In Gratitude

I want to tell you about my eyes. 

I’ve been thinking more about eyes since I first held my granddaughter June and looked into hers.   She has big blue eyes, that I’m told could yet change to brown.  I’ve also learned newborns don’t see much besides shapes and light for a while.  I don’t know how babies think, but by June’s face, it appears she is fascinated by what she sees, however vaguely, and thinks deeply about the world around her.  But then I’m biased about my first granddaughter. 

I may think more about eyes than most.  My vision has been a challenge not only for me but the doctors who have tried to help me since I was in my teens. 

After finals were over at ISU in the spring of 1972, I made an appointment with my optometrist at the Gailey eye clinic in Bloomington. I was convinced the nagging blurriness I was experiencing while studying was caused by scratches on my contact lenses.  No matter how much I soaked and cleaned them nothing changed.  I figured they needed to be buffed up, maybe replaced.  Instead, I got bad news. 

My optometrist said it wasn’t my contacts that were damaged, it was my eyes.  My corneas to be exact.  While I was in the exam room, he brought in another doctor to look at me.  Never a good sign. 

Seven days later I was examined by an ophthalmologist.  When he finished, he took me to a small conference room where my optometrist and another doc were waiting.  They explained I had a condition called keratoconus, in which my corneas become cone-shaped.  As the corneas change, warp if you will, they create scars akin to stretch marks.  Corneal scars can’t be buffed out.  Plus, the uneven shape of the cornea, bumpy instead of a normal smooth arc, distorts your vision.

They laid out a plan for me. They would fit me with new contact lenses that would touch the cornea in the center.  The plastic discs would hold back the cone forcing it into a more normal shape.  My optometrist, who had seen me through several corneal abrasions since I began wearing contacts at sixteen, assured the other doctors I tolerated pain well.  They wouldn’t be comfortable, they explained, but they would help me see better, and I would pass my driver’s test.

The eventual fix, the ophthalmologist told me in a serious tone, was a corneal transplant.  I remember that conversation well.

“Why not do the operation right now?” I asked.

”Because we can still correct your vision within a normal range without surgery.”

“But I would see better with the surgery, right?  Isn’t that the point?  Being able to see as well as possible?”

“It’s not that simple.  You’ll function fairly normally with new contacts.  You would be hard-pressed to find a surgeon to do that operation now.  It’s risky.  The longer you wait the better.  Researchers are better procedures and materials all the time.  We’re learning more all the time.  Trust me.  It’s better to wait.”

I must have looked like I needed more convincing. 

“Recovery from a corneal graft, once a donor cornea becomes available, means lying in a hospital bed for perhaps weeks with sandbags around your head waiting for the incision to heal.  The cornea is held in by only a few stitches.  Patients don’t always achieve the results they want.  Neither do surgeons.” 

That was a kick in the head.  I developed a fatalistic attitude.  What if reading became even more of a problem?  Reading was already tiring, wearing my eyes out, and I was an English major headed toward a career as a teacher.  Who in their life ever heard of an English teacher who couldn’t read for extended periods of time?  Grading papers? Hello? 

Ironically, 1972 was the year Jackson Browne made his first album and recorded what would be his best-selling single “Doctor My Eyes.”  Check out these lyrics.  When I first heard it on the radio it was like he was talking directly to me.  Click this link for the whole song on audio

https://www.youtube.com/watch?v=xEDUFgCK_1g

Doctor, my eyes have seen the years
And the slow parade of fears without crying
Now I want to understand.

I have done all that I could
To see the evil and the good without hiding
You must help me if you can.

Doctor, my eyes
Tell me what is wrong
Was I unwise to leave them open for so long?

In spite of my doctors’ assurances, I secretly feared blindness or something close to it was in my future. I taught high school English for a year, went to Europe, resigned by telegram from Spain, and began a period of my life where I traveled extensively.  I was intent on seeing everything I could while I still could.  Call it 22-year-old drama, fear, or whatever you want.  I racked up a lot of miles.  Mostly by hitchhiking.

