For those of us who fall easily into worry spirals, one of the only things worse than knowing you have to go under the knife is knowing you’ll be awake for it. Surgery already lends itself to a chain of escalating what-ifs — listening to doctors cut through your skin and flesh can only add fuel to the fire.
And yet, as the New York Times recently reported, a growing number of people are choosing to forego general anesthesia, opting instead for a local anesthetic that lets them observe their own medical procedures. Patients make the decision for a variety of reasons: Some worry about potential complications from going under; others believe surgery will be less frightening if they know what’s going on; others still are just curious, or think it’d be cool to see their own tendons or bones (orthopedic surgery is the most common type to stay awake for, the paper noted, though “surgery in breast, colorectal, thoracic, vascular, otolaryngological, urological, ophthalmological and cosmetic specialties is also moving in this direction”).
It’s a good idea, in theory, if you’re the type that can stomach it — local anesthesia is cheaper and less dangerous than general — but it comes with a caveat: Doctors aren’t really sure how to act around their conscious patients. The Times explained:
[A]s surgical patients are electing to keep their eyes wide open, doctor-patient protocol has not kept pace with the new practice. Patients can become unnerved by a seemingly ominous silence, or put off by what passes for office humor. Doctors are only beginning to realize that when a patient is alert, it is just not O.K. to say: “Oops!” or “I wasn’t expecting that,” or even “Oh, my God, what are you doing?!”
There’s also the fact that surgery’s rarely as exciting as it seems. What looks dramatic on TV is usually much more of an uneventful slog in real life, and a long one a that. Eventually, even looking at your own insides can get boring — which means the only thing left to do is chat up the people poking around inside your body. Doctors “might have to make small talk throughout the entire case,” physician David Dickerson, an anesthesiology professor at the University of Chicago, told the paper. “They don’t teach that in medical school.” Asking questions is part of being a good patient, but you’re probably better off getting them out of the way before the procedure itself and taking a cue from one of the patients the Times interviewed: When it came time for his surgery, he showed up at the hospital with a stack of magazines.