Cornea Transplant (Part Two)
Aug. 29th, 2013 08:57 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
maychorianThis part is even longer than the first one.
After the laser cutting, I was so exhausted I could barely keep my eyes open. Part of it was because I'd only gotten about two and half hours of sleep the night before (anxiety is a bitch), but most of it was the adrenaline crash. After taping another shield over my left eye, the techs put me in a wheelchair to go to the surgery center, because even walking could jostle my eye in a bad way. My dad was with me. I signed a bunch of paperwork. And then I sat in the waiting room of the surgery center. Dad tried to talk to me but I couldn't muster the energy to understand him. My head nodded but I forced myself to stay awake. My left eye began to tear, then to ache and hurt. I tried to see through it but couldn't make sense of the information. The numbing drops had worn off. All I wanted was for someone to put in some more. The wait seemed interminable. Somebody else who was waiting in the room (a family member of another patient getting cornea surgery, perhaps) was snoring in the corner.
Finally, a nurse opened the door and called my name, and I was wheeled into the surgery center. The main room I entered had beds on several walls. They asked me if I needed to go to the bathroom, but I said I was fine. I was still struggling to keep my eyes open. The nurse was asking me medical questions, if I had any heart disease or other conditions, cancer, and so on and so forth. I answered as best I could. I signed another piece of paper about the surgery. At the top was a line in which was handwritten the precise kind of surgery I was getting: "anterior lamellar keratoplasty." The nurse explained to me what was going to happen, like the tech had before, so I would understand it all going in.
I really can't explain how much I appreciated that.
Dr. Price and the surgery techs had discussed with me at length what was going to happen during the surgery, but when it came around for real I was tired, anxious, and having trouble following what exactly what was going on. Having someone there to talk me through it all helped to give me a feeling of control, even though I truly had no control at all of what was going on. I knew that the doctor was going to attempt what they called "partial tissue" cornea transplant instead of "full thickness." This meant that instead of removing the entirety of my bad, distorted cornea, they would leave a thin layer of my own cells to graft to the donor tissue. This would make the graft much stronger and cleaner, especially since we were using a laser to cut both sides, and I would heal quicker and stronger with less chance of rejection. I would have to use anti-rejection medicine for many months, but not for the rest of my life like I would with a full cornea transplant. I was really hoping this plan would work out. I was also aware that my cornea was extremely thin and scarred because of my long-standing condition, so the partial tissue surgery might not work and the doctor might have to "convert" to the full thickness transplant on the day of. So yeah, there was plenty of anxiety to go around. But everyone who had contact with me at the surgery center were very calm, very professional, and very confident. On the actual day, during the actual procedure, I had no time to worry about any of this. Mostly I was just trying to stay awake.
So I got into a hospital gown, stripping from the waist up and putting my shirt and bra in a bin (I was allowed to keep my skirt and even my shoes), and got into the hospital bed. The bed wasn't mechanized--a nurse turned a crank at the foot to raise or lower the head. I was hooked up to a nasal cannula, a blood pressure cuff around my left arm, a pulse oximeter on my right index finger. Really, the least strange thing was getting the IV in my right hand. I told the nurse that I used to give blood every few months, so that little bitty needle was nothing. I had a net cap over my hair and booties over my shoes.
As had happened the day I had my exam with Dr. Price, I was one of their youngest patients. Most eye problems show up later in life. The lady in the bed next to me, the folks in the waiting room--most of them were probably in their sixties. It just so happens that keratoconus is a young person's disease--it typically shows up in adolescence or the twenties, worsens for awhile, then stabilizes. It's often in both eyes, usually with different amounts of severity. No one really knows what causes it, though there's definitely a genetic component--my brother Peter was recently diagnosed with keratoconus in one of his eyes, though it's nowhere near as bad as it is for me in either of my eyes.
I had already been informed that I would not anesthetized for the surgery itself, but beforehand for ten minutes when the doctor would prepare my eye. Rex had also told me that I probably wouldn't remember the surgery itself, which would take forty-five minutes, because of the drugs I would be under. I do remember some of the OR, but I'll describe that later.
Dr. Price came to my bed to see how I was doing and reassure me that everything had gone fine in the laser room and so on and so forth. I was still having trouble keeping my eyes open. He asked how I was and I said that I was very, very tired, both because of the laser and because I hadn't slept well the night before. "You've been worrying about this?" Dr. Price asked, and for some reason that made me choke up. I nodded and he patted my foot, still in its booty. He said that they would take good care of me and they were going to get me to see again. I think I said something along the lines of "that would be great."
