Expert: JM Starkman, MD - 7/2/2009

Question
I have had several surgeries in Baltimore. I remember waking up in the OR at the end of the procedures or in the RR. I remember being on a ventilator briefly and being extubated. I was cooperative and considered the experience not a big deal.

I now live in Wilmington, NC. Several years ago, i had CABG surgery and spent 4 days in the heart ICU (so i'm told). This was considered routine. 20 years ago i was an open heart ICU nurse and was looking forward to experiencing being the patient. Apparently, Versed was used while i was in the ICU; my visitor told me that i was conscious, talked appropriately, and seemed to be cooperative. I resent missing the experience. I'm not a masochist but i have a high pain tolerance and am certainly knowledgeable about postop expectations. When i was a practicing nurse, we didn't used amnesic drugs and most of our patients seemed to selectively forget their ICU stays (most didn't recognize or remember the nursing staff if we visited them after they were transferred to a regular room).

One month ago, i had a carotid endarterectomy. Before surgery i was interviewed by 3 different anesthesiologists and i told each about my heart surgery experience and requested that Versed or a like drug not be used. They all argued that the OR experience was not one that i would want to remember. How dare anyone presume to know what i think or want to remember. I said that my memories were mine and didn't want drugs to interfere with them, etc. I finally agreed that they could use anything they wanted during the actual surgery but i wanted to be awake in the RR. Well, i have no memory of the RR or my visitor, etc. Ahhhhhhhhh!

In 2 weeks, i'm scheduled for a nephrectomy. What can i do or say, without being threatening, to wake in the RR and have my memories intact? I understand why amnesics are used and don't want to be awake and paralyzed during the surgical procedure, but before my experiences in this hospital, surgery always went well and i was awake and aware in the RR. My friends all agree that they wouldn't want to remember ventilators, being intubated or extubated, etc. I say, OK, but i do. If i were to freak out, then i should be sedated, but as long as i'm cooperative, i want my memories.

Thank you for reading my story and i'd appreciate any advice you can give me.

Answer
Apparently, there are no limits to the pompousness of physicians (this time anesthesiologists) who "think" they are qualified to overrule their well-informed patient's life decisions.  You're an experienced nurse so you've seen this all before;   here are a few suggestions that may help:

1.  Make sure that the same group of anesthesiologists that violated your request for no amnestics is not involved in your next surgical experience.  If it requires changing hospitals then so be it! If that's the case,  make sure the administration of the hospital knows why---in writing, and written as professionally and politely as possible to garner credibilty for yourself. You can bet it will get back to the egocentric anesthesiologist who was there for your CEA.

2.  Add "no amnestics" to your surgical consent and to the hospital admission agreement.  If that is not acceptable to anyone, then see (#1) above.

3.  Lie:  tell them you're allergic to versed, valium, lorazepam and make sure it's plastered all over your chart.  Given the degree to which today's nurse-bureaucrats enforce the "allergy rules"  as opposed to time-honored  patient-advocate requests, this will undoubtedly work quite well to achieve your end.

4.  Please give reconsideration that the anesthesiologists were right to begin with....and "leave the driving" to them!  (After all, you're a risky patient to anesthetize with your vascular disease and marginal kidney status;   you had major surgery--and you're alive and well to complain about it!)