Anesthesia, page 14
One of my favorite studies, mainly because they actually went to the trouble of doing it, took place at the Scottish seaside in the mid-seventies. Researchers approached a group of divers in Oban on the west coast and asked if they would help them with a study on “context-dependent memory.” Once the obliging divers were in wetsuits the scientists had them learn lists of words either on the beach or six meters underwater. Afterward they tested them to see how much they remembered. It was cold and wet and the logistics were challenging, but what they found was that it didn’t much matter where the divers did their learning: on dry land or the ocean floor. What did matter was where they were tested. Those who had listened to words underwater could remember far more when tested underwater than they could on land, and vice versa.
Many years after I had heard him speak in Hull, I came across a written account by U.S. anesthesiologist Anthony Messina of that traumatic experience of childhood surgery—memories that had stayed hidden until he was an adult, but that resurfaced dramatically one day early in his medical career.
During the first few months of my residency, while attending a lecture on muscle relaxants, I read a case report written by an anesthesiologist in 1948 describing his experience of self-injection of curare. I had an uncomfortable feeling, like the topic was familiar to me. A week later, I anaesthetised my first child [using an inhaled anesthetic and a paralyzing muscle relaxant]. Suddenly, I became very upset and had a flashback. The nightmare that I had experienced for years as a child had actually happened. Once I had the flashback to my childhood experience, I concluded that I must have been drawn to the field by some unconscious process. And that my purpose was to prevent other people from becoming victims of what I went through as a child.
Of course there may have been other reasons Anthony Messina went on to become an anesthesiologist, but there is little doubt that the experience has shaped his adult life. As a cardiac anesthesiologist he advocated the use of techniques that allow surgeons to operate without paralyzing patients. He recently completed a high-level review of data spanning from 1950 to 2016 on ways to reduce awareness during surgery.
Another reason why people might not retain information delivered to them during surgery for long, if at all, is that most of it is really boring. Boy/girl, bitter/sweet, blah/blah. Once again, we can blame Levinson. The emphatic emotional reactions of some of the patients subjected to his famous mock crisis (“I don’t like the patient’s color!”) mean that today’s researchers must make do with blander fare. They usually try to prime patients with lists of “neutral” words—peach, grape, melon—unlikely to be either meaningful or memorable. Others have tried to prime for more complex tasks by playing anesthetized patients tapes of obscure factoids and then testing them later to see if they get the answer correct.
But as Bernard Levinson himself has pointed out, if you were in surgery and your brain was indeed able to take in some of what was going on around you, perhaps this is not the information you would fix on either. “I am walking across a suspension bridge,” he told an audience of anesthesiologists at the first MAA conference in Glasgow 1989. “It is only ropes and a few slats of wood. Thousands of feet below me is a raging, rock-strewn river . . . My whole being is focused on getting to the other side. Behind me, someone is saying . . . orange . . . pigeon . . . what is the blood pressure of the octopus . . . ?”
Lost days
I kept thinking about what Melbourne psychiatrist Graham Burrows had said. About my fourth birthday and all the other lost days sequestered inside my head (“. . . because everything that’s actually occurred to you is registered up there. Do you know that?”).
Did I? Not really. But I wanted to.
It took me four months to arrange a preliminary appointment with Graham Burrows. This was mid-2005, four years after our initial interview. His secretary was helpful and harried. Dr. Burrows was very busy. Could I send an email? I sent two, both saying more or less the same thing. I was working on a book, I was interested in implicit learning during anesthesia. I was interested in clinical hypnosis. I was interested in the relationship between the two. “On a more personal note—but also something I would like to write about in the book—I am hoping that you (or if you think it more appropriate someone else) could do some hypnosis work with me, partly to demonstrate the process, but also to help me try to understand my preoccupation with this topic.”
Burrows’s secretary emailed me: “Sorry to take so long in getting back to you—Professor Burrows’s answer is yes.”
