I did not enjoy a very comfortable sleep, but I rarely do on the night before the day when I must rise at an unusually early hour. As I had selected 05:00 as the best time to rise, this easily qualifies as ‘unusually early’ for me. But it was not too early, for it allowed me just enough time to get prepared for the day and the hour long drive into London and to the hospital. As a diabetic, it is not wise to head out without sustenance – blood sugar goes down as well as up.
The Christmas break – synonymous with people on leave and hence a massive reduction in the amount of traffic clogging the roads – was over and motorway traffic reflected this even when we commenced the drive at 06:00 in the morning.
Once in London proper, traffic was busy – not yet rush hour and nowhere near its daily gridlock, but nevertheless teeming with vehicles.
As I had previously reconnoitred where the hospital was, the location of the Moorfields Eye Hospital clinic within the hospital’s sprawling complex and most importantly, where the parking area was – parking is the scourge of London – overall, I had a good idea of where we were going.
On our arrival we drove into the expansive campus and made our way to the parking area, driving past the entrance to the Moorfields Eye Department. As we drove by, I duly noted that several people were waiting, in the dark and cold, by the entrance door.
Knowing that today was going to be knocked for six by the procedure, and as we were early, I took advantage of our early arrival and walked around the large, spread out institution twice for some exercise – the 10,000 step per day goal isn’t achieved automatically. Then, as the department had opened, we paid for our parking (the machine only begins dispensing tickets at 07:00) and in we went.
At reception we were told to proceed up the corridor and take the first right and then to take a seat on the ‘green chairs’. So off we traipsed.
The ‘green chairs’ were not in a room but stretched along one side of the side corridor. There we encountered those who had been waiting outside. It seems that they, like me, were there for a cataract procedure.
Waiting outside in the cold and dark ensured that they were now at the head of the queue. They were chatting happily amongst themselves. It seems we all had an ‘early morning’ appointment.
It did not require Sherlock Holmes to deduce that this portion of the corridor functioned as both a corridor and as a ‘waiting room’. We took the next available green chairs, sat down and commenced the task of waiting.
Now if you are waiting for a special treat, to meet someone you have always wanted to meet, or to go somewhere you always wanted to go to, there is a palpable excitement and anticipation, impatience even.
But, waiting for something that is essentially intrusive and unpleasant, something that ‘must be done’, just isn’t in the same league.
There I sat, stewing in my thoughts, pondering what I ‘think’ is coming, and, yet, not really knowing – I have no previous experience to inform my mind. However, my imagination can be quite active when it is provoked – this procedure was definitely provoking it, and it was busy filling in the blanks.
After not a lengthy time of musing, I began to wonder if what I have told others is really true: “The only thing worse than cataract surgery is living with cataracts”.
Maybe cataracts aren’t so bad after all…
In the waiting corridor there is not a lot to do. The main, well, the only task really, is to wait. Whilst sitting there, ‘waiting’, I observed.
I noted various members of staff, in diverse uniforms going about their labours; moving trollies of waste, or shifting supplies, or entering or leaving various rooms with design and direction. They are engaged in a wide range of activities and have purpose – we on the green chairs sit with nothing to do, save, think and anticipate – rather docile, cowed, subdued…
Someone pops out of the room on our side of the corridor and calls one of the people waiting on my left. They rise and disappear into the room.
After a bit they return and sit down. Another name is called and in they go.
And this procedure is repeated another time.
Then one of the people previously called, is called again and they return to the room.
And so it goes, the first three folks are called and return and called again. At one point they return with an arrow drawn on their foreheads with black felt tip marker, indicating which eye is getting the ‘treatment’.
Then, after half an hour, my name is called.
I rise, lacking any enthusiasm and with motions more like a condemned man, I enter the room.
I see that it is a not large room; a simple rectangular space that has been subdivided into three divisions by curtains. In each little division there are chairs, tables, cupboards and various types of equipment.
I am directed into the first division.
A surly nurse was there. She didn’t greet me. I smiled – she didn’t reciprocate. I don’t think she was having a ‘happy’ day, and it was just beginning.
She sat me down, a grump on her face, and took my blood pressure. Once my blood pressure was duly recorded, she then did a ‘finger prick’ blood test for my blood glucose levels. She informed me, only after I inquired, that both results were good. She then brusquely dispatched me back to the corridor to wait.
