What I’ve Learned About General Anesthesia
In 2000 I had surgery on an adrenal gland (near the kidney). I’ve been wanting to pass on some tips about general anesthesia.
First of all, surgery can be a marvelous thing. It can keep people alive. General anesthesia is an essential part of many surgeries and helps make many other surgeries possible under the current levels of counseling resource in operating rooms. Although scientists still don’t know how general anesthesia works, in recent years it has apparently gotten “lighter” and more quickly recovered from, due to insurance-company pressures to shorten patient time in hospitals.
What’s called “general anesthesia” is really a “cocktail” (a mixture) of chemicals tailored to each patient. One of a relatively new group of drugs called “amnestics” (“forgetters”) usually goes into the cocktail purposefully to make the person forget the surgery, unless one specifically requests not to have it. Versed is one brand name for midazolam (generic name), a familiar example of an amnestic. It’s a good idea to discuss anesthesia ahead of time with both your doctor and the anesthesiologist. (My anesthesiologist didn’t argue about Versed being left out.)
Sedatives or tranquilizers, for example, Valium, sometimes have a medical purpose such as to relax certain muscles. (I agreed to have this during my surgery if it turned out to be medically necessary, but I don’t think I ever got it.) Otherwise, they are just to make the patient docile and “comfortable” and can be left out of the cocktail if the patient can remain calm and still so that the doctors can work.
An anesthesiologist told me that all general anesthesia has some “forgetter” effect. He said that’s why they don’t use it for Caesarean childbirth, so as to guarantee that the mother can remember the birth and foster the important relationship with the newborn. For Caesareans they use “regional” anesthesia instead. For my surgery, I had a regional anesthetic (“Bupivocaine,” a cousin of what they use in dental work) in the rib/adrenal-gland “region” and also general anesthesia. An experienced nurse who is a Co-Counselor told me why a regional anesthetic is prefer- able. It blocks the pain impulses locally and doesn’t affect the mind. Morphine, on the other hand, enters the brain. It does not block pain impulses but rather tells the mind that it can’t feel them.
THE ANESTHETIZED PERSON IS “ALL THERE”
Harvey Jackins wrote that as in all human experiences, the anesthetized person is “all there.” All the memories are recoverable through discharge. Anesthesia causes both physical hurts (that need to be dis- charged by yawning) and emotional hurts (that need to be discharged by crying, trembling, and so on). Harvey wrote that everything that goes on while a person is anesthetized “is installed as a recording. Such a recording needs to be discharged thoroughly, not only because of the physical shutdown, pain, and so on, that have been recorded, but also because any words and other sounds which have been recorded during the anesthesia can have very compulsive effects on the individual if the recording is allowed to remain in place. The results can be as bizarre and harmful as anything ever demonstrated with ‘hypnotic’ commands.” (The List, section 8.028)
I remember Harvey talking about an RCer who had odd thoughts after surgery until she recovered the memory that the surgeon had said something offensive in the operating room. She went back and told the surgeon that she knew she had been spoken about in a derogatory way. The surgeon paled, was shaken, and admitted it. Apparently it is not unusual for hospital staff to comment disrespectfully about their anesthetized patients as they work.
Even “neutral” and “good” messages heard under anesthesia become recordings and create difficulties. Someone wrote about this in Present Time (April 2002). While she was under a “twilight” drug for a procedure (not full general anesthesia—she was still conscious), her medical people said something favorable like, “It’s all over. There’s nothing left.” They were referring to whatever they wanted to remove from her body. Her mind took it in literally and interpreted it as a message of doom, as if there was “nothing left” in her life. She felt “depressed” until she suspected what was going on and found a way to discharge. She told Harvey the story several times, and he said that we underestimate the work we need to do after operations involving anesthesia.
In order to minimize distress recordings from spoken words during general anesthesia, I used earplugs and earphones connected to repeating taped music. My surgeon agreed with Harvey that the anesthetized patient is “all there” and said he tended to speak only quietly while working. (Surgeons generally seem used to patients’ music or other tapes in the operating room.) I later learned that during the surgery the surgeon had some long moments of doubt about my future, then solved a tricky surgical problem. (He looked really pleased after the surgery.) Possibly that’s why I feel like I died already but don’t “remember” any particular tension coming from that experience.
With all my efforts to avoid spoken sentences coming in as recordings, I seem to have acquired a different recording. I got addicted to earphones. I often can’t sleep now without ear-phones playing the radio very softly. I did try to avoid exposure to terminology that associated anesthesia with sleep: “being put to sleep,” “waking up,” and so on. Actual sleep is such an alive, full activity—with dreams, drowsiness, relaxation, all sorts of great body processes—completely distinct from a drugged state.
COUNSELING ON ANESTHESIA
During my birth in 1944, my mother (and I) had a documented overdose of general anesthesia, either scopolamine or sodium pentathol. I had an “aha” moment when I heard from a Co-Counselor what those 1940s anesthesias did. Instead of numbing the birth pangs, they made birthing mothers forget the experience by causing hallucinations so upsetting that they were occluded. It is not yet clear how these anesthetics work, but the dose that anesthetizes is very close to the dose that kills (Scientific American, 2001).
