Anesthesia, page 18
Such cases, while striking, were unusual. But Strickland and Butterworth note that some of today’s commonly used anesthetic drugs can elicit similar responses in modern patients. Indeed, they said, “[t]he authors have encountered the problem of sexual ideations or dreams in sedated or anesthetized patients in their own anesthesia practices . . .” One of the anesthesiologists I spoke with in the process of researching this book told me about a patient who had awoken from surgery looking very pleased with herself and immediately asked what drug she had been on. He told her he had been using propofol—an increasingly popular intravenous drug favored by anesthesiologists for its ease of use and patient satisfaction.
Why, he asked?
“You won’t believe this, but I’ve just had a half-hour orgasm!”
Anesthetics are well known to have a disinhibiting effect, particularly in the second stage—the evocatively named plane of delirium, or excitation. Like alcohol, they can suppress our polite selves. It is not unusual for patients, just before passing out, to tell surgical staff how attractive they are, to invite them on dates or even to bed. Perhaps such recklessness flows through into dreams.
But while dreams are by their nature ephemeral, they can create some very tangible problems for patients and for surgical staff. In the years following Morton’s successful demonstration of surgical ether, several cases were reported of women claiming to have been sexually assaulted after having been anesthetized by their dentist or doctor. In the first of these cases to go to court, a Parisian dentist was accused in 1847 of abusing two girls he had etherized. One later said she had been aware of him touching her but that she felt unable to move or fight him off. The dentist was convicted, despite his denials. Some years later, however, the medical journal The Lancet published an article outlining various cases in which doctors or dentists had been wrongly accused by women under the influence of ether or chloroform. One woman woke after childbirth convinced her doctor had molested her, even though her husband had been there beside her the whole time.
It is hard to know what to make of these stories. On the one hand there is the extreme vulnerability of the women (and nearly all the early reports were from women), unconscious and open to attack from opportunistic medical practitioners. On the other are the mind-altering effects of drugs such as ether. Either way, the distress for the dreamer or supposed dreamer was real, and perhaps lasting. Stille was convinced that ether and chloroform could produce vivid dreams or “memories” of events that had never happened or were “real occurrences perverted from their actual nature.” What was striking, he said, apart from their unreliability, was their tenacity—there was, he wrote, “reason to believe that the impression left by the dreams occasioned by ether, may remain permanently fixed in the memory with all the vividness of real events.”
(“Oh,” said my father. “Oh. Absolute terror.”)
In the years after Ether Day, the main lesson for the (exclusively male) surgeons and dentists of the day was to make sure they were never alone with unconscious—or seemingly unconscious—patients, particularly women. The other, related, lesson was that patients emerging from anesthetics were not to be trusted. “It is our decided opinion, that the evidence of even a partially etherized person should not be received as valid, without corroboration,” the Boston Medical and Surgical Journal said in an editorial of 1854. It is not surprising, in this light, that doctors tend now, as then, to dismiss patients’ claims of anesthetic awareness, and not just the erotic ones, as dreams or hallucinations.
In July 2009, amid emotional courtroom scenes, a Pittsburgh dentist was acquitted of multiple counts of sexual assault brought against him by seventeen former patients. Despite saying he found the women’s accounts “compelling and disturbing,” and that he was confident that they genuinely believed they had been assaulted, Judge Mariani cited defense testimony that the women had been under the influence of powerful drugs designed “to take away memory and take away perception.” Things ended very differently in 2014 for a Canadian anesthesiologist who was convicted of sexually assaulting twenty-one sedated women during surgeries and sentenced to ten years in prison.
At the very least, what such experiences make clear is that the line between anesthesia, dreams and reality is indistinct and sometimes permeable.
•
The dream which I had during anaesthesia came to mind. I was surrounded by sounding-depth made of paper-pulp with many fishes and basketfuls of bread. I dreamed I heard your [the anesthesiologist’s] voice which made me feel relaxed but I don’t remember what you said.
This patient had been played the story of the miracle of loaves and fishes during anesthesia.
