It was a Saturday morning in the late summer, just before the beginning of school. That time of year in every family practice, when the schedule is packed with kids, whose parents, overwhelmed with bored little ones and last summer trips, are eager to cross one more thing off their back-to-school preparedness list. That time of the year when the doctor wishes she had remembered to take a vacation but is nonetheless determined to get through the day with her wits intact and her patience unruffled.

Dr. Kane walked in promptly at 9:50 and was relieved to see that her tech, having arrived early, had already turned on the acuity screens and prepped the day’s charts. There was a harried young woman with three boys under the age of six, sitting in the waiting room, trying to fill out a questionnaire, while her sons performed death-defying acrobatic feats for the entertainment of the optician who appeared to be praying for their (or his own) survival. Dr. Kane glanced at the schedule and noted that the ten o’clock was a new patient. There was a comment stating, “Pt. requests her boys also be seen for their annual eye exams today– very hard for her to come back on a different day.”  Sure, thought Dr. Kane, the day is young, the kids look healthy, let’s bang these out – and proceeded to invite the family into exam room 1. 

It was a Saturday morning in the late summer, just before the beginning of school. That time of year in every family practice, when the schedule is packed with kids, whose parents, overwhelmed with bored little ones and last summer trips, are eager to cross one more thing off their back-to-school preparedness list. That time of the year when the doctor wishes she had remembered to take a vacation but is nonetheless determined to get through the day with her wits intact and her patience unruffled.

Dr. Kane walked in promptly at 9:50 and was relieved to see that her tech, having arrived early, had already turned on the acuity screens and prepped the day’s charts. There was a harried young woman with three boys under the age of six, sitting in the waiting room, trying to fill out a questionnaire, while her sons performed death-defying acrobatic feats for the entertainment of the optician who appeared to be praying for their (or his own) survival. Dr. Kane glanced at the schedule and noted that the ten o’clock was a new patient. There was a comment stating, “Pt. requests her boys also be seen for their annual eye exams today– very hard for her to come back on a different day.”  Sure, thought Dr. Kane, the day is young, the kids look healthy, let’s bang these out – and proceeded to invite the family into exam room 1.

Darkening the room lights and flipping the eye chart onto Finding Nemo had the desired effect of silencing the boys just long enough to get a brief sketch of everyone’s entering complaints. Nothing out of the ordinary and examinations proceeded without a hitch until it was time for drops. Not to be deterred by the unearthly howling that began to emanate from the middle child at the mention of drops, Dr. Kane asked all three boys to lie down on the floor and pretend to be sleeping lions.

“Whoever stirs or opens their eyes will of course, be the loser and when it starts raining, as it is often wont to do in the DARKEST, DEEPEST, RAINFOREST of the optometrist’s office, the lions must not stir, except to blink,” intoned Dr. Kane in her most serious DEEP JUNGLE VOICE.

The howling middle child paused to see if his brothers were sprouting manes, there was a sudden commotion, and then three perfectly frozen small bodies lined up on the carpet.

“BE VERY STILL, LIONS! THE JUNGLE RAIN IS COMING!” 

The drops began to fall and one by one, the boys blinked, rubbed their eyes and, bless their competitive little hearts, immediately refroze.

Only 20 minutes behind, Dr. Kane ducked into exam room 2. Here, snuggled into the red examination chair, sat a fairy princess in full silver-winged regalia, a little early for Halloween, but adorable nonetheless. Mom and dad were squeezed side-by-side onto a matching upholstered red bench. Dr. Kane, having apologized for the delay, was greeted by a glare from the Fairy King Father and a nervous smile from the Fairy Queen Mother. The Princess looked indifferent but that could very well have been due to the fact that one of her eyes pointed directly at the wall, while the other aimed suspiciously at Dr. Kane’s left hand.

“It’s not a lollipop. Don’t lick it,” said Dr. Kane, handing the occluder to the skeptical sprite.

By the time lunch had come and gone (a fanciful hour that was always blacked out on day’s schedule but somehow disappeared into another dimension where doctors had Holodecks into which they could escape for a brief but peaceful midday snack), Dr. Kane had seen nine children and one adult without a glitch, and was happily looking forward to the rest of her day which looked to be comprised of mostly grown-up human interactions with just one pediatric aphake in the mix.

