Doctors are notoriously bad patients. Before undergoing two cataract operations, I heard that familiar joke. Cataract replacement, with a 98% success rate, is one of the triumphs of modern medicine; would that psychiatry could come near to equalling it.
Cataract surgery is now generally performed under local anaesthetic, which provides the patient with a different perspective.
My initial assessment was a model of how these things should be, but pressures in the eye unit later undermined the ideal. The consultant surgeon conducted a thorough examination. An additional problem, double vision, was then explored by an orthoptist, who explained everything well. They recommended surgery on both eyes. I signed the consent form and was sent to book the operation. The booking clerk said there was a cancellation slot the next day, which I gladly accepted.
On arrival I was surprised to find myself under a different consultant surgeon with no explanation. I was seen by a nurse and then by the new consultant’s specialist registrar who would be doing the operation. The examinations were quick, mainly form-filling exercises. I learned that there was no operating list schedule, and that patients would be called to theatre in no particular order. As it happened, I was the last one, some five hours after the arrival appointment; no food to be taken whilst waiting.
In the theatre ante-room there was repeat paperwork to eliminate risk of error; confirmation that I was the right Peter Woolf (not Dr, the IT didn’t have provision for that option); date of birth, which eye was to be done, etc.
Inside theatre, the scene was intriguing, with elaborate hi-tech machinery. I was laid down flat with my face covered, so one could not see what was going on. Background music played. The injections and processes were virtually painless. They involved what sounded like a dentist’s drill in one’s eye; you could feel it, but nothing hurt.
However, at one point, I sensed that all was not right. The consultant surgeon himself came in and took over, and the procedure extended to what felt like twice the expected duration, before on completion the team expressed relief and satisfaction.
Nothing at all was said to me throughout the lengthy process. Afterwards the consultant explained that because the new lens which had been inserted proved to be a faulty one, it had to be replaced, apparently a tricky exercise. The anomaly was so unprecedented that he had never encountered it before. The abnormal lens would be returned to the manufacturer with a complaint.
Next morning I returned to the department and the bandages were removed. Two sets of eye drops were supplied, to be taken alternately, hourly for a fortnight. It was a relief to have two eyes again.
At the follow-up clinic a fortnight later there was paperwork again, to plan for the second operation. It all seemed de novo. I was asked: “Do you want it done? It’s entirely up to you”, as if the decision had not already been made. The same risks explanation, as per the leaflet supplied, and a second consent form to be signed. In that rushed interview in a busy clinic there really was no time for, or encouragement to ask, pertinent questions.
Once again I was sent to arrange the second operation with the bookings clerk, from whom I learned that for various reasons the first opportunity would be several weeks later. On enquiry I learnt however that my original consultant could to do it the next week, so the clerk went off to explore whether I might be re-allocated to the original team, with which I had experienced such good rapport.
She returned to tell me firmly that was not to be, “you’re now under Mr X and must stay under him”.
Whilst waiting for the second operation recovery continued steadily, with the gratifying experience of regaining colour clarity and brightness, which I had been losing over the years without realising. Between the two operations grey morning skies seen through the right eye became blue through the new left lens.
At pre-examination before the second operation the same routine was repeated, with people in the clinic behaving as if they did not recognise me. I mentioned having not being told what had been happening during the previous prolonged operation. The response was: “No, we don’t talk to the patients in case it makes them more agitated”. I said that for me, the opposite would apply; written note was taken of that preference.
In theatre again the atmosphere was tangibly less relaxed than the first time. The consultant was present throughout. The theatre nurse sounded less confident than the previous one. After some time things began to sound fraught. There were problems with the new lens; another was needed: “Should it be the 70 or the 70.5?” Some equipment available was not as wanted: “the straight one, not the curved one”. No reassurances or explanations were addressed to me.
Eventually all was complete. Sitting up again I was assured that the operation had been completed, technically perfectly. Surrounded by all the high-tech equipment I said that, being a doctor myself, it would be interesting to watch one of these cataract operations in theatre. The SpR thought that would be “against rules” but that I could look them up on the internet.
During the evening, worrying visual manifestations occurred. The bandaged eye produced a coloured show, with bright, kaleidoscopic effects which somehow swamped the vision of the other eye. A thing like a shimmering coloured table cloth appeared - scary! My worried wife phoned the help number provided for nurse advice but failed to get through.
On the next morning - as the great freeze of 2010 got under way - I returned early to the hospital, worrying whether the retina might have been affected (detached retina is one possible complication on the patients’ leaflet).
I told the clinic nurse that I had a worry. She did not know me, nor that I was a doctor, as I re-iterated when asked to give my particulars all over again. “Well, I’ll put down, you like to be addressed as Dr.” The SpR saw me in due course, and reassured me that the visions were not sinister; probably some “edge optical effect” of the “very large replacement lens” they’d put in.
Despite the typically harrassed atmosphere (the snow had disrupted travel for both staff and patients) I did pursue some questioning and received from the lead consultant, who was also at the clinic, another explanation of my bizarre kaleidoscopic visions: “just the jelly rolling around in the back of the eye - it sometimes picks up the retina a bit but only quite slowly”. I also mentioned that the atmosphere had seemed fraught at the second operation, with the nursing assistants unable to find instruments, etc?
Several weeks later, at the final out-patients review I was called in from the corridor loudly, Peter Woolf, by that same consultant (as if he hadn’t connected who I was?). Again the various people who saw me that morning seemed unaware that I was a doctor. A nurse asked how long I’d been one and seemed impressed that I answered “about sixty years”. Later the consultant reassured me that the two operations were perfectly normal “apart from circumstances”.
This is, of course, just one story; one with a happy ending, that could be widely duplicated. But the message has to be that time constraints loom large in medical practice, whether it be GP appointments or a busy specialist hospital department that is, in a way, a victim of its own success.
The staff have no time to achieve rapport with patients; instead there is an expectation that patients are totally deferential to an overly stressed clinical team. There is plenty of scope for improvement in everybody’s best interests - however busy a clinic.