I spied him outside in the corridor, a smallish, reddish figure, carrying a plate that held four party pies with sauce. He ate as he walked. Inside he got straight to the point. The book, what was it about? Who was funding me? What did I want from him? All the things he wanted to know made sense but he seemed to want to know them all at once, all in his determined staccato. It was unnerving. I stumbled my way through a partial explanation: Rachel Benmayor’s birth story, my interest in the philosophical and psychological dimensions of anesthesia, other stuff. I trailed off. Was this helping? In a way, he said, but it all sounded a bit like gobbledygook. He said this not unkindly, and I found myself agreeing. “And I’m not certain,” he added, “whether you’re trying to sort yourself out, or whether you’re trying to sort out other things.”
The meeting went on for half an hour and for much of it I felt that I was running to catch a bus that had left the stop ahead of me. I had brought with me to his rooms a sheet of paper on which I had written out my questions for him, and these I shouted as I ran. From the back of the bus (one of the open-backed red buses of my London childhood), Burrows hurled his answers. Eventually, halfway through our meeting, he simply reached across and took the sheet from me. Preempting my flailing interjections, he started asking and answering my questions himself, speaking in concise, precise nuggets. The complexities of memory, the limitations of hypnosis, the difference between the conscious and unconscious minds (to start with, these were processes, not places, and secondly, “Well that’s very complex, that would take a whole book to answer.”) Always that intense categorical focus. He had discovered hypnosis when studying science and had begun with chickens and snakes before moving across to medicine, then psychiatry and eventually starting the Australian Society of Hypnosis. The thing was, he said when I finally managed to ask, that hypnosis was not something you dabbled in. You did it properly. It was not an entertainment. Also, it could be completely unreliable, “particularly if the technique used is poor.” Besides, he didn’t have time.
But, he said finally, if I was wanting to understand myself, if I was willing to enter a genuine psychotherapeutic relationship with him, then that would be different. He could see me as a client. He sent me away with a copy of his textbook on hypnosis, instructions to see my doctor, get a blood test, complete a detailed form about myself, keep a diary and fill in a daily mood chart. Three months later, just after Christmas, I returned and we embarked on a process compromised throughout by the fact that we wanted completely different things. He wanted to diagnose and treat me; I wanted to get hypnotized.
In the end, we lasted six sessions. From the outset I felt we were engaged in some sort of struggle. Each week I would go away and fill in the mood charts and the diary and the dreary, detailed summary of my life so far. Each time I returned he would reach for and scrutinize them at speed, all the time catapulting questions. (“Don’t worry,” he said once, “I can do both.”) We talked about my moods, my relationships, the sagging sack of my inner life. We talked about my health and about hypnosis and my ambivalence about committing to this therapy. We talked about his practice; he mentioned murderers he had interviewed (he was sometimes called as an expert witness in court cases), and other journalists he knew (“you’d be surprised”). He told me that he used to demonstrate the power of hypnosis on medical students by having them close their eyes and feel that a hand had gone numb, before he pushed a sterilized needle into their palm. We talked about the place of drugs in psychiatric treatment. I found this last conversation disconcerting.
Early on, he arrived at an appointment with his left arm in plaster. He said he had broken his wrist skiing in Canada, knocked over from behind by an out-of-control snowboarder. Burrows had bound the arm himself, he said, using self-hypnosis, and had skied with it like this for several days before eventually getting it plastered, at his convenience, at the end of the holiday. Now, he said, the cast was letting him get on with his day-to-day life. It might be a bit annoying, but it supported the arm while it healed. By analogy, he said, the plaster might be like medication.
I wasn’t sure I liked where this was going. Medication? I’d tried antidepressant medication once before and had not much liked anything about it. I had not persevered, as advised, or given it a chance, but had taken myself off it after a few months and felt neither better nor worse as a result. Now I felt obscurely like the character in a comedy who hops on a gurney to hide from the villains, only to find himself in a theater about to have his leg amputated. (This is an exaggeration.)
