| The Trauma of Awakening | | | | the nonverbal mind with a potential to intrude into |
| Awareness under anesthesia ranks second only to | | | | consciousness whenever triggered. The suffering |
| death as a dreaded complication of surgery. It is | | | | individual will not relate the emerging panic to |
| reported to affect 40,00-140,000 patients per year in | | | | unremembered and wordless experiences during a |
| the US but there is reason to believe that many | | | | past surgical operation. |
| more have awakened during surgery. Because | | | | Over half of the patients that remember coming light |
| modern anesthesia consists of three agents - a light | | | | under anesthesia develop the full syndrome of |
| dose of painkiller, a paralyzing drug, and an amnesic | | | | posttraumatic stress disorder (PTSD). Survivors with |
| agent that blocks memory of the experience - most | | | | or without memory often become phobic about |
| patients do not remember awakening and so do not | | | | surgery and their avoidance of triggers may |
| report it to their doctors. The paralyzing drug | | | | generalize to a fear of hospitals or doctors or of |
| prevents any struggle or gesture as sign of distress | | | | white coats. They may suffer attacks of frozen |
| so the surgeon, the anesthesiologist, and nurse | | | | panic or depersonalization, sometimes with clouded |
| cannot see that the patient is awake. Some | | | | states of altered consciousness. They may |
| experimental studies estimate the rate of awareness | | | | repeatedly hear the voices of operating room staff. |
| may be as high as 44%. | | | | Their conditions are often misdiagnosed as panic |
| Not remembering does not diminish the pain, fear, | | | | disorder, major depression, schizophrenia, or epilepsy. |
| and utter helplessness of awakening under the knife | | | | Treatment of Surgical PTSD |
| and being unable to let anyone know. Nor does it | | | | Once the true cause is suspected the condition can |
| diminish the traumatic effect of that experience. | | | | be readily treated and cured with trauma therapy. |
| Survivors who finally recall the awakening usually | | | | Successful treatment does require processing of the |
| describe an experience in which their center of | | | | entire traumatic experience so the therapy must be |
| awareness coalesces outside their helpless body and | | | | able to access that seemingly forgotten memory. |
| they watch the scene from above. Their frozen | | | | The memory is there even though conscious verbal |
| state and accompanying depersonalization seems to | | | | probes fail to reach it. It was not verbally coded |
| go on and on without a clear point of resolution. The | | | | when the person was under the dual effect of the |
| return to the body may happen in the recovery | | | | anesthetics and the instinctual trauma response. Even |
| room or even later in the hospital room and, rarely, | | | | though it was stored in fragments of nonverbal |
| only after days, weeks, or years. | | | | perception it can be processed into a narrative form |
| Posttraumatic Consequences | | | | that will be available to conscious thought. |
| The experience of awakening in a panic during | | | | Hypnosis is very effective in providing access to the |
| surgery and finding oneself unable to move or cry | | | | traumatic memory fragments. Other approaches that |
| out creates a dramatic crescendo of survival instincts. | | | | use nonverbal communication can also be effective. |
| The drug-induced paralysis thwarts any impulse to | | | | These are the creative arts therapies such as art |
| escape and deepens the instinctual freeze response. | | | | therapy, movement therapy, music therapy and |
| Awareness during surgery carries the exact | | | | psychodrama. In most applications the person |
| conditions known to induce post-traumatic symptoms. | | | | constructs a verbal narrative of the trauma and |
| The horrors of the experience become embedded in | | | | comes to own it as a finished historical event. |