Anesthesiology:
doi: 10.1097/ALN.0b013e3182065e36
Education: Mind to Mind

Going Under

Netzel, Lizabeth A. B.A.*
Section Editor(s): Cassella, Carol Wiley M.D., Editor

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IT IS 1958 and I am 4 years old, having a tonsillectomy. Just before surgery, I ask the doctor, “What do you do with the tonsils?”
“We feed them to the pigs.”
I imagine a trough brim-full of slimy, pink kids' tonsils. I inhale ether, which smells like my baby brother's diaper pail. I am at the mercy of strangers.
Fifty years later I am going under for a second time, for a laparoscopic hysterectomy. The surgery is not elective. Fibroids have made me bleed 115 out of 180 days—rivers, oceans of blood. I've been dropped to the floor by menstrual cramps. I've developed blood clots in my leg, swallowed “rat poison,” injected porcine intestinal mucosa into my belly, and endured daily blood draws. My hematocrit has plummeted to 19, and I've been transfused with two units of blood. In sum, I have no choice now but to forfeit my misbehaving uterus.
I've watched the procedure on the Internet. I've grieved for the babies I never had. I'm as mentally, physically, and emotionally prepared as one can be when under a state of siege. But there's one thing I can't prepare for: becoming a child again.
Having surgery, being anesthetized, means being helpless—vulnerable down to one's most raw, instinctual self—trusting one's caregivers to nurture us like mothers should, in a setting in which tending to emotional needs may be professionally self-defeating.
Going under is an intense, mind-altering experience endured while one is weak and humbled by pain. It forces the bravest, sanest adult to relive the visceral nightmares of toddlerhood, to shiver right down to his or her rubber-stripped hospital booties.
A technician botches the IV plant, apologizing as she mops my bloody wrist. Chin up. This is only the beginning, the adult in me warns. The anesthesiologist peers at me over neon-blue eyeglass frames and asks if I have any concerns. “Can you prevent vomiting?” I beg. Cool Blue assures me the drugs she plans for me will not have that effect. She soothes, “I'll give you a little something now, since you seem anxious.” I trust you. Honest, I do.
Nurse Baby Voice materializes from behind the curtain to walk me down a hallway to “the spa.” Landscape photographs on the walls seem to vibrate. We enter a brilliantly lit surgical theater in which blue-clad people are scurrying. I hear swine snuffling, rooting for their dinner. I clamber onto the table and tumble into the great void for a 4-hour surgical tour de force.
When I awaken, Nurse Spiky Hair asks if I remember yanking on my breathing tube. My throat is parched. I cannot breathe. My heart has been cut out by butchers—pig fodder? I whimper against my will until someone sends in a technician to perform an electrocardiogram, to rule out a heart attack.
Amazingly, I'm released the next morning, armed with narcotics and fresh syringes of anticoagulant. My now-flat abdomen bears three small, blood-black scars, a trio of prim hyphens dashed out by the shop tools of modern medicine. Three days later, I'm up and about.
Ten days into my quick recovery, 10-level pain slices through my guts, unrelieved by Percocet. Is this normal? I don't have a fever. The doctor said look for a fever. An agonizing 36 hours later, I'm back in Emergency.
The gynecologist on call is so cheerful, he actually laughs when I say I think the surgeon might have mistakenly left behind a clamp. “You set the bar pretty low for us,” he says. When I complain of pain, Nurse Crazy Eyes almost gleefully squirts Dualid directly into my IV, a sensation that is the closest thing to shooting heroin I am ever likely to feel. Given his vicarious enjoyment, I suspect he's tried it himself. The privacy curtain floats around me like a deep blue wave.
The computed tomographic scan reveals an abscess in my belly. Will they cut it out? Fill it in with a length of pig intestine? I know where the pigs are kept—out back behind the dumpsters. I am admitted to the hospital. Between noisy antibiotic IV treatments in the wee hours, I wake sobbing from a nightmare. I am riding my bicycle on a snowy, ice-rutted street. A cop car pulls up beside me and a woman steps out. She's a fake cop and shoots at me with a Taser. I don't know if I've been hit. I try to wrest the Taser from her hands, but I am too weak. She keeps shooting at me while I scream at her to stop.
At dawn, a swarthy staffer wheels me back to the now-dark and ominous computed tomography lab for a procedure whose grisliness I cannot conceive. I lie miserably in the gloom. At long last, the flamboyant technician who scanned me the night before appears. I recognize her long hair, cigarette breath, and cat eyes.
Forty-something Dr. Goatee explains that he will use the computed tomogram to guide a tube-sheathed needle through my buttock and pelvis all the way to the front of my body and into the abscess. Then he'll leave it there. He recites a litany of dreadful things that could happen, and has me sign a form saying that is all A-OK with me.
Mommy! By now I am weepy with terror. Cat Eyes leans over me like a lover and utters a stream-of-consciousness pitch about how she's seen this a million times, how Dr. Goatee walks on water and how I needn't be afraid. Then she introduces the anesthesiologist, Chipper Blonde. She is nearby mixing potions, and the two of them joke that she's going to fix me up with a fine little cocktail, inquiring whether I'd like a martini or perhaps some cabernet. I ask for a “gin-and-tonic.” Cat Eyes instructs me to roll onto my belly with my arms above my head, like I'm being shot from a cannon.
The room is cold and bright. Chipper Blonde squirts my IV full of Versed, a drug that leaves me conscious but mangles time. Dr. Goatee drives the foot-long needle while watching his moves on the computed tomography scanner being operated by Cat Eyes. I lie like a butterfly pinned to a board, overhearing snippets of animated conversation between Dr. Goatee and Cat Eyes about Obama's position on gun control. Cat Eyes insists that Obama will take away her guns. Dr. Goatee seems to acquiesce. I want to argue, but cannot speak. I imagine the two of them cackling madly, spraying pigs with a blast from their Uzis.
Some very deep part of my insides that was never meant to be touched is being invaded. I flinch at a sudden pain, like a snakebite, wondering helplessly if the anesthesia is wearing off. At the end of a procedure that I am sure has taken no more than 5 minutes, I am astonished to learn that an hour and a half has elapsed.
I suddenly snap alert, a drainage tube now protruding painfully from my left buttock. Dangling from the tube is a plastic bag the size of a paperback book. I endure another traumatic night, begging Nurse de Sade in vain for pain pills. By midday, roughly two tablespoons of yellow-orange fluid have drained into my pouch.
I long to regain the dignity, reason and self-determination that adults convince themselves they possess. As if in answer to my prayer, the saintly gynecologist on call removes my tube. It comes out curly, like a pig's tail.

© 2011 American Society of Anesthesiologists, Inc.

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