Saturday, 23 January 2010

stickler - the operation, part two

I learned towards the end of the surgery that there were four people in the operating theatre with me. From the start I knew there was at least there my surgeon - Dr Mahmoud, I think, not sure of the spelling - and two nurses, I'd reckon both of south-east Asia background. I found hearing the doctor and nurses chatting quite lightheartedly to be quit reassuring, adding to the idea that this was a routine operation with nothing to be worried about in particular. Nevertheless I was quite tense, and did tell the nurse, who I took to be the main nurse, that I was scared; she laughed, more or less, and reassured me. After I had my first anaesthetic injection I said I could still see, and she said that was a goodsign, laughing again. Iwasn't sure how much of my vision would disappear during the operation; I certainly didn't want to be gazing up at anything descending upon me. I had to get off the trolley I came on and onto the operating place - this before the anaesthetic, of course. There was a little pillow, perhaps gel-filled; it wasn't particularly comfortable bur I don't think that was the idea, the idea was that it would keepmy head sitting in it nicely. They covered my eyes with some material and moulded it to my face I think by spraying something on it (I'm giong to be quite uncertain on a lot of the details here, and the sequence of things, and of course my impression of what was giong on at any point may not reflect reality very well), and then I think/presume they cut a hole in it over my eye.

Forgot to mention that when I was up in the clinic on the eighth floor Dr Mahmoud popped in briefly to see me fist thing, before he came down to the operating theatre, an one of the things he did was to draw an arrow in black marker pen above the eye to be operated on.

I had at least three injections of anaesthetic, those are ones I felt and heard being referred to at least - I had the first which the doctor told me was coming, then before too long he said he was going to give me another one, which I guess may have been because I was behaving as if I was in discomfort and tensing and moving about, which is certainly true, although as per previous posting I'm not sure I could describe it as pain; although as I heard a couple of people say durng my various visits, people do express pain differently. I then had a third one well into the operation, again perhaps because I was reacting a little and also perhaps because the operation was taking longer than anaticipated. I may have had another one later than that too. Around the time of the third mentioned injection, I did feel something different from the 'pressure' a couple of times, a little spell of something which felt like very faint tickling, and then also, not sure if earlier or later, a few little pinpricks. I did occasionaly see a tiny spot of red or green light, as if you were seeing a traffic light which was very far away. I think I had my left eye open pretty much all the time; I really can't remember what the vision was like, I think just as if my eyes were closed, I certainly had no sense of looking at anything with my left eye, though when they took the material off at the end I could see perfectly normally with my left eye.

They put liquid on my eye a few times; at the time I thought it might be cooling or numbing me insome way, but on reflection it may ahve been more for rinsing and washing away stuff.

I knew that the operation was going to involve both laser work and cryo work, but I didn't look up in advance what exactly these things would be doing to me, and I haven't yet since. You could hear the equipment, though; in paticular at least one of them would give a spoken message to say 'cutter on' or 'cuter off', presumably to emphasise to everyone exactly the status of that particular item.

There was a point fairly early on where I wondered how long it was going to be, but found that very unhelpful to think about, this certainly being a phase where I was aware of pressure, and so I stopped thinking about that. When it was over and I asked what time it was, which was when I was in the entrance lobby to the operating theatre with the clinic nurse waiting for a porter to come and wheel me back upstairs (and just before I got another warm blanket put on me for mey return journey from the hot cupboard in the corrider outside, which felt very good; I've a feeling the warm blanket I got on the way in didn't stay on me for very long), I was surprised that it was longer than I had thought. I felt more at ease, I seem to remember, when the actual 'meat' of the operation was going on than in what I took to be the preliminaries; towards the end I was probably a bit more at ease than at the start since I knew we were in the home stretch.

As I've implied, I was in reality less troubled by actual pain during the operation than by my imagination of what the pressure and other physical sensations I was feeling in my eye corresponded to in physical practice; my imagination was the problem to a large extent. And it's not one of these situations where you can think to yourself, or have told to you, that it's not as bad as you imagine: if you were imagining entirely accurately what was going on, that would still be a terrible thing to be imagining. I started off with a typical diversion tactic, as mentioned before, of taking your mind off a sensation in one part of your body by creating a discomfort or pain in another part, and was pinching my right hand; then I stated using my right hand to pinch my body; then I found the thing to do which I did for most of the operation, to the extent that there was a point during the laser work that the surgeon had to tell me to stay still, and I stopped then: with my right thumb and forefinger I was pinching around my belly button as if it was a clock, and saying to myself (silently, in my mind) the 'o clock' which each pinch represented, and visualised those belly button pinches going on. I don't know what the stuff thought I was up to, but I guess they're used to all kinds of peculiar behaviour. I didn't see it myself, but afterwards Bethan said I had a very red ring around my belly button.

