How Scared Should I Be of My Anesthesia Not Working

Note: In the column “How Scared Should I Be?” VICE staff writer and generalized anxiety disorder sufferer Mike Pearl seeks to quantify the scariness of everything under the sun. We hope it’ll help you to more wisely allocate that most precious of natural resources: your fear.

From Broadly: What It Feels Like to Have Brain Surgery When You’re Awake

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When I went to the doctor a few months ago for persistent abdominal pain, he told me that, based on where I was pointing, it might be gallstones. He told me no big deal, but I should probably, maybe, get an ultrasound as a precaution, just to be on the safe side. As any good hypochondriac knows, one popular treatment for gallstones is surgery to remove your gallbladder. And I am terrified of surgery.

My fear of going under the knife is rooted less in the knife itself, and more in the fact that I might feel the knife going in, and remember the knife forever. That’s because as an avid reader of tabloids, I have filled my head with mind-bendingly awful horror stories about something known as anesthesia awareness—also known as waking up on the operating table, often paralyzed by drugs, and forced to experience everything in a kind of waking nightmare.

So how likely is it that this will happen to me, if I need to get my gallbladder removed?

“I think it’s something we’re frequently, and maybe even continuously, thinking about,” said Dr. Ronald Pearl (no relation to me) in an interview. Pearl is chairman of the anesthesiology department at Stanford School of Medicine. Avoiding awareness is paramount, he explained, when patients “have a breathing tube in their mouth, and they’re being operated on in a painful procedure.”

Estimates vary as to how likely a patient is to wake up on the operating table. According to a 2011 report published in the journal Duetsches Arzteblatt, 1-2 of every 1,000 surgery patients experience some form of awareness. That comes out to about 100 people per day in the US, according to calculations by CBS news. In a drastically less terrifying study from last year on patients in the UK and Ireland from the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland, awareness was only found to occur in one out every 19,000 cases.

It also helps that I’m not a child. According to the Duetsches Arzteblatt study, the risk is eight to ten times higher in children due to “inadequate depth” of anesthesia. It’s not an accident that anesthesia for kids doesn’t go to the same “depth” as it does for adults. “We know that too deep a level of anesthesia potentially has some very negative consequences,” Pearl said. He explained that anesthesiologists are constantly trying to get the right balance between reducing a patient’s suffering on one hand, and prolonging the recovery or risking brain damage on the other.

But even though waking up is unlikely, the remote possibility of awareness is pretty scary when you consider the dire consequences. Not all patients experience pain, but some do. According to that study in the UK and Ireland, 51 percent of patients who came into awareness experienced distress and 41 percent had long-term psychological problems.

In one eight-year-old case from the UK, a woman named June Carson told British tabloid The Sun that she woke up during a sterilization procedure. “Feeling the knife cutting into my stomach, I thought I would die immediately. It’s impossible to describe the pain but I felt as if I was being tortured.”

For more about surgical complications, watch our documentary Buttloads of Pain.

In 1998, a US woman named Carol Weihrer felt everything after waking up while her eye was being removed. “I heard, ‘cut deeper, pull harder,’” she told CBS news back in 2003. Like most patients who wake up during surgery, she had been given drugs to paralyze her. “You have no control,” she told reporters. “You can do nothing.” She said her trauma was so severe she became afraid of lying down at all, and had to sleep in a chair.

Weihrer later started the Anesthesia Awareness Campaign, an activist organization and support group online, which has since vanished from the internet. I tried to reach out to her by email, but an automatic reply informed me that “The AA Campaign is no longer in business.”

But how hard could it be for a surgeon to tell if his or her patient has woken up? Aren’t the patient’s vital signs being monitored, and wouldn’t an unusual change sound an alarm? According to Dr. Pearl, that’s not always the case. “The blood pressure may become low, and we will decrease the anesthetic drug we’re giving, and give medicine to increase the heart rate and blood pressure because it’s low. When the heart rate and blood pressure go up, you might interpret that as something from the medication you gave, rather than from awareness.”

But despite that horrifying possibility, according to Pearl, they eventually do figure out what’s going on. “It’s uncommon for people to have awareness for long periods of time before they get treated for it.”

It’s somewhat comforting to know that operating rooms are sometimes equipped with awareness detectors, devices that detect the brainwaves associated with consciousness, and alert the surgeon or anesthesiologist that something is wrong. But “Some people use them; some people don’t,” according to Pearl, who says those can be less accurate than just monitoring the amount of drugs they’re giving you.

It seems that the possibility of awareness is just a troubling but permanent part of working in operating rooms.

The answer to all this, oddly enough, might lie in the ability to erase a patient’s memory. “We don’t right now have ways of reversing the fact that someone had a period of awareness,” Pearl lamented, suggesting that something akin to the neuralizer from Men in Black could one day be a useful addition to every anesthesiologist’s toolkit. As crazy as that may sound, the journal of the American Psychological Association published a paper earlier this year in which it was shown that traumatic memories had been erased in lab animals. So a memory eraser might just be on the horizon, but until that day, according to Pearl, you’re stuck with your memories. “We can’t give you a drug when we recognize that that has occurred that will be very effective.”

Surgery still terrifies me. I’ve been to the funeral of someone who died due to surgical complications. I used the American College of Surgeons’ handy Surgical Risk Calculator to figure out that if I really did need a gallbladder operation, I would have a 2 percent chance of a major complication. While that’s actually much scarier than my supposed 1 in 19,000 chance of waking up, awareness during surgery scares me in a way that is beyond all logic. Consequently, I never plan to get surgery that I don’t absolutely need.

But I will be getting that ultrasound.