Departments
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Week of 9 January 1998 |
Vol. I, No. 15 |
Feature
Article
A surgery patient's nightmare -- awakening and incommunicado
by Marion Sawey
A Boston University School of Medicine psychiatrist is investigating every surgery patient's nightmare -- waking up during an operation, but being powerless to alert surgeons to the fact.
Janet Osterman believes that the problem has gone unrecognized within the medical profession and hopes that her research project will lead to improved treatment for victims, or "awareness survivors," most of whom are severely traumatized.
However, one of the obstacles she must overcome is finding survivors to take part in the project, as many cannot bear to recall the experience or even to enter a hospital to be interviewed.
The volunteers are patients who were given general tracheal anesthesia and who awoke during surgery. Osterman is interviewing them and comparing them to a control group of similar patients who did not waken.
"The anesthesia paralyzes every muscle, so patients can't breathe. A breathing tube is placed in their trachea, and they are put on a ventilator," she explains. "When wake-ups occur, in essence what you have are patients who are trapped within their bodies, not being able to communicate, but having conscious awareness of the events going on around them. The subjects we have interviewed so far remember feeling pain, terror, helplessness, and fear of death and making frantic efforts to communicate."
Osterman's research, begun almost a year ago, has already received some media attention, including a mention in a recent article in Time magazine that estimated that wake-ups occur in at least 40,000 of the nation's 20 million annual surgeries. She believes that the number is probably greater given the difficulties besetting research into the problem.
One of her findings, for example, has been that not every victim can initially remember clearly what happened during the surgery, an experience consistent with traumatic memory, but that can make diagnosis difficult.
"With trauma, a period of amnesia is not uncommon, nor is having memories that come back in fragments, as flashbacks or intrusive thoughts or nightmares," she says. "Also, feelings of complete numbness and avoidance of triggers that can spark off flashbacks mean that it can take a while to sort out the whole picture, making the victim's actual experience difficult to process."
Another difficulty facing researchers is that many awareness survivors don't tell anyone of their experience, Osterman says. "They don't tell their doctor; they don't tell their family. They are suffering quite quietly just as they did during surgery."
Reasons for this vary, but a common one is the sense of betrayal that patients have, she continues. "These people just don't trust their doctors anymore. When you put your trust in someone who didn't take care of you, it is difficult to trust him or her again and to go back and say what happened. Also, some of the patients who did tell their doctors were not given very much support. They were told that it didn't happen or that they dreamt it. Of course, this makes them feel retraumatized because they have once again made an effort to communicate and it has not been heard, just as happened on the operating table."
The appropriate treatment for trauma victims -- which might have to be modified to fit the specific needs of awareness survivors -- is exposure-based therapy, says Osterman.
"This means helping victims to conquer their memories, rather than running away from or avoiding them. It means providing a very safe and supportive environment where they can go back, look at their memories, and gain some control over them."
Failure to do this can lead patients trying to erase memories to narrow down their lives so that there are fewer and fewer potential triggers that could spark off a flashback, she warns.
"For example, we have talked to patients who have eliminated the color blue from their homes because just seeing blue -- the color of hospital drapes and of surgeons' scrub suits -- can trigger a flashback," Osterman points out. "Some don't watch television because they never know when a surgical theme is going to appear in an advertisement or a program. Others can't go into hospitals because doing so floods them with anxiety and intrusive thoughts."
Osterman says she has tried to surmount this problem of hospital fear among her research recruits by arranging to interview them in the nearby Trauma Center, a Victorian house with none of the threatening environment of a major hospital. "We try to make the volunteers as comfortable and relaxed as possible. It is just very hard for them to come to a doctor whom they don't know to talk about this awful experience that was inflicted on them by doctors. They may be aware that it wasn't intentional, but it doesn't matter. Their minds and bodies won't let them forget."
The very fact that their form of suffering is being recognized has already been of help to some victims, says Osterman. "It is very rewarding for me that people have called up to say that although they do not feel able to come in to be interviewed, they are grateful that at last there is some public acknowledgement that what they experienced can and does actually happen. It gives their experience a validity and provides a forum for them to talk to their families about the difficulties they have been having."
For Osterman, achieving recognition and acknowledgement of the awareness experience is one of the main aims of her project. "We need to get this experience out in the open -- we need to talk about it, and we need to educate ourselves about it," she says. "Psychiatrists, mental health clinicians, and surgeons have to know that when patients come to them with postoperative depression, they should be asked whether they woke up during surgery. The situation is similar to that in the past where doctors didn't ask about sexual abuse and subsequently didn't find it. These are not experiences that people volunteer to talk about."
In a year's time, when her research should be complete, Osterman hopes to have interviewed 30 subjects and to have reached a better understanding of what they have undergone, of how best to diagnose their experience in the first place, and of how to treat their trauma most effectively.
"I hope to get the research findings out there for the world to see," she says. "I don't want this problem to continue to be an unknown entity."
Anyone wishing to take part in the project can contact Osterman, at 638-7890, or the Trauma Center, at 731-3200, ext. 136. Volunteers must be able to travel to the Center, which is at the Boston Medical Center.