A Trip to the Clinic with a Reactive Human

Did you ever wonder exactly what the heck could be going on inside your dog’s head at the vet? Maybe why your toddler is freaking out, or why your cat tries to make your insides into your outsides when it’s time for a medical exam or treatment?

We don’t have mind-reading equipment yet, but we’ve got the next best thing — a human who can explain from inside a clinic where she’s uncomfortable.

I have an eye squick. It’s not a phobia, by definition, but it’s something that makes me very uncomfortable to think about, discuss, or — back off — have handled. I can’t watch someone use eye drops, I once hid grimacing inside my own hat while as a fellow costuming and makeup panelist discussed colored contacts, and the world will probably never know if I am a candidate for Lasik surgery, because I won’t discuss it with a doctor. While I don’t enjoy gory movie scenes, they don’t tend to bother me; at the last horror movie I watched, people around me recoiled and screamed at a bloody jump-scare, while my first thought was honestly, Did someone get paid for that makeup job? But a brief suggested eye scene in the 1996 PG-rated movie The Phantom has been the stuff of my nightmares for more than 15 years.

So a visit to the ophthalmologist is stressful.

But I needed to go. My eyes are pretty lame (I really only use one, and it’s behaving oddly), and the thought of leaving something untreated to develop into a greater problem scared me into going in.

Scared child

It feels like this. (Photo credit: Wikipedia)

So if you ever wondered what might be going on inside your reactive learner who can’t articulate for himself, it might be something like this.

The Waiting Room

This was fairly easy for me. I knew where I was and what was coming, but the doctor had moved recently to a new office, so this was my first time in this environment — fewer external stimuli to serve as familiar triggers! Also, I found a way to occupy myself, quietly sorting receipts from my wallet and organizing and reporting expenses using an app on my phone. Accounting requires enough of my brain that I didn’t have any neurons to spare for anticipating and imagining and freaking out. When my name was called, I stuffed my receipts into a pocket and went back in a fairly neutral frame of mind.

Take-away message #1: Quiet busywork can actually be useful here. Sitting still not only allows physical tension to build more easily, it leaves a giant mental vacuum which Nature will abhor and fill, probably with all the wrong thoughts. For a dog or cat, alternate calming petting with simple, quick behaviors which can be quickly reinforced. Sits, downs, matwork, high fives, etc. are all good options.

The first room

I was led into a small room and told me to sit and wait. I took the indicated chair and felt my physical reaction before I even consciously recognized what I was looking at — an over-sized poster on the wall in front of me of a giant, expanded eyeball, showing all the parts in hideous color. I immediately turned away and was suddenly eye-to-freaking-eye with another, much closer.

I turned away and stared steadily at the door.

I have no idea what the posters were actually of or what purpose they served. My best guess is that they’re analogous to the smiling teeth in my dentist’s office which identify gum and enamel and remind us to floss. But all I was seeing was exploded eyeball and as I said, I reacted physically before I could even consciously identify the cause.

Take-away message #2: What some might see as normal or even necessary in the environment may be strong triggers or terrifying stimuli for others. I self-managed by getting them out of my field of vision, but some people or animals might need help turning away. Or, it might not be possible to remove or avoid them (if there had been another poster on the door, I would have stared at my hands in my lap or even closed my eyes), and we should be ready to distract or assist with more busywork or alternate coping mechanisms.

A technician came to perform the first test, which was pretty easy. (Look into the box and read the letters — this I can do!) That finished, I avoided looking at the posters again and we headed to the next exam room.

The physical exam

The ophthalmologist's exam chair and equipment. Seriously, this is some sort of futuristic sci-fi torture chair.

Seriously, this is some sort of futuristic sci-fi torture chair. Don’t try to pretend it’s not.

Ohboyohboyohboy. This is the tricky part.

I started tensing up in the chair, as the tech asked me standard questions about my vision, any dryness or itching, etc. And then it came time to use numbing drops and measure the pressure in my eyes.

I obediently tipped my head back for the drops, but I flinched and jumped with each one, even though she placed them appropriately so that they didn’t hurt.

I was good; this was the same technician who, when I on a previous visit had told her that I found this process very invasive and uncomfortable, had told me that I didn’t really have a problem. If I’d had a real problem, she said, I’d be a lot more demonstrative and wouldn’t be able to handle it.

Sorry, but that’s wrong. She had no idea what was really going on in my head and how much work I was doing to stay quiet and outwardly calm.

Take-away message #3: Most of us try to “be good” and stay well within social parameters until we really can’t. We can’t assume that because a dog is quiet, it’s also calm and relaxed. (In fact, the opposite is often true.)