Finally, however—the hypnosis. A relaxation exercise. Burrows asked me to sit back in my chair and imagine myself on a comfortable couch in a room where I felt safe and relaxed, a secret, stress-free room. Following his instructions, I moved my attention through my body, progressively loosening each limb, letting numbness move through my body, feeling warmth spread up into my chest. It felt a bit awkward, but fine; a feeling of heaviness. “And when you want to wake yourself up you can, easily, by counting backward from three.” Later, he said: “At least we know you can be hypnotized,” And he gave me a tape of the exercise to take home and play to myself in the evening, or whenever I needed to relax.
I took it home and played it. Diligently. The problem was that much as I wanted to let go, sink down, find my secret room, I found that every time I turned on the tape, part of me was resisting. The more Burrows told me to let my body go loose and floppy, the more my body stayed stiff and hot. The more Burrows told me that my shoulders, my arms, my hands were going numb, the more I imagined him sticking a needle into me. At our final session, he looked at my mood chart with its erratic undulations, announced that I had a depressive disorder and said I should consider prescription drugs. His tone seemed brusque. I should go away and think about it. Normal people didn’t have a graph that looked like this.
That was the last time I saw him.
In the years since, when I have glanced back at those encounters it has been with mild embarrassment—a little mind gap that when I push against it opens to reveal something closer to judgment, aimed both at myself and at him. Me for being foolish, self-serving, impure of motive. Him for . . . What? His manner, his message? For telling me I might need drugs? And what had it all been for, anyway? Mainly I have avoided looking back at those sessions at all. Not long after the final one I realized I was not going to write about them. Not in this book. Not anywhere. Even thinking about them made me feel uncomfortable. Murky.
Recently, after I heard the news of Graham Burrows’s death, I listened back to the relaxation tape he had made me: the nonrelaxation tape, as I used to think of it. I had to find new batteries for my antiquated Sony Walkman, with its antirolling mechanism. The words, when they came, were slightly distorted. The tape sagging. What I heard was completely unexpected.
Burrows’s voice: Now stretch yourself out, close your eyes and let yourself relax. But this wasn’t the haranguing, robotic tone of my memory. He sounded calm and convincing. Kind, even. As I listened again to the tape, I found my breathing deepening, the muscles of my face and neck beginning to relax. If I had focused enough my hand might even have started to go numb. Most of all he sounded absolutely normal. I could not, and still cannot, reconcile the voice on the tape with the voice I had been imagining.
It occurred to me that I had been a terrible patient.
Then I looked for the first time in many years at the diary I had kept during the time I saw Burrows, the one that he had asked me to write.
Hot. Too hot. I keep worrying about the weather. It feels apocalyptic. I keep thinking: this is how it’s going to be, more and more heat, and I think about trees dying and rivers drying and air conditioning failing and all of us scratching around in this terrible heat till we die.
On it goes. I am sleepless, I am stressed, I am angry, I am guilty, I am afraid. I am driving through a sort of thick sadness. I worry that the bamboo we’ve planted down the side of the house will invade the neighbors’ garden and destroy the fence. I worry about the algae in the kids’ pool and the fact that the chlorine has not got rid of it. I wonder if the algae have mutated into super germs.
Sleep poorly again—dream that in the bottom of the still-green paddling pool are three drowned puppies . . . I know I should get them out, but I can’t bear the thought of having to pick up their cold wet bodies.
