If you hit wikipedia.org you can get a capsule definition of Strabismus that is close enough for Rock and Roll. And a squeamish alert as there are photos of my eye pre and post surgery in the posting.
Today, infants with strabismus and amblyopia are treated very young, often before their first birthday. In 1957 it wasn’t done, as the general prognosis was "He’ll grow out of it". Oh well.
The human eyeball has four muscles that hold it in place and move it around. Think of a globe of the Earth. The muscles that move it around are on the North and South poles and along the Greenwich and International Date Line meridians at the equator. It is an elegant machine for moving an orb around in specific patterns.
Mechanically, if you want to look to the right, the muscles relax and tighten in a specific order to move the eyeballs. You lean this set of actions in your first few days of life and it becomes automatic, as the infant eye and brain likes bright, moving things.
You can see this test being done with newborns, using a small light to see if the eyes track together. Infants can’t quite make sense of what they’re seeing, as the brain hasn’t quite figured out all this real world stuff yet. Sometimes newborns don’t track properly, but it goes away after a few days and is probably an artifact of the the various human systems getting used to being out in the world and trying to figure out the basics. The newborn brain learns stuff at a ferocious rate.
To square up my particular situation, lenses or prisms to force a correction would not work, as it had gone on forty-nine years too long. Surgery was the sole option. Unfortunately the surgery is declared a ‘cosmetic’ procedure and is almost not covered by health insurance. I could have gone to the US and dropped several thousand dollars for a cosmetic procedure, but didn’t.
Adult strabismus corrective surgery for cosmetic reasons is severely underfunded by health insurance in Ontario. I got on the waiting list almost four years ago. I’ve got no complaint there, as it is ‘cosmetic’ ophthalmic surgery. It’s not as frivolous as a bigger set for a pole dancer and not as important as fixing an infant with strabismus or a senior with glaucoma. I can appreciate that the funding well isn’t as deep as one might like. Priorities have to go to the serious stuff first. Last May I got the word that I would be up for surgery in March 2007.
Meeting the surgeon was important. I knew approximately, how the surgery would go. By judging the angle off square, the surgeon loosens one muscle and throws a few stitches in the other. In my case, loosen the left eye muscle next to the nose (East) and tighten up the muscle to the West by putting four or five stitches in it, shortening the length of the muscle and pulling the eyeball more forward. I was 45 degrees off square, pointing East, or inwards towards the nose.
Knowing the mechanism and procedure is important, but even so, I’ll confess to a deep fear here. You can call it a morbid fear if you like, as everyone has at least one, be it spiders, snakes, pubic speaking, circus clowns or Cream of Wheat.
Mine is my eyes. Having only one working eye, I have guarded it all my life, as losing it means White-Cane Time.
I’m sitting in a office with a guy who is going to be taking a scalpel to my eye? Holy Hannah and Maynard! I made sure I told him that the whole concept scared the hell out of me. Had I had a fully open choice, I would have opted for full general anesthesia. Knock me out cold, work me over with a ball-peen hammer and let me feel like crap in the recovery room for a few hours. I could get a general, but it would postpone the surgery until December 2007.
With a local, I was scheduled for March 22nd. Four days before my 50th birthday. That seemed to be some kind of omen to me, starting off the next half-century with straight eyes, so I put on my big boy underwear and said do it. Local anaesthetic, but be prepared to shoot me full of drugs if I start to panic in the OR. Agreed. Nitrous, Atavan, Valium, Jack Daniels’, Afghan Hash, or a mallet to the head, whatever it took.
The night before, I took this picture. The Before. I am looking at the camera lens, at least with the eye to your right.
This is what I’ve seen for 49 years, 360 days and what everyone else saw when they looked at me.
Well, not with the camera under my chin. That would be silly.
No coffee, no tea, no smokes as of midnight. I arrived at the hospital at 0700. The Riverside Hospital is all day-surgery, so I waited around a bit, and then was called into the back room. Strip off, wear the angel wings, blood pressure, checklists, pulse, sit here. I read for a bit, knowing that like all hospitals, unless you have a javelin stuck in your head, things take the time they take. After a chapter or two, it was my turn. On the bed, warm blanket, head back and get comfortable. They take my eyeglasses and book. I lay back and close my eyes to meditate a bit.
A gowned gnome comes over and takes my blood pressure and pulse again. He doesn’t bother introducing himself so I ask, "Who the hell are you and what are you doing?" It turns out he’s the anesthesiologist, Doctor Unpronounceable Muttered.
