Hello all.  I survived the first cataract surgery, an experience that is turning out to have quite an interesting outcome that I’ve decided to journal here with you all. It falls so neatly under the topic we often discuss here, about what the health care deliver system has become now, both pro and con, and whether an ordinary consumer can be heard or not.
The good news is that already I can see much better with the right eye, just one day out. It was a very dense cataract, so I have stitches and won’t get full results for a week or so. But already it there is a remarkable difference.  The other good news, (in some ways), was that the entire process, from walking in the door of that surgery center till I walked back out was two hours flat.  I felt no pain in the eye during surgery, under the conscious sedation type anesthesia.

Yet it was a very difficult experience for me, personally, because I have a  fairly serious PTSD type surgical phobia that I cannot control, based on traumatic previous experiences, which is why I put this all off till I was practically blind. And why I did everything in my power to clearly communicate this to the surgeon at my first visit, and to every person I have had to see since, in preparation for this surgery. This doctor convinced me that he not only understood and accepted this as valid, but would see to it I would have all the needed support and medication, to get through this.  

Unfortunately, he did not seem to remember me yesterday, which was a long time after that appointment, and by the time he showed up, I was already pretty far gone into a stress reaction and not functioning well at all. PTSD anxiety reactions are horrible: it is an internal kind of hell no one else can see, and most do not believe exist, even when you try to tell them.   I assume there were no visible notations on my records about this,  because every step of the way in the lead up weeks, I had to explain it all from the start all over again, to whoever was involved, and asking me questions.  I kept at it because I wanted to ward off another negative experience.  

However the usual response of all of these very busy and efficient people was repetition of info I already had been given a dozen times  about how easy this surgery was, how wonderful conscious sedation works, how I won’t feel a thing, and a many other reasons why I shouldn’t feel anxious at all.   I did not feel successful in making it clear that this wasn’t the usual kind of pre op nervousness.

Anyone who has ever suffered from any kind of genuine anxiety disorder knows that when all people do is tell you why you shouldn’t feel that way, the inevitable outcome is of course, increased anxiety.  

This was my first time through one of the new `surgery centers”. This is not a hospital, but a place set up just to do eye, ear, nose and throat surgeries, this one for a chain of eye clinics affiliated with a large corporation.   It was like a lot like walking straight into a very large oscillating fan!  The staff, while very pleasant and courteous, were moving at warp speed no matter what they were doing.  Within a minute I had signed releases I couldn’t even see that probably insured that no matter what could possibly happen to me in there, I had been warned in advance and knew I was getting into!  It would have taken me a considerble while  to actually read all those papers, even if I could see.  

I was disrobed and laid flat out with a bonnet on my head before I knew what hit me!  Nurses were literally flying in and out of my cubical, with four sets of eye drops, IV’s to insert, all very cheerful and efficient, and totally engrossed with their equipment and assigned tasks.  They all spoke very nicely to me but no one looked at me or seemed to have time to really hear my concerns; again, whatever I said was again apparently dismissed as normal pre surgical nervousness, as the response was the usual repeating of  info and reassurances I’d gotten all along.  Right about here was when I had to begin “retreating  inward” in order to control the rising panic at not being heard and feeling having events spinning out of my control so rapidly.

They had whisked me away before my kids had arrived, and they did allow a few minutes for them to come in. By now I was stressed enough to begin leaking tears, against my will, and I hated to see them leave. The doctor stepped in for a few seconds and asked me if I had any questions for him, but was too late for me to be able to communicate effectively: (I was too busy working on staying in control of the emotions)  

The came the really important person, the anesthesiologist, who I knew was the one with the power to grant me sufficient medication relief, or not, as he so saw fit.  Unfortunately, he also spent most of his few minutes with me telling me why I ought not feel anxious.

That’s when I knew I was really on my own from there on.  Somehow, with or without the help of extra calming medication that I may or may not get, I would have to find a way to keep from panicking and moving at the wrong time during this surgery.  

They finally did give me some pre op medication in the IV that helped a lot, but only for a little while, then we zoomed off to the OR.  The conscious sedation worked fine, for while. I did not feel any surgical pain and I really didn’t seem to “care” what was going on.  I thought the worst was over.

But then came the terrible stomach cramping I experience whenever given morphine. (I was wearing a wrist band stating I had Morphine allergies.  This is not a common side effect, but not an unheard of one either, and the pains are like those of an acute gall bladder attack, no joking matter, let me tell you.) I will need to find out what drug I was given, so I can add it to the list of drugs I just can’t take. This caused overall body tensing which set off back spasms and no longer was I able to “not care what was going on”: I was in such intense pain, and scared to death I’d move and wreck everything.  

