If I ever put photos of Jamie on the blog (incidentally, the reason I don't has nothing to do with paranoia over child stalkers - I'm just too lazy busy to learn how to use the software for uploading photos from the digital camera onto the computer), then you might have noticed a difference in him in the past couple of months over and beyond the way that he's shooting up. Specifically, his left eye is now pointing in something much more closely resembling the direction in which his right eye is pointing.
We were quite surprised to get a call in March offering us a choice between two dates in April for his squint operation, since we hadn't gone on the waiting list till December and had been told at the time that it would be six months; but it seemed we were in luck and, despite everything we'd heard about NHS waiting lists, we'd actually been one of the lucky families to get a wait shorter than we were expecting. So, pleased at the thought of getting it over with, we booked the April 4th date.
When I blogged previously about our plans to get the surgery done, I was surprised to see another blogger talking about what a difficult decision this must have been. Which made me feel quite a fraud - I have to admit that I really didn't find it that difficult to decide that I'd prefer my son to have a minor, low-risk operation than to go through his childhood with a squint. While I did have the odd fleeting moment of "Oh my god, what if this ends up being one of those stories you read about in women's magazines where the mother talks about how she wasn't worried about it beforehand and then it all went horribly wrong...?", my main concern as we came up to the time of the operation was how we were going to persuade a two-year-old that he couldn't have anything to eat or drink when he got up in the morning. To this concern, as the surgery date approached, was added the worry that they would end up cancelling the operation due to the horrible snotty cold and cough he'd had for weeks and we'd then have all the hassle of keeping him fasted a second time around. Concerns about whether he was actually going to be killed or maimed by the experience somehow ended up fairly tertiary.
Anyway, I went through the proposed order of events with Jamie several times in the weeks beforehand while going through the 'hospital' story in our Usborne First Experiences book - "Jamie's going to go to the hospital too! You're going to go and have your eye fixed. When you get up in the morning you won't be able to have any breakfast or any milk until after your operation. Then we'll get in Daddy's big car and go to the hospital. We'll go to a ward like this one, and you'll see a nurse like this lady here, and a doctor with a stethoscope like Mummy's, and then you'll go for a ride on a special trolley like this one, and this doctor will put a mask over your face like this one, and that will make you go to sleep, and when you wake up the operation will all be over and you'll have lots to eat and get to play with all the toys." It's hard to know how much of this Jamie took in - he was much more interested in the little yellow duck pictures that Usborne sneak into the First Experiences book for children to spot. He probably thought the hospital was a place where you can find ducks everywhere. I hoped he wouldn't be too disappointed.
I had a plan for the day of the operation which went like this: Wake up early, change Jamie's nappy somewhere between 5.30 and 6.00, thereby waking him up just enough to give him a drink of water (the letter from the hospital said that we were allowed to give him water up to 6 a.m.), settle him back to sleep again, wake Barry, get everything else completely ready for departure with the engine running in the car, go get Jamie just before 7.00, slip his coat over his pyjamas, put him straight in the car, and hope he's drowsy enough to fall straight back to sleep when we start driving and sleep his way to the hospital, where there will be so many strange and interesting things to look at that he will be distracted from thoughts of food for the next hour or so, at which time his operation should start. (We'd been told that the hospital would try to arrange for Jamie to have the first slot, as he was so young - I phoned up the day before and confirmed that they had indeed managed to do this, which was quite a relief.) Having made this plan, I waited with trepidation to see what would go wrong with it.
What happened was that Jamie, in a rare display of impeccable timing, woke up of his own accord at around a quarter past five. This would have been a problem if it had been a normal Wednesday on which I was trying to get ready for work at this time, but, of course, on that particular day it was perfect - I went ahead with getting him changed and giving him his water, then snuggled up next to him in bed for the next half hour so that he could go back to sleep and I could enjoy a little while of lying down with him. Unfortunately, he then woke up again shortly after six while I was trying to get ready, which was less perfectly timed. I made him stay in his room while I rushed round getting my own breakfast and getting ready, as this often gets him back to sleep when he's woken up too early, but on this occasion it didn't work. Meanwhile, my nerves were not helped by picking up the booking letter to put it in my bag to take with us and noticing for the first time the line that had escaped both me and Barry beforehand - "Should he develop a cold or any other illness between now and his admission, please contact me as soon as possible." Oh, great, I thought - not only are they going to end up cancelling the operation, but they're also going to be cross with us for not having let them know beforehand that he had a cold. Which I probably should have done, but, for goodness' sake, he seemed absolutely fine and I know that ideally you wouldn't want to operate on someone with a cold but surely if you cancelled a child's operation every time he'd had a cold you'd just never get it done?