The anesthesiologist introduced herself, just like the nurse had done before, but I can't remember their names. Dr. Price said now was the time when they told patients to think about a happy place. He said one patient had said that this was a happy place for him, but another one had said that Hawaii sounded better. "So where's your happy place?" he asked me.
I was already fading out. I knew the anesthesia was running already. I didn't have time to think about it much, but as soon as they said "happy place" only one place occurred to me, a place would much rather have been at that moment. (More than once the night before, and on the way down, and during the whole laser procedure, I thought that I wished I could say I had changed my mind, I didn't want cornea surgery after all, I just wanted to drive to work and treat this like any other Monday.)
But I told Dr. Price, "At home with my cat, Murphy."
He sounded pleased and amused. "Oh yeah? What does your cat look like?"
"He's dark gray with black stripes. He's very friendly."
And the next thing I knew, I was waking up. I twitched my shoulders and a nurse immediately came over to ask how I was doing. I said I was cold and she got a blanket for me, and also fetched my dad to come sit with me. I was actually much more awake than I had been before the anesthesia. At least I could keep my eyes open. Or one eye, anyway. My left eye was blocked with a device. I never really got a good explanation of what that was for, or what it looked like. Or someone probably did explain it, but I don't remember it.
So we waited for awhile for the patient before me to be done with their surgery. A forty-five minute procedure, just like mine, and I was awake for thirty-five minutes of the wait. It didn't seem like that long, though, at least not in my memory of it. Dad and I chatted. I wasn't as freaked out and exhausted as I had been. I don't know if they were already giving me the drugs in my IV or if I had just calmed down on my own, but either way it was much nicer. I felt some dread about the surgery, knowing that I would once again be awake and be expected to keep my eyes open and relaxed, but I had been assured many times that the laser was the hard part and the rest would be easier.
Mostly I just felt the way I often do right before I wake up, when I'm aware that I'm dreaming but not yet ready to open my eyes. I have that feeling of sleep paralysis, unable to move even in the dream--so it's different from lucid dreaming, in that way, because I'm aware of what's going on but unable to control it. Sometimes I find those dreams disconcerting, because I'm trapped in whatever situation the dream has left me in, but more often it's just a comfortable sort of warmth and heaviness. Sometimes in the dream I'm even laying in a bed, and then when I wake I'm in bed again. Anyway, this period of waiting felt like that--I was entirely unwilling to move even so much as to twitch my fingers, but I was not uncomfortable or upset about it. I was feeling no pain.
So after awhile the time came for surgery. They unhooked all my cables and piled them on top of me, then wheeled my bed into the OR. In a dreamy sort of fugue, I watched the top of my IV pole as it passed under the double doors into the hallway, slightly amazed that it hadn't even brushed the top of the frame, but then thinking, "Well, of course, they wouldn't have IV poles that were too tall for the doors."
In OR, the techs started hooking up all my monitors and such. I said I was cold, and they said they would set everything up, then cover me up. Somebody put one of those nasal strips on my nose. And then the next thing I knew. Dr. Price was telling me not to go to sleep, and I struggled to open my eyes. With my right eye, I was looking up a white rubber sheet placed over the top of my head--it reminded me of a getting a filling at the dentist. Information from my left eye was...confusing. My hands were outside of my blankets and they felt like blocks of ice, like they'd been out for a long time.
"My hands are cold," I said. I expected one of the techs to cover me up, like they had promised. But Dr. Price just said, "That's okay, as long as your heart is warm," or something like that, I can't remember exactly what it was. I realized later that this was already the middle of the surgery. Like Rex had told me, I must not be able to remember the first part.
But at this point, I was awake, and Dr. Price kept telling me to stay awake. My eyes would start to drift and I'd get the flash of a dream, the way you do when you are very, very tired and finally drifting off, and then his voice would come and I would force my eyes open again. That happened probably half a dozen times. The flashes of dream were very weird, like they always are--cartoon animals and nonsensical situations and snatches of stories and songs that don't exist. I wish I could remember them.
Finally, though, I managed to keep my eyes open and pay a little more attention to what was happening. Like I said, my right eye was staring at a rubber sheet directly above me, yellow-white. Sometimes I could see movement beyond it, someone's hands holding instruments, shadows on the wall of my tiny plastic cave. But weirdest of all was the irregular spot of color that kept appearing in the middle of the off-white sheet, moving and bending, like looking through a dot of water kaleidoscoping into colors and patterns. After awhile I realized that this was what my left eye was seeing.
