Anesthesia: The Gift of Oblivion and the Mystery of Consciousness

by Kate Cole-Adams

Overview

"An obsessive, mystical, terrifying, and even phantasmagorical exploration of anesthesia’s shadowy terra incognita." —The New Yorker

Anesthetize: to render insensible

First there’s the injection, then the countdown—and next thing you know, you’re awake. Anesthesia: The Gift of Oblivion and the Mystery of Consciousness is the story of the time in between, an exploration of that most crucial and baffling gift of modern medicine: the disappearing act that enables us to undergo procedures that would otherwise be impossibly, often fatally, painful.

In the past 150 years, anesthesia has made surgical intervention routine, from open–heart surgery to the facelift. But how much do anesthesiologists really know about what happens when their patients go under? Can we hear and retain what’s going on? Is pain still pain if we don’t remember it? How does the unconscious mind deal with the body’s experience of being sliced open and ransacked—and how can we help ourselves through it all?

Kate Cole–Adams weaves her own personal experiences with surgery and its aftermath with the explorations and personal accounts of others, doctors and patients alike—accounts of people who wake under the knife, who experience traumatic reactions, dreams, hallucinations, and submerged memories—accounts that evoke and illuminate the provisional nature of the self.

Haunting, lyrical, sometimes shattering, Cole–Adams leavens science with personal experience, and brings an intensely human curiosity to the unknowable realm beyond consciousness.

Product Details

ISBN-13:	9781619029576
Publisher:	Catapult
Publication date:	12/01/2017
Sold by:	Penguin Random House Publisher Services
Format:	eBook
Pages:	416
File size:	1 MB

About the Author

Kate Cole-Adams is a journalist and novelist. Her debut novel, Walking to the Moon, was published in 2008. She lives in Melbourne with her family.

Read an Excerpt

Introduction: Into the Blue

I am in a smallish, whitish room in a hospital in Brisbane. It is night. On the wall opposite my bed I can dimly make out a crucifix with its limp passenger. Beneath it float wide blank windows through which I watch the synapses of city light: a web of tiny illuminations and extinctions that seem, when I loosen my gaze, almost to form patterns; as if they are about to make sense. I am surprised at how calm I feel.

In the weeks leading up to this moment I have set my affairs in order, of sorts. Made a will, written letters for the children, waxed my legs. Said my farewells at the airport and boarded the flight from Melbourne with my mother. July 2010.

Some months before this, after decades of resistance, I gave in at last to the inevitability of major surgery. My capitulation was sudden and took place in a different wing of this same hospital, where I had come to consult a respected spinal surgeon. The surgeon had a quiet, almost diffident, manner and a moustache that put me in mind of a doleful Groucho. I am not sure what made my mind up, the moustache or the way his finger traced my wayward spine quite gently on the X-ray before him. But just as he began to tell me that I would not be a candidate for the type of non-invasive surgery we had been talking about, I realised with a small thud of certainty that, not only was I going to have this surgery—invasive though it might be—I was going to come back to Brisbane and he was going to do it.

In the aftermath of my decision, I was buoyed in a backwash of something like relief; a giving up of hope and its attendant efforts, a yielding to forces beyond my will. But when I lay awake at night, disquiet rose around me. It was not just the surgery that was worrying me—the cutting and drilling, the inevitable risk—it was that in some blank corner of myself I felt that I would not wake up afterwards. I knew logically, and during the day could convince myself, that for an otherwise healthy forty-eight-year-old, the likelihood of calamity was low. But at night, there in my bed in Melbourne, the conviction multiplied inside me that even if everything went according to plan, the me who woke after surgery would not be the same in some essential way as the me who had been wheeled into the operating theatre beforehand. I developed a dread of the moment when the anesthetic drugs would take effect and I would cease to be. I pictured myself in a stark, poorly lit room with two doors, one in, one out, neither of which I could open from within. Otherwise the room was empty. No windows, no furniture. In this darkness—which I now realise had the same sinuous quality as the shadows beneath my childhood bed—I would be trapped alone. Perhaps forever. At least until such time as someone else chose to release, not me but some other, ostensibly similar, version of me who would slip soundlessly into the life that had once been mine.

