Anesthesia Awareness

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#1
WARNING: The insect in the eye thread has nothing on this!!

I do hope the thread warning was enough for everyone because I found this rather uncomfortable reading - I think it is partly something to do with eyes (c.f. Chien Andalou):

Woman Warns Against Anesthesia Awareness

By MATTHEW BARAKAT

McLEAN, Va. (AP) - The pain in Carol Weihrer's eye was so severe she decided to have it surgically removed, believing it was the only way to get on with life.

Instead, the surgery was the beginning of an unending nightmare. Her anesthesia failed, leaving her awake but paralyzed for a five-hour surgery in which doctors cut and gouged to remove her right eye.

``You feel really grueling pulling on your eye, but you can't move to relieve the pressure,'' Weihrer said recently.

She felt no pain from the cutting, because the painkilling portion of the anesthesia was effective. But the tremendous pressure exerted to remove the eye was painful in its own way.

``You're sure you'll die if you can't let them know you're awake, she said. ``And you think, 'That'd be fine, too, as long as this ends. And then you think, 'Maybe you did die ... and maybe you're in hell.'''


Since her ordeal in 1998, which brought her an out-of-court settlement, she has suffered from post-traumatic stress disorder, and sleeps in a chair because lying down triggers the feelings of fear and helplessness.


Weihrer, who lives in Reston, has since dedicated her life to warning of the dangers of anesthesia awareness and agitating for changes in how doctors monitor a patient's consciousness.


She has won significant attention in the medical community, but some anesthesiologists worry her campaign may be causing undue fear.


Roger Litwiller, a Roanoke anesthesiologist and president of the American Society of Anesthesiologists, said it's important to keep the issue in perspective - that awareness during surgery occurs only in about one or two of every 1,000 procedures.


That perspective can sometimes get lost, he said, when people hear horror stories like Weihrer's.


``We meet people at a time when they're very vulnerable,'' he said. ``They don't need a whole lot of extra things to worry about.''


Even so, a hospital accreditation organization plans to issue an alert to hospitals about anesthesia awareness.


Robert Wise, of the Joint Commission on Accreditation of Healthcare Organizations, has spoken with Weihrer several times about the issue. Since there are an estimated 20 million surgical procedures a year requiring anesthesia, even an incidence rate of 0.1 or 0.2 percent translates into a significant problem.


``If you're one of those people, it's a pretty awful side effect'' that can trigger later problems like post-traumatic stress disorder, Wise said.


In addition to giving interviews, Weihrer has taken her campaign directly to doctors. She has also testified on behalf of death-row inmates facing lethal injection, who are executed using some of the same drugs that caused Weihrer's problem. That has led to concern from some that the inmates are awake, paralyzed and possibly in extreme pain for several minutes before they die.


As for prevention, Weihrer points to a simple, relatively inexpensive brain activity monitor.


The technology, approved by the Food and Drug Administration, is called a bispectral index (BIS) monitor. The theory is that if a patient is awake but paralyzed, it will show a high level of awareness to alert the anesthesiologist to adjust the medication and put the patient to sleep.


Litwiller contends the research is inconclusive on a BIS monitor's usefulness to an anesthesiologist.


Peter Sebel, anesthesiology professor at Emory University, led a study last year that estimated 100 patients a day experience some form of awareness during general anesthesia.


Sebel said it's hard to know exactly how many cases of awareness are relatively minor, such as coming to just as surgery ends. But in severe cases, ``it appears to affect people in a very nasty way,'' he said.


At George Washington University Hospital in Washington, doctors have been using the BIS monitors in the operating room for several years. Last year they expanded use to the intensive care unit for monitoring heavily sedated patients, said Barbara Jacobs, the hospital's director of critical care.


``We want to make sure you're not feeling anything,'' Jacobs said. ``It does not replace a human being monitoring your vital signs, but it is another tool we have to make sure you are properly sedated.''


Weihrer said in her surgery - a step she took because of recurring problems from a rare cornea condition - the worst part was her inability to move. ``It's like being entombed,'' she said.


Sebel said he is perplexed by the Society of Anesthesiology's cautious approach to the use of monitors.


``Anesthesiologists have their head in the sand,'' he said. ``I find the profession's attitude to this puzzling.''


