The `Troubled’ reader

Henning Mankell blipped onto my radar screen for the first time several weeks ago.  I was in the mood to read a good detective story and discovered his latest book, “The Troubled Man,” in a brief summary toward the back of the New York Times Book Review.  Mankell, I read, has an international reputation and is very popular in his native Sweden and in Germany.  I bit.

“Troubled” is supposedly the last in Mankell’s Kurt Wallender series.  Wallender is a fictional police detective in the small Swedish city of Ystad, in the southern part of the country.  At age 60, he is a curmudgeon of moodiness and impatience,  brought on by loneliness, a fear of death, resentment of his artist-father, regrets of a lost love and, in this book, a descent into the dark world of Alzheimer’s.  Not to mention his diabetes and alcoholism.   He can be deceitful, uncommunicative and cold.  It is beyond imagination why anyone likes him but almost everyone does.  The book is as much about Wallender’s life as it is plot. 

Espionage, Sweden’s “neutrality” during the Cold War and its paranoia of the USSR and later Russia form the crux of the story.  It is a plot not normally in the province of a lowly city policeman.  But Wallender becomes enmeshed through his pregnant daughter Linda’s boyfriend, Hans von Enke.  Hans’s father, Hakan, is a retired admiral in the Swedish navy and is seemingly obsessed with spying and Soviet submarines violating his country’s territorial waters during the 1980s.  When first Hakan then his wife, Louise, disappear, the mystery is on and Wallender unofficially joins in the search for answers.  There is a murder and rumors of a longtime female spy in the highest echelons of the navy that takes the detective to Berlin, Copenhagen, Stockholm and other places, small and large.  

At the end of it all, “Troubled” is a hard book to like.   It is rambling and descriptive details are sparse.  The astonishing and dramatic conclusion have little basis in logic.  Wallender moves through his murky landscape largely on instinct, his inability or reluctance to be more curious are maddening.  And worst of all, where is one likeable character?  Wallender himself can be deceiful, uncommunicative and rude.  It defies imagination that anyone would like him but everyone does.  Daughter Linda is far too bossy and Hans is remote and preoccupied with his career in high finance to the point he seems to care not a whit about his missing parents.     The English translation by Laurie Thompson does not help.  It is wordy, at times unclear and uses too many clichés.  

The book made the New York Times bestseller list a week ago at No. 6 among hardbacks. Last week it was gone.  And it got no truck on the lengthy E-Reader list, leading me to believe that in the U.S. at least Mankell has a small but dedicated cadre of readers willing to cough up big bucks to collect the author’s first-edition.

For me, I enjoyed most following on a map the Swedish places Wallender visited.  His hometown of Linkhamn, near Malmo, the castle at out-of-the-way Glimmingehas and the little restaurant by the river at Soderkoping from where the climax springboards.  Sadly, there was little else.

A cataract-surgery journal: Part II

NOTE:  Part II deals with surgery on my right eye and post-op, or recovery.  Part I described events leading up to the surgery, a period of three months, January 22 of this year to April 21.  Part III will cover surgery on the left eye, May 5 through post-op.  I’m considering a Part IV, which would be a short, overall assessment of my experience with cataract surgery.  

