Anesthesia, page 11
Personally, I have never much approved of my unconscious self. By this I mean not the multitude of unconscious, automatic processes that form the substrate of my waking life—reading, writing, riding a bike—but the half-formed, unarticulated thoughts and memories, associations and opinions that together constitute what I think of as my hidden self. I like it in theory, and sometimes in the cinema of dreams, but up close it frightens me. It is unruly and I cannot control it. I feel that it makes me vulnerable. Sometimes it gets in the way of me doing the things I think I want to do. Often it tells me things that I don’t want to know. (Once while kissing a man I liked I had the vertiginous sense that his mouth would open and open and that he would swallow me whole.) And too often I push it away. But wherever I go it trails along, insistent and unquiet. Like a small dog yapping behind me. The harder I push, the more insistent the yapping.
Who knows what to make of Freud’s psychoanalytic unconscious? What is it? Where does it happen? Is it even a thing? Freud’s labyrinthine theories have been pilloried and parodied in part because of their imprecision, as well as their pervasive emphasis on sexuality. Even if we accept the basic idea that there are things about ourselves that we don’t want to know (without actually knowing that they are there not to be known)—and that we somehow exile them to an uncertain realm where they settle like silt, if only for a while—the limits of this kingdom remain obscure. As do its laws. As do the means of banishing or retrieving material to or from it.
Yet the evidence of my own life tells me there are parts of myself that I do not recognize or necessarily welcome, but which influence the choices I make, the interests I pursue, the people I love and the way I love them. I also accept Freud’s contention that this hidden self makes itself known to us—or rather, we make ourselves known to ourselves or to others—through secret channels and unintended gestures. We glimpse it in dreams or express it, unwittingly, through our verbal slips and bodily processes, our flushing, our vague malaises and our inexplicable medical woes; we give it form in our art. British sculptor Henry Moore’s famously gigantic tactile nudes are said to have had an umbilical connection to the fact that as a young boy he used to massage his mother. This reminds me of a set of Post-it notes my own mother gave me one Christmas, with a picture of old Sigmund alongside the quote When you mean one thing but say your mother.
My mother, as it happens, is also an artist. For a long time she has explored in her prints and paintings the collision between native vegetation and human patterns. She views the earth from above as if through some high eye: huddles of remnant forest dissected by fields and fences and furrows; bald hills draped with fluid linear contours. Before and after. Wilderness and constraint. One of my favorite works is an etched landscape of neatly sectioned fields intersected with meandering creek lines and dark clotted pools. The fields are filled in from above in orderly rows that mark the lines of their plantings. And from beneath (a sepia stain) blooms of submerged water seep upward and through.
My mother.
When I visited her in the hospital a few nights after the surgery to remove her cancerous kidney my mother reported a dream she had had the night before. It was not like her other dreams.
Generally, she said, “people tend to plod around in my dreams, looking for a door or a place or a toilet, and nothing much happens.” But in this dream she had discovered or been delivered a box of light bulbs. What interested her about the bulbs was that she knew with the logic of dreams that if she could work out how to turn them inside out she could transform them into Christmas decorations. This appealed to her immensely. But as she got to work, she realized that the light bulbs were multiplying. Faster than she could transform them, they began spreading around her. She woke into darkness and an unfamiliar unease. She climbed out of her bed and raised the blinds. Wrapping a blanket around her, she moved to the chair against the window and here she sat and waited for the sun to rise over the warehouses and terraces and sports grounds of East Melbourne.
The thought of my mother sitting there alone like that makes my heart hurt; an ache behind the breastbone that does not go away even when I rub at it. But as poignant as this story seems to me, at least my mother knew she had been asleep and was now awake. This is not the case for some people waking from anesthetics. William Morton’s historic public demonstration of surgical anesthesia in the Ether Dome may have been the first record of anesthetic awareness (his young patient having later admitted to being in pain during the procedure). But his rival for the title of founder of modern anesthesia, Horace Wells, had already beaten him to another dubious distinction, although he was not to know it: the first recorded case of hidden awareness in anesthesia.
This contradictory notion loosely describes the experiences of people who can be shown to have taken in information during surgery but who later have no knowledge of it. While Wells’s ill-fated attempt to publicly demonstrate surgical anesthesia with laughing gas destroyed his career, the patient who had ruined his demonstration by crying out as Wells pulled his tooth later claimed to remember no pain. He was unaware of having been aware. By today’s standards Wells would almost certainly have been deemed the more successful anesthesiologist. (Plus, the drug he used for his demonstration was nitrous oxide, still the workhorse of many of today’s anesthetic mixes—unlike ether.)
