The creepy claim about anesthesia awareness in the new movie Awake.

Health and medicine explained.
Nov. 28 2007 3:28 PM

Operation Fear

The creepy claim about anesthesia awareness in the new movie Awake.

Awake. Click image to expand.
Terrence Howard, Hayden Christensen, Jessica Alba in Awake

Since the 19th-century appearances of Drs. Frankenstein and Jekyll, films and literature have built up the doctor-horror category. The latest entry is a slight, amusingly hostile movie called Awake, starring lots of brand-name actors who do their Hitchcock best to creep out the audience. They succeed pretty well—on a one-to-10 creep-o-meter scale, the movie gets a seven—until, inevitably, a head-scratching silliness overwhelms them. But what makes Awake a bit more annoying than most medical jaunts is that, unlike its peers, it claims a noble and self-righteous pedigree: As the first exposé of a previously covered-up, denied, and miserable condition called "anesthetic awareness."

Here's what the term means: When a real-life patient receives anesthesia for surgery, it typically consists of two main ingredients. The first produces paralysis, allowing the machines (ventilators, for example) to work without the pesky patient fighting back. The second part of the cocktail makes the patient comatose so he or she doesn't have to feel or hear what's going on during the surgery. The problem is that, once in a while—at a rate that is subject to much debate—the paralysis part works just fine but the coma part, not so much. And so a patient might have the nightmarish experience of being 100 percent paralyzed yet 100 percent awake. This is worse than your typical nightmare of being unable to scream when an evil-doer is chasing you down a dark alley, because this time the surgeon is holding a noisy buzz-saw an inch above your ribs.

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Of course the Hollywood approach to adopting a cause (and a cause it is, complete with this Web site and victims' stories) is to concoct a sly plot device and then drop it. True to form, Awake starts with a grim recitation of alleged statistics scrolled out in Star Wars script—21 million Americans will receive anesthesia this year and 30,000 will have an anesthesia awareness experience. If true, that's pretty scary. Then we meet our hero, Clayton Something the Third (Hayden Christensen), a young zillionaire with a cute horny girlfriend (Jessica Alba) and a terminal cardiac condition. At the movie's opening, Clayton is submerged in a bathtub. For a long time. A nice creepy touch.

But then our heroine bounces into the tub for a quickie, and the whole anesthesia awareness thing takes a back seat to standard lovebirds fare. Hollywood's attention deficit disorder trumps its ever-faltering social conscience. This is too bad because as a plot device, anesthetic awareness is pretty neat. It's sort of like being invisible—you go unnoticed in a room full of people who know you but don't recognize that you are sentient. You could really do something with that. Oh well.

Still, let's take Awake more seriously than it deserves and return to the question raised by that opening Star Wars scroll—does anesthetic awareness exist, and is it worth worrying about? Well, sort of. In 2004, the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) issued one of its dreaded Sentinel Event Alerts on the subject. The Joint Commission is in charge of accrediting American hospitals and health care, and their pronouncement amped up the clash over anesthetic awareness between patients, strung together across the Internet by their frightening tales, and the American Society of Anesthesiologists, which has long downplayed the syndrome as rare and certainly no reason to avoid surgery.

Patients place the estimate at 30,000 people a year, or one in every 700 surgeries—the number Awake cites. But it's the academic anesthesiologists who have actual data (never argue with people who control both data collection and analysis). Earlier this year, they produced an impressive article examining the experience of a large private anesthesia practice that conducted 200,000 surgeries over three years. What makes the findings compelling is that, as part of their routine practice, they called every patient 48 hours after the surgery and asked about any experience resembling anesthetic awareness (or "intra-operative awareness" as they defensively called it). They arrived at a frequency that is 1/20th as large as the 30,000-a-year claim, or the equivalent of one in 14,000 procedures.

So anesthesia awareness is real, but rare, it seems, though arguments will continue over what constitutes an Awake-like extreme and scary experience, and what is nothing more than a groggy patient remembering a conversation that might have taken place in the OR or the recovery room—or might have been a drug-induced nightmare. From the moment William T.G. Morton etherized a patient with a sore tooth in 1846 and created the field of anesthesia, the discipline has had its share of unhappy moments. After all, 21 million times a year in the United States, anesthesiologists chemically push people to within an inch of death and then snap them back to life. That is a real feat. The problem is that TV and movies make the miraculous seem simple and kind of boring. And so the entire medical magic show—anesthesia, surgery, chemotherapy, antibiotics—is forever burdened with too-high expectations.

Medicine is a risky risky business, now and forevermore. So please stop with the oh-my-god surprise every time a procedure takes an unexpected turn. The answer to the questions that inevitably follow is always the same. Yes, it happens, yes, it is awful, and while it doesn't happen as much as you might fear, it does so more often than the specialists think. But no, there is no vicious coverup. That part is all Hollywood.

Kent Sepkowitz is a physician in New York City who writes about medicine.

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