Wake-Up Call

Jodie Stanley awoke from anesthesia during an operation on her right hand. (Steve Gates - For The Washington Post)

"The unexpected awareness is traumatic enough. But when the patient tells the doctor what happened and he says it couldn't have, that's a secondary trauma," said Frank Guerra, a board-certified anesthesiologist and psychiatrist at the University of Colorado School of Medicine.

"The anesthesiologist told me I must have been dreaming, I couldn't have been awake," said Jodie Stanley, 67, of Rainbow City, Ala., who said she woke up sobbing in the recovery room of a Gadsden hospital after outpatient hand surgery last January.

Stanley, who had worked as a cardiac nurse in the same hospital for years, said she later learned that her vital signs, including her blood pressure, never spiked even when the surgeon made two incisions in her palm, "which felt like he was using a red-hot blade."

At the urging of her family and alarmed by her inability to stop crying, Stanley said she consulted a psychiatrist who seemed clueless -- or skeptical. "She asked me to rate the pain from 1 to 10 and I said, 'Start at 1,000, " said Stanley, who said she has undergone numerous other surgeries at the same hospital, including cardiac bypass. "After she asked me if it hurt like a paper cut, I stopped going."

Williams, the Austin heart patient, said that when he told a nurse in the recovery room he had been awake, she told him he was mistaken -- until he recounted conversations and told her where different members of the medical team had stood.

He said the nurse then summoned the anesthesiologist. Williams said the doctor seemed unconcerned and told him, "It's nothing to worry about, these things happen all the time." He said he overheard the anesthesiologist tell the nurse Williams "won't remember anything tomorrow."

Dismissive reactions are not uncommon, said Colorado's Guerra. Anesthesiology, he said, is a specialty that attracts doctors who don't tend to think in psychological terms or spend much time with patients. "I have tried to teach anesthesiologists that when awareness happens they need to lean into the problem and make themselves very available to the patient," he said. "In the real world, the anesthesiologist gets freaked out and runs away from it."

Van der Kolk, a psychiatrist, said the apparent lack of concern reflects "part of the culture of medicine -- to minimize the suffering people go through."

Patrick W. Clougherty, chief of anesthesiology at Inova Fairfax Hospital, said his approach is different. In the past five years, he said, 10 cases of awareness out of 200,000 surgeries have been reported at the hospital; two occurred this year. None has resulted in a lawsuit, Clougherty said, and all were investigated and handled with compassion.

Clougherty, who is past president of the Virginia Society of Anesthesiologists, said brain wave monitors have been installed in Inova's operating rooms, and his department is developing policies about their use by its 100 anesthesiologists and nurse anesthetists. He said he expects to have the policies in place by April, when a JCAHO accrediting team is due to make a scheduled inspection.

Clougherty's interest in the issue is colored by an experience he had as a resident 20 years ago, when a patient told him she had awakened during bowel surgery but felt no pain.

"I was absolutely shocked," said Clougherty, who subsequently discovered he had used too little anesthetic gas. "I basically resolved that would not happen again."

"The last thing I would want myself or a family member to undergo is what these people describe," he said. "You could just imagine that would be the worst possible outcome."•