I’ve done a lot of discharging on my birth. My initial impression was that I had fought the oblivion long and hard and had managed to prevail and keep a little flame of vitality alive. However, as a result of counseling, I’ve realized that what had felt like a long fight during birth was actually of very short duration, almost instantaneous—and that I had been overwhelmed and had to succumb to the nasty stuff. Over the years I have struggled with the elusive character of anesthesia-installed “non-feelings,” “mental fog,” numbness, indecision, hopelessness, pulls to take drugs, pulls not to feel, and a sense that everything is hard and awful.
Other patterns probably ascribable to early anesthesia include feelings of fury at the world and people; a tendency to live “near the edge” with insufficient resources and insufficient margin of slack; fear of ambient chemicals; fears about not surviving; nausea, seasickness, physical disorientation, exhaustion, and a variety of other physical recordings; forgetfulness; unusual thinking processes; aversion to fighting for myself; isolation; negative feelings about myself related to things said about me while I was still anesthetized.
When I first began counseling on anesthesia, my impressions of it were inaccurate. I had an illusion of well-being, even though undergoing anesthesia is actually scary and feels horrible. When I was coming out of the anesthesia after my recent surgery, the evening looked outstandingly beautiful, the lights were twinkling in the nearby buildings, I felt a great sense of well-being in my body, my bed was marvelously comfortable—all morphine-induced feelings, which I can bring back if I think about that time. Because Co- Counselors might “feel” good when they think about their surgeries, they might conclude that they have nothing to discharge.
After the surgery I did what Harvey suggested. I recounted all that I remembered up to the near edge of the “gap,” then took up the story again at the far side. Although I haven’t finished this work, I have recovered shadowy impressions of feeling unspeakably alone because of the thick obstruction of my non-feeling body between me and any friendly human touch.
I have also noticed recordings of feeling “depressed” and recordings that I “died already,” which date from the surgery. (I’ve heard from a wide world source that it’s common to feel such things after general anesthesia.) The surgery seems like a “continental divide” when I look backward. I have to re-remember facts from before the surgery in order to haul them over to this side of my life. My legs want to twitch at times, which is new. (I shook best after the surgery when touched physically around the incision by a particular Co-Counselor and by three brilliant non-RC health workers.) I have obtained medical reports and internet information and have counseled about what I’ve learned and about wanting information generally. In counseling on both the early and recent anesthesia experiences, I have impressions of heightened colors.
Although I still have much to discharge about the recent surgery, I got some good tips and did some things that diminished the after-effects of the experience.
MY EFFORTS TO MINIMIZE DRUGS
Before scheduling the surgery, I said I was too afraid of anesthesia to have surgery right away. The doctor seemed amenable and gave me six weeks.
As is typical, the hospital gave me an interview ahead of time with an anesthesiologist, but that person was not necessarily going to be on duty at the time of the surgery. Therefore, I wasn’t able to be confident of the attitude of the anesthesiologist I would have. However, in Massachusetts at least, it is illegal to drug a patient against the patient’s wishes. With that law to back me, I generally got across that I wanted the minimum of drugs. I saw fifty health workers in my seven days in the hospital. I told every one that I didn’t want drugs. New ones would come into the room, read the big notations on my chart, and say, “So you’re the woman who doesn’t want many drugs.”
In addition to mentioning my drug views to all and sundry, I went to the hospital as a counselor, not a client. It’s a lot of work, but there’s no question that it’s the best thing to do. The staff were too pressured and their ideas were too at odds with mine to make me want to put myself fully into their hands.
Further, hospital patients should have someone there to advocate for them—at all times. That person, standing up and wearing regular clothes, is much more effective than the prone patient in a nightgown, hooked up to tubes, and having a lot going on physically. (I got this good advice from a former hospital social worker.)
I had two successful arguments for minimal drugs. First, I said I believed that people heal better with fewer drugs. No one argued with me, and many seemed to agree. Second, I said that like my mother I was ultra-sensitive to drugs (which is true, but I would have said it even if it wasn’t true; and anyway, people who generally use few drugs tend to be more sensitive to them). My mother and I had both been overdosed with anesthesia, I said, and we both tended toward fainting. (That argument makes them think about malpractice lawsuits.) I had to keep up the push against more drugs with everyone I saw. Nurses, especially, want to make patients “comfortable” and generally equate the discharge of a hurt with the hurt itself. They don’t consider that pain “un-felt” will show up later to be felt. They don’t know that pain recordings hinder healing.
The anesthesia comes in through tubes (into veins) that remain for a few days after the surgery. My anesthesiologist readily agreed that I could stop routine intravenous morphine once the surgery was over. That didn’t, in fact, happen because he was off-duty and I was too groggy from the morphine to protest (and my advocate was exhausted and underdischarged); so I have an extra twelve hours of morphine to discharge. I had the minimum permitted of the regional painkiller afterward, and much of that happened to leak onto the bed. I never used the button for self-administering more regional painkiller.