April 21, Thursday:  I arrive at Barnet Dulaney Perkins Eye Center in Phoenix on time, 7 a.m., for cataract surgery.   While the rest of the building is dark and vacant, the surgery area is busy.  A half-dozen other patients sit quietly watching a color TV.   A woman behind me is attempting to photograph the eye of a friend before surgery.  Nebra tried that last night on me with no luck.  A receptionist greets me with several documents.  Initials here, signature there.  I’m startled by two items in the documents.  One, my insurance won’t cover the entire bill as I was told it would.  I produce a Visa card for the extra $385.42.  I’m too far along now to stop on a dime.  I’ll deal with it later.   Two, I’m asked to sign an agreement that I “understand”  my vision after surgery will be no better than 20/50.  That’s not good enough to pass the Arizona’s driver’s test without glasses.  No one mentioned that before.  Something to check into tomorrow morning during my first post-op exam with Dr. Pinkert.  At 7:15 I’m hustled off into a little room for testing of blood pressure and temperature.  The BP is very high for me, 163 systolic, but the nurse doesn’t blink an eye.  Guess she figures most everyone coming in for the first cataract surgery is one notch from blowing a gasket.  I’m asked to identify the eye I’m to have surgery on.   My answer, “the right one,” is not good enough.  “Point to it,” she says, and I do.   A clear eye shield is slipped over my left eye.  I’m given three eye drops:  one for dilation, one to fight infection and another, I think, to relax the eye, to keep it steady during surgery.   The surgeon, Dr.  Scott Perkins, pops in to see me.  Upbeat as usual, confident, affable.  I feel I’m in good hands.  He checks my name tag, smiles, says something and taps good-naturedly on my chest before disappearing.  It is the last time I see him in the flesh on his day.  I’m told to have a seat in a large room I call “the on-deck room.”  Two men and a woman are stretched out on gurneys, waiting for their turn “at bat” in the operating room on the far side.   A half-dozen nurses, all women, swarm the area in blue uniforms with “party hats” of blue netting.  Though pleasant, these hustling nurses seem dead serious and do not stop to chit-chat with anyone.  Soon I’m on a gurney of my own, a BP monitor hooked up to my left bicep and an intravenous “connector” stuck in the right one.  The anesthesiologist, a cool dude in his 50s, swings by to introduce himself.   He says I should be on my way home very soon “barring complications.”   I wonder what those are but he too disappears quickly.  I’m given a sedative that almost puts me to sleep.  Shortly my gurney is wheeled into the operating room under a bright light.  By now the right side of my face is numb and completely covered with a cloth.  If a hammer hit me on that side, I probably wouldn’t so much as flinch.  I can see absolutely nothing out of my right eye except gauzy whiteness.  “Doctor Perkins will be here in 2 1/2 minutes,” a nurse says.  I think, god, I really am on an assembly line.  A nurse later tells me that Perkins is doing 17 cataract surgeries today alone.  I’ve read he has done more than 40,000 in his career.  About 8 a.m. I hear the voice of Perkins nearby.  He begins work almost immediately after shifting me into better lighting.  I’m told by a nurse if I have to cough, please give warning.   The slightest unexpected movement can mean trouble.  Perkins and I chat as he cuts into the eye and takes out my old lens and inserts the new one.  He answers some of my questions:   The incision is only about 1/8 of an inch.  My cataract is apparently a large by his standards.  The new lens is inserted folded through the cut then stretches into place on its own.  The surgery will not affect my eye’s macular hole in any way, it being a long way off in Perkins’s world of eye surgery.  Less than inch maybe.   In all, the surgery lasts 4-5 minutes.  I have felt nothing.  No pain, not even discomfort. Nothing.   Science and technology have carried eye surgery a long, long way, it seems.   No telling what doctors like Perkins will be able to do in another decade.  My right eye is bandaged shut.  I can take it off in three hours.   I’m quickly wheeled into a recovery room and on my feet in no time, seated next to a nurse who is giving me detailed instructions on post-op.  By 8:20, I’m back in the reception and Nebra, my designated driver, is on the way.  We arrive back at the house at 9 o’clock.  Only two hours have elapsed since I walked into the Eye Center.   It would’ve been an hour and a half had Nebra stayed and not driven back home.  I’m eager for 11:15 to roll around.  That’s when I can take off the bandage and see what my eye has in store. . . . 11:15 a.m.  I stand in one of our bathrooms facing the mirror, slowly pulling off the bandage from the right eye and wondering what my vision will be like.  I’ve been told over and over it will take two or three days for the new lens to settle in.  I’m expecting distortion and fogginess and that’s what I get when I finally can see.  My eyes are watery.  I can see shapes but little else.  Still I all but know things will get better. . . .  11: 30 a.m.  It’s time to start the eye drops again.   Durezol,  a steroid anti-infammatory, has been added to the mix with the pre-surgery drops, Vigamox and Nevanac.  I’m to take all three, five minutes apart, every four house that I’m awake.  The drops leave a slightly stinging sensation . . . . 1 p.m.  I’m stretched out on the living room sofa, noticing how the right eye’s vision is improving.  I look out a window into the blue sky.  I close my right eye and peer out with the cataract-hardened left.  The sky is a bluish-brown.  I close the left and open the right and, voila, the sky is brightly blue.  The unclouded right eye is obviously letting in much more light. . . .2:15 p.m.  On our way out to lunch, I glimpse on a promotional card the title of a play, Nine, we’re planning to attend Saturday night.  There is something odd about the letters in white capitals, NINE.  I look at the letters with only my left eye and see the usual blurry double-images.  The right eye, I find, shows only a single image.  Blurry but single.  My double-vision, it seems,  has gone away in that eye.   2: 30 p.m.  While eating at the Athenian Express near the city center I look up into the room’s lights.  I’m dismayed to see a halo circling every light when using only the right eye.  Still, the right eye’s clarity is improving though objects appear blurry.  I look across the room at a chalkboard menu and can read the larger words  fairly easy.  That’s new for me . . . . 8 p.m.  Nebra and I walk a mile in darkness up to the Spaghetti Factory for supper.  I’m suddenly amazed at the sharpness of the right eye’s long-range vision.   9:15 p.m.  On our way back home I stare into the bright lights of the restaurant’s parking lot and see giant halos in rainbow colors surrounding the bulbs.  The purples and greens are very pronounced.  I’ll have to ask about the halos tomorrow at the post-op. Most of the day I’ve had a small headache off and on just above the right brow, a nagging condition that has yet to require a Tylenol fix.   Also at times I’ve felt a rough edge inside the eyeball.  And there has been the pink spot, very light in color and the size of a dime, that sometimes appears when I bring my right eye to focus on something nearby.  But all in all, it’s been a very rewarding day.  I feel I’m on the path back to decent vision.

