In the last two weeks of his life, Sherman Sizemore felt like people were trying to bury him alive.

Now, more than a year later, members of his family say the horrifying experience of being conscious during surgery but unable to move or speak led directly to the Beckley minister's suicide — perhaps the first such case in the country.

Advocates say Sizemore's death should draw attention to a little-discussed phenomenon called anesthesia awareness that could happen to between 20,000 and 40,000 people a year in America.

In some instances, patients might be conscious for only a few seconds, but cases like Sizemore's, where people remain conscious for most of their surgery, can lead to post-traumatic stress, experts say.

"It's the first time I know of anyone succeeding in taking their own lives because of this, but suicidal thoughts are not all that uncommon," said Carol Weihrer, president of the Virginia-based Anesthesia Awareness Campaign, which she founded after her own experience with anesthesia awareness.

Sizemore, a former coal miner and Baptist minister, was admitted to Raleigh General Hospital on Jan. 19, 2006, for surgery aimed at diagnosing the cause of abdominal pain, according to a lawsuit filed March 13 in Raleigh County Circuit Court.

An anesthesiologist and nurse anesthetist who worked for Raleigh Anesthesia Associates gave Sizemore paralyzing drugs to prevent his muscles from jerking and twitching during the surgery, the complaint alleges. But it says they failed to give him general anesthesia to render him unconscious until 29 minutes into the procedure — 16 minutes after the first cut into his abdomen.

Sizemore was awake for the procedure, but couldn't speak or move. Worse, the complaint charges, Sizemore was never told that he hadn't been properly anesthetized, and was tormented by doubts about whether his memories were real.

The lawsuit, filed against Raleigh Anesthesia Associates by two of his daughters, goes on to say that in the two weeks after his surgery, Sizemore became a different person. He couldn't sleep, refused to be left alone, suffered nightmares and complained people were trying to bury him alive.

On Feb. 2, 2006, Sizemore killed himself. His family says he had no history of psychological distress before his surgery.

"Being helpless and being in that situation can obviously be tough on people's psychological well-being," said Tony O'Dell, a Charleston lawyer who filed the complaint, which seeks unspecified damages.

Calls to Raleigh Anesthesia Associates were referred to Charleston lawyer Bill Foster, who said he wouldn't comment until he had more time to study the complaint.

Anesthesia awareness — also called unintended intraoperative awareness — happens when a patient who should be under general anesthesia is aware of some or all of a surgical procedure. Causes can include doctor errors, faulty equipment or patients who can't take a deep level of anesthesia, as with some trauma cases or emergency heart surgeries.

The Joint Commission on Accreditation of Healthcare Organizations cites studies that show anesthesia awareness could happen in 0.1 to 0.2 percent of surgeries involving general anesthesia in this country — or between 20,000 and 40,000 a year. Patients who have experienced it often report sensations of not being able to breathe and feeling pain. Half of all patients also report mental distress after the surgery, including post-traumatic stress disorder.

In 2005, the American Society of Anesthesiologists adopted guidelines calling for doctors to follow a checklist protocol for anesthesia equipment to make sure proper doses are being delivered. However, the ASA stopped short of endorsing brain-monitoring equipment as a standard of care, saying doctors should decide on a case-by-case basis whether such machines are necessary.

"It could be that some day everybody who gets anesthesia will have a brain-wave monitor," said Dr. Robert Johnstone, a professor of anesthesiology at the West Virginia University School of Medicine.

Johnstone says such monitors are used at WVU, but in conjunction with a range of other equipment anesthesiologists use to measure everything from blood pressure to body temperature. When such monitors and tests are used properly, he said, the chance of someone being awake for a lengthy surgery is slim.

It was not clear whether Raleigh General uses such monitors. Calls to the hospital were not immediately returned Monday.

"The incidence of unintended awareness is rare," said Lisa Thiemann, director of practice for the American Association of Nurse Anesthetists. But she said the organization is concerned enough about it to adopt its own guidelines, including calls for hospitals to conduct post-surgery interviews with patients to learn whether they were awake during surgery.

Weihrer said that recognition of the experience and proper psychological counseling is often the only thing patients want.

"The reason people sue is because they want to be acknowledged," said Weihrer, who won an out-of-court settlement after her anesthesia failed during a five-hour eye surgery in 1998. "They don't want to be told 'you weren't awake, it was a dream.' I hate the word 'dream."'