Two days ago at this time I was waiting to be called into the same day surgery area of a major eye hospital in a major city. I checked out my paperwork and saw I had a diagnosis of senile nucleus stenosis. While I understood this was an age-related cataract, I was not too fond of the senile part. I filled in some forms, giving the same information I had supplied before surgery. On the anesthesia form, I was asked: “Do you have any concerns you want to discuss with the anesthesiologist?” I wrote “Don’t want to see knife coming at my eye.”
The TV was on in the waiting room, tuned to a food channel. It was 1:30 PM. Having not eaten since midnight, I watched the chefs prepare simmered chicken, garlic mashed potatoes, and cranberry juice cocktails. My mouth watered.
Part of my brain was tuned to being a patient, and part of it was watching everything going on around me, from a patient safety perspective. Here are some memorable moments.
The holding room
I was brought into the holding area about 2:15 PM, invited to take off my jacket and leave on a tee shirt, and to remove my shoes. All other clothes stayed on. I placed a patient gown (opening to the back but not tied) and an OR hat on my head. The nurse hooked me up to a cardiac monitor, placed a pulse oximeter clip on my finger, and began examining my right arm for veins. She tapped and slapped and manipulated my arm for long moments in a concerted effort to find the right vein. Meanwhile, I am thinking positive thoughts, like,”You will find a vein on the first try and not strike my nerve.” We discussed the fact that the anesthesiologist liked the right arm to be used for medication if the doctor was working on the left eye. Otherwise, they would crowd each other.
When I told her blood was usually drawn from my left “antecubital” (inner elbow) vein, I inadvertently revealed I was a nurse. This lead to a discussion of how the nurse admired medical surgical nurses (the kind I am) because of the need to multitask the care of 10 patients. She became an ICU right out of nursing school and when she was pulled to a med surg floor, she had a hard time. (I always admired ICU nurses because of their knowledge.)
The holding room nurse, noting the coldness of the room, offered me a warmed blanket. I gratefully accepted it, telling her the last time I had one of these was when I delivered my first child 35 years before. She gave me eye drops three times, which gradually reduced my vision, and I realized she was dilating the pupil.
The anesthesiologist came in, looked in my mouth, listened to my lungs, and told me I would get sedation during the surgery. I pressed him for the name, and he said it was Versed, which can wipe out memory of the surgery. He told me I could get Morphine or Fentanyl during the procedure if I was uncomfortable, but that was not common. I did not see him again.
Next I saw my surgeon checking my chart. He is a man of few words. He confirmed my left eye was going to be operated on. I told him I had been thinking of drawing an arrow on my cheek and pointing up to my left eye. He laughed, touched my shoulder and said, “We have many ways to verify the correct side.” I did not think it was the right time to tell him there are two wrong site/wrong patient surgeries per day in the United States. After he left, I shared this statistic with my husband, who is not a medical person, and he advised me to not think about that.
The woman in the holding room next to me had undergone surgery that morning in a different location for a malignant tumor in her eye. She was being prepared for plastic surgery at this hospital. The anesthesiologist spent about 5 times more time with her than with me, and I was very happy to be in my stretcher and not in hers.
The nurse anesthetist bounced in. She had a cheerful, friendly personality. I brought up the subject of seeing the knife coming at my eye and she told me she could make sure that did not happen. She made me feel comfortable, and reassured that she understood my concerns. As I was being wheeled into the operating room, about 3:15 PM, she was pulled away to help with a different room and I received a different nurse anesthetist.
My stretcher became the operating room table. My OR nurse introduced himself, and put another warm blanket on, which was positioned so my hands were tucked against my body. I asked him if these were my restraints, and he quickly denied it. Then a roll of tape appeared and the nurse taped my head to the stretcher. I told him I felt like I was on a board with a cervical collar after a car accident. He was probably wondering when I would stop making observations about what he was doing. Many of the things that were done to be in the OR occurred without explanation or forewarning, which I would have preferred receiving.
The nurse anesthetist told me her name, which was an unusual one, and I said I had never met anyone with that name before. “Most people haven’t”, she told me. The nurse anesthetist gave me Versed 2 mg. I could feel the warmth begin to spread in my blood, and announced, “Ah, the Versed!” I don’t think it wiped out any memories, though.
The surgeon arrived – again without saying anything – and put a numbing gel on my eye. Then, he placed a thing on my face. It was like a Batman mask. It covered my forehead, eyes and cheeks. It had a sticky backing on it, and it was pressed onto my face to make it adhere. I was tempted to say that this dressing was not for the claustrophobics but I felt I had volunteered enough observations. The dressing blocked my vision of what was occurring.
Imagine lying on your back in a dark cave looking up. You can see a hole at the top of the cave. It is partially blocked by something. There are vivid red, green and blue colors in the cave. I watched the top of the cave, dutifully tilted my chin upward when instructed, and then the cave became cloudy. (This must have been when the lens in my eye was being broken up and suctioned out. I heard a suction sound. Then a clear round object floated into the cave. It looked like a jelly fish. I noticed it come and go a few times before it disappeared from view. This was the new lens. The end of the procedure involved the surgeon pressing on my eye in a way that really hurt. I called out for Morphine or Fentanyl, but he said, “I am almost done.” I wasn’t too happy about not getting pain medication.
The Batman mask was ripped off my face. That hurt! The tape was pulled off my forehead. That hurt too. The pain was temporary, though. The surgeon placed a clear plastic eye shield on my face. The clearness was a surprise, and eliminate the problems with losing peripheral vision that result from an opaque shield.
The recovery room
Food! Yes! In rapid fire, the nurse listed what I could have: “peanut butter crackers, vanilla crackers, salmon crackers . . .” – “Wait, salmon crackers?” She repeated, “Cinnamon crackers.” We agreed there would not be much of a market for salmon crackers. My husband entered with half of a tuna fish sandwich, which he purchased on the ground floor of the hospital while I was in the operating room. He had enough time to get downstairs, buy the sandwich, eat half himself, and return upstairs while I was in the operating room. He barely missed the chance to see the surgeon, who assured him all went well.
That day, on the way home, I had a vague sense something had been done to my eye, but there was no pain. There has not been pain. I created a medication administration record to keep track of the postoperative eye drops, and am resting my eyes periodically.
The difference in vision is remarkable. My new lens is so clear that light looks almost blue, compared to the almost yellow from my right eye. I can use the computer without needing glasses, which I have not been able to do for years. In a month I will have cataract surgery on the other eye. I informed my surgeon yesterday that I liked my new eye a lot. He smiled.
Pat Iyer is President of Avoid Medical Errors. She loves her new vision.
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