April 22, Friday:  I have the post-op in late morning at the Eye Center.  It’s not with Pinkert as scheduled but with a Dr. Duony, also an optometrist.  The recovery is proceeding OK, she says.  An assistant measures the sight in my right eye at 20/50.  That’s better.  It  had been 20/70 before surgery.  Muong says I will continue to have a little blurriness for two or three days until the swelling goes away.  The top eyelid is slightly sore to the touch.  The halos may diminish, I’m told,  but likely will not disappear.  I’m given a sheet with the new eye drop schedule for the next three weeks.  I’m to use all three drops three times a day for the first week.  By Week 3 I’m taking only the Durezol once a day.  I’m seeing much better. . . . After supper tonight we drove up to a DQ, and I saw NO halos through the right eye.  Not on a street lamp, stoplight or on an open bulb.   That’s the biggest improvement over the last 24 hours. While double-vision has disappeared, distortion remains.  If I’m looking at a word, say, the middle letters are bowed and curved to the point of making them, and often the word itself, undecipherable.

April 23, Saturday:  Day 2 after surgery.  Tonight Nebra drove us out to Scottsdale to see the French film, Of Gods and Men.  It was the first time in many years that I’ve been able to watch a movie without the aid of eyeglasses.   We sat toward the back of the theater and I was able to read the English subtitles without missing a beat.  Surely once the cataract in the left eye is removed I will see even better.  And for the second straight night, no halos around lights, none.

April 24, Sunday:  Day 3 after surgery.  I read two or three pages tonight of Henning Kellman’s “The Disappointed Man” on my E-reader — without glasses!  It was painstakingly slow and I gave up after a bit.  But I read them.  Amazing.

April 25, Monday, Day 4 after surgery.  On waking, the right eyelid is sticky and won’t open easily without aid from my fingers.  My vision warms up slowly in the morning.  It’s an hour or two before it’s back to the new normal.  Using Blink, the lubricating eye drops that was in my post-op packet, seems to help.  I haven’t worn the protective shield for two nights.  It disturbs my sleep. . . . In early afternoon, I turned to switch off the overhead kitchen light.  To my surprise, it was already off.   My vision has so much more light in it now that I was fooled. . . . I’m probably unrealistic but this was a disappointing day.  No dramatic changes.  And walking late tonight, I noticed the slightest of halos around the street lamps.  Nothing like the giants of two days ago, but little halos, almost indistinct.

