It was meant to be a smooth cancer-related hysterectomy surgery as physicians in Toronto hospital prepared to remove the uterus and ovaries of a 54-year-old patient as soon as the anaesthetics were in place.

Lynn Hillis had hoped that by the time she woke up, the surgery would have been well and over. But the prospect of a smooth recovery turned into a haunting nightmare when she woke up to excruciating pain as she felt the surgeons ripping her apart.

Frozen by paralytic drugs, Hillis lay helpless on the operating bed, unable to move or speak.

“Someone was inside me, ripping, ripping me apart,” Hillis testified. “It was excruciating. It was burning and burning and burning.”

"It's probably one of the worst sorts of things you can imagine anyone going through," said Hillis's lawyer, Stephen MacDonald.

A rare and devastating complication of surgery

Diagnosed with endometrial cancer in December 2008, Hillis was admitted to Toronto General Hospital for laparoscopic surgery to remove her uterus, ovaries and fallopian tubes, as it would help prevent the spread of the disease.

However, it was a devastating case of human error, and according to the judge, the patient woke up because of an anaesthetist’s negligence.

In the harrowing ordeal, the patient suffered ‘accidental surgical “awareness”’ - a breakdown in anaesthesia that can render patients helpless witnesses to their own operations. In ruling the medical malpractice suit, Judge Kendra Coats noted that the patient had no way of indicating something was wrong.

“She described trying to move, open her eyes and scream but being unable to get the attention of the doctors,” said the judge.

According to a British study, for patients who wake during surgery, the worst part is paralysis, not pain. After the operation, Hillis recounted what one expert called an “explicit memory” of the surgery, describing events without any prompting or questions, said Coats.

Patient wins Canada’s first malpractice ruling

Lawyers for the doctors say the anaesthetic was administered properly, and that the awareness, a known risk factor, was not the fault of anything they did.

They added that the case was compounded by the fact that Hillis suffered from a condition that prevented them from using certain gaseous anaesthetics, which are easier to monitor. Besides, there was no significant change in the patient’s heart rate or blood pressure, something that usually, but not always, occurs during awareness.

Hillis’s lawyers sued two anaesthetists — a staff doctor who did not stay for the entire operation, and a “fellow” — an advanced trainee — who was there the whole time.

However, the judge maintained the staff anaesthesiologist, Dr. Massimiliano Meineri, was not at fault and was justified in leaving the patient in Dr. Reza Ghaffari’s hands.

The judge has ruled in favour of Hillis suing the anaesthesiologist, making it the country’s first malpractice ruling.

Judge Coats concluded that Dr. 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.

A traumatic experience

The chance of waking during surgery is extremely small, says Dr Eric Jacobsohn, professor at the department of anaesthesia, in the University of Manitoba. It's unclear how often this occurs - about one in 1,000 surgeries - and Dr Jaconsohn says, “That means probably a couple of thousand people may have had an episode of anaesthetic awareness.”

“People wake up because the anaesthetic dosing for that patient at that time is too little,” he explains, attributing this to technical factors like failure of the anaesthetic machine or gas running out on the machine.

In the case of Hillis, it was a question of how much and when the anaesthetic was given. The two sides have worked out the compensation that the patient would receive though her lawyer declined to divulge the amount.

The experience had been more than traumatic and one that would continue to haunt her. Her lawyer MacDonald said Hillis needed several months of psychological and psychiatric counselling after the incident.

“Even during the trial she was at times very weepy and emotionally upset,” he said.

Hillis is not alone in her terror. In 2008, a Canadian patient, Donna Penner, who stayed awake through her one-and-half-hour surgery, was diagnosed with post-traumatic stress disorder afterward and still suffers from the condition. MIMS

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