Archive for the ‘health’ category

Corneal Scarring, Part II

July 8, 2008

I have this incurable habit of going off on a tangent. Many of my students know this and seem to gleefully lead me astray in class with unrelated questions to minimize actual study time. I want to say that I realize what they’re doing but allow them to do so anyway as way to give them an academic break and relieve the day-in and day-out stress of college life just a bit. Unfortunately, the reality is that I just like to talk and simply lose track of my thoughts. My inability to stay on topic is apparent here as well.

Now where was I? Oh yeah, my cornea….

Previously…

“Perhaps I had been fooling myself all along. I mean, I had come to terms with my lack of depth perception, but the adjustments in the brain more than made up for the visual acuity I needed to function in everyday life. I felt that I was able to enjoy anything and everything life had to offer. I was wrong. But, hey!–and maybe I’m just trying to rationalize my situation–3D is not the end all of life. It just seemed like it would be a little more fun.Unfortunately, it turned out that my vision affected more than my enjoyment of 3D effects. So I had an operation.”

Back in 1993, as I was working on my dissertation, I would get severe headaches. My eyes would tire easily and I came to realize that I was actually reading texts with only my left eye. Indeed, following the cursor on a computer while editing large portions of texts with only one eye was neither an easy nor a comfortable task. Doctors told me the only way to fix the problem was to get a cornea transplant. I did not like the idea of going under the knife, but the headaches were becoming intolerable so I was willing to confront the issue with an open mind. But of course, nothing is easy. There was a waiting list, and for me a rather long one at that. Since I had one functioning eye, I would perpetually be pushed back–those who could not see through either cornea due to injury, age or illness were always bumped up to the front of the line. I was told the wait would be about three years.

However, one doctor offered another solution–laser surgery. The procedure was called excimer laser surgery, and was being carried out on an experimental basis under the auspices of Japan’s Ministry of Health. They were looking for appropriate candidates for trial laser surgeries and I was a good guinea pig since I only needed one eye done–in other words, I guess, if they screwed up the surgery I’d still be able to function. The good news was that the trials had been going on for about a year without any notable issues, and the procedure itself would be cost free. I’d only pay for basic hospital visit co-payments and post-op pharmaceuticals. This sounded like a plan to me, so I agreed and I was sent to Juntendo University Hospital in Tokyo.

I initially went through a battery of tests: they gave me a physical exam as well as visual tests to determine the health of my eye. I have to admit I found the experience very interesting. Since the alphabet is not the standard writing form in Japan, the eye chart is a bit different as you might imagine. There are a variety of charts in Japan, some using the Japanese syllabary, others using a combination of numbers and alphabet. But I was particularly stumped by the broken circle chart. You tell the tester where the break is: left, right, top, bottom left, top right, etc. When vision is blurred, it is virtually impossible to tell where the break in the circle is.

Another thing about the Japanese medical system is the waiting. At a local clinic in Japan, there is no such thing as an appointment. You go in, hand your health insurance card to the receptionist and wait… If you’re lucky, you’ll get seen within half an hour. If not, then you wait… and wait… and wait. Fortunately, at a major university hospital, they actually have appointments. I was skeptical on my first visit to meet the doctor who would perform the surgery, but after handing my insurance card to the receptionist, they called my name in about five minutes. そうこなくちゃ! Now this is what I’m talkin’ about, I thought. They instructed me to go to the next room where… there were more people waiting. Yikes! I sat myself down, glad I had brought a manga just in case. In about 40 minutes–I was almost finished with the manga–they called my name. Whew! I was led into a dim hallway that had cushioned benches lining one side and doorways to small examination rooms lining the other. And yes, there were more patients sitting on the benches waiting! Aargh! I finally figured out the strategy. By moving you from room to room, they create the illusion of movement, of getting closer to your appointment. I finished the manga and decided that next time I should bring a novel. I closed my eyes to rest, maybe even to doze off. Kanzaki-san, Please step in to see Dr. Murakami. It had taken almost an hour and a half to see the doctor. I had many subsequent visits to this hospital, but I learned that this first visit was relatively quick. I can still recall having a 1:30 appointment and after exams and waiting–again–for prescriptions dispensed by the doctor, I’d be lucky to leave by 4 o’clock. The shortest wait was always at the cashiers window. That will be 1500 yen please. I wonder why…

The Surgery

After the preliminary exams checking my fitness for the procedure, I was set to have surgery. You can understand how nervous I was. Today, Lasik eye surgery is ubiquitous and seemingly mundane, but back in 1993 I found nothing mundane about a laser that would cut a thin layer off the surface of my cornea. Japan is notorious for babying its patients. In the US, women who give birth to a child without any complications are regularly sent home on the very same day, but in Japan, a one week stay is not unusual. So I was shocked to learn that mine was an outpatient procedure–Check in, then check out after the operation if there were no complications. I guess free surgery meant free surgery.

