Awake- A true experience of an Anaesthetist. My Story.

The most common sensical way to plan and act out anyones daily encounters is to handle a situation using his experience from a previous somewhat similar exposure to an event.
Its when the event happens to be new to us that it draws us out of our comfort zone, throws us into the limelight and dissipates us into the vulnerable self, squandering for an understanding of how to tackle it. In the end, we scrape through, grab a safety ring to stay afloat waiting for a miracle and an end to our trauma and return to normal.

Im an Anaesthetist. Having handled a decent number of cases from one of Indias best training centres, Im proud to say my patients are happy going in and out of surgery. I make it a habit to always keep my patients engaged and smiling before they are sent off to dreamland. Hours later, finding themselves in the recovery unit asking the staff nurse on duty when they would be shifted in, only to find out surgery finished many hours earlier. One of the many fears of anyone getting into the operation theatre is the fear of knowing what happens during surgery. Intermediate would be going to sleep, waking up in pain. Worst case, wake up in the middle of surgery, realise youre supposed to be asleep and then hope youre painfree and near end of surgery, only to realise its only somewhere in the middle and youre just about to be a live example of the movie Awake, difference being, youre an Anaesthetist, you know whats wrong, but you cant move, you cant suggest, youre in extreme pain, and you can hear EVERYTHING! Welcome to my nightmare!

My story:
It was nearly 6 months ago, I was fresh out of my training, back in my hometown and looking to have a swelling in my chest removed under General Anaesthesia. Ive never been to a small clinic running an Operation theater. I assume Anaesthetists work the same everywhere, our only difference being the use of different medications to put our patients to sleep. Each to their own. I met with a Plastic surgeon who agreed to have it excised. A fairly simple procedure, fairly superficial and involves no invasion into the abdominal cavity or into where my heart or lungs were. I was asked to meet with the visiting Anaesthetist. He was a Senior who was quite casual with me, of course I had my fears as is expected of anyone when it comes to their own surgery. He went about the plan with me. Sedate me with General Anaesthesia, use a supraglottic airway device( a simple tube that stays about your airway tube and ensures it remains patient throughout surgery) to keep me breathing spontaneously while Id be deep asleep with ongoing Anaesthetic Vapours and opioids. I made him make an entry that me being overweight was also prone for snoring, which would be a slight risk for obstruction of my airway if I was extubated(LMA being removed) with me being too deep asleep and left unsupervised. Easily circumvented using a Nasal Airway(Another wonderful small piece of tubing to keep the airway patent via the nose while preventing the tongue and soft tissue caving in to obstruct my precious Oxygen).

The Change in Plan:
As planned, blood tests were done, an ECG and Chest Xray were taken at an outside laboratory. I kept myself nil per oral as per our usual orders. Day prior surgery, I was informed there would be a change of Anaesthetist as my original guy had a family emergency to attend to. No issue, I went along and met the new lady at her then regular hospital. The day finally came, I was sedated and surgery began as planned. Im not certain, but few hours in the surgery, I woke up to the familiar sound of a monitor beeping. Any colleague would recognise the tone to be my heart rate and oxygen saturation. It took me a few seconds to realise I was actually awake during my own surgery. I initially felt nothing of the drapes over me, my eyes were closed and probably covered with a gauze pad as I couldnt make out any red haze one would be aware of when closing their eyes to bright sun light. This led to my assuming my pain medication was appropriate for that moment, and that I was probably coming to the near end of surgery. My initial surprise led to fascination as I eavesdropped upon the conversation between the surgeon and his assistant, few laughs at casual conversation, something people in our field are so used to hearing. It just felt natural to me. To me, this was perceived as an interval when the depth of anaesthesia was termed light, meaning, the patients conscious level comes closer to reality, this is the shift to real life. The weaning moments before waking up from surgery. The temporary tranquil soon faded as flashbacks of the movie Awake began to overshadow my thoughts. I felt calm, as I clearly understood what was happening here. Any experienced colleague would easily recognise this phase in a flash, give a top-up of a sedative or adjust the inhalational agent adequately to ensure I stay deep(required level of anaesthesia to not be aware of anything ). However as seconds turned to minutes, I became more and more aware of the drapes covering me, the surgeon asked for forceps and began pulling at the swelling. I hastened to make some physical effort to let both surgeon and anaesthetist know I wasnt deep enough. I couldnt move, I wondered how that was possible as the plan wasnt to have me intubated(in which case I would have to be given a muscle relaxant ).
What started was an initial twitch evolved to a yank and tug as he strained to pull at it, I began to sense pain for the first time, that sequentially grew. My grief be it that the swelling was on the left side of the chest and it felt more and more like he was pulling at my heart. My heart reacted, it raced as the pain grew. My paroxysmal distress became timeless and unforgiving as I tried in whatever way I could to move and jump off if ever possible to get away as he asked for the scalpel.

