Monday, July 23, 2007
"Thankzzzz doc yer th greatiszz.... No, rilly man.... yer the...... zzzzz ..."
"Huh? The operation's over? No way. You're kidding, right? Bandage? Oh yeah, lookit that. Wow. The operation's over? No way. You're kidding, right? Over? You're kidding, right? Is the operation over? You're kidding. Right? Bandage? Oh yeah..."
"I robbed a bank, y'know. Had to kill a guy. Put the money in a Swiss bank. The account number is...."
I've heard it all. Well, except that last one. And I've been asked frequently: "Did I say anything when I was out?" Readers of this blog have wondered the same. Evidently it's a pretty common concern: do people reveal stuff or otherwise embarrass themselves when under the effects of anesthesia drugs? Relax, people; the answer is "no." OK, gotta be truthful: it's also "yes."
Sodium pentothal, formerly used extensively in the operating room but now largely replaced, has been referred to as "truth serum." Whereas it's true that under the influence of some drugs people can get a little disinhibited, it's not the case that they'll get all revelatory. I haven't learned any secrets from my patients. When asked, however, I'd often say, "Well, you did tell me about that Swiss bank account." Only once did that result in a worried look....
Most surgical patients get a little something to relax them before they get wheeled into the OR. It's not unlike a couple of nice martinis -- without the olives. (No solid food before surgery.) So yeah, tongues loosen a little. Giggles sometimes; rarely, tears. "Wow, this feels great..." Stories get told. Amusingly, when the story is interrupted mid-sentence by the arrival in their brain of the knock-out punch, I've seen people wake up later and begin exactly where they left off, unaware of the passage of time. And yet, I've never heard anyone say anything they'd be sorry about. Unless telling me how wonderful I am is in that category...
Generally, I enjoy operating on a patient who's awake. We talk, usually light-heartedly. Given some sort of anti-anxiety drug, the conversations can be loose, chatty, funny. People will say the same thing over and over, ask the same questions repeatedly. My goal is to keep them comfortable; if they want to ramble on, it's fine with me. Most often they doze, wake up, talk a little, doze some more. It's pleasant, not confessional. Because such talk is commonplace, even when particularly entertaining it goes out the other side of my mind as quick as it enters; my head -- and, I'd aver, those of everyone else in the OR -- is a sieve that way. Talk like that is texture, not substance.
The flip side of this is a theoretical utility. Far as I know -- and the anesthesiologists who sometimes wander by (Mitch?) might be able to amplify -- studies of suggestibility under anesthesia are equivocal. Still, I liked to give some positive thoughts to my patients as they went off to sleep and when they emerged: "We'll take good care of you. You'll going to be comfortable when you wake up." And, after it's over, "Everything went great. You're going to be glad we did this. Comfortable, no nausea." I have no idea if it had an effect or not. I always made it a point to talk to my patients when they were awake in the recovery room, not only telling them how it went but -- unless it wasn't true -- telling them I expect things to be fine, give them some positive vibes. With practically no exceptions, no matter how engaged and appropriate they were in those conversations, people never remembered what was said, or even that I'd been there. Or that they'd asked me the same thing five times in a row.
If it were possible, I'd love to see a study of people wherein within a standard time of emergence they'd receive some suggestions. Some would hear words saying they'd be comfortable, be up and out of bed soon; others would hear something neutral, unrelated to pain. The floor nurses wouldn't know who heard what. Pain medication use would be recorded. I'd like to think the former group would need less. (The problem with any sort of surgical studies is that even when operations are "the same," they really aren't. Different surgeons, different operating times, incision size; different people getting the procedure. It's really hard to standardize. Still, it'd be interesting.)