April 28, Thursday:  The one-week post-op.  More tests of the right eye — but the left one too — before meeting with Dr. Pinkert who says the healing is going normally.  “It looks much better than last week,” he says, “and it will continue to improve.”   I still have the “wrinkle,” the wavy distortion  in the vision of my right eye.  For the first time, Pinkert talks briefly about the more serious problem causing it.   A macular hole in the back of the eye.  It will, as Dr. Perkins said earlier, require a third operation to fix it.  I will have to see a retina specialist for that.  For now, I must deal with the cataracts.  Surgery on the left eye comes in exactly a week.  Next I talk with a scheduler.  I sign a surgery-consent form, and about a half dozen other forms.  Even one saying I had seen the forms.  Again I must pay almost $400 for the left-eye surgery.  It’s the 20 percent that Medicare won’t pay.  My Blue Cross/Blue Shield insurance should cover that.  But, the scheduler says, Medicare says I have no other insurance.  She’ll look into it and call me.

A cataract-surgery journal: Part I

2011

A NOTEI’m scheduled for cataract surgery soon.  The right eye, my worst, is to be done on April 21, the left on May 5.    The following account is a work in progress.   Part I deals with events leading up to surgery.  Park II deals with surgery and recovery, or in the words of the medically hip, post-op. 

Iris - eye anatomy

   AN EXPLANATION:  Cataract surgery is the removal of the crystalline lens (seen on the left) and replacing it with a  synthetic one.  It is said to be a simple operation.  This lens is located in the inner eye, just behind the iris and helps focus light  on the retina.   A softer material, the cortex, surrounds it in a capsule-like bag and all of it is held in place by a system of tiny wires called zonules.  In the beginning the lens is felxible allowing easy focus on distant and close objects by changing shape.  As the aging process occurs, the lens hardens and changes color.  Blurriness and clouded vision set in.  The lens becomes in essence a cataract. (Drawing  from stlukeseye.com)

 

January 22, Saturday:  The trip to eye surgery really began today on another trip.  Nebra and I arrived at the Honolulu airport in late afternoon to begin a 9-day vacation on Oahu.   While picking up a rental car at Enterprise, I was shocked to discover I had allowed my Arizona driver’s license to expire.  I had been driving illegally since mid-September.  Normally the renewal is no big deal.  But this time it is.  I  knew that meant a vision test when I got home to Phoenix.  That worried me.  My vision had worsened considerably in the past year.  Not only was the world turning more blurry, it was darkening.  I wore only a tinted pair of strong +4 reading glasses purchased at Ace Hardware for $3.  Reading a book or the newspaper by lamp was a pain.  I needed strong light, preferably sunlight.  For some time, I had asked Nebra to do most of the night driving.  I could not read the local green and white street signs to save myself.  The thought of having my license revoked is a very real possibility.  Not being able to drive is unthinkable.

February 4, Friday:  I travel by bus to the Motor Vehicle Division office on North 51st Avenue, Phoenix, to hopefully get my driver’s license renewed.  I haven’t driven now in almost two weeks. I’d been to this place before under less foreboding circumstances.  Anxiety sweeps over me.  It is busy as usual.  I wait about 45 minutes before my number is called.  The clerk is young, arrogant and disinterested.  He fills out the paperwork, takes my check and directs me to a nearby area for the dreaded vision test.  I’m to read a sign with rows of letters.  Even the big letter “E”” on top is blurry.  I’m sent back to Mr. Arrogance.  The tester says, “He failed.”  The clerk freaks out.  He doesn’t want to redo the paperwork.  It’s like he’s getting paid by the number of applicants he handles in a day.  I’m sent back to do yet another test.   This time the sign is brighter but I struggle to read more than a few rows down.  The tester again delivers me back to the antsy clerk.  “He passed.”   A sigh of relief from the clerk and from me.  I’m given a restricted license.  Daytime driving only.  This will be a huge imposition on my life.  I’ll be dependent on Nebra and others to chauffeur me around after dark. I go home depressed.

