I’ll confess. I’m afraid of having a general anesthetic.
Seem strange given my profession? Anesthesia is safer than it’s ever been. I’ve given thousands of anesthetics myself. I know about the massive observational studies that tell us modern anesthetics are low risk – especially in patients like myself who are perfectly healthy.
But I’m still afraid. I had an anesthetic as a child but I don’t remember much about the experience other than that I was promised ice cream by the nurses before the surgery but not allowed to have ice cream after because I was puking. Given that’s pretty much all I remember, other than that my roommate had a toy Cringer and I was jealous, that should serve as a good reminder how important promises are to children. I also had sedation for wisdom tooth extraction. I remember waking up with a bloody gums and feeling like they had knocked me out and then hit me in the mouth or otherwise assaulted me. Somewhere in the recesses of my rational brain I knew I’d given them permission to do so…but emotionally I felt like I’d been violated. I was confused and crying for the better part of an hour.
I’ve never liked losing control. I’ve proved to not be easily hypnotizable. When I took psychology 101 they brought in someone to hypnotize the entire lecture hall. It was an interesting experience. I felt myself drifting down and then it was like someone was yanking my brain sideways. I yanked back and then sat there watching as the hypnotized students around me tried to catch an imaginary fly.
I know my unease about undergoing an anesthetic is more about losing control than about a fear of something bad happening to me.
I’ve always had sympathy for patients that are nervous or afraid before their surgical procedure. But I reserve a special place in my heart for my elderly patients.
When I started my training, I thought to myself, “anesthetics are safer than ever, why is this elderly person so nervous?” I thought that I could decrease their fear by telling them anesthetics were pretty safe.
Then I had an epiphany.
Anesthetics weren’t so safe 50, 60, 70 years ago.
My elderly patient probably knew someone who died “back in the day” during or just after an anesthetic.
Maybe a friend. Maybe a member of their church. Maybe a neighbour. Maybe a family member.
And so, when I have an elderly patient, and they volunteer or admit to me that they are nervous or frightened, I ask them, “did you know someone who had an adverse event or maybe even died under anesthesia?”
The answers have been illuminating. It takes maybe a couple of minutes to talk about, but the rapport we develop is astonishing and more than worth my time. Rapport is often of short supply given that I typically meet a patient about 5 or 10 minutes before I essentially hold their life in my hands.
Some recent experiences with elderly family members have led me to another epiphany. My elderly patient has probably lost a friend or family member of the same vintage after an operation during the last year. For many of our elderly patients, an operation is the first in a chain of events that leads to death. Not immediately, since we can get almost anyone through the actual operation and up to the surgical ward…but weeks or months later. They suffer debilitation and deconditioning from lying in bed and don’t have enough access to occupational and physical therapy. Some of them will contract urinary tract infections from catheters. Some of them will not cough effectively due to pain and develop pneumonia. Some of them will have heart attacks, strokes and/ or episodes of heart failure. Some will have deteriorating kidney function. Many will develop delirium from medications, pain, and being away from familiar surroundings. What’s the big deal with going a little loopy, you ask? The development of delirium is strongly associated with an increased risk of mortality over the next months to year as well as admission into a long-term care facility.
My elderly patients can’t articulate the risks above but they all know of someone who deteriorated in the weeks or months after an operation. They all know of someone who went into the hospital and ended up being “forced” into a long-term care facility. They do not make the decision to proceed to surgery lightly.
I respect them greatly.
When an elderly family member recently had surgery, I received a lot of questions leading up to the operation. Mostly about the anesthetic and the operation itself. Those questions are important, but the experience has really brought home to me that no one was prepared for the long road to recovery. I should have seen it coming. I should have helped prepare my family. I should have educated them and helped them line up the services and equipment that would be necessary to support recovery and a return to independent or semi-independent living. After all, I’ve seen this before.
But I was overly focused on the anesthetic and surgical events.
I am resolved to spend more time during future anesthetic consultations discussing some of the issues surrounding recovery from surgery. Anesthesia is still an evolving field. We are becoming expanding from our role in the OR and becoming perioperatve medical specialists. We are playing larger roles in preparing patients for surgery through pre-admission clinics and helping them recover through our post-operative acute pain services. I need to better reflect that during my discussions with patients.
I doubt I can keep them from being afraid. I think, given the situation, that fear is rational. But there is strength in acknowledging a patient’s fear and facing it together.