Anesthesia, page 12
They had taken in more than they knew and their behavior showed it even when they denied it. How much subjective reports such as these can tell us about the existence or otherwise of unconscious perception is arguable, but Sidis thought his findings adverted to “the presence within us of a secondary subwaking self that perceives things which the primary waking self is unable to get at.” This, he believed, was evidence of a mysterious hidden force at the heart of each of us. “The life of the waking self-consciousness flows within the larger life of the subwaking self like a warm equatorial current within the cold bosom of the ocean.”
Similar sorts of experiments cropped up over the next half-century, but were generally met with skepticism from a populace not yet shaped by Freud, Jung and their successors, and who (like me) did not much like the idea that people could be pushed and pulled by inner forces beyond their control. It wasn’t until the late 1960s and early ’70s that scientists got serious about investigating this intriguing but elusive form of perception. They took patients with damage to the visual center in one hemisphere of the brain (rather than in the eye itself), and who could therefore make out objects clearly through one eye and not at all through the other, and presented shapes or patterns to the so-called blind eye. The subjects—while protesting they could see nothing—would most often be able to correctly “guess” what they had seen. These experiments in “blindsight” have been followed up with other studies showing the same can happen with hearing, touch and smell. Other experiments famously showed that patients whose short-term memory had been destroyed through disease or brain damage could nevertheless be shown to have “remembered” people and information without knowing it.
Researchers these days distinguish between explicit memories (those you can remember having) and implicit, or hidden, memories which are inaccessible to their owners but can be identified by changes in performance or behavior—the process known as priming. New brain imaging technology is beginning to show which parts of the brain light up during such unconscious learning. But at this stage, scientists remain uncertain whether they are looking at two or more distinct or perhaps overlapping memory systems, or one that perhaps expresses itself in different ways.
It took until the mid-eighties for researchers to start testing in a systematic way whether similar processes might be at work in anesthetized patients.
In 1985 a team led by U.S. psychologist Henry Bennett—this was the same edgy, fast-talking Hank Bennett I met in Hull—randomly assigned thirty-three patients in the hospital for hernia or gall bladder or spinal surgery to two groups. During surgery all patients wore headphones. Patients in the larger control group had the sounds from the operating theater relayed back to them through the headset. The remaining eleven were played a pre-recorded tape interspersing suggestions about how well they would heal, with songs and music. Five minutes before doctors reversed the anesthesia at the end of the operation, each of these patients was also delivered a personal message through their headphones. The pleasant recorded voice of Bennett, whom the patients had already met, talked about the patient’s postoperative recovery and goals, and then made an extra suggestion about something the patient should do during an interview scheduled for two days later. “When I come to talk with you, you will pull on your ear. Your ear might itch a little and you will need to pull on it, or you might just know to pull on your ear. That way I will know you have heard this.”
At the subsequent interviews none of the patients reported any memory of the surgery. Nor did the study report any differences in recovery between the groups. But it did show that patients who had been played Bennett’s message were around twice as likely to touch their ears as those from the control group. They also touched their ears more often—a total of sixty-six touches compared with eighteen. Even when the patients were hypnotized and “regressed” back to the time of the operation, none remembered the ear-pulling suggestions. But the fact that nine of the eleven nonetheless pulled, two of them repeatedly, suggested, said Bennett, a failure of memory retrieval rather than one of memory formation: the memories were there, but unavailable to the conscious mind—or even perhaps to language. The patients’ bodies did the talking.
There was another interesting aside to the study. When Bennett hypnotized them after the surgery, two patients did turn out to have some memories. One young man remembered hearing music, a familiar tune that he liked to hum to himself, by jazz great Chuck Mangione. The other was a thirty-five-year-old woman, not from the experimental group but from the control group, who had had the sounds of the operating theater played through her headphones while doctors tried to perform a graft onto her thigh bone. Under hypnosis the woman said she remembered something being wrong—“. . . my leg, it’s not going to work right. The doctor said it wasn’t going to work the way it should.”
