Kate Cole Adams’ exploration of the science, ethics and philosophy of anaesthetic is subtitled “The gift of oblivion, the mystery of consciousness”. Anaesthesia starts as medical journalistic analysis and emerges a deeply personal memoir interrogating the edges of the unknowable. Anaesthetic is a modern medical miracle, surrounded by fear partly because it is an experience that brings into the oblivion of death and back again – something that simply should not be – but also because quite simply again and again scientific study of the anaesthetic experience has shown that we just don’t know what is going on, or how it works. We just know that it mostly does.
Is that scary? I think it’s scary. But I also find the intersections between psychology, medicine, physiology, philosophy, pharmacology, science and morality fascinating. So despite the challenges, I read on. I first listened to a conversation between Cole-Adams and Richard Fidler on ABC’s Conversations and found it captivating; a base fear stopped me from reading the book until a recommendation from a close friend. I wanted my engagement to be academic, I didn’t want to wear the mystery personally; I wanted to remain grateful and not know too much.
There is perhaps a shocking variety contained within the general catch-all term general anaesthetic including inhalable, injectable, short-term, long-acting, working on the brain, working on the body, depending on the patient, the procedure, the surgeon, the anaesthetist. There is no standard dose. Generally today’s cocktails contain three main elements: hypnotics to render you unconscious and to keep you that way; analgesics to control pain; and a paralysing muscle relaxant to prevent to from moving on the operating table thereby enabling some surgeries actually possible.
After drawing bounds around her long-running preoccupation with the subject, a sketching of the history, some grappling with the framework within which she will dive, Coles-Adams is drawn along with this intense, almost morbid curiosity; the undercurrent an impossible-to-articulate personal motivation that takes her to boundaries of darkness. The concern is not just anaesthetic, but the lived experience of it, and where the self goes; then it becomes her lived experience, where her self has been, and the battle of writing this book.
“It is one thing to have the ‘I’ – the so-called ‘vertical pronoun’ – writing itself into the story, offering opinions, musings and other such personal flourishes. But to have the ‘I’ as a subject of research – to take the vertical pronoun and lay it on the psychoanalyst’s couch, or perhaps the surgeon’s trolley (the pronoun now prone, horizontal) – seemed improper: self-regarding.
And yet every time I tried to harness my ‘I’ and wrest the book into a respectable journalistic narrative, it would thwart me.”
I loved this book for the challenges it provoked in me. How much does your mind know what is going on when you’re on the operating table? Can you hear, can you remember; does it matter? Is pain still pain if we are not awake to feel it? How do we define consciousness, and why do we think it’s in the brain? How does the unconscious mind deal with the body’s lived experience of being cut open, ransacked? Are there parallels between the anaesthetised experience with dreams, meditation, Alzheimer’s disease, psychotic conditions, other drugged states? The biggest one for me: If you experience pain during an operation but due to the amnesiac in the anaesthetic drug cocktail cannot remember it afterwards, does it matter?
Amongst this all, it is important to acknowledge that until 170 years ago, many people chose death over the ordeal of surgery. Now there are hundreds of thousands of operations every day that prior to anaesthetic were impossible, painfully dangerous. My overwhelming feeling for anaesthetic is a positive one, one of gratitude, and that definitely informed my sometime-irritation with Cole-Adams as her fear dragged her deeper.
I don’t know whether to recommend this to people who are already afraid the experience of general anaesthetic. Having gone under twice and still find myself immensely grateful for the fact it allowed me to live my life as a young woman without physical disability, I had no time to harbour fears or doubts. I wanted wellness, and anaesthetic was on that path. I felt fear, but it was a vague trepidation of pain within a lengthy life experience generally marked by distress, lack of control, recovery and necessary emotional distance to release into the required process. So I do have something personal invested here when reading Anaesthesia but I come from a very different place to Cole-Adams.
I am fascinated, and slightly shocked, at the doubt that suffuses the science behind the profession of anaesthetists; challenged by the philosophical grapplings with concepts of consciousness; and provoked by the ethics behind competent anaesthetists making split-second decisions protecting their patients to the best of their understanding. I am reading from a place where it is ok to be challenged, but a closing message from the book seems to be that you will come out of anaesthetic how you came in. So if you already harbour deep fear and being exposed to what is not known by the experts who will carry you through the anaesthetised experience will engender more fear, maybe don’t read this book.
What can you do? Communicate – with your loved ones, with the nurses and other care givers, with your anaesthetist and surgeon and trust their expertise. Be proactive – take ownership of you and your body’s role in this experience. The passivity naturally physically brought about by general anaesthetic can be balanced by your state of mind going in. Meditate.
Anaesthesia is a fascinating, challenging book; heavy, morbidly curious. You don’t need to have a anaesthetic experience to have some sort of personal resonance here; Coles-Adam’s explorations have wide-ranging, stunning implications. In it there are ideas that interrogate the bounds of our very existence, the way we see and the world and our very selves, and the way we come to understand it.