I am the sort of person who likes dreams, my own and other people’s. Not that I like all the dreams, or even many of the dreams, that I have, but I like the fact of them. I like the sense that somewhere beneath the thoughts and plans and entanglements with which I map each burdened day, there is another, wilder, me. One who is accountable only to herself. For many years I used to dream that I was about to go skiing. These dreams started in my teens, before I had ever put on skis. The dreams would be filled with a sense of enormous anticipation and pleasure, as I prepared myself for the descent. Inevitably, however, I would be unable to find my skis or the snow would have melted; or I would find myself not at the top of a brilliant alpine slope, but poised on the edge of what looked like an illustration in a cheap children’s book—two-dimensional and badly drawn, a shabby theatrical backdrop.
These dreams always let me down—or I them—and yet what I remember most vividly now is the exquisite sense of possibility they engendered: that the slope existed; and one day I might ski down it. Perhaps they say something about my need for control. Perhaps if my waking life were less thought out, my dreams would not need to be as intrusive. As it is, there are dreams I remember more clearly than whole years of my waking life. My memory for events, places, sometimes even people, is intermittent at best. There are decades, almost, of life from which I retain only scraps. But there are dreams that even now, years later, seem more essential, more alive, than anything that might have been happening in my day to day life.
Dream theory is as fraught and tangled as the dreams it attempts to understand. At one end of the spectrum are those who argue that dreams are simply the mental detritus generated by the night-time firing of synapses as they replenish and reorganize the brain. At the other, with the mighty shadows of Freud and Jung looming over them, are those who treat dreams as meaningful and often symbolic representations of conscious or unconscious memories or conflicts. A way of processing and resolving day-time fears. Coded messages from the self to the self. Either way, various researchers have pointed out that dreaming is in itself a form of consciousness, albeit one disconnected from the external world.
This fact alone, that I am the sort of person who dreams and remembers my dreams, also means I am statistically more likely to dream when under anesthesia—or at least to remember any dreams I might have had. Not that I have any such memories from any of my brief early anesthetic experiences. Each remains a void.
Yet something was happening to my dream life during the writing of this book.
June 2005. Wake early from what feels like transient preoccupied sleep, thinking about structure and organising the book. Body tense, unrefreshed, it occurs to me that I have been thinking in order not to dream. Then suddenly clear as day, as if it has been lying alongside but in a separate container, comes the dream. Strange gothic tale. I am in a space that feels almost cave-like but is part of some big house—a cellar? In the dream there is a book and in the book is a story about something that happened here in another room, in the past. It happened to a man. What happened was so horrible that no one fully explains it. It is written up in this big old book, but the script is archaic, medieval perhaps, and most of the words I can barely recognise; enough however to get the sense that there had been some elaborate torture here, involving him being perhaps castrated. I am very aware of the horror of what happened to him. I identify quite strongly with him. All that remains, however, apart from the book, is a dried-out piece of skin or flesh. There is a little hair attached, which was what they cut off him. It is bigger than I had imagined, an irregular circular sort of shape, dried and blackened. I have to wipe it down carefully with a damp cloth. I am afraid it will fall apart with the pressure or the moisture, but it doesn’t. Later I walk down a long corridor to find my son.
Back in the early noughties, Kate Leslie, the Melbourne anesthesiologist who, with Paul Myles, shot to prominence through the B-Aware study of the BIS depth of anesthesia monitor, started thinking a lot about dreams. Not the sort you or I have during the night. As part of the postoperative interviews during the BIS study, she and Myles had asked surgical patients if they remembered dreaming during the anesthetic.
“I dreamed that I saw my daughter, who was pregnant, having a caesarean section,” said one woman.
“I had vivid dreams about rescuing a pup from a tunnel, flying a plane, swimming and being stuck in a boat,” said another. “I felt restricted in my movements and felt I was gagging.”
Another dreamed he was fishing in a boat that sank in a storm.