March 11, Friday:  I visit an optometrist, Gary Shapiro, in late afternoon.  I want to correct my vision if possible so I can drive again at night.  It’s been about 30 years since I last had my eyes tested.  At one time, I wore trifocals.  I didn’t like them and soon switched to cheap reading glasses.  I started at +2.5 and worked up to the +4s.  Shapiro has a small office in a renovated house on McDowell, just west of Central.   I go through a battery of tests, first with a technician and then with Shapiro.  He tells me I have cataracts in both eyes.   I don’t know why but I’m astonished.  I didn’t think I was old enough.  Anyway, the right eye, it seems, is more clouded than the left.  Surgery is advised.  That means lens implants, a once in a lifetime procedure.  A new world of vision will open up, Shapiro says.  I’ll need eyeglasses only to read, perhaps.    Long-range vision should hit 20/20.  I’ll probably be able to drive again at night.  I’m eager to get started.   The staff makes an appointment for me with Barnet Dulaney Perkins Eye Center up near Camelback Road.  This is the place Shapiro said he sent his mother to have her cataract surgery.   I feel optimistic now, almost giddy.

April 5, Tuesday:   I report to Barnet Dulaney Perkins Eye Center in early afternoon for a preliminary exam.  The waiting room is nearly full.  Most of the patients are elderly.  Some are in wheelchairs.   I fill out a ream of paperwork, wait 30 minutes before a technician dilates my eyes with three drops from different solutions.  The drops brighten the surroundings but also makes them foggier.   Then come the eye tests.  On one, I cover an eye and try to read the rows of letters with the other.  To pass the driver’s test, the technician says, I must have 40/20 vision.  That’s the fifth line down.   I can barely see some of the letters on Line 4 even with the reading glasses.  Line 5 is impossible.  The technician voices surprise I passed the daytime driver’s test.  “You probably shouldn’t be driving at all,” she says.   I think she’s wrong.  I do very well in daylight.  Certainly I’m no more of a danger than the zillions of drivers I see on cellphones or texting. Later I meet with a Dr. Pinkert.  He checks my eyes and confirms I have cataracts and that surgery is the answer.  The surgery itself will last only several minutes.   The old, clouded lens will be removed and a synthetic lens implanted.   I choose the right eye to be done first, no particular reason.  I should see “dramatic change” by the next day, Pinkert says.  I have two options, it’s explained:  A “standard” lens or a “special” lens.  The standard corrects my long-range vision but not the close up.  In that case I likely would wear glasses for reading.  My Medicare and Blue Cross/Blue Shield should cover the entire cost, minus the anesthesia.  The special lens will correct both far and near vision but the cost is $2,500 an eye.   My insurance will not pay for that luxury.  I have a few days to decide.  I’m to see my surgeon, Dr. Perkins, in two days.  Maybe by then I can make an informed choice.  I next talk to a counselor, Wendy.  She schedules me for eight more appointments, counting surgery and post-op.  As I leave I write a check for the deductible, $60.84. 

April 6, Wednesday:  I’m back at the same place for Appointment 2, an A-Scan and a physical exam.  The A-Scan, I’ve read, measures the length of the eye and the power of the cornea via ultrasound. The test calculates the power needed for my implanted lens.  I sit in a chair, my chin and forehead resting against braces.  A technician turns on a machine.  He sits behind it facing me, punching in computer commands.  Red dots of light appear against a black background as I stare into the machine.  Later an on-end yellow rectangle appears.  The tech has a limited vocabulary.  “Blink” and “open wide” are all he says to me.  The process takes only 5-10 minutes.  I’m none too happy to read the A-Scan is only “fairly accurate”  and imprecise measurements can occur.  After another 30-minute wait, I’m ushered into a small room for a very basic physical given by a middle-aged woman in glasses.  She listens to my heart and lungs and checks my blood pressure.  I take meds for BP and think maybe I may not pass this hurdle since I have “white-coat syndrome,” that sends my pressure up 20-30 points when measured in a doctor’s office.   Just in case, I’ve taken with me two BP readings from the previous night, measured on my home monitor:  113/73 and 107/64.  Today, I measure 140/80, but I’m told, “That’s good, considering you’re in a doctor’s office.  Most people are a lot higher.”   I walk out of the building shortly after noon.  It looks good.  My meeting with Dr. Perkins is still scheduled for tomorrow.

