Dr. Liska has recently been featured with: The Oprah Winfrey Show, Dateline, Inside Edition, Leeza Show, Tom Snyder Show, Mary Lou Heson Show, ABC, CBS, NBC News Shows, Health Specials throughout USA, CNN Health News, 20/20, People Magazine, Time Magazine, U.S. News and World Magazine, Red Book Magazine, Allure Magazine, Major Universities, Numerous Journals, Lectured in over 36 states, Lectured to ASA, AANA and at the International Society for Traumatic Stress Studies.

"I Was Awake During Surgery... (But the Doctor Didn't Know)"
Redbook, March 1998
by Michael D'Antonio

THEY GAVE HER ANESTHESIA, BUT SHE FELT THE SCALPEL ANYWAY. AND WHEN SHE TRIED TO SCREAM, NO SOUND CAME OUT. THE SCARY TRUTH IS, SUCH STORIES ARE FAR MORE COMMON THAN ANYONE REALIZES. By Michael D'Antonio

Jeanette Tracy wasn't worried about her hernia surgery. She had been operated on twice before: once for appendicitis and a second time to have her tonsils out. In both cases, the anesthesia had put her softly to sleep and surgery had gone smoothly: her only complaint had been a touch of nausea when she awoke. This time, as she was wheeled into a chilly operating room. The 34-year-old Dallas woman was relaxed enough to joke about how her blue gown and cap made her look Iike a giant Smurf. She asked the anesthesiologist if he could do anything to prevent post operative nausea. He said he would try and he injected a sedative into her intravenous line. Jeanette looked up at the bright lights hovering over the table.

"Okay, you guys", she said as she began to drift into unconsciousness. "Take good care of me."

As she gradually awoke, Jeanette could hear the same nurse and doctor she had heard l while being prepped for surgery. At first she was groggy, but with each heartbeat she became more alert. She felt the plastic breathing tube of the ventilator in her throat. She felt the oxygen being puffed into her lungs. She tasted blood in her mouth. But she wasn't able to speak. And as she listened, she realized that the operation wasn't over‹it hadn't even begun. The nurse and the anesthesiologist were still waiting for the surgeon.

'They're going to give me something more when he gets here." Jeanette told herself. "I'm not going to be awake for this."

When the surgeon arrived. Jeanette heard c. him snap on his rubber gloves. The anesthesiologist began to talk about a girlfriend who was considering breast implants. He said~ that~omen were overly concerned about having large breasts. "Take her, for instance," he said as Jeanette's gown was opened. "She's got the right size."

Someone swabbed her abdomen with cold iodine. She struggled to open her eyes. She tried to move a finger or make some kind of noise so they would know she was awake. But the anesthesia had paralyzed every muscle in her body.

She heard the surgeon ask for a scalpel.

"In my head, I was screaming, 'Don't cut me! Give me something!' But I wasn't making any sound at all. Then I felt him cut me. I could feel the layers of tissue coming apart. It felt like someone had punched a blowtorch into my stomach and turned it on."

As the surgeon cut deeper, the pain became unbearable. Jeanette smelled her own flesh burning as the incision was cauterized. Then a new, crushing pain began in her chest and spread to her collarbone and down her left arm. Alarms sounded. The operation stopped. At this moment, Jeanette had her only respite from the ordeal: She felt as if she had left her body and was standing next to the surgeon, calmly viewing herself. As one of the doctors gave her an injection (to calm her racing heart, she later learned), she realized she was not going to die. She returned to her body‹and to her agony‹as the surgeon started cutting again.

"I tried to pass out," she says. "I sang songs in my head. Then I heard the surgeon say, 'Oh, no! I thought she had a hernia, but it's just a bit of tissue."

A terrible price to pay
In the recovery room, Jeanette went into shock, her body convulsing violently, She was wrapped in blankets. Nurses told her to be quiet‹to stop saying, "I was awake! I was awake!" It was only when she got to her private room that she was able to talk to a friend who believed her and helped her contact her personal physician, who was outraged by what he heard. Jeanette then confronted the anesthesiologist. He insisted she'd been hallucinating. But when she reminded him of what he'd said about her breasts‹and the fact that the surgery was unnecessary‹he apologized.