The three-year-old aphake, being the first appointment after the imaginary lunch, was in for a contact lens follow-up. Noting that the tyke’s eye had some mild punctate staining under her RGP, Dr. Kane told mom that she could use artificial tears a little more often.

“WHAT?!!!” Perked up the Little One who, heretofore, was totally engrossed in putting tiny, custom-made, glasses on the Winnie the Pooh Dr. Kane had given her ten minutes ago. 

“WHAT ARE ART OF FISH TEARS?!”

“See the cabinet under my sink?” Said Dr. Kane. “Well, in there, if you are very still and quiet, and you listen very carefully, you will hear some very soft sighs. Because in there, lives a very small and very sad crocodile. He is sad because he is very hungry. He is small because he never gets much to eat. The problem is…he likes to eat badly behaved children. Of course, no badly behaved children ever visit me, so he never ever gets to eat anything. That makes him hungry. And being hungry makes him sad. And being sad makes him cry.”

The child’s eyes got so big that her contact lens hung in place by sheer force of water tension, making the underlying fluorescein pattern quite readable in the process.

“Do you hear the sighing? The sobbing? Yes?” continued the relentless Dr. Kane. “He is crying right now. Very, very hard. Because you are being so very good and quiet and cooperative that he knows for certain he will never get to eat. And so he cries. Big crocodile tears.” The doctor’s own stomach growled in commiseration and the child began to levitate out of her chair from sheer astonishment. “Tonight, when everyone has gone home, I will open that cabinet and give him some crocodile food. He doesn’t much like it, preferring to eat badly behaved children, as crocodiles do, but having no choice, in return for the food, he will give me a whole bucket of excellent tears which are soothing to children’s eyes. That way, the Good children, who are very well behaved and cooperative, need never cry…”

Pleased as punch at her own ingenuity, Dr. Kane muddled through the rest of the day explaining presbyopia twenty times over to three witless middle-aged men who insisted their vision was perfect, while their exhausted wives rolled their eyes in the background and handed them their own reading glasses so they could fill out the intake forms; cataracts to one incredulous lady with senile dementia; finally the last refraction of the day, which threatened to squeeze the very last drop of patience from the good doctor’s  soul when the patient said, “May I see number 6 again? I think it was blacker than #10 but thinner than #2,” was over.

Tired but happy in that very special way one can only be when children dry their tears and give hugs, Dr. Kane thanked her equally exhausted staff, locked up, and stepped out into the night air. It was only 7 pm but the sky was dark and the wind blew the first orange leaves in little eddies on the sidewalk. The late summer air still felt clammy, creating an odd haze in the air. Dr. Kane pulled her silk scarf a little higher on her neck and concentrated on the delicious drink waiting for her at her favorite neighborhood Italian restaurant. Optometry was great.

A few minutes later, warmer now in the glow of the candles at the bar, Dr. Kane sipped her drink as she waited for her favorite dish, a wood-grilled, panko-crusted portobello mushroom. Her mouth watered and she powered up her phone to distract herself from her growling stomach. Remembering that she had promised Scott, the bartender, a review after her last meal, Dr. Kane opened her Yelp app and finished writing a glowing appraisal of last Saturday’s vegetable lasagna. As an afterthought, she decided to check her own page. Not a lot of reviews, as she had a firm policy of avoiding Yelp like the plague, but a healthy number of five-star accolades from satisfied patients. Just as she was about to switch to Facebook, a new review notification popped up on the screen.

One star.

ONE STAR.

ONE STAR?!!!!

What?! The sip she had just taken of her perfectly mixed Moscow mule went down the wrong way and she launched into a coughing fit, prompting her husband to pound her soundly on the back.

“Who gave us a one-star review?! Was someone upset today because I ran late?!” “What do you care?” said her levelheaded husband. “Just put that thing away and enjoy your drink.”

She looked again, unable to tear her eyes from that evil-looking, sickly-yellow square. “M.O.T.  Manhattan, NY 0 friends, 5 reviews.”