If only Bernard Levinson had been there on the day of Horace Wells’s doomed demonstration. He might have hypnotized the young patient and taken him back to that moment when his tooth was drawn and he cried out, before forgetting what had happened. That said, hypnosis is, in its own weird way, as mysterious as anesthesia, and considerably less reliable. Psychiatrists warn that in this vulnerable state patients may unwittingly confuse or even create events—“confabulating” memories, dreams and imaginings into some hybrid beast they might wrongly believe to be real.
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Among the papers in my study is a precious and fading fax, sent to me by Bernard Levinson, with the notes he wrote after that flawed and fascinating 1965 study. Here is twenty-two-year-old motor mechanic Mr. R. Under hypnosis a month after his dental surgery, Mr. R also reported memories of the procedure, but in his case the mock crisis appears to have been largely overshadowed by a real drama. Just before the anesthesiologist interrupted the operation, the surgeons accidentally cut an artery in the man’s mouth. Now Mr. R appeared to be reliving the hitherto forgotten episode in Bernard Levinson’s rooms.
Mr. R: My gum feels like it’s being cut. It feels like they’re breaking my tooth: with a hammer and chisel, or something—and they’re picking out the pieces. I can taste blood.
BL: You can taste blood?
Mr. R: Ya. I can taste blood—and they’re pulling now. Cutting and having trouble I think. Pulling out bits on this side. Little bits here and moving something. Uh . . . uh . . . my hands are being held.
BL: How do you mean, your hands are being held?
Mr. R: I don’t know. I’ve just got that sensation. My hands are held fast to my side.
BL: Anything else? Anything being said?
Mr. R: Some people are speaking over there. Something about a dental artery. My mouth is full of blood. It feels like it’s bleeding a lot.
BL: What’s he saying?
Mr. R: Got to cut deeper—or something like that. Someone’s saying there’s a nerve there.
[A little later in the interview, Mr. R has mentioned the anesthesiologist, and Levinson asks if he recalls Viljoen saying anything during the surgery.]
BL: Can you go back now and try and hear what that voice which you described to me was saying?
Mr. R: He’s saying it’s all right. Yes, it’s all right now, they can finish the job.
So what just happened? And what are we to make of it? Levinson believes that the mechanic was retrieving an unconscious memory formed under deep anesthesia. (“I kept on saying to the anaesthetist, you’ve got to go deeper, and I will signal to you when the electroencephalogram is flat, and he had never taken his patients to that level of anesthesia.”) Others have suggested that Mr. R and the others who reported similar experiences after the mock crisis might not have been as unconscious as Levinson liked to think: perhaps the anesthetic (an ether-based cocktail also including nitrous oxide) had left them awake enough to register parts of the procedure before forgetting again. Perhaps these were not memories at all: perhaps the patients were merely responding to cues Levinson himself had accidentally given when he hypnotized the ten after—or even before—their operations. It is impossible to know. And of course, all this happened a long time ago. By the 1970s ether had largely fallen out of favor in Western nations—not only did it smell bad and induce an unbearable sense of suffocation, it was highly flammable (even the carcasses of animals euthanized with ether are potentially explosive). In most parts of the world it has long been superseded by other inhalable anesthetics. In the operating theaters of the new millennium, with their panoply of drugs and monitors, their sophisticated anesthetic cocktails, few anesthesiologists would seriously entertain the possibility that experiences such as recounted by Levinson or Cheek could happen today, if ever they did.
But suppose for a moment that Levinson is right. What if something about the effects of ether—or even of that particular cocktail on that particular day—means that those memories were both unconscious and real? I can’t help wondering about the patients who became agitated when later questioned under hypnosis—and about the two who claimed to remember nothing at all. Levinson has no idea what became of them. Maybe they walked out of his rooms and that was the end of it. But there must still be tens of thousands of other people walking around today who have had ether anesthesia. Might some of them still be carrying fragments of their surgeries around inside them?
There was a strange case, reported in the mid-1980s by Australian psychologist Julius Howard, of a twenty-nine-year-old woman who had suffered chronic insomnia following a hysterectomy three years earlier. The patient, said Howard, “had been aware vaguely of some fearful anxiety which had kept her awake, but had no idea of its real meaning or cause.” Under hypnosis, however, she remembered the anesthesiologist saying she would “sleep the sleep of death”—a claim the anesthesiologist later confirmed. The next time Howard saw her, he said, at a follow-up three years later, the insomnia and anxiety had disappeared. Howard referred to another patient who had become suicidal after a minor operation. Under hypnosis, she later reported hearing the surgeon say, “She is fat, isn’t she?”
Again, such scenarios can’t be scientifically replicated. Hospitals have ethics committees to make sure of that. But nor can they be dismissed out of hand.
An “adequately” anesthetized patient will feel, see, smell and taste nothing until they regain consciousness. But they may still hear—unlike the other sensory systems, the brain’s auditory pathways resist to some extent the depressive effect of the drugs, meaning that hearing is often the last sense to fade under anesthetic. And they may still form memories—even without knowing it. While Bernard Levinson’s study lives on today largely as a curiosity, there is plenty of evidence that information can still enter and be processed within an anesthetized brain.
