You'd be able to watch."
"My own operation?"
Dr. Steve Auer was standing over my bed in the pre-op area at Beverly Hills Medical Center, a spare, white curtain pulled around us for privacy. Moments before, an orderly had shaved my right knee. Now Auer, an amiable, bearded anesthesiologist, was giving me the unexpected option of staying awake during my arthroscopic surgery. The surgeon had said earlier that I'd get general anesthesia, be put to sleep.
"That's merely what most patients want," Auer explained. "You have a choice."
I, too, was tempted to go to snoozeland. But everyone knows that general anesthesia can be risky--one patient in 10,000 doesn't wake up--and now there was this kicker. The surgeon would be guided by images from inside my body projected on a TV screen. If I went with "regional" anesthesia, I'd be able to see it with him.
"Let's do it," I said.
It was not until an hour later that I began having second thoughts. By then, I was prone in the operating room, watching my torn knee tissue swirl around a 20-inch Sony in living color while the surgical team muttered comments such as, "Worse than we thought" and "We'll have to cut all the way to the end."
Then there was the reaction of my wife when she met me in post-op. "You did what?" she asked when I told her of my morning's TV viewing. "You're nuts."
Only much later, when I started polling friends, did I discover that most people agreed with my wife. Very few could stomach the notion of watching their innards being cut and repaired, even if the action was filtered through a camera.
Yet two trends have made such surgical voyeurism almost an everyday option. The first is an impressive increase in outpatient surgery for which regional anesthesia or nerve blocks--simply numbing part of the body--make it easy to enter the hospital in early morning, have an operation on cataracts, hernias or whatever, and leave by lunch, clearheaded. The second is the increasing use of narrow, fiber-optic scopes, which enable surgeons to work in the body without slicing it open.
In my case, the scope was going into my knee, which had given way during a tennis match. A veteran of athletic injuries--I wear so many bandages that friends call me "the mummy"--I know when it's time for an orthopedic surgeon.
"There's severe tear of your lateral meniscus," Dr. Clive Segil reported, referring to the sheath of cartilage that provides cushioning in the knee. "Three tears, in fact."
Segil later confirmed why he didn't mention the possibility of my staying awake for the two-hour operation--fewer than 10% of his patients could fathom that option. Usually it's "Do what you have to do, Doc, then wake me up when it's finished."
I nodded, thinking of my wife. She won't eat fish if it's served with the head attached, eyeballs staring back. Yes, she'd go the lights-out route.
But I sensed something else at work--the preference of surgeons, as well, to have unconscious bodies before them. I could understand how an alert patient might disrupt the operation, pestering the surgical team with nervous questions or, in a worst-case scenario, panicking. And what doctor would want to worry about some Bozo on the table misinterpreting a routine comment, perhaps a harmless little "Oops"?
Of course, I wouldn't be a problem. If I was going to be awake, I'd be a relaxed, model patient. After all, women watch themselves give birth every day, don't they?
Utah is the place to go," Auer said. He was chatting with the nurse about ski vacations as they wheeled me toward the operating room.
"No fair to talk about such adventures," I interjected, "before a pitiful, sidelined athlete."
"OK," Auer cautioned the nurse, "no talk about golf games."
Moments later, Auer was putting a needle in my wrist, injecting a sedative.
He inserted a second needle near my lower spine. Epidural anesthesia. In 10 minutes, my lower body would be numb.
A drape was placed over my chest, obscuring the direct view to my knee. Whatever I'd see would be on the TV to my left.
Segil made three incisions. The first, above the knee, was for a tube to flush in saline solution to swell the area like a balloon, making room to poke around.
The next, below the knee, was for the arthroscope. It would provide the "lights" and "camera" for the morning's entertainment.
And there it was. It reminded me of the first shots of men on the moon, how you expected them to be all fuzzy, but they were as clear as home movies taken in your back yard.
The screen was showing shredded tissue--white fragments, some floating loose. There was blood as well, the tiny camera picking up the red just fine.
The "action" part of the production came last. Forceps the size of a pen tip emerged through the third incision, also below the knee. On the screen, they looked like a giant PacMan, opening and shutting its mouth to gobble up useless tissue.
Although the sedative had made me groggy, I was alert enough to ask, "What's that?"
But my attention soon drifted to my throat. It was incredibly dry. Auer got some lemon-flavored swabs I could suck on.
As the saline solution flushed through my knee, the scene on the screen resembled debris whirling in a tornado.
"Quite extensive," I heard someone comment. "How'd you say he did it?"
"It looks like a football injury."
Had 10 minutes passed or an hour? My throat was parched again. I'd gone through a package of three lemon swabs.
"You have any more?" I asked.
"You may have to go to the sixth floor," someone told an orderly.
The screen was showing more cracked tissue. Pac-Man gobbled on. Suddenly, I'd seen enough. I wondered whether there'd be any cartilage left. I had visions of my bones colliding with each other.
"Are we almost there?" I asked.
"Not quite," Segil said.
The orderly returned with a new package of swabs. I stuck all three in my mouth.
My mind started to wander. Then I heard a voice, Segil saying, "Let me show you what healthy cartilage looks like." He'd taken out 80% of the meniscus, but reached the end of the disaster zone.
Soon I was being wheeled to the recovery room.
A few weeks later, while Segil was testing the flexibility of my knee in his office, I asked what he would have done in my spot--watch or take a general anesthetic?
A 52-year-old second-generation surgeon, he surprised me with the emotion of his response.: "I'm afraid of anesthesia. I don't want to go near the operating room. My problem is, I don't want to lose control. I know what can happen." If he had to go under the knife, he said, "I'd go for a spinal."
I later learned that most physicians choose that option when they have surgery like mine. I felt relieved. In that case, they didn't really mind an occasional patient staying awake. Right?
"It's fine," Segil said, "as long as the person is not interfering with your concentration. If they keep asking, 'Why are you doing this?' the nurses can get upset."
Certainly I hadn't done that, had I?
After a pregnant pause, he noted, "You did keep mentioning that your mouth was dry. Someone had to run out of the room." Maybe he saw my face drop. "Remember," he consoled me, "this is from the surgeon's point of view."
So, would you do it again?" my wife asked as we drove home from the hospital after the surgery. Through my physical discomfort, I was enjoying her ranting about how foolish I had been to watch. I was defending myself with the old "You, squeamish woman--me, manly man" bit.
"So-o-o-o-o?" she repeated, turning to stare me down as we stopped at a traffic light. "Tell the truth. Would you do it again?"
"Well," I dodged. "I'm glad I did it once ."