Citing several studies, Sebel contends the BIS monitor can reduce incidents of awareness by more than 80 percent. But Litwiller says the studies, including Sebel's, are suspect because they were financed by the monitor's manufacturer, Aspect Medical Systems.


``I am concerned that in addressing this issue we use good science that is not biased in any way,'' Litwiller said.


Aspect Medical says its monitors are available in about 30 percent of hospital operating rooms, but their use varies widely. The machine itself costs about ,500, and the single-use monitors cost .50 each, according to the company.


On the Net:


http://www.anesthesiaawareness.com/


American Society of Anesthesiologists: http://www.asahq.org
Source

Well OK its possibly not as bad as the insect in the eye as she didn't feel any pain (thank God) but I'm just covering my bases ;)

Emps
 

OneWingedBird

Beloved of Ra
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#2
At a minor tangent, a few years ago I had a chance meeting with a man who claimed that he'd had his hypothalamus burnt out by knitting needle sized electrodes, in an eight hour operation, while conscious. I'd always figured him for a b*llshit artist until I found out that his case actually is documented:


"Derek was given 10 sessions of ECT and prescribed Largactil and other psychotropic drugs. His psychiatrist, Dr Todd, suggested that it was time something was done to control his aggression. Derek objected that his aggression had never been irrational, 'but this Todd said, "How would you like to be responsible for the death of one of your children?" I told him there was no possibility of that, but he said that violence was self-progressing, and I could hit one of my kids and they could die afterwards. I couldn't allow that to happen, no matter what. So then he said that there was this operation.'

This operation - 'the stimulation and destruction of the posteromedial hypothalamic nuclei in restless and aggressive behaviour' - had been pioneered in Japan by a neurosurgeon called Kajo Sanno. Only much later did Derek discover that Sanno had been struck off when all the patients on whom he tried it had died. He was told at the time that 12 people had had the operation in the UK; he has tried subsequently to track them down. 'I've only found one. He's in a private nursing home and can't speak.'

The neurosurgeon who was to carry out the operation, a Mr Wall, had worked - presumably with Sanno - in Japan. He explained that the procedure involved inserting, under anaesthetic, two nylon balls into the scalp and guiding rods through them into the brain to burn out the areas that were 'responsible for aggression'.

After the insertion of the balls - 'which involved pinning back a flap of my forehead' - Ruth was so horrified by Derek's appearance that she refused consent for the second part of the operation. Dr Todd himself went to visit Derek's mother. 'He went at 8pm. He knew she was an alcoholic, and by then she'd be out of it. Even though she didn't care about me a lot, she wouldn't have put me in that sort of danger if she'd known what she was doing.'

But she signed the forms, and, for eight-and-a-half hours, Derek was operated on while awake. (Knowing how far to go with the procedure apparently required the surgeons to watch the dilatation of his pupils). 'The only thing I can liken it to is having a tooth out without anaesthetic, putting a needle in to the nerve, wiggling it around and then burning it. I felt I'd been hit on the head with a sledgehammer, and then as if I was cooking.'

The operation did not make Derek less violent. One of his first actions after returning home was to storm into High Royds and physically attack Dr Todd. The hospital did not press charges. 'Previously, I might have got into a fight, but now I would plan violence. There was stuff going through my brain that's not the stuff people normally think about. I can't say what, without making myself seem a monster.' He came close to shooting somebody, and almost firebombed a house. 'I was meticulous about planning it. I came close to killing that man.'

Derek and Ruth had two more children, twins. But in 1978, while the rest of the family was out at church, 'I just walked out. I couldn't bear the thought that I might hurt one of my kiddies. But it didn't make sense. We'd been married 13 years and had five kids.' He is still close to tears when he talks about it.

