WHAT'S UP, DOC?

When Andrea Thaler, 46, was wheeled into the operating room for routine gallbladder surgery five years ago, she thought she was in a safe place. But as soon as the operation began, the Nashville, Tenn., HMO executive realized that the sedatives and pain-killers administered by her anesthesiologist hadn't quite taken hold. She could feel the surgeon make six "slicing, burning" laparoscopic incisions in her abdomen, but she was trapped by the paralytic drugs given along with the anesthesia, and she couldn't cry out or even open her eyes. "I was screaming in a black hole," she recalls. "I thought I would die on the table and nobody would know what happened."

Thaler was experiencing a phenomenon that anesthesiologists delicately call "awareness." These unexpected wake-ups occur in at least 40,000 of the nation's 20 million annual surgeries, according to Emory University anesthesiologist Peter Sebel, who has studied the problem. In most cases the pain-killers keep working, and all the patient feels is the unnerving pressure of a scalpel cutting and scraping. But, Sebel estimates conservatively, in at least 400 such awareness accidents, the pain breaks through the veil of drugs. It's possible, say other experts, that the number of patients who wake up each year to excruciating pain in the middle of surgery could be in the thousands.

Adding insult to injury, many "survivors," as they call themselves, report that doctors and other medical personnel routinely leer at or ridicule the inert bodies before them. Jeanette Tracy, a television producer from Dallas, suffered this when she was anesthetized for a hernia operation in 1991. Enduring pain she describes as "a blow torch in my stomach...every tissue tearing like a piece of paper," she heard the anesthesiologist say she had "the right size breasts" and was in "great shape" for a mother of two. "You can't cover yourself," she says furiously. "You're screaming as loud as you can inside your head. It's like being raped and buried alive."

The humiliation is not just for women. Tracy, who went on to found a support group called AWARE (Awareness with Anesthesia Research Foundation), tells of one male patient who woke up to a female nurse holding up his penis and laughing about its diminutive size.

For a variety of reasons, most awareness survivors never tell their anesthesiologist about the experience. One study suggests that only 35% ever say anything. But such studies are rare, and most anesthesiologists have no conception of how deeply their patients suffer. "I used to think people who talked about this topic were flakes," admits Texas A&M; anesthesiologist Charles McLeskey, who became a believer after a patient told him what he had overheard while he was under.

Boston University psychiatrist Janet Osterman is having trouble recruiting survivors for a research project on awareness at Boston Medical Center because so many refuse to enter the hospital to be interviewed. Osterman says her subjects display all the symptoms of post-traumatic stress disorder, including flashbacks, irrational fears and, particularly common, severe insomnia. "They are afraid to go to sleep," she explains. "Letting go feels too much like going under anesthesia."

The good news is that there may be a technological solution. At last week's annual meeting of the American Society of Anesthesiologists in San Diego, one of the booths displayed a toaster oven-size device called the Bispectral Index Monitor, which can reduce or even eliminate surgical wake-ups. A specialized EEG machine, the system monitors the patient's brain waves and then translates them into a single "depth of consciousness" figure that the operating-room staff can watch like a number on a digital alarm clock. Zero is an induced coma; 100 is fully awake; the ideal sleep state is 60. Anything higher represents a potentially dangerous state of awareness. Anything lower, and the patient could be oversedated.

"This is anesthesia's Holy Grail," proclaims Nassib Chamoun, the Lebanese-born inventor of the device. Without a way to directly monitor brain activity, he says, anesthesiologists have had to gauge sleep level by monitoring blood pressure and other vital signs--a method that is too one-dimensional and distressingly hit-or-miss because it primarily measures the effectiveness of pain-killing drugs. Ideal anesthesia, says Chamoun, involves a triangulation of pain-killers, sedatives and paralytic drugs, whose collective "depth" can be measured only through brain waves.

The device seems to be catching on. Chamoun's company, Aspect Medical Systems of Natick, Mass., won FDA clearance last year and has already placed 711 systems.

But they're too late to help Andrea Thaler, who won a settlement from her anesthesiologist but still suffers post-traumatic flashbacks. "When someone introduces himself as an anesthesiologist," she says, "sheer terror overcomes me." Nightmares and memory problems also dog Jeanette Tracy as she lectures and travels. Both women are trying to reach out to other survivors. "At first you think you're the only person in the world this has happened to," says Thaler. "People have called me on the telephone and cried for hours." This time, at least, someone can hear them.