The operation was well under way when all of a sudden I heard Mr Laidlaw say something like 'Why are you cutting so far down?', from above my head somewhere. That was the first time I knew he was there; I don't know how long he had been there. He was the senior consultant over my case and I had seen him on the Tuesday, and had heard him and Dr Mahmoud discussing who would be done tomorrow, but I wasn't surprised when I seemed to be in Mr Mahmoud's hands alone. But I guess Mr Laidlaw was supervising, either because this would be routine, or because it was a potentially unusual op because of the Stickler syndrome, or because Mr Mahmoud was still gaining experience on this kind of surgery - I did hear Mr Mahmoud on the Monday say something to someone as if he was a bit frustrated that he hadn't got to do any actual surgery on that day, and a couple of things on Monday and Tuesday made me wonder if he was relatively new in the department.

So things became very interesting then, hearing the two surgeons talk about what was actually going on, with Mr Laidlaw obviously teaching Dr Mahmoud to some extent. I don't know if it was planned, but Mr Laidlaw did seem to take over the larger part of the surgery after he first piped up. I guess some people might have been a bit freaked out by the thought that there was some kind of practicing/teaching/learning/instruction going on in the operation currently in progress within your actual body but it didn't bother me at all; it's a teaching hospital, and how else are people going to learn how to do these things, and the man in charge was there too. And as Margaret said subsequently, if they had really been worried about how a 'learner' might have got on doing your op, they'd have given you a general anaesthetic so you'd be none the wiser.

I was then in a bit of a dilemma, of course, because I did want to hear them talking about the operation and what was going on, but without visualising how the things they were saying corresponded to the actual activity in my eye, so I was trying to listen and store away what they were saying to process later while still at work on my belly button clock. It worked okay. At the end Mr Laidlaw said it was the trickiest eye he'd done for quite a while,, but that it had gone well. I also picked up from what they were saying at various points that the Stickler syndrome gave the eye jelly an unusual consistency that made it hard to work with, and that the Stickler syndrome also explained why my retina was virtually falling apart as they worked on it, and that in the end they had fixed the whole 180 degrees length across the top of the eye, some with laser and some with cryo (and that you can't do cryo on bits you've lasered), and that it's not advisable to do work on a bit that you can't actually see. Some people might have felt touchy about them talking about my eye, during and particularly afterwards while I was lying there and they were talking about how the operation had gone to each other, as if it was a medical exercise and not appearing to think of me as a person, but again I was perfectly happy with that - I had no interest in being thought of as a person, just forget about me and concentrate on the matter in hand, that's fine by me. At one point Mr Laidlaw shouted 'Get off the phone!' One of the nurses had taken a call from one of the other doctors about something; he said afterwards that he was sorry for shouting, but that it had taken them an hour to get to that point and they needed to act quickly before the moment slipped away; the nurse didn't mind, and said she'd worked in theatre for six years and it was far from the first time she'd been shouted at. There were a couple of mentions of the fact that they were working with only the four of them there, which made me wonder if someone hadn't got in with the snow or whether they were just having to run a tight ship staffing wise.

At the end of the operation Mr Laidlaw was obviously stitching me up; I guessed that they might be stitching my eyelids shut, but it became obvious the next day when they took the dressing off that this isn't what he was doing and that he was actually (no, no, don't even type it) stitching my eye. When I had my post-op check-up on the Thursday, after they'd taken the dressing off and the doctor looked at my eye, he said that the pressure in the eye was a bit high and there had been a bit of a bleed, and that one of the stitches looked a bit long and might need to be cut, which I took to be related to the eye pressure, and that made me really not look forward to the check-up on Tuesday and the thought that they might get to work on the stitches in my eye if thepressure was stil high. Happily there was no word of that subsequently.

Well, I think that's about it for the hospital experience; I'll note down any other details if they pop into my mind. I got Bethan to take some photos of me when I was lying recovering back up in the clinic recovery area, just for the historical record, with the eye padded up and, I believe, a dried trickle of blood running down to my ear which they'd missed in cleaning up, or had come since. I was going to take photos of myself once the padding was off, but actually there was pleasantly little to see - the area of my eye was swollen and red, but there was no bruising. The eye itself, including the white, was very bloody though, and Bethan gets lots of credit for doing my eye drops without flinching in those early days in particular. I think the Monday was the first time I tried to do a drop by myself, when Bethan was out at work I guess, and it was really hard for me since I had no depth perception and of course couldn't see out of the eye I was trying to put the drops into - it took me about a dozen goes to get one in, and that being the Pred Forte, is still the easiest one to do and the only one I do myself, as it's more frequently needed and is also white which makes it easier to see if you've got it in. The white of that drop is also very instructive in that I've previously had eye drops where I put a drop in and a drop went out of my eye immediately and I thought it was the same drop, but the white drop shows you that when this happens it's dispalcement of some of the liquid in the eye already, not the same drop rolling straight out, even though the drop that comes out is quite white, they liquid in the eye is white too.