Mom and Dad: Cataract removal

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Mom had a cataract that was starting to bother her. She talked to her brother, and a few other people who have had cataracts removed, and finally decided that she was ready to do something about hers. I called the doctor’s office and set up the appointment. They explained, in detail, that this visit was to get readings, measurements, and determine what was the best course of action.

The appointment fell on a day when Dad was feeling needy. He had a very hard time sitting still in the waiting room, until he fell asleep. Mom kept trying to wake him, but I suggested his napping kept him in his seat. Mom wasn’t convinced - Dad has fallen right out of his chair a few times. I assured her I would keep an eye on him; if he started to lean, I’d prevent a fall.

Once Mom was seated in the eye exam chair, it was clear that they thought she was there for her annual eye exam - I had to remind the assistant why we were there. She decided that, since we were already here, they’d go ahead and do her exam as well. Mom and Dad have had their eye exams on the same day for years - I wondered if either of them would remember? I wasn’t even sure their insurance would cover an early exam, but we were there and they were ready to do the full exam.

Mom has to have a tissue on hand at all times. She has a ritual she goes through before leaving their room: check purse for portable kleenex pack, check pockets for spare kleenex, check purse for loose kleenex, take one tissue from one of the boxes in the room and fold it carefully and tuck it into the palm of her hand. While the assistant is trying to ask Mom questions, Dad is trying to take Mom’s purse to hold it for her. Mom, distracted by the possibility of not having her purse in reach, is ignoring the assistant’s questions and trying to get her purse back from Dad. Dad allows Mom a moment with her purse, which Mom uses to search for a tissue. I answer the assistant’s questions.

Mom, having secured a kleenex, returns her attention to the assistant who is attempting to get Mom to read letters from a card. Mom closes one eye and adjusts her head to better see the card. The assistant tells Mom, “Both eyes,” to which Mom responds by closing the other eye. I chuckled, the assistant dropped her head, I said, “You haven’t seen anything, yet.”

After each stage of the exam, the assistant returned to the computer keyboard to enter the data. Every time she moved away from Mom, Dad, thinking it was time to leave, got up and tried to help Mom out of the chair. I’d get Dad to sit, but not until after Mom had extracated her purse from his grasp and started searching for another tissue. “I have to make sure I have a kleenex, Bill. Give me my purse.” New kleenex aquired, or previous kleenex re-discovered in her hand, she’d allow Dad to take back the purse. The assistant would move in for the next test.

As with last year’s exam, when asked to read the smallest line she could read, Mom would say, “Ok, but the line below it is very blurry.” The assistant saved herself by closing off view to all but one line at a time - can you read this? how about this? She’d turn to make note of results, Dad would swoop in to get Mom out of the chair and the kleenex battle would begin anew. After 4 or 5 times of this happening, Mom started to get concerned that she didn’t have enough kleenex! I pointed out that there was a box on the counter, if she needed another tissue, she should get one of those rather than using up her entire package. The assistant slid the box of tissues closer to Mom, who was then satisfied that she would not run out of tissues… for the moment.

Mom read off letter after letter, commenting that the line below was blurry every time the assistant forgot to close it off. Comparing lenses… is this one better or worse? better or worse? Mom asked to have every one of them repeated, then carefully thought out her answer to each. When the assistant started to show signs of exasperation, I reminded her that we had come in only for cataract surgery pre-op exam. I supposed whoever screwed up scheduling would be hearing from her after this exam was finished? I’m not sure if it was her choice to start the exam, her choice to continue the exam after I originally protested that we were not here for her annual, or if that’s how it was entered in Mom’s file and she was powerless to do anything but the annual exam. When I reminded her of why we had come in the first place and that all this could have been avoided, she seemed to regain her composure. I wonder if that scheduling person has had her lunch stolen, her car keyed, or has turned up missing…

Dad asked about the assistant’s hair. She has it dyed in layers of dark and light with colorful highlights in one patch at the front. Dad wanted to know what her mother thought of it, to which she said she didn’t like it much. Dad then offered to cut it off so her mother would love her again. Dad then offered to cut my ponytail off. I asked if he thought my Mom didn’t love me because of my hair to which he responed by giving me a big hug saying, “Why, you…!”

The assistant finally got around to the cataract discussion. On the way to the office, earlier, Mom had been concerned about the lens. Her sister in law had a corrective lens implanted and doesn’t need her glasses anymore. Mom wasn’t sure she wanted such a thing, and was concerned that the cost would be more than they could afford. As soon as the assistant mentioned the various types of implants, Mom became nervous. I suggested the assistant avoid mention of implants and instead try the word “lens”. Mom was visibly more comfortable with the word lens, and the assistant only had to censor herself once after that.

When the doctor came in to do further testing, he could not be dissuaded from using the word “implant”, which stressed Mom again. The same assistant was in the room, so we both told him how important it was to be careful of the word. He first protested that the patient has to be informed, but upon giving ‘lens’ a try, he discovered she indeed responded better. He repeated many of the previous tests, but with the assistant entering information as he rattled it off to her, he didn’t need to roll away - leaving no opening for Dad to attempt to get Mom out of the chair.

Mom was given a disposable pair of sunglasses to wear with her normal glasses. Even with these, the sunlight was too much for her sensitive eyes. I let her wear a pair of mine over her glasses along with the disposable ones she wore under her glasses. This helped some, but we decided not to stop anywhere on the way back to the facility.

Mom repeated telling me about talking to her brother, who gave her a coupon for some money off a pair of glasses. He also gave her a coupon for a discount on tinted lenses. He has those and likes them very much. She remembers she and Dad used to have sunglasses in their prescriptions to wear outside. She remembers glasses that darkened when they went outside, and not liking them because they darkened when getting their pictures taken, also. She has a coupon from her brother for some money off a pair of glasses, and a coupon for a discount on tinted lenses.

