Ophthalmologist

Another visit to the eye specialist. The easy two-word option; much easier than laboriously working my way through the spelling of ophthalmologist - spell checker or no spell checker.

This is a medical appointment that I’m never entirely relaxed about. 

The first part is the easy bit.  The technician sits me in front the eye chart and starting at the top I work my way down the lines. The top lines are easy; it’s a different story on the last line with it’s tiny, tiny print.  There’s much squinting and grimacing and hesitation and wild guesswork on my part as I work my way across this last line.

The fieldwork test takes place in what might pass for a broom cupboard with double doors, at the end of a short corridor.

 The fieldwork test is not so fearsome, it requires concentration. Watching the little red dot and pressing the button when you see a brief flashing light elsewhere on the screen. My concentration and reflexes flag and I’m damned if I know whether I’ve imagined the flashing light or total paralysis has set in and there will be huge blanks on the screen and the verdict will be that I am as blind as a bat.

It’s the third stage which I really detest. The pressure test which makes me want to pull away from the eye contact and which does not impress the ophthalmologist one little bit. I opted for concentrating on my breathing and at last it was all over.

And some good news. The suspected glaucoma from the previous consultation did not appear this time.  I now have the cataract surgery to look forward to and that is some way into the future.

I walked out the surgery door, skipped along the street and into the nearest café for a restorative coffee.

Energy issues

This whole lack of energy thing is beginning to get me down.

The first half of nearly every day is a struggle to stay awake, never mind doing something constructive. Most mornings I will have a very good idea of how the day will go.  Often the first half of the day is something akin to driving a car with the handbrake on.  At midday the handbrake is gradually released and the day starts to gain a little more momentum.

The most active time of the day, for some reason, happens between 6 pm and 9 pm. It’s better than nothing at all but it’s a short time frame to cover the things I’d like to achieve some days. And it’s that time when the end of the day is nigh.  And it’s dark. I prefer to work around the Trash Palace in the daylight. All the better to see the trash, you know.

I was warned about one of the effects of drug hormone therapy, which is fatigue. I nodded in understanding when given this information but I had no idea it would be like it is most days.

I recently attempted to winkle some information out of the hospital pharmacist about how the drug works but the answer was not particularly helpful and veered off into that morass known as the half-life of drugs.

Perhaps I should talk to my local pharmacists, one has been in the business for years and has a lot of practical experience and understanding of prescribed medications. I’m sure he could explain the half life of drugs, even to someone as slow-witted as I am.

Another thing to be taken into consideration is the hot weather we have experienced lately; I’m sure it does nothing to improve the situation.

Eucalypt trunk detail                         circa December 2005

Low-dose codeine

 As from February 1st low-dose codeine will no longer be available as an over-the-counter product in pharmacies.

This law has been a long time coming.   It has been discussed in media articles for many years and in 2009 a national pain conference was convened in Melbourne to address the matter.

Patients may become hooked on painkillers following surgery when opiate-based pills are prescribed to deal with chronic pain.  The increase in pain-killer use has become apparent in hospital emergency departments; patients looking for relief will present in emergency departments when all other avenues have been exhausted.

While Schedule 8 substances, such as oxycodone, require a permit before prescription, it is still possible to buy over-the-counter products which contain lesser amounts of codeine.  It is here, with these drugs, that problems arise with constant use. Unbeknownst to many users, these lower dose pharmaceuticals have a half-life; when some-one takes another pill to alleviate the pain it may cause a build-up in their system and the risk of overdose.

After political debate and discussion, the incumbent Federal government has finally brought in legislation to prevent misuse of over-the-counter drugs.  This has sparked much debate about the cost of consulting a doctor to obtain a prescription but it is now up to pharmacists to advise on suitable replacement drugs with their customers.

As an occasional user of low dose codeine drugs, I went along to the pharmacy today to be sure I had a packet of my drug of choice on hand. All the medications to be withdrawn were sitting up on a shelf behind the counter and there were only a few packets left.  I don’t think I am the only person with this mission in mind.

No, there will not be a stash of drugs in the dungeon at the Trash Palace, just a standby packet on the medicine shelf. After that, if I need more, I will be asking my GP for a prescription.

Cake, cereal and conventional cow’s milk.