April 7, Thursday:   I show up at 11:30 for the appointment.  First, my eyes are dilated again, this time with only a “mild” solution.  The woman assistant describes in detail what happens on Surgery Day.  In short, I will be taken back to a “preparation room” and given an anesthesia to relax me, the eye numbed and dilated.  The surgery will take only 4-10 minutes.  The cataract, the old lens, is broken up by ultrasound and washed away with fluid.  The new lens is then implanted through a small slit in the eye.  I can expect to stay at the Eye Center for 1 1/2 to 3 hours, and will need someone to drive me home.  I sign a consent form for the surgery, noting that all may not turn out perfect.  I’m directed to another room where I will meet my surgeon, Scott Perkins, for the first time.  I know only a little bit about him from a handout.  He graduated from the Temple University School of Medicine, in Philadelphia, and did his residency at Boston University Medical Center in 1989.  I read he has performed more than 40,000 cataract surgeries and his been a part of this firm almost 20 years.  A light knock on the door.  Enter Perkins.  He is slender, maybe 5-11 and looks to be 45-50 years of age.  He exudes confidence and has a pleasant personality.   “I really enjoy working on people like you because you’re going to see such a big change in your vision,” he says.  Perkins examines both eyes.  He sees a slight astigmatism in the left one, saying that can easily be dealt with during the cataract removal.  But then he finds something else in the right eye.  It is a hole in the retina, a “fairly common” condition during the aging process, he says.  For some reason it was not detected in the earlier tests.  I undergo a retina test in another room.  It is confirmed that I have a hole.  Perkins says I will need another surgery, maybe three weeks after the cataract surgery, to deal with it.  I am disappointed when he tells me I have only one option now with the cataract surgery, the standard lens.  “Save your money,” he says.  “The special lens won’t enhance your vision that much.”   I heard Perkins say something to his assistant about “macular,” but I was so focused on the cataract that I let it slide.  I don’t know that I would’ve gone for the more expensive surgery.  But to know I don’t have a choice now, that’s a little depressing.  I ask Perkins if he thinks I can drive again at night.  He leaves me a crumb.  “That’s my expectations,” he says. 

April 12, Tuesday:  Nebra returns from chorus practice tonight at Phoenix College with a cataract story from one of the other members.  This woman had cataract surgery on both eyes,, years apart, one eye for close vision, the other for distance.  Sounds crazy to me. 

April 15, Friday:  Tom, a neighbor tells me tonight about his 80-year-old sister’s successful cataract surgery a few years ago.  She now can see near and far without glasses, but chooses to wear them anyway.  She’s worn glasses most of her life and doesn’t think she looks  good without them.  

April 17, Sunday:  I’m letting my thoughts drift about cataract surgery when suddenly I remember the words spoken almost two weeks ago by Dr. Perkins.  Hole in the eye.  A second surgery after cataracts.  Macular.  Part of the aging process.   I’d been so hung up on the cataracts I forgot those words.  “Many people have them,” Perkins had said.  I had come away feeling “the second operation” was routine, no big sweat.  I Google the words.  Quickly a long list of websites appear:  “Macular hole surgery.”  The surgery is called “vitrectomy” and the hole is a  serious problem, though I have none of the distorted vision yet that I read is associated with it.  The hole can lead to blindness if untreated.  I read on.  “A macular hole,” one site says, “is a small break in the macula, located in the center of the eye’s light-sensitive tissue call the retina.  The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail.”   Surgery is successful 90 percent of the time, but improved vision is the million-dollar question.  Again, I have the hole only in the right eye.  It is rare to have it in both, I read.  I go to some testimonials and find some good ones on  medhelp.org.  I begin to realize how difficult recovery can be.  The head must be kept face-down for up to three weeks.  Gas bubbles, stages 1-4, oil substitutes.  It’s more than I want to know for now.  I’ll push macular hole surgery to the background, concentrate on cataracts.  One bird at a time.