I was led into the operation room, but it looked more like an empty conference room. It was clean but did not comfort me with the sense of sterility or competence that an actual operating room would convey. There was no heart monitor. No IV stands ready for action. None of the trappings of ER or Chicago Hope or even Dr. Kildaire. Only an operating table, a tray with utensils, three or four computer screens and a humongous laser machine with overhead lighting. Besides the doctor and a nurse, there were three suits monitoring the computers–were they government people monitoring the operation? Representatives of the laser machine company, to make sure the laser operated properly? When I think about it now, I should have asked more aggressively who everyone in the room was. Instead, I just lied down on the table as instructed, like any good guinea pig would. While the nurse put a patch over my left eye, the doctor forced open the eyelids of my right eye to place a ring directly onto it to prevent my eyelids from closing should I get the urge to blink during surgery. He then put some eye drops in my eye to desensitize it. Local anesthesia? I asked. Yes, it should be more than enough.

How exciting, I moaned beneath my breath.

A few moments later, I felt a sting in my eye. Did you feel that? The doctor asked. Hell, yeah! I wanted to growl back, but I just nodded. Apparently, he poked the side of my eye with a probe to see if the anesthesia had kicked in. He added some more drops in my eye and five minutes later I felt the same sting again. Before he could ask I told him firmly, Yes, I can still feel it.

“Do you drink lot of sake?” The doctor asked.

“Uh, yeah. Why?”

“Well, often, heavy drinkers need a larger dose.”

Great, I thought. Who knew I had developed a resistance to anesthesia.

After a while, a red light lit up above my eye. Look directly at the red light and don’t move your head, he instructed me. Ah, they’re getting ready to start, I thought when I suddenly smelled the unmistakable odor of hair burning. What the…

The surgery had begun. Unbeknownst to me, the doctor had prodded my eye again, but since I didn’t react, he figured I was fully anesthetized. Personally, I wish he had asked.

For what seemed like about fifteen minutes, I saw a beam of light slowly scan my eye left to right, then right to left as the doctor peeled off layers a fraction of a micron thick from my cornea. And all the while, it smelled like my hair was burning. I was an awful odor.

Fortunately, there was no pain. The laser and red light went off, and the doctor taped some gauze over the eye. I then followed him to his office where he gave me instructions to come back the next morning and a prescription for pain killers. I told him that they eye didn’t hurt at all. He smiled and told me get the pain killers anyway. I soon found out why.

As I waited for my prescription in the cavernous main lobby of the hospital, my eyes began to sting. I finally got the medicine, and decided to take a dose immediately. It didn’t take away the pain immediately, but I was confident that it would eventually take effect on the way home. However, at the Ochanomizu station, the eye began to hurt something awful. Tears flowed down my cheek and the eye patch was soon soaked. In pain, I clenched my right eye shut as I tried to navigate my way through the rush hour throng from the platform to the train with my one good eye. I barely was able to change trains at Shinjuku to get onto the Keio line home. By the time I got to Nagayama station, about an hour and fifteen minutes after leaving the hospital, I was in so much pain I had to grip the handrail with all my might as I descended the staircase leading out of the station, pausing every few steps to muster my strength and will myself further. I thought I was going to die.

The aftermath

When I got home, my then-wife asked rather cheerfully how it was. どうだった? I didn’t even answer her. I just walked passed her to the bedroom, pulled out the futon and lied down exhausted. I remember having asked her if she would accompany me to the hospital, especially since it was an outpatient procedure. Indeed, the doctor and nurse asked me why I had come alone. I couldn’t remember why she didn’t, but it didn’t matter at that point. All I wanted to do was go to sleep.

The next morning, the pain was still there, but it had subsided considerably. My then-wife said she’d go with me to the appointment, but I told her not to bother at this point. もう、今さらついて来なくていいよ。 She insisted and came anyway, although I basically ignored her. (Yes, I could be a jerk, I guess.) I had changed the gauze patch two or three times at home, but because of the pain, my eyelids remained tightly closed. But, as I rode the orange Chuo line to the hospital, I noticed that the pain was almost bearable, and somewhere between Yotsuya and Suidoubashi, I decided to see what I could see. As I looked out the window of the train, I gently peeled up the gauze and slowly opened my eye.

I was shocked.

Although it was an overcast day, the autumn leaves never looked so bright, so yellow and red. Even the gray condominiums and office buildings in the background shone oddly brighter. Even stranger, they seemed deformed.The edges framing the structures seemed to stand out in relief. Parts of some buildings seemed to bulge toward me. It was the effect of the new curvature of my cornea, but I concluded at the time that it was my first view of Tokyo in 3D. And that was as good a reason as any. It just all seemed so beautiful.