Shortly after making my decision I rang a separate Brisbane medical practice. I asked to speak to the doctor whose job it would be to render me unconscious and keep me that way during the long operation. Halting, almost apologetic, I explained to the receptionist that I had spent some years researching the process known as anesthesia, and that I was now rather nervous about what was going to happen to me. 'I think I know too much,' I said.

'Oh dear,' said the receptionist. 'That's not good.'

*

This book explores perhaps the most brilliant and baffling gift of modern medicine: the disappearing act that enables doctors and dentists to carry out surgery and other procedures that would otherwise be impossibly, often fatally, painful.

anesthesia.

The term was appropriated from the Greek by New England physician and poet Oliver Wendell Holmes in 1846 to describe the effect of the drug ether following its first successful public demonstration in surgery. Anesthetise: to render insensible.

These days there are other sorts of anesthetics that can numb a tooth or a torso simply (or unsimply) by switching off the nerves in the relevant part of the body. But the most widespread and intriguing application of this curious craft is what is now known as general anesthesia. In general anesthesia it is not the nerve endings that are switched off, it is your brain—or at least parts of it. These, it seems, include the connections that somehow enable the operation of our sense of self, or (loosely) consciousness, as well as the parts of the brain responsible for processing messages from the nerves telling us that we are in pain: the neurological equivalent of shooting the messenger. Which is, of course, a good thing.

More than a good thing. I would not have boarded that plane for Brisbane had it been otherwise. And I don't assume my fears were greater than those of anyone else in my predicament. But it was also true that for the previous decade I had been deeply preoccupied with a question or series of questions, often nebulous and contradictory, that amounted to this: what really happens to us when we are anesthetized?

By this I mean not what happens to the pinging, crackling apparatus of our nerves and spinal cords and brains, but what happens to us—to the person who is me or the person who is you—as doctors go about the messy business of slicing and delving within us? And, fused somehow to this, another odd and stubborn question: can whatever happens (or doesn't happen) while we are under anesthesia continue to affect us in our waking lives? Can it change the way we feel or think or behave in the minutes, months and even years after surgery? Finally I wondered—a niggling, almost soundless irritation largely obscured by the first two questions—why did I care?

Not so long ago, if you were unlucky enough to need surgery and strong enough to withstand it, you would be tied down and cut open, usually conscious and probably screaming. Poppy. Hemlock. Hemp. Over the centuries healers tried every imaginable way of preventing or deadening pain: pressing on arteries, pinching nerves, soaking sponges in narcotic herbs for patients to breathe through. Some practitioners favoured a blow to the jaw; others rubbed stinging nettles on one part of the body to distract from another. Alcohol. Opium. Hypnosis. Prayer. Until the mid-1800s, surgery was almost always an agonising last resort. Most of today's routine operations were impossible, and even when they weren't, many patients chose death in preference. 'Suffering so great as I underwent cannot be expressed in words,' wrote one survivor. 'The particular pangs are now forgotten; but the blank whirlwind of emotion, the horror of great darkness and the sense of desertion by God and man . . . I can never forget.'

In the end a patient's best hope was often simply speed. A Napoleonic surgeon called Langeback claimed he could amputate a shoulder 'in the time it took to take a pinch of snuff'. The brutality of their trade made some surgeons wretched and others hard-hearted, but even amid the burgeoning humanism of the Enlightenment, pain was considered so integral to life that few could imagine surgery without it. 'To avoid pain, in surgical operations, is a chimera,' said the French surgeon Velpeau in 1839. 'Knife and pain, in operative surgery, are two words which never suggest themselves the one without the other . . . and it is necessary to admit the connection.'

Surgical anesthesia brought the gift of oblivion.