Fortunately, in spite of his early wake-up time, Jamie was quite uncomplaining for the entire car journey, which was a long one. The journey between our house and the hospital offers a choice between ploughing through an area of infamously appalling traffic or going a very long way round the outskirts. We opted for the latter; I'm still not convinced it actually took any less time overall, but at least we spent that time moving, which is an improvement on staying still when you're in a car with a toddler, particularly a toddler who has just been upgraded to a new car seat with restraints that he can get out of whenever he decides that staying there has become too dull for his liking.
The route difficulties meant that getting to the hospital on time was practically a photo-finish. On top of this, we then made it through the front gates to the realisation that we had possibly been a bit naive in assuming that we could simply find a sign saying "Eye Unit" and follow that. (Oh, great - not only are we going to turn up and be in trouble for bringing along a child with a rotten cold and not letting them know beforehand, but we're not even going to have the grace to do so on time.) After some driving around, we found someone who could point us in the right direction and I hauled Jamie out of his car seat and headed straight up there while Barry parked. We made it, only a couple of minutes after the 8.00 time that we'd been given.
The next hour was a blur of seeing the nurse, the anaesthetic SHO, the nurse again, the consultant ophthalmologist, and the consultant anaesthetist, and answering long lists of questions - was he allergic to anything? Any history of liver problems? Any previous anaesthetic? Any loose teeth? What time did he last have anything to eat? (In the 91st minute of the Liverpool game just as Kuyt got carded, apparently. I'm not totally sure the anaesthetist found this impressive precision entirely helpful in practice.) Did I have any questions myself? I asked how long it was likely to take, how soon I'd be able to see him afterwards, and whether I could be with him as he woke up. About an hour altogether, I was told, counting the time for him to surface sufficiently from the anaesthetic for me to see him, and I could come round to recovery to see him as he started to wake up. (I hoped he wouldn't go through the last stage of waking up more quickly than predicted and wake up before I could get there, but there didn't seem to be much I could do about it other than keep my fingers crossed.) And would the cold be a problem? Well, ideally you wouldn't operate on someone with a cold, but if you cancelled a child's operation every time they had a cold then you'd just never get it done. Hooray! My feelings exactly. We were all set to go.
The ophthalmologist had told us when we saw him in clinic what the plan was for the surgery, but he went through it again. Basically, squint surgery involves lengthening one of the muscles attached to the eyeball and shortening another, so that it comes more back into line. (I have no idea how they actually do this without slicing the child's face open - he gave no further details and I very carefully avoided finding any out. Now that it's all over and no longer a matter of oh-my-god-they're-going-to-do-that-to-my-child's-eye, I'll probably look it up eventually.) They might not correct it all the way because there would then be a risk of overcorrecting, and they'd rather err on the side of correcting too much than correcting too little. (I didn't ask why this was - I'm guessing it's because a slight cross-eye looks better than a slight wall-eye.) It was an extremely low-risk operation - apart from the possible risk of under- or over-correction, he couldn't think of any risks to write down on the consent form (which did indeed have a specific section for listing risks. By god, they've grown more detailed since I was a junior doctor.) I asked him about the risk of infection, but he told me it was so rare he couldn't actually remember ever having had a case. I signed the consent form, reflecting that out of all the signatures I'd put on consent forms in the past, this was the first time I'd ever signed in the 'patient or parent' section rather than the section for the doctor.
Jamie was weighed (something he greatly enjoys, as he's worked out that bouncing up and down on the scale makes the dial swing back and forth most interestingly - the anaesthetist managed to persuade him to stand still long enough for us to get a reading) and changed into a hospital gown, as I hadn't bought his pyjamas (he was very pleased with this as well, as it had numbers on it), and given pre-emptive doses of paracetamol and ibuprofen, and had local anaesthetic cream applied to the backs of his hands ready for the needle (I'm getting events out of sequence here - this last was done much earlier in the proceedings, so that it would have time to work). Then, when everything else had been done, he was allowed to go along to the playroom with us for the next few minutes until they called him for the operation, where he toddled around happily exploring the playhouse and the miniature table and chair with buttons that played music. His gown was too big for him and trailed on the floor; he looked like the world's smallest, most colourful acolyte.
