EDITORIAL Kathleen Walsh Spencer, MSN, MA, RN, CS, CPSN

Getting Honest About Awareness

When Shelly Springer sent me her “Taking the OR fin. It was the day I should have been buried. Just to the Office” department for this issue on the topic then, the senior OB resident walked in for rounds, of Anesthesia Awareness, I immediately e-mailed and I burst in to tears. “Today should be my funeral.” her back: “Great topic!” After a moment’s hesitation, I knew I should have died. I added, “I had awareness once.…” Within minutes, When I was lying in , I could hear every she had me agreeing to add a personal account to word. The obstetrician arguing with the CRNA her department. It didn’t take me long to regret that. about whether to start another IV line (why was Revisiting the experience of awareness is painful for there any question?). My husband yelling at a nurse me, just like it would be for every other patient who to get blood. The OR technician crabbing that she has experienced it. However, part of the privilege of had to run to OR to get the hysterectomy pack, since writing an editorial is to be able to shine a spotlight they weren’t stocked in OB anymore (cost-cutting). on an issue that is important to me—controversial The OB resident was still pounding on my belly to or not, painful or not. try to massage the uterus. A nurse screaming at my As Shelly wrote in her column, anesthesia aware- husband, a , to get out of the room: “You ness or unintended intraoperative don’t belong here.” A lot of swearing. The brightest can be a terrifying and devastating experience for white light was in my eyes, even though they were the patient. These patients often experience psycho- closed. At some point, the lights went out, and I logical difficulties that appear following surgery woke up a few days later on a vent in the ICU. that can last for years. As I read through Shelly’s col- The same day that I woke up in my “coffin,” my umn, I was mentally ticking off all of the things that anesthesiologist came for a postop visit. He said, applied to me. Yep…it was an emergency surgery, in “Some patients think they are going crazy because my case a hysterectomy to stop the bleeding after a they remember surgery. They don’t bring it up “routine” vaginal delivery. Yep…hypovolemia was a because they think no one will believe them….” factor. I was in the process of receiving a total of More tears. The doctor explained that my blood 27 units of blood products. pressure was too low to give much anesthesia and Yep…low blood pressure, if any. Too low for he suspected that I might have “anesthesia aware- much . Yep…flashbacks and . Still ness.” He said that patients benefited from talking have them, nine years later. It was a Tuesday morn- to someone about it. Since I delivered at the hospi- ing, four days after I delivered a perfect baby daugh- tal where I worked, I was worried about the “stig- ter. I woke up lying on my back, my covers neatly ma” about a psych consult. Now, I wouldn’t have tucked around my legs up to my waist, my hands worried about it so much, knowing how important folded across my abdomen, my head on one soft pil- low. I opened my eyes to rows of flower arrange- ments on either side of me. I thought I was in a cof- Plastic Surgical , the official journal of the American Society of Plastic Surgical Nurses (ASPSN), presents the latest advances in plastic and reconstructive surgical nursing practice. Written by and for Kathleen Walsh Spencer, MSN, MA, RN, CS, CPSN, is a Clinical plastic surgical nurses, Plastic Surgical Nursing features clinical arti- Nurse II at William Beaumont Hospital, Royal Oak, Michigan, and cles covering a wide variety of surgical procedures. Patient education the Editor of Plastic Surgical Nursing. techniques and research findings are also included, as well as arti- Address correspondence to Kathleen Walsh Spencer, MSN, MA, cles discussing the ethical issues and trends in this expanding clini- RN, CS, CPSN, at 4560 Stoneleigh Road, Bloomfield Hills, MI cal nursing specialty. 48302 (e-mail: [email protected]).

Plastic Surgical Nursing ❙ April-June 2006 ❙ Volume 26 ❙ Number 2 55 it was. Nevertheless, my husband arranged for a is especially important because then the patients are psychiatrist from a different hospital to see me, and starting to feel physically better after surgery, but I followed up with him for at least a year after. may be alone in their heads with all of the frighten- Just like the patients that Shelly described, I was ing thoughts. If patients have about surgery, never the same. Typical of patients who have Post believe them, validate them. Do not dispute or trivi- Traumatic Stress Disorder, I had/have a heightened alize reports of its occurrence. Help the patient to startle response. Countless times, my husband get the support he or she needs, which is likely to be would quietly enter a room and I would leap out of counseling. my skin when I saw him. An unexpected hand on After my experience with awareness, I tried to the shoulder had the impact of an electric shock. I find a support group of other patients to talk with. was preoccupied about “dying the next time.” Rid- There was one online chat group nine years ago, run ing in the car was anxiety-ridden, especially driving by a recovery room nurse, I believe. Recently, I along cliffs or roads with low guard rails. I had searched the Internet for resources and came up about being beaten up, the same beat- with hardly anything. I asked the librarians at my ing in the abdomen as when the resident tried to hospital to search as well. They came up with what massage my uterus back down. Flashbacks intruded I did. The most valuable website for patients is during the day. It’s like the video was replayed, but I www.anesthesiaawareness.com, which describes had no control over when the “PLAY” button was the Anesthesia Awareness Campaign. The campaign pushed: folding laundry, rocking the baby, driving to was started by one victim, Carol Weihrer, who suf- the grocery…and a would reduce me to fered awareness during surgery to remove her dis- quivering jello. eased eye. Her horror and disappointment with the Six months after the event, I remember telling anesthesia profession is apparent in her courageous me husband that I felt that I had “rejoined the liv- writing. I think it is important for all of us to hear ing.” There was finally pleasure in simple things like what she has to say. The goal of the campaign is “to pushing the stroller, walking the dog, chatting with prevent patients (even one) from experiencing anes- the neighbors. Soon after, I was able to return to thesia awareness and its consequences through edu- work. cation, prevention, and empowerment by replacing The most important thing we can do for our ignorance or fear with knowledge.” The problem is patients is to be honest about awareness. I found a that there are very few resources of support for Web site that criticizes anesthesia personnel for patients. If I was challenged to find support, imag- “denial” about this serious problem. Thank God for ine our patients! If you are aware of resources, the compassion of my anesthesiologist and his col- please contact me and I will publish them in a leagues. As Shelly suggests, assess the patients for future issue of the journal. Carol Weihrer wants us awareness. The secondary assessment at 1 to 7 days to be aware of awareness. I want you to be, too.

See Shelly Springer’s article on Anesthesia Awareness on page 96.

56 Plastic Surgical Nursing ❙ April-June 2006 ❙ Volume 26 ❙ Number 2