 Listening to BBC World Service recently, I was informed that Britons eat far too much cake at work.  Too much cake at work?  Can this be true?  The suggestion is made that fruit, nuts and cheese be offered instead of cake; a birthday cheese?  An idea which may not go down well with people wanting to avoid fat in their diet. And try sticking candles on a wedge of cheese.

At the moment cake features high on the menu of what might pass for supper time at the Trash Palace.  The blame is placed squarely on the festive season and particularly those shops (you know who you are) selling such delicacies as mince pies and dastardly, dark fruit Christmas cakes.

Cereal came in for some criticism on the same program, in particular the amount of cereal consumed by British children at breakfast time.  While breakfast is often touted as the most important meal of the day, there is no doubt the amount of sugar in packaged cereals is very high and as a result much loved by children with a sweet tooth.

Examine any packet of sugar cereal, especially those where Milo and cocoa and fruity-loopy-frosty words are boldly displayed on the packet.  Simply reading the sugar content label is enough for instant cavities to form in your teeth.  And while all this may be financial music to the ears of some dentists it is going to be costly to parents who find they are faced with huge dental bills and a painful outcome for the small person sitting in the chair.  Sugar is both seductive and addictive; adults are often just as attracted to the taste of sugar as children.

And now for conventional cow’s milk.  I wouldn’t have a conventional cow’s milk dilemma if I wasn’t clearing up the clutter – in this instance paper/magazine clutter.  Here I was thinking a conventional cow was one that roughly filled the cow criteria of having four legs, a head, a tail and all the workings within and without that lead to milk production.  Further research (read time spent poodling around on Google) on this topic tells me I need to be thinking about the milk word, not the cow word. 

The battle is between conventional cow’s milk and organic cow’s milk; conventional cows might be classed as grain fed and pastured on grass onto which large quantities of fertilizer have been applied.  Organic milk is classed as coming from cows where less fertilizer is applied to the pasture and there is less reliance on high volume production breeds. 

At the Trash Palace, until a substantial increase in price occurred early last year, organic milk was the first choice of the Head Chef in the Soup Kitchen. The prime reason for this choice was not the organic classification but the fact the milk was non- homogenised.  The Head Chef insists the taste is better and all this spinning and whirling and general mucking about with the milk when it is homogenised, makes the milk taste bland.   And while the increased cost has seen the former first choice milk now sharing equal  purchase ranking with other locally owned and produced milk, it is still rated as best of all.

A bunch of  my favourite conventional cows, borrowed for the occasion. 

ZZZzzz

Rest and sleep are the main aim of the next few days.

I intend to rest up, as advised, in the morning after breakfast and again in the afternoon after lunch.  I’m taking this rest and recuperation program very seriously.

This morning I make the mistake of being in the dining room just after 7 am, only to discover that breakfast will come to me in the room. I will not make this mistake twice.

More ZZZzzz time each morning.  

Very important results

Friday is the day the pathology tests are reviewed and patients are given their results, together with the form of treatment needed, depending on the outcome.

Not everybody has to wait the three days; some are advised of the outcome soon after surgery, when it is obvious they will need to be placed in a treatment program.  Others will wait the three days to see whether any destructive cells are concealed in another area not too far from the original site.  Not a particularly happy prospect but one which needs to be considered.

In the late afternoon Assistant Surgeon Jones breezes in and in short order delivers the results; happily for me the outcome is a good one.   She assures me I will not be needing any further treatment but will be placed in a check-up program; the commencement date will be given to me when I come back to the clinic in six weeks time.

It takes a little while for the news to sink in and become reality; all that time of waiting and worrying about the outcome is now behind me.  I lay quietly on the bed, digesting the good news, before I allow myself to deliver a mental air-punch.

In the early evening the Surgeon General, who had informed me prior to surgery of the outcome success rating, arrived and repeated, more or less, the good news delivered earlier on by A/S Jones

Time to start calling the support team and giving them the good news now.

Third day

A room companion arrived yesterday; the wards-man wheeled the other bed away mid-morning and wheeled it back again late in the afternoon, complete with patient and her personal possessions neatly stacked at her side. 

Before six this morning the sound of liquid being sipped from a cup came from behind the curtains around her bed; her husband has arrived with a thermos of hot soup for breakfast.  What a kind, caring man. 

Wen’s first language is Chinese and although she has a few words of basic English and her husband has a good grasp of the language, the hospital provides interpreters to deliver important information such as the results of the surgery, what progress can be expected together with instructions about stitch removal and other limitations during the recovery process.  In the confined quarters of a two-bed ward there is no way the person in the next bed can avoid being privy to this conversation.