After a while, I was called again, by a doctor, or maybe a junior doctor, I do not know, and I entered into the second division for a brief consultation.
My file was on open on the table before him and he informed me that as my eye is astigmatic it was essential that a special scan of my eye be taken to determine what kind of replacement lens to apply – normal or ‘toric’ lens – whatever ‘toric’ means. I had had the scan done prior to this appointment (at a different Moorfield’s clinic in a different hospital) – but, alas, the scan printout was not in my notes.
They arranged to have another scan taken there and then. Hence, I was sent back to the ‘waiting corridor’ whilst they busied themselves getting the operator found, the machine turned on and prepared to take the scan. This was not planned.
Once the machine was turned on and fired up and with two members of staff in attendance, the scan was once more accomplished and the printout duly affixed to my file. The operator then busied himself examining the printout.
Back I went to the waiting corridor.
After a while my file came out of the ‘scan’ room and into the room where the consultation had taken place.
And still I waited….
Well, it is a ‘waiting corridor’ after all.
After a while, I, once again, was called in to see the doctor or junior doctor, whatever he was. My file now displaying my multi-coloured eye scan is lying on the table. Indeed, I was to receive the ‘toric’ lens, which will go some way to correcting my genetic astigmatism.
I have subsequently learned that a toric lens has two different curvatures to assist in correcting both astigmatism and short or long sightedness – and as such is rather difficult to fit as it must be set correctly in the eye for both curvatures to work correctly.
The doctor, or junior doctor then informed me that, as part of the preparations for the procedure, he now had to stick a needle in my eye (!).
This was not what I would call good news, and I had no previous knowledge that this would be happening, but as I’m on this ‘ride’, I have no control as to what happens, I can only get on or get off the ride.
But, if I have decided to have the procedure done, then I must submit to whatever is required, or opt out and get off the ride – to abandon the procedure – and continue living with an active and growing cataract.
Stinging drops were once again administered – this is becoming a habit. The drops were to numb the eye, so I wouldn’t ‘feel’ what was going on. He then got a sealed, packaged needle out, ripped it out of it sterile environment and had me place my head in the head rest with my chin on the chin rest and forehead pressed into the forehead rest.
He, positioning a microscope like device in front of my eye, moved in close and pressed the needle into the left side of my right eye.
“Well, that’s all done…” thought I, “not too bad…”.
He did it again.
Oh, and again.
Then there was a lateral movement, a tearing like movement. I’m not feeling ‘pain’, but I am more than aware of the poking, prodding and dragging transpiring within my eye.
Pleasant is not the adjective I would choose to describe it.
Horrific and terrifying are also not words I would choose, for it wasn’t, but, it definitely was not in the ‘pleasant’ range.
He then moved over to the opposite side of my eye and proceeded to poke around in my eye with the needle on that side.
Definitely not ‘pleasant’.
Also, at some point he declared that he needed to ‘mark my eye’.
Please note: not mark my forehead identifying which eye for the procedure, but he was referring to actually ‘marking my eye’ with what looked like a wee marker pen. This, too, was applied to my eye, my living, poked, prodded and eye-dropped eye.
This was added to the sum of what I had experienced thus far, and I must admit, that overall, it was not really a pleasant, fun experience and it kind of was setting the stage for the actual procedure yet to come…
Also on this occasion, subsequent to the physical ‘marking of my eye’ he also did make the ‘mark’ on my forehead, identifying which eye was to be subject to the procedure. I must admit, I think that marking my forehead with a large, black arrow pointing at the target eye is a good thing to do.
After all this, it was back to the waiting corridor for me… now clearly designated with the ‘mark of the operation’ on my forehead.
The next time I was to be called, after having been duly poked, prodded, scanned, pricked, eye-drops dropped and marked, as I was, would be to go in for the actual procedure…
Oh joy, the anticipation…
After some additional waiting in the waiting corridor, I was duly summoned and leaving my glasses behind, like a lamb to the slaughter, I meekly shuffled down the corridor. The nurse gave me a wee little plastic head covering to put on to cover my hair and I entered ‘the room’, on the opposite side of the corridor.
As I entered I immediately noticed one member of staff, perched on a high stool diligently reading the morning newspaper. The other nurse then instructed me to lie down, on my back, on the raised table in the middle of the room and place my head in the head rest.