I remembered that Rex had said I wouldn't remember what happened in the OR, so I was suddenly determined that I would NOT forget this. The surgeon's hands would dip toward my eye, and that wad of clearness and color would bend and fracture with the movement. I realize now that this must have been when he was putting in the sutures. At the time I had no explanation for what was going on. The spot was clear, then lavender, then the point of the instrument would invade, bending it down, turning the irregular oval into an egg shape, and then the point would retreat and the spot would turn back into a pool of watery light. I wasn't scared at all for this part, which I'm sure is because of the drugs. I was just sleepy, and fascinated, and trying very hard to keep my eyes open and my mind engaged.
Eventually it was done, though. The rubber sheet was removed and my left eye was covered. Dr. Price patted my shoulder and said everything had gone perfectly. I might have blinked or murmured in response, I really have no idea. I still haven't even seen Dr. Price with a good vision--the first day I met him I had been without my contact for two weeks so my corneas would be in a natural state for the all the tests I needed to have done, and this time I wasn't wearing my contact, either. So my impression of him is rather blurry, but very nice.
They wheeled me back to recovery and offered me something to drink, but I really needed to go to the bathroom more. And then it was probably half an hour till I was out the door and on my way to the hotel where dad and I stayed overnight because my first follow-up was the very next morning and it didn't make much sense to drive all the way to Fort Wayne and back in the meantime.
Since then I've spent a lot of time sleeping. My first follow-up went very well. I'm not even in very much pain--extra-strength Tylenol is enough to control it.
Dr. Price was able to do as he planned--the partial tissue instead of the full thickness. There's a thin backing of my cells connecting the donor tissue to my eye. Every time I look in the mirror, I can see the ring of stitches around my left cornea, which is pretty cool. It took a bunch of tries, but I finally got a pretty good picture of it. It's a lot easier to see in real life.
And yeah. I'm on my way. It will take up to a year for the vision in my left eye to fully stabilize, and even then I'll probably need glasses or contacts. My right eye needs some work, too, though hopefully we'll be able to avoid another transplant. But I'm very hopeful for the future. It's just good to have this part officially behind me.
After the laser cutting, I was so exhausted I could barely keep my eyes open. Part of it was because I'd only gotten about two and half hours of sleep the night before (anxiety is a bitch), but most of it was the adrenaline crash. After taping another shield over my left eye, the techs put me in a wheelchair to go to the surgery center, because even walking could jostle my eye in a bad way. My dad was with me. I signed a bunch of paperwork. And then I sat in the waiting room of the surgery center. Dad tried to talk to me but I couldn't muster the energy to understand him. My head nodded but I forced myself to stay awake. My left eye began to tear, then to ache and hurt. I tried to see through it but couldn't make sense of the information. The numbing drops had worn off. All I wanted was for someone to put in some more. The wait seemed interminable. Somebody else who was waiting in the room (a family member of another patient getting cornea surgery, perhaps) was snoring in the corner.
Finally, a nurse opened the door and called my name, and I was wheeled into the surgery center. The main room I entered had beds on several walls. They asked me if I needed to go to the bathroom, but I said I was fine. I was still struggling to keep my eyes open. The nurse was asking me medical questions, if I had any heart disease or other conditions, cancer, and so on and so forth. I answered as best I could. I signed another piece of paper about the surgery. At the top was a line in which was handwritten the precise kind of surgery I was getting: "anterior lamellar keratoplasty." The nurse explained to me what was going to happen, like the tech had before, so I would understand it all going in.
I really can't explain how much I appreciated that.
Dr. Price and the surgery techs had discussed with me at length what was going to happen during the surgery, but when it came around for real I was tired, anxious, and having trouble following what exactly what was going on. Having someone there to talk me through it all helped to give me a feeling of control, even though I truly had no control at all of what was going on. I knew that the doctor was going to attempt what they called "partial tissue" cornea transplant instead of "full thickness." This meant that instead of removing the entirety of my bad, distorted cornea, they would leave a thin layer of my own cells to graft to the donor tissue. This would make the graft much stronger and cleaner, especially since we were using a laser to cut both sides, and I would heal quicker and stronger with less chance of rejection. I would have to use anti-rejection medicine for many months, but not for the rest of my life like I would with a full cornea transplant. I was really hoping this plan would work out. I was also aware that my cornea was extremely thin and scarred because of my long-standing condition, so the partial tissue surgery might not work and the doctor might have to "convert" to the full thickness transplant on the day of. So yeah, there was plenty of anxiety to go around. But everyone who had contact with me at the surgery center were very calm, very professional, and very confident. On the actual day, during the actual procedure, I had no time to worry about any of this. Mostly I was just trying to stay awake.