   

The surgeon and the interpreter arrive and the performance begins.  The surgeon has issued these reports and instructions many times before and recites them off pat, only pausing to allow the interpreter to translate.  And so the recitation is delivered, the surgeon saying his piece and the interpreter responding with a translation delivered with the speed of machine-gun fire.

Wen was undaunted by her lack of English and a number of comical, conversational exchanges took place, not the least of which was the Cuts Competition.  I conceded immediate defeat in the Cuts Competition; even if I took into account the tiny nick below the main incision, which looked suspiciously as though either the Surgeon General or his assistant made a miscalculation or even worse, dropped a scalpel, I could not find the numbers to even equal five, never mind top it.  Wen was left triumphantly holding her hand aloft; fingers spread wide – the clear winner of the Cuts Competition.

Meal time sparked even more mental gymnastics on my part, as Wen puzzled over her meal tray and asked questions about the food.  If a nurse or someone from catering happened by, the degree of required mental gymnastics ability was suddenly tripled as we ran the gamut of food possibilities and how to actually make that desired food appear from wherever it might be hiding. 

 The other routine procedures through the day were mostly navigated successfully language-wise and on those occasions when Wen’s allocated nurse spoke Chinese, food and language problems vanished into thin air.

All mental gymnastics and comical situations aside, it gave me first-hand insight into the difficulties faced by a person in hospital whose first language is not English.  The interpreter is not going to appear to give you a rundown on the meal tray items; the best you can hope for is to have a nurse on the ward who might speak your language.

Or where possible you may resort to that wonder of modern technology, the mobile phone, for an instant solution to whatever problem ails you.

Second day

Before first light I decide the plan for today is to lie very, very still, press the pain relief button from time to time and repeat parrot-like my name and date of birth, every time yet another drug needs to be administered.

This is a short-lived plan; it lasts until the food and drink arrive and the realisation dawns that I might need to engage in some other activity apart from pressing the pain control button. I might have to attempt to sit up in the bed.  At this early stage I haven’t yet mastered the mechanics of the raising and lowering of the bed and the bedhead.  I will need to acquire some bed mechanics knowledge, or the art of drinking from a glass of water, with or without a straw, and not pouring it all over the bed, will be but a dream.

The first big surprise of the day is the constant parade of people who appear at my bedside; first is the anaesthetist who interviewed me yesterday.  Yes, the young, dark, handsome one.  He is followed by Assistant Surgeon Jones and her note-taking offsider, the lovely Rangi.

 Next is the pharmacist and hot on her heels, the physiotherapist; the latter attempts to give me handy tips on how to sit up in bed, how to avoid slipping down to the end of the bed and how best to attempt the business of getting out of bed.  There is no cossetting of patients; if you are conscious and reasonably mobile then out of bed you will get.

And get out of bed I do; it is no easy task.  Imagine a very large walrus lying on its back, taking in the sunshine on a sandy beach; for whatever reason it needs to turn over and position itself to make a get-a-way.  This is difficult business for a walrus; a lot of weight has to be manoeuvered about and the walrus will make several slow and very awkward attempts before it achieves its goal. Have a search on You-Tube and it will give you a very clear understanding of what getting out of bed entailed for me.  Not a pretty sight I can assure you.

And that is just the beginning of the exercise; what follows is trailing all the attachments around the bed and finally making it to the chair.  All this entails about twenty steps; by the time I flop unceremoniously into the chair I feel as if I have walked twenty kilometers.

The real purpose of the move from bed to chair, watched over by the attendant nurse, is to get the patient started on the coughing exercises torture; this is important to remove congestion from the lungs and prevent pneumonia.  Deep breathing and coughing will become a regular part of each day.

According to informed and reliable sources the following excerpt is the best guide to a successful coughing exercise:

Coughing exercises:

The most comfortable position in which to cough is sitting upright.  Hold a pillow or rolled-up blanket against your stitches or staples.  This may make coughing easier.  When you cough, relax your neck and shoulders. Cough from your belly, not from your throat.  Bending your knees may also make coughing more comfortable.  Cough two or three times, then rest.  Do not be afraid to cough. Your incision is firmly held together by stitches or staples.