We were called just after nine. I'd been wrong about the Ride on the Special Trolley, as it happened - the day case surgery ward was sensibly situated right next to the theatres, and I simply carried him round with me when the nurse came to get us. The ophthalmology theatre was separate from the rest, and as the nurse was new on the ward and didn't know this we ended up in the wrong bit and had to go out and come in again. When we found the right place, I was asked to sit on a stool, holding him firmly in a hug while the anaesthetists pulled off the sticky patches holding his topical anaesthetic cream in place and examined his hands for veins. If you're wondering, I felt a lot calmer than I'd have expected now that we were there - glad to be getting it done and over with.
"There are some bubbles up there, if you want them," the theatre nurse said to Becky, the nurse who'd come with us from the ward. I wondered idly what on earth part of anaesthetic equipment or medication this was - surely bubbles were things you wanted to avoid getting in IV lines? - but then realised that what she'd actually meant was, well, bubbles. Bubbles to blow as a distraction for children. Jamie watched them intently - he was too overawed by this strange environment to be as delighted by them as he would have been in other circumstances, but he was coping well. He jerked and cried out for a moment as he felt the needle go into his hand - the anaesthetic cream hadn't been a hundred per cent effective - but, whether because the cream was having some effect or because he's such a brave boy, he settled after that while they slid the IV all the way in and taped it in place, and I held him firmly. He looked wide-eyed at the strange thing in his hand and at the syringes the anaesthetist had, wary but interested.
"A little aeroplane in your hand!" the anaesthetist told him. "Now, some petrol to make the aeroplane go..." He started injecting the contents of the second, much larger, syringe. "Hmmm, I think... could you just move him over to the trolley? Just like that..."
I moved him carefully, not wanting to jerk his hand away from the syringe accidentally as I stepped backwards. Concentrating on that, I didn't even notice the moment when he went limp in my arms. By the time I laid him on the trolley a second later, his eyelids were half-closed over my final sight of the squint.
"Now, then, Mum," the theatre nurse said to me "if you kiss him goodbye and go back to the ward, we'll take good care of him."
"You do that," I said, as I straightened up from bending over him for that last kiss. "He's a special little boy."
I went back to the ward, and told Barry that Jamie had been sent off to sleep successfully, and we went down to the refreshment stall in the main foyer to get drinks. Then we went back up to the ward for a long blank hour of paging through magazines and waiting, and, in Barry's case, pacing back and forth as the time ticked past the hour we'd been estimated and Becky reassured us, when I asked her, that an hour was just an estimate and it could take longer for someone to come round.
When someone finally came to tell us that one of us could go round to recovery, I let Barry go - it seemed fair, since I'd been the one to go in with Jamie. And after another long wait, Barry came back carrying a very sleepy blanket-wrapped bundle who slid gratefully onto my lap, locked his arms round my neck, and slumped against me in fiercely determined slumber.
I needn't have worried that he'd wake up too quickly - he showed no inclination to wake up at all. Barry said that in recovery he'd been trying to stand up, his innate urge to keep moving fighting against the fact that he was in no shape to do so, but he showed no signs of it now. All he wanted to do was sleep. The little boy across the ward from us, who'd had teeth extracted under a general anaesthetic, wasn't so lucky - he screamed "I want to go ho-ome!" non-stop for at least twenty minutes solid. It was an oddly soothing sound in my post-jangled state - I leaned my head back in my chair and let my own eyes close and my mind drift into a doze, letting the boy's screams and the unsuccessful attempts of his mother and the nurse to comfort him wash over me in a distant rhythm, feeling the comfort of my son's limp weight snuggled against me.
Eventually Barry asked to hold him for a bit and I relinquished him, and after a further while we decided that we really did need to get him to wake up if we were ever going to get out of here - by then, I felt his sleepiness had less to do with after-effects of the anaesthetic than with the fact that he'd been up far too early in the morning and was trying to catch up on sleep. Barry walked around with him a bit and finally resorted to the secret weapon of taking him back to the playroom and putting a Teletubbies video on. That did the trick - within minutes, he was wobbly but awake and following the tape with glee.