I found it rather ironic for in Turkey I have to put plastic booties over my shoes to visit the dentist, but here, for my cataract surgery, surgery to be executed on my eye, I have my street shoes on – just as they are, as I lie on the table.
The nurse put a pulse monitor on my finger and began explaining what she would be doing. This nurse, unlike the other member of staff, who was fully engrossed in reading the morning paper, was in charge of getting me ready for the procedure.
Not sure what the other member of staff was there to do.
However, one of the tasks that the busy one had to do, was to put another series of drops in my eye…. So the poking, prodding and dropping was not yet completed.
These drops were to dilate, numb, and freeze the eye – oh and to sting. Fun.
At one point my eye was smarting rather smartly and my whole body was tensing up, as it does. Now, in the background I could hear the beep, beep, beep of my pulse monitor. But when I tensed up, the beeping stopped….
I must be dead !
There is no beep beep…
But I didn’t feel dead – there was a bright light in front of my eye, but not the one accompanied by Heavenly music. Rather the bright light had to do with what the nurse was doing to or in my eye. After a bit, the beeping recommenced, reassuring me that I had not died, or at least I was once again in the land of the living.
When she had positioned me properly on the table, settled my head into the rest and finished with the drops in my eye, she said she was going to help the person who had just had the procedure in the theatre out and then I would go in…
So, there I lay, eyes shut – with my head in the rest, aimed at the ceiling, hence there was nothing to see, and besides my right eye had shut on its own. Resting, anticipating, musing and pondering if I really should be having this procedure done… all a wee bit late in the day… but what else do you have to ponder and consider…
I heard the doors open and the nurse return. It was at that moment I realised that I was already lying on the operating table as I was directly wheeled into theatre, dirty shoes and all.
I can only see with my one functioning eye and then it is just the ceiling and lights – not the most intriguing and entertaining perspective on life. My table is wheeled in under the operating theatre lights and comes to a stop.
I can hear two men talking – well, one man talking rather authoritatively to another.
He was saying things like “you kept pressing on, you should have stopped” and “you need to be aware of…” and other corrective and instructive statements.
Corrective, instructive, and indicative that the person doing the previous procedure was not, er, ah, well, fully trained, or maybe trained but not yet fully qualified.
Not a warming, good thought in the cockles of my heart.
Moorfields Hospital4 are experts in eye surgery and cataract surgery, and are also a renown ‘teaching hospital’… A teaching hospital, yes, a “teaching hospital” which, er, well, engages in teaching – and that involves hands on experience for the trainee doctors… I hadn’t thought about that before, but I definitely was considering it then and there, on the table…
This all resulted in the natural and inescapable thought: “Yikes! Will I too, have some novice doing his first procedure on my one and only right eye…”
Then the authoritative speaking voice said, “Go and write up your notes”. The ‘other man’ was being dismissed – sent from the room.
That was encouraging, but, alas, there could be other novices silently waiting in the room, awaiting their turn to try their hand at this delicate and critical procedure.
Then a face came into view in my one functioning eye. He introduced himself and said that he was the ‘consultant’ who would be doing the procedure.
Immense relief filled me… the consultant, the instructor to the instructees, would be doing the procedure.
Very selfish I know, but I felt a strong sense of reassurance and, frankly relief.
He explained it would take between fifteen to twenty minutes for the surgery with the bulk of the time given to preparations.
I thought, “So much for ten minutes – in and out,” that I had heard and read about. I had already been in hospital for over two hours and they were threatening that I would be there for another two or three hours…
After the consultant conducted a series of checks, looking at my hospital bracelet on my right wrist, having me tell him my name and date of birth and also having me confirm what procedure I was having and to which eye and which lens would be applied. Then the consultant confirmed a bunch of things about the lens being employed and a myriad of other details that I could not begin to understand with other health professionals in the room (out of my very limited vision). He then excused himself to go and get ‘scrubbed up’.
A new pulse monitor had been fixed to my finger, but this beep was not as loud, I could not hear it very easily. And as part of the preparation, the consultant had securely tapped my head to the head rest – no movement possible. Hence now I could not turn and see the pulse monitor and in the same manner I could not see what my pulse rate was. Considering the operation that was about to take place, probably a good thing that I could not physically wiggle my head about.