April 19, Tuesday:  I pick up a phone message in late afternoon from the Eye Center. I’m to report for surgery at 7 a.m. on Thursday.  Nebra is my designated driver.  I call her at work.  “Are you ready?” she asks.  “Yes,”‘ I say without hesitation. “Let’s get it over with and move on.”

April 20, Wednesday:  I begin taking prescription eye drops shortly after 8 a.m. in preparation for surgery tomorrow.  One of the drops is Nevanac, an anti-inflammatory.  The other is Vigamox, which fights infection.  I must instill them in my right eye, the one that is to be operated on, three times today and once more before surgery in the morning.  I’m concerned about missing the eye with a drop or two.  The drops come in small platic containers and are very expensive:  $124 for the Nevanac, $80 for the Vigamox.  For the first drops I try the so-called Ritch-Sussman Technique, used by some glaucoma patients.  I grip the container between the index finger and thumb on my right hand.  With my left index finger, I pull down the bottom of my right eye then crook the finger into a right angle.  I bring the container to a point where the knuckle of the right thumb touches the knuckle of the left index finger.  The container should be right above the eye now.  I use the technique first for the Vigamox and then five minutes later for the Nevanac, as instructed.   Splash-down.  Most of it hits the eye.  Some does not, and I roll my head to force the errant solution into the eye.  Everything takes practice.   The Vigamox creates a slight itching, and the Nevanac a slight stickiness.  My vision is unaffected.   I even take the technique an unnecessary step further.  I push down on the corner of my eye with a finger to stem the fluid from entering the rest of my body via the tear duct.  Later, it dawns on me this is the last full  day in the life my natural right lens, the one I was born with.  It has aided me in seeing many things over the years.  I know it’s silly but I feel a touch of sadness.  It’s like ditching an old friend when he’s down and out. . . . It’s almost 11 p.m., time to fast until after surgery.  Nothing to drink or eat, not a sip of water nor even a cough drop.  The warning on the instruction sheet is a stern one:   “If you have anything by mouth, we will cancel your surgery.”

April 21, Thursday:  I’m up shortly after 6 for my 7 o’clock surgery appointment at the Eye Center.  It’s about a 15-minute drive, plenty of time yet.  I put the Vigamox and Nevanac drops in the right eye.  Forget the Riche-Sussman Technique for now.  I simply hold the dropper over my eye and squeeze.  Perfect splash-down both times.  I put the Celtic cross in a front pocket of my bluejeans. Can’t wear jewelry or an undershirt.  I wake Nebra to act as my chauffeur and we push off about 6:40.  I’ll write about the surgery later, in Part II.

Lookout Mountain summit: A small pleasure

Lookout's summit (left) as seen from the north with creosote in foreground.

I had built this trail up in my mind.  I called it the World’s Toughest Half-Mile Summit hike.  From what I read the way to the top of Lookout Mountain, at a mere 2,054 feet elevation, was short but not so sweet.  Loose rock and steep with some scrambling near the top.  I figured it might be one of those trails that was so ugly you might not enjoy the summit views, no matter how nice.  

But I started out anyway on this warm and cloudless Sunday afternoon, knowing in a matter of weeks triple-digit temperatures would make this hike a death march.

Lookout Mountain lies in the far-flung Phoenix Mountain Preserve, well within the city limits and yet about 15 miles north of where I live near downtown.   The Preserve is a large area of desert that has been spared from the city’s hungry-eyed developers and homeowners who can not gobble up pristine areas like this fast enough.  Then as close to wild nature as they can stand, these goggley-eyed surbanites have the gall to complain about the javelina and coyotes in their backyards.  Yes, I know.  Another story, another time, .  

I marched out from the trailhead at the end of 16th Street, south of the Greenway Parkway.  There is a little parking lot there and it was nearly full.   A bulletin board with a map and a water fountain rest nearby. 