We have a little talk. First up, buddy, what is my name? He consults the chart. David Smith. What is my middle name? Eugene. What is the procedure I’m going to have? Strabismus. Which eye? Left. Are you sure? Yes I am. Who is the surgeon? Doctor Delpero. What’s the offset? 45 degrees. Good.
I want to make sure they’ve got the right guy and the right procedure, as David Smith is a fairly common name. The hospital is doing 38 ophthalmic procedures in six hours, I want to make sure they know who they’re doing and what they’re doing to this patient. Then we have the discussion regarding fear. The gnome stops in his tracks. He didn’t know I was fearful. So I explain it to him using small words and easy to understand concepts. He inserts a little venous shunt into the back of my hand and tapes it down. Then pops a syringe into the shunt and gives me a squirt of something.
Then he peels my left eye open and pops some ‘drops to numb your eye’ into the left eye. They sting like hell and I tell him so. Don’t worry, it’s just the first freezing. Then he swabs my eye area and cheek with an antiseptic, probably Betadine, as it has that iodine chemical smell. Then he takes a Sharpie marker out of his pocket and puts a dash over my left eye. That’s encouraging. I could truly run amok with a Sharpie and box of Hi-Liters.
I lean back. In a few minutes he returns. How are you? Scared Shitless, Thanks for Asking. I get another shot in the back of the hand. The drugs kick in. Wheeeeee!
An orderly comes by, looks up the chart and asks my name. David Smith, I manage to reply. He unlocks the wheels and gets me rolling down the hall. I park in the hallway, looking at the ceiling tiles for a while. Clunk and we’re rolling again, this time into a room with a stainless steel ceiling and too many lights.
Doctor Delpero greets me, wearing his OR blues and a mask. How are you? Right now, I’m starting to shake in fear and I feel some tears coming out of my eyes. Nnn-not so good, is about all I manage to stutter. I feel a pressure on my right hand as another shot of FeelGood goes in. Someone takes a length of tape and tapes my head to the table, forehead and chin, so I can’t move.
A pulse clip goes on my finger, while someone sticks cardiac monitors to my chest. They’re cold and I can feel the leads being hooked up. Then I hear the cardiac monitor beep and feel the blood pressure cuff inflate on my right arm. I didn’t even know it was there, such is the power of FeelGood into the back of the hand. For that matter I never noticed someone turning down my gown to put the cardiac pads on me. Only when I head the beeps did it register that I was hearing me.
Then, in a moment of exceptional weirdness, someone puts a Styrofoam box on my chest and tapes it down. I open my eye and look down. No word of a lie, it looked like the kind of Styrofoam clamshell box you get takeout lunch in, big enough for salad, a sandwich and dessert.
I laughed out loud and asked if they were taking lunch while working on me. It was explained that they can’t put an oxygen mask on me, as the doctors need the room to work, so the box has an oxygen feed line to blow on my face.
You ready? As ready as I’ll ever be. Doctor Delpero puts a length of opaque adhesive plastic over my face, more or less a square of shower curtain with Post-It Note glue on one side. I start to hum to myself and close my eyes. I hear a few things, like this will feel weird. At that moment he’s clipped my left eye open with a tool that looks like it came from the Inquisition, to give him room to work. I breathe into the weirdness.
There are whispered instructions between Delpero and his student who is doing some of the work. I feel pressure and a pinch as the freezing is pumped into my eye area with a needle. I breathe some more, but I can hear the heart rate beeps increasing. Since I’m reasonably certain nobody else is hooked up in the OR, that could only be me. You OK? Yessssss. I reply.
I can feel the side of my head going numb from the nose back to my ear. I’ve had extensive dental surgery before and I know that the freezing only takes a minute to numb it all out. I’ll feel pressure, but no actual pain. Here we go.
I hear someone ask for a hook and start to hum to myself again. I don’t want to know and try to conjure up some happy drug-induced images, but I only partially succeed. I feel pressure as my eye is pulled a bit, a hand on the side of my face. I hear a clipping sound, then a request for cautery and can see a hand pass over my now wide open right eye, with the shower curtain over it. I hear a little beep as the cautery iron works. Again please. Another beep. Damn. Not the word that you want to hear in the OR.
I ask, what’s up? Oh the cautery isn’t working right, so we’re going to get another one. Fair enough, I say. You still with us David? Yep. Right here. There is a momentary pause and a few beeps while the new cautery is fired up. I get hit again and hear a That’s better. A few more tugs and a few more beeps.
The plastic drape is starting to close in on my nose and mouth a bit, as the doctors work. I ask for a moment, explaining what is going on. The drape is adjusted and the Styrofoam lunch box is repositioned. I feel a swab over my left eye.
