Katie Ortiz has gone through a range of emotions, both before and after surgery to remove a tumor from her eye.
When she was first diagnosed with the choroidal melanoma, a tumor in the blood vessel layer choroid just beneath the retina, Katie first felt disbelief and shock, asking herself, "What did the doctor just tell me?"
"I don't care how strong of a person you think you are, you will grieve," said Katie.
"Then I asked God to prepare us - the family - for this. My faith kicked in and He got us through this."
Katie underwent surgery at UC Davies Medical Center in San Francisco on Feb. 14.
Dr. Devron H. Char had removed a dime-sized tumor and was ready to close the incision, but a small anterior blood vessel would not stop bleeding. Dr. Char tried to tie it off, then cauterize it, but it continued to bleed. He had to remove Katie's eye or she could die.
Katie accepted the fact she lost her eye - but she still had her eyesight. The 34-year-old woman, mother of two children, had another concern with her husband Dan. Would he still find her attractive?
"Dan has been an angel through this whole ordeal," said Katie. "He's a gift from heaven and he's been a great strength for me."
After Katie's healing time from the surgery, she and Dan traveled to Oakland, Calif. on April 30, to meet with ocularist Steven R. Young, a board certified ocularist, who creates prosthetic eyes.
Young is one of 15 ocularists in the state of California; there is none in Nevada. He is also one of the most highly recommended ocularists in the world.
On the first of three daily visits, Young removed the conformer - used as a temporary space - placed in Katie's eye socket. He mixed together a powder and liquid solution called alginate, put it into a plastic syringe and then injected it into her eye socket.
The alginate is the consistency similar to the white part of a hard-boiled egg. It sets in 2-3 minutes, at no discomfort to the patient, making an impression of the socket. After removing it, the impression is encased in dental stone. It provides a mold of the entire volume of the socket.
The impression material is removed from the mold, and molten wax of a hard type is poured into the mold, then allowed to cool and harden. What results is a wax piece that constitutes a pattern for the artificial eye.
The wax material allows for changes to be made on the front surface and edges to improve the appearance and comfort of the piece easily by removing or adding wax where desired.
A plastic piece similar to the pupil, iris and cornea of the front of the eye is selected and built into the wax pattern. The plastic piece is ground and sanded to match the shape of the eye.
"The first day is the fitting," said Young. "The second day is the artsy-craftsy thing, and on the third we hand it over."
"At this point, we are very pleased," said Dan. "Everything is coming together very well."
"It doesn't hurt," commented Katie on having the plastic piece placed in her socket, "but it's a little uncomfortable. Kind of a weird sensation."
In the "old days," doctors used to have boxes of glass eyes and told their patients, "Here, pick one." But no more. Each eye and patient are unique. Young has found a helpful way to ease the worries and tense situations with his patients - he interjects his own brand of humor.
"By the time the patient comes to me, they're pretty bitter and upset," said Young. "The only way I know of to distract them or keep them from unconsciously blaming me is to make them laugh. So when they come in here, I just pop in a movie into the VCR, let them watch it and keep the mood upbeat."
"He's a great artistic person," said Dan. "God's blessed us with a great man."
The cost of a prosthetic eye is about $1,600. The procedure is painstaking, but Young has found this to be the best way to produce a superior prosthesis. Katie's prosthesis was paid through fund-raisers and members of Fountainhead Foursquare Church, where she and her family attend.
Young begins to paint the iris and pupil area of the prosthesis. Several colored powders used to color the plastic are sprinkled in different areas on a glass, black palate. After a number of paintings and touch-ups, Young holds the piece next to Katie's own eye to measure his progress. He compares the size of the pupil and the colors of the iris. The piece is removed and he goes back to painting, sanding, painting and letting it dry.
Then fine, red fibers are placed on the sclera portion of the piece, representing the blood vessels. Young also paints the corner of the eye, adding pink to the sclera. More drying and another fitting to see how the colors and position of the iris and pupil are matching Katie's good eye.
"We're pretty close at this point," said Young. "I just need to make a couple more small changes. Not all irises are round. They're oval and oblong, and not all are centered."
Within Katie's socket, the six muscles are surgically attached to an implant made of coral surrounded by donor sclera. When the prosthesis is put in, about eight weeks after surgery to allow for swelling to reduce, the muscles surrounding the implant then help move the prosthesis.
An estimated one in every 500 people has a prosthetic eye. The more familiar reasons for prosthetic eyes are tumors and accidents - which include golfing, BB guns and construction accidents.
Once Young determines the color to be correct, the piece is returned to the mold and the layer of transparent acrylic is cured permanently onto the front of the surface to protect the color during polishing and wearing. It is recommended the piece be polished once a year and replaced every six to seven years.
On the third day, Katie returns for a final fitting. Young makes a couple of minor adjustments to the prosthesis, then hands Katie a mirror for her to see.
Katie is quick to notice there is muscle movement, but wants to move her eye more than the prosthesis will allow.
"It feels like a boulder right now," said Katie. "I'm not used to having this in my eye and I understand it will take some time to get used to. But I'm very pleased with it.
"Steve Young is a godsend. Dr. Char could have sent me to anyone, but they sent me to the best. He's been very good throughout this whole deal. He's really put me at ease.
"I've pretty much been at his mercy with the jokes, but it's helped me to relax."
Katie and Dan leave Young's office with a new outlook. She has overcome many hurdles. Thinking this would be the easiest to handle, the prosthesis has become her hardest.
Young explained that it would take a couple of weeks for the prosthesis to become properly lubricated, as plastic is porous and starts out feeling very dry. Katie will also need to return in about two weeks, as the socket is still healing and deep ocular swelling should be reduced by then.
"I'm having a hard time dealing with the difference," said Katie. "It was not what I expected. It's in my mind constantly that it is there. To me, when I look in the mirror, it's not normal. This is where my faith will be a strong guidance for me.
"I'm finding this is just another trek in my journey with Jesus Christ. Like when total strangers would ask why I had a patch on my eye. My minister friend in New Mexico told me it was their way of giving me permission to share my story and my faith with them. I've heard from people I went to grade school with because of it.
"I know this will get better. It's getting over the self-consciousness that's been hard. It may suck, but you have to deal with it. God has let me be a part of my everyday life again. He has been very gracious to me."
Katie's children, Emily and Andrew, have been supportive and have asked questions when in doubt about anything.
"They have found that I'm exactly the same person, living the same outside as inside our home. Because of this, Emily's emotions and faith have grown even deeper. She and Andrew have been very good through all of this and still maintained their straight-A averages in school. We are very proud of them.
"Most people don't realize how precious sight is until it's taken away from you. At this point, I have to do everything I can to protect myself and my remaining sight. I no longer have a spare."
Katie can continue with her normal activities, including swimming, skiing and anything else she chooses. It is recommended she avoid aromatic hydrocarbons or anything that will damage plastic.
"I am so thankful to God," said Katie. "I did not have any pain with this tumor, was not given chemotherapy or radiation and do not have to take any medications. Plus, I've had great support from my family and friends while going through this. I almost feel guilty I wasn't devastated.
"Communication has been the key to everything with both kids from the beginning. Since getting back home, it's pretty much life as usual for the Ortiz family."