When OBs Pop the Cork

May 24th, 2011 by Harrumpher Leave a reply »

iEye“You must have been a forceps delivery.”

I lost track of how many times I’ve heard that as a statement or question. Opthomologists, optomatrists and even opticians revel in the geometry of my funky left eye. They enjoy its relative rarity. I am less thrilled.

As a boomer, I am one of many, many babies forcibly twisted in utero or extracted with the help of what are basically pliers or kind of metallic salad tongs. Corneal and choroidal (the eye’s thick membrane) iatrogenic anomalies are apparently quite common. They are common enough that eye pros can figure out the offense that led to the visual problems.

OBs grabbing a fetus’ head either blind when it is still inside mom or impatiently when the head is fully or partially out goofed up who knows how many times. Eye-related ruptures and deformities are less obvious and less severe than other blunders in the delivery room, but often last a lifetime.

My left eye, for example, is tri-toric on the surface. That is, it has a double wave. In turn, if you pardon, glasses can’t really correct the vision because the lens scatters the light wildly. Before my eyes hardened in presbyopia in my 40s and when I still could wear contact lenses, I got better correction. The hard contact lenses could for a more natural curve and correct better. The left lens was a work of true craftsmanship to fit the cornea. I would insert it and see and feel it shift as it rolled around into a meshing position.

That little daily thrill was decidedly not worth the bad vision.

My sight is correctable enough for daily purposes, such as keeping a driver’s license. I was cut off from many options. I liked the idea of being a pilot very much, but did not begin to qualify. More immediate was my effort to make sure I (with my very low draft lottery number) did not play bullet tag in Vietnam. I applied to the Naval Academy, got to the interview and physical, and had plans for college financing as well as service without wounds or death. The left eye queered it. My superior grades and SATs earned me a waiver, but not enough to overcome an eye that would never be 20/20 correctable.

Old Marble Mouth

The head of my HS math department was sympathetic and a bit outraged for me…and himself. John Boyer was a brilliant mathematician, who taught our smart-kids’ classes of calculus, trig and such. For one indication of personal ability, he solved an insoluble problem a student brought in from the MIT magazine. He glanced at it, said it should have a solution and went to work. The huge classroom had chalkboards on three of its four walls. He covered nearly all of that and arrived at the answer. The student mailed (pre-email after all) it to MIT, which acknowledged the solution and thanked them.

Old Marble Mouth, as he was called behind his back for his indistinct speech (I mumbled and understood him, so many times other students would ask, “What did he say?” or “What’s the assignment?”) met his own vision wall. In the Korean Police Action War era, he had been a military mathematician. He was very patriotic and loved helping his nation doing his forte. The service told him to get lost and that they would never promote him, exclusively because his vision did not meet officer spec, even with glasses.

Of course, I identified with the absurdity of a desk-bound number guy being held to field and battle standards. The military reasoning was what we see in political bifurcations today. Rules are rules to a chunk of us. Mr. Boyer said he kept hearing how sorry they were, but the rules said an officer had to be physically capable of leading troops in battle even if the closest he got to firing a rifle was a wielding pencil. Rules are rules. The country lost the career-long services of a great math guy.

Mechanical Blunders

To the forceps, the expedience of OBs seems to have resulted in many thousands, maybe millions of damaged adults. A search in a library or online provides myriad examples and discussions. The problem was well well known in the early 20th century, for one example. Vision-specific blunders are in medical texts, as here.

The theory and technique of safe forceps use seems complex but straightforward enough. All these require are patient, flawless and attentive practice. ’nuff said.

I got it double — OB and Army. There were a lot of us born when Johnny came marching home from WWII. The birth factories were military style fast and efficient. Plus, I was born in Ft. Sill Station Hospital, with the overlay of those rules are rules types, which figures in my name and I’ll explain below.

OBs have long had the deserved reputation of doing what they think and feel makes life easy for them. The babies and moms often suffered. Way back, there was the not washing hands thing that killed who knows how many of both. Even today, many hospital births are with the mother strapped and in stirrups…and heavily anesthetized. Let’s be plain. That’s for the doctor’s convenience foremost.