Ready for the other side now. I hear the request for the hook again and feel some tugging. Then a request for suture material. More tugging, just gentle pulling, as I breathe into it again.
I can hear the heart rate start to race a bit. Could I have another shot please? We can’t David, you might start to come up out of the drugs if we give you more, as there is a border between relaxed and then suddenly awake. OK. Then give me a second. I feel their hands move away from my face. I bring my knees up a bit, straightening out my back as best I can while taped to the table. A couple of deep breaths. A couple more. OK. Keep going.
A few more whispered requests then an quiet, Yep. That looks about right. OK David, I’m going to uncover your right eye and I want to see how they track together. Off comes the drape and I blink into the bright lights. Look left. Look right. Look up. Look down. My left eye feels like it is full of aquarium gravel and I notice tears in my right eye. I blink a couple of times. So? Looks good so far.
The drape goes back down and someone swabs the trail of tears heading towards my right ear. It would seem I am crying at least on one side of my head. There are a couple of more tugs, then a ratcheting click and a release of the pressure on my left eye. All done, I’ve taken the instrument out and now I’ll put a patch over it.
I feel my right eye well up again with tears as the shower curtain drape comes off. Someone swabs the tears away and I let out a little sob. You OK? Yes. I think so. Hands undo the Styrofoam lunch box on my chest. Others take the tape off my forehead and chin. I close my eyes as the gurney is rolled out. I choke out a Thank You. I’ve been waiting nearly 50 years for this. Thank you.
Trundled down the hallway to the recovery room, I get hooked up to the blood pressure cuff again. I close my eyes and and sleep for a bit.
When I wake up, I can barely feel half my head. My nose is still half frozen and my left eye itches like a son of gun, so I touch the gauze patch over my eye and press on it very lightly. It helps. An aide asks me if I want anything. Coffee and something to eat would be good. I get hospital strength coffee-related product and some kind of carrot muffin. I eat and nod out again.
Later, after snoozing for a bit and reading for a bit, Doctor Delpero comes in for my adjustment. What happens is he leaves two slip knots hanging out of my eye. With the freezing in, he can’t be certain that the lineup is bang on, but now that the freezing is almost out, he can adjust the slip knots to give me a precision alignment.
In the initial consultation I said I’d be happy with something close enough, as nothing is guaranteed. My example was Ellen Barkin, the actor, who is just ever so exquisitely off eye alignment. Not that I want to look like Ellen Barkin, so stop thinking that way, you dirty minded swine.
The patch comes off and I blink a few times. I can feel the suture slip knots on my cheek, which is a very disturbing feeling to be sure. Look up, look down, look left, look right. Follow the finger. He opens a sterile pouch of instruments and has me look around again. I feel one of the sutures tugged a bit as he tightens things up. I start to panic a bit, as this is a very weird feeling, but I breathe and relax, knowing it won’t take long.
A few more tugs, then a couple of snips. Look up, look down, look left, look right. Bingo. Bang on. A few lengths of adhesive tape and some gauze pads come out. Close your eyes David. A patch goes on and gets taped to my head. I’ll see you tomorrow at my office and we’ll see how it all worked out. He leaves me the instructions and a prescription for various things. I shake his hand and say thank you.
After another half hour, I’m released. Back in the hotel I take this picture. Call it The After
Yes, I know the patch should be black and I should have a parrot on my shoulder, but considering hospitals have no sense of humor, I did OK.
With the application of much medication, I sleep. Part the way through the evening, I notice something. I stare at the bedside light and cover my right eye with my hand. I can see light through my patch. I check again. Yep. Light and Dark. Holy Shit. I try not to cry, as tears have salt and salt in fresh stitches hurts. But I cry anyway. I can see bright light and darkness through an eye that I have never seen through.
The next morning I drive to Doctor Delpero’s office. I want to know if I’m just dreaming this, or hallucinating, or just full of wishful thinking. The patch comes off and Delpero shines a light in my left eye. I can see it. I ask if this is possible? It can happen, he explains. Perhaps the nerves are there and hooked up but since the brain couldn’t make sense of the image, it ignored it all these years. Now, with the image being closer to lined up, the brain is trying to make sense of it. Only time will tell if it develops into anything. By the way David, the lineup is right on.
I look in his mirror. I look like I’ve gone rounds with Mike Tyson, but that is expected and it will go away in time. The sutures will dissolve in four weeks and the eye will look a bit red for another few weeks after that.
So here’s the After II on Friday and After III on Sunday.
I’ll finish it up in the next installment.