Friday, 27 September 2013

son of stickler - cataract op

On Thursday 5 September I went in about an hour early - before half eleven - for them to redo the eye measurement test, again on the fancier machine. I'm not sure now if it was because they wanted to try to get a better reading or if it was because they thought the eye pressure had been significantly higher than they'd have liked and they wanted to see if it had come down. Either way, it was still high, I heard later.

I went up to the unit where they do the surgery for half twelve. I had the logging in process with the nurse, with measurements and questions and drops, and then waited with the others for the doctor to come on at half one and do the preliminary conversations and assessments with us all, after which they would decide the order we would be done in (I remembered from the last time that this was the way they did it, so wasn't expecting my op to be anytime near half twelve - we'd all have been called for that time). I sat in the corner by the window, it's a great waiting room, up there on the eighth floor of the north wing, looking down onto County Hall and the river; it was a nice day, and people were out on the hospital grass.

When the doctor came, she explained what I said above re the assessments and ordering. The person I thought of when I saw her first was Phoebe from church, though she didn't look that much like her in reality; I described her at work as 'the schoolgirl who operated on me'; she did look very young, but I didn't mind that; she was a registrar, her name was Anna (I couldn't find her on the website after, or the staff board in the hospital, I guess because she's not part of the permanent staff), and I'd guess very loosely that she had a south-east Asian background, though her accent made me think of Germany. Unless I see her name on a related document I'll never know any more about her, probably.

When I went in she had a look in my eye. She asked me if I'd had iritis. I said I didn't know what that was, but that I had had retinal detachment surgery. That's important for me to know, she said, which confirmed to me the importance of not assuming that they've had time to read your file in detail rather than just having picked it up when you came into the room. So I said also that the detachment has been the result of me having Stickler's syndrome. She mostly then spent the time telling me that because of the previous surgery and the Stickler's there was a much-increased chance of complications, or lack of success, during or after the operation; it was more complicated for me, but they'd try to sort out anything that arose at the time, 'on the table'; I was fine with that, as usual; operations have risks, and even if a worst-case scenario is blindness, well, that's the definite scenario without an op. (A couple of people in the process - I think she was one of them - asked me if I'd had the other eye done yet, which wasn't very encouraging; perhaps non-post-op cataracts usually come in pairs; or perhaps Sticker's ones usually do.)

I came out thinking I'd surely be on first or last, and sure enough when she'd seen everyone and came out - about half two - to tell us the running order - emphasising that the order was for no reason other than medical reasons - I was on last (out of five or six). I went to the desk and told them I was on last, so could I go and eat something; they said fine, so I took off my gown, retrieved my rucksack from the locker, and off I went downstairs to shepherd's hall and had a meal, then went out and rang Bethan. I didn't rush, as there were four or five people to be operated on before me, but when I came back up a nurse said she'd been looking for me to give me a tablet to reduce the pressure in the eye before the op. When I went back into the waiting area there were two people out already having had their surgery, and a third came out soon after that; they were really rattling through them.

I waited as the others went and came. A young couple were waiting, and a different surgeon came out to tell them the op on the child had gone very well, and that she was still sleeping but they'd take them in so they'd be there when she woke up. I would hear - but not see - that surgeon later.

I waited, feeling too full and sorry that I'd had a twix with my coffee after the meal since I hadn't expected the op to be coming so soon and I was afraid I might be sick if I was nervous (no reason to think I would do that, of course). I was prepared and taken to the entry room to the theatre, but was taken away again because I'd been called too early and they were still stitching up the person before (I think they may all have been women, in fact). Then taken back to the entry room. I don't remember during which of the entry waiting periods I heard a child howling - from what I took to be the adjacent operating theatre - and said to the nurse, that'll be me; it so won't be, she said. I don't know if it was the child mentioned earlier; I thought at the time it was more likely another one. The second time I was taken into the entry room I asked what the time was; it was twenty to five.

