emergence delirium

On PTSD, anesthesia, and other matters of the body

I woke up on the gurney in February and my breasts were still there. Gigantic, pendulous, horrible things, a constant reminder of my deep failure at womanhood and of men putting their hands on me when I did not want them to. One of the first things about me people noticed. Short, mean face, fat, big tits—an introduction I did not want. It was all wrong. They bent my back, they strangled me in my sleep, they made clothes unwearable and my torso disappear. People said I had such a fertile silhouette. (My reproductive system, which I can only describe as a hostile environment, would beg to disagree.) You’re not having kids? … Oh.

I had been through a year of waiting and doctors signing off and being evaluated and having my dysphoria medically confirmed and raising money I did not have. They were supposed to be gone. 

I woke up on the gurney in February and my breasts were still there. 

It is hard to describe the sensation of coming out of anesthesia—less a fog lifting than everything being too light, too loud, too strange, too sudden. It is even harder to describe coming out of anesthesia to find a thing you have wanted and worked for for a very long time has not happened.

I kept touching my chest. It couldn’t be real. Sick joke. Sick joke. Sick joke.

My partner was there, and my surgeon, holding my hand: “You went tachycardic during the initial anesthesia. That means your heart rate and blood pressure went so high we had to cancel the surgery. If you’d stayed that way, you could have had severe brain damage. We couldn’t let that happen to you.”

I began to cry. Big, stupid, body-wracking, bubbling-up sobs, childish and primordial. My body had been betraying me my whole life. Now it had sabotaged my attempts to change it to be more livable. I could not stop crying. Big, stupid, gluey crying, snot glopping up my throat. It felt endless. 

What happened to me, it turns out, was residue from all those men who had touched me when I did not want them to. You can be in therapy for decades, careful and conscious of your choices, much more functional than someone who grew up with the amount of violence you did should be. You can do all the right things with the resources you need and still it is there, in your limbic system: you are not in control and you should run. People are touching you and you should run. It happened, specifically, when they tried to put the tube down my throat, to clear my airway for the ventilator that was supposed to breathe peacefully for me. Remember when you had other things forced into your mouth and down your throat. Remember gagging. Remember fury and terror and pain and sadness and how you wished you could bite down but you were afraid they’d kill you. You clench your jaw a lot now. You grind your teeth.

The cardiologist who stood in the way of trying again saw the fat first. I told him that I was diagnosed with PTSD, that I had been in treatment for a long time. I described to him what happened. I described to him my levels of activity, and that I was also in therapy for an eating disorder—not uncommon for sexual assault survivors. “You need to lose weight,” he said dispassionately. “Go to the gym four or five times a week.” I told him how I used to run myself on the treadmill for over an hour, sometimes two, eyes glued to the calorie counter, trying to winnow my unyielding flesh into nothingness, trying to erase myself. How I fainted a lot. At work, in the car. It is not that I wanted to be desirable, necessarily, though I did feel as though my body—an anonymous thing to be used, a Kleenex made of skin and bone—was all I had to offer anyone; I wanted to disappear. (I did not tell him that.)

“Well,” he said, flustered, waving his pen around, “you’re obese. We’ll do some tests.”

And so I was hooked to monitors and scanned every which way I could be, blood drawn, thyroid levels taken, EKGs and ECGs and stress tests and ultrasounds. One particularly awful day involved the 24 hour blood pressure monitor, hooked to a heavy box I had to carry around, which squeezed my arm every 15 minutes. I did not sleep. All the money I had raised was gone.

Nothing there. I had told him and he hadn’t believed me. Story of my life.

My community rallied to my side; I may sound cursed, but I am lucky. They gave me the money to try again. Nobody complained about my jumpiness and irritability, about the old demons that had swum up to the surface and were clattering around in my dreams. They held me in the dark when I was frightened. They stroked my hair. They reassured me. I do not have the words for my gratefulness; all I can do is return it in action.

What happened to me isn’t uncommon. There’s a lot of scholarly work out there on PTSD and anesthesia, both in the operating room and afterwards—that’s what they call “emergence delirium,” those arisen demons, battlefield terrors and nightly flashbacks. There are treatment protocols, but they aren’t commonly adopted. Most surgeons live within their specialties, deeply focused; I’ve worked around them and I know this to be true. PTSD is a psychiatric problem, they say. You cannot put your hands on it, you cannot dissect it. But it lives in the body nonetheless. 

Nobody warns us. We have to look out for ourselves. We have always had to look out for ourselves.

Here, I am warning you: please. Do not let what happened to me happen to you. Talk to them, fight them if necessary, bring them studies to look at. Make a plan. Do not let them tell you you are crazy. Their own peers are trying to tell them, if only they would listen.

We did it again in August, once the cardiologist begrudgingly signed off. This time there was a trauma protocol and this time it took. My surgeon says I am healing like a starfish, that my body bounces back from severe stress easily. I can only say that I have had a lot of practice.