Wednesday, April 3, 2013

So what the heck did they do to me anyway?

Since I've had some questions about it, and I can't sleep, and it's more or less officially been a week since surgery, I figured I'd provide a bit of detail about the actual procedure I had done neigh upon seven days ago.

The condition that I had - well, one of them anyway - is called strabismus, or a misalignment of the eyes. While this condition is annoying enough in and of itself, it can contribute to at least one of the other conditions I have, nystagmus, an involuntary jittering of the eyes. But more obviously, it causes a lot of confusion with my social interactions with people, as I regularly run into situations when people don't think I'm looking at them, or are confused by my appearance. I will get into the whole topic of living with my various eye conditions - and how they've shaped me as a person - in another post later this week. It'll be a doozy so it may take me a bit to complete.

The surgery I had done last week is alternately called "strabismus surgery", "eye muscle surgery" or "eye alignment surgery". I had it performed at the illustrious Massachusetts Eye and Ear Infirmary, though my surgeon was officially affiliated with Boston Children's Hospital, as it's much more common for this procedure to be conducted on children than adults. Typically they try to correct this kind of thing in childhood, but in my case they didn't, and my history with the medical profession related to my eyes is yet another blog post to come.

The specific procedure involves (good time to put down your lunch now) the following basic steps. First, a handy illustration:

No, nothing gory, but before you search for strabismus surgery on Youtube you REALLY should put away your lunch.

Anyway, the basic concept of strabismus surgery is to reposition the placement of the eye muscles so as to allow the eye to point in the correct direction. As far as this layperson knows, that involves the following:

1. slice through the clear outer layer of the eye (called the conjunctiva)
2. detach the muscles needed to align the eyes - my lazy eye drifted toward my nose, so they detached the muscles responsible for left-right movement, known as the "lateral rectus" as illustrated above
3. "loosen" or "tighten" the relevant muscles and reposition where they are attached on the eye to pull the eye in the right direction - in my case they "loosened" the lateral rictus on the inside of the eye (nearest my schnozzus grandius), and "tightened" the one on the outside
4. reattach the muscles to my eye in new places, allowing the eye to be aligned. They did this using dissolvable, adjustable sutures
5. stitch up the conjunctiva and send the poor sap on his way

Simple, right?

It does sound very brute-force in some ways, but remember this is being done on quite the microscopic scale by human beings with mechanical instruments. Steady hands indeed.

I was under general anaesthesia for the main event, which was actually the most nerve-wracking part of the whole affair for me. I am a wee bit nervous of being put all the way under, as I know it can have nasty side effects, not the least of which is not waking up, and I made the n00b mistake of reading up on general anaesthesia on the web, and anything called "medically induced coma" is not going to put my mind at ease. But statistically it's safe and so I sacked up and took the risk.

So last wednesday about 10:15am I rolled into MEEI and got checked in. I hadn't eaten or drank anything since the night before (save a small cup of black coffee when I first woke up, which they allowed). I got a slick - pre-heated - patient robe (yes, MEEI is a 4-star affair) and sidled on up to bay number 1. I lay out on a gurney and a phalanx of nurses and other folks introduced themselves to me. Eliza was there too, and one of them, while attaching leads to my body, argued that I was too skinny and that Eliza needed to make me a massive dinner every night. I encouraged Eliza to take their pedigreed medical opinion to heart. At this point I started to feel weird again, because, well, I was mostly naked on a hospital bed with wires attached to me, able to hear my own pulse from a nearby machine. My surgeon came in (names suppressed as I haven't gotten permission) and very kindly reviewed the surgery with me and confirmed I was good to go, and seemed genuinely excited about the whole thing. I love her. Then they wheeled me down the hall a la so many episodes of taut medical dramas. This of coursed caused innumerable associations to references to "Dr. Allcome" and various other hyper-realized medical emergencies, but hell I was strapped to a board and ready for ignition so I wasn't going to let a lifetime of pop culture give me the heebie-jeebies now.

They parked me in the surgery room, which wasn't altogether different from bay number 1, and put a nice blue bonnet on my head. The anaesthesiologist came in, stuck me with an IV, and said that I would start to seem very relaxed. I noted that I did...

... and then next thing I knew I was awake again.

