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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The Disease Nobody Knows About Until it’s Too Late

If you know much about sepsis, chances are the condition has affected your family.

Sepsis has a high mortality and kills 37,000 people a year in the UK, about 1,000 of them kids. So this week I’m parking the levity and using my blog to sum up what you need to know about sepsis. Photo by Jean Scheijen FreeImages.com/Jean ScheijenUnderstand what it is.

Sepsis is when the body responds to severe infection in such a way that it attacks its own organs and tissues. Without treatment, this quickly leads to organ failure and death.

Most people have heard of blood poisoning (septicaemia) which is much the same thing. But doctors now prefer the term sepsis because there isn’t always blood poisoning in this condition.  

Sepsis isn’t exactly a household name – yet. Personally I think ‘sepsis’ sounds weaker than either septicaemia or blood poisoning, but we’re stuck with the term that scientists agree on.

Know the signs.

The symptoms depend on age, but the main point is that there isn’t any one specific sign like, say a swollen jaw with mumps. A child with sepsis can have a high fever, or an abnormally low one. The younger the child, the vaguer the symptoms.

Here are some signs to look out for in children (from the UK Sepsis Trust’s Paediatric Pocket Guide):

symptoms of sepsis in children

And here are some signs to watch out for in adults (from the UK Sepsis Trust’s excellent Symptom Checker card):

symptoms of sepsis in adults

If I could highlight just two consistent points about sepsis, they would be these:

You or your youngster will be more unwell than expected.

Things get rapidly worse, especially in children.

Understand who gets it.

Anyone can develop sepsis from a bacterial infection (or sometimes a virus or fungus). But some are more at risk, like the very young, very old, pregnant women, diabetics, and people on long-term steroids.

The initial infection can be a serious one like meningitis, or seemingly trivial, like a horse-fly bite.

Surgery can be linked with sepsis, especially emergency operations on those in poor health, or with peritonitis or bladder infections.

scalpel

Know what to do.

Sepsis is a medical emergency and needs urgent hospital care. Don’t waste a single moment.

Sepsis isn’t one disease, but rather a syndrome that cuts across almost every medical speciality. The first doctor you see could be a paediatrician, a gynaecologist, an orthopaedic surgeon, or your GP, and sepsis may not feature at the top of their list. That’s why it’s so important for you to mention it. When you see the doctor or nurse, make sure you say, “I’m worried about sepsis.”

Thanks for bearing with me.

Litmann type stethoscope

Here’s a selection of further reading if you’re interested.

The UK Sepsis Trust is a charity founded to save lives and improve outcomes for survivors of sepsis by instigating political change, educating healthcare professionals, raising public awareness and providing support for those affected. For their general factsheet on sepsis, click here

Sepsis Awareness Month: Rory’s Story. One mother’s personal account.

Three and a Half Heartbeats by Amanda Prowse. A novel of love, loss, and hope about a family devastated when their child dies of sepsis. And proceeds go to UK Sepsis Trust.

Plunkett A, Tong J. Sepsis in Children.  BMJ 2015;350:h3017. A detailed medical article from the British Medical Journal.

One Good Thing about Having Surgery

Sanjay is only in his 30s but he’s had a lot of surgery, all of it since the cancer was diagnosed. That’s if you don’t count ingrowing toenails as a teenager, now best forgotten along with his pongy trainers.

As with Laura, Geoff and the other people in my novel, I made Sanjay up.  He only lives, breathes and sheds tears in my fiction.

In his opinion, the only good thing about operations is the pre-med.  That injection is chock-full of morphine.   Makes you as legless as a freshers’ night out.  There’s also some stuff to dry up secretions, so your mouth is like an African drought.  But with the morphine on board, who gives a fuck?

Then the anaesthetist gets him to make a fist.  “Now count to 10 for me.”   He never gets beyond four before drifting away.230991_2134 surgeon crop

Whatever delicious thoughts he has on going to sleep, there’s always hell to pay when he wakes up.  Last time, someone was moaning like a wounded animal in the recovery room.

And Sanjay was in serious pain.  Just because you were asleep when they plunged a knife into your neck didn’t stop it hurting like hell afterwards.

He thought of his mate Ben.  He must have been in agony for hours.  Sanjay wondered if anyone had given him enough morphine, whatever ‘enough’ means when an IED has ripped off one of your arms and a hunk of leg.  Was there was someone sitting by him, like this nurse here?  Probably not.  Just another wounded soldier, doing his best with a tourniquet and praying the MERT would show before they both snuffed it.

In the recovery room, Sanjay had the irresistible urge to sit up, but the pain and the nurse kept forcing him back down.  He had a sore throat and felt sick.  The smell of antiseptic didn’t help, nor did the bilious scent of dressings.  Nurses insisted there was no smell, but they were wrong.  Since the chemo, he could smell everything.

The moaning still hadn’t stopped.  Some poor deranged sod really didn’t want to be here.  “Hush now” the nurse said. “I’ll get you a sip of water.”

The thirst was unbearable, but all he got was a plastic thimble of water, with instructions to take a small sip.  Most of it went down the front of his hospital gown.  Miraculously, the moaning stopped when he drank the water, which was when Sanjay realized that he was the deranged sod making all the noise.

He patted his neck and shoulder tentatively through the dressing.  Strange that such a small procedure would lead to so much trouble.  Maybe it was the drugs.  It was always a bad idea to mix drugs, but hospitals dosed you with reckless abandon, with gases out of metal cylinders, and loads more stuff into your veins.  One of the anaesthetists explained it.  She was one of the new docs, a woman with long red hair and a piercing that went right through a massive freckle on the side of her nose.

She was flirting with him, he was sure.  So he flirted back, as best one could when lying down and wearing a hospital gown instead of Paul Smith loafers, Armani jeans and lucky pants.  That was when he learned about the IV anaesthetic drugs, like fentanyl and ketamine.  All the stuff to make sure you didn’t come to during the op. No wonder by the time he got to the recovery room he felt he’d gone four rounds with David Haye and had an overdose of Ivory Wave or whatever high you could get for a tenner these days.

Jeremy's scalpel

He’s hoping he won’t go under the knife again, but the cancer always seems to have other ideas.