For a couple of years, Derek lived with his mother. Then he met Carol, a single parent, and married her. 'She has looked after me for about 20 years. No one could have done it better.' She is evidently devoted to him: she explains that he is extremely sensitive to temperature and passes out if he gets too hot. He has no appetite and could happily go two weeks without eating. His short-term memory is terrible, and he often picks up the telephone, dials a number and forgets whom he is trying to call. His sleep patterns are disrupted: he naps throughout the day and wants to be up talking at 4am. He has had repeated flashbacks - which he now believes to be post-traumatic stress disorder - ever since the day of the operation. 'Sometimes I go through it 12 times a day. I know exactly which instrument Wall is going to ask for next.' "

http://observer.guardian.co.uk/review/story/0,6903,679915,00.html


I know they say that the brain can't feel pain, but much like the eye operation, this seems to have left him horribly traumatised :(
 
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#3
Awake Under The Knife

POSTED: 11:12 am EST November 12, 2004
UPDATED: 11:28 am EST November 12, 2004

WASHINGTON -- There is a rare but frightening phenomenon in the operating room: some patients have been waking up during surgery.

The problem is called Anesthesia Awareness and there's a new effort in hospitals to try to prevent it.

Carol Weihrer of northern Virginia recalled how her nightmare unfolded six years ago. During surgery to remove her diseased right eye, she woke up.

"I was thinking clearly as I'm talking to you now. I heard the surgeon say to the resident, 'Cut deeper. Pull harder.' I saw them clip the optic nerve. Everything went black," Weihrer said..

Even though she knew what was happening, there was nothing she could do to stop it. She had been given general anesthesia that included a drug that left her temporarily paralyzed and powerless.

"I was screaming at the top of my lungs, but I knew no sound was coming out," Weihrer said.

Anesthesia Awareness happens when a patient isn't given enough anesthesia. It's more likely in some cases, such as traumas, open-heart surgery and emergency cesarean sections. In those cases, it's too dangerous to give patients high doses of anesthesia.

Doctors estimate that 20,000 to 40,000 patients experience awareness each year. That's rare considering about 21 million people are given general anesthesia annually.

However, the group that accredits the nation's hospitals says awareness is "under recognized and under treated." And it wants that to change.

In an alert issued last month, the Joint Commission on Accreditation of Healthcare Organizations called on hospitals to:

* educate staff and patients about Anesthesia Awareness.
* provide counseling if a patient wakes up during surgery.

"We, as anesthesiologists, the first thing we want to do is prevent awareness," Dr. John Dombrowski said.

Anesthesiologists do that by monitoring the amount of medicine being given to a patient, checking vital signs and, in some cases, using a machine that measures brain activity.

Anesthesiologists are also looking for new ways to keep patients from waking up during surgery.

"We think there are a lot of new technologies out here, and we embrace them. But we want to embrace them cautiously, after we have ferreted out in terms of the scientific method, in terms of proving them correct or incorrect," Dombrowski said.

Carol Weihrer filed a lawsuit after her surgery. She settled the case and started a patient advocacy campaign to educate people about Anesthesia Awareness.

"We don't speak to scare. We speak to spare," Weihrer said.

Experts suggest talking to your doctor and anesthesiologist before your surgery and ask them about your risk. Also, be honest with them about your medical history.

---------------------
Copyright 2004 by nbc4.com.
http://www.nbc4.com/news/3913996/detail.html
 

James_H

And I like to roam the land
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#4
I once had fillings with non-effective anaesthesiac - I thought it was probably still meant to hurt a lot and didn't say anyhting, just grimaced and cried - but it doesn't seem very much on this :p
 
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#6
Channel 4 tonight:

21:00 Bodyshock: When Anaesthesia Fails

This programme uncovers the little known phenomenon of people waking up during surgery and reveals it to be a condition that is far more widespread than previously realised.
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When Anaesthesia Fails

Dr Martin Brookes

February 2005

There was a time when ignorance of anaesthesia made surgery only slightly more appealing than execution. In those dark and distressing days, operating theatres staged gruesome performances of extreme human suffering. Prostrate patients, delirious with fear, had to be restrained with straps, while surgeons cut, sawed and hacked against the clock. This was not so long ago. Indeed, it wasn't until the late 1840s that anaesthesia became a regular part of surgical procedure. Now we have sophisticated sedation systems, but the fear of an anaesthetized patient regaining consciousness during surgery remains, for those on both sides of the knife.