Anyway, I was still trying to be “normal” as I sat rigidly in the chair. She told me to uncross my legs (body language!) so she could bring the machine close. I set my chin and forehead against the machine and concentrated on breathing.

Blink (Doctor Who)

“Don’t blink.” Riiiiiight.  (Doctor Who, “Blink”) (Photo credit: Wikipedia)

The horrid little probing gadget came to my eye, and I flinched and blinked. “Don’t blink,” she said.

I tried, I really did, but it came again and I jumped and blinked again. “I feel it,” I said. “I’m not numb enough.”

“You had the drops,” she said reasonably. And indeed, I’d never physically felt it before when numbed (the thought was enough, thank you), and when I related this story afterward, none of my family had ever physically felt it, either. But it wasn’t my imagination; for whatever reason, this time the drops hadn’t quite worked, and I could physically feel the gadget touching my eyeball. And any normal person even without an eye squick is going to blink when something touches the exposed eyeball.

"Don't blink. Blink and you're dead." speech from Doctor Who, Blink, in eye chart form.

Exactly like this.

“Don’t blink,” she said.

I blinked.

She reached around the machine. “Here, let me just help you hold your eye open.” And she grasped my face and caught my upper and lower lids and pinned them.

I froze. I mean, I was rigid before, but I went more so. I think, looking back, it was the cognitive dissonance in my head of knowing she thought she was being helpful with the intrusion of someone grabbing at my eye. Grabbing my eye, and I was already stressed. If I hadn’t been so very focused on remaining still (and hadn’t known for very sure that she was trying to help me in her clueless way), I probably would have reacted violently. But the dissonance locked me up so thoroughly that I could not even speak to tell her to let go.

As it was, I still blinked.

At that point she gave up and applied more drops. More thoroughly numbed, I was able to hold in place while she probed again.

Take-away message #4: Trust the subject. While anticipation and hysteria can lead to imagined pain or preemptive jerking away, sometimes there’s a good reason for a subject’s resistance. Arguing that it shouldn’t be that way is worse than useless, as it only proves to the subject that signals will be ignored and must be escalated, and the handlers and/or techs are not to be trusted.

(Something similar happened to my husband as a child, when he told his dentist that the Novocaine wasn’t working and he could feel the surface drilling. The dentist told him it was his imagination. When the drill hit the tooth pulp, everyone learned with great conviction that it wasn’t his imagination! and the experience left a deep distrust and avoidance of dentists which took decades to overcome.)

Take-away message #5: Just because you got away with handling a stressed subject once doesn’t meant that she was okay with it. You may have gotten lucky or you may have used up the last bit of tolerance remaining, and you might be unpleasantly surprised the next time when “the bite comes out of nowhere.”

My eye pressure was fine. My blood pressure was another matter, but that wasn’t important now.

At that point we went on to a different test, which I think was something about testing eye tracking, I don’t even know because I couldn’t really focus at that point. She handed me a card with a picture and told me to look at the man. But it wasn’t a man, at least not to my blurred vision, it was a clown.

I don’t have any fear of clowns, but I know enough people who do to think it was a stupid thing to hand to someone who was already freaking out. But again, I don’t think she knew how stressed I was.

She left me then, and a few minutes later the doctor walked in. He immediately said, “Oh, I didn’t know you were so cold back here.” It was at that point that I realized I was coiled and folded into myself in the blue chair, my body language very loud but obviously not very clear.

Take-away message #6: Look at the context. Body language always means something. A dog panting when the room isn’t hot? A woman holding herself when the room isn’t cold? That’s not coincidence or irrelevant.

How is this not creepy?

How is this not creepy?

He wanted to examine my eyes, using the same machine which was used for the pressure test. Aw, no. I took a deep breath and leaned toward the machine. I was almost settled into it — I admit, I wasn’t really speedy, but I was certainly getting there — when he reached around the machine and cupped my head into place.

And that was bad. Again, I didn’t react much outwardly, mostly because I was already working so hard on getting my head into place, but the external pressure did only harm. Now I was worried about getting away, even though no one was touching me any longer, and my forehead kept pulling back from the frame and I had to be reminded repeatedly to stay in place. I don’t think I would have been quite so focused on pulling back if I hadn’t been pulled forward.

Fortunately this was a lot less invasive, though, with nothing touching. I can handle bright lights, just no touching. Then he removed the machine — huzzah! — and told me to look in a certain direction while he leaned into my face and peered into each eye.

I focused hard on a target. I focused hard on a target, keeping all my thoughts on holding that target. It was bad when he leaned into my field of vision and cut off my view of my target! but I just focused on his hairline or something instead. Target. Target. Target.

