Wednesday, August 10, 2005

"I've never seen that happen before."

"I've never seen that happen before." Are there any more comforting words you can hear from your doctor in the middle of eye surgery?

When the IV didn't go the first time, I should have known that the stars just weren't right. But I'm not superstitious, so I didn't think anything of it. But I should have.

I was scheduled for a Lamellar keratoplasty. That's a type of eye surgery. A type of cornea transplant, to be precise.

In a Lamellar keratoplasty, they only remove a portion of the cornea,leaving the endothelium intact. In a penetrating keratoplasty, on the other hand, they cut the whole thing out and replace it with a new one. But perhaps I should elaborate.

The last time I had one of my corneas swapped out, it was a penetrating keratoplasty. And it was a penetrating keratoplasty because I'd had a penetrating keratoplasty on that eye before, and once the endothelium's gone, it's gone. And once it's gone, the tissue they graft on loses about 4.5 % of the cells each year. The cornea gets thinner and thinner until it cannot hold its shape or it becomes cloudy or both. Any way you slice it, vision suffers.

When I first had a cornea transplant 15 years ago, this fact was not appreciated. Or at least it was not communicated to me. I was under the impression that once they replaced the diseased cornea, the operation was good for life. I was under that impression because that's what the doctor told me. Unfortunately, such was not the case, an the operation had to be repeated. And repeated it was with more than satisfactory results. I now see better out of my left eye than I have in decades.

Unfortunately, I did not have such happy results with my right eye.

I had done the calculus of pain, balancing the cost and discomfort of surgery and the prospect of having to have it redone every 15 years or so with the gain in vision, and decided that I didn't want to have my right eye done. I could see well enough out of my left eye, and my right eye wasn't all that bad (correctable to about 20/100).

But then there was the Lamellar option. By peeling off and replacing only the outer layer of the cornea and leaving the endothelium intact, the cell loss should be avoided. So I arranged for some time off work, ponied up the not insubstantial cash payment of the deductible and the co-pay, and had the surgery.

But it didn't work. My endothelium was too thin or the cut was too deep or something, and there wasn't enough of an intact layer to peel off the old cornea but still leave the necessary tissue intact. So the surgery had to be aborted and the old cornea stitched back in place.


Really. It's quite discomforting.

My initial impulse was to go ahead and get the penetrating keratoplasty done ASAP. I'd already paid the deductible, took time off work, and suffered the initial pain of recuperation, so what's another couple days? So I scheduled another cornea transplant for the following Monday (it would have been Friday, but they didn't have a suitable cornea available). But then I though about having to have it redone every 15 years or so and changed my mind. I still have until December to change it back and still get the second operation done under the same deductible.

I don't know whether the problem that my endothelium was too thin or that the instrument just cut a bit too deeply, or some combination of the two, and I really don't care. Shit happens, as they say. Given the delicacy of the work and the extraordinary precision required, I'm amazed that this sort of surgery ever works at all. I hope my day job isn't causing the doctor to lose too much sleep over it.

By the way-- The surgery was last Wednesday. It's now early Wednesday morning, a week later, and this is the first time I've been able to keep my eyes open long enough to write this.

And by the by the way, although my eye's been rather inflamed and inoperative the last few days, the day after the surgery I was seeing much better than before, even though it was just my old cornea stitched back into place. It could have been better or worse or the same, but so far, it seems that I've gotten an inadvertent improvement. So I guess it's not a total loss.



Blogger Laurie said...

Wow. That's it. Just wow.

Oh, you're a good person to be able to be objective and not be too hard on the doctor. In our profession, we see a lot of imcompetent professionals of all sorts. Being lawyers and working for lawyers people always think we're ready to sue everyone at the first opportunity but through the years we also learn the difference between incompetence and simple, stupid, unavoidable fate. Life sucks sometimes but it's not always someone's fault.

Wednesday, August 10, 2005 6:41:00 AM  
Anonymous Anonymous said...

That's because he is not just a lawyer, he's "awesome"

Wednesday, August 10, 2005 9:55:00 AM  
Anonymous Anonymous said...

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Wednesday, August 10, 2005 1:01:00 PM  
Blogger Bonnie Ransonette said...

You should never schedule surgery while Mercury is retrograde. Or at least that's what I'm told.

I'm sorry you've gone through all that pain but an eye patch can be pretty cool. Worked for most pirates. I wouldn't suggest the peg leg thing. Probably hard to balance on a Harley with a peg leg. And forget trying to brake with a hook hand.

But I "dygress"

Wednesday, August 10, 2005 3:37:00 PM  
Blogger Jack said...

Laurie: Maybe being a lawyer has something to do with my attitude. I've seen enough incompetence to recognize it's absence.

Anonymous: Aw, shucks. You're embarassing me.

Anonymous Spammer: If Real Singles is so great, how come you're wasting time reading some obscure blog rather than spending time with your True Match?

Bonnie: I wish I'd had that information before letting the doc off the hook. They're the ones who picked the date, and if they did it without consulting a certified professional astrologer, I don't see how they could not have been negligent. When you're dealing with people who seem to be competent professionals, you just assume they'll take care of those things. Oh well.... Live and learn.

Wednesday, August 10, 2005 5:23:00 PM  
Anonymous Dorothy said...

So sorry. I woke up last week with eyes so bloodshot, I thought I was dying. What a real wussy was I compared to the pain and suffering you're going through.

Wednesday, August 10, 2005 9:20:00 PM  
Anonymous Ruby Ransonette said...

Hello Mr. Wang chi, I am Laurie and Bonnie's Mom. (Please don't hold that against me.) So glad you are feeling much better. I also have problems with my eyes. Years ago they found out I have Folds in the back of my eyes. There is no surgery to correct this. In one of the Folds in my right eye, it had formed a coating that has caused my vision to be distorted. Thank God my left eye is still good. I have had TWO incidents of BAD LUCK in Hospitals, both caused by incompetents. What can you do?
Just Keep On Trucking.

Thursday, August 11, 2005 11:47:00 PM  

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