By the beginning of the 19th century, a number of drugs began trickling into public consciousness. Alcohol and opiates had been available for centuries and their intoxicating properties were occasionally exploited during surgery, but it was in 1799 that the English chemist Sir Humphrey Davy discovered the anaesthetic properties of nitrous oxide (laughing gas). It could do wonders for a toothache, he claimed. Two decades later, his protégé Michael Faraday found that ether had similar effects.

The first official public demonstration of ether anaesthesia took place on 16 October 1846 at Massachusetts General Hospital in Boston. It's difficult to overstate the importance of this medical milestone. For patients, the deep, ether-induced sleep offered escape from a terrifying trauma. For surgeons, it opened the door to a whole new world of operative inquiry. With the patient sedated, surgery could slow down, allowing a much-needed element of accuracy and control to come into the operation. The surgeon's scope of activity, once limited to speedy amputations and work at the surface, could now encompass more delicate areas like the inside of the chest, the abdomen and the skull. Suddenly, surgery was no longer seen as a last resort, but as an integral part of medical practice.

ABC of anaesthesia

First up is a thorough evaluation of the patient: in some ways, this is the most important aspect of the procedure. An assessment of the patient's weight, age, medical history and current medication enables the anaesthetist to make informed decisions on which drugs to use, when to use them, and in what dosages.

Before a patient enters the operating theatre, they are often given a sedative to help them relax and relieve any anxiety they may be feeling about the operation. This is followed by the general anaesthetic itself, usually administered via intravenous injection, which will cause loss of consciousness in the patient.

At this stage, it's also common to inject a muscle relaxant, so that the patient's body becomes more submissive to the surgeon's knife. Early forms of muscle relaxant were derivatives of the plant extract curare, a potent neurotoxin used by South American Indians to make poison arrows.

With the muscles paralysed, breathing is impossible, so the patient must be intubated and attached to a breathing machine throughout the operation. To sustain the anaesthesia, the patient typically breathes a sleepy blend of nitrous oxide, oxygen and halothane. This mix of gases is sometimes augmented by drugs fed intravenously through a canula in the patient's hand.

As soon as the operation is over, the patient is injected with a cholinesterase, a drug which reverses the effects of the muscle relaxant. Once normal breathing is re-established, the intubation tube can be removed and the breathing machine turned off. As the patient comes round, analgesic drugs are made available to control any post-operative pain.

A waking nightmare

In 1960 the medical community woke up to a startling revelation. A study had found that more than 1% of patients experienced some kind of awareness whilst under general anaesthetic, ranging from full-blown consciousness to recollection of fragments of surgical events. Pain and anguish during the operation were followed, in many cases, by mental problems afterwards. Some patients suffered from anxiety, depression and a pre-occupation with death. This was years before post-traumatic stress disorder was a recognised syndrome, but its symptoms were already on full display.

Anaesthesia has come a long way since this seminal study. More sophisticated drugs and improvements in technology mean that anaesthesia is safer than it's ever been. But the fear of consciousness regained during surgery still haunts the operating theatre. In a recent survey of over 10,000 patients who were due to undergo an operation, 54% said that they were anxious about anaesthetic awareness.

Are these fears justified? Latest estimates suggest that about 1 in 1000 patients will experience some level of awareness during surgery. What seems like a small percentage becomes far more significant when you realise that worldwide there are about 100 million operations annually. Which means that about 100,000 people will suffer from anaesthetic awareness every year. In 90% of cases, patients will suffer no pain, but the memory of the experience may lead to psychological trauma.

In a sense, anaesthetic awareness is a more terrifying prospect than the unsophisticated surgery of yesteryear, before the advent of anaesthesia. Back then, patients could at least register their discomfort with a scream. Today, there's no such luxury. The drugs for muscle paralysis that are often administered during surgery may leave patients utterly helpless. If the patient does wake up, there's no way to raise the alarm. They may hear and feel everything that's going on around them, but they are unable to communicate their pain.

The anatomy of failure

Mistakes are inevitable in any procedure involving a human operator. Some patients have woken up during operations simply because the anaesthetist failed to spot an empty gas bottle or a leak in the breathing system. But negligence alone cannot explain all cases of anaesthetic awareness.