When you feel physical pain at any moment from an injury, its usually momentary, happens so fast, you are never in a state to voluntarily react. Instead, you have your blessed involuntarily ability to flex away (never giving credit for it). And when you do and manage to get away, that pain lingers stronger for a given time before it begins to trifle away. Its like having your fingers burnt, withdrawing your hand and feeling the pain and heat greater than before even with your hand far away from the fire. Yes, eventually it does go away, and you get back to doing whatever it was your busy mind was constrained with.

My case was different, I knew not what else I could do, I was facing the worst pain of my life. I turned to prayer, as does most of us when we are troubled at threshold. The pain got more and more real, my thumping heart resembled African drum beats that got louder and louder, as if to let the physical being know Buddy, drop whatever youre doing and manage this trauma, Im not going to let you distract yourself away from this now!. The monitor beeps blared from behind me(my very obvious heart rate), he continued to cut, then felt him keep the scalpel away and ask for more gauze pads to mop up bleeding. Theres too much bleeding, his pressure and heart rate are up, could you give him something for it? Is he light? Get him deep. Soon after he said those words, I zoned out(She must have finally given me my bolus!). You usually dont dream then, its just a blank screen, youre in oblivion and cant sense anything. Thank goodness its over!
Atleast I wished it were!

Moments later, I hear the monitor beeps again. I wasnt sure if this was a dream now, as our job be it, we are so used to hearing the monitor beep, and instead of getting annoyed with it, we immediately identify if the tone is in rhythm, not to fast and not dulled out. Too fast would mean a fast beating heart! Mine was a bit on the higher side. Not too fast though, not yet. He was poking about. I didnt feel that, but this time from my last experience, I knew soon I would. Whoever is reading, having to go through it once was most traumatising. Dont even try to imagine what it would be like to go through it a second and third time. Yes, I woke up three times before he finally said give him a good dose, theres too much bleeding!

Robin, Robin, open your eyes, take a deep breath!. I dont want to open my eyes, my heart is still racing. Then I remember I wouldnt be shifted out unless I show adequate conscious levels and ability to follow commands. So I strain to open my eyes to the blurred view of the operating light and breathe. Im told the surgery went well and get moved to the postop room. My brother and parents see me. Brother asks if I feel pain, not now I dont. I strain to tell him I was aware during surgery. I wasnt sure if he understood, Im still groggy and doze off. The surgeon enters soon enough, Anaesthetist nearby, he asks how I feel. Do you really want me to answer that question honestly?
I fear the Anaesthetist nearby. I fear for my life thinking what she would do if I were to say what happened or quote whatever conversation I heard during surgery. I mumble and pray she leaves. I am afraid to look her direction. I sleep off.

Its late in the evening, he visits again to check on my drains. This is when I tell him I was aware. I dont have the energy to explain details. He interrupts me saying some of her previous patients complained of being able to hear events during surgery and goes on to tell me that surgeons talk during surgery(Probably fearing Ive overheard some comments I shouldnt have). Im least bothered about the talk. Its only natural for doctors to talk as they work. Helps them relax and stay focussed. I asked him to inform her and warn her to correct her technique. I dont want to have to face or talk to her after the trauma Ive been through.

So How am I now? Its been over 6 months. The first 3 months went by with me waking up in drenched sweat from nightmares of the pain I was through. I would have Imaginary pain even with my body at rest and lying down. I wonder if this is how Phantom Limb pain is like after a limb amputation. Im still numb from it. The last 3 months were a bit easier, keeping busy with work, ensuring my patients are always deep and painfree. Both are first priorities. Not that they werent. Every Anaesthetist is looking for the best and safest trail with patient care as priority.

What went wrong or why?
This was a non hospital setting. The post op care does not include a ventilator or proper nursing staff to ensure emergency management if something goes wrong. Im a bit chubby. She might have considered lower doses of pain meds and sedatives to avoid me having a respiratory distress when she isnt around.
I assume other reasons from a checklist would have been circumvented. Things like ensuring adequate solution in the Vapouriser(The equipment providing me inhalational vapours to maintain anaesthesia depth).

I must say this wasnt my first surgery. Ive been anaesthetised for another surgery almost 6 years ago as a medical student, went perfectly well. I woke up being dreamy and remembering nothing. Just happy not knowing anything. Again, Anaesthetists are rarely given credit for their work. I was an example for being one among many in that position as a patient. Please remember to thank your Anaesthetist if you wake up satisfied. Its similar to any work. Knowing you did well means you continue doing the same. Feedback plays a role. No, I dont intend to be personified, nor am I seeking attention. In fact youll normally not see your Anaesthetist anytime soon after surgery, theyd be running off to get ready for their next case.

Im not taking my doctor to court. I have communicated with her and ensured none of her patients go down the same road I did though. She has made a note of what I said and will be more alert and careful. Stays anonymous.

Thoughts?