31 May 2011

Eye witness

I have recently been on the receiving side of patient care. My cataract surgery was a complete success, and I am surprised—no, amazed—how much brighter my world looks now.

I reported to the eye clinic at a local hospital one morning last week. My ophthalmologist, who looks like she belongs in high school rather than a hospital, did a quick eye exam to determine if I was an acceptable surgery risk and then sent me off to the outpatient surgery section. There, I was met by two lovely young nurses, Petra and Jane, who explained that they each spoke a little English and that, together, would get me ready.

They were so helpful and pleasant I was sorry I caused them extra effort with my language requirements. I changed into scrubs, had my name plastered on the front of my shirt on a piece of tape so they wouldn’t forget who I was, and was led into the surgery-suite waiting area. There, one of them appeared every 10 minutes to put different medicated drops in my eye.

I’ve traveled a good bit of the world and one thing I’ve always marveled at is, no matter how friendly a society is or is not toward Americans, everyone—and I do mean everyone—likes American music. So there I am sitting in this room, surrounded by several Czechs waiting for eye surgery, and I’m listening to American country music.

After I completed several rounds of eye drops, I was transferred to the operating room, positioned for surgery and draped out. I have a bit of claustrophobia. It isn’t one of those run-screaming-out-of-the-room things but rather a nervous tension. I knew I was going to have a drape over my face, and I was a little concerned about this, but I shouldn’t have been. I only had a moment to worry about being covered up before the instruments started coming toward my eye. For the rest of the short procedure, I gave no thought to being enclosed. I was too focused on the needles and the sucker thing I was watching attack my eyeball.

I readily admit there was no pain! And, to prepare me, my ophthalmologist explained everything that was happening. The nurses were great, comforting and reassuring me, and one even held my hand. It was not a bad experience; it was a strange experience! I’ve never had eye surgery before, but I have had surgery in the United States and I can honestly say that the surgeon, staff and facility met any expectation I would have had at home. I would not hesitate to recommend them.

I’m now in the recovery phase, which has been surprisingly easy. I had no post-operative pain at all, only a patch on my eye for 24 hours. The patch came off and—voilĂ —bright, clear vision! I’m channeling Bob Marley lately as I sing, “I can see clearly now.”

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

23 May 2011

Getting my eyes Czeched

For some months now, I’ve noticed my vision becoming less sharp. I finally decided to see if a bit of LASIK surgery might be a possible solution and scheduled an appointment with Prague’s premier LASIK center at a local hospital.

The appointment started off in the opposite direction I had hoped for when I was told the ophthalmologist with whom I had the appointment was not in and that his associate would see me. After a few minutes wait, a lovely young woman came in to speak with me and asked questions about my medical and visual history. I thought she was the nurse. She was the associate.

A few minutes later, I was ushered into the examination room where the young doctor did an eye exam. She quickly informed me that LASIK would not help me, and I needed to meet with her colleague. She thereupon personally walked me up to the next floor, where I met an equally young and lovely lens implantation specialist. In spite of the fact that I’m a medical provider, I can be a bit slow on the uptake. I was still of the mindset that we were talking about improving my vision which, in my mind, was a simple matter of loss of visual acuity due to aging.

The second ophthalmologist told me all about this wonderful multifocal lens that would improve my ability to read, without the Dollar Store readers I’ve used for years. “Yea!” I thought. I would love to ditch the readers. She then took me into her examination room and started with the same basic eye exam I had one floor below.

At some point, I threw out the question, “I guess LASIK would not work for me?”

“No” she said, “it will not correct the cataract.”

Cataract! What? Where did that come from? I immediately said, “I’m too young for a cataract!”

“Obviously not,” came her reply.

I was still trying to absorb this information when the young lady, now peering into my dilated right pupil, said “Oh!”

I do medical examinations and, as hard as I try, sometimes that “Oh!” just slips out. It usually isn’t good.

Now, the doctor is speaking Czech to her assistant. Next, the assistant is on the phone, and then we are moving hurriedly to another office. I asked what the “Oh!” was about. The doc tells me she thinks she sees a hole in my retina, and I’ll need retinal laser surgery.



My goodness, the Czechs move quickly! This time, the retinal specialist is a rather ordinary-looking man who, though quite pleasant and reassuring, does mean things to my eyeballs as he looks for holes. After about 10 minutes of misery, he announces that my retinas are not perfect, but they are good enough and—drum roll—NO HOLES! “No laser today,” he says.

By now, I am so relieved I don’t have a hole in my retina I don’t even care that I have a cataract. Back we go to the second office, where the informed consent for cataract surgery and several bits of paperwork for pre-surgery testing are prepared. Alas, I am told that, because my retina is not perfect, I can only have the monofocal lens and will still have to rely on readers. They scheduled me for cataract surgery in three weeks, and I left the office with the typed medical report in my hand, just two hours after I arrived in the ophthalmology department.

Beat that!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

05 May 2011

Spice girl

I have just returned from two weeks in the United States to welcome my newest—and eighth—grandson. He is a great little guy, peaceful and even-tempered, and, considering that his next older brother is a real handful, I hope he stays that way, in deference to his mom.

Lately, I have been corresponding with a couple of people who are interested in what my job entails. I’ve been asked to recount my "typical" day, and I’ve given a great deal of thought about what a typical day is for me. However, there is a big picture to my job, and it can’t be answered as easily as one might think.

First of all, typical, in the sense of the types of patients I see in the clinic, depends a great deal on where that clinic is located. State Department embassy medical units are located worldwide, so health risks differ from location to location. While there might be an allergy or influenza season in any location, acid bug, malaria, dengue or Japanese encephalitis risk only occurs in some locations. However, most patients are seen for basic primary-care causes, just as in a U.S. clinic, but the daily patient load is less, as our responsibilities are broader than patient care.

Patient safety and health issues also vary by location. For example, the risk of gastroenteritis in Southeast Asia, and the community education required to prevent it, far surpasses the risk in Western Europe. When I was in Southeast Asia, evaluation for and treatment of food-borne disease was a daily event. In Prague, I have never discussed food-borne disease with a patient; it isn’t required.

My typical day in some posts might include a visit to the embassy cafeteria kitchen to observe and reinforce proper food storage and preparation practices. Our North American standards of food service are a mystery to food workers in much of the world, and it falls to the post medical unit to enforce the standards we expect.

A frequent task is evaluation of medical resources to use as consultants for the embassy community. In the majority of these cases, a continuing relationship and rapport must be nourished by frequent contact, visits with the consultant and sponsorship of social events. Medical associations in the United States are largely pure business while, in a great deal of the rest of the world, successful business requires social interaction like "tea and biscuits" to keep the relationship active.

In the beginning, I found this very difficult. I was used to calling a consultant and immediately launching into information about a patient. I've learned to be more sensitive to the cultural needs of the practitioners I call, which usually requires discussion of niceties first—"How are you? How is the family? How was your recent trip to X?"—before I launch into the medical conversation.

A typical day for me includes meetings—management, country team, emergency action committee and other committees of various sorts. I may be the medical officer, but my official duties cover many things that aren't medical at all. I admit I’m not a fan of meetings, but they are a necessary part of the job.

If variety is truly the spice of life, I have a very spicy life. Just the way I like it.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.