His words of regret were too little too late.

Try as she might, Jeanette couldn't overcome her terror and outrage. Nightmares plagued her, psychiatrists and psychologists couldn't do much to help, and while her two teenage daughters offered unwavering support, her second marriage disintegrated. Her real healing didn't begin until a therapist showed her an article from a medical journal. The article addressed the problems of thousands‹perhaps millions‹of people who had awakened during anesthesia. That's when Jeanette realized she was not alone.

And she began a crusade.

A wake-up call for doctors
Jeanette started by telling her story at a conference of anesthesiologists in Atlanta. Many of them had never considered the kind of suffering surgery patients can endure when they are presumed to be asleep. "They had been denying this was possible ' she says. "They thought it was a thing of the past. It isn't."

In fact, anesthesiology, which began in the nineteenth century, remains "as much art as science:' says Peter Glass, M.D., an anesthesiologist, researcher, and associate professor at Duke University Medical School. "We do our best, and we do a. pretty good job, but on rare occasions, something like what Jeanette experienced occurs. There are documented cases of this."

But only recently, as Jeanette and others have spoken out, has public awareness grown. In one such case, a 46-year-old healthcare executive, . Andrea Thaler of Nashville, was awake during a gallbladder operation, and felt the searing pain of the incisions. Like Jeanette, Thaler could do nothing to signal her doctors to stop the operation; she later filed a lawsuit and won an undisclosed settlement.

These two whistle-blowers' cases underscore how little most of us know about general anesthesia Though it is typically described as "drifting off to sleep," being anesthetized is more like being knocked out cold. Drugs with three distinct properties are involved. Paralytic agents immobilize the patient so that surgeons can work on a perfectly still body. Analgesics are supposed to block the pain, and sedatives make patients lose consciousness. Every individual responds differently to these drugs, however, and in many cases the nervous system does experience pain even though the patient has no conscious memory of it.

"This is one reason why some surgery patients wake up g and say they feel like they were hit by a truck," says Henry g Bennett, Ph.D., a psychologist in Madison, New Jersey, who refers to such people as "awareness patients." "Their nervous systems really do experience tremendous stress, because they register pain on some level. They usually take ~. longer to recover from their surgery."

Full awareness, in which a patient can hear and feel all that happens in the operating room, occurs in a tiny portion of surgery patients‹roughly 40,000 each year out of a total of 20 million, according to Peter Sebel, M.D., an Emory ~- University anesthesiologist who has studied the problem. (Jeanette and other advocates for awareness patients contend that this is a very low estimate.) For reasons not yet under stood, women wake up twice as fast as men and are three i. times more likely to be involved in an awareness claim. Since anesthesia doses are based on studies performed on men, it's possible that doctors have overlooked pertinent differences between the sexes. And until recently, most awareness patients were dismissed as hysterical.

"Most doctors, especially those who are not anesthesiologists, didn't know this could happen," explains Janet Osterman, M.D., an assistant professor of psychiatry at Boston University School of Medicine. "I wasn't taught about . this in medical school. I learned about it from a patient."

Finding little written on the subject, Dr. Osterman became fascinated and sought out other victims. With coaxing, they spoke of the fear and helplessness they'd felt. "They were hurt in a setting where people were supposed to be taking care of them:'she says.

Surgical trauma is often unavailable to conscious memory, she adds. "But slowly a lot of people remember snippets of this or that. They recall the sounds of the operating room, the smell of alcohol. Sometimes they have recurring dreams. Gradually, they put it all together and they have a very upsetting story to tell."

Many awareness patients are traumatized a second time when no one will believe them. In fact, many never even try to tell their stories for fear of how they'll be perceived, says Dr. Osterman. But silence doesn't ease their trauma. Many become afraid of medical care and refuse to even go near a doctor or hospital. Their fear can worsen to the point where they can't work or function normally.

