My patient screams suddenly in my Post Anesthesia Care Unit (PACU). She had a simple incision and drain of a small abscess, and her surgery was only 20 minutes long. She had no previous medical history, and was counted as a healthy woman in for a simple surgery. So you can imagine the surprise in the department when she began screaming for help.
For patients waking from anesthesia, the experience is often shocking. There is a loss of time, and it doesn’t matter if the procedure was 5 minutes or 5 hours, every patient must reset their grip on reality. Some patients cry when they wake up. Others smile and appear quite content. The reaction is unique to each person and one can never really tell what it will be. It is as if anesthesia takes away all of the coping mechanisms, facades, lies and masks we have put up and our most base and naked self is revealed. I have had loving fathers and husbands raise fists to me as I approached with ice water. I have had little old ladies go on and on about how thankful and appreciative they are. Other patients sit quietly and weep, and they don’t even know why. The baggage we carry is spilled onto the floor when we wake up from anesthesia.
Today, my patient is yelling for help. We rush over and make sure she is safe. Her fear is visceral and her wide eyes are like glass as she scans the room in panic unable to register her surroundings. We calmly deliver some fentanyl and versed to calm her back to sleep and give her another chance to wake up. In about 20 minutes she wakes up again, startled, but redirectable. I introduce myself and tell her she is in the recovery room. She looks around a moment, then closes her eyes and starts to cry softly.
A fresh warm blanket and tissues is all she needed, so I comforted her by being present and silent; allowing her space to process her experience. After a time, she turns to me and says that she is sorry. I affirm to her that tears are not uncommon after surgery. She reports that she does not have any pain from her surgery. And then she told me a story.
Anesthesia takes away our filter, as well as our mask. Here in the corner of the recovery room, my patient tells me about how she was molested by her dad when she was young. She describes how he would take her camping, or stay up watching movies, or read her stories at night, that became something so much more horrifying. This went on for years, and she never told anyone. She ran away from home when she was 17, and never looked back. It has been decades since she has even thought about it, even longer since it happened; and together we put the final nail in her unprocessed fear and anger about her life experience by simply talking it out over saltine crackers and ice chips.
All of us carry the scars of past hurts. Abuse, embarrassment, shame; any number of difficult experiences. When we are wounded, we convalesce for a time, then a scar is formed and move forward. I have coped with tragedy in my own life as well as bore witness and assistance to the tragedy of others. What I have discovered for myself, as many people I wake up from surgery have, is a realization of just how thinly veiled our coping is.
I love the fact that this place is called the Recovery Room. Many people I love are still in recovery, trying to loosen the tourniquet of deep pain and bad decisions. In “recovery” not related to the hospital, the word evokes a sense of prolonged work and devotion to self mastery that may take a lifetime. In the real world, recovery is learning to cope with reality by accepting reality. Reality is a bear. It's like we were trained as young children at it's very sight to either scare it away by pretending to be bigger then we are, or drop to the ground and protect our most vulnerable parts. Some may spend most of their lives in this fetal position, praying that "Bear Reality" will wonder off and leave them alone. Lay in the dirt long enough, and suddenly a good coping strategy becomes a death sentence. Reality is pill. A pill so hard to swallow many would rather choke themselves to avoid it than risk asphyxiation by capitulation of their imagination to reality. Be it a bear, or a pill, or a fear, or an inadequacy; reality isn't going anywhere. Sooner or later, we all will have to face it. That is what real recovery is; a lifetime of facing your reality. In the hospital, the Recovery Room is perhaps the shortest visit you will have. Between 30-90 minutes and you are recovered, ready for the next step in your life after surgery. In the Recovery Room, the emotional scar of being terrified of surgery will fade long before you even develop a scar on your body. In the real world, the emotional scar will hardly begin healing after the physical scar has long since faded.
This world of healthcare is incredible, and intimate, and vulnerable, and deeply personal. We stand as butlers and stewards of other people's journey; protecting them from themselves with education, a calm voice, and sometimes restraints. I am blessed to have been present when this beautiful person finally faced and put away her past by speaking her truth. Decades of pain, now managed and packaged up for good. Recovery only took 73 minutes, and someone else is calling for ice chips.