It was done. And I was surprisingly alert, and enjoying my new view for the first time. It was blurry as I had no corrective lenses, but I could tell right away that my double vision, that frustrating clash of imagery that I had become so accustomed to my whole life, was different. The world seemed more dome-like somehow, as I was getting a wider view out of even my good eye.

My surgeon came in and did some preliminary tests. They had put in adjustable sutures, and wanted to know how well the aligned the eyes, and whether some fine tuning was needed. I determined that I still had a bit of double vision, and that when they covered my left eye, then my right eye, then my left eye, my eyes did move to focus on a point of light, so clearly some tweaking was needed.

Here's where the real fun began.

First, they asked Eliza if she wanted to stay. She said she did. They next said they were not responsible for her passing out. I assured them that she is tougher than I am (I enjoy calling her "pioneer woman" as she clearly could have settled the West by herself), and they proceeded.

They did not put me back under. They put in some "numbing drops" (quotes deliberate), and attached to my eyelids what can only be described as "clockwork orange eyeclamps". They then reached in with their tiny instruments, undid the stitch in my conjunctiva, and nudged the sutures around. I had the sensation of my eye being moved around like you'd move a camera lens, an odd sweeping motion, independent of my right eye.

And there was another sensation - stinging white-hot pain.

But I channeled my inner yogi and breathed through it, because they had tiny instruments in my eyes. I told them it hurt like a mofo, and they applied more drops.

How was I not completely freaking out at this point, you may ask?

a. they had tiny instruments in my eyes and I was afraid to move
2. it hurt like hell and I was kind of focused on that
d. it was all oddly fascinating and I had quite the close-up view

After a few minutes, they assured me I was doing an awesome job, and closed me back up. The whole thing took about 5 extra minutes. All in all, that to me is FRIGGIN AMAZING.

I was able to relax for a few minutes as they watched me closely. My surgeon did some follow-up tests and we confirmed that the alignment was improved.

After a few minutes I looked over at Eliza, and noticed right away that the bedrail seemed to ... loom closer to me. "Something's different" I said.

I did not want to hope, but I had reason to believe.

I put my hands in front of my face, one in front of the other. The hand nearest my face ... loomed closer in a way it didn't before. I switched hands, and started to giggle.

"Something's different" I said again.

As I continued to giggle, the nurse looked askance at me "ok, you're starting to freak me out" she said.

"No, this is good! This is amazing!"

Again, I did not want to hope for this. I questioned what I was seeing, but all I can tell you is that right away, in that moment, it sure as hell looked like closer objects were viscerally CLOSER in a way they hadn't been before. I WAS SEEING DEPTH.

In a matter of minutes I was out of the bed, clothes back on, being wheeled in a chair back to registration. That wheelchair ride was amazing, as objects, walls, ceilings swelled toward me in a new and magical way. My brain was going "TILT TILT TILT" as it tried to process it all. I stared around at everything, awestruck.

The revolving doors were astounding. The world outside forever (hopefully) changed.

We'll see, anyway. Ugh, inadvertent visual pun #136. I had wonderful depth yesterday, but as you can see, I am not having good sleep tonight at all. I've already been up for a few hours and decided to just get up and write for a bit in the hope that would tire me back out. Off to go see if it worked. But I will remember that if I do not have depth today as a result, it is not a failure, it is not a sign that it is gone forever. It is likely a sign that I should get some exercise tonight, drink a glass of warm milk before bed and do my best to set myself up to sleep well so the brain can do the critical work of processing all the new input and be ready to take it all in the following day.

And in closing, I would like to say that my whole experience with Mass Eye and Ear was fantastic. The staff were capable, confident, and also KIND, which is a label that not all medical staff get to enjoy. They were cool, and what they did for me is nothing short of a miracle in my eyes (ugh, pun #137), and I am forever gratified for their services and in their debt. I want to give my surgeon a thank-you present when I see her next week. Is that inappropriate? I thought something nice like a gift card for a dinner for two or something. I'll figure something out. Anyway, the whole thing was really a great experience, and I was home with plenty of time to go pick up Lyra at school. Totally amazing, it may as well have been drive-thru.

1 comment:

  1. Unbelievable. Amazing. Fascinating.

    Thank you for sharing the nitty gritty.