The fetus manipulating and plucking forceps have a similar mystique. The snappy patter is that the tongs approach is essential in fetal distress and the hardest deliveries.  In reality, it was a common expedience and in many places still is. Plunging forceps literally blindly and doing a best guess grab to rotate the head or pull out the fetus is very risky and has very frequent bad effects. Beyond the vision, there’s crippling, and brain, limb and spine damage.

This is the same profession that brought us faddish gall bladder removals for no reason in my grandparents’ time, unnecessary and routine moneymakers like tonsillectomies, and in the delivery room, unjustified episiotomies and cesareans. It always allegedly was essential for the health of the patients, but literature says otherwise.

Rules Are Rules

In a similar less dramatic way, I think back to my recent broken leg with the surgery to ream the length of my tibia to insert a metal rod. In hospital, the nurses started immediately with morphine and brought around the extras including laxatives and prescription strength anti-acid/reflux meds. I was doped up and in agony, but I had to get some justifications.

Rules are rules appeared again. I had to stay ahead of the pain, as all the nurses said repeatedly. So it was lots of narcotics. I was certain to get constipation and ruinous stomach upsets from the drugs and being in bed. These tablets and capsules were standard. So take them.

I didn’t. I argued successfully with numerous nurses and a couple of doctors. I took about a third of the narcotic dose — with repeated verbal battles throughtout every day — and refused the laxative and reflux meds. I had no symptoms and no history to justify the latter two. For drugs, my ideas and practices are an occasional aspirin, mugs of coffee and a goblet of wine. I had no need for the GI meds during or after the hospital stay. Yet, I could see the nurses not wanting to deal with a constipated or gut-pained patient. So, unnecessary drugs were the prophylactics.

For the narcotic, I left with a bottle and a prescription for three more refills. I am very wary of narcotics and will put more pain on my scale than risk of dependence. I did not finish the bottle and did not refill the prescription. The pain was indeed intense, rather exquisite in its power. I did take some relief, but was off the drug long before the docs and nurses would have me doped up. Their argument that somehow gutting it out would prolong the recovery made and makes no sense, and was not at all what happened.

My wife insists I’m an outlier. I am in fact very sensitive to pain. It’s just that I compartmentalize the physical and emotional aspects as much as possible. Yet I know many nice and bright people who take strong meds at the hint or anticipation of even the most transient pain. It’s a judgment call.

Name That Baby!

Back in Ft. Sill, I got another permanent birth residual — my name. The rules-are-rules Army nurses insisted that my mother name me immediately. That’s the military way or was then.

She was small and even emerging, I came with a big head, shoulders and chest. She said that was the catalyst for the OB saying he’d use forceps. That came with a burst of gas, which was also the norm. She had arrived (by foot) at the base hospital fully dilated and had no anesthesia until then. There wasn’t time.

With a new son plucked from her and groggy from the drugs, she says two nurses were there with the birth certificate, demanding an instant naming event. I got drugged tags for life.

To her credit, she never told me what the alternatives were. She did not yet know the gender of child number two but had noodled options for both with her husband. Yet in her drugged state, she could not produce them. Thus, she went with what did come to mind. I got my father’s last name as mine. I got his middle name (the vanilla Robert) as my middle. My first name, Michael, was my mother’s maiden name. It may be worth noting that I was named after both parents in that she was spirited enough to play tackle football with her brother and his friend into her college days. While she was also a campus beauty queen as well as scholar, her toughness earned her the nickname among all her peers of Mike, from her last name.

There are times I’ve wanted a less common first name. I don’t even look up when someone calls “Mike!” There are far too many of us and I’ve been burned too often as another Mike responds correctly. It is what I call the YAM situation for Yet Another Mike.

I’ve gotten used to the name even though I could change that in court. For the eye, there’s really nothing useful. I’m not a candidate for surgery short of corneal transplant, which is damned risky for a (low-level) functioning eye.

Many people have far more to carp about than a terrible eye.

Tags: harrumphharrumpherbirthforcespvisionmilitarydoctorsnursesdrugs


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