
“Excellent! Oh, it is nearly lunch time, would you join me for lunch in the staff dining room, my treat.”
I got off the exam table and had to steady myself. Maybe I had slept a bit more than I thought.
I followed Jim to the Senior Staff Dining Room, according to the sign next to the door. Jim opened the door and I entered a dining room that could have been a private dining room in a 5 star restaruant complete with a combination Maitre D’ and steward.
“Good afternoon Dr. Simpson and you must be our guest, Mr. Charles, welcome. Dr. Alexander and Dr. Harris are already here. If you would join them, I’ll bring your drinks. What would you like?”
Jim answered, “Iced Tea for me, what would you like Jack?”
Somewhat disoriented, I mumbled, “Iced Tea is OK for me, also.”
We walked to a table for four. The two men seated there rose to their feet and Jim made the introductions.
Part 9 - The Grand Tour
“Jack, this is Dr Sam Alexander, Sam is our staff neuro surgeon and psychologist.”
“And this is is Dr. Bill Harris, Bill is our staff Mechanical Engineer, Physicist, and Chemist.”
We shook hands. “Nice to meet you Dr. Alexander and Dr. Harris.”
“Please Jack, call me Sam.”
“Same here Jack, call me Bill please”
We sat down and Sam opened the conversation. “Well Jack, how do you like our facility?”
“It is amazing, uh Sam.”
“What do you think of your treatment so far and the quality of your glasses? I understand that you have had problems in the past getting glasses that corrected your strabismus and gave you good acuity.”
“Sam, the treatment has been incredible, I don’t feel like I am in a typical medical office. The quality of the glasses is also incredible, they have corrected my double vision and the acuity is razor sharp.”
“Jack, you can thank Bill here for the quality of your glasses. He is the guy who designed our lab and invented the machine that makes the lenses so quickly and optcally accurate.”
I turned to Bill. “Bill, if you are responsible for these glasses, you have my admiration and gratitude. In the past I have had to wait weeks for glasses that I could barely wear and your lab has produced exceptional glasses in amazingly short time.”
Bill turned to Jim. “You haven’t given him the grand tour yet? He hasn’t seen my pride and joy?”
Jim responded “Not yet Bill. I plan to give him the grand tour after lunch.”
About that time, the steward arrived with our teas and recited the luncheon menu. While we were waiting, Sam and Bill asked me a lot of questions about my education, interest in vision and things optical. They were particularly interested in the fact that I had self studied about vision and the optics of vision correction and that I had experimented with glasses over contacts and had been wearing prism in my glasses for several years.
Sam exclaimed “Jack, you are an amateur in the original French sense. A lay person who studies a subject out of love. No doubt you are aware that many scientific discoveries were made by amateurs like Sir Isaac Newton, Faraday, and Voltaire in the 17 and 1800s. Johann Mendel was a Monk who discovered the basics of Genetics.”
I replied, “Sam, you are embarrassing me. I am interested in vision and the optics of correction, but no where near the knowledge you gentlemen have. That is why I came here.”
After a very fine lunch, Sam and Bill left Jim and I with a parting “See what he is doing for dinner, Jim.”
I stared at Jim and asked “What was that all about?”
“I think Sam and Bill would like to get to know you better. Lets take the tour.”
The tour was much more than I expected. We toured operating theaters, what appeared to be guest (patient) rooms, lecture halls, and finally Bill Harris’ lab.
“Jack, these are the machines that make the lenses for glasses. Bill has developed a 3-D printer and the polymers that can make very high quality opthalmic lenses with amazing speed. Glasses like you are wearing take less than an hour to produce at very low cost. No grinding, cutting, or risk of breakage. The finished lenses come out of the printer ready to fit in the frames. We think it will revolutionize the making of glasses - particularly a complex high prism prescription, like you are wearing.”
I realized my mouth was hanging open. I closed it at said “Jim, I hope you have applied for patents. The more I learn about this place, the more trouble I have figuring out what kind of a medical clinic this is.”
“Jack, never fear, we have applied for world wide patents and The Strabismus Institute is not an ordinary medical clinic. It is a private, well funded, vision research institution that is operated by a foundation, established by a very wealthy individual, who will remain nameless for now.”
“Well Jim, it is an amazing place, I can’t believe how lucky I was to have discovered it.”