“Who the hec is M.O.T.?!” “Was there a patient with those initials today?”

Needless to say, dinner ruined, husband irritated, she walked home with a chill in her soul that belied the still-warm summer breeze.

“You’ll sleep it off and forget about it in the morning,” said her ever-reasonable spouse. Fat chance. A one-star review., after breaking her head all day to keep all those children calm and entertained; after fitting in three patients without appointments; after apologizing to people who, god-forbid, had to wait fifteen minutes and were angry because they were too selfish to acknowledge anyone else’s needs; after skipping lunch and holding out on bathroom breaks till her bladder extended past the normal capacity of a small racehorse; after her staff stayed two hours late on a Saturday to make sure that the red glasses ordered for a certain Mrs. PIA were exactly the shade of apple that did NOT clash with her newly auburn locks. A one-star review?! No! She would get to the bottom of this. Tomorrow. Tomorrow she would check the schedule and figure out who M.O.T. was and then call and figure out what went wrong.

That night, the good doctor tossed and turned in her bed. It was a lovely, chilly night – just the kind of weather she craved all summer long, created specifically for open windows and blissful sleep – but sleep was not to be had. That one-star review kept spinning in her dreams. When dawn finally broke, she got up earlier than normal, determined to get to the bottom of it all. The staff greeted her cheerfully as she stormed into the office that morning and their sunny countenances were quickly replaced with trepidation as Dr. Kane asked them all to drop what they were doing and join her in the lab for an emergency meeting. Each was asked to recount, in detail, the prior day’s events, leaving no interaction unexamined, no matter how trivial they thought it was. On trial for crimes they did not commit, they reluctantly racked their brains for infractions. Dr. Kane, whose irrational frenzy seemed to grow as the interrogation proceeded, took issue with every detail. No one could remember anyone patient who had left upset or unhappy the day before or for that matter, in the past week. Impossible, thought Dr. Kane. 

“Is no one here paying attention?! Do you think your jobs are safe just because you’ve all been here 20 years?!” She was losing her temper, which she rarely did, but from now on, things would be different. Clearly, she had become too lax and it was time to shape up and pay attention to customer service. No one would leave the office unhappy and she WOULD find M.O.T. if it killed her.

The next few days were grim. Dr. Kane’s mood continued to deteriorate as that one star haunted her every night. The staff was tasked with calling every patient on the schedule for the past month and asking them how they enjoyed their visit to the office. This yielded odd results. Some were annoyed at being called at home. Many were perplexed at the question – does one ‘enjoy’ a visit to the doctor? Maybe – but they thought the question peculiar coming from an office that was normally efficient and generally not engaged in intrusive surveys, requests for reviews, and annoying questionnaires that have plagued the medical professions of late. Many just hung up and sighed, sadly lamenting the inevitable fact that the doctor they had gone to for years was now joining the growing ranks of telemarketing health care providers, more interested in profit than patient care.

A week later, and still no signs of the elusive M.O.T., a dark cloud seemed to settle over the practice. Dr. Kane added a new patient satisfaction survey to the already considerable pile of HIPPA, insurance, medical history, dry eye, demographic, and review of systems forms, heaped on the patients at the beginning of each encounter. Several patients wrote angry remarks borne of frustration at the longer wait times that resulted. The forms took time to fill out and time to review. The many young children seen by the practice were cranky by the time the doctor came in to see them. The staff was cranky from reading the comments on the forms. The doctor was cranky from the attitudes of her staff. 

A day came when a patient took the stack of forms handed to him by the tech and threw it back at her saying, “I hate forms! I’ve never had to fill them out before! Can’t I just see Dr. Kane and talk to her like I always have?! I’m not filling this out.”

The tech, terrified of the Wrath of Kane, tried to explain the need for the forms. The elderly gentleman, endowed with less than saintly patience, got up and stormed out and several other inhabitants of the waiting room, witnessing the performance, grumbled in agreement with his general sentiment. That evening, Dr. Kane told her tech to pack her things and go home. Her services would no longer be required. The rest of the staff watched the tears well up in the young woman’s eyes and shook their heads in disbelief. A month ago, this would never have happened. Dr. Kane used to always take their side, knowing full well how fickle the patients could be and shrugging off incidents like these with a joke. 

