I was an ophthalmic surgeon for over a decade. In that period, I operated on hundreds of patients. It was an experience unlike any other, to be able to cure someone of some disease forever. Walking into the operating room was a solemn moment, even if I entered joking or humming a song. There was my staff waiting for me, a scrub nurse, a running nurse, a surgical assistant, an OR technician all waiting for me; a trolley covered with green cloth with its array of fine surgical instruments, the futuristic looking phaco machine with its colorful touchscreen, the operating microscope looming like a gigantic arm; and in the centre of it all lay the patient, covered with blankets, his head swathed with sterile sheets leaving only one eye exposed. At times it was only the eye that I noticed, nothing else.
26th July was my experience from the other side.
I entered the OR and immediately changed into OR clothes. It felt dis-individualizing. Waiting in the pre-op room with dozens of other patients, each trying to find someone to talk to, to relieve some of their nervousness; I had to refrain from telling them who I was because I would be bombarded with questions and some of my answers might have gone contrary to what their surgeon would have told them. Then the ward-boy came to take me to the OR. I got up to walk, but he asked me to sit in the wheel-chair. I felt so weak and dependent, being carried from one room to another even though it is simple hospital policy. I had to wait outside the OR for a few minutes while things were being prepped inside. Once in, it was surreal. I haven’t been in an OR in over two years. And this was jarring, seeing the bustle of activity from a patient’s eye. Nurses running around, residents checking and re-checking instruments, patient lists, IOL powers and consumables, and the surgeon in the middle of it all, barking orders.
Lying on the table swathed in those sheets, seeing through only the one half-blind eye, I waited for the operation to begin. Of course, knowing each step of the process didn’t help; there’s something to be said for the element of surprise. The surgery was done under topical anesthesia, just a few drops of anesthetic to numb the cornea, no injections. Personally it was not a technique I favored, but I appreciated its benefits provided the patient was cooperative enough. Let me tell you how it feels like, step by step.
For one, it’s not entirely painless. For that, you need a peri-bulbar block. And it required my cooperation in focussing fixedly on one spot and not moving my eye. I felt a pin-prick as the keratome entered my eye through the cornea in a Z-pattern, to form a self-sealing incision; only it was a duller but more intense pin-prick. A smaller prick on the other side. Then a dull ache as the space in front of my lens was filled up by a viscous gel to prevent the eye from collapsing while instruments went in and out of it.
The human lens has no nerve endings so you can feel no pain when it’s manipulated, but knowing that he was was performing a rhexis, taking a thin needle and creating a round hole in the capsule of my lens caused me to hold my breath in tense anticipation; I realized later that my hands were frozen in mid-motion through the procedure. This was the most crucial step – if anything had gone wrong here, I was potentially screwed. I could make out what was being done because of my knowledge obviously, and also by the fact that while the lens had no nerves the structured holding it in place did, and I could feel it being jostled around.
The phaco process itself was relatively painless, though each time an instrument entered my eye it touched off a few stubborn nerve-endings that refused to go numb. A lot of fluid flowed out during the process and I was acutely aware of some of it bypassing the drains and trickling down my temple. I was frozen stiff during the procedure, my ears pricked for every change in sound as the small tip of the phaco probe whirred inside my eye, emulsifying my lens protein into a powder that flowed out with the balanced saline. I knew what it meant as the sound went up an octave, or when that tinkling bell sounded, and of course, when the gentle voice of the machine said, “cortex” or “epi”. I could see the shadow of the probe as it came into my eye, the bright light from the microscope made sure that I did. It became gradually brighter as the white layers of my cataractous lens were cleared away, I could see the contact-lines between the thin streaks of visco injected into my eye. Then came the final, climactic moment. My eye was introduced to its new foreign resident.
More pain as the wider tip of the IOL injector entered my eye (the anesthetic was also wearing off). Then I could see it inside my eye; it’s folded haptics with their slits in the middle, the central optic as it gently unfolded, its movements as it was manipulated into the correct axis (I had astigmatism as a result of my corneal issues and a toric IOL had been decided upon; this meant that it was imperative to position it just right, with a margin of error of less than a few degrees), the pain of more visco being injected and the IOL was finally laid to rest in its proper position. And finally the cleaning up and removal of all the visco gel and any stray fragments of lens material that might be hiding in some nook or cranny. An injection into the cornea itself and he was done.
I had often wondered what my patients felt during the procedure, I didn’t think I would get to share their experience so soon.
17 days on, I am recovering well and waiting for my new glasses before I can return to normal activity. It’s been a long gap since I posted last but I think this essay makes up for most of it. 😀
Thank you to those who cared enough to wish me well and ask about me during this period, it felt really good to read your messages of support, especially Amy and Sabiscuit who I am especially thankful to. 🙂