Shortly after my first meeting with Kate Leslie in her tiny office at the Royal Melbourne Hospital, she faxed me details of an experiment reported by New York anesthesiologist David Adams in the late 1990s. Adams and his team had taken twenty-five unconscious heart-surgery patients and played them audiotapes of paired words: boy/girl, bitter/sweet, ocean/water . . . About four days after the operation, the team had each person listen to a list of single words—some of which had been among the word pairs played while they were unconscious—and asked them to free-associate, or respond to each with the first word that came into their minds. The patients were significantly better at free-associating the word pairs they had already encountered than those they hadn’t. Not only had they heard the information, they had, without knowing it, remembered it. Ocean water. Bitter sweet.
Admittedly this is nowhere near as interesting or complex as announcing that the patient is turning blue. But it does suggest that while only a small fraction of patients have conscious memories of their experiences on the operating table, many more of us may have unconscious traces—things we don’t even know we know that may nevertheless affect how we will later behave.
Most of life is like this. I remember the moment (sitting in my car in my early forties, the recently single mother of a young son) when I realized that the place I had arrived at in life was exactly where I had always imagined myself being. Not a place that I had planned. Nor a place that my younger self might have selected had she been offered a menu of options. But the place that I had dreamed myself toward. Blindly, diligently. Repeatedly. As if I had a map that was secret even to myself, but that I had followed all the same, slipping in and out of relationships, jobs, predicaments: unsure for the most part how I came to be where I was. And without ever realizing that I had drawn the map myself.
It was, at least in part, unconscious forces that propelled me as a younger woman, some years before the Adams study was published, to Darwin in Australia’s tropical north. I had left Melbourne after a failed relationship in pursuit of a newer, I hoped less fallible, one. I moved into a tiny sweatbox above a fish-and-chip shop with the man I had recently fallen in love with. It was a deep, rectangular space with no hot water in the shower and with one long wall looking onto the neighboring brick wall about a meter away. It was very dark and very hot. The cockroaches were the size of jam-jar lids, and they flew. A large rat used to climb the outside guttering and walk across the windowsill. But the place had been imparted a reckless sort of charm by the addition of textiles, floor rugs and Aboriginal artworks, and by the color scheme, which included rooms of aqua and tangerine. It was like living inside a Rubik’s cube. Outside, on the streets, everything was so bright I could scarcely drag my gaze to the horizontal. Mangoes rotted on the pavements and I would swerve to miss them as I rode my bike slowly to the Parap pool and back. In summer the sea was unswimmable, taken over by swarms of deadly box jellyfish. Even in winter the water felt as if you were plunging into your own urine, and there was always the chance of crocodiles.
During the days my partner would go to his air-conditioned office and I would stay at home and try to make a living as a freelance journalist, hoping the sweat from my fingers would not short-circuit my laptop. Sometimes I would go down to the supermarket and wander around the freezer aisle where it was cool and I could pretend I was doing something useful. Often I would simply lie on my back watching the ceiling fan go around.
From time to time I would be sent to do a story fifteen hundred kilometers to the south in the desert country around Alice Springs. Stepping out of the plane into the exact moistureless heat I would feel myself start to wake up, a blip of excitement deep in my stomach, the dog smell of dust and temperatures that plunged wildly at night. In Darwin the towels went moldy and I felt that I was enveloped in a viscous haze. My partner was away a lot, during which time I felt disconnected and lonely. When he was in town we would drink and smoke too many cigarettes. When he was away, I would drink and smoke too many cigarettes. I used to joke to long-distance phone friends that living in Darwin was like finding myself on a package tour, sharing a room with someone I couldn’t stand: myself.
A year or so into my time in Darwin I went to see a counselor, a kind man with strong calves who wore long shorts to work. Among the things I remember saying to him, which mostly centered around a muffled, corrosive unease about my relationship with the man I had followed across Australia, was that I felt that the center of my chest was rigid and heavy, as if I was carrying something inside me, a black box, and that sometimes I had trouble breathing.
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The idea that there may be two types of knowing—one you know about and one you don’t—first began to take hold in the late nineteenth century. But unlike the psychoanalytic unconscious later postulated by Freud—brimming with memories and desires, lost (temporarily or forever) to the conscious self—these early experiments hinted at something in a sense more mundane, a perceptual unconscious mediated through senses such as sight and sound.
In 1898, U.S. psychologist Boris Sidis undertook a study in which he asked people to look from a distance at letters and numbers on cards and report what they saw.
[T]he subjects often complained that they could not see anything at all; that even the black, blurred, dim spot often disappeared from their field of vision; that it was mere “guessing”; that they might as well shut their eyes and guess. How surprised were they when, after the experiments were over, I showed them how many characters they guessed correctly . . .
