Creepy long-read on the science of surgery patients who wake up during anesthesia

I have breast cancer, and I am going in for more surgery tomorrow. Awakening, by Joshua Lang in The Atlantic, may not have been the best choice for pre-op reading material, but it is a fascinating piece. Read at your own peril if you're planning on a trip to the O.R. any time soon. The tl;dr: tens of thousands of patients each year in the US slip out of anesthesia and regain wakeful consciousness during surgery. They can't alert anyone, and they suffer PTSD in high rates. What does it mean to be conscious? And how can this phenomenon be prevented?

• [Lynda Gutierrez]

  This happened to my mother in law — it wasn’t fun, but she had no PTSD either.  Maybe you could ask to speak to the anesthesiologist beforehand and ask him or her to put your mind at ease by promising that they will watch for any signs of wakefulness (my MIL wiggled her toes but they didn’t see.) Remember, the odds of it happening are slim. Try not to worry. : )

• [Charles Campbell]

  Good luck and a speedy recovery Xeni!

• [Shibi_SF]

  Sending you big healing vibes, Xeni!

• [theophrastvs]

  Good luck and give ‘em hell Xeni!   oh, and tell one of those reprobates that you work with to post us the-great-unwashed how you’re doing.

• [Bob Mulroy]

  Good luck tomorrow, Xeni.  The occurance is incredibly rare, so don’t worry. 

  It IS important to be frank with your anesthesiologist about any opiate, sedative, and  alcohol use.  They aren’t judgemental people.  They just want to keep you comfortable and safe.

• [Tony J. Stanislawski]

  My wife broke her wrist on Saturday and is having surgery on Wednesday. I dare not show her this. I have had many surgeries and was well aware of this. This is why I try to fight the anesthesia than succumb to it, just to make sure.

• [Bevatron Repairman]

  There are methods (and devices) to monitor the depth of aensthesia, but patients also claim they want a a quick recovery time so doctors do try to keep you on the edge rather than just zonking you completely out.  I think if you tell the aensthesiologist that you’d rather feel sick and be fully out, rather than risk this, I’m guessing they can make the adjustment.  

  And go get ‘em tomorrow.  We need you around forever.

• [Diana Lieb]

  Yup. This happened to me at the end of a relatively minor surgery in 2007. I regained consciousness, was in pain, but was still paralyzed. I couldn’t control my tongue to speak. I could only cry without syllables like an infant. I kept trying to say “It hurts.” What came out (I could hear) was, “ih uh.” Then a nurse made a highly inappropriate suggestion that enraged me. She said, “Pray to [enter any deity here].” I’ve had much better anesthesiologists since then.

• [pdffs]

  Happened to me a number of years ago, I wasn’t in surgery, but had all four wisdom teeth out in a dentists chair, with the general administered by a geriatric anaesthetist.  When consciousness came, I couldn’t tell direction, it felt like I was constantly falling, couldn’t see, couldn’t yell or indicate my condition – I can honestly say it was the most traumatic, frightening experience of my life.

• [Daniel Swan]

  Happened to me 15 years ago.  Woke up in a foot surgery, saw my foot wide open, and the docs working on it with what were recognizably doctor-grade power tools.    They were cutting bone, and screwing in metal.    Wasn’t much different than what takes place in my woodshop, except the difference in materials being worked.

  I started to ask questions, but they got annoyed, and asked me to stop.  Can’t recall if I went back under on my own or was given more sleep-juice.

  I felt absolutely nothing, it was not traumatic in the least.  

  I remember the incident quite clearly – Probably not memories I’d want to have if it was my gut instead of my foot.

• [snowmentality]

  I’ve never experienced pain while under anesthesia, but I do remember hearing the surgeon and nurses chatting during one surgery I had as a child. I couldn’t feel anything, just hear. It wasn’t scary or traumatizing; I actually found it interesting that my hearing could be online while everything else remained offline.

  I would definitely talk to your anesthesiologist about this tomorrow — I’m sure you’re not the first person to ask. Ask them what they look for in terms of signs of consciousness, ask them what they do to prevent their patients from waking up on the table, basically just air your concerns and see what their answers are. At least for me, knowing that they’re aware of this and that they’ve thought about it would make me feel a bit better.

  • [LydiRae]

    I had the exact thing occur when I went in for my wisdom teeth extraction at 17. They were still in the bone, so they drilled in, broke them up, and took them all out at once. I was under, but remember hearing conversational voices behind some SUPER-LOUD crunching noises.
    Not at all upsetting, just surreal.

