When Shelly Springer sent me her "Taking the OR to the Office" department for this issue on the topic of Anesthesia Awareness, I immediately e-mailed her back: "Great topic!!" After a moment's hesitation, I added, "I had awareness once.[horizontal ellipsis]" Within minutes, she had me agreeing to add a personal account to her department. It didn't take me long to regret that. Revisiting the experience of awareness is painful for me, just like it would be for every other patient who has experienced it. However, part of the privilege of writing an editorial is to be able to shine a spotlight on an issue that is important to me-controversial or not, painful or not.
As Shelly wrote in her column, anesthesia awareness or unintended intraoperative consciousness can be a terrifying and devastating experience for the patient. These patients often experience psychological difficulties that appear following surgery that can last for years. As I read through Shelly's column, I was mentally ticking off all of the things that applied to me. Yep[horizontal ellipsis]it was an emergency surgery, in my case a hysterectomy to stop the bleeding after a "routine" vaginal delivery. Yep[horizontal ellipsis]hypovolemia was a factor. I was in the process of receiving a total of 27 units of blood products.
Yep[horizontal ellipsis]low blood pressure, if any. Too low for much anesthetic. Yep[horizontal ellipsis]flashbacks and anxiety. Still have them, nine years later. It was a Tuesday morning, four days after I delivered a perfect baby daughter. I woke up lying on my back, my covers neatly tucked around my legs up to my waist, my hands folded across my abdomen, my head on one soft pillow. I opened my eyes to rows of flower arrangements on either side of me. I thought I was in a coffin. It was the day I should have been buried. Just then, the senior OB resident walked in for rounds, and I burst in to tears. "Today should be my funeral." I knew I should have died.
When I was lying in surgery, I could hear every word. The obstetrician arguing with the CRNA about whether to start another IV line (why was there any question?). My husband yelling at a nurse to get blood. The OR technician crabbing that she had to run to OR to get the hysterectomy pack, since they weren't stocked in OB anymore (cost-cutting). The OB resident was still pounding on my belly to try to massage the uterus. A nurse screaming at my husband, a surgeon, to get out of the room: "You don't belong here." A lot of swearing. The brightest white light was in my eyes, even though they were closed. At some point, the lights went out, and I woke up a few days later on a vent in the ICU.
The same day that I woke up in my "coffin," my anesthesiologist came for a postop visit. He said, "Some patients think they are going crazy because they remember surgery. They don't bring it up because they think no one will believe them[horizontal ellipsis]." More tears. The doctor explained that my blood pressure was too low to give much anesthesia and he suspected that I might have "anesthesia awareness." He said that patients benefited from talking to someone about it. Since I delivered at the hospital where I worked, I was worried about the "stigma" about a psych consult. Now, I wouldn't have worried about it so much, knowing how important it was. Nevertheless, my husband arranged for a psychiatrist from a different hospital to see me, and I followed up with him for at least a year after.
Just like the patients that Shelly described, I was never the same. Typical of patients who have Post Traumatic Stress Disorder, I had/have a heightened startle response. Countless times, my husband would quietly enter a room and I would leap out of my skin when I saw him. An unexpected hand on the shoulder had the impact of an electric shock. I was preoccupied about "dying the next time." Riding in the car was anxiety-ridden, especially driving along cliffs or roads with low guard rails. I had nightmares about being beaten up, the same beating in the abdomen as when the resident tried to massage my uterus back down. Flashbacks intruded during the day. It's like the video was replayed, but I had no control over when the "PLAY" button was pushed: folding laundry, rocking the baby, driving to the grocery[horizontal ellipsis]and a flashback would reduce me to quivering jello.
Six months after the event, I remember telling me husband that I felt that I had "rejoined the living." There was finally pleasure in simple things like pushing the stroller, walking the dog, chatting with the neighbors. Soon after, I was able to return to work.
The most important thing we can do for our patients is to be honest about awareness. I found a Web site that criticizes anesthesia personnel for "denial" about this serious problem. Thank God for the compassion of my anesthesiologist and his colleagues. As Shelly suggests, assess the patients for awareness. The secondary assessment at 1 to 7 days is especially important because then the patients are starting to feel physically better after surgery, but may be alone in their heads with all of the frightening thoughts. If patients have recall about surgery, believe them, validate them. Do not dispute or trivialize reports of its occurrence. Help the patient to get the support he or she needs, which is likely to be counseling.
After my experience with awareness, I tried to find a support group of other patients to talk with. There was one online chat group nine years ago, run by a recovery room nurse, I believe. Recently, I searched the Internet for resources and came up with hardly anything. I asked the librarians at my hospital to search as well. They came up with what I did. The most valuable website for patients is http://www.anesthesiaawareness.com, which describes the Anesthesia Awareness Campaign. The campaign was started by one victim, Carol Weihrer, who suffered awareness during surgery to remove her diseased eye. Her horror and disappointment with the anesthesia profession is apparent in her courageous writing. I think it is important for all of us to hear what she has to say. The goal of the campaign is "to prevent patients (even one) from experiencing anesthesia awareness and its consequences through education, prevention, and empowerment by replacing ignorance or fear with knowledge." The problem is that there are very few resources of support for patients. If I was challenged to find support, imagine our patients!! If you are aware of resources, please contact me and I will publish them in a future issue of the journal. Carol Weihrer wants us to be aware of awareness. I want you to be, too.