Dara closes one eye, then the other. “What the hell?” she thinks. The vision in one eye is noticeably darker and worse than in the other eye. She exits the dark room, where she had been coding a new website for a client, and heads to the bathroom. She looks at herself in the mirror. Nothing seemed wrong with her eyes. Nothing hurts, well, maybe a slight headache, but she gets that sometimes when she is anxious.
She compares the two eyes again. The vision in one eye is still noticeably darker. Maybe a little worse? This is too weird. She pulls out her phone and calls her doctor’s office.
A soft female voice answers: “Good morning! Dr. Khan’s office. This is Alice, her AI assistant. How can I help you?”
“I am slowly losing vision out of one eye!” Dara blurts out as her anxiety grows, “I need to talk to someone!”
“Oh no, that must be very distressing for you! Do not worry, we will do our best to help. Can I confirm your name and birthdate so I can find you in the system?” says Alice.
With barely controlled irritability, Dara says, “Dara Feldmeister, April 9th, 1992”
“Oh, Dara! I recognize your voice. Unfortunately, Dr. Khan is currently with patients. I will send her a text explaining the situation. Can I ask you a few questions about what you are experiencing while we wait?”
***
Dr. Khan receives a notification from Alice: “50-year-old female on the phone with subjective vision loss in one eye. Per records, history of controlled DMII, HTN, ASCVD-intermediate risk. Family history of MS in grandmother.”
“Why is it always just before lunchtime?” Dr. Khan thinks as she scoffs down a granola bar and gets some coffee. She receives another notification: “Dr. Khan, I think the patient needs to go to the ER for her condition. Please join the call as soon as possible.”
Dr. Khan takes a deep breath. This is likely one of Dara’s anxiety-ridden calls about some vague symptom. Vision loss? Really? She presses the button to join the call.
“Hello again, Dara! This is Dr. Khan.”
“Dr. Khan! I need help!”
“Present the patient, Alice,” Dr. Khan said, remaining calm, trying not to reflect Dara’s anxiety.
“Dr. Khan, Dara is a 50-year-old female with intermediate ASCVD risk, with a sudden onset of left eye painless vision loss. She says it is getting darker by the minute. No double vision or other visual symptoms. No eye pain.”
“Actually, I do have a slight headache,” Dara interjects.
“Is it just on one side? Any weakness or numbness anywhere?”
“The headache is only on my left side. I feel fine otherwise. Tell me what is happening!”
“Dara, to be honest, you could have a few different things. The good news is that they are treatable if we catch them early. You need to go to the ER to get treated. Alice, can you send the directions to Dara?”
Dara receives a text with the Google Maps link detailing directions to Wonderland ER from Dara’s location. She reads it, then says, “Yes, I think I can still drive. I will go right now,” In her anxiety, she hangs up the call without saying so much as a goodbye.
Dr. Khan continues the conversation, “Alice, what is the current differential diagnosis?”
Alice: Central retinal artery/vein occlusion, MS, optic neuritis, and ophthalmic migraine appear to be the most likely candidates.
Dr. Khan: Add stroke; common things being common. There are some less likely ones to add, like retinal detachment and metastases. We should add rarer conditions like anterior ischemic optic neuropathy, GCA, sarcoidosis, and vitreous hemorrhage.
Alice: Got it, I will remember in the future. For the ER, I have: Dara is a 50-year-old female with intermediate ASCVD risk, with a sudden onset of left eye painless vision loss, though she does have a slight headache. We are mainly worried about stroke, central retinal artery/vein occlusion, and MS/optic neuritis, given her family history. Differential includes retinal detachment, vitreous hemorrhage, metastases, anterior ischemic optic neuropathy, autoimmune conditions like Giant Cell Arteritis or sarcoidosis. As usual, I will give them access to the medication list and all recent records.
Dr. Khan: Sounds good. Call me if anything comes up. I will go back to my afternoon patients.