When researchers listened to the recording made of the surgery, they found that forty minutes into the operation her surgeon had said this: “We’ve got this all goof-balled here, didn’t we . . . this is going to be a terrible bone graft. It’s going to be the worst bone graft ever . . . this is going to be awful.”
The woman took longer to recover than anyone else in the study, and needed twice as many pain medications as the next-highest user. Whether her pain could be explained in part by the surgeon’s lurid prognosis, or whether this was the inevitable result of a “terrible” bone graft, the researchers did not speculate.
Weird science
The first anesthesia conference I attended was the annual scientific meeting of the Australian and New Zealand College of Anaesthetists in 2000. I was working on a feature story on anesthetic awareness (the sort you know you’re having). I had arrived, notebook in hand, at the Crown Towers hotel on the banks of the Yarra River to find suited waiters serving tea and coffee from white-draped trestle tables. It was a Saturday afternoon and the gathered delegates, many in jumpers and slacks, were mingling and chatting in a soothing, businesslike sort of way. The industry display was in an adjoining room and here, along with more tables bearing bite-sized pastries, medical manufacturers and retailers had assembled the latest anesthetic equipment and drugs, among which small groups browsed. It was a very smart-looking display—the first impression was of the cosmetics section of a plush department store, except that men seemed to outnumber women. The booths were brightly colored, with posters and displays and a feeling of polished chrome: bright, efficient, slightly unsettling. Several of the booths featured elaborate displays with what looked like shop dummies lying on trolleys, being subjected to various unpleasant procedures. On one there was a disembodied molded head, neck arched back, mouth open and grimacing around a gag-like apparatus through which a tube protruded. The promotional material told me this was a new intubation device to let anesthesiologists pump air into the lungs of paralyzed patients.
There were pharmaceutical reps peddling products I had never heard of. Mesmerizing price said one poster. There were snatches of conversation. “They’d rather not be sick,” one man told another over tea in white cups. “They’d rather tolerate a little pain and not be nauseated.” Most of the conference I found incomprehensible. There were sessions with titles such as Advances in the Management of Thromboembolism and Thromboprophylaxis; Reduced Neuropsychological Dysfunction Using Epiaortic Echocardiography and the Exclusive Y graft; or The In-vitro Effect of Sevoflurane on Gravid Human Myometrium. I chose only those with titles I could pronounce or that had been recommended to me as good general topics. Even then I found myself sitting through talk after talk in which the language and concepts were almost completely impenetrable. People chuckled at jokes I hadn’t seen coming. I sat with my tape on, taking intermittent notes, trying to follow the new strands of meaning and waiting. Beyond a few passing references and one lunchtime discussion group, the question of patient awareness during general anesthesia seemed to go unnoticed.
But every now and then, someone would say something that would wake me up.
The conference was divided into three streams—anesthesia, intensive care and pain medicine. At 11:15 on the Sunday morning, Melbourne psychiatrist Professor Graham Burrows was in Palladium C, delivering a talk on Novel Psychoactive Agents in Pain Management. Much of the talk, according to the scant notes I took, was about the relationship between pain and depression and the role of psychiatry and drugs in treating chronic pain. Right at the start of the session, however, was one throwaway line that I marked with two heavy black Biro lines. “Years ago I learned that you could take people who had been anesthetized and hypnotize them, and some of them I could get to recall what the surgeons and anesthesiologists were talking about during their anesthetic procedure, and it taught me very quickly that you have to be very careful what you say when you’re doing . . . anesthesia.”
Several weeks later I walked late one afternoon down the drab corridors of Melbourne’s Austin Hospital, past a sign that read Chaplains Dial 9 to Burrows’s office. Burrows, a man I guessed then to be in his sixties, divided his time between teaching and practice. He was, as I would discover, formidable: medical director, professor of psychiatry, promoter of numerous committees and causes, advocate, author, workaholic. Officer of the Order of Australia. Chairman of the Australian Society of Hypnosis. More.
