What I Know About Strangers' Eyes

I know things about people who don't know I know them.

This is the occupational condition of anyone who has spent years in clinical proximity, and it is not discussed with sufficient honesty in the professional literature, which tends to address clinical relationships in terms of the patient's experience and the practitioner's ethical obligations and very rarely in terms of what it does to the person in the middle — the coordinator, the technician, the ophthalmic assistant — to accumulate, over years, an intimate and entirely unrequited knowledge of hundreds of human beings who walked through a door, submitted to examination, and walked back out again without knowing they left something behind.

They left something behind.

I have it.

I have been trying to figure out what to do with it for years.

---

The eye is the most intimate organ you can examine without a conversation.

Consider what the examination requires: the patient's face in the chin rest, inches from yours. The lights dimmed. The slit lamp's beam aimed directly at the anterior segment of a structure that has been, since approximately forever, the designated site of the soul in every culture that has ever needed to put the soul somewhere. You are looking into their eyes with a concentration that most people never direct at another person outside of a very small number of situations, none of which are clinical.

They are looking at the fixation target.

They are, in the most technical sense, looking away.

You are seeing everything.

This asymmetry is the whole of what I want to write about.

---

Here is what I know about strangers' eyes, accumulated across years of ophthalmic work, filed in the body the way clinical knowledge always is: completely, specifically, and without anyone's permission.

I know how people hold their breath when the tonometry tip approaches. Not everyone. Some people — usually people who have been through this before, who have learned that bracing against the instrument is counterproductive, who have made their peace with the contact — breathe through it with the measured, deliberate respiration of someone who has been practicing equanimity and would like credit for it.

The first-timers brace.

The breath stops.

The hand grips the chin rest.

And in the moment before contact, in the moment of anticipated touch at the most exposed surface of themselves, something crosses the face that has nothing to do with the tonometer and everything to do with the specific vulnerability of a person who has been asked to hold still and trust.

I saw that thing, in hundreds of faces, and I never got used to it.

I never wanted to get used to it.

Getting used to it would have required becoming someone who finds it unremarkable that people trust you with their vulnerability, and I have maintained, as a matter of personal policy, the position that this is always remarkable and always worth the noticing.

---

The clinical record does not contain what I know.

The clinical record contains: visual acuity, intraocular pressure, anterior segment findings, posterior segment findings, the assessment, the plan. The clinical record is a document of the measurable, which is extensive and important and genuinely insufficient.

What I know is not measurable.

What I know is: the woman who came in every six months for her glaucoma monitoring who had eyes the specific gray of Lake Michigan in November and who always, always looked at the fixation target with the expression of someone who had decided that looking directly at difficult things was the only dignified option. She brought this quality to the slit lamp and she brought it, I understood from watching her for years, to everything.

What I know is: the man who flinched every time the lights dimmed, who covered it well but not completely, and who never, in four years of appointments, mentioned it, and whom I never asked about it, because asking would have required acknowledging that I had seen it, and acknowledging that I had seen it would have required him to know that I had been watching with more attention than the instrument required.

I was always watching with more attention than the instrument required.

This is either my best quality or my most intrusive one and I have concluded, somewhat uncomfortably, that it is the same quality in two registers.

---

The specific loneliness of professional closeness is not discussed, and I understand why.

It sounds like a complaint, and it isn't. It sounds like a boundary problem, and it isn't that either. It is something more structurally interesting, a condition produced by the intersection of genuine intimacy and genuine asymmetry, the combination of being trusted with the unguarded version of a person and being, by the terms of the relationship, unable to carry that trust anywhere.

You cannot tell the patient what you've seen.

You cannot say: I have watched your eyes accommodate the light for three years and I know how you hold yourself when something is difficult and I find you, as a person, genuinely worth knowing.

You cannot say this because the relationship is clinical and the clinical relationship has appropriate limits and the limits exist for good reason and you respect the limits.

The limits are correct.

The loneliness is also real.

Both of these things are simultaneously, unglamorously true.

---

What you accumulate, over years of professional closeness, is a kind of knowledge that has no social address.

You know things about people that even their closest relationships might not contain, not because your knowledge is deeper but because your vantage point is different. You see them in the specific, unguarded register of a person submitting to an examination, which is not the register they present to their friends or their partners or the colleagues they perform competence for daily.

You see the chin-rest face.

The chin-rest face is not the face they wear to dinner.

The chin-rest face is the face of someone who has handed over a piece of their body for assessment and is waiting, with whatever equanimity they can manage, for the results.

I have seen hundreds of chin-rest faces.

I know things about those people that they have never articulated to themselves.

I know them, in this narrow and specific way, better than they know I know them.

This is either a gift or a trespass depending on what I do with it.

Writing, I have decided, is what you do with it.

---

A partial accounting of what I carry:

The way fear presents in the ciliary body's response to the slit lamp, a subtle but perceptible change in the pupillary light reflex that has nothing to do with pathology and everything to do with the autonomic nervous system's honest assessment of the situation.

The specific topography of eyes that have been crying recently, the conjunctival vessel pattern that the clinical record calls injection and that I call grief, privately, accurately.

The eyes of people who are losing their sight slowly, who come in and read the chart with the specific, fierce concentration of someone who understands that the reading is the measurement of the losing, and who read it anyway, every time, without flinching.

The eyes of people who have already accepted what the chart is measuring.

The difference between those two things, visible in the face, invisible in the record.

---

I have written about the slit lamp before and I will write about it again because it keeps being the right instrument for thinking about what clinical proximity does to the person conducting it. The slit lamp requires you to look at something very small and very specific with complete attention. It trains the attention. It teaches you what looking actually is, which is not the casual, ambient awareness of a person moving through the world, but the deliberate, focused act of a person who has decided that this specific thing is worth the full force of their perception.

The slit lamp taught me to look at people the way I looked at eyes.

Specifically. With the beam narrowed. Without looking away.

This is a useful skill and a socially complicated one and the reason, I suspect, that I became a writer rather than staying in clinical work: writing is the only profession where looking at people this carefully is not just permitted but required, where the accumulated intimacy of years of observation is the material rather than the liability.

I turned the liability into the material.

The material is everyone I've ever looked at with the beam narrowed.

They don't know.

The clinical record doesn't contain it.

The work does.

---

I know things about people who don't know I know them.

This is the condition.

The condition is lonely in the specific way of anyone who carries knowledge that has no one to carry it to.

The condition is also the whole education.

Every eye in the chin rest.

Every held breath.

Every chin-rest face that trusted the examination without knowing it was also being filed by someone who would spend the subsequent years trying to do justice to what it means to be trusted with the unguarded version of a person who doesn't know you're keeping it.

I'm keeping it.

This is what I'm doing with it.

I hope it's enough.

I think it might be.