"People die. You may think you can control when, where or how it happens. But you can not. When it comes your time has come. And nobody can do anything about it ..."
Dr. Jack Harper (Terrence Howard) in "Awake"
During my Ph.D., I spent 4 years as voluntary attending physician at the Department of Gynecology and Obstetrics University Hospital in Santiago Compostela. The first information on the intraoperative perception me by a veteran anesthesiologist who had personally experienced several situations of this kind throughout his career. Specifically, on waking from anesthesia, a patient underwent a cesarean section had told him in great detail the conversation between the surgeons who operate it ended ...
One of the most common fears reported by patients at the time of having to undergo surgery with general anesthesia is the fear of not waking up, especially if size also implies a restlessness that kept paralysis fully awakened consciousness in a kind of catatonic awesome. It looks like a fantastic issue, an urban legend ... But we see that there is truth in all this.
A note cinephile. They say that director and screenwriter of "Awake" ( Joby Harold, 2007) came the inspiration for this film while suffering a haunting renal colic.
Although we are dealing with a work that surely will not go down the annals of film history, we do have to recognize its originality on two issues:
- pose as central hub the plot that strange and rare condition known as intraoperative awareness or conscious anesthesia ,
- turn the viewer into the protagonist psychological thriller, making it a key part in the first person in this overwhelming tessitura.
advertising to increase the impact of this film, and sure step box office success, the producers hired two promising stars. Although initially thought Jared Leto for the title role of the sickly millionaire Clayton Beresford Jr. finally chose Hayden Christensen , a young actor had been incredibly popular to play Anakin Skywalker two the aftermath of "The Wars" : "Attack of the Clones" ( George Lucas, 2002) and "Revenge of the Sith " ( George Lucas, 2005). The sexy Jessica Alba would Samantha (Sam) Lockwood, the character sexy, very sexy and sly counterpoint become so timid beau ideal.
Jesicca Alba and Hayden Christensen in "Awake"
The plot begins with a voice off , that of Dr. Jack Harper ( Terrence Howard), a cardiac surgeon graduate at the prestigious Johns Hopkins University , tells how he lost his life in the theater his friend Clay Beresford, failing to overcome a complex intervention heart transplant.
The celebrated Dr. Jonathan Neyer ( Arliss Howard), a surgeon of celebrities and presidents, a personal friend of Lilith Beresford (Lena Olin ), Clay's mother, we information about the disease of character, a heart of undetermined etiology that we initially thought it might be a idiopathic cardiomyopathy, all this box would be aggravated by ischemic heart disease since Clay and Dr. Jack Harper met and befriended when the latter tried to millionaire after suffering a stroke infarction, by triple by-pass .
Lena Olin is Lilith Beresford
By Dr. Neyer know also a very important figure in the denouement of the film: the mother and son have in common blood group 0 Negative . For this very special circumstance, Clay lead on the waiting list a year, awaiting the appearance of a donor ... Recall that the much needed full support of the HLA system only occurs in 25% of the receptor family members ...
Finally, despite the recommendations of Mr. Neyer and the insistence of his mother, Clay will be operated by Dr. Harper and his team at Bellevue Hospital of Manhattan ...
AWARE ALERT STATUS UNDER GENERAL ANESTHESIA.
There is a wonderful booklet that has seen the light thanks to the joint efforts of the American Society of Anesthesiologists (ASA ) and the American Association of Nurse Anestesists (AANA )
He has served as a consultation document to assess the type of medical treatment - scientist to receive this particular state in "Awake" .
First, make clear that intraoperative awareness is an exceptional circumstance but not improbable. The initial appropriations package contains an error, because we caution that in the U.S. each year 21 million people receiving general anesthesia ; of them all, approximately 30,000 individuals may have this problem. Actual data on the frequency of the condition report 1 in 14000 high-risk patients and 1 in 42,000 in the rest. For exaggeration, a minus for the film.
Nevertheless, there are several investigations underway to improve the techniques to avoid this problem, such as monitoring brainwaves. However, in an exercise of professional integrity that honor, those responsible for the ASA and AANA recognize that at present none of these techniques is perfect. A credit to the film.
Another positive in this film is due to the approach of a well-documented, they are more frequent in alert states high-risk surgery (Urgent, heart and caesarean section).
Secondly, before any planned operation, the service Anaesthetic and depth normally reviews the patient's medical history, diseases and treatments, assess the surgical risk, potential rule drug allergies, claims analytics, electrocardiograms and X-rays, including interviews with the patient. All these precautions are intensified to a case heart transplant.
Although all This preparatory procedure would be implicit in the development of this film, the unexpected change of anesthesia by Dr. Larry Lupin (Christopher McDonald ) in extremis, and from another hospital, would take away too much credence . We note here a new blot on the record film.
Third, while developing the intervention of Clay, the theater seems more like the lobby of a department store, with staff moving in and out of the room without any control. Rounding out the team of Dr. Harper sinister assistant, Dr. Puttnam ( Fisher Stevens) and Nurse Penny Carver instrumentalist ( Georgina Chapman). With so much movement, so essential aseptic shine by their absence. This situation is completely unrealistic. Another minus point for the film.
Terrence Howard is Jack Harper
Fourth, while operating at Clay, his wife Sam is bag drop several boats with the patient's medication. This is a beta blocker brand Levatol ( penbutolol), a ACE inhibitor (enalapril ) and digoxin . The 3 drugs are common in the treatment of patients with heart failure . In this regard, a credit to the film.
Fifthly, we found another mistake. Dr. Harper began to prepare the surgical field before the surgeon has properly intubated Clay. Typically, the patient is sedated first, which is given immediately anesthesia and intubated him. Recall that the sedative-hypnotics may increase the susceptibility of some patients at the time of suffering hallucinations caused by sensory stimuli such as noise, light or feeling of coldness caused by applying the disinfectant to the skin.
Sixth, to Clay charge, Harper and his cronies used intracardiac injection of adriamycin . This drug exerts its toxicity on the myocardium, producing a nonspecific cardiomyopathy, as they form vacuoles in the myocardial cells and dilated mitochondria. Thus, the impaired contractility may be gradual and progressive. Clay deposited full confidence in Samantha, to the point where she was responsible for supplying all the medication to treat his heart condition. Gradually discovered how he had been poisoned with adriamycin.
Another drug named in this film is the milrinone, which inhibits phosphodiesterase III , increasing intracellular concentrations of cAMP and calcium to improve myocardial contractility, due to its potent positive inotropic and chronotopical. It is usually used in cases of terminal heart failure or in patients scheduled for cardiac surgery. A new tribute to the documentation of this service film.
Finally, in "Science vs. Fiction" , one of the blogs I recommend strongly from this blog, there is a revealing entry that complements the critique of this film:
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