Her sister in law had her cataract surgery and no longer needs glasses. Maybe that’s why her brother gave her the coupon? They both have glasses that darken when they go outside, or maybe just he does? She doesn’t need glasses anymore. Does she have sunglasses? Could she use these disposable ones? Which of these glasses is she supposed to wear? Mine, or hers? The disposable ones or her regular ones? Her brother says cataract surgery is very easy, no worries, see just fine afterwards. Will she still need her glasses?

What did that nurse mean when she said they have different kinds of implants? She doesn’t want an implant! I assure her that they are only going to remove the cataract, not give her some kind of implant. They will only remove the cataract, a new, clear lens would take its place. Never mind that the new lens is an implant, she was just too distressed over the implications of the word ‘implant’.

The surgery did go well. Mom’s eye would not dilate as much as they wanted, but the doctor did not have to use hooks to hold it in place. He did have to stretch the pupil some, but once stretched it stayed without aid of hooks. Mom remembered this, as she was not knocked out for the surgery, and for the entire ride back to the assisted living facility told how the doctor had to do something to make her eye bigger. There was no more mention of implants

While Mom was in surgery, I sat with Dad in the waiting area. I had a very hard time getting him to stay in his seat or even in the waiting room. He kept wanting to get back to his wife, could not understand why he wasn’t allowed to be with his wife, and insisted they didn’t know what they were talking about - he could be with his wife and there’d be no problem. Every time the door to the pre-op hallway opened, he was up and headed for the door. He spent a great deal of time standing at that door looking for an opportunity to sneak in. I walked him around showing him the paintings, sculptures, and waterfall. When I offered him a coin to toss in the fountain, he held it for a very long time. Even after seeing me toss a couple coins in, he was reluctant to go along with it. He finally just let it fall from his fingertips and walked away.

I had to ask a staff member to keep an eye on Dad while I went to the bathroom, especially keep him away from the pre-op doors! She was able to keep him distracted for about a minute - then the doors opened, and it was all she could do to keep him from bolting through. I came back just in time to call to him, stopping him from going through the door and giving it time to close. I thanked her for her assistance and returned to keeping him distracted.

Of course the surgery went longer than predicted - Mom’s eye not dilating added nearly an hour to the expected wait. Telling Dad it would only be a little while longer was not working. Telling him how much time we would be waiting only helped until he discovered a clock and figured out how much time had actually passed. He wears two watches, both of which have the correct time, but he doesn’t tell time with them. He started showing them to other people in the waiting room - one is a Mickey Mouse watch which makes him laugh to look at. He calls Mickey a monkey and giggles at remembered antics of organ grinder monkeys from days long gone.

Once surgery was complete, we were permitted back in the room with Mom. Dad kept trying to get her up off the bed so we could go and get something to eat. The post-op staff had been made aware of his condition and played along nicely. Within half an hour, we were ready to go. Mom was given a small bag with sunglasses and eye drops along with a protective eye cover and some tape to hold it in place. The eye drop instructions were explained, but they used the name of the drop rather than the color of the box to explain which to do when, how often, and for how long. I finally got through to them they needed to explain it by box color! I ended up writing down the instructions: red - 2 drops, before breakfast, after afternoon activities, before bed - wait 5 minutes then… blue - 2 drops 5 minutes after red each time. Mom took these instructions, read them, picked the correct boxes from the bag, and understood what to do. The nurse asked, “A little dementia?”

Not knowing if Mom would remember to keep her hands away from the eye, I went ahead and fitted the eye cover to her eye when we got back to their room. I escorted Dad to the lunch room and sat with him while he ate. Mom wasn’t hungry and wanted to take a nap. After lunch, Dad was ready for a nap, so I returned him to the room and went off to visit their friend. I returned to their room in time to remind Mom it was time for her afternoon eye drops. She had already done them because the doctor’s office had called to remind her. Swell… I called to see if they planned to call and remind her each time she was due for drops - that would be fine, if they carried it through the weekend. It would be fine if they called at the same 3 times every day. But, if they planned to only call when it crossed their minds and couldn’t promise it would be the same time every day, it would be better if Mom were left to the instructions I had written down and she seemed to understand. The person I spoke with was apparently the same one who called to remind her - she recognized the “red and blue” that Mom kept referring to. She decided it would be best to let Mom handle it herself as repeated calls for a few days, then nothing for the weekend, could lead to serious complications.

Dad was terribly distressed over the protective eye cover Mom was wearing, but whenever she took it off, he put it on himself. He couldn’t see how she could see well with it and decided she needed led around. Mom worries that she’ll lose her balance or that Dad will pull her too hard - she started getting testy with him and finally jerked her arm away from him. Dad retaliated by taking her overglasses sunglasses and wearing them like a movie star, prancing around saying, “Look at me!” then taking them off saying, “Dark!”

I programmed my phone’s reminder to call Mom and remind her of her eye drop schedule, checked that the rest of their medicines were current or called in for refills, and made my way to the door. Dad followed, always wanting to see the car, often wanting to go for a ride, always wanting to walk as far as the car. I’ve learned to only unlock the drivers side door if they are not going with me. I had a hard time convincing him he should stay inside, finally caught the eye of one of the staff and pleaded for assistance - either come with me to the car and make sure he returns to their room, or distract him so I can escape. She opted to walk with us to the car. Dad thought she was coming with us for something to eat. She offered him some ice cream from the soda/coffee shop, and he turned to go back inside before they even reached the parking lot. Bye, seeya.

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