“Take it Easy”, a song Jackson Browne and Glenn Frye wrote, and The Eagles made famous, became the song that played most often in my head when I had my thumb out.

https://www.youtube.com/watch?v=FMA3lIeqV8M

              Well, I’m a standin’ on a corner in Winslow, Arizona

              And such a fine sight to see.

              It’s a girl, my Lord, in a flatbed Ford,

              Slowing down to take a look at me.

Come on baby, don’t say maybe,

I gotta know if your sweet love is gonna save me.

 

We may lose, and we may win,

Though we will never be here again.

So open up I’m climbing in,

So take it easy.

 

Take it easy, take it easy.

              Don’t let the sound of your own wheels drive you crazy.

              Lighten up while you still can,

              Don’t even try to understand.

              Just find a place to make your stand and take it easy.

 

I took it very easy for a year and a half, or so I said.  Parts of the trip were desperately difficult.  I limped home from that eighteen-month trip to Europe and North Africa having lost my original left contact lens in Chefchaouen, the blue Moroccan city in the Rif mountains.   

I lost the spare left in a hammam in Benghazi, Libya.  When I reached Egypt and looked at the pyramids in Giza, it was through two right contact lenses.

When I got back to the states, I went straight to the Gailey clinic. The keratoconus was status quo.  I resupplied myself with newly fitted contact lenses, worked and saved money, bought another spare pair, and set out for South America within a year. 

When I got back from the second trip, profoundly and utterly broke this time, I had it in my mind to accomplish whatever I could by staying in one place.  I moved into a tiny Illinois Valley house by an abandoned canal and grudgingly entertained the notion that work might turn out to be more than a means to get money to do other things.  That felt somehow like admitting defeat.

Jackson Browne recorded an album in 1977 with another song that spoke directly to my new situation called “The Pretender.”  Were we living parallel lives this Jackson Browne guy and I?  Or was he that good at naming the times we all were living in?

https://www.youtube.com/watch?v=SqRvJLH_-vU

              I’m going to rent myself a house,

              In the shade of the freeway.

              I’m going to pack my lunch in the morning,

              And go to work each day.

              And when the evening rolls around

              I’ll go on home and lay my body down,

              And when the morning light comes streaming in,

              I’ll get up and do it again.

              Amen.

              Say it again.

              Amen.

 

              Caught.

  Between the longing for love

              And the struggle for the legal tender.

              Where the ads take aim and lay their claim,

              To the heart and the soul of the spender.

              And believe in whatever may lie,

              In those things that money can buy

              Though true love could have been a contender.

             

              Are you there?

Say a prayer.

              For the pretender.

Who started out so young and strong,

              Only to surrender.

        

Life changed.  I moved to a better house and got increasingly more meaningful jobs.  I borrowed money to buy a car that was not a beater.  And in one dizzying year, 1982, I got the job I would keep for the next 30 years, married the woman I loved, and we had our first child.  There are times in life when everything seems to happen at once.

My vision was still corrected fairly well, though my astigmatism continued to increase. 

Both before and after being diagnosed with keratoconus, I suffered collisions with immovable objects.  I ran full tilt into a fire hydrant while throwing a football around in college. I slammed into a set of concrete steps while playing frisbee on a Chicago lakefront beach.  I skied into a wooden fence in Wisconsin having no idea where it came from. Had I seen it coming, I like to think I would have fallen down on purpose before I hit it and broke my leg.  I always blamed those accidents on wonky vision, though I could have taken too many risks.  People who know me well contend I am afflicted with both problems. 

When I began taking trips with optometrists hosting volunteer eye clinics in Mexico and Central America, I roomed with my brother-in-law Tony Ortiz, an optician who taught me his craft in that first clinic in Queretaro, Mexico.  One morning before breakfast he became alarmed watching me fumble around on a tabletop trying to find my contact case.  I had stopped going to the Gailey clinic in Bloomington and relied on whatever optometrist was convenient.  Tony suggested I see his optometrist brother Phil. 

“You need somebody that knows what they’re doing to look at those eyes.”

At my first appointment, when measuring my astigmatism with a keratometer, Phil had to get auxiliary lenses for his instrument.

“You’re not doing so good,” Phil said.