    • [John Ridley]

      I had two wisdom teeth out this year with just local (I don’t bother with even local for simple fillings and such).  It’s definitely loud.  My surgeon used a reciprocating saw that was loud as hell, and since the tooth was well rooted it felt like he was sawing directly on my skull. It was interesting.

• [Antinous / Moderator]

  My solution is to refuse general anesthesia in favor of a local and a hit of Fentanyl.

• [jsd]

  Nope. Definitely not reading this, 

• [Kludgegrrl]

  For both my surgeries I was able to talk to the whole team before any drugs were administered, and I think that’s pretty standard.  Best to share your concerns with them then so you can feel sure that they will be paying attention to anything that could signal your not being fully knocked out.

  My thoughts are with you Xeni!  (And take some comfort in the fact that surgery is actually where modern medicine excels)

• [sforslev]

  This happened to someone I know in the 90′s. During heart surgery. It was absolutely horrifying and I don’t think he’s ever gotten over it.

  Happily it was a rare occurrence then and even rarer now. 

  • [thomas vesely]

    ditto,i found it interesting, chest open…..
    was convinced i knew something i had to write down.
    the Doc gave me a pad and biro.
    i scribbled about 20 lines.
    in the morning i saw that i had written undecypherable shapes,
    not letters as we know them.
    about mid 90′s.

    • [Nathan Hornby]

      For something so rare there are a lot of people in these comments that have had experiences with it…

• [druidbros]

  I awoke during a procedure where they had a tube down my esophagus a few years ago. The Dr and nurses were screaming at me and one of the nurses gave me more anesthesia immediately. Being the not shy or reticent type I loudly proclaimed my displeasure after I woke for the second time. The Dr’s office had the nerve to bill me for a co-pay. It only took one call for them to stop that nonsense. The Dr retired very shortly after that. Yes, they sent me an invitation to the retirement event but I didnt go – I sent a note saying I approved.

  Xeni, I am sure many will be thinking of you tomorrow. Your online family cherishes you.

• [sockdoll]

  I read somewhere (BoingBoing?) that they were adding some kind of amnesia-inducing drug into the mix when giving people general anesthesia these days, so that if people awoke during surgery they wouldn’t remember it.

  OK… they cover something like that later in the Atlantic article. It’s definitely a rewarding read.

  • [Antinous / Moderator]

    Versed (Midazolam). Its sole purpose is to keep you from killing your doctor.

• [Ipo]

   Everything will go great.  Your team will be on point. 
  You’re strong. 

• [Haroun]

  I had both hips replaced back in 2006, 2 weeks apart.   For months ahead of time I used meditation time to embed the idea that if I woke up during surgery that I should not move, not jump, not anything.  In the 2nd surgery I came up out of the Fentanyl, the spinal still fully in effect so there was no pain.  It was while the doctor was hammering away to set the cup of the prosthetic in my pelvis, making my whole body shift with each blow.  I lay there for a bit & then said “he’s really whaling away there, isn’t he?” to the anesthesiologist who promptly shit a brick, said you’re awake?  & then zapped me with more, though not enough, Fentanyl.  I then woke while they were stapling the incision shut.  I found it fun & amusing as I’d prepared for it, & I had a much better post operative time as the room wasn’t spinning face first for 5 hours after I awoke.  My main concern was to wake during the operation & start, causing a problem with the work being performed.  

• [prof_jellis]

  Remember, lady, this is incredibly rare, far far FAR rarer than these comments suggest.  Best wishes from many many MANY people for your procedure tomorrow!

• [Lyle Hopwood]

  I had a mastectomy a few years ago and although I didn’t wake up during the surgery, I did wake up before I was out of the operating room. I’m not sure if it’s the same phenomenon. 

  But I do have to remark that it totally hurt a lot. I told the nurse attending me that it hurt – I was quite polite about it – and she said, “I’m starting pain control now.” And she must have been – I can’t say I remember anything else for an hour or so afterwards. 

  When I had a follow-up surgery, I told the anesthesiologist what had happened (so it wouldn’t happen again) and he said, “It’s ok, you don’t remember things like that.” I thought that was an odd thing to say, but at least I didn’t wake up during that surgery.

  I had to prep for yet another one later and I told the doctor about previously waking up before pain control. He said, “It’s okay, you don’t remember things like that.”  

  What? It must be some sort of mantra they learn in medical school. Whether it’s to reassure me or them, I’m not sure. I do remember it in detail, I can assure you. But it happened to me a long time ago, so it seems like it happened to someone else, and I don’t flinch when I think about it, so maybe that’s what they mean by ‘not remembering’. 

  Having said all that, good luck Xeni. I’m sure it’ll go better for you.

