A Living Surgical Nightmare

"Someone was inside me, ripping ripping me apart."
"It was excruciating. It was burning and burning and burning."
Lynn Hillis, 54, Cancer patient, Toronto

"She described trying to move, open her eyes and scream but being unable to get the attention of the doctors."
Judge Kendra Coats, Toronto

"The impact was just profound. It started with the nightmares."
"It's been nine years [since her own 'awakening' during surgery] and I still have nightmares. I still wake up screaming."
Donna Penner, Winnipeg, former surgical patient

SunMedia    In the first ruling of its kind in Canada, a judge says an anesthetist was at fault for a Toronto woman's nightmare experience of waking up in the midst of surgery

 

Surgeons and anesthesiologists are increasingly aware that on occasion a patient under sedation in preparation for surgery can 'awaken' and be entirely aware of what is happening as an operation proceeds. Because of anesthetic immobilizing them physically and breathing tubes inserted through their mouths since the autonomic breathing is interfered with when anesthetic is infused into a human body, the newly-awakened patient, while aware of what is transpiring and feeling horrible pain, cannot communicate with the surgeons. It is only after the surgery that the surgical patients can describe the horrors they experienced.

 

New research appears to have concluded that this 'awakening' phenomenon almost exclusively impacts on morbidly obese patients resulting from the difficulties anesthesiologists experience in calculating how much anesthetic to administer; just enough to keep them sedated; not too much so that there is danger blood flow may be restricted to the heart and brain. Most anesthesiologists end up calculating the amount of anesthetic required by body weight, and with obese patients those calculations tend to discount body fat, just weight minus the fat out of concern of administering too much.

 

In Lynn Hillis's experience the accidental surgical 'awareness' left her vulnerable to physical helplessness, and being forced to be aware of everything taking place during her surgery, including the incalculable pain she experienced. Suddenly, halfway through her operation resulting from her diagnosis of endometrial cancer where laparoscopic surgery to remove her uterus, ovaries and fallopian tubes was taking place at Toronto General Hospital, she awoke.

 

What she experienced during that 2008 operation forever changed her life; she was diagnosed with severe trauma; post-traumatic stress disorder. Her experience of being frozen by paralytic drugs leaving her unable to communicate with the surgeons focusing on her surgery was the stuff of nightmares. And it is calculated that roughly one thousand patients annually in Canada undergo some version of being 'awake' during surgery when anesthetic fails; sometimes fleetingly, sometimes throughout the surgery.

While waking during surgery is not common, professor of anesthesiology Dr. Eric Jacobsohn says it needs to be taken seriously. (Jean-Sebastien EvrardAFP/Getty Images)

Ms. Hills decided to sue the two anesthetists who took part in her surgery; one a staff doctor who handed over her care halfway through the surgery to a "fellow"; an advanced trainee, present for the entire surgical procedure. Ms. Hillis was able to recount the entire proceedings of the surgery, including what the surgeons transmitted to one another as they spoke and how the surgery proceeded. And while the doctors' lawyers insisted that anesthetic was properly administered, the judge hearing the case concluded that Dr. Reza Ghaffai had erred in failing to increase the intravenous Propofol sufficiently.