He put me in recently developed gas permeable contact lenses that allowed more oxygen to my corneas and experimented with different fits.  He helped me a lot.  Then I flunked the vision portion of my driver’s test.  They explained I would need to have a letter from a licensed optometrist before they would issue me a license.

Phil gave me that letter but in exchange for a promise.

“You may be at the end of your rope with those corneas.  I’ll sign this form so you can drive, but you have to promise to see a friend of mine who is an ophthalmologist and a surgeon.  It may be time for a cornea transplant.”

“How are they doing with corneal transplants these days?”

My consultation with the docs at Gailey Eye Clinic came back to me in a rush.   

“Well, I can’t speak for everyone, but this guy is doing really well.”

That guy was Jim Noth, an ophthalmologist and surgeon working out of Hinsdale.  The year was 1990 and I was 39.  Dr. Noth and I had kids the same age - seven and five. 

Dr. Noth explained the process to me.

“While you’re sedated, I secure your eyeball on something of a stage and, working under a microscope, take out a small circle of the damaged cornea covering your pupil and iris.” 

“What do you do that with?” I asked.

“Something like a tiny and very sharp biscuit cutter.”

“Sounds tricky.”

“It’s not that bad.  I cut the donated cornea to fit the hole I create and sew it on with thread thinner than your hair.”

“How many stitches?”

“Usually about 12.  Each one has a separate loop and knot.  You stay in the hospital overnight, I look at your eye in the morning, and if everything is OK, you go home the next day.  I remove the stitches one or two at a time, depending on the shape your eye takes, over a period of six months or longer.  There’s no blood in the cornea and no nerves to worry about.  Your eyelid feels the stitches at first, but you get a callous.  There’s not a lot of pain.  You’ll start noticing improvement in the first month.  Dr. Ortiz can  put you in corrective eyeglasses, the prescription in the right eye will change as the cornea changes, and after a year or so you’ll stabilize.”

“What can go wrong?”

It’s a transplant, so your body can reject the tissue.  Pretty rare in the eyeball, but it happens.  Even if it does, we have great drops now that help us save the procedure.  Not always though.  I’ve only had it happen a couple times.”

“What if it fails?”

“We do it again.”

His staff gave me a beeper. When I reached the top of their list and an appropriate cornea from a cadaver became available, they would beep me.  I had to respond within an hour by phone accepting the cornea or they went to the next person on the list.

That was the right cornea.  A year later Dr. Noth replaced my left cornea.  After the second operation, I went home the same day.  And for the next 25 years, I had the best vision I’d had since I was a teenager. 

But the keratoconus never left me.  I had hoped when the old corneas were removed the disease would go with it.  Not so.  Destroying corneas is what the eyes of those afflicted with keratoconus do.  Over time my vision began to worsen, primarily in my right eye.  I saw it coming (pun intended).  It got harder and harder to find my golf ball.  I once again depending heavily on STOP AHEAD signs, and it seemed not long at all between brake replacements.  I struggled to read the numbers in the crossword puzzle.  My optometrist saw it too.

It was Phil’s son Tim, who took over is father’s practice at Ortiz Eye Clinic in Morris, who told me once again he could no longer improve my vision.

“I think it’s time to see Dr. Lubek again.”

Dr. Noth retired about the same time did.  Dr. Lubek is a younger ophthalmologist who removed my cataracts and replaced them with corrective lenses.  He also did some radial keratotomy on my corneas to relieve growing astigmatism.  He knew my eyes.  At a recent visit, he examined my right eye, checked out a printed colored topographic image of the cornea created by a great new diagnostic machine, and told me I needed a new cornea.  There was no fixing the one I had. 

“How soon can you get it done?”

“We’ll find out.”

I had my right cornea replaced for the second time on March 23^rd.  I was in and out of the Center for Minimally Invasive Surgery in Mokena in under five hours. 

They gave me valium and a little something to put me under.  I woke up sometime after the halfway point of the procedure.  I looked up into a gauzy whiteness, all with my left eye I’m sure, as they worked on the right.

“How’s it going?”

“Good.  I’m putting in stitch number ten.”  It was Dr. Lubek’s calm voice.

“How many more?”