Yet 170-odd years after a Boston dentist named William Morton gave the first successful public demonstration—removing a lump from the jaw of twenty-year-old Gilbert Abbott—we still don't understand fully how anesthetics work. Each day specialist doctors known as anesthetists (or, in America, anesthesiologists) put tens of thousands of people like you and me into chemical comas to enable other doctors to enter and alter our insides. Then they bring us back again. It is mind-blowing. But quite how this daily extinction happens and un-happens remains uncertain. Researchers know that a general anesthetic acts on the central nervous system—reacting with the slick membranes of the nerve cells in the brain to hijack responses such as sight, touch and awareness. They have nominated areas and processes they know are important: the microscopic channels through which neurons blast their chemical relays; the electrical circuits that pulse and groove between different regions of the brain. But they still can't agree on just what it is that happens in those areas, or which of the things that happen matter the most, or why they sometimes happen differently with different anesthetics, or even on the manner—a sunset? an eclipse?—in which the human brain segues from conscious to not.

Nor, as it turns out, can anesthetists ultimately measure what it is they do.

For as long as doctors have been sending people under, they have been trying to fathom how deep they have sent them. In the early days, this meant relying on signals from the body; later, on calculations based on the blood concentration of the various gases used. More recently brain monitors have come on the market that translate the brain's electrical activity into a numeric scale—a de facto consciousness meter. For all that, however, doctors still have no way of knowing for sure how deeply an individual patient is anesthetized—or even if that person is unconscious at all.

*

I am not an anesthetist, or a surgeon, or even a doctor. I am, however, one of the hundreds of millions of humans alive today who have undergone a general anesthetic. It is an experience now so common as to be mundane. These days there are gases and vapours and chemical infusions. Drugs to knock you out, to wake you up, to make you lie still in between; drugs to take away pain. There are machines to measure your heart rate, blood pressure, oxygen level, brainwaves; machines to breathe for you when you cannot. anesthesia has become a remarkably safe endeavour: less an event than a short and unremarkable hiatus. The fact that this hiatus has been possible for fewer than two of the two thousand or so centuries of human history; the fact that only since then have we been able to routinely undergo such violent bodily assaults and survive; the fact that anesthetics themselves are potent and sometimes unpredictable drugs—all this seems to have been largely forgotten. An-es-thee-zha. Most of us can barely pronounce it. Yet it has allowed the body's defences to be breached in ways previously unimaginable except during warfare or other catastrophe. Through the use of powerful poisons, it has enabled entry into the secret cavities of the chest and the belly and the brain. It has freed surgeons to saw like carpenters through the bony fortress of the ribs. It has made it possible for a doctor to hold in her hand a steadily beating heart. It is a powerful gift. But what exactly is it?

Table of Contents

Table of Contents

Introduction: Into the blue
Part 1
Going under
1 Awake
Rachel Benmayor wakes during surgery; awareness and the nature and history of anesthetics
2 Denial
What anesthetists say about their craft; the author's mother receives a diagnosis
3 Paralysis
Muscle relaxants in anesthesia: awakening helpless
4 Two hearts
How do you measure unconsciousness?


Part 2
The cold bosom of the ocean
5 Questions without answers
The experts investigating memory and awareness in anesthesia
6 Things you don't know you know
The unconscious
7 Weird science
Hypnosis
8 Moonless nights
Taking in information under anesthesia
9 Lost days
Searching for memories under hypnosis
10 The most famous anesthetist in the world
Ted Eger and the attempt to test the unrepeatable experiment


Part 3
Adrift
11 The island
Experiments on the working of the brain
12 Dreams
13 Altered states
Hallucinations after surgery
14 Ghost stories
'The parts of ourselves that are not available to conscious inquiry'


Part 4 Small bright fish
15 General amnesia
The role of forgetting in anesthesia
16 A working hypothesis
Unconscious memory, unremembered awareness
17 The memory keepers
Propofol, benzodiazepines – and who really benefits from anesthetic amnesia
18 The perfect anesthetic
Light anesthesia and sedation