Although I couldn’t see the pulse monitor, I could hear it – just – and I found it somewhat reassuring to hear the beep beep beep… however it was too low a sound… sometimes it was audible and others times not… a transitory reassurance – undependable.
I lay there waiting…. well-strapped to the table as I was, I couldn’t actually stretch my legs, nor do a runner could I.
The consultant returned and they all began to busy themselves around ‘the table’. A blanket was laid over my legs – the room was distinctly chilly, and a tray of something was deposited on my legs, instruments were being prepared.
“I’m going to put a sheet over you now” declared the consultant.
A plastic thing was then placed over my right eye. Now, as far as I am concerned, my right eye has been and continues to be closed. I can see nothing.
So much for, “you can’t see any details just a light”; for all I was aware, my eye was closed – I could see nothing, not even the ‘light’.
I did wonder when they would open the eyelid for the procedure… I wasn’t looking forward to that, but I’m along for the ride, they know what they are doing and it will be dragged open in the fullness of time.
The thing he placed over my eye seemed to have a large ring of flexible play-dough like material. I’m not saying that is what it was, just, that is what it felt like – I saw nothing. It completely surrounded my eye like a very large doughnut.
He pushed down on it and vigorously worked it, like if you were working dough or something like that – pressing it down on my face and making it conform to the unique form and shape of my face.
I had been told that when the eye is opened they spray a wee mist on it, to keep it moist, and this liquid can run off your face, and often into your ear – I was told to expect this and not be alarmed by it.
However, at the end of the procedure I came out bone dry, I can only assume that the round, pliable doughnut shaped thing that was firmly pressed and worked down on my face had conformed sufficiently to my face that not a drop seeped out to find my ear. T later recounted to me that the previous occupant of the table, she saw them in the recovery room, was soaked, not just her ear but hair, neck and down her back. Once again, I am very thankful for the consultant performing the procedure.
Back to the Theatre – what a strange name for the place where the procedure will take place – after the fitting of the round pliable thingy, an instrument was inserted on the right side of my nose, I assume either into the eye, or ready to do whatever it is that it does to or in the eye. Something was positioned above my eye at about my eyebrow line. I was very aware of various movements, motions and ‘workings’.
I’m still wondering when they will ‘roll up my eyelid’ to enable them to see what they would be doing, and hence I would perceive the ‘light’ and ‘shadows’ that I had been told about.
Yet, I could feel things ‘inside my eye’; sometimes still, sometimes moving, often just the presence or motion, sometimes there was a wee sharp pain.
So much for “no pain – you feel nothing”.
I felt something and it wasn’t pleasant.
Don’t get me wrong, there was no gut wrenching, out right PAIN pain, just the occasional, wee sharp prick that reminded me, if I needed reminding, that they were poking, prodding and well, mucking around inside my eye.
Then there was a sudden loud sound, a ‘Beep-boop’ followed by another ‘Beep-boop’. I have no idea what that sound means – but to my overactive and a little paranoid mind, it says “oh-oh, went to far” or something negative like that… kind of a warning sound. But, truth be told, I do not know what it actually means and as there was no “gasp” or reaction of any kind at the intrusion of this sound, it must have been ‘normal’.
They all calmly carried on without the slightest reaction – almost like they initiated whatever made the noise and fully expected it – unlike me.
For them it was normal, nevertheless, nevertheless, throughout my time on the time, and at various points, I became aware that my body had tensed up – all the muscles from my neck to my toes were tensed and tight, even my back arching slightly.
I’ve encountered this experience many times in the past, especially whilst reclining in the dentist chair. The whine of the drill filling my ears, the pressure and activity in my mouth and I would silently, without my conscious mind directing it, tense up. Every time I became aware of this tensing and tightening, I would focus on relaxing, take a deep breath, slowly releasing it, and all the while consciously relaxing all the tensed and tight muscles… until next time.
And so, I applied that technique here in the operating theatre. At every occasion when I became aware that I was tensed up and my muscles were tight, I would exhale, take a deep breath and let it out slowly, consciously relaxing all the tensed and tight muscles.
Every time I became aware of this natural physiological reaction to the stress of being in the operating theatre and the activity going on inside of my eye, I would focus my mind and thoughts, not on what was going on, but on the task of relaxing and breathing.
