Four Hours in the Eye Surgery Day Unit

On looking back, the signs had been there for years. First, Nadia had trouble at night from the glare. Then reading got harder, especially the day she picked up an Egyptian newspaper in Paddington. Arabic, with its tiny script and its proliferation of vital dots above and below the letters, is the least appropriate language for someone with poor vision.

She wonders why she’d got cataracts by the age of 55. Probably to do with a stupid game they used to play at the beach in Alexandria.  She, Zeinab, Chou-Chou, and of course her sister Simone all dared one another to look straight into the sun for as long as they could. Nadia still has the memory of the after-burn. How was she to know, until Simone told her, that her school friends all cheated by shutting their eyes when she wasn’t looking at them?

“The Nile has cataracts too,” says Chou-Chou. She is still stupid despite being middle-aged now.

“They’re not the same thing,” Nadia replies loftily, even though she is unsure of the difference.

Nobody gets a bed on this day surgery unit. They get an armchair, but only if there’s one free at the appointed time. There isn’t. Along with three other patients, Nadia sits in the corridor. Waiting in corridors is normal in the NHS. It was never like this in Egypt, if you could afford bakshish.

An Iranian nurse and two Irish nurses seem to run the place. Each of them asks Nadia if she is diabetic.

“I’m not diabetic.”

In a nearby office, a doctor sits with the door open. Nadia can hear her complain about the computer system. Doctors always do this.

Once Nadia is installed in her allocated chair, an Irish nurse comes in to put drops into her left eye. “Are you diabetic?”

“No.”

After two lots of eye drops, her vision is so blurred that she can no longer decipher the stream of bile about immigrants, shameless young people, and disgraced celebrities in the newspaper someone discarded.

A young doctor comes to explain the op, reeling off a long list of potential complications. “There’s a one in 1,000 chance of losing all the sight in that eye.”

Nadia recalls a handsome man at Montazah who wore tiny briefs and an eyepatch. He liked to say he’d lost an eye in a duel, though, as her sister told her later, it was really a cataract operation gone wrong. She signs the consent form, sure that things have moved on and that it won’t happen to her.

The surgery is under local while her surgeon hums snatches of an aria and asks about her family.

“There’s nobody left.” Still, Nadia cradles the hope that improved vision will help her find her lost sister.

Everything is bright with a watery blue light. A machine buzzes, and the lens fragments are washed out before a new lens is put into place. She feels nothing.

Soon he says, “All done,” and peels the plastic drape off.

“You can sit up now,” says someone else.

So many voices she doesn’t know, and her head swims when she sits up.

Once back on the ward, a nurse offers her tea and asks again if she is diabetic.

Nadia checks in the mirror that she always keeps in her handbag. There she is, a plastic shield over one eye, with two long strips of tape holding it down.

The nurse returns with tea and instructions: eye drops for the next four weeks, eye shield on at night for a week, sunglasses for a few days, and no hair-washing for five days.

Of course Nadia will wear sunglasses! If her hair is going to be filthy, she doesn’t want anyone recognizing her.

The next day, she removes the eye shield for the first time. Everything is so bright. She can see every leaf on the trees, every speck of dust on the windowsill, every wrinkle on her face. They don’t make mirrors like they used to, that’s for sure.

***

Nadia is a character from my next novel, which is set in Alexandria and London.

If you’d like to know more about cataracts, try this link from Moorfields Eye Hospital.

You may also enjoy Six Lessons from the Eye Clinic.

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Six Lessons from the Eye Clinic

Today Sanjay takes his mother to her hospital appointment.

He’s a nice young man, a character from my novel One Night at the Jacaranda. Although I made Sanjay up, maybe you know someone like him?

He and his mother walk past a sign warning of the symptoms of Ebola.

Not surprising the font on the sign is massive. This is the eye clinic.

1138666_78954230 medical eye

The morning is a learning curve. They arrive at 9.30am to find there are over 40 patients there already.

Beta, I should have brought chair from home,” says Mrs Shah. Here comes Lesson One: in addition to bringing glasses (including bifocals), appointment letters, and any medication they are taking, in original containers, patients should bring something to sit on.

The only empty seat belongs to a man who’s just gone to the loo, which doesn’t flush, as he explains to all and sundry on returning to waiting-room.

A poster on the wall advises patients that clinic visits can take up to four hours. The notice on a board by the receptionist says the clinic is running 90 minutes late. Sanjay isn’t sure if this time should be added to the four hours, or whether it is already part of it. Nobody knows. Lesson Two: don’t ask stuff. Just accept it may take some time.

They stand in the corridor for a while.  A nurse emerges from somewhere and calls out, “Philip Nutmeg” or something similar. When Mr Nutmeg fails to respond, she says it again, looking meaningfully at Mrs Shah. Sanjay says helpfully, “She’s not Philip Nutmeg.”

The nurse glares at him.

Frame on eye chart

Eventually Sanjay’s mother is summoned into a little room to have her vision tested by another nurse, and to learn Lesson Three: computerised medical records do not necessarily contain any medical records. The entire hospital went computerised two months ago, this nurse says, but there are no clinical data on them. So Mrs Shah gets to recite her entire medical history. She looks over the nurse’s shoulder to make sure she writes everything down.

When they come out again, a cleaner in a hijab is here to deal with the loo. And Philip Nutmeg still hasn’t shown.

Lesson Four: nobody gives old people a seat, not even when they are rubbing their knee and looking around hopefully.  It shocks Sanjay that not one person has stood up for his poor old mother.  He considers ejecting someone forcibly, but then his mum isn’t as old or as poor as some of the others.

In the corridor there are two wheelchairs blocking doorways. In one, a woman with one leg. In the other, a man (or possibly a woman). This person has two legs, but Sanjay is not sure about the face because it’s covered with a blanket.

There’s also an old man pushing out some zeds and a younger man who reeks of alcohol. It is 10.45am.

Sanjay notices a woman with a pinched face and a jute bag bearing the name of a firm of solicitors. The doctors will love that, thinks Sanjay.

One of the doctors appears now to find out what’s wrong with the man with the blanket on his head. He insists there’s nothing wrong, but the light hurts his eyes.

Lesson Five, thinks Sanjay: bring dark glasses to the eye clinic because the lights can become unbearable once you’ve got dilating drops in your eyes. Now the man in the wheelchair is mighty pissed off because the doctor has asked him not to cover his head with the blanket. “It scares us, you see. We think something‘s wrong.”

Sanjay’s not so sure. He reckons you could die in the clinic and not be noticed.

The crowd eventually thins out and they get somewhere to sit.  Sanjay’s stomach is rumbling, and so is his mum’s. Lesson Six: bring something to eat.

989041_50471101 baguette

By the time they’ve been there three and three-quarter hours, Sanjay’s mother has had her visual fields tested and her corneal thickness measured, and her pupils look as wide as a dead cat’s. She’s also gone into the inner sanctum, where the consultant sits at a desk in front of a large cutaway diagram of an eye. This is worrying. Shouldn’t the doctor know what eyes looks like by now?

The medical verdict is not too bad. Mrs Shah’s eye pressure is fine today, and her cataracts don’t need doing yet.

Unlike a patient leaning on the front desk. There’s only one receptionist left, and this patient is pleading with her to expedite his cataract surgery because it’s very urgent. Unfortunately, the receptionist tells him he’s only on the routine waiting list.

By the time Sanjay and his mother leave, there’s just one man left in the waiting-room. Maybe it’s Philip Nutmeg.

1221586_15421511 nice eye