Part 5
Merging currents
19 Coming apart
Questions about the dynamic unconscious
20 The hypnotist
The author in pursuit of her unconscious
21 Regression
Fear, vulnerability and ceding control


Part 6
Surfacing
22 Pulsations and palpitations
The brain and its waves
23 The shallows
Surveying long term psychological effects
24 Blood and blushing
Patients managing their experience of surgery
25 Ballast
The apprehension of death and the importance of the 'selves' we bring to surgery
26 That younger me
The author approaches her own surgery and her past self
27 Flying fish
Dreams, memories and the journey back to self; a reunion with Rachel Benmayor
28 Letting go
An operation and a death
29 Wings
An awakening


Notes
Sources
Index

Editorial Reviews

10/09/2017
Australian journalist and novelist Cole-Adams (Walking to the Moon) mingles her own experiences under anesthesia with those of other patients and doctors, producing a personal work that is a mix of agony and insight. Anesthesiologists, she writes, routinely overestimate the amount of “anesthetic cocktail” needed to sedate a patient, but a strong dose still does not prevent “one or two per thousand” patients from waking up during surgery. Cole-Adams relates patients’ experiences of pain and paralysis; she also chats with psychologists as they prepare patients for surgery and, later, work with patients who have difficulty getting back to health after surgery. A medical history of anesthesia is worked through the text. Cole-Adams considers surgical-room banter and its effects on patients; she refers to a strange incident in which a patient became suicidal after surgery, revealing under hypnosis that she heard the surgeon say she was fat. The limitations of hypnosis, the complexities of memory, and the difference between the conscious and unconscious minds are questions that persist throughout this book. Cole-Adams weaves her own mounting personal problems throughout the text. Readers may react to this work similarly to the psychiatrist who told Cole-Adams, “I’m not certain whether you’re trying to sort yourself out, or whether you’re trying to sort out other things.” Agent: Jenny Darling, Jenny Darling & Associates (Aus.). (Dec.)

Publishers Weekly

Praise for Anesthesia

"An obsessive, mystical, terrifying, and even phantasmagorical exploration of anesthesia’s shadowy terra incognita."" —The New Yorker

"Ms. Cole–Adams’s journey was spurred by her discovery in 2010 that she was to be scheduled for major spinal surgery. A novelist as well as a journalist . . . she writes fluidly and dramatically, using her travels, researches, and interviews to trace her anxieties about her forthcoming general anesthetic back to their roots. Her book is as much a diary of the writing process as a scientific investigation."" —The Wall Street Journal

"Cole–Adams gives us something valuable: a humanistic meditation on pain and our will to forgetting . . . Anesthesia . . . serves as an apt metaphor for our cultural impulse toward numbness . . . Awake to the eventualities of suffering and death, Anesthesia suggests, we might treat ourselves—and each other—more kindly." —Los Angeles Review of Books

"Her book explores the terrifying topic of anesthesia awareness . . . Cole–Adams blends bits of pharmacology, neurology, philosophy, and ethics with interviews of patients, researchers, and anesthesiologists . . . with big, baffling questions about the nature of consciousness and memory." —Booklist

"Cole–Adams . . . mingles her own experiences under anesthesia with those of other patients and doctors, producing a personal work that is a mix of agony and insight." —Publishers Weekly

"Cole–Adams blends research, reflection, and memoir to try to grapple with the meaning of consciousness . . . These are thought–provoking questions, and Cole–Adams presents a lyrical journey through the vital question of what it means to be human."" —Kirkus Reviews

"If you’ve ever gone under—or even if you haven’t—the book will horrify you."" —Los Angeles Review of Books

"Kate Cole–Adams’s new book, Anesthesia . . . us[es] a combination of memoir and journalistic inquiry to investigate what consciousness really is. Reading Anesthesia, one learns a great deal about the practicalities of anesthesia, the errors that are made, the attitudes of medical professionals about anesthesia, even the history of anesthesia and how (gruesomely) invasive surgery was done prior to its invention." —The Cut