The Summit Trail, #150, veers sharply off the perimeter trail about 50 yards out and rises rapidly up into some loopy switchbacks.  The trail, yes, is largely loose rock about golf ball size.  But small paths of dirt have been worn through by the steady foot traffic.  Though probably the least known of the half dozen peaks within the Preserve, I count about 20 other hikers coming up and down as I travel along.  That’s a lot in a half mile.  And the going is steep despite the switchbacks.

My definition of a steep trail is this:  1,000 feet elevation gain in one mile.  The Summit Trail is said to rise 475 feet in a half mile.  That by my math is equivalent to 950 feet in a mile.  Close enough to qualify. 

This is mostly a land of creosote, a wonderful desert plant.  Shoulder high with long gray spider legs leading up to little greasy green leaves at the ends.  I like the creosote so much I’ve grown one in my backyard.  No water, no care.  And it’s a mammoth thing. The creosote is in full bloom now with small yellow flowers, many of them already turning into small gray fuzz balls of seed.  There are neighbors.  Green-skinned palo verde trees dot the landscape and a few yellow-flowering brittle bushes are here and there.   But I saw no cactus along the trail. 

Looking up at a false summit and a couple with a baby coming down.

The trail is unrelentlessly steep and rocky.  My wind is not great and my leg muscles above the knee are turning soft.  Walking five to six miles a day for years on flatland does not prepare you for this.  I see a saddle up ahead and plod onward, my eyes on the ground so as not to be discouraged by the grade.  I drop down on a large rock in the saddle and look ahead, watching a man and a woman clamber down over uneven boulders in a very steep crevice.  He is carrying a baby in one of those kangaroo pouches and at the same time helping the nervous woman over the boulders.  I welcome the rest and the view.  To the south, beyond the vast sea of upscale homes, I catch sight of Lookout’s sister mountains, North Mountain and Shaw Butte, a few miles to the south.

A view from the summit

The saddle is by my reckoning three-fourths of the way to the summit.  How much farther can the summit be?   An eighth of a mile?  Not far. Directly above me is a high point.  I wonder,  is that the summit?  The couple with the baby passes and I struggle to my feet again and head up “the crevice.”  I like to give names ot landmarks.  It somehow helps me orient myself. 

A woman is easing down as I go up.  She is wearing flimsy shoes.  I liken them to slippers you wear around the house.  I’m wearing my thick-soled Garmont low-cuts, and feel no pain at all.  As she passes, the woman, almost apologizing, says she regrets leaving her hiking shoes at home. 

It’s a bit of a scramble at this point.  Scrambling is halfway between hiking and climbing.  You have to use the hands.  No way a handicapped elderly person could reach the top, I think.  Not on this trail. 

The “high point”  seen from the saddle was a tease. But it is near the summit, a short and flat walk to the signifying metal marker.  I wait while a young couple take a quick view from the top and head back down.  A teenage boy pops up from nowhere, with an I-Pod.  I can hear the music.  He’d never hear the rattle of a snake, never know what bit him until it was too late. 

The summit itself was unremarkable.  Flat and rocky.  No register.   Hardly any sound except the buzzing of some bees, fighting over water rights to a small tank in the rock.  But the views, they were spectacular.  Smaller Shadow Mountain to the east.  Downtown Phoenix highrises and beyond in the light haze South Mountain.  None of the radio towers and other crud you find on Shaw Butte or North Mountain.

Then down I go.  Only 15 minutes to the parking lot, less than half the time it took me to get up there.  In my time, I’ve sat on the summit of Mount Whitney in the Sierras, the highest U.S. peak outside of Alaska and Hawaii.  I’ve been to the top of Arizona’s highest peak, Mount Humphrey, and reached the highest point in this county, Brown’s Peak, in the Mazatzals, one of the Four Peaks.  But climbing little Lookout Mountain has its joys.  To look out from any vista, no matter how high or low, is one of life’s pleasures.

This was a good day.  And who can forget?  I had conquered “the world’s toughtest half-mile summit trail.”