So once I had the morphine stopped, I didn’t have much pain- killer, and from what everyone told me, I had a really big surgery. The hospital’s argument in favor of painkillers was that the body has to move—for example, to cough to keep the lungs clear of fluids and hence pneumonia, or to walk. When they told me I wasn’t clearing my lungs well enough, I figured out how to laugh. That worked well to clear my lungs. On the third day, I was able to cry (for the first time) when a Co-Counselor sang me a moving song. That was also good for clearing my lungs.
Once the tubes were removed, I did not use the suggested over-the-counter painkillers. My surgeon said, “That makes you a group of one.” I do have numbness recordings, but it was never a struggle to go without drugs.
SUPPORT FROM OTHERS
Getting help for a surgery is a big project that can put a burden on people. I tried to rely on friends and family rather than Co-Counselors where there was a choice. Friends and family were a small group, but they were troopers.1 My Co-Counseling “surgery angels” also put themselves out 2 enormously. I was one of a string of people who’d had surgery that year in that Community, and I hadn’t been participating full-time there for some time.
My Co-Counselors advised me that if I had to allocate scarce counseling resource, it was even more useful before the surgery than after, so that I would be relaxed and in good shape for the experience. This I wouldn’t have figured out by myself. I was lucky to be in a big counseling Community with lots of people I knew and trusted who were willing to offer me time both before and after. Beforehand I had sessions and a little intensive. 3 In these, I decided to “cooperate” with anesthesia, talked to all my body parts as their leader, and discharged more on the early scares.
Counselors went with me to pre-surgery appointments to take notes, help me think, and let me discharge a little. During the surgery, one counselor stayed at the hospital all day. I felt I couldn’t face the restimulation of my birth scare without knowing that that particular thinking person was in the building. After the surgery, it was great to have a couple of people come in every day and to tell them about the experience. I didn’t have enough attention to be a full client at first, which I think is to be expected. I eventually regained enough attention to client fully, then to do two-way sessions. A couple of much-appreciated organizers helped all this happen. I was motivated to work even more on early anesthesia hurts.
I am so glad I had some RC information independent of the great and valuable information I got from the doctors. I do have a warm feeling of help and connection when I think of all the family, friends, and Co-Counselors who gave me their attention during the experience.
In my perfect world, I would have had the surgery without general anesthesia (which was technically possible). In addition to getting the kind of counseling I did get, I would have been tutored beforehand about surgery in general and mine in particular. I would have watched surgical preparations and operations ahead of time and discharged about them so that I wouldn’t get upset or startled on the day. I would have had rotating skilled surgical “attention-givers” for me in the operating room, with both our faces inside some kind of soundproof “spacesuit” contraption and a way to hold hands. I would have been free to be client within the constraints of having to hold still, keep my body relaxed, keep my attention out, and shield the medical staff from my feelings. The medical staff would have been fully discharged and would have had extensive background training in the impeding effects of drugs and the accelerating effects of discharge on physical healing. They would have had their own specialized attention- givers as they worked.
1 They were troopers means they tirelessly and admirably did what was asked of them.
2 Put themselves out means extended themselves beyond what was expected.
3 An intensive is several hours of one-way counseling.
Reprinted from Present Time No. 134, April 2004, page 18
Learning More . . . .
I recently learned more (about anesthesia) when my daughter had a small surgery on her neck (thyroid).
First, I learned that it is possible to have a general anesthesia without morphine or any other narcotic. Because my daughter was nursing her baby, when she asked for minimal drugs the anesthesiologists listened. (She would have asked anyway for no amnestics, such as Versed, that make you forget the whole experience and for no sedatives or extra painkillers.) They offered her anesthesia without morphine—just plain general anesthesia. They called it a “hypnotic.”
The surgeon, who does three hundred of these surgeries a year, said that my daughter was the most alert patient coming out of anesthesia that she had ever seen and that maybe the hospital should change its protocol. My daughter was also spared the illusion commonly induced by morphine that the surgery was pleasant. In the days following, she got to feel yucky (bad) when she was falling asleep, she had bad dreams, and so on.
Second, I learned that doctors consider general anesthesia a “hypnotic.” I had already linked in my mind what Harvey Jackins said about hypnosis and what he said about anesthesia. Both seem to involve ceding decision-making power. I had excessive anesthesia at birth in the 1940s. I struggle with decision. I understood Harvey to say that anesthesia recordings and hypnosis recordings are especially sticky and persistent. Maybe both are especially hard to “decide your way out of.”
There is a growing body of experience with and information about general anesthesia for surgeries, including in articles by Barbara Deck (Present Time No. 127, page 37), Elizabeth Skidmore (Time Present No. 139, page 12), and others in more recent issues of Present Time.
Seattle, Washington, USA
Reprinted from Present Time No. 149, October 2007, page 15