• [Jeffrey Swainhart]

  Good luck Xeni!

• [Pat L]

  Good luck and a speedy recovery from surgery, Xeni!

• [MarlboroTestMonkey7]

  Be strong, you can do it.

• [Bruce Arthurs]

  Good luck, Xeni.

  Had surgery last month after managing to shatter my right humerus.  Don’t remember the surgery at all.  The post-surgical pain has been… awkward at points.  (When they discharge you, why do they tell you to make a follow-up appointment for three weeks ahead, but only give you an Rx for a week’s worth of painkillers?)

• [Stef of Ing]

  My (Swedish) grandfather went in for cataract surgery in the early 60s and said he was awake throughout the whole messy procedure. During the year he was waiting for the other cataract to mature so that too could be removed he drank himself to death.

• [ocker3]

  Apparently the epidural they gave my mother during my birth only knocked out her motor nerves, not her pain nerves, so during the ceaserean she could feel everything but couldn’t react in any way. 

• [IronEdithKidd]

  I’m really squeemish about blood and have never had so much as a wisdom tooth removed.  (I’m a genetic freak with only one wisdom tooth, and it’s not impacted.)  I’m squicked just thinking about the notion of waking up in the middle of a surgery.  No *way* am I reading this article.

  Xeni, this isn’t your first time at the rodeo, if it hasn’t happened to you yet, it probably won’t happen this time, either.  May you have smooth sailing tomorrow and a zippy recovery.

• [embryoconcepts]

  Cancer’s an asshole, and I’m sorry you’re still having to put up with him.  Best of luck to you and yours.

• [blueelm]

  This happened to me, but they had also used something for pain I think or else I was in shock. I warn them ahead of time that I have been known to wake up. I don’t actually remember the pain (but then I don’t remember the pain when I broke my arm and I KNOW that hurt because I was looking at the bone). What I do remember is the terrified look on the faces looking back on me and a nurse shouting “don’t try to move!” and I thought to myself “you think I want to die, lady” and then waited for them to do SOMETHING. There was blood everywhere, all over them. I was trying to figure out what devices they had and how they’d be used, but I was pretty out of it so I have no idea.

  Same thing happened when I had a major wound on my face. I’m sure they thought I was under. I could feel them putting the staples/stitches into the wound but my face was covered up (I was a small child during this one) with a blue cloth with a hole over the injury. I sat perfectly still because the last thing I remembered was my parents fighting, blood everywhere, and my father saying “you used to be pretty!!! You’re going to be a monster!!!” and generally flipping out. I could feel a tooth falling out and my mouth wouldn’t move. “OMG you used to be pretty!!!!” So I was afraid if I moved the doctor wouldn’t be able to fix me and I’d be a monster.

  Again I don’t remember pain, but instead I remember that whatever they did to staple the wound made blood shoot into my mouth and I was surprised how good it tasted. Kind of like baking soda.

  So… maybe these things are more disturbing than helpful, and maybe I have such PTSD that I wouldn’t know one PTSD trigger from another… but it’s not the horror that it is always made out to be. 

  Usually you know you wake up because it’s happened before. Now I know just to alert the doctors (assuming I’m going in for surgery) that it could happen and to be prepared just in case.

  *Adding: to me it is way too fascinating to be that traumatic. How many chances to you get to see the inside of your own bone, or to see what surgery looks like. Personally, if they could keep me awake but stop all pain I’d be totally for that just so I could enjoy the show. (Brain surgery FTW on that one I guess) Maybe I’m a little dissociated because to me it is just too damned interesting and I can’t remember any pain.

  But everyone is pretty much right. If it has not ever happened to you it probably NEVER will.

• [Lynda Gutierrez]

  I’m hoping for a happy update from and/or about Xeni sometime soon . . . 

• [jimmyungreek]

  Same here.

• [Pixelfish]

  I woke up during surgery on my leg and I tried to say something, and it must’ve gotten somebody’s attention because I do have a memory of somebody saying something about me not being under far enough. Not traumatic for me though. (I can imagine IT COULD BE, but it just wasn’t at the time.)

• [literatewench]

  Best of luck, or best wishes, or whatever will make you feel better about going in for surgery tomorrow. :) *hugs*

• [Walker Shurlds]

  I found the lack of mention of the work of Douglass Hofstadter on pages three and four suspicious. Especially since page four talked so much about some book and how the neuroscientist author is marketing it.

  But this is so far from my usually territory I really don’t want to use any word more than “suspicious” for fault of sounding like a moron/fanboy.

  The first two pages were extremely informative, though. Chilling read.