"Elegantly and, at times, heart–breakingly parsing the murky space between presence and absence, Cole–Adams has crafted a mesmerizingly unique memoir that is bound to haunt readers well beyond the last page." —Winnipeg Free Press

"For those who wonder what becomes of the body while it is undergoing general anesthesia—perhaps the closest that many of us have been to the experience of death—this book looks at the notion of being rendered unconscious from a panoply of sources. A must–read for anyone who woke from surgery and couldn’t remember anything about the experience." —Signature Reads

"With Anesthesia, Kate Cole–Adams has given us a gift. She explores not only the concepts but the characters who hope to understand the shadowy world of the anesthetized mind. However, Cole–Adams transforms from being an observer to a fellow journeyer, providing authentic insight and transmitting the excitement of those who believe that these drugs are ethereal keys that could unlock the vault of consciousness itself." —George Mashour, author of Neuroscientific Foundations of Anesthesiology

"I think [Anesthesia] is utterly brilliant. I will read anything this woman writes forever more. She is Just. So. Good. Human, funny, insightful, supersmart, a most original and perceptive writer. I ended the book in tears. It is not just about medical stuff, but deeply personal stuff. About the psyche, and pain of all kinds, and triumphing, surviving, exploring, being brave and powerful and honest. About what is said and what isn't, about listening, about dreams and hypnosis and consciousness, which is to say, about our deepest selves. You might be getting the picture: I adored it to bits." —Charlotte Wood, author of The Natural Way of Things

"A work of splendid richness and depth, driven by a curiosity so intense that it hazards at times the extreme boundaries of the sayable." —Helen Garner, author of Everywhere I Look

"Kate Cole–Adams has written an insightful and moving exploration of general anesthesia: a must–read for anesthetists and their patients." —Professor Kate Leslie, head of research in the Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; former head of the Australian and New Zealand College of Anaesthetists

"This book is a compelling exploration from a patient perspective of the still poorly understood phenomenon of 'anesthesia', and of the uncertain border between being unconscious and awake. Much of this material will be new not only to patients but also to many practitioners." —Professor Jaideep Pandit MA, BM, DPhil, FRCA, FFPMRCA, DM, Consultant Anaesthetist, Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust & Fellow St John's College

From the Publisher

2017-09-17
Melbourne-based journalist and novelist Cole-Adams (Walking to the Moon, 2008) blends research, reflection, and memoir to try to grapple with the meaning of consciousness.When someone is anesthetized for an operation, they are usually told that they will be "going to sleep." What actually happens is much more complex, and not even anesthesiologists can agree on or fully explain what happens under anesthesia. In her first work of nonfiction, the author seeks to uncover some of the ethical implications of this procedure, such as the potential impact of words by doctors when a patient is unconscious or how to deal with the small but still troubling percentage of patients who wake up in pain during surgery, unable to communicate. She depicts her interactions with some of the foremost researchers working to understand these and other questions—e.g., why patients remember things that happened under anesthesia only when hypnotized and how an anesthesiologist can actually tell if a patient is awake. While Cole-Adams has amassed a lot of useful information and telling anecdotes, her purpose is not to simply narrate a history of anesthesia or to describe with scientific detail what happens to the brain when anesthetized. Incorporating dream accounts and bits of memoir, weaving in and out of her own and others' stories, and sharing her own limitations of understanding, the author uses a collagelike structure that seems to mimic the amorphous nature of the mind as someone drifts into unconsciousness under anesthesia. As Cole-Adams writes, "part of the difficulty in talking about anesthesia—not how to do it, but what it actually does—is that any discussion veers almost immediately into the mystery of consciousness."While the author raises more questions than she answers, and some readers may be put off by her less-that-straightforward style, these are thought-provoking questions, and Cole-Adams presents a lyrical journey through the vital question of what it means to be human.

Kirkus Reviews