So I got into a hospital gown, stripping from the waist up and putting my shirt and bra in a bin (I was allowed to keep my skirt and even my shoes), and got into the hospital bed. The bed wasn't mechanized--a nurse turned a crank at the foot to raise or lower the head. I was hooked up to a nasal cannula, a blood pressure cuff around my left arm, a pulse oximeter on my right index finger. Really, the least strange thing was getting the IV in my right hand. I told the nurse that I used to give blood every few months, so that little bitty needle was nothing. I had a net cap over my hair and booties over my shoes.
As had happened the day I had my exam with Dr. Price, I was one of their youngest patients. Most eye problems show up later in life. The lady in the bed next to me, the folks in the waiting room--most of them were probably in their sixties. It just so happens that keratoconus is a young person's disease--it typically shows up in adolescence or the twenties, worsens for awhile, then stabilizes. It's often in both eyes, usually with different amounts of severity. No one really knows what causes it, though there's definitely a genetic component--my brother Peter was recently diagnosed with keratoconus in one of his eyes, though it's nowhere near as bad as it is for me in either of my eyes.
I had already been informed that I would not anesthetized for the surgery itself, but beforehand for ten minutes when the doctor would prepare my eye. Rex had also told me that I probably wouldn't remember the surgery itself, which would take forty-five minutes, because of the drugs I would be under. I do remember some of the OR, but I'll describe that later.
Dr. Price came to my bed to see how I was doing and reassure me that everything had gone fine in the laser room and so on and so forth. I was still having trouble keeping my eyes open. He asked how I was and I said that I was very, very tired, both because of the laser and because I hadn't slept well the night before. "You've been worrying about this?" Dr. Price asked, and for some reason that made me choke up. I nodded and he patted my foot, still in its booty. He said that they would take good care of me and they were going to get me to see again. I think I said something along the lines of "that would be great."
The anesthesiologist introduced herself, just like the nurse had done before, but I can't remember their names. Dr. Price said now was the time when they told patients to think about a happy place. He said one patient had said that this was a happy place for him, but another one had said that Hawaii sounded better. "So where's your happy place?" he asked me.
I was already fading out. I knew the anesthesia was running already. I didn't have time to think about it much, but as soon as they said "happy place" only one place occurred to me, a place would much rather have been at that moment. (More than once the night before, and on the way down, and during the whole laser procedure, I thought that I wished I could say I had changed my mind, I didn't want cornea surgery after all, I just wanted to drive to work and treat this like any other Monday.)
But I told Dr. Price, "At home with my cat, Murphy."
He sounded pleased and amused. "Oh yeah? What does your cat look like?"
"He's dark gray with black stripes. He's very friendly."
And the next thing I knew, I was waking up. I twitched my shoulders and a nurse immediately came over to ask how I was doing. I said I was cold and she got a blanket for me, and also fetched my dad to come sit with me. I was actually much more awake than I had been before the anesthesia. At least I could keep my eyes open. Or one eye, anyway. My left eye was blocked with a device. I never really got a good explanation of what that was for, or what it looked like. Or someone probably did explain it, but I don't remember it.
So we waited for awhile for the patient before me to be done with their surgery. A forty-five minute procedure, just like mine, and I was awake for thirty-five minutes of the wait. It didn't seem like that long, though, at least not in my memory of it. Dad and I chatted. I wasn't as freaked out and exhausted as I had been. I don't know if they were already giving me the drugs in my IV or if I had just calmed down on my own, but either way it was much nicer. I felt some dread about the surgery, knowing that I would once again be awake and be expected to keep my eyes open and relaxed, but I had been assured many times that the laser was the hard part and the rest would be easier.
Mostly I just felt the way I often do right before I wake up, when I'm aware that I'm dreaming but not yet ready to open my eyes. I have that feeling of sleep paralysis, unable to move even in the dream--so it's different from lucid dreaming, in that way, because I'm aware of what's going on but unable to control it. Sometimes I find those dreams disconcerting, because I'm trapped in whatever situation the dream has left me in, but more often it's just a comfortable sort of warmth and heaviness. Sometimes in the dream I'm even laying in a bed, and then when I wake I'm in bed again. Anyway, this period of waiting felt like that--I was entirely unwilling to move even so much as to twitch my fingers, but I was not uncomfortable or upset about it. I was feeling no pain.
