Don't look up

an experience of undergoing eye surgery

by Daniel Borgström

"Don't look up," Dr. Lee told me, "You'll have to keep your head down, your eyes on the floor for a week or maybe two weeks." He was speaking of the recovery period. Clearly, that was not something to look forward to. But it was the surgery itself which struck me as bone chilling, downright gruesome.

The surgical procedure would include the use of a laser beam, and the injection of gas into the eyeball. It was a routine outpatient operation, they wouldn't even have to put me to sleep. It would only require local anesthesia, and I'd be going home the same day.

"You mean I'll be awake while you're doing that to my eye?" I asked, doing my best to conceal my sense of shock and horror.

"You won't feel a thing," Dr. Lee attempted to assure me, again telling me that it was a routine operation.

Routine for the doctor, maybe -- not routine for me. I was thoroughly disturbed. The doctor showed me photos and illustrations; instinctively, I closed my eyes tightly; I couldn't bear to look at them. I should maybe say here that I'm squeamish about medical stuff in general, and this was totally beyond my comfort zone. Moreover, the necessity of such an operation was really hard for me to accept. For 73 years my eyesight had been reasonably good; I didn't use glasses except for reading. But as of very recently, beginning a few weeks earlier, objects had become blurry, it was like watching a movie that's out of focus. And it seemed to be rapidly getting worse. That was due to something called a "macular hole" in the retina of my left eye, a condition requiring surgery. A dreadful thought. Nevertheless, this surgery being what was necessary to save my left eye, my mind was quickly made up. I'd do it.

So, Dr. Lee scheduled the operation for March 3rd, several weeks in the future, and I went home to await the awful day. Among the first thoughts to pass through my mind was the memory of someone once saying that "for a writer there is no such thing as a bad experience."

Really? No? Well, consider this one -- that I was going to lie there fully awake while they poked needles in my eye, shot in a laser beam, and even injected a bubble of gas.

Nevertheless, I felt fortunate that this surgery was available. Fifty years ago it probably wasn't. Though hardly a pleasant experience to look forward to, the eyesight in my left eye would be saved, most of it, that is. Dr. Lee had told me that it couldn't be fully restored to what it had previously been, but it would be better. My eye would be saved.

As the weeks went by, friends and acquaintances told me of others who'd gone through similar eye operations and came out well. Eye surgery seemed to be fairly common in today's world. Everything I heard was reassuring, and as the dreaded day approached, I became somewhat psyched into an acceptance of the upcoming surgery.

Meanwhile, in preparation for recovery I needed to get a device with a special horseshoe-shaped pillow, on which I could lie face down. I also went to several libraries and borrowed a collection of audio books on CD. I might not be able to read, but I could listen. In the Oakland library I found the Carl Sandburg biography of President Abraham Lincoln -- 45 hours on 37 disks.

The day came. Virginia, my landlady, caring friend and micro-manager, drove me to the hospital and held my hand while we sat in the waiting room. In a few hours it would be over with, and she'd be there to take me home.

Then my name was called and I was led to a pre-surgery ward where a nurse introduced herself as Sylvia, telling me she was going to be part of the surgery team. Her husband had undergone such an operation, she told me, and had come out of it well. She was an up-beat, confident woman. Then came the anesthesiologist, a reassuring, encouraging sort of person who inspired trust, as did Dr. Lee.

It was, nevertheless, hard to be brave at a time like that. "This too shall pass," I told myself as they wheeled me down a hall and into the surgery room. There was all sorts of equipment around me and overhead. The anesthesiologist spoke to me as he got ready to apply the anesthesia. After a minute or two, the ceiling started to swim around.

I must've gone out for a bit. Gradually I became aware of myself. I was in total darkness, lying on my back, covered with blankets, my hands at my sides. Voices. I heard the doctors and nurses speaking from time to time, though not saying much. I guessed they didn't need to say much; they probably had it all down pat. I was totally awake by now; at the same time totally immobile. No pain; I felt nothing, absolutely nothing. It occurred to me that this might compare favorably to being in a dentist's chair. Well, in a way, but not really, because I knew exactly what was going on -- they were working on my eye, poking needles and whatever, a horrible reality to be aware of, even though I couldn't see or feel anything. Then a bright light filled the darkness; I guessed that must be the laser beam that they used to fix the macular hole. It lasted only seconds; then all was dark again. "Are they done now, are they done now?" I kept thinking to myself. I'd been told that the operation would probably take about an hour an a half. I wondered how much time had gone by. I so much wanted it to be all over with. And then finally I heard one of them say something to the effect that they were finishing up, and, moments later, it was over.

They rolled back the blanket, uncovering my face. I looked around, able to see with my right eye, as they wheeled me back to the previous ward. There seemed to be a patch over my left eye, the one they'd just operated on. A nurse introduced herself as Kathryn; she sat me up and asked me how I felt. Any pain? No. I didn't feel anything. She asked if I'd like something to drink. (I hadn't been allowed to drink anything since midnight the night before.) "Cranberry juice or apple juice or ginger ale?" she asked. "Can you mix all three together?" I asked. "Sure," she said; her cheerfulness was reassuring. We spoke for a bit and then she told me that now I had to start holding my head down.

Soon Virginia was there. She and the nurse helped me into a wheelchair and wheeled me out to Virginia's car. I sat there in the passenger seat, head down as we drove up one street and down another. I always like to see where I'm going, but of course I couldn't, and that was disconcerting. The gruesome part was over, now for the days of discomfort that were to follow.

Once back home, I lay face down on a cot, using the horseshoe-shaped pillow, and began listening to an audio book, the Lincoln biography by Sandburg. The position was not at all comfortable, but the book was well written and recorded by an excellent reader; it held my interest, somehow making the ordeal bearable. From time to time I got up and walked around the room, head down, eyes glued to the floor. That is, my one good eye on the floor and the other presumable did likewise. I could eat, with my head down of course; to drink I used a straw.

