Compassion With The Sting Of Iodine

First they shoved a needle into my face!

I lay flat on my back in a small darkened room far from home. A pair of intense spotlights in the ceiling directly above shone in my face. A man with an unusual, foreign-sounding name I had met only a few hours earlier produced a syringe from the shadows and advanced toward me while his assistant stood between us and the door. This was only the first needle. Later he would drive another deep into the interior of my right eye. And that only after battering that aching, bleeding orb with other instruments that for the moment lay concealed, not yet attached to the cabinet of chemicals at my feet. And this first, this preliminary, this prologue, this sharp little appetizer of a sticking tool was not even directed at my eye itself—only to my face where, the man said, I might feel "a little pinch" just as he slid it in.

Did John Conyers or Henry Waxman or Ted Kennedy or anyone ask that guy W put up to take over the Department of Justice if he might think this sort of treatment would be torture? I haven't experienced the officially sanctioned drowning treatment, but I'm pretty certain I wouldn't like it. But this eye business, needles and other instruments and some pinches, pains and several other discomforts notwithstanding, I found interesting, unalarming, non-frightening, and to a degree amusing. And it was my own fault.

There had been that mild blow to the head a few weeks ago. Jumping out of the way of potentially worse trouble, I'd landed unharmed except for a somewhat crumpled glasses frame and a small cut on my right eyelid. But that might have started the process that led, about ten days ago, to a serious corruption of my right visual field. After putting up with it for a couple days without resolution or improvement, I had my optometrist shine her light into the subject. She seemed quite delighted: "I haven't seen a good one of these in about four years." She confirmed what a half hour of Internet investigation had convinced me—I had a detached retina.

So it was that I lay supine as Dr. Richard Bazarian and his capable assistant Shirley (last name unknown) welded the flopping organ into its proper bed with tissue-wrecking bursts of extreme cold delivered to their instrument and to my eyeball from a tank of liquid nitrogen (somewhere around 320 degrees Fahrenheit below zero). Then the needle which, I guess I'm thankful, I didn't see as it approached my blocked, deadened, senseless eye.

I did feel a solid pressure and I heard a sort of crunch as it penetrated. Through this needle Dr. Bazarian introduced three-tenths of a milliliter of C 3 F 8 , a gas known as perfluoropropane, a version of ordinary propane with the hydrogen replaced with fluorine. Over the course of the next two days this volume increased fourfold by absorbing oxygen and nitrogen from blood and tissue in its environment, the by then 1.2 ml. bubble serving to hold the retina in place while the frozen tissues healed to secure it.

I am now one week post-operative and the bubble is an old friend. It is black, translucent, like those balloons some persons find appropriate for the birthday celebrations of fifty year olds. Starting as a series of nine small bubbles known in the ophthalmic trade as "fish eggs," it coalesced and grew into the single large oval I now enjoy. Its consistency, shape, and surface tension are somewhere in the realm of a cheap water balloon or the mammary apparatus of a large-breasted, middle-aged woman. It is a wobbly shape-shifter, not unappealing, and serving its intended function admirably. My intra-ocular pressure is an ideal 16 mm. of mercury.

It is true that I look out through a polluted industrial fog effect of yellowed vitreous humor corrupted with cellular debris and obstructed by this bubble that will dissipate only slowly over several weeks. But there is light and focus and peripheral vision, and I anticipate a return to full function. I made, it appears at this juncture, the right choice. Or at least a right choice.

The preferred repair for my condition was a scleral buckle and a vitrectomy. I think these, too would have been interesting and fun. And the success rate would have been somewhere in the ninety-eight per-cent range, but with a near certainty of the necessity of a cataract operation within a year subsequent. And the cost? Well, it requires general anesthesia; I lost interest when the sum of the labor and materials got up somewhere around twelve thousand dollars. The option, but with only maybe a two out of three likelihood of a complete fix with one intervention, was the pneumatic retinopexy I chose, at an anticipated cost of maybe three thousand.

Dr. Bazarian laid out the details, the risks, the approximate costs. I made the decision. Not so many years ago (and likely even today in many instances) a physician did not invite his patient into the decision. One was told what he or she would get; the job was left to the experts and if the outcome was poor one could live with it, die or sue.

I balanced cost and complication and expense and made an informed decision. I am grateful for having been given direct, technical details of the possible procedures and their costs, and for being considered more a partner than a passive substrate.

With insurance would I have chosen the more involved, much more expensive option? I don't think so, although many might. I hired a well-trained, capable craftsman whom I liked and trusted. He used good materials, applied his skill and experience. I shall pay his invoice without correspondence or phone calls or confusion from any insurance company intermediaries.

And I'm not pleased to be spending this sum. But I could do two or three of these a year for the cost of an insurance policy that would, in the end, still have a deductible, a co-payment, and a trail of complexity that would increase my pain and suffering far beyond the agonies Shirley and Dr. Bazarian inflicted upon me.

Restored sight is not all I have gained. I am not by nature inclined to turn myself over to the care or direction of others. It has been good for me to be reduced, handicapped, dependent. My wife drove me three times to Portland so that I would not endanger the driving public. She and my grandson, by their proximity and concern, comforted me. The assumption that I was capable of understanding my condition and treatment and influencing its course gratified and reassured me.

I am not spiritually reborn. The eye is not a proof of God. It is an imperfect amalgamation of tissues that for most owners most of the time does a good job. My surgery and recovery was not a miracle, and my trouble did not happen "for a reason." It happened because I'm an aging myopic with a knockabout lifestyle. Cars and houses and people wear out. Systems break down. Carpenters and electricians and plumbers and doctors fix what they can for as long as they can.

My optometrist, Carol Farrar, in Bath, did not charge me for her examination and referral, a small kindness one likely would not receive from some eye doctor attached to an optician's store in a shopping mall. She deserves recognition for that. You can tell her I sent you.

Clamping my deadened eyelids apart with a traction device, Dr. Bazarian scraped an iodine-soaked cotton swab across the surface of my eye, suggesting that might "tickle." I found it considerably more irritating than that, but it did bring to mind Leonard Cohen's song, "Iodine." We debated at work once years ago if, given a choice, we'd prefer to go blind or deaf. My partner chose blind; I opted for deaf. I have an excellent, facile, detailed memory. (Many of us with higher-functioning Asperger's share this trait.) Having once heard Leonard Cohen I can replay his songs for all time, not to mention Tom Waits' weirdly wonderful "The Eyeball Kid" and a thousand others. But there is much I have yet to see.

The backache, the insufficient knees, the arthritis and hair loss do not trouble me. I intend to limp and lurch into as advanced an old age as I can. But as Warren Zevon sang so honestly and affectingly as his own days closed and diminished, "Don't let us get stupid, all right?" I can see and hear and say what I think and feel. And tonight I can say "I Feel Good!" even if I cannot yet quite affirm "I Can See Clearly Now…."

And why do I tell you this and why might you care? Bill Moyers interviewed black theologian James Cone while I was holding my head just so to properly position my gas bubble the other night. He talked about slavery and lynching and oppression, but I think his message is applicable to other sorts of loss and diminishment of body and mind and spirit as well: " When you can express and articulate what's happening to you it gives you a measure of tra n scendence over it." So we live, we learn, we read and we write and we wait for the slow absorption of our perfluoropropane and the arrival of the bill for its insertion. I don't re c ommend retinal detachment followed by pneumatic retinopexy, but if it should happen to you, it is, I can attest, an interesting ride.