Lynn Hillis’s cancer surgery at a Toronto hospital started smoothly enough, anesthetic knocking her out as physicians prepared to remove her uterus and ovaries.
But then in mid-operation, Hillis suddenly was not unconscious any more: she felt the surgeons inside her abdomen, heard them talking, and experienced burning pain.
And yet, frozen by paralytic drugs, she was unable to move or speak.
“Someone was inside me, ripping, ripping me apart,” Hillis testified recently. “It was excruciating. It was burning and burning and burning.”
Someone was inside me, ripping, ripping me apart
The 54-year-old had suffered the nightmare scenario known as accidental surgical “awareness,” a breakdown in anesthesia that can render patients helpless witnesses to their own operations.
And in what appears to be the first court ruling on the issue in Canada, a judge hearing the woman’s medical-malpractice lawsuit has just ruled that Hillis woke up because of an anesthetist’s negligence.
The patient had no way of indicating something was wrong, noted Judge Kendra Coats in a ruling released this month.
“She described trying to move, open her eyes and scream but being unable to get the attention of the doctors,” the judge said.
She described trying to move, open her eyes and scream but being unable to get the attention of the doctors
The two sides have agreed on how much compensation Hillis will receive, but her lawyer, Stephen MacDonald, said he was unable to divulge the amount at this time. A lawyer representing the doctors could not be reached for comment.
The case underscores a rare but devastating complication of surgery, arguably once given short shrift by medicine but now the focus of research and preventive measures.
Evidence suggests that awareness happens in as many as one surgery per 1,000, though some studies have concluded it’s much less frequent. As well, patients don’t always feel pain and it can last for as little as a few seconds.
In Hillis’s case, the question of fault boiled down to how much anesthetic she received, and when.
The patient had been diagnosed with endometrial cancer and in December 2008 entered Toronto General Hospital for laparoscopic surgery – made without a large incision – to remove her uterus, ovaries and fallopian tubes to prevent the disease spreading.
It was excruciating. It was burning and burning and burning
Hills sued the two anesthetists who handled her case – a staff doctor who did not stay for the entire operation, and a “fellow” – an advanced trainee – who was there the whole time.
After the operation, Hillis recounted what one expert called an “explicit memory” of the surgery, describing events without any prompting or questions, according to the ruling by Coats.
Lawyers for the doctors say the anesthetic was administered properly, and that the awareness, a known risk factor, was not the fault of anything they did. The case was complicated by the fact that Hillis suffered from a condition that prevented them from using certain gaseous anesthetics, which are easier to monitor.
And there was no significant change in the patient’s heart rate or blood pressure, something that usually but not always occurs during awareness.
But Coats concluded that Dr. Reza Ghaffari made a mistake when he failed to sufficiently increase the dose of intravenous Propofol after reducing the flow of nitrous oxide at the request of the surgeons. The gas was distending Hillis’s colon, making it difficult for them to carry out the procedure.
The staff anesthesiologist, Dr. Massimiliano Meineri, was justified in leaving the patient in Dr. Ghaffari’s hands and not at fault, the judge said.
It started with the nightmares. It’s been nine years and I still have nightmares. I still wake up screaming
Hillis needed several months of psychological and psychiatric counselling after the incident, said MacDonald, her lawyer.
“Even during the trial she was at times very weepy and emotionally upset,” he said.
That comes as no surprise to Donna Penner, a Winnipeg woman who had an agonizing episode of awareness in 2008. She was diagnosed with post-traumatic stress disorder afterward and still suffers from the condition.
“The impact was just profound,” she said. “It started with the nightmares. It’s been nine years and I still have nightmares. I still wake up screaming.”
But, as a spokeswoman for the Canadian Patient Safety Institute, Penner has strived to get doctors more focused on the issue, and speaks regularly to anesthesiology residents and medical students at the University of Manitoba.
Penner said the doctors in training have told her that listening to a patient’s story directly gives them a new appreciation for the impact of the phenomenon.
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