Anaesthesia remains an inexact science. While things normally go according to plan, the whole procedure is dogged by elements of uncertainty. The anaesthetist's initial evaluation will direct him towards the most appropriate course of treatment, but the system isn't foolproof. Patients don't always tell the truth about themselves, especially when it comes to sensitive issues like drink and drugs. Even when patients are forthcoming, exact outcomes are impossible to predict. Individuals vary in their response to anaesthesia because of differences in health, history and genetics. And while the anaesthetist may be able to get a handle on the first two factors, tailoring an anaesthetic to an individual's unique genetic make-up is still something for the future.

Added complications arise in those operations where the anaesthetist is already walking a fine line. In caesarean sections, for instance, the anaesthetist must balance the needs of the mother with the needs of the unborn child. If he uses too much anaesthetic he runs the risk of damaging the child. But use too little and there is a real danger that the mother will wake up.

Of course, the modern operating theatre is equipped with all kinds of gadgets designed to help the anaesthetist monitor and control the anaesthesia. But the depth of anaesthesia remains a notoriously difficult quantity to measure. A monitor that provides a definitive guide to awareness is seen as the Holy Grail of anaesthesia. Currently, there is considerable excitement surrounding the bispectral index (BIS), a new device which turns the electrical activity of the brain into a simple measure of awareness.

The memory effect

General anaesthesia can be seen as a controlled coma, in which the anaesthetist steers the patient into unconsciousness and back again. Throughout the operation, the patient should remain oblivious to the surgeon's knife and unresponsive to instructions. When the patient wakes up, the surgery should be a blank to them. Of course, anaesthetic awareness represents a catastrophic failure of these principles. But the picture is far from black and white.

Evidence seems to suggest that even patients who have been adequately anaesthetized retain some sense of memory. In one experiment, for instance, patients under general anaesthetic were read a series of words during surgery. After the operation, they had no memory of the event. But when asked to pick out the suspect words from an identity parade, they were far more successful at doing so than the control subjects. In other words, explicit memory had been wiped clean, but implicit memory (involving the sub-conscious processing of information) was intact.

Interestingly, not all anaesthetic agents produce these kinds of effects. The physiological mechanisms underlying the action of anaesthetics are still poorly understood, but it seems clear that different anaesthetics act in varying ways, leading to correspondingly different effects on implicit memory.

There is concern among some physicians that any memory retained during operation, implicit or otherwise, represents a failure of general anaesthesia. Although implicit memory doesn't imply awareness, there are cases where patients have experienced classic post-operative symptoms of anaesthetic awareness, like depression, nightmares and anxiety, without any explicit recall of surgical events. Thankfully, anaesthesia has come a long way in 160 years, but with gaps like this in our knowledge it remains something of an enigma.

----------------------------------------
Find out more

Channel 4 is not responsible for the content of third party sites

---------------
Websites

Anesthetic awareness fact sheet
http://aana.com/patients/aware/factsheet.asp
Useful page of information from the American Association of Nurse Anesthetists.

How to avoid waking up during surgery
www.abcclassics.com/science/news/stories
/s1118130.htm
Looks at new research that uses a machine to monitor the brain activity of patients during surgery, and how it could reduce the risk of waking up under the knife.

Learning and awareness during anaesthesia
www.shef.ac.uk/~pc1ja/anaesthesia.html
Recent Canadian research has suggested that almost one in five children become aware during surgery under general anaesthesia. Studies are now being carried out with a tourniquet applied to the patient's arm, so they can move their hand to alert the anaesthetist.

Utopian surgery
www.general-anaesthesia.com/
Excellent and comprehensive site that covers the history of anaesthesia and the consequences of the public demonstration of ether anaesthesia carried out in 1846.

Women and anaesthesia
www.annieappleseedproject.org/womandan.html
Interesting article looking at several studies that find women are more prone to waking up during surgery.


--------------
Organisations

Action for the Victims of Medical Accidents (AVMA)
44 High Street
Croydon
CR0 1YB
Helpline: 0845 123 23 52 (Mon-Fri 10-12pm and 2-4pm)
E-mail: [email protected]
Website: www.avma.org.uk
Charity supporting people injured by medical accidents. Offers free practical help and advice to anyone who has suffered injury or harm as a result of inappropriate medical care, poor treatment, misdiagnosis and failure to diagnose.

