December 2022: Cataract Surgery — Ready, Set

Disclaimer: There is no medical expertise or advice whatsoever in this story. It’s not meant to promote cataract surgery or anything else. Your surgical needs, precautions, pre-existing conditions, life experience, impressions, medications, and everything else may vary completely. Ask your doctor, not some language major.

Dedicated to Captain Wing (designated Grownup, surgery 1), and to Angelina (designated Grownup, surgery 2). 

__________________________

Before surgery, I followed a checklist.

List all pre-surgery, surgery, and followup appointments together copied to computer desktop, and printed out on the wall at home and the wall at work, with a copy for supervisor. Note them all as Away time in shared calendar, and payroll schedule. Print a binder for the office with FAQs that anyone might have. Set automatic replies to let everyone know I’d be off email for most of two weeks.

Print a “Cataract Adventure” binder with clear acetate page protectors to carry in to clinic. List date and type of surgery (and which eye to work on), Captain’s & Angelina’s contact information, parking garage and driving instructions, family contacts, primary care provider and other care team contacts, health history questionnaire sent to me by the clinic, insurance information, pharmacy information, religious affiliation, Do Not Resuscitate orders, and health summary (no, no medication allergies that I know of; no, no difficulty with anesthesia in the past; yes, neck has a full range of motion and can tip back; no, no chipped or broken teeth).

Clean house. Clear any fall hazards up off the floor. Clean off work surfaces. Take down pots and pans off their high shelf, to avoid pulling one down on my head.

Wash and iron all clothes.

Stock up all filtered water bottles.

Prepare a week of easy-heat low-inflammation fridge and freezer meals.  

Print out a schedule for eye drop prescriptions (two different medications on a staggered schedule for the two eyes for the next four weeks each.)

Print an envelope wrapper for my cell phone with my alternative contact information if found.

Dedicate a workspace just for medications, eye shield, tape, and pharmacy instructions.

Schedule LOTS of time to drive to the hospital. Text meeting place, time, and plan three times in advance to designated grownup. Email them driving and parking garage directions. Emphasize the option to cancel in bad weather, or if their families need them.

Leave behind office keys and office access card and any superfluous items in a special box on desk.

Pack information binder, and lots of large and small dollar bills and quarters for pharmacy and parking garage. 

Pack black glasses, orange tinted goggles to deflect blue light, and sun hat.

Day before:

Complete “e-CheckIn” function on clinic’s software.

Drink water. The team asked me to drink enough water the day before to be fully hydrated; they needed good hydration for easy access to a vein when they put in my IV.

Midnight, day of surgery: nothing by mouth; not a bite of food, and no beverages. The team emphasized NO milk, cheese, or other dairy products. (Captain Wing explained. In the OR when the team tips back the chair the patient can experience acid reflux, and dairy makes that a lot more uncomfortable.) 

Morning of:

Check the weather for winter warnings. Call and email clinic in case they need to close. (When I called, the clinic let me know that they never close.)

Spread out blanket roll and pillows all ready for immediate rest time upon return.

Bring water and snack.

Meet neighbor outside at the meeting place 15 minutes early. (Both Captain and Angelina made a point of being right there 15 minutes early too, with the cars running and all warmed up. Or maybe they were parked out there all night? Who knows?)

On the way to surgery, chill out and cash in some trust in the universe.

The night before both surgeries I woke up often to check how many hours ’til alarm time, and to read bulletins from the National Weather Service. Our winters are extremely mild, with only regular soft rainfall, so scheduling them for December seemed reasonable. But our city completely shuts down in wintry weather, and all night the forecasters couldn’t tell whether we would get black ice and sleet, or six to ten inches of snow, or nothing. That left hours of time to sift through various discouraging thoughts like these.

  1. If I were a reasonably loveable person, I’d have a family of some kind by now. They could come with me. I wouldn’t have to ask for this huge favor from wonderful neighbors who have families of their own to care for and had to take time off for this.
  2. What if the weather gets worse? We’ll have to cancel. Then the surgery team will say “Forget it. You disobeyed our instructions. Now we’ll have to kill you.” (I don’t really think that is how surgical teams view the matter, but that inner program concerning authority figures is pretty well entrenched.)
  3. Or, the surgery team might say “Forget it. You cancelled on the day for a 9:00 am surgery, so we’ll cross you off our Good Standing patient list and will operate only on other people. Even if we ever do let you back, when we operate on you we will not be in a good mood.”) I don’t think that’s what hospitals say either, but the OR turnover for this rapid surgery is so precise that the team won’t like just standing there with a time gap.
  4. Or, we might drive there and the car might get stuck in bad weather or in a fender bender and it’s all my fault.
  5. Or, somebody might snatch my knapsack with my cell phone, ID, and keys, right out of the arms of my good neighbors in the waiting room!
  6. Maybe after two weeks off, the office won’t want me back. (Spoiler: They did. It was fine.)

It was sobering too, to ponder how much Privilege is wrapped around this surgery. It takes proximity to a good eye surgery center, a job with insurance and sick leave, a safe place to sleep and recover, washing facilities for keeping everything clean and sanitary, neighbors to drive, text and email access for the many clinic alerts, and enough mindfulness to follow all the physical restrictions during recovery and to log two medications on two staggered schedules for two eyes. 

At last, it was morning for Surgery 1. We were breathtakingly lucky with the weather. The worst of it either held off for the next several days, or passed right by.