No pain. Hours went by and the anesthesia presumably wore off, but I continued to feel nothing. Then at around midnight I began to feel some very low-level pain in my eye. It was bearable, and even reassuring as it seemed to me that this was an awareness of my eye healing, the incision knitting itself back together. My body was apparently doing what it was supposed to be doing. I just kept my head down, listening to the audio, disk after disk. I didn't sleep much that night; it wasn't because of the pain, it was the terribly uncomfortable position.

Morning came. The low-level pain seemed to be going away. That afternoon Virginia took me to a follow-up appointment with Dr. Lee. He took the patch off, and asked me what I saw.

"A lot of light," I said, "flashing in from all directions, like a light show in a discotheque."

He scanned my eye through an optical device, and expressed satisfaction.

"So it's a success?" I asked hopefully. The doctor cautioned me that it was too early to say for certain, how well I'd be able to see. My next appointment would be the next Wednesday, a week later.

Virginia led me back to the car, which was parked just around the corner, only a couple hundred feet away. Face down as always, I shuffled along, feeling terribly helpless and vulnerable. Even getting into the car seemed to be a minor challenge.

Afternoon became evening. Some 36 hours since the surgery, 36 hours towards healing. I counted the hours as I lay there listening to the disks. Another night of face-down. The pain was gone by now, but the face-down position was as uncomfortable as ever, and I didn't sleep much that night either. I'd doze off for a bit, then wake up, replay the part of the disk that I'd missed while asleep, then briefly doze off again and wake up to repeat the process. I kept the disk-player on the floor by my cot where I could look down at it to change disks, using a flashlight. Finally the day began to dawn, light coming in the windows and announcing the arrival of morning. Soon it would be 48 hours since surgery, a full two days.

Virginia was making breakfast. I got up and was able to help somewhat, after all I did have one good eye, just that I had to keep looking down. I could not look up, not even to put in the eye-drops that I had to be applied three times daily. Virginia helped with that too. She'd take off the patch, and I'd open my eye with my head turned sideways, still looking down. It was like peering into the bottom of a goldfish bowl.

The goldfish bowl effect was because, as part of the surgical procedure, they'd injected gas into my eyeball, where it formed a bubble. The purpose of the bubble was to hold the healing parts together against the back wall of my eye while it healed, functioning sort of like a bandage, and that's why I had to keep my eyes on the floor. The laser incision had been made on the back of my eye, so in order to keep the bubble where it needed to be, I had to look down.

Sometimes Virginia read to me. Sometimes I listened to the radio, but mostly I listened to the audio book. Disk after disk, the days and nights and mornings and afternoons went by as I lay face down, immersed in the Civil War era, becoming acquainted with Lincoln's associates and contemporaries. The father of someone in the story was an old guy, so old that he was almost blind. Back in those days there wasn't much the doctors could do. Once again I was reminded of how fortunate I am to be living in the 21st century.

Later that day I was still thinking about that old guy when Virginia and I were listening to a radio news report about Congress discussing a plan to cut Social Security and Medicare. Congressmen often talk about cutting Social Security and Medicare, so the news was no surprise, but at that moment it hit me as especially disturbing, since, among other things, such a cut could deny eye surgery to a lot of people, leaving them to go blind.

"Keep your head down!" It was Virginia's voice, cutting in on my thoughts. I immediately returned my gaze to the floor, hoping I hadn't incurred any damage. It had only been for a second or two. It was frightening to think that in some unguarded moment I might forget to keep my head down.

For the same reason, I was even afraid to go to sleep, fearing that I might roll over on my back. That could be a worst-case scenario.

The Sandburg book came to an end sooner than expected. I went through those 45 hours pretty fast, so I started in on another audio about the Civil War. And finishing that, I went on to yet another. In this way that very uncomfortable week somehow passed, and it came time for my next appointment with Dr. Lee, who put me through the now-familiar battery of tests. My eye had healed sufficiently so that I wouldn't have to keep my face down any more. I could now hold my head up straight and look horizontally, at walls, doors, landscapes, though not up at the sky or the ceiling above me; for that I'd have to wait another week. Now the bandage could come off and I could begin to use my left eye again.

The gas bubble, which caused the fishbowl effect, had decreased in size, and now affected only a portion of my left eye, and, according to the doctor, should completely dissipate over the course of the following week. Until it did, my eyesight was limited to what I could see over the top of the diminishing bubble. It was like peering out through the porthole of a partially submerged ship.

Looking through my left eye, people in front of me seemed to be standing up to their necks in water. Then, closing my left eye and using only my right, everything reverted to normal. It made me feel like a circus freak. Wondering what my left eye might look like to others; I went to a mirror, but my eye looked perfectly normal, the gas bubble not being visible from the outside. The optical illusion was all in my head, in my eye, that is. I guess it would be quite appropriate to say that the unreality was in the left eye of the beholder.

Each day the "horizon" sank lower and lower, until, one evening, it was just a tiny round bubble at the bottom. The next morning, I woke up and it was gone. Totally gone. That didn't mean I was home free; I wasn't. There was a strong likelihood of a cataract developing in about half a year; and that would require treatment.

Dr. Lee had told me that my eyesight would never return to what it used to be. Expressed in numbers, the vision in my right eye was and is 20/25. My left eye was probably about the same before the macular hole appeared last year. By the time I went to the doctor, it had degenerated to 20/126, and probably would have gotten even worse. The surgery restored it to 20/60, a considerable improvement. Without the operation, I would've lost vision in that eye. Dr. Scott Lee and his team saved my eyesight. The result is that I can continue living a normal life.

April 16, 2015

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