***
Dara pulls up at the Wonderland Hospital Emergency Room, her heart pounding with anxiety. The sudden loss of vision in her left eye left her apprehensive and scared, and she had kept Alice on the phone the whole way just in case something happened. She notices her environment as she walks in. The ER sign is written in red, foreboding capital letters, while the separate cheerful Wonderland Hospital sign had a unicorn on it, smiling at every patient who walks in. There is also a wood-framed sign with the smiling face of its CEO, under which there is a quote in big, bold, black letters on gold: “Unique, personalized care with a smile!” She laughs inwardly despite her current terror. She is sure that this is a reminder to the employees rather than the patients. The smiling unicorn must have been a joke played on the hospital by some focus group. Also… wood and gold? Even in Wonderland, corporate messaging needs work.
Her terror returns, breaking the momentary mindfulness as she receives a text from Alice: “I talked to the ER triage nurse and gave them a summary. Her name is Lomell; ask for her when you check in!”
While waiting in line, she rechecks her vision. Her left eye is definitely darker against the bright LED lights. Worse than before. Some cloudiness, too?
Another text from Alice includes a transcript with the ER nurse. Alice had sent over her medical history and a list of potential diagnoses. Most were Greek to her, but she has one main fear, given her family history:
“Could this be MS?”
Alice replies, “It is one of many possible conditions. Do not worry, we are covering all the bases!”
“Ma’am, are you OK?”
Dara looks up from her phone to see a young front-desk lady staring back at her. She stammers, “Yes… I mean no, I am not OK; I cannot see very well out of my left eye. Dara Feldmeister, birthdate: April 9th, 1992.”
“Oh yes! Lomell told us to look out for you. Lomell! Your eye lady is here!” she calls across the room.
“Eye lady?” Dara thinks, “What am I, a diagnosis or a human?”
Lomell approaches and smiles at Dara. “Hi Dara, I have been told about what happened to your eye. I am sorry, that must be so disturbing. Come this way into the triage room.”
In the triage room, Lomell checks her eyes and pupil reactions. She holds up a Snellen’s chart and performs a routine eye exam. Dara is surprised at how bad her vision has become on her left—she can barely read the 20/100 line. Her dominant right eye was compensating.
“Do not worry, we will take good care of you. Let us get you settled in a room and start with some preliminary tests.”
Once roomed, Dara sees a text from Alice asking permission to collaborate with John, the hospital AI. She presses Yes. Alice texts back: “John says they are doing basic labs, EKG, and a CT scan of your head to start.”
A man in gray coveralls introduces himself as Nikolai and transports her to CT. A tall tech efficiently does the EKG. Alice texts: “The EKG was normal. Your assigned doctor is Dr. Patel.”
The next morning, Dr. Khan checks her notifications. Alice’s summary stands out: “Dr. Khan, Dara has not been discharged yet. She has been diagnosed with optic neuritis based on the MRI, which showed a high T2 signal and homogeneous post-gadolinium enhancement. She has been admitted for steroids and workup.”
“It is MS, is it not?” Dr. Khan asks.
Alice texts back: “The overnight neurologist has included MS or other inflammatory etiologies in the differential.”
Dr. Khan stares at her phone, thinking about Dara lying in that hospital bed, probably terrified and alone.
***
In her hospital room, Dara stares at the ceiling, the weight of the unknown pressing down on her. The cheerful unicorn from the hospital sign feels like a distant memory, replaced by the stark reality of IV lines, the steady beep of monitors, and the TV channel stuck on HGTV. She is no longer just a web developer with a headache. She is a patient, admitted for treatment of something that might change her life forever.
The finality of it settles over her like the darkness that had first clouded her vision. There is no going back to that dark room where she was coding, no pretending this is just anxiety. She is here now, in this bed, waiting for answers that might reshape everything she thought she knew about her future. The admission papers have been signed, the IV started, the steroids begun. This is her new reality—at least for now, and possibly for much longer than she ever imagined.
Bhargav Raman is a physician executive.