I am not a happy human. I am not even a healthy human. And then this:
February 21, 2006
We are in the grounds of what might be a school. Me, Pete and the kids. Some sort of carnival. People everywhere. And permeating the whole, a sticky, oozing dread. No one else seems to notice, all the heedless happy families, but I know what they don’t. Beneath the school is a dungeon; and in the dungeon is a creature so malevolent, so evil, that if it gets out it will kill us all. People keep taking it in turns to go down there and hurt it, mock it. Even from the playground, I can picture it—the squat muscular little troll’s body, slashing at their arms through the metal bars. I have to get us away. I find the kids on the climbing frame. But now the dream morphs. I’m in the corner of its cell, flattened against the wall behind a wooden box or cabinet. There is a part of me that feels sorry for it, everyone laughing and taunting, but I know what will happen when it is unleashed. I can feel its terrible pitiless hatred. I also—and this, I understand later, is the true source of my terror—sense that even though it cannot see me, it knows I am here, it knows who I am. When I wake I can feel the feeling of the creature and my fear of it so vividly I am convinced it is real. That it can only be kept at bay by dint of constant vigilance. As soon as I start to think like this, I lurch toward a new terror. I will go mad. I get up, start to write and then stop. It is a long time before I can take myself back and know the thing I don’t want to know. There is no escape. The rage is mine. The creature is me.
This was the dream I woke from on the morning of my second interview with Chris Thompson, the anesthesiologist who sent me into a kind of trance, the one I came to think of as Mr. Anesthesia.
The most famous anesthesiologist in the world
The Medical Sciences Building of the University of California San Francisco is a sandy slab of around twelve stories a short walk from Golden Gate Park. It has rectangular grids of municipal-style windows that proceed dourly across the building’s otherwise bland facade. On the day I visited, many of the windows were obscured by curtains or drooping blinds or the backs of cupboards or cardboard boxes or just grime. It looked as if it had had a hard night.
The anesthesia research laboratories were on the fourth floor. From the main corridor, a small pink-and-green linoleum-tiled entrance hall sloped upward rather quaintly as if toward a nursery, and then opened into a longer corridor, where, a few doors to the left, and behind a large metal knocker in the shape of a lion’s head, was the office of the most famous anesthesiologist in the world.
Arranging a time to meet with Edmond I. Eger II had been tricky. At seventy-seven, he still worked full-time and was away a lot traveling. To my emailed request for an interview he had first suggested that we speak by phone. When I persisted, he responded with an exuberant OKEEDOKEE. Just before I was due to fly out of Australia, the interview was postponed a day. I persisted partly because Ted Eger knew more about anesthetics than just about anyone else, partly because he did not believe that a properly anesthetized patient could remember anything (consciously or otherwise) and mostly because, twelve years before, he had headed the team that set out to repeat the unrepeatable experiment and put Bernard Levinson’s startling thesis to the test.
Now I was standing outside his office wondering what sort of person would decorate his door with a lion’s head knocker, and what it might say about his inner drives. From around the corner a man appeared. He was small, almost elfin, with a thin face and a keen, speculative expression. He wore a blue-and-white-striped shirt and a dark blue tie decorated with mauve and orange butterflies. His feet, rather disarmingly, were clad in open sandals through which his besocked toes poked blackly. We shook hands.
“They call this my den,” he said, gesturing fondly as he led me in.
The room was small, maybe three by four meters, and into it were crammed three desks and five chairs. The walls were covered in bookshelves and family snaps, kids’ pictures, a huge blackboard, a wedding photo. Ted Eger sat on a swivel chair in front of his desk and I on a shabby office chair next to a small couch piled with paraphernalia including two pairs of shoes. A heap of brown cardboard boxes teetered nearby. On the desk beside him two computer monitors sat flanking each other, alongside several tins of McCann’s oatmeal cookies. On another desk a laptop sat open. Here was a room so embedded with personality you could not imagine anyone else ever inhabiting it. There was even a pop-up toaster.
As a young man in the 1960s, around the time Bernard Levinson was staging his now famous mock crisis, Eger had set out to solve a problem so basic it seems astonishing that nobody had done it before. Through a series of painstaking—and, to an outsider, unsettling—studies he set out to measure the relative strengths of the various anesthetic vapors then in use, and to calculate how much of each it would take to keep a patient unconscious. Eger and colleague Giles Merkel had been prompted by a mentor, John Severinghaus, who wanted them to investigate the properties of a newly discovered anesthetic vapor. To do this they would need to be able to compare it with other vapors already in use, but the problem was no one had yet worked out a way of doing so.
