Anaesthesia Awareness

You’re lying flat on a cold table in the operating room. Goosebumps prickle your arms and legs as the ventilator blows chilled air into room. There’s soft music in the background and chatter: a cluster of activity as the surgical team sets up. A nurse is by your side, smiling down at you as she hooks you up to the vitals machine. Despite the fact that the team has ingrained the entire process of the procedure in your head, watching the anaesthesiologist approach you with a face mask makes your heart beat faster. This is it, it’s happening!

“Okay,” the anaesthesiologist says, “nothing to worry about. I’m going to administer the final anaesthetic. Count down with me. 10 - 9 - 8 -,”

You nod slightly and count with him. “7 - 6 - 5 -,” your breath cuts off midway and your eyes grow heavy but you keep counting in your head. 4, 3, 2 - your eyes finally grow heavy enough and they close. One. Okay, now what? You think as the anaesthesiologist adjusts the mask around your face. 

“She’s out,” he says.

No, not really, not yet at least, you think, trying not to panic. It’s okay, you tell yourself, this is how it’s supposed to work. I just have to fall asleep. Despite the doubt multiplying in your mind, you try to go to sleep to hasten the process of the medication, so that in half an hour you can wake up and go home.

Before you can even conjure up an image of a fluffy white sheep, you realize something is terribly wrong. A feeling of dread slams through you as you feel the touch of a marker being drawn on your chest. Should I be feeling that? You see red before your eyes as your blood pounds and you feel yourself losing control.

Hello! You scream! Wait! The medication didn’t work yet! I’m still awake!  

You hear the revving of a machine. You hear the tinkling of metal. Then you feel the tip of a sharp, icy tool land on the tip of your sternum. The voices around are nonsensical amidst your own screams! WAIT! you shriek, knowing that you panicking won’t help, but you can’t control yourself. Shouldn’t I be sleeping right now? You try to make your mouth move, but your voice is only in your head. Why can I hear you, why can I feel that, what is going -

A tool digs into your flesh with the force of a monster truck ramming into your side and your mind explodes! Your eyes flash - your brain can’t handle the pain - every fibre, every nerve, every receptor fires. You feel like you’re on the verge of death.

The tool digs deeper, slices away at your skin, pulls apart your muscles, cuts through nerves. Pain like no other: sizzling, fast, and monstrous. The smell of your own burning flesh has you wanting to gag, but the paralysis has taken that away from you.

Is this real? Is this happening?

Even death, in it’s sombre nothingness, would be better than this hell. You find yourself praying to die, begging for that relief. You don’t know how much more you can take of it. You hear a saw and voices saying to proceed. The next pain you feel is indescribable.

          But it goes on.

                         And on.

                               And on.

Every fibre of pain, you feel. Every touch of steel, you store in your mind. The voices blur in your head as blood pounds against your eyes and fill up your sockets. You’re body is lit up in a scorching flame and you’re just waiting for it to consume you.

                                But it doesn’t.

                          It goes on.

                    And on.

As the world continues on as if nothing has happened, and you’re stuck inside, dying every millisecond a little more. The loneliness you feel is enough to break even the strongest of souls.

A second feels like an hour, though you’ve long forgotten the meaning of time.

And you can’t even cry. Can’t even shed a tear as the torture continues. The tools digging deep into your soul tear your innocence into shards, and you can’t so much as protest.

                       The pain goes on.

                                   The paralysis remains.

                                              The torture continues.

Eventually the voices dull out, the tearing and tugging in your body stops, but the screams never die in your head. The horror never stops. The nightmare will live on.

When it’s over - you don’t feel the relief. You don’t see it. You can’t hear it. You’re still in the depths of hell--your body throbbing and aching and feeling like it’s still cut open on the table. The coldness that entered your bones has turned to ice. The pain between your eyes is a block of concrete pushing against your brain, shoving your eyes out of their sockets. You can’t distinguish between reality and nightmare, heaven or hell, life or death.

The moment you come to, a torrent of tears flood out. You’re gasping and sobbing so hard you can’t speak. There’s panic in the eyes of the nurses and your family as they surround you, but there are no words to describe what you felt, only tears. The hopelessness you felt while under is a palpable void in your chest and hasn’t left. It has become a part of you.

This is called Anaesthesia Awareness, and however much we’d like to believe it’s just a nightmarish horror story, this is not a myth. According to Bischoff and Rundshagen in their paper  Awareness Under General Anaesthesia, it can occur in “one to two per 1000 operations under general anaesthesia.” Frightening statistics!

The fact that the patient’s body rarely shows any indication of anything awry happening makes it so hard to recognize. A rise in blood pressure is seen in only 15% of the cases, and in 7% of those cases, the heart rate also increased, with 2% showing altered motor movements. But these aren’t enough to indicate anaesthesia awareness. It could be indicative of malignant hyperthermia, or any other anaesthesia side effects, but with monitoring the vitals and seeing a steady screen, it is hard to determine if anaesthesia awareness is occuring. And at this point, the next steps are hard to determine when the cause is also not known at that time. Is it a cause of not enough medication being used, or a neurological disorder or a genetic disposition that renders anaesthesia useless? The common causes are “the inadequate anaesthesia use or equipment failure or misuse” (AANA).

Since anaesthetic medication (to induce paralysis) is often given with opioid analgesic medication (to sedate and eliminate pain), a balance needs to be established to ensure both medications are complimenting each other. If the paralytic medication is effective but the concoction of opioids fail to be effective - it becomes “virtually impossible for the patient to communicate this dire situation to the anaesthesia provider” (AANA). Their bodies become paralyzed while their minds run wild. This happens to be the most traumatic situation of anaesthesia awareness. In other circumstances, the paralytic medication fails to work, thus the patient moves around during the procedure. Or, on the other hand, both the paralytic and the sedative pain medication wear off during the surgery - resulting in a dangerous situation when the confused and disgruntled patient attempts to stand up and/or remove their endotracheal tube by force! In this case, the anaesthesia provider will administer more medication. Unfortunately, when paralysis remains and mental orientation returns, the trauma felt is unimaginable.

Hayden Christensen plays the main character in Awake, a movie about a protagonist who experiences Anaesthesia Awareness on the operating table. The movie does a great job of showing the horror of what happens, but the true horror can be seen in the testimonies of victims who have opened up about their experiences on social media platforms such as Youtube. Their experiences are as haunting as you’d imagine, and the pain can still be seen present in their eyes as they recall the horrific memory. Most victims often experience an out of body experience that they recall with heart-breaking clarity and sadness. However, they all employ the attitude of ‘what doesn’t kill you makes you stronger’. Though most victims often develop PTSD, they also grow from the experience.

There are support groups for survivors of anaesthesia awareness within in the foundation called the Anaesthesia Awareness Campaign that works to educate about the phenomenon and calls for the prevention of it.

You can learn more about Anaesthesia Awareness by visiting these sites:

Anaesthesia Awareness: Waking up during surgery: https://www.asahq.org/whensecondscount/preparing-for-surgery/risks/waking-up-during-surgery/

American Association for Nurse Anaesthetists (AANA): https://www.aana.com/

Awareness Under General Anaesthesia: https://www.ncbi.nlm.nih.gov/pubmed/21285993