“Oh! Look at the time. Remember, we need you to stay overnight for that last test and Sam, Bill, and I want to have dinner with you this evening. You might want to go home get ready for an early dinner. The place we are going requires a coat and tie. Our driver will take you home, wait for you, and bring you back here. Sam, Bill and I will meet you here and the driver will take us to the restaurant.
Part 10 - An Offer I Couldn’t Refuse
A quick drive home, a shower, suit, tie and some overnight gear and I was ready to go. When we got back to the Institute, Sam, Bill and Jim were waiting and we were off.
Dinner was at a very nice restaurant I had heard much about, but never thought I could afford. We ordered and then relaxed with a before dinner cocktail and the most surprising conversation of my life began.
Sam seemed to be the spokesman and he began. “Jack, how would you like to join the staff of The Strabismus Institute?”
My mouth dropped open, if this kept up, I was going to need a chin strap. “I’m not sure I understand what you mean”
“Jack, we would like to have you on the staff. We have been looking for an individual who is interested in vision and vision correction, but is not a ‘professional’ in the traditional sense. We like your open mind and your curiosity and willingness to think and ask ‘Why’ and ‘why not’.”
I looked at each smiling face and they were nodding ‘yes’ in agreement. “But what could I do?”
Bill interjected, “We are not sure, but we are also curious and we would like to give you a chance to get involved in some leading edge research which is really a lot of fun. The salary and benefits are also pretty good also.”
With a frown, I said “but my background and education are in a different field.”
Jim commented “Yes, we know, but you are fundamentally a problem solver and you offer a different perspective which we need.”
Sam seemed to be next in the rotation. “If you would like to further your education, we have many contacts in the academic world and you can persue almost any thing you wish and the Institute will pick up the tab.”
Then, Bill said, “You will have access to any and all of our facilities. If you decide you would like to try a different prescription, just let me know and the printer can make it for you. You might like to try GOC and glasses to get an idea of the problems faced by someone who is very myopic or hyperopic complicated by high strabismus for example.
Jim said, “Ah, here is dinner. If we haven’t ruined your appetite, you can think about your answer while you eat.”
I ate dinner, but we could gone to a fast-food hamburger place. My mind was churning with disbelief and anticipation of the possibilities. For the life of me, I could not remember what I ate. I guess it was good and probably expensive - my guest menu did not have prices.
After dinner, we went back to the Institute and I got ready for my overnight test.
I was given one of the very nice guest rooms and I was fitted with something like a shower cap. It was not uncomfortable and it had some electrodes that detected my brain waves which were recorded. I did not think I would sleep very well after the dinner conversation, but with a selection of very quiet music and an amazingly comfortable bed, I fell asleep dreaming of the unbelievable offer to be part of this incredible organization - and get paid for the privilege. My answer, of course, would be a resounding YES. It was a dream come true.
BAM! I was jolted awake in extreme confusion. What was I doing at home,in my bedroom!
I don’t know if you have ever had night time leg cramps, but they are the best alarm clocks on the planet. You WILL NOT sleep through an episode. Other than the excruciating pain, a big problem is that you can’t decide when you want to wake up. I looked at the clocks, both of them, and reached for my glasses to fuse and clarify the images. This cramp attack at least waited until 5:30 to jolt me awake. I had planned to get up around 6 anyway for my early eye appointment, so further sleep was out.
I got up and started walking off my cramps. I’ve tried about everything, sleeping with a bar of soap under my pillow and drinking quinine (tonic) water, but what works best is just walking them off. I have asked doctors what might help. Most have no idea and one neurologist even suggested the soap and quinine. Curiously, the soap seemed to help prevent them, but no one seems to know why it works.
After a few minutes of walking, I was able to take my shower and get ready to go to my appointment. I was still a little confused. I was pretty sure I had had a dream, but I could not remember much about it other than I was pretty sure it was very pleasant and definitely not a nightmare.
There were butterflies in my stomach as I approached the entrance to a rather modernistic building. Actually the butterflies were more in anticipation than apprehension. Maybe, just maybe, my search for a solution to my vision problems was inside that door. Somehow, I had the feeling that I had been here before, but that was ridiculous. Just next to the door, in keeping with the elegantly simple architecture, was a very tasteful, brilliant brass placard with the words, The Strabismus Institute.
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