When it comes to deep-rooted fears, there are several that top the list for the average person: heights, flying, and enclosed spaces. But fears extend past the mundane and can include things like being buried alive, involved in a terrible car crash, or attacked by a rabid animal. Former anesthesiologist Dr. Paul DeLeeuw knows that for many people, there is a fear of being put under for an operation only to awake mid-procedure and feel every cut by the surgeon.
Dr. Paul DeLeeuw has been practicing medicine for almost 50 years, including 26 years as a high-level anesthesiologist in South Florida. Although he retired from anesthesiology in 2008 due to a shoulder injury, he is often asked if any of his patients were awake during an operation, paralyzed but able to feel what was happening to them.
The answer is yes.
There are those patients that receive regional anesthesia of an arm block or an epidural to make their legs numb. These patients felt nothing and received mild sedation but were at least partially awake during their surgeries.
Then there is general anesthesia, which is used for major surgeries like those on the chest or abdomen. When using general anesthesia, the patient is intended to be fully unconscious and unable to feel pain.
Only once in his career did Dr. Paul DeLeeuw find that a patient had awoken during general anesthesia in a major surgery. Unfortunately, the situation was unavoidable. Fortunately, it was not as horrific of an experience as many fear it would be.
A Late Night Call
The call came when Dr. Paul DeLeeuw was home in bed. It was an emergency.
An OB/GYN surgeon had an acute abdomen case in the ER. Dr. DeLeeuw asked the OR desk nurse to transfer his call to the ER so that he could call in premedication.
Immediately following the call, DeLeeuw got dressed and drove to the hospital. The patient was a young woman in her late 20s and was already in the OR holding area. Pale and frightened, her problem was an ectopic pregnancy. This occurs when, after fertilization, the baby develops outside the uterus, in the abdomen. This is always a delicate and unfortunate situation. At some point, early in the pregnancy, the embryo bursts open, causing massive hemorrhaging into the abdomen.
Dr. Paul DeLeeuw introduced himself to the patient as he injected a mild sedative into her IV. He then put her to sleep, secured the airway with an endotracheal tube, and started a big central IV. Most patients in this situation bleed heavily, and transfusion blood was ordered – but not ready yet.
The patient was stable after induction of anesthesia, so DeLeeuw dialed in an inhalation vapor to keep her unconscious. The surgeon began his work with a cut across the patient’s abdomen.
As soon as the surgeon opened the abdomen, serious bleeding began. It had previously been blocked by the rigid abdominal wall. Instantly, the fight began to save the woman’s life.
The surgeon needed to gain control of the bleeding vessels while DeLeeuw simultaneously pumped in fluids as quickly as possible. He used the blood substitutes that he could as he waited for the blood bank to “type and cross” the patient’s blood in search of a compatible unit of blood.
As he waited for the transfusion blood, the patient’s blood pressure began to drop. With no other choice, DeLeeuw lightened the anesthetic. That helped the situation, but as the bleeding continued, he had to give less and less anesthetic. The dosage fell to a level at which DeLeeuw feared consciousness.
DeLeeuw gave the patient a drug that reduces recall, and as much narcotic as her blood pressure allowed. For 15 minutes, the situation was extremely tense. Once the surgeon had clamped all the bleeding vessels and removed the ectopic pregnancy, the patient stabilized. A unit of blood arrived for transfusion, which gave DeLeeuw control over the situation once again. The patient’s blood pressure was coming up, and he could give the correct anesthetic.
Memory of the Procedure
The patient officially woke up in the Recovery room. When she was clear-headed and able, DeLeeuw spoke with her. She admitted to having some fuzzy memory of abdominal pressure and hearing talking during the operation.
DeLeeuw explained that due to her massive intraoperative blood loss, she had very nearly died. At times, he was forced to reduce the anesthetic just to keep her alive.
The patient was grateful for his life-saving care and felt that she fully understood the situation. When DeLeeuw visited her again the next day, she was up in bed, talking and laughing. He mentioned her being awake during the operation.
She said “Well, I would hardly call it awake. I remember feeling pressure and hearing voices. It seemed like just a minute or two. You saved my life, and I am eternally grateful.” As an anesthesiologist, Dr. Paul DeLeeuw’s role was not only to maintain unconsciousness during surgery but also to monitor and control the patient’s vital life functions, including heart rate and rhythm, breathing, blood pressure, body temperature, and body fluid balance. Although that meant sacrificing potential pain management and comfort, Dr. Paul DeLeeuw ultimately made decisions that saved the young woman’s life.