His office, in a windy tower atop the hospital, was furnished with three gray leather armchairs, two televisions and, on the walls, pictures of tigers, seals, a lynx and an owl. Burrows himself reminded me of a beaver—small, alert, busy—or perhaps a fox: reddish hair and a quick, impatient intelligence. He didn’t exactly bark, but he talked quickly, without waiting for my responses. His manner was that of a man used to being heard, helpful and slightly brusque.
Burrows was interested in anesthesia, he said, partly because his wife was an anesthesiologist (she tried to keep people asleep, he had joked at the conference, while he tried to keep them awake), and partly because, as a psychiatrist, he was aware “that many things that occur in our life we register without necessarily consciously knowing them.” Sometimes, for instance, in his clinical work the police sent him clients who might have witnessed crimes. “We’ve used hypnosis in clinical cases where the person while hypnotized is able to describe the car, the numberplate, although in their conscious state they weren’t aware that they knew.”
Sometimes, he said again, you could do the same with surgical patients. “You can hypnotize some people and they will recall things that happened in surgery, which they didn’t know that they knew.” Most likely, he said, the memories would have been formed as someone was going into or coming out of the anesthetic—half-asleep, half-awake—although sometimes the patient might believe they had been awake throughout. The point, he said, was that it was not always easy to tell how deeply unconscious a patient was. “It’s fair to say that most modern anaesthetists are very much aware of the need to be alert to the fact that the person can be hearing things. So you don’t tell smutty jokes, if you like. Or make rude personal comments about the person. I’m sure there’s an exception every so often, and people will recount that.”
Beyond that, he did not have a lot to say on the topic. He did, however, have plenty to offer on the effect of general anesthetics on the brain. The thing to remember, he said, was that anesthetics were very powerful drugs. Anesthesia, like hypnosis, altered consciousness. And, as with hypnosis, it was hard to predict how those alterations might affect different people. “Now, the psychological impact of surgical anesthesia on patients can be very positive and it can also be negative.” Anesthesia was, after all, a chemical process that changed the neurochemistry of the brain. Different drugs did slightly different things to different brains. “I won’t get too high-powered on the influence, but that influence can have quite a lasting, telling effect on them.” You might, for instance, wake up looking and feeling normal but be unable to perform simple mathematical tasks you’d carried out with ease only hours before. You might no longer be safe behind the wheel of a car. These effects could last twenty-four hours or more.
A small proportion of patients, he said, had quite strange reactions. Some became very anxious, some had panic attacks, some felt indecisive. Others experienced what psychiatrists call “depersonalization.” “They feel that their body is altered in some way, that their hand’s too big or too small, that their tongue is too big or too small, or their abdomen and so on.” Some anesthetics could cause what he described as marked depersonalization. “I remember seeing one patient who thought she was a fiberglass ski-board. She was really quite bizarrely affected.” Others might have a sense of “derealization,” in which it was the world around them that distorted, “so the table’s smaller or bigger, or the door’s further away, or the foot doesn’t quite touch the accelerator pedal, and so on.”
It was all very Lewis Carroll.
•
Early morning. Screams from the garden. Our daughter, curled on the ground near the rabbit hutch, clutching her foot. She has impaled herself on a rusty nail, which is in turn attached to a lump of wood. I give it a tentative tug. More screams. We have never got through the emergency department faster. There is no blood, but the sight of a ten-year-old nailed to a fence paling seems to galvanize the staff. In a curtained-off room beyond reception, the doctor regards my daughter’s dramatic footwear. I get the sense that left to his own devices he might simply have given the plank a short sharp tug. But no, we’ll give her some ketamine, he says. Ketamine is one of those dissociative anesthetic drugs that Graham Burrows talked about.