There’s a very clever sea lion at Shedd Aquarium, Tyler, who I noticed tends to hold his breath during duration behaviors. I wasn’t quite doing that — I don’t have the breath control of a sea lion — but it felt like it.

And then he was done, and he sat in the chair and we talked. That was easy. I only had to answer questions about my vision, not about eyeballs, so that was no problem at all. I realized I was relaxing when I felt my feet reach the floor again.

Take-away message #7: “Hold still” or “don’t move” isn’t really feasible for a lot of scared or stressed minds. “Touch this” or “look here” is a lot easier to do. A visual or physical target is a concrete task on which to concentrate. (Laev usually does chin rests while someone inserts a needle to draw blood. No restraint, no movement, much greater sense of control and therefore less stress.)

Take-away message #8: Again, look at the body language for clear indications of emotional state. I often watch stressed dogs starting matwork to see when their tails lower enough to touch the floor; I hadn’t realized it would be so literal in myself as well.

The clicker test

The next test was back in the room where I’d started, with another tech. This test, looking for macular degeneration, required me to thumb-press a handheld remote with a raised button when a colored dot changed. At last! This was something I was very comfortable doing!

I clicked each color change like a pro. Avoiding the exploded-eyeball posters was easy, because I had another task which I felt confident about.

Take-away message #9: Again, busywork with fluent behaviors can be huge in a tough environment. I was more relaxed doing this interactive, focused test than I had been simply staring at the door and Not Looking at the posters.

Don’t patronize me

When finished, I asked the tech if I could go back and take photos of the exam room. “Why?” she asked.

“I blog about behavior, and this is a scary thing for me, so I’m going to write about how I cope with being freaked out.”

“Oh,” she said, her voice almost cooing, “that’s so cute.”

I took my photos and went out to pay my bill.

Take-away message #10: I see far, far too often people being amused or dismissive of their dogs’ fears. It’s most offensive when people laugh when a dog is terrified, but it is most dangerous when they ignore or fail to notice it. Like the woman who thought I wasn’t really upset and so felt free to grab my eye, people who aren’t aware of a dog’s emotions might induce a justified bite, leading to an even worse experience for both dog and human and an even worse scenario the next time.

I think everyone has a squick or a fear. Many are lucky enough that theirs don’t show in public or in front of other people, or don’t come up very often, but that doesn’t mean they don’t exist.

It’s better to address fears and discomforts and teach tools to mitigate them. I spent the hour and a half in the office picking targets for myself and concentrating on my breathing, and while I still crushed my own fingers in my lap during the exams, I was able to channel my anxiety enough to get through the procedures. Without the skills I regularly teach to worried dogs, I would be a less cooperative patient — or, like my husband for years after his bad dental experience, I would simply avoid the clinic entirely and not get the care I need.

It’s healthiest for the learner and safest for all involved to teach good coping mechanisms up front along with proper socialization and desensitization. We want to prevent problems! but we can’t prevent everything, and having a Plan B of coping mechanisms is a good idea.

I got all physically tense and breathing fast again just writing this. Whew.

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About Laura VanArendonk Baugh CPDT-KA KPACTP

Laura was born at a very young age and started playing with animals immediately after. She never grew out of it, and it looks to be incurable. She is the author of the bestselling FIRED UP, FRANTIC, AND FREAKED OUT. She owns Canines In Action, Inc. in Indianapolis, speaks at workshops and seminars, and is also a Karen Pryor Academy faculty member.

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  1. What awesome timing. My opthalmologist appointment is in 35 minutes =:-D The first time I ever went, I had the distinct impression that the technician wanted to smack me during the “don’t blink” ordeal. How on earth do people put contact lenses in?

  2. I have no real issues with my eyes, but I got tense just reading about your tension! Fabulous example, though I’m sorry you had to go through it. Tagteach, bringing a friend next time to advocate for you, finding a new clinic with more empathetic technicians?

    • I like this doctor, and the techs just didn’t realize how hard I was working! Which, honestly, is something I hear about Laev a lot. “Oh, look at her, she’s so calm and relaxed,” said a woman in the vet waiting room, while Laev was concentrating so hard on her matwork that it was practically a workout. Yep, we’re just making it look easy!

      And I did come up with some TAGpoints for myself, but after the fact. “Forehead to bar” will be one for the next visit.

  3. Thank you for such a wonderful article! I have a PTSD from a terrible medical experience, one which most people don’t understand or relate to. I can’t imagine it’s any different for a dog. Thank you for giving them a voice.

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