Thursday, July 01, 2010

The strabismus surgery

The brain brain aneurysm started about 6:30 p.m., about 5:45 minutes after I woke up from the anesthesia in the recovery room. It felt as though a though there was an oxygen cylinder in my head and it was slowly leaking, causing my head to expand. The accompanying nausea made it worse, and forced me to toss and turn on the couch.

My 11-year-old son had a baseball game and my wife was just about ready to leave, and I made sure she gave me a couple more Vicodin before she left. I knew I just too 2 four hours ago, but the directions said every 4-6 hours as needed (PRN) and I was going to take advantage of it. She also gave me a phenergin pill for the nausea.

About 15 minutes earlier Crystal woke me from a nice 2 hour nap, which to me is not normal unless I worked the night before. I usually don't take naps because when I do I don't sleep at night when I'm supposed to. Yet today that surgery, and the effects of the anesthesia, was my excuse to snooze. She probably wouldn't have awakened me, but I said she could if KK, my 7-year old girl, wanted to stay in the neighborhood and play with the neighbor girl.

So here I was lying on the couch listening to the accustomed sounds of sub division: the yelling, the crunch of plastic bike wheels on pavement, the occasional slamming of a door, the occasional bark of a dog, and the whooshing of cars. And now that my wife was gone, and the house empty, my head was ready to explode.

The ironic thing was that while my right eye felt a little prickly and a tad bit itchy under the patch, I really didn't feel any pain there. The pain was the rest of the head. While the cause might have been the eye, I had a distinct feeling I was having a major hangover from the wearing out of the anesthesia. I lied on the couch, mostly on my left side so I didn't put pressure on my right eye, and placed a shirt over my head to block out light. Yet I just couldn't get comfortable.

It hurt so bad I couldn't snooze. I wanted so bad to get up and take another Vicodin, yet I didn't think I should -- or at least a phenergin.

My daughter came in about 8:00 as she was instructed, and I told her to take a shower and get ready for bed. Also said, "You have to stay inside and help me. Remember," I said, my voice barely audible as my mouth was dry as a cotton ball and my throat a bit raw from the intubation, "A few days earlier when you were sick I stayed up all night with you. Here's your chance to spoil your daddy."

"But daddy," she said, "I want to play with Alisha. He bed time is 8:30, so I'll come back then. Under normal circumstances this would not stand, yet these were not normal circumstances.

"Well, go ahead then!"

An hour passed and KK did not return. I wanted my wife, my own personal nurse, home. You know how us guys are when we're not feeling well: we like to be coddled. Yet what I really wanted was for her to come home and say it was okay to take another Vicoden.

The door opened. It was Crystal, "Well, Lany never stopped crying the whole first two innings. I felt bad for Jordan because I couldn't watch the game, I had to breast feed instead. So I figured I might as well come home."

"Why was she crying?" It was a rhetorical question

"Well, she didnt' get a nap today."

I think the real reason Laney was because babies have telepathy, and my Laney new I had a headache. After Crystal left and came back from picking up the boy, I strolled right to bed thinking I'd fall asleep. That never happened.

At 11:00 p.m. my personal nurse came in with some vicoden and a cup of water. She slipped in next to be and started rubbing my back.

"I never heard the kids come in," I said.

"That's because I told them to be quiet."

"That's rare that they listen," I said. It shows they can be good when they choose, I wanted to say, yet the words were stuckf floating among the air billowing around in my brain.

I arrived at the surgery center before my scheduled time of 9:30 A.M. and was immediately in with someone answering questions. Unlike our own hospital, they didn't ask me the same questions I was asked over the phone two days earlier. That was nice. And five minutes later my wife and I were lead to a recliner in the surgery preparation room by a young lady carrying a clipboard who said she was my helper. I do not remember her name.

She set the clipboard on the counter top to my right, and gave me a gown and told me to take everything off except my undies and "put on this gown." She left and I did as instructed. When she returned she picked up the clipboard and said, "So, it says here your RIGHT eye is being operated on. Is that right?"

She left and moments later a nurse's aid whose name I don't recall came in. The first thing she said was, looking at my wife, "Wow! When are we due?" After a brief chat she asked me tons of questions, ending with, "So, we are operating on your right eye?"

She took my blood pressure: it was 155/88, high for your humble RT. She took my blood pressure: 78, high for your humble RT, although in normal range.

Then anesthesiologist #1 came in to ask a few more questions. I don't remember her name either. She looked in my mouth, and I said, "Is this an LMA mouth or an ETT mouth?"

She said, "I'm not going to be taking care of you in surgery. Another anesthesiologist will do that. I'm just checking. "It says here you are going to have surgery on your right eye. Are you in agreement with that?"

A nurse came in next, and the first thing she said was, "When's the baby due?" Once again this set off a nice discussion, and it ensued until she was ready to insert my IV. "I'd rather have an ABG than an IV," I said.

"Really? I'd think ABGs would hurt worse," she said.

"I had an IV put in at the same time an ABG was being performed once," I said, "and I never even felt the ABG."

"We are operating on your right eye, right?"

Moments later anesthesioligist #2 came in. "We are operating on your right eye. Am I correct," she asked. He looked at my mouth. When I was finished, I said, "Are you going to use an ETT or an LMA?" She smiled in a way that indicated it was a question she never expected from a patient.