Ultimately, I had to apply steroids daily to prevent the “wound” from trying to heal itself–or something like that. And for three years, I was fine. Indeed, I felt smarter. Is it me, or is my dissertation coming along more smoothly? I began to wonder if reading text with both eyes–i.e. gathering information through two portals each connected to its opposite cerebral hemisphere–increases cognitive ability? Does comprehension improve when data is retrieved directly through my right eye which is connected to the left, more analytical side of the brain? Well, it sure seemed like it. By 1996, I had finished my dissertation, received my Ph.D., landed a gig on my first go-round on the job market, and started teaching here in Washington DC in the Fall semester of the same year. Sadly, I had trouble getting a prescription from local doctors for the medication I needed. All the documentation I had of the surgery was in Japanese and doctors here–perhaps afraid of being sued–were reluctant to prescribe pharmeceuticals for procedures that they themselves did not perform, or that was based on documentation they could not read for themselves.

Without the steroids, the cornea slowly repaired itself and now I’m left with scar tissue that is larger than the original scar. Which brings me back to my original dilemma: Whether or not to get a corneal transplant. I’ve lived with this condition for so long, I really don’t see the point in it anymore. But I would, just once, like to experience a 3D movie the way it was meant to be experienced. I never did get the chance.

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Corneal scarring–Part One

June 30, 2008

A couple of comments asked about the corneal scar I mentioned in my last post. Well, it isn’t as dramatic as Onigiri might imagine–no, I did not get stabbed in the eye like your cousin. Whew! Now that would be a story to tell. My story is much more mundane, but the effects of this “malady” are much more amusing… well as amusing as a handicap can be.

My memory is not perfect, as my regular readers know, but there are photos of me when I was around 5 years old with my right eye patched up with gauze. I vaguely remembered–and I later verified this with my mother–that the eye was suffering from an infection, and I had to wash out my eye two or three times a day. Mom would pour a solution into an eye cup, after which I would face down to place my eye socket onto it and then while holding the cup tightly to my face look upward blinking two or three times as the solution bathed my eye. I hated this ritual, which is probably why I remembered it.

Fast forward 12 years…

One day in the summer of 1973–those glorious days of high school when I was basking in my new found independence and stupidity–I was returning from the beach with my girlfriend, Aileen, when suddenly I realized that I was seeing double. I would see two sets of railroad tracks but would only feel one set as I drove over them. For three days, my vision was strangely blurred. I hoped that it would just pass, but when it didn’t I finally screwed up the courage to see an opthamologist. After a battery of tests, they determined that my vision problem was based on a small scar on my eye. He showed me a blown up photo and pointed out a small imperfection. He said it was smaller than a grain of sand, but that was enough to refract light in a way that would blur my vision. He asked me if I had injured my eye, but when I told him I didn’t, he told me that it was probably the result of an infection when I was younger. When I got home, I recalled the eye patch and the eye baths when I was kid. I pulled out old photos and showed them to mother, which is when she confirmed the infection for me.

So this is the cause, I thought. But the sad thing of this predicament was that the scar was not curable. Perhaps, if laser technology was as it is today, then I may have been able to do something about it. But back then, it was what it was, and you learn to live with scars and injuries. Besides, after a week or so, my vision seemed to revert to normal. I thought it had healed itself, as any scar would heal, and I continued on with my merry summer of ’73.

But life, as I was to learn, was neither so simple nor forgiving.

*   *   *   *

A few years later, I began to notice that I had trouble gauging depth. I had knocked over more than a couple of beers, but I attributed this clumsiness to being drunk. I mean, what else would I attribute it to? Then one day I went to Westwood to see a movie with two of my buddies, Cary and Sam. We were a little early and so we were strolling around the shops and small malls. At one point, we were going to leaving a shopping area that was on the second level. I strode forward and found myself tumbling down a short flight of brick steps. My friends rushed to my side.

“Ray, you okay?” They asked as they helped me get up. “What happened?”

“Yeah, yeah. I’m okay.” I assured them as I brushed myself off. But when I looked up I was shocked. “Steps?”

“What are you talking about?”

“I fell down these steps? I don’t get it. I could have sworn it was a ramp.”

“Dude, if that’s a ramp…” But before Sam could finish his sentence, I went up the steps down which I had stumbled. I had to see again what I thought I saw. When I reached the top of the steps, I looked down and in front of me–Huh?–was a short flight of about 5 steps. I don’t get it, I said again to myself. I swear I saw a ramp. But when I took astep side ways toward the center, the steps magically turned into a ramp. “Woah!”

“Woah, what?” Cary asked.

“Shit, you know these stairs? If you stand right in the middle, the lines kinda blend together and they don’t look like steps anymore.”

As Cary and Sam came up to see for themselves, I explained to them that from this particular point of view, the vertical space between the bricks looked like one continuous line making the steps look flat, and thereby appearing like a ramp. But when my buddies stood next to me, they laughed.

