In my previous life, before I became an anesthetist, I had worked for years in critical care and PACU. I became quite familiar with the care of post-operative patients and the issues that surround operative care.
When I decided to start my family, I carefully read every book I could lay my hands on about a natural, well-planned and thought-out labor and childbirth. I attended my prenatal classes, practiced my breathing, and, when I went into labor, already had my overnight case packed, with books to read, music to listen, phone numbers ready.
Life doesn’t always go like you plan it. It took me many painful hours (more than 24) just to dilate to 5 centimeters (in those days that was the magic number to receive an epidural). I actually hadn’t even planned on getting an epidural. Nope, didn’t want one. I quickly changed my tune after the first 24 hours of contractions. Epidural went in fine, pain relieved, but for the next 24 hours, I would not finish dilating. Got to 9 cm, but could not progress any further, despite everyone’s best efforts. My baby was starting to show non-reassuring signs on the fetal monitor, and it was decided that I would need a Caesarian section. So much for my plans.
But, to make matters worse, my epidural was deemed non-suitable for delivery – apparently it had dislodged. Suddenly, my baby’s heartrate dropped precipitously, and I was rushed off to the Operating Room. They had to put me to sleep with general anesthesia to get the baby out as quickly as possible. Now I realized I would miss my baby’s birth. But his safety was paramount to me, and I gazed into my husband’s eyes as I drifted off to sleep.
It is not as hard for me now to talk about what happened next as it was at earlier times in my life. I used to not be able to even think about it without getting a hard pit in my stomach and a well of tears.
In the middle of the operation, while I was still being cut and before the baby was out, I woke up. Yes, I felt the sharpness of the knife and the tearing of my tissues, the pushing on my belly, and indescribable, unspeakable pain. I tried screaming and screaming (in vain), and then realized that I had the breathing tube in my throat, plus I was still paralyzed from my anesthesia drugs and could not even move a finger or open my eyes. How many patients had I cared for, how many patients waking up from anesthesia, how many incisions and how many pain medications? Why was this happening to me?
This was beyond a nightmare; it was some kind of cruel joke. No one could hear me (I WAS SCREAMING), and I was totally awake and could not communicate to anyone what was happening to me! What seemed like hours but may have only been a few minutes, I was in some different parallel universe of torture and agony. And then, that’s all I remember. Everything went blank after that; next thing I knew, I woke up (again in a lot of pain) in the PACU, and it was over. The psychic pain, though, remained for a long time.
When a mother must undergo general anesthesia for a C-section, she is traditionally kept “light” – a term that means that “not too much but just enough” anesthesia is given. Mothers under general anesthesia are kept light until after the baby is delivered, because of the real concern about anesthesia drugs crossing the placenta into the fetus and possibly causing an unsafe situation for the newborn. This is exactly what happened to me; sadly, I was a little too light. When I “blanked out” during the C-section, I had probably just been “deepened” with anesthesia because my baby was being delivered.
This experience was life-changing on many levels, but I will speak here about how it has informed the way I practice. I fulfilled a career-long dream to become a nurse anesthetist about 10 years after the delivery of my son. I love everything about giving anesthesia – it is clinically stimulating, intellectually challenging; it’s about making a sound differential diagnosis, navigating the decision tree, and problem-solving. But what it’s really all about is the patients.
Patients’ fears and concerns are real, all of them. None of them are silly, neurotic, or whimsical. I take them all seriously, and I allow my patients to talk freely about what is worrying them about their upcoming surgery. Often their biggest trepidation is the anesthesia – dying, brain damage, loss of control, throwing up, feeling pain, waking up in the middle of the operation . . . .
My horrific experience under anesthesia has empowered me to become a strong listener, a better CRNA, a more genuine patient advocate, and a more caring person. I try to tune in to my patients’ preoperative anxieties, and I pay particular care and diligence to ensuring that their anesthetic experience is optimized to their comfort, well-being, and safety. To do anything less for my patients would be diminishing to the standards of my profession, to what I’ve lived through, and to who I am.
For more information about awareness under anesthesia, I would refer you to this outstanding book, Silenced Screams, and to this information released by the American Association of Nurse Anesthetists. As a postscript, I would like to assure my readers that the frequency of awareness under anesthesia is quite low and uncommon today, ranging between 0 .1- 0.2% of the adult population.