When the phrase put to sleep creates fear: The misconception behind “Ditidurkan”

THE call came from Kota Marudu late in the evening, and like many urgent surgical cases, it began not with technical terms but with fear. A 60-year-old man was in severe abdominal pain, and the scan showed a condition that could not wait. The surgical team explained the need for urgent intervention and the risks of delay. Then came the phrase that changed the atmosphere in the room. They would need to “put him to sleep.” His wife fell silent, one of his children leaned forward and asked what countless Malaysians have asked over the past few years, and the memory of the pandemic settled heavily in the air. If he is put to sleep, will he wake up?

This reaction is not ignorant. It reflects how collective experience shapes health behavior. Across Malaysia, the words sedated, intubated, ventilator, and put to sleep became emotionally loaded during the COVID-19 pandemic. Families heard them in hospital updates and associated them with the most severe cases. For instance, COVID-19 patients categorized as Category 4 and 5 required oxygen or advanced life support, and while these represented a small fraction of total infections, they dominated public imagination because they were the sickest and most visible. When families watched loved ones deteriorate despite intensive care, the brain formed a simple link, and sedation became wrongly associated with death, even though death in these cases was driven by severe organ failure rather than the act of being sedated.

This misconception grew strong enough that the Ministry of Health Malaysia (MOH) had to publicly clarify that the term “ditidurkan” does not mean life is being ended, and that when patients who are sedated later die, the cause is the severity of their illness and progressive organ failure rather than the sedation itself. Yet perception rarely follows official statements at the same speed as emotion. Studies during the Movement Control Order (MCO) showed that many Malaysians relied heavily on digital platforms for information, even while acknowledging that these sources were not always the most credible. Health information now circulates in the same online environment as scams and political misinformation, where dramatic narratives often travel further than measured explanations.

The problem arises when this pandemic-shaped perception is carried into a very different clinical setting, the operating theatre. Sedation in intensive care and anaesthesia in surgery are often spoken of using similar language, but medically they represent two distinct realities. In Intensive Care Unit (ICU), sedation is frequently used in patients whose lungs, heart, or brain are already failing, and whose bodies cannot tolerate mechanical ventilation while awake. In the operating theatre, anaesthesia is a planned and controlled medical state designed to protect the patient from pain, stress responses, and physiological instability while surgery is performed.

In critically ill patients, sedation is used when a person cannot breathe adequately, when oxygen levels are dangerously low, or when major organs are failing, and in such situations, it is part of life-saving support, not a cause of death.

Globally, more than 300 million surgical procedures are performed each year, each requiring some form of anaesthesia. Modern theatre practice is supported by layered safety systems, including continuous monitoring of oxygen saturation, blood pressure, heart rhythm, and breathing, alongside structured processes such as the WHO Surgical Safety Checklist. In a large multinational study, introduction of this checklist was associated with a reduction in surgical complications from 11% to 7%, and a drop in inpatient deaths from 1.5% to 0.8%. These figures represent lives saved through structured safety systems. Within this environment, anesthesia professionals are not simply “putting patients to sleep.”

I spoke to Daryl Victor Nestor, Assistant Medical Officer and Anaesthesia Technologist at the Department of Anaesthesia, Queen Elizabeth Hospital, who explained that anaesthesia safety begins long before surgery. “My responsibility starts with ensuring that all equipment, medications, and monitoring systems required for safe anaesthesia are properly prepared, checked, and functioning optimally, because even small technical issues can affect patient safety. During surgery, we continuously monitor equipment performance, assist in troubleshooting, and anticipate changes in the patient’s condition, as anaesthesia is dynamic and physiology can shift rapidly due to surgical stress, blood loss, or underlying disease. Being proactive rather than reactive is essential to maintaining stability and ensuring safe recovery.”

Mathew Bin Joannes, Senior Assistant Medical Officer and Anaesthesia Technologist expert at Queen Elizabeth Hospital II, who has managed many referral cases across Sabah, emphasised that while anaesthesia carries risks, the overall probability is very low. “We inform patients about possible complications such as injury to the teeth or airway, aspiration, allergic reactions, or rare heart, lung, or stroke related events, but these complications are uncommon. Patients need to be informed, yet the term ‘ditidurkan’ itself often creates unnecessary fear, even though the risks from untreated disease or delayed surgery are usually far greater than the risks from anaesthesia.”.

Anaesthesia is not risk free, particularly in older patients or those with severe heart, lung, or kidney disease, and in emergency surgery. However, large contemporary studies involving millions of cases show that anaesthesia related deaths in healthier patients undergoing planned procedures are rare, with most perioperative deaths linked to underlying disease or surgical complexity rather than the anaesthetic drugs themselves. Modern agents are short acting and patients are closely monitored until recovery.

Large reviews suggest anaesthetic related mortality has fallen dramatically over decades, and in well-resourced settings it is now uncommon, especially in lower risk elective cases, although the exact rate varies by country, patient risk, and definitions used.

From a public health perspective, the greater danger often lies not in the anaesthetic but in delay. When fear of being “put to sleep” leads people to postpone hernia repair, gallbladder surgery, or early cancer treatment, they frequently return later with complications that require emergency surgery, longer hospital stays, and carry higher risk. In this way, a perception problem becomes a health system problem, influencing patterns of presentation, resource use, and outcomes across populations.

Hospitals are not neutral spaces in people’s memories, and the pandemic intensified their association with loss. Public health communication therefore has to do more than provide facts. It must rebuild understanding in language that connects experience with evidence. When families hear the phrase “put to sleep” or “ditidurkan” they deserve to know that in the operating theatre, it describes a controlled medical state surrounded by monitoring, expertise, and multiple safeguards.

The fact that national health authorities felt the need to issue public education messages on this topic shows how widespread the misconception has become, and why correcting it is not only a clinical task but a public health responsibility.

Returning to the case in Kota Marudu, the team took time to explain the monitors, the drugs, and the recovery process, clarifying that the greater risk lay in leaving the disease untreated. The family agreed, still anxious but now informed. When patients wake after surgery, it is not a miracle, but the expected outcome of systems designed to keep them safe. Malaysia does not need blind trust in medicine, but informed trust grounded in context, data, and transparency. Understanding what anaesthesia truly means is part of health literacy, and correcting the myth that “being put to sleep” equals death is not only a clinical responsibility but a public health one, because sometimes the greater danger is the fear that keeps people away from timely care.

Melvin Ebin Bondi is a PhD candidate in Public Health at Universiti Malaysia Sabah. He writes a weekly public health column for The Borneo Post.