YOU ARE HERE: LAT HomeCollections


April 28, 1991|PAUL LIEBERMAN | Lieberman is a Times staff writer.

You'd be able to watch."

"My own operation?"

"That's right."

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?"

Los Angeles Times Articles