Happy Talk

My next newspaper column. Chillin' at the end of a nice vacay in Hawaii.

Taking a mental health break from Donald J. Trump, VSG:

"Thangzz doc yer th greatiss .... No, rilly man... yer the... zzzzz ..." "Wha? Operation's over? No way. You're kidding, right? Oh yeah, lookit that. Wow. The operation's over? No way. You're kidding, right? Over? You're kidding, right? Is the operation over? You're kidding. Right? Oh yeah..." "I robbed a bank, y'know. Had to kill a guy. Put the money in a Swiss bank. The account number is...."  

I've been asked frequently: "Did I say anything when I was out?" Readers of my blog wondered the same. Evidently, it's a pretty common concern: do people reveal stuff or otherwise embarrass themselves when under the effects of anesthesia drugs? Relax, people: the answer is "no." Mostly.  

Sodium pentothal, formerly used extensively in the operating room but now largely replaced, has been referred to as “truth serum.” Whereas it's still true that under the influence of para-surgical drugs people can get a little disinhibited, it's not the case that they'll get all revelatory. I haven't learned any secrets from my patients. When asked, however, I've been known to say, "Well, you did mention a Swiss bank account." Only once did that result in a worried look. 

Most surgical patients get a little something to relax them before they get wheeled into the OR. It's not unlike a couple of my perfect martinis. So yeah, tongues loosen a little. Giggles sometimes; rarely, tears. "Wow, this feels great..." Stories get told. Amusingly, when the story is interrupted mid-sentence by the arrival in their brain of the knock-out punch, I've seen people wake up later and begin exactly where they left off, unaware of the passage of time. And yet, I've never heard anyone say anything they'd be sorry about. Except telling me how wonderful I am (for my regular column-haters, there’s no drug that potent.)  

When possible, I enjoyed operating on awake patients. We’d talk, usually light-heartedly. Given some sort of anti-anxiety drug, the conversations can be loose, chatty, funny. People will say the same thing over and over, ask the same questions repeatedly. My goal is to keep them comfortable; if they want to ramble on, it's fine with me. Most often they doze, wake up, talk a little, doze some more. It's pleasant, not confessional. 

Because such talk is commonplace, even when particularly entertaining it went out the other side of my mind as quick as it enters; my head -- and, I'd aver, those of everyone else in the OR -- is a sieve that way. Talk like that is texture, not substance.  

The flip side of this is a theoretical utility. Studies of suggestibility under anesthesia are equivocal. Still, I liked to give some positive thoughts to my patients as they went off to sleep and when they emerged: "We'll take good care of you. You'll be comfortable when you wake up." And, after it's over, "Everything went great. You'll be happy we did this. Comfortable, no nausea." I have no idea if it had an effect or not. 

I always made it a point to talk to my patients when they were awake in the recovery room, not only telling them how it went but -- unless it wasn't true -- telling them I expect things to be fine, give them some positive vibes. With practically no exceptions, no matter how engaged and appropriate they were in those conversations, people never remembered what was said, or even that I'd been there. Or that they'd asked me the same thing five times in a row. But I always did it.  

If it were possible, I'd love to see a study of people wherein, within a standard time of awakening, they'd hear suggestions. Some would hear words saying they'd be comfortable, be up and out of bed soon; others would hear something neutral, unrelated to pain. The floor nurses wouldn't know who heard what. Pain medication use would be recorded, along with nausea, time before getting out of bed. I'd like to think the former group would outperform. (The studies I'm aware of played recorded messages during surgery.)

The problem with any sort of surgical studies is that even when operations are "the same," they really aren't. Different surgeons, different operating times, incision size; different people getting the procedure, for differing reasons. It's really hard to standardize. Still, it'd be interesting. Valid or not, I liked doing it. 

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