I knew I could not lay still much longer and said so, quite clearly.  Doc said “Don’t move, we’re almost done.”   I think he was done too in just a moment or so,  but for me, it felt like a solid hour of agony and sheer panic.
But I  made it. I didn’t move.

Here’s what I know. It would have taken SO little to have prevented me from having to go through this.  All it would have taken was adequate communication from person to person along this very efficient delivery system about a very real potential complicating factor.  A simple written order adequately communicated via my record to everyone there that day, including the anesthesiologist, that this patient suffers from PTSD /surgical phobia and will need enhanced pharmaceuticals would have done it.  They would have had the info they needed in a form they could recognize as credible.  

Instead, it seemed no one knew, no one had time to listen, and even if they had, once I am already in that stressed position, I am at my most vulnerable and am not able to communicate very effectively at all.

So, it’s over.  I made it through without stroking out or moving at the wrong time, and the surgery looks to be successful, so why not let it go?  

There are a couple of factors that won’t let me. One, I have to go though all of this again for the other eye on November 9.  Although the temptation is there to settle for good vision in one eye, so as to avoid this experience again, I will not give into it.  I really want both my eyes working.  I can’t choose another place: this is the only one that I can afford on my special program.

The other factor is this.  Over my long career in this profession as an RN, I have watched  health care  slowly be transformed from what it was when I was so proud to be part of it, back when it was still the healing arts, when everything was centered around excellent care and comfort of the whole patient first and foremost, to this assembly line form of health care delivery.

I am the first to be grateful for all the advances. I remember taking care of cataract  patients when they had to lay in hospital beds for days, with their heads locked in place by sandbags.  My negative experience yesterday takes NOTHING away from my gratitude for the progress that has made it possible for a simple surgery like this to restore my sight. It also does NOT decrease, in any way, my sincere appreciation for all the efforts everyone there DID make yesterday, to try to make it easier for me, in spite of their time constraints.  

It is not the fault of the front line doctors and nurses that they have so little time to spend with patients anymore to hear and respond to concerns like mine.  Just recently my own regular doctor expressed this too, how little time is allowed to them anymore, to actually spend with their patients. And  I know personally and painfully, how it feels when ones hearts lies with meeting patients needs, but ones actions  are ruled by a clock and  performance expectations that seem geared to take you AWAY from them.

So that’s why I know I cannot let this just “go.”  I received a call this morning, a routine call, from a nurse at the surgical center, checking on how I am doing.  I asked her if she was open to some feedback, and she said yes.  I relayed what I have written here to her and it was not easy for her to hear, I know.  I give her credit for listening very well, and saying she would relay all of this and that someone would be getting back to me. I made sure she understood I intend this as constructive feedback that it was not in the nature of an angry complaint about their performance, but something I believe that can be used to everyone’s benefit.

I will see the surgeon this afternoon as planned, and will relay all of this to him as well, as objectively as I can, and hope he will be able to hear it as well.  I will be asking all of them to work with me so that the next surgery on November 9th can turn out less difficult for me.  I will also be prepared with specific ideas and suggestion of how this kind of thing could be easily avoided at no loss of efficiency or any extra cost to the system.

I know that raging against the dehumanization of my chosen profession does not work because I’ve been doing that for far too many years already. It just gets defensive responses and earns me more scars and retribution. Like all, I am dependent on this system, like it or not, and as I age, no doubt I’ll need it even more.

So I hope to be able to marshal together whatever communication skills it will take me to deal with those I have to deal with, in ways that just might make things better for me, not worse, and hopefully in the process, maybe help alter a few attitudes and mindsets a  little bit.  It’s not going to be easy climbing up over years of resentment, anger and bitterness I feel at all the unnecessary suffering I have watched due the dehumanization and privatization of health care.  But hey, it’s a new challenge and I do love a challenge!

Just last month, I formally retired my license to practice nursing.  Maybe now I am ready approach this from another direction, using my own current experiences as my small megaphone and do so from a calmer, hopefully more balance perspective.

There is no reason there cannot be cost effective health care that is ALSO humane.
It takes no more that a second to make genuine, meaningful eye contact or a comforting touch.  It takes very little time, only willingness to really listen well with an honest intent to understand.

It would have actually have taken people around me yesterday much LESS time and energy to simply hear and accept my fears as valid, than they all spent trying to tell me why  I shouldn’t have them at all !  

Because if I had felt really heard, believed, and understood yesterday, I wouldn’t have had to go through any of the hard stuff I did.  And they would still have been “on schedule.”  

ONward. Stay  tuned for the next installment.  Hopefully it will be positive news.

PS: My big bag of Boo Hugs and good wishes that I took along really helped. Thanks again.