Captain Wing’s crack starship-level rush hour driving was a treat. The excellent car stereo played a fascinating mix of modern Chinese hits. All of them were strongly cheery, and lavishly orchestrated. Each note and beat sounded flawlessly produced. I even recognized a few words, such as Wo ai ni, or “I Love You.” 

Then, a completely new vocalist swept in. Her voice was not only perfectly recorded, but had a naturally stellar command and tone. “Say,” I cried out. “This Chinese vocalist is really fine!” Captain Wing was uncharacteristically silent for a moment before tactfully explaining “Because she’s Sarah Brightman.” (I hope I did not hurt his feelings. With a few buttons and dials he smoothly swapped out the mixed musical menu for an all-Sarah program of opera and lighter music.) 

The song was Sarah’s cover in Spanish (not Chinese) of “Tú” (Tú, sin más porqué, Tú que bésame…), by composer José María Cano. One of the striking moments of the song was Sarah hitting a clear pure high note and holding it, while the melody line fell in plaintive unusual intervals. The music is copyrighted, but here is just a morsel with the interesting key signature and that striking second measure with falling notes:

Where else had I heard falling notes in a pattern like that?? It was a real rest for an apprehensive mind, to just gaze out the window at the early morning sky and the soaring bridges and skyscrapers, and to let the memory tick back over many many songs, fitting and re-fitting that template for a good match. Finally the answer surfaced from the 1970s. It’s “Look at the Moon” by Gerry Rafferty, and those lush beautiful chords falling at the end (complete with recorded fox bark). Solved!

The cataract surgery team was absolutely wonderful. Despite all the stresses at a regional trauma center and the added workload of the pandemic, their morale was superb. After all, their OR handles only relatively fortunate patients, for elective advance-booked non-urgent surgery that is over and done in minutes, with low risk and high revenue and dramatically positive outcomes. Hopefully the financial gain to the hospital gives the team some well-deserved job appreciation. Clearly they all enjoyed working together, in synch and in touch as they maneuvered their own checklists. They completely supported their surgeon, and he in turn was clear about voicing his appreciation for them and giving them all their due credit. They caught on that I was open to good humor, and engaged in gentle delightful banter with me and each other.

“So how sedated will I be?” I asked the nurse anesthetist, as she installed my IV. The clinic had been non-committal about this question, since every patient is different.

“Not at all,” she cheerfully explained. “This IV has no needle, so you can flex your arm; we put it in only for emergencies or in case you decide that you do want sedation, and then I’ll administer it right away. I’ll be right beside you the whole time.”

(Wait, what? Really? People just sit still with a scalpel coming at them?)

“You will have plenty of local anesthetic,” she assured me. “There will be pressure at one point, but you should not feel any pain.” (She was right. There was no pain at all.)

The team administered several kinds of eye drops. They applied adhesive electrodes, and tucked me in with a heated blanket. Then they wheeled me in to the OR, and clipped on an oxygen cannula. “You will have plenty of air to breathe under the drape,” they promised. They confirmed for the last of many times who I was and my birth date and which eye they would work on and why. Then they swabbed around my eyes and applied a large upper-body adhesive drape leaving only the eye uncovered. The surgeon greeted me and gently taped open my eyelashes, then fitted on an eyelid retractor to keep the eye open. (That had seemed a disturbing prospect, but fortunately a constant wash of cold silvery anesthetic took the place of tears and numbed the eye completely.) My hands were shaking from nerves, but really all one had to do was stare into a microscope lens and keep the gaze steady through a shifting wave of colors, shadows, and lights while the surgeon talked me through the procedure. The room was full of interesting tones: vital sign monitor, the sizzling whir of the machine pulverizing the cataract and aspirating it out. In one moment of pressure the new lens was fitted in. I breathed very slowly and steadily, counting each breath with full attention, sending thankfulness and appreciation to the surgical team. At deep breath number 166 the surgeon said “Done,” and peeled off the drape. They tipped forward the chair, and wheeled me back to the recovery room to remove the IV and electrodes, tape on an eye shield, and give me a team chat about medications and physical safety.

In the waiting room Captain Wing stood at attention, holding my knapsack out for me. He was ready to calibrate my balance as I minced along to the elevator, down to the very kind and overworked pharmacy staff. (With my Ofloxacin eye drop prescription, labeled “Patient speaks ENGLISH,” the staff included paper instructions. They were for Omeprazole, a GI tract medication. The instructions were in Spanish, perhaps as a tribute to composer José María Cano.) Then Captain stepped aside for a word with the main street reception desk. By the time I stood there ogling around with one eye and caught on that he was handing in his ticket from the parking garage, he was all paid up and escorting me to the garage elevator for the car. After I arrived home and got into bed, Mrs. Wing contacted me with an offer to bring me dinner. Fortunately I was able to assure her that the fridge was stocked up.

In the Tom Hanks film Sully: Miracle on the Hudson, when everybody braces for impact the flight crew chants “Get down, Stay down!” That made a pretty good motto for that day: Rest in dim light, get up only to tip down the eye shield and take the drops, re-tape the shield, write down the time, and back to bed. Stay off the internet, and phone screens. Rest both eyes in dim light for the first couple of days.

Through the eye shield there were very strange silvery flashes of a clear brave new world. But exploring that was an adventure for the following day.

Next up: Day 2.

About maryangelis

Hello Readers! (= Здравствуйте, Читатели!) The writer lives in the Catholic and Orthodox faiths and the English and Russian languages, working in an archive by day and writing at night. Her walk in the world is normally one human being and one small detail after another. Then she goes home and types about it all until the soup is done.
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