Anesthesia by Kate Cole-Adams
Anesthesia: The Gift of Oblivion and the Mystery of Consciousness “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.” Cole-Adams asks “what happens to us—the person who is me or the person who is you—as doctors go about the messy business of slicing and delving into us?” Can anesthesia change the patient in some profound way and “continue to affect us in our waking lives?”
The poet and physician Oliver Wendell Holmes appropriated anaesthesia from the Greek in 1846 to “describe the effect of the drug ether following its first successful demonstration in surgery.” Even then surgery was a last resort and was as often the proximate cause of death as the reason for the surgery. Without anesthetic, speed was the standard. One surgeon famously said that he could amputate a shoulder in less than the time needed to sniff snuff.
General anesthetic, a process that switches off parts of the brain rather than specific nerve endings, is the primary focus in Cole-Adams’ book. It is a delicate procedure fraught with inherent danger, and a surgical patient should research the anesthesiologist as well as the surgeon. Within this broad category, Cole-Adams examines the nature of pain, the pharmacological cause and effect of anesthesia, the effect of various anesthetics on the nervous system, hypnosis, and whether memories can be formed while under anesthetic. Importantly, she asks, what is unconsciousness: “An ‘adequately’ anesthetized patient will feel, see, smell and taste nothing until they regain consciousness.” But they may still hear because “the brain’s auditory pathways resist to some extent the depressive effect of the drugs….”
One of the important questions she addresses is whether patients wake up during surgery. The answer is yes, perhaps 1 or 2 of 1,000 patients, 20,000-40,000 annually in the United States alone. It can be as painful and horrifying as one might expect. The pain comes from the cutting, of course; the horror arises because most operations require that the patient be paralyzed to prevent movement. So that presents a terrible situation in which the patient is awake and aware of what is happening with the pain, but unable to say or do anything. In 1998 Carol Weihrer, an American musician, was undergoing surgery to remove her diseased right eyeball. Although initially asleep, she was awake for nearly two hours. She “felt her eye being scooped and wrenched from its socket, and then the fibers of the optic nerve being severed. ‘Nothing gets much darker than those seconds,’ she would tell a conference in 2004.” The process was so traumatic and debilitating that more than six years later she claimed that she had “not slept in a bed…because I cannot face lying in the same position as the surgery required….”
Cole-Adams’ book is a deeply personal account and exploration of what it means to be anesthetized. It was Rachel Benmayor’s story (“a caesarean birth endured conscious, paralyzed and in agony”) which provided the author “an emotional and philosophical pivot around which I have circled for nearly two decades….” A second impetus was her surgery for advancing scoliosis and a concomitant desire to understand what would happen. Her mixture of anecdotes and personal accounts from other patients combined with the science and theoretical wonderings about the nature of anesthetics makes for a compelling read. It caused this reviewer to revisit my first (and only!) time receiving gas in the dentist’s chair in the mid-fifties: as I breathed the gas, I developed this terribly frightening and visually vivid picture of me sliding down a funnel from which I could not escape nor pull my still-conscious self toward the surface. I can still remember the office and the two windows overlooking the streets on each side of the building. Now I better understand what was happening to me.