In theory I'm sure the above paragraph has some merit, however I can tell you this, pillow or no pillow, it damn well hurts.  The best I could manage today were tiny, kitten-like throat coughs, totally unproductive, painful and exhausting.

I have well and truly failed the coughing exercise test.  I am going to be in big trouble with A/S Jones when she arrives for the next round of lung-listening.

Routine

                                          

Early, very early, on this first day of My New Life, absolutely nothing relates to routine as I had previously known it.

Setting the alarm for 5.15 am?  Unheard of.  Packing the necessities for the hospital stay into a small striped bag, including cramming in a dressing gown which can only be described as antique and bulky?  Never.  Not eating breakfast?  You’re kidding.

This is how the day starts.

It’s a dark, wintry morning; Robyn of Richmond arrives promptly at 6 a.m.  Fifteen minutes later we pull into the hospital car park; after a hug and good wishes, I take the elevator up the ground floor.  The day surgery is in darkness; a handful of patients are seated on couches in the outside waiting area.   I have arrived early; another truly remarkable occurrence.  Chalk that up!

At 6.30 a.m. the day surgery door opens; we file into the waiting area and the hospital routine begins.  This routine follows an order not immediately obvious to the patient awaiting surgery but one fixed feature of the day’s routine is the repetitive question: “What is your full name and date of birth?”   Should I be unlucky enough to be visited at a later stage in my life by dementia, I’m absolutely certain the answer to that question is now forever embedded in my memory bank.

Eventually, decked out in hospital gowns, caps, cute little disposable bootees and white dressing gowns, the ladies listed for surgery today take their place in one of the reclining chairs in the pre-surgery waiting area.   Time passes. One by one the waiting patients disappear in the direction of the operating theatres.

Somewhere nearby, the loud bawling of a prospective sergeant-major announces his arrival in the world to all within earshot.

The one person left in the pre-surgery waiting area is now in complete charge of the television remote and the magazine rack. Immediately the TV channel is changed, from the one where Federal Government’s Leader of the Opposition is making yet another fatuous statement, to the way more interesting indigenous TV channel.

I watch TV for a while; I’m starting to feel hungry.  I close my eyes and doze.

A man, dressed in blue scrubs, enters stage right and greets me; in my semi-awake state I mistake him for the anaesthetist who reprimanded me about not taking my reflux medication on a regular basis prior to the initial investigative surgery.    ‘Don’t you remember me from 1983?’ the man in blue asks in a voice of mock reproof and then he laughs. I certainly can recall that year and the hospital procedure; now it’s my turn to laugh.  Really?  Is he serious?  I have no recollection of seeing this man in 1983 and I say so. I consider fleetingly that this may not be the most diplomatic response.  Ah well, I’ll have to live with that faux pas – it’s out there now.

At this stage of proceedings I am more than happy to have this timely distraction, which has come about because  the man in blue, who is the chief operating surgeon (henceforth to be known as the Surgeon-General), was surprised to find his handwriting when reading the case notes at the very back of my file.  We have another laugh about the long arm of coincidence, a brief chat about 1983 and the doctor I do remember, followed by a short resume on how the S.G's career has travelled in the last thirty years. 

Finally with all the interviews and explanations and other rigmarole behind me I’m ready to pass through the door to the area where My New Life will move on to its next stage.  The anesthetists put the final touches to their preparations, the nurse covers me with a warm blanket and in the blink of an eye I am out like a light.

Much later…….

From a great distance a male voice is calling my name; the voice belongs to Craig, the nurse looking after me in recovery.  He poses a question; on a scale of one to ten how would I rate my pain? I give the answer some consideration.  I'm in serious pain; fifteen seems a reasonable answer from my point of view. It is, however, well above the suggested scale and I opt for eleven.  I have absolutely no further memory of the recovery room.

Later again……..

It is dark outside; I am in a darkened two-bed room, my bed is nearest to both the door to the corridor and the door to the bathroom and even in my heavily sedated state I am pleased about my proximity to the bathroom.  In reality it wouldn’t matter if the bathroom was at the far end of the corridor; I will not be leaving this bed for some time. I am hooked up to all the necessary equipment and mostly everything I need will come to me over the next 24 hours.

A nurse appears in the doorway;  this is Su, who is looking after me tonight.  She has a warm smile and a calm, reassuring manner; the requisite observations are taken, instructions are given in the use of the pain relief button and the call button is placed within easy reach.

I close my eyes and drift off into oblivion one more time.