ABSTRACT
Joan was referred to me by her physical therapist, who thought that Joan might be suffering from PTSD. As she walked into my office, I noted that her posture was quite dramatic, with a position of defensive flexion of the left arm, head, and shoulder, as if protecting her left chest area from assault. Her eyes squinted in the fluorescent lighting, and she spoke slowly with a stutter. Her thoughts were scattered, and it took her almost ten minutes to state that her symptoms had begun two months before, following postmastectomy breast reconstruction surgery. During that procedure, she had awakened shortly after having been anesthetized to find that she was helpless, paralyzed, blindfolded, intubated, and fully conscious while the surgeon made his first incision. She then remained fully awake throughout the surgery while she listened to conversations of the operating room staff, and felt every painful detail of the opening and manipulation of her body by knives and forceps. She made every effort of will to alert the staff to her conscious state, but EEGs, cardiac monitors, and her blood gas levels gave no clue to her being awake. She began to hallucinate toward the end of the ninety-minute operation, and really felt little pain, although she still recalls the content of conversation in the room during the procedure and the coldness of the water used to irrigate her wound. As drugs and tubes were removed at the end, and the paralysis cleared, her muscles involuntarily went into such violent contractions against the restraints used in the surgery that she had massive bruises for weeks on her arms and legs.