When I was back in the waiting area I asked someone there what the time was; it was quarter past five. So although it had been complicated, it hadn't taken longer, or much longer, than a routine one. So it was much shorter than the retina op, and I'd say it was less gruelling. I'd say I experienced more pain during it, though; either this is because, happily, the memory of pain fades pretty effectively, or because the surgery was less major/invasive and so there was less anaesthetic knocking about. There was more sharp pain and less - none, really - of the pulling/tugging/manipulating which is my major memory of the retina surgery. I told them near the start that I was feeling pain, and they gave me a bit more anaesthetic. I didn't need to tell them, because I was doing a lot of toe wiggling, making little noises and making my body very tense, all of which they told me I had to try not to do, because it was making me move but also because it was increasing the pressure in the eye which was already making it difficult. When I say 'they', it was mostly the other surgeon who was telling me this. I don't think any of this was said to me directly, but rather my registrar surgeon Anna talking to the other, obviously more senior, surgeon (who I"m pretty sure was Luis Amaya, who I see has one of his specialities as paediatric opthalmology; she had put me on last obviously because I was more potentially complicated, but also because she had asked him if he would stay to be on hand after he'd done his ops. He stayed, and she talked to him throughout, but at no point did I get any sense that he was intervening or taking over; on the contrary, his primary contribution, apart from telling me to relax, was to assure her that she was doing very well and that her decisions were the right ones. She checked with him the strength of the lens which the doctor on Tuesday had recommended putting in, I think because she wasn't sure it was right or perhaps that she'd understood it right, but he confirmed it.

Before the op I'd avoided doing too much online research, and was happy with just looking at this page on the NHS website, which contained a nice animation re the procedure (I definitely wanted to avoid seeing any real-life footage). I'm pretty sure the procedure as outlined there is what I had. I heard the sound of the thing they used to break up the 'cataract' (though in reality that seems to mean the whole actual lens, since they insert a whole new lens in its place), which is an extraordinary thought that they can break it up with sound.

The most unnerving thing - and I really don't remember this from before - is that for much longer I could see relatively clearly out of my eye, so I could see them approaching with various implements. I really didn't like that at all. On one of the occasions on which I made a noise they asked if whatever they were doing was causing discomfort, and I said no, but I can really see you. I thought I should say this, in case I wasn't meant to be able to see them so well, but she was quite laid back about it and said that that was normal in this kind of procedure.

When they were finished and getting me ready to get off the table, one of the nurses expressed surprise at how drenched in sweat I was; were you really nervous, she said; yes, I said.

I wasn't the only one, as it turned out. Anna said as I lay there after we'd finished that she'd been very nervous about doing it, but that it had gone really well, it couldn't have gone better. You don't mind hearing your surgeon saying they're nervous, as long as it's after the op and the op has been successful; not what you want to hear beforehand. She came into the waiting room later to tell me again that it had gone well; perhaps because they thought I had been such an anxious patient that I needed further reassurance.

I phoned Bethan, who had already rung the hospital and so was on a bus on the way, and I got a cup of tea and a biscuit. After they arrived I was discharged with some post-op eye drops - Maxitrol, one drop four times a day for a fortnight then twice a day for another fortnight - and three days worth of tablets to keep the pressure down in the eye. I was told to take it easy for the next day or so, and not too much bending, but that was it; a very different recovery process from the retina.

As I said to people later, if the next day had been one of my working days, and it had been a day of meetings rather than screenwork, I could have gone in; I felt a bit washed out, that was all; and I didn't feel any particular pain in the days after that led me to taking any more paracetamol than I would normally have done in any given week. I slept sitting up for a couple of nights, although they hadn't asked me to do that and it was more for myself, wary of knocking the eye knowing that I move about a lot in my sleep; they gave me an eye shield to wear at night, which I am still wearing (again, I don't suppose most people would wear it this long), but won't for much longer.

The eye has felt fine, just feeling things which I remember from last time and so which I'm not worried about feeling this time - sometimes a bit watery (hardly now), sometimes a bit gritty/stingy (less so now), and sometimes a bit light sensitive (getting back to my usual level of light sensitivity now, I think).