So after awhile the time came for surgery. They unhooked all my cables and piled them on top of me, then wheeled my bed into the OR. In a dreamy sort of fugue, I watched the top of my IV pole as it passed under the double doors into the hallway, slightly amazed that it hadn't even brushed the top of the frame, but then thinking, "Well, of course, they wouldn't have IV poles that were too tall for the doors."
In OR, the techs started hooking up all my monitors and such. I said I was cold, and they said they would set everything up, then cover me up. Somebody put one of those nasal strips on my nose. And then the next thing I knew. Dr. Price was telling me not to go to sleep, and I struggled to open my eyes. With my right eye, I was looking up a white rubber sheet placed over the top of my head--it reminded me of a getting a filling at the dentist. Information from my left eye was...confusing. My hands were outside of my blankets and they felt like blocks of ice, like they'd been out for a long time.
"My hands are cold," I said. I expected one of the techs to cover me up, like they had promised. But Dr. Price just said, "That's okay, as long as your heart is warm," or something like that, I can't remember exactly what it was. I realized later that this was already the middle of the surgery. Like Rex had told me, I must not be able to remember the first part.
But at this point, I was awake, and Dr. Price kept telling me to stay awake. My eyes would start to drift and I'd get the flash of a dream, the way you do when you are very, very tired and finally drifting off, and then his voice would come and I would force my eyes open again. That happened probably half a dozen times. The flashes of dream were very weird, like they always are--cartoon animals and nonsensical situations and snatches of stories and songs that don't exist. I wish I could remember them.
Finally, though, I managed to keep my eyes open and pay a little more attention to what was happening. Like I said, my right eye was staring at a rubber sheet directly above me, yellow-white. Sometimes I could see movement beyond it, someone's hands holding instruments, shadows on the wall of my tiny plastic cave. But weirdest of all was the irregular spot of color that kept appearing in the middle of the off-white sheet, moving and bending, like looking through a dot of water kaleidoscoping into colors and patterns. After awhile I realized that this was what my left eye was seeing.
I remembered that Rex had said I wouldn't remember what happened in the OR, so I was suddenly determined that I would NOT forget this. The surgeon's hands would dip toward my eye, and that wad of clearness and color would bend and fracture with the movement. I realize now that this must have been when he was putting in the sutures. At the time I had no explanation for what was going on. The spot was clear, then lavender, then the point of the instrument would invade, bending it down, turning the irregular oval into an egg shape, and then the point would retreat and the spot would turn back into a pool of watery light. I wasn't scared at all for this part, which I'm sure is because of the drugs. I was just sleepy, and fascinated, and trying very hard to keep my eyes open and my mind engaged.
Eventually it was done, though. The rubber sheet was removed and my left eye was covered. Dr. Price patted my shoulder and said everything had gone perfectly. I might have blinked or murmured in response, I really have no idea. I still haven't even seen Dr. Price with a good vision--the first day I met him I had been without my contact for two weeks so my corneas would be in a natural state for the all the tests I needed to have done, and this time I wasn't wearing my contact, either. So my impression of him is rather blurry, but very nice.
They wheeled me back to recovery and offered me something to drink, but I really needed to go to the bathroom more. And then it was probably half an hour till I was out the door and on my way to the hotel where dad and I stayed overnight because my first follow-up was the very next morning and it didn't make much sense to drive all the way to Fort Wayne and back in the meantime.
Since then I've spent a lot of time sleeping. My first follow-up went very well. I'm not even in very much pain--extra-strength Tylenol is enough to control it.
Dr. Price was able to do as he planned--the partial tissue instead of the full thickness. There's a thin backing of my cells connecting the donor tissue to my eye. Every time I look in the mirror, I can see the ring of stitches around my left cornea, which is pretty cool. It took a bunch of tries, but I finally got a pretty good picture of it. It's a lot easier to see in real life.
And yeah. I'm on my way. It will take up to a year for the vision in my left eye to fully stabilize, and even then I'll probably need glasses or contacts. My right eye needs some work, too, though hopefully we'll be able to avoid another transplant. But I'm very hopeful for the future. It's just good to have this part officially behind me.
