Sunday, August 4, 2013

Screaming During Surgery

I am aware that a very widely held belief has been circulating for several years that many people are not being sufficiently anesthetized during surgery, causing excruciating pain that they remember.  I remember when I first heard this story floating around that it seemed a bit implausible, at least for the deep anesthesia used for major operations.  That kind of pain isn't just bad for the patient; it causes big problems for the surgeon as he as to work on a twitching, screaming body.

When the anesthesiologist was getting me ready for this surgery, he put on an EEG monitor that was supposed to check for signs of consciousness.  Being a bit cheeky, I asked him if showed that I was currently conscious, and he laughed.  I asked him, "Wouldn't the experience of pain, well before
consciousness, show up in increased heartbeat, respiration, blood pressure, as the body reacted to the pain?"  He admitted that it would, and he had little confidence that the EEG monitor for consciousness actually did any real good.  I have my suspicion that they use this device as a way of reassuring
those who have heard these horrifying stories the last few years. 

I don't find it implausible that because there have been some people undergoing surgical procedures with relatively mild forms of sedation who may have come out from under earlier than expected.  My anesthesiologist told Rhonda after they moved me into the recovery room that I was "narcotic naive."   This means that my past history of alcohol and drug abuse is so trivial that sniffing a wine cork would probably make me legally incapable of driving a car for a couple of hours.  My liver doesn't metabolize anesthetics and narcotics quickly, and I was deeply out for a long time.  People whose college major was Drugs of the Western Hemisphere and have not moved beyond that since graduation will likely come out from the doped up state more quickly.  Perhaps some people who have woke up fairly quickly in the recovery room (which is a scary place, although I can't quite remember any details) before the post-op staff has increased pain killers enough are, in this confused state, imagining that they were actually in surgery at the time.

Humans are dangerously suggestible, and the more that these stories of surgery on screaming, awake, conscious patients get passed around, the more likely it will produce nightmares like this.  And in many cases, it may discourage people getting surgery that they need.


  1. When I had a colonoscopy I was given Versed as anesthesia and discovered that what they said about transient amnesia was true. My memory of the procedure is completely gone and the two hours afterward is quite sketchy.

    So I wonder if some people do experience pain but forget that they did. I might have.

  2. I awoke during one of my hernia operations, and felt and observed the surgeon stuffing mesh into my groin. I recall no pain. Several months later, an anesthesiologist at that hospital got busted for cribbing some of each patients' drugs for himself. Was never able to connect the two incidents, but.....

  3. Hi Clayton,
    Good days and bad days. I reached a point where I would park myself on the sofa and watch something appropriately mindless on TV. A minor point but you really don't want to fall asleep while watching "Storage Wars".
    The thing that was most disturbing to me about being out was the lack of transition. One moment I'm in a large, brightly lit room joking with the OR staff, the next moment I'm in a small, dimly lit room with a tube down my throat. I'm not sure what I was expecting, but I was expecting something. Nothing was a little frightening.

  4. Way back in 1942 my father had his appendix removed while in Basic at Gulfport Mississippi. I think they were trying some sort of spinal block, because he says he told them part way through the operation that he could feel what they were doing, the anesthetic was wearing off. The doctor said that couldn't be, so my dad said, watch that foot, and he moved his foot. The doctor then said "that shouldn't happen, and gave him another shot of whatever they were using.

    And then there's the story of my boss kicking his (pediatric) dentist in the nuts when he tried to drill without enough anesthesia.

  5. After I had healed enough from bypass surgery, I still had atrial fibrillation. The cryomaze procedure was supposed to stop that, but sometimes cardioversion is required, which is basically shocking the heart.

    They don't grease up the ol' paddles, though, they put a wet sponge bandage on your back and another on your chest. They also put you under.

    I, however, woke up just in time to see the surgeon grab a towel, wrap it around his hand for insulation, and really push into my chest. I then lit up like a Christmas tree. I literally felt it from my toes (had to be shooting sparks according to how I felt), and my hair (figured it was standing on end).

    I couldn't move or do much of anything, and I didn't scream because I about bit my tongue in two!

    I rode home packing gauze and spitting blood.

  6. It's a common fallacy that you are put under "deeply" during surgery. Present treatment modalities actually have you very lightly sedated so you are just under the level of consciousness. Less danger to the patient that way.

  7. It is a common misunderstanding to believe that one is "heavily" or "deeply" sedated when undergoing major surgery. In fact, you are sedated but only to a point just under consciousness. Other chemicals are introduced to the body as well (i.e., paralytic agents) at this time which makes it complicated. But you are not in a deep, deep unconscious state. In fact, in many cases you awaken rather quickly in the OR and are responsive to questions posed by the surgeon and OR staff, although you often have no memory of this and believe that you first awoke in the recovery room or in your own bed.

  8. I just read a posting about amputations during the Civil War. One point was that while patients were sedated with chloroform, ether, and opium, their bodies were still responsive to pain, and they sometimes moaned or even screamed - but recalled no pain later.

    There were some odd effects. Stonewall Jackson, in the interval between his amputation, and his death from infection, said that he was semi-conscious during the surgery, and recalled hearing music - which he concluded was the sound of the bone saw. But he did not recall any pain.

    Neither did General Dick Ewell, when he lost a leg.

    (One general lost an arm and then a foot. After the war, he ran for governor, and told the voters he was too one-sided to be a judge.)

    As noted above, anesthetic sedation is dangerous, and the object is to use the least amount that renders the patient unconscious and immobile.

  9. The Civil War era anesthetics were pretty primitive, I think, compared to today.

  10. I've also heard that during surgery, the patient is kept just unconscious and administered a paralytic to keep the muscles from jumping around.

    There are other drugs which prevent the transfer of memory from short-term to long-term, resulting in the patient having no memory of what transpired while those drugs were in the system. When the patient is awakened, after the amnesiac drugs have done their thing, there is no memory of anything that happened during the procedure.

    I'm told when I was coming out of anaesthesia after having plates removed from my leg, it took three people to hold me down. I wonder if maybe the timing of coming out of various drugs was a bit off.