The doctor was next. "Are you in agreement we chose to operate on your right eye?" I agreed, and he took a black marker and marked over my right eye.

Another nurse came in. "I'll be your nurse during the procedure. We are operating on your right eye, right?"

"Just think right," I said.

Finally I was alone with my wife. White coat fever in full force, and my vitals proved it.

I walked to the cool operating room, and the doctor was sitting at the back of a bed all smiles. I do remember his name. There were 5 or so other's in the room. I hopped on the bed, was covered with a few warm blankets, and the anesthesiologist placed a mask a few inches above my head, "It's just oxygen," she said.

"Do you ever use gas to knock people out anymore," I asked, "or just IV stuff?

"We only use gas on kids."

"I remember that. In fact, I think that's what made my pukey after I woke up."

"You had this before?"

"Yes." I could feel the tingling now. I figured I'd be going out pretty soon. I would keep taking until I was out, which is out of character for me because I'm usually taciturn.

"And you have experience with nausea?"

"Yes."

"Have you ever had another surgery before. One not on your eye."

"Yes. I had this one three other times, and I remember being sick all three times. And in 1993 I had nasal septal repair. I did not get sick." My voice was starting to echo in my head. The medicine was working.

"Did you wake up nauseous for that one

"No."

"That's because for some reason when we operate on eyes and scrotums people tend to get nauseous."

I could hear my wife saying, "Don't say that to him." She wants me to get the big V.

That's my last thought before waking up. The blood pressure cuff was going off. I could feel the prick of my right eye. "What's the pain level," she asked. He name was Kathleen. I remember it, but only because I asked her 3 times.

"About an 8." It was purely subjective. I couldn't say 10, because to me 10 is so bad you can't sit still and scream. In fact, if you go by that measure, I was probably a five. Yet I didn't want her to be conservative with the medicine.

I could feel the blood pressure cuff squeezing my left arm again. When it was done I asked, "What was it?"

"Diastolic 100. The doctor said your young enough I can give you labatolol." She did, and the next time the cuff went off she said my blood pressure was 108/58. She said that was good, but to me it was low. I could really feel the tingling in my blood at that point, and as I tried to speak my words were drifting off.

"How long do I have to stay in this room." I was asking too many questions, although I was feeling great, like warm and tingly great. I could feel myself drifting off.

"Just until we have your blood pressure under control. I think it has to do with pain, so we have to get that under control."

"Take a deep breath," she said. Her voice coming from the distance. "Your sat is only 88."

I did, yet she repeated herself, "I need you to take in a deep breath. You probably know all about that."

I did. And I know that taking in a deep breath will only increase a sat while I'm taking in the deep breaths.

I felt no pain. And all the way home I felt no pain. I mean it felt awkward with a patch over my right eye, yet no pain. We stopped on the way home to pick up the kids from my mother's house, and I never even left the car. I had a blanket over my head, and all the meds in my body wouldn't let me move.

I heard a rap on the window. I waved, yet it was a feeble wave. I heard my 1 YO say, "Daddy, eye." The right home was abnormally quiet. Once home I felt great, and I was able to eat a couple pieces of toast.

The phone rang. It was 2:00. I picked it up. It was the doctor who poked my eye a few hours earlier. "Most people like to just lie around the first day," he said.

"I feel pretty darn good, considering. Although I don't have my hopes up based on my history."

"That's great. You can keep the patch on over night, if you want. I gave you antibiotis that should last 24 hours, so that should be okay.'

"I'll probably do that," I said.

"Your surgery went pretty good. Considering you had this done three other times, your muscle was still pretty intact. There wasn't much scar tissue. I think things went pretty well.

I took a nap, and when I woke up the oxygen tank in my head made it feel as though there was a herd of elephants in there.

Overall, I'd have to say I'm pretty impressed with the surgery, although it's only been 24 hours since my admission time yesterday. Other than the headache last evening, I've felt pretty good otehrwise. My eye feels a little weird, and uncomfortable, so I can see why a kid having this surgery might be a challenge as this guy wrote.

I had the surgery when I was 2, and my mom said I had a patch and was agitated by it. When I was 10 I had it, and I remember wanting the patch off, and the nurse took, it off, and then I insisted it be back on. I guess when you're uncomfortable you want to do something different, so this time I just left the patch on knowing it wouldn't feel any better with it off.

So, in this regard, I can see it's a much better expericne as an adult than as a child. Yet, I would highly recommend getting this done as a kid. Not being able to see properly can have its negative consequences. Whether you or your child as intropy or extropy types of strabismus, it's worth it to get the procedure done -- however annoying the post operation period is.

However, basically, you're loaded with so many good medicines the discomfort really isn't too bad. And it gives you an excuse to take a few days off and loaf around and sleep.

Overall I'd have to say it was a pretty positive experience. I was really impressed at all the people who saw me at the center, even while it was only a few moments for most. They all made doubly sure to recheck what I was having operated on. They all wore smiles. They all made what was a nerveracking experience not so bad.

Customer service is something Shoreline Medical works on with new employers, and then we are reminded in monthly meetings. Yet I imagine the screening tests we undergo before we're hired pretty much screens out the folks who wouldn't fit in.

And, as Kathleen noted, "Good customer service is probably a product of us all really enjoying our jobs."

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