It has been noted that more discomfort is felt and the mind is more focused on any distress when you are tensed and tight. The opposite is also equally noted, that you feel less and are less aware of the distress and pain when relaxed. It is a matter of degrees, for you are still aware and there still is stress and discomfort – it is whether it is more or less…
It was a helpful goal and helpful technique to apply – especially on the ‘table’ as I was.
Then there was a new sound, a series of tones and a vibration. I heard the tones, and there was a sympathetic vibration in the back of my head.
I felt that.
“Ah” surmised I “we must be at the destroy the old lens stage”. I had been told and read that that was how the old lens was ‘broken up’ in order to be removed.
‘Broken up’ is a pleasant way to say ‘irrevocably destroyed’. There is no opportunity for repentance now, no changing of my mind – it is all in now.
“Ah,” I also surmised, “if we are at that stage, my eye lid must be open…”. And yet, I could still see no light.
Then, once again, the melodic series of tones and the corresponding vibration. And again.
Time for the relaxation technique – tensing, it seems, comes very naturally to this old man.
Then there was another sound indicating that something else was happening. No idea what, just ‘something was happening’. Maybe the ‘sucking of the broken lens’ out of my eye… don’t know for certain.
Following this I felt that some instrument was being twisted, like the winding of a watch like feeling and of course an accompanying sound.
Everything, it seems, has a sound, a beep or tones to it.
The consultant then informed me that there is some plaque build up on the lower side of my capsular – the vitreous sac that once contained my birth lens and is now host to my artificial ‘toric’ lens. This was not overly surprising as I had a posterior sub-capsular cataract. It seems the cataract was composed of layers of plaque and not all of it was broken up with the repeated melodious vibrations that I had earlier experienced.
He said he would try to polish it away, but as it was in a critical position, at the bottom, in the centre, there was a danger that if he went too far, it could pierce the capsular resulting in a whole range of complications that he informed me, neither one of us wanted, hence, he continued, he may not be able to expunge all of the plague.
I’m glad it is the consultant who knows when to stop.
He tried to polish it away as best he could – but some has remained.
I was then informed that it could either break up on its own and not be a problem, but if not, in about three months time it could be removed with a relatively common lazar treatment. The treatment could be done at a much later date, if it becomes a problem – but nothing could be done until the healing was complete and that was stated as ‘at least’ three months.
The cataract surgery has now been completed, gauze has been applied, the pulse monitor removed from my finger (no more beeping) and I was sat up on the operating table.
There followed a fuller discussion with the consultant about after care, what I would need to do and then I was helped to the recovery waiting room. I’m shambling along on my own, but assistance is literally by my side.
Once in the recovery waiting room, where T has been patiently awaiting my arrival, the duty nurse offered me a drink; tea, hot chocolate, coffee, cappuccino. I opted for cappuccino. He also offered a sandwich. It seems this is standard practice after the trauma of a procedure like this, and it is a trauma – minor on the scale of traumas, but a trauma none-the-less.
A hot beverage and some sustenance are extremely beneficial in the recovery period.
For many, their blood pressure will be spiked or often highly elevated and/or their blood sugar will either drop or go sky high.
He took my blood pressure and found it the same as was taken before the procedure began – that is to say, it was good with no change. He also repeated the blood glucose test and it, too, was very similar, lower actually, than the previous test but still in the good zone. As both were good, the nurse asked me how it was so. I explained my relaxation exercise whilst on the table and experiencing the wonders of eye surgery.
Minor and routine though the procedure is, it is still inherently a rather stressful experience and most people reflect that in their blood pressure and blood glucose levels.
After my recovery time, another nurse came with my prescriptions and explained their use and gave some other information and finally sent us on our way.
The one-eye man, with a eye patch and protective shield over his right eye, beginning a new chapter sans-cataract, was about to be chauffeur –driven home courtesy of my dear wife.
This rather routine, pedestrian procedure, which is nothing major, nor truly traumatic, has been done. But still, it took a lot out of me.
I was told that “I’ll be back to do the other eye”.
That was said before the procedure and I did not understand that as my other eye was, at that time, my ‘good’ eye.
Now, days later, with the patch and eye shield off, seeing as I am, in High Definition for the first time in a very long time, I understand that my ‘good’ eye is now my ‘bad’ eye. My former ‘good eye’ is now the eye that is effectively drawing down my over all vision.
I may very well have the other eye done….
… but not for a while…