“I’ve got it planned for sixteen.”

“Good cornea?”

“Great cornea.  I’ll tell you about it later.”

“You’re busy.  I’ll be quiet.”

“Thanks.”

He and the nurse had a moment.  He asked for something and she gave him the wrong thing, or from the wrong tray.  Whatever happened, he didn’t like it.  He told her calmly but firmly.  She apologized.  I think I dozed off after that.

I saw him the next day.  After he took off the shield and the patch and examined my eye he leaned back on his stool.

“What do you think?”

“You can’t tell, because I’m wearing a mask, but I’m smiling in a big way.  I mean its swollen, and we’ll know much more in the weeks to come, but after less than twenty-four hours, it’s fitting very nicely.  I’m really pleased.”

“Can you tell me anything about the donor?”

“72 -year- old male, died of natural causes, from the Midwest.”

“72?  Last time I got a cornea they said they would never give me a cornea from a donor older than me. I’m 69.”

In 1990 and 1991, the corneas I received were from people in their 20’s. 

“That’s an old assumption.  We have much better ways of determining the quality of corneas now. They go by cell count, elasticity.  That 72-year-old gave you a great cornea for me to work with.  Really.”

“I forget about the recovery.  What’s going to happen?”

“You won’t see much through that eye for two weeks. Your eye has to make the new tissue its own.  But when it does, it goes faster.  Tim Ortiz will hopefully give you a corrective lens after a month or two. You’ll have several prescription changes over twelve months, I’ll remove stitches slowly over that year, and then it will settle down into a smooth and hopefully much less astigmatic cornea.”

“Thanks, doc, for making this happen for me.”

“You’re welcome.’

He paused.

“This is one of the procedures I enjoy most.  Someone donates a cornea, maybe knowing how valuable it is or maybe not.  I act as the bridge, making the best use of the donor’s gift as I can, giving it to someone who needs it.  Like you.  I know how much you needed this cornea.  Hopefully, you will make use of it for a long time.  Something could still happen you know.  Rejection is the biggest risk, but it’s very small odds.  I think you know that.  But I’m pretty sure your vision will improve a lot.”

He stood up. 

“I think corneal transplants are a great thing for all three of us: the donor, the surgeon, and the recipient.”

 

Old singer songwriters; Neil Young, John Prine, Joni Mitchell, Leonard Cohen, my friend Jackson Browne, and a whole list of others tend to write their best stuff, or maybe their most famous and frequently heard, at the beginning of their careers.  But they have such long careers.  How could they possibly sustain their popularity?  We expect so much from them.

Jackson Browne, now in his 70’s,  recorded his last album in 2014.  No hits that I recall.  You would not likely recognize the song titles.  I listened to it to see if we are still on the same road.  We are.  I found these lyrics in a song called “Standing in the Breach.”

https://www.youtube.com/watch?v=TeErlCbO2mM

And though the earth may tremble, and our foundations crack
We will all assemble, and we will build them back
And rush to save the lives remaining still within our reach
And try to put our world together standing in the breach.

So many live in poverty while others live as kings
Though some may find peace
In the acceptance of all that living brings
I will never understand however they've prepared
How one life may be struck down and another life be spared

I want to think that the earth can heal
And that people might still learn
How to meet this world's true challenges
And that the course we're on could turn

And though the earth may tremble and the oceans pitch and rise
We will all assemble, and we will lift our eyes
To the tasks that we know lie before us
And the power our prayers beseech
And cast our souls into the heavens, standing in the breach

You don't know why it's such a far cry
From the world, this world could be
You don't know why but you still try
For the world, you wish to see
You don't know how it's going to happen now
After all, that's come undone
And you know the world you're waiting for may not come
No, it may not come
But you know the change the world needs now
Is there, in everyone.

 

All that poetry and beautiful guitar besides.  Thanks, Jackson Browne.  Thanks, Drs. Ortiz, Dr. Noth, Dr. Lubek.  Thanks especially to the three donors who I’ll never know who gave me their corneas after they had left the stage.  I’ve been blessed by your gifts.  I’ll try to use them well.

 

Donate your eyes when you’re done with them.  Someone will see you as their hero.