Then we had another very long wait for his medication - Paracetamol, Ibuprofen, and some antibiotic eye drops to apply twice daily for five days. Finally, the medication was sent up from the hospital pharmacy and the nurse went through the doses with me and advised me to give him the wrong dose of Paracetamol. I mean, obviously she didn't say "Give him the wrong dose of Paracetamol", but the dose that was written on the bottle was incorrect. I pointed this out and she assured me that it had been rounded up and I said that, yes, but a dose for a 15 kg child rounds up to 5 ml of the 6+ strength, not 6 ml, and she made some reassuring comment and I let it drop, since mental arithmetic has never been my strong point and I wanted to work it out properly on a calculator before blowing my mouth off about it, and, besides, what was she going to do about it? She was the nurse, she couldn't change it, and I was going to work out the right dose for him anyway when we got home, which we never would do at this rate. But, yes, I ran the numbers through the calculator when we got home (or, to be more precise, got Barry to do so), and, yes, indeed, the proper dose would have been 4.5 ml and even rounding it up shouldn't give a dose as high as 6 ml. Which all presented something of a dilemma - should I write to the hospital about this? After all, no harm done, and it's one mistake, anyone can make a mistake, there but for the grace, etc. Then again, I have no way of knowing whether it is just one mistake or whether the doctor responsible was making the same mistake regularly and whether I should, perhaps, have got someone to draw his attention to it before he made it with a child whose parents didn't spot it. So, yes, theoretically I should write to someone about it. I'm still trying to figure out a way of doing so that doesn't sound as though I'm whinging over a silly little quibble.
Jamie recovered from the operation without difficulty. He had a patch of blood visible under the surface of his eye for about a week or so, and he developed a slight swelling around the eye a couple of days post-op which didn't become hot or red and went down of its own accord as the day wore on. (Excuse the detail. I'm including this because this blog gets a lot of hits from people looking for information on toddler squints, so I figure some of those people might want information on what's normal post-op.) He hated his eye drops with the fire of a thousand suns - it turned out to be a good thing he had his operation just before the Easter weekend, as it meant I was around to hold him down while Barry put them in. Which I did, following hospital instructions like a good little sheep, spellbound, I suppose, by the spectre of some shadowy and unspecified Divine Authority labelling me a Bad Parent if I didn't do so and punishing me by smiting my son with eye disease. The question of why, exactly, we were doing this if the risk of infection was as low as the ophthalmologist had told us did niggle at the back of my mind, but I never did research it to find out whether the eye drop use was actually evidence-based.
(His strawberry-flavoured Ibuprofen, on the other hand, was a resounding success. When I introduced strawberry-flavoured toothpaste shortly after that, he rapidly dubbed it his 'medicine toothpaste'.)
As for the final effect, it isn't perfect - I ditched my original post title of "The Banishment Of The Squint", as I felt it was a mite optimistic - but it's a noticeable improvement. He's also using that eye quite a lot more, switching between one and the other as he looks at things rather than relying primarily on his right as he was doing before. I was hoping that this might mean we could finally ditch the eye patches (which he has started to rip off within minutes of having them put on each day), and, in fact, when he went back to see the orthoptist again she did teeter on the verge of so advising, but she caved at the last minute and decided that we 'might as well' go on with using them for now. Might as well?? That's not the phrase I'd use to describe the struggle to convince a toddler that he should keep his patch on even when he hates it. Unfortunately, I was not at the consultation to point this out, so that was the advice we were left with and we're still struggling with the patches. He has another follow-up in a month, so we'll see what happens then. Meanwhile, at least his eye looks a lot better, and at least we have one of life's stresses behind us rather than ahead of us, and Jamie dealt with the whole thing very well, so, despite the continued eye patches and the absence of any yellow ducks at the hospital, we're really rather pleased with events.
I would like to use this for the next edition of Pediatric Grand Rounds. Please email me awesome_mom2061 AT yahoo DOT com if I have your permission to use it. Thanks!
Posted by: Awesome Mom | Saturday, June 02, 2007 at 16:51