Minutes later my daughter slumps back on the bed looking dazed, then, as the doctor gives a hearty yank, lets out an extended yowl before subsiding back. She looks up at us blearily, then with incredulity. “Hey-ee. You’ve got three eyes,” she says as I move toward her. “That’s so weird. Wow.” She looks at her father. “Ooh, Daddy, you’ve got four eyes! Woah, everything’s moving.” Then to both of us, and perhaps the doctor and nurse also: “I love you! I love you! Wow. Your faces are so big. You look so weird.”
I think of a T-shirt I saw years ago with three words on the front, one beneath the other: the first, clear black print; the second, wavering; the third almost indecipherable. Drink. Drank. Drunk. I thought it was pretty funny at the time.
Drink Drank Drunk
Blink Blank Blunk
She won’t remember any of this, I decide, as my daughter beams up at us, cross-eyed. But she does. She remembers a dream she had before she woke up to find us all morphed into many-eyed Cheshire cats. “There were streamers falling from the ceiling,” she tells us later, “made of film reels from old movies. They were just hanging and falling, and Daddy and you and Finn [her brother] and Boingo [the rabbit] were all in different corners of the room, and I knew I had to rescue you all, but I didn’t know who to rescue first.”
So here we are in the depths of my determined daughter’s psyche. And what does she want? She wants to save us.
Not so blank then.
•
Graham Burrows again: odd anesthetic reactions could take place in “so-called normal people” he said, depending upon the anesthetic agent. There were others, too, who following a general anesthetic could even become psychotic; sometimes the drugs could precipitate an underlying condition, or reactivate a previous disorder. Then there was a group—probably larger than many realized—who went on to become depressed after an anesthetic. “Most of it’s transient, and short-lived, but the tearfulness, the abreaction as we call it, the emotional outpouring that occurs, is quite common.”
Psychiatrists sometimes even used anesthetic agents deliberately to trigger such responses in patients, though not so much these days.
In the end, he implied, it was not always, or even often, possible to administer hypnotic drugs with any certainty as to their effects. “In short, the person undergoing the anesthetic from a psychiatric or psychological point of view can have very positive results because their lump or their pain or whatever it is, is taken away. But it can also be negative if they have both their own personal fragility or vulnerability, and also because of the chemical processes of the anesthesia on their particular brain, at that point in time.” Good anesthesiologists knew to thoroughly assess their patients after surgery. They knew to look for emotion. Not that anesthesia was traumatic for most people. It wasn’t. “But for some people it’s very traumatic—”
“Which I presume relates to some of what you were saying—?”
“With hypnosis,” Burrows cut in. “It was. The abreactive sort of stuff. What I was really saying,” he continued, “is, um, do you know what you got for your fourth birthday?”
“No.”
“No. But if you were a good hypnotic subject I could find it out, OK, because everything that’s actually occurred to you is registered up there. Do you know that?”
•
Weird hypnosis fact #1
No one really knows what hypnosis is.
Weird hypnosis fact #2
Hypnosis can change our perception of pain.
Weird hypnosis fact #3
It can also change how and what we remember.
Hypnosis is a curiously liquid phenomenon. A naturally occurring trance state of the kind you might enter while reading a good novel, in the hands of a skilled (or in some cases unskilled) hypnotherapist or hypnotist it may be used to achieve ends that range from the therapeutic to the bizarre. Definitions lap and overlap, encompassing a seemingly eccentric array of behaviors and experiences. But there is broad agreement that at its heart lies a condition of inner absorption and focused attention that can leave you more than usually receptive to suggestion (your own and other people’s), more than usually able to tolerate internal contradictions, and in which you can experience disturbances in perception (the way things feel, look, sound or taste) and memory. We do it all the time. Daydreaming, gazing out of the train window, listening to music. Hypnosis works very well with 10 to 15 percent of people (these types tend to lose themselves in a task or activity: the sort who can keep reading as the house burns down around them); and poorly with 10 to 15 percent. Most of us are somewhere in between.