Citizens Advice Bureau
www.adviceguide.org.uk
Provides advice on a range of subjects including health issues through hundreds of offices across the UK. The telephone directory will list your local CAB. The website has lots of useful information and contact details as well.

Health Service Ombudsman
13th Floor
Millbank Tower
London
SW1P 4QP
Tel: 0845 015 4033
E-mail: [email protected].
Website: www.ombudsman.org.uk/hse
The Health Service Ombudsman investigates complaints about the National Health Service. The Ombudsman is completely independent of the NHS and the government. There is no charge for the service.

National Institute for Clinical Excellence (NICE)
MidCity Place
71 High Holborn
London
WC1V 6NA
Tel: 020 7067 5800
Fax: 020 7067 5801
E-mail: [email protected]
Website: www.nice.org.uk
Part of the NHS, NICE provides patients, health professionals and the public with guidance on current best practice. Website contains a comprehensive range of health and patient links, including regional health authority websites.

Patients Association
PO Box 935
Harrow
HA1 3YJ
Tel: 020 8423 9111
Helpline: 0845 608 4455 (Mon-Fri 10am-4pm)
E-mail: [email protected]
Website: www.patients-association.com
Represents the consumer voice in UK healthcare. Website has news articles and campaigns.

Patient Concern
PO Box 23732
London
SW5 9FY
E-mail: [email protected]
Website: www.patientconcern.org.uk
Organisation committed to promoting choice and empowerment for all health service users and campaigning on issues that matter to patients. Website has campaign information and news. Leaflets on a range of issues will be sent to you if you write to them with a SAE.

Patient Protect
Tel: 01227 713661
Fax: 01227 711426
E-mail: [email protected]
Website: www.patientprotect.org
Dedicated to the prevention of neglect and incompetence in the NHS, and to the elimination of the secrecy that allows problems to flourish. Website has a good section on what to do should you want to make a complaint.

Scottish Public Services Ombudsman
4 Melville Street
Edinburgh
EH3 7NS
Tel: 0870 011 5378
E-mail: [email protected]
Website: www.scottishombudsman.org.uk
Offers members of the public an independent, free and fair response to complaints about public services, including health services.

Sufferers of Iatrogenic Neglect (SIN)
Tel: 01924 407195 or 0115 9431 320
E-mail: [email protected] or [email protected]
Website: www.sin-medicalmistakes.org
Patient support and pressure group for sufferers of iatrogenic neglect – this relates to medical disorders or symptoms caused inappropriately by any clinician through diagnosis, manner or treatment.


------------------
Books


How to Stop Your Doctor Killing You by Vernon Coleman (European Medical Journal, 2003)
Coleman argues that the person most likely to kill you is not a relative, a mugger or a drunken driver but in fact, your doctor. One in six patients currently in hospital are there because they have been made ill by a doctor.


Silenced Screams: Surviving anesthetic awareness during surgery: A true-life account Jeanette M Liska (American Association of Nurse Anesthetists, 2002)
Harrowing story of Jeanette Liska who found herself awake during routine surgery in 1990. During the months and years that followed, Liska struggled to cope with the psychological and emotional aftermath of her experience.


Trust Me I'm a Doctor: The guide to getting the best from your doctor by Phil Hammond and Michael Mosley (Metro Publishing, 2002)
Examines health issues from a consumer's perspective, exposing the myths and reluctance of the medical profession to pass on findings to patients.



How to Make a Complaint (Patients Association)
This booklet guides you through the national complaints procedure across all areas of the NHS.
Available free
Source
 

fluffle9

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#7
Coleman argues that the person most likely to kill you is not a relative, a mugger or a drunken driver but in fact, your doctor. One in six patients currently in hospital are there because they have been made ill by a doctor.
one in six? no way. has this person ever been inside a hospital?
 

uair01

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#8
I have this from a trusted source. In his youthful days a surgeon had the following discussion with his patient after a successful and otherwise unremarkable operation:

P: Doctor is it possible to hear sounds while under anaesthesia?
D: Why do you ask?
P: While I was unconscious I had the definite impression that the whole operating team was singing a soccer song about green grass and leather ball.
D: No, you certainly must have dreamt that.

You will have guessed by now that indeed, the complete operating team was singing a soccer song while operating
 
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