The cutting edge
Thanks to Jeanette and other advocates, doctors and researchers are working on a number of fronts to solve the problem. A new device, invented by Nassib Chamoun, a Harvard-trained medical engineer; is especially promising. It measures electrical activity in the brain as the drugs are being administered, allowing the anesthesiologist to give a more precise dosage. Chamoun's device, which relies on a sophisticated computer program, took ten years to develop. In trials involving more than 5,000 patients, not only was the awareness problem (caused by under medication) very nearly eliminated, but the opposite problem‹giving more drugs than necessary (which slows recovery and increases the risk of side effects)‹was significantly reduced. In fact, anesthesiologists used, on average, 20 to 50 percent less medication. Hundreds of hospitals have already purchased the monitor, which adds a cost of about $18 to a typical surgical procedure.

Another promising device, invented by Dr. Bennett, monitors normally invisible movements in facial muscles and will be marketed soon. Dr. Bennen, who is also a postsurgical counselor, began his research after meeting an awareness patient at the University of California at Davis Medical Center. He went on to investigate more than 150 cases and discovered that even low-level awareness can have dramatic ~ psychological repercussions. In one 5 case, a cancer patient suffered long lasting depression and was convinced that part of a tumor had been left in her body. Years later, in a conversation with her doctor, she realized the source of this fear.

"She told him, 'I heard you say that you didn't get all the black stuff out,"' recalls Dr. Bennett. "To her, that meant there was still cancer in her body. Well, first of all, cancer is not black, although a lot of people imagine it that way. But the surgeon remembered that in the operating room he had said something about the floor tile, and that he couldn't get all the black out of his bathroom tile at home. Obviously, she had heard this comment and it had haunted her. She never accepted that all the cancer was gone until she had this conversation."

Dr. Bennett spent five years developing his device; the tiny changes in muscle tension that it registers are a very good measure of a patient's state of arousal, he says.

For their part, anesthesiologists say they are supportive of efforts to detect and prevent awareness. A spokesperson for the American Society of Anesthesiologists says that while the society doesn't endorse specific technologies, its doctors take the problem very seriously.

They are also increasingly sensitive about the comments they make during surgery, says Dr. Glass. "There are -- cases where people in the operating room are disrespectful:' he concedes. "But these days, I think people are more aware of what's appropriate. There aren't any official rules, but the kind of irreverent talk that used to be common is on the wane, I would say."

No more secrets
Despite these advances, however, the problem won't be eradicated anytime soon. It will be years (if ever) before all of the thousands of operating rooms in America are equipped with high tech consciousness-measuring devices. In the meantime, most anesthesiologists will continue to rely on their experience and judgment, and a small fraction of their patients will suffer through some level of awareness

For those who do endure the trauma of awareness, there is better follow-up treatment. Dr. Osterman advocates a series of postoperative interviews for all patients, and support and counseling for those who say they were aware. "There may be temporary amnesia after | surgery, so patients should be contacted about a week after they go home to see if they are having disturbing thoughts or dreams ' says Dr. Osterman.

One key to helping those who report being awake is a face-to-face meeting with the doctors who were involved. "We predict that the best recoveries will happen when the anesthesiologist and surgeon believe the patient and offer support," says Dr. Osterman.

This recommendation may worry doctors who fear being sued, but Dr. Osterman says a patient is much less likely to file a lawsuit against a doctor who acknowledges what happened and expresses concern‹as was the case with Jeanette Tracy. She decided not to sue, and she won't publicly name her doctors, which, some say, has made her a more effective advocate.

"Jeanette took the high road, and that helped her to be accepted and heard by the medical profession," says Charles McLeskey, M.D., an anesthesiologist at Texas A&M; University. "A lot of us didn't appreciate this problem until a few years ago. I know, because was one of them," he adds. "Now we're appreciating the problem and there's something we can do about it, both with education and technology." A lot of the credit goes to Jeanette and other patients who came forward with their stories, he adds.

In addition to bringing the problem t to doctors' attention, Jeanette has advised thousands of awareness patients through an organization she founded‹the Awareness with Anesthesia Research Education Foundation. She has spent her life savings and sold her jewelry in order to support the foundation. "I did this because I never wanted what happened to me to happen to anyone else," Jeanette says. "And believe me, it's a problem we should all be concerned about, because sooner or later, we all end up in the operating room."

- Michael D'Antonio writes frequently about health.


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