“Have you been drinking already? These look like steps to me, no matter where you look from.”

“No, seriously. Stand in the middle. Doesn’t it look like a ramp?” I said flustered. How could they not see it?

“Ray, the only way this is going to look like a ramp is if it was a 2-D picture.”

A wave of events suddenly washed over me, blending together in a very intertextual manner–irreparable scar on cornea, the belief that the scars had healed, knocking over glasses of beer and now this. Was I perceiving the world in two dimension? Was I looking with only one eye? Leave it to my friends to help me put things in perspective, even if it was only a two dimensional one.

With this new insight, I began to figure things out. I fell down the steps at dusk when there are no real shadows. I had knocked over beers only at bars where the light was dim. Did that mean, perhaps, that during the day I would consider other factors unconsciously to calculate distance? The shadow of the can of beer is three inches, and the can itself is five inches, A² + B² = C². Ah, Pythagoras, who knew! I also began to think that some of my other senses were heightened. I have always been able to hear things that others could not–In a car with the stereo up high, I always heard a siren well before other passengers. My olfactory senses seemed pretty sharp even though I was a smoker. I mean, I could smell rain before it actually did–I learned later that it wasn’t really rain, but bacterial spores that are emitted after a long dry spell–not an unusual situation in LA–when the humidity rises right before it rains. Or something like that. But the point being, I could smell things others seemed to miss.

More importantly, I realized that my brain was playing tricks on me. I went to the optometrist to get new glasses soon after. They took photos of my eyes and they asked me if I knew that I had a scar on my cornea.

“Yes, I found out a few years ago.”

“Do you not have trouble seeing? It’s the size of a poppy seed.”

Now what the heck would an optometrist know about poppy seeds? I thought for a moment but was soon overcome by the realization that the scar had grown from a grain of sand to a poppy seed. Oh crap. I am seeing the world in two dimension. But what intrigued me most is that I had not even realized it. My brain would take into account any and all sensory information, then adjust my 2-D world into a 3-D one. The only time it would fail me, I deduced through my own–albeit unscientific–observations, was when I didn’t have enough information, like when there were no shadows to measure. Or when I had headphones on and could not hear other sounds.

Or when I watched 3-D movies?

*   *   *   *

Our school holds an orientation for incoming freshmen every year, and yesterday I participated in the Major Fair, an event where new students have the opportunity to talk to faculty about majors they are interested in pursuing. I was there with a Chinese colleague, a late 20-something, single, and attractive–I am particularly vulnerable to Chinese and Vietnamese women. We had our share of students interested in studying Japanese or Chinese, but as you can imagine, the numbers do not come close to those interested in the “popular” fields such as, say, psychology or political science. Go figure.

Anyway, when there were no students asking us questions, we had an opportunity to chat and get to know each other better–just because we’re in the same department, doesn’t mean we hang out. She is a native of Taiwan and claims her English is not very good, although I would beg to differ. Her English is quite good. But she told me that it can be quite awkward at times when she is the only one in an English speaking setting that doesn’t get the joke. Man, can I relate with that.

Back to the story…

Back in 1973, I went to see Andy Warhol’s Frankenstein in 3D with Aileen, Diddly and his girlfriend. It was relatively amusing to watch a tree pass by right in front of your face, and body parts jump off the screen. Well, amusing enough for a 17 year-old. But 16 years later, I went to Disneyland in LA and went on the ride, Michael Jackson’s Captain Eo. This too was in 3D. I didn’t really notice much in terms of the 3D effects, but the ride jostled me up and down, left and right, and the lack of 3D didn’t seem to matter. It was fun anyway. But another ten years later, and it became all to obvious that I was being left out.

I went with my daughter to Tokyo Disneyland and watched “Honey, I Shrunk the Audience”. This particular attraction had its share of physical special effects–tails whipping our ankles when rats escaped sent K sqealing with delight, and the mist spraying on us when the dog sneezed was grossly amusing… or was that amusingly gross? But all the 3D effects on screen just did not happen for me. When glass shatters and shards flew toward the audience, everyone around me screamed and ducked, but all I could do was lean over and ask my daughter:

“Did something happen?”

Seriously, do you know how sad that is? I was like my Chinese colleague, the only person in the room who did not get the joke. Perhaps I had been fooling myself all along. I mean, I had come to terms with my lack of depth perception, but the adjustments in the brain more than made up for the visual acuity I needed to function in everyday life. I felt that I was able to enjoy anything and everything life had to offer. I was wrong. But, hey!–and maybe I’m just trying to rationalize my situation–3D is not the end all of life. It just seemed like it would be a little more fun.

Unfortunately, it turned out that my vision affected more than my enjoyment of 3D effects. So I had an operation.

Cont’d next.