“You shouldn’t have fired her,” said her husband on their walk home that night.

“We never had these problems before we had a tech!” replied Dr. Kane. 

“We never had so many patients or so many new tests to run before we had a tech either. The practice has grown and we needed her,” said the beleaguered spouse.

Autumn had settled in. The oppressive heat of summer gone, eagerly-awaited new fall fashions donned, lovely footwear pulled out of storage and brushed off, this was a time of joy for native residents of the Great City. On her way to work, Dr. Kane walked by blindly by gorgeous carved pumpkins and fall flowers displayed on every brownstone stoop. The click of her suede boots on the pavement was no longer music to her ears. The past few weeks had been awful. With her tech gone, the remaining opticians held down the fort but their most valiant efforts could not contain the flood of delays caused by inefficient patient flow. The special testing room sat vacant more and more as there was no one available to run the expensive fancy machines. Exam revenue dropped. Eyewear sales declined because the opticians were tied up taking calls and making appointments. Normally, the short walk to work was occupied by pleasant daydreaming during which, many of the stories Dr. Kane used to entertain her youngest patients, were invented. Now, she could see only one thing – that lone star hanging in a poisonous yellow box. 

That morning, being her husband’s day off, she arrived to a dark office at 9:55 am. Her opticians normally arrived at 9:50 but perhaps the subways were delayed. The first patient arrived at 9:58- still, no staff. Dr. Kane rushed to uncover equipment, power up screens, try to answer the phones. She noticed an envelope on her desk, addressed to her in a lovely cursive, but decided to wait until the staff arrived to open it. By 11:20, phones ringing off the hook and going to voicemail, patients glaring at her from the waiting room, and still no staff in sight, she decided to open that envelope.   

Dear Dr. Kane,

We have been very happy here for many years, but lately, the office is just not the same. We have tried to talk to you on several occasions but you’ve been either too busy or too angry to listen. It is with heavy hearts that we have decided to resign. We wish you the very best,

Lila and Renee

By now, chill of late October permeated the practice. The harried husband stepped up to the plate but the downward spiral continued to accelerate. That one lonely yelp star now glittered in a sky full of one and two-star reviews. Bereft of any joy her work used to bring, Dr. Kane shrugged her shoulders and, resigned to her fate, turned out the lights and closed up shop for the very last time, on the day before Halloween. No sense of wasting candy on ingrates, she thought.

On a beautiful, sunny, Halloween morning, a young woman hurried to get her boys dressed and ready for school. Mother of three boys under the age of six, she was always harried, and today, on top of the normal lunches, snacks, and backpacks that had to be prepared and sorted, there were costumes to be donned. Almost ready, she called the boys and got the usual responses,

“In a minute!” shouted the eldest.

DEAD SILENCE,” from the youngest.

An unearthly howl came from the middle one, practicing his lion’s roar. Ever since his visit to the eye doctor earlier this year, he was obsessed with being a lion. It was really quite adorable and reminded her that she should send that note she had written to Dr. Kane, thanking her for being so sweet to all three of her sons. It was still sitting on her hall table. She had an awful habit of stamping envelopes and forgetting to put them in the mailbox.  It was getting late and she proceeded to gather her offspring from their various hideouts in the apartment. The youngest had to be dragged away from a long line of boxcars he was aiming at a tower of blocks. The eldest was glued to his latest Magic Treehouse adventure (another thing she had thanked that eye doctor for –Dr. Kane had suggested the series – and she had finally been able to wean the child off of his video game addiction). Her middle son cut a hilarious figure, sitting at her desk in his lion costume, a pajama get-up he had worn to sleep the night before. She crept up behind him to see what he was up to on her computer.  Looking over his shoulder, she noticed her Yelp account was open and her five-year-old son, commenting under her username, ‘M.O.T.,’ was posting a review of his dentist whom he had seen the day before. 

“What in the world are you doing?! I thought you had fun at Dr. Scrivello’s?”

“I had SO MUCH fun – I’m giving him a gold star!” said the little yelper.