One day in the nineteen-eighties, a woman went to the hospital for
cancer surgery. The procedure was a success, and all of the cancer was
removed. In the weeks afterward, though, she felt that something was
wrong. She went back to her surgeon, who reassured her that the cancer
was gone; she consulted a psychiatrist, who gave her pills for
depression. Nothing helped—she grew certain that she was going to die.
She met her surgeon a second time. When he told her, once again, that
everything was fine, she suddenly blurted out, “The black stuff—you
didn’t get the black stuff!” The surgeon’s eyes widened. He remembered
that, during the operation, he had idly complained to a colleague about
the black mold in his bathroom, which he could not remove no matter what
he did. The cancer had been in the woman’s abdomen, and during the
operation she had been under general anesthesia; even so, it seemed that
the surgeon’s words had lodged in her mind. As soon as she discovered
what had happened, her anxiety dissipated.

Henry Bennett, an American psychologist, tells this story to Kate
Cole-Adams, an Australian journalist, in her book “Anesthesia: The Gift
of Oblivion and the Mystery of
Consciousness
.”
Cole-Adams hears many similar stories from other anesthesiologists and
psychologists: apparently, people can hear things while under
anesthesia, and can be affected by what they hear even if they can’t
remember it. One woman suffers from terrible insomnia after her
hysterectomy; later, while hypnotized, she recalls her anesthesiologist
joking that she would “sleep the sleep of death.” Another patient
becomes suicidal after a minor procedure; later, she remembers that,
while she was on the table, her surgeon exclaimed, “She is fat, isn’t
she?” In the nineteen-nineties, German scientists put headphones on
thirty people undergoing heart surgery, then, during the operation,
played them an abridged version of “Robinson Crusoe.” None of the
patients recalled this happening, but afterward, when asked what came to
mind when they heard the word “Friday,” many mentioned the story. In
1985, Bennett himself asked patients receiving gallbladder or spinal
surgeries to wear headphones. A control group heard the sounds of the
operating theatre; the others heard Bennett saying, “When I come to talk
with you, you will pull on your ear.” When they met with him, those
who’d heard the message touched their ears three times more often than
those who hadn’t.

As a teen-ager, Cole-Adams was diagnosed with scoliosis. She came to
dread the dangerous surgery she might someday need to correct the
curvature of her spine; in middle age, she grew increasingly stooped and
realized that the surgery was inevitable. She began researching
“Anesthesia” in 1999, perhaps as a means of mastering her fear, and,
after nearly twenty years’ work, has written an obsessive, mystical,
terrifying, and even phantasmagorical exploration of anesthesia’s
shadowy terra incognita. In addition to anesthesia, the book describes
Cole-Adams’s childhood, her parents, a number of love affairs, and
various spiritual experiences and existential crises—a drifting,
atemporal assemblage meant to evoke the anesthetized mind. Cataloguing
her many forgotten experiences and unfelt feelings, she wonders to what
extent we already live in an anesthetized state.

Anesthesiologists speak of patients descending through “the planes of
anesthesia”—from the “plane of disorientation” through the “plane of
delirium” toward the “surgical plane.” While we go under, they monitor
our brain waves, titrating their “anesthetic cocktails” to make sure
that we receive neither too little sedation nor too much. (A typical
cocktail contains a painkiller, a paralytic, which prevents muscles from
flinching at the knife—the early paralytics were based on curare, the
drug South American warriors put on the poison-tipped arrows with which
they shot Europeans—and a “hypnotic,” which brings unconsciousness.) But
even as they operate the machinery of anesthesia with great skill,
anesthesiologists remain uncertain about the drugs’ underlying
mechanisms. “Obviously we give anesthetics and we’ve got very good
control over it,” one doctor tells Cole-Adams, “but in real
philosophical and physiological terms we don’t know how anesthesia
works.” The root of the problem is that no one understands why we are
conscious. If you don’t know why the sun comes up, it’s hard to say why
it goes down.

In her attempts to understand what going under anesthesia really
entails, Cole-Adams encounters what Kate Leslie, an Australian
anesthesiologist, calls “spooky little studies”—odd, suggestive, and
often unreplicable experiments. In one such study, from 1993, Ian
Russell, a British anesthesiologist, ties a tourniquet around the
forearms of thirty-two women undergoing major gynecological surgery. He
administers his anesthetic cocktail—the hypnotic drug midazolam, along
with a painkiller and a muscle relaxant—then, by tightening the
tourniquet, prevents the muscle relaxant from entering each woman’s
hands and wrist. During surgery, a recorded message plays through
headphones in which Russell addresses each patient by name. “If you can
hear me, I would like you to open and close the fingers of your right
hand,” he says. If the woman moves her hand, Russell lifts one of the
earpieces and asks her to squeeze his fingers; if she squeezes, he asks
her to do it again if she is in pain. Of the thirty-two patients Russell
tested, twenty-three squeezed to suggest they could hear, and twenty
squeezed again to say they were in pain. Although Russell was supposed
to test sixty patients, he was so unnerved by these results that he
ended the trial early. It’s possible, he suggests, that the women were
conscious and suffering on the operating table. If that’s the case, then
general anesthesia might be better described as “general amnesia.”
(Afterward, none of the women recalled hearing Russell’s voice or
squeezing his hand.)

Could Russell have failed to administer enough anesthetic? (He says he
used as much as he would in any normal operation.) Could he have been
feeling movements that weren’t there or that weren’t significant?
(Cole-Adams attends an operation with Russell, during which he again
employs his “isolated forearm technique”; this time, when the patient
grips his fingers, he deems it a meaningless “reflex movement.”) It’s
possible that the patients were aware, but only partially—aware enough
to squeeze Russell’s hand, but not enough to know their own names, for
instance, or to recall anything about their lives. Daniel Dennett, the
philosopher of mind, argues that consciousness is not a binary state
but a gradual
one
;
it’s possible to be “sort of” conscious and, during that time, to have a
“sort of” self. Every year, thousands of people have colonoscopies under
so-called conscious sedation: they are drowsily awake and can
communicate with their doctors, but remember little or nothing about the
procedure afterward. If you don’t remember the pain, does it still
count? Did it happen to “you”? Maybe being “sort of” aware during
surgery isn’t so bad.

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