Given that using the BIS monitor dramatically reduced the chances of a patient waking during surgery, Leslie wondered whether dreams, or at least some dreams, might indicate more than just psychic static—whether they might instead represent moments of awareness or “near-miss awareness,” in which surgical patients had not in fact been disconnected—or entirely disconnected—from the external world. This idea was given weight by the fact that dreamers tended to wake more quickly after surgery and be less satisfied overall with their anesthetic experience.
Certainly, some of the dreams reported by patients in the trial seemed uncannily reminiscent of the experiences they had just been through in the operating theater. “I dreamed that I was having a conversation with my anaesthetist about the research trial. The dream was interrupted by the anaesthetist’s voice trying to wake me up.”
Another possibility that Leslie was investigating, however, was that dreamers were in fact describing drug-induced hallucinations.
It was an almost direct reprise of the debate 150 years before, minus the sex.
But this time Leslie had a crucial advantage. Use of the BIS monitor had halved the rate of patients who reported dreaming during the B-Aware study. With the BIS she had a tool that could, she was confident, accurately measure how deeply anesthetized a patient was. In a new study she and her colleagues monitored the BIS values of three hundred patients undergoing elective surgery. They interviewed them immediately upon waking, and again two to four hours later, and then correlated these responses with the BIS measurements. Close to a quarter reported dreaming at one or both interviews. “There’s lots of dreams,” confirmed Leslie in 2006 shortly before the study was released, “there’s some great ones.”
And while many appeared not to be related to surgery, a few clearly were. She recounted one dream that suggested the patient had been awake.
This woman was having something under my care—division of adhesions, that’s right, in the tummy, so it was quite a stimulating operation—and toward the end of the operation she moved quite a lot, so I said, “Don’t worry, everything’s all right, we’re giving you more medicine,” (which is what I do, and everyone thinks I’m mad, but, you know . . .) and I put her back to sleep. Immediately post-op she said she had a dream that she was in a car, it could have been an ambulance, and it went down a big black hole in the road and it was falling down and she couldn’t move but she heard a doctor say “everything’s all right” . . . Two or three hours later she couldn’t remember very much about it at all.
Leslie reported this with good humor and a certain relish. She too loves dreams, though probably not in the way that I do: Leslie is a scientist.
In the end the team concluded that the vast majority of dreamers did so regardless of how deeply anesthetized they had been. Most of the dreams were pleasant and many involved family or friends in familiar places. The reason for this, Leslie believes, is that most dreams do not happen during surgery, but later in the recovery room, either the legacy of the hypnotic drugs, or as the patient tips into normal sleep before they wake properly.
Anesthesia, she stresses, is not sleep.
This is not to say it does not have similarities. Researchers have reported that some anesthetics appear to recruit the brain’s sleep circuitry. But it also has critical differences. For one, sleep can’t kill you, as the drug propofol did the singer Michael Jackson. For another, if, while you are sleeping, someone sticks a small sharp knife into your leg or your abdomen or your eye, you will wake up. In any case, Leslie is now confident that, while intriguing, dreams reported by people waking from anesthetics are largely irrelevant.
And yet.
She mentioned another patient she had met early in her research, a man who had had knee surgery, who had dreamed he had an Aldi supermarket inside his knee. There were lots of trolleys in the store, but not many people. He felt alone. The Aldi dream, said Leslie, had all the characteristics of a drug-induced hallucination. “You know, it’s the sort of thing you’d think about if you were taking mushrooms or something . . .”
I couldn’t quite agree with her. I thought it was the sort of thing you might well dream about if you were having surgery on your knee: the metallic clanking; the sense of isolation. To me the dream seemed laden with allusion. I wondered if Leslie had ever shopped in an Aldi store. (“That would be a no,” she said later.)
“So symbolism’s not necessarily important?” I asked.
“The only symbolism that’s meaningful from my perspective is whether they’re using information they obtained during anesthesia to formulate the dream or not.”
I think about my father and his ether dream, and wonder if that would qualify as “information obtained during anesthesia,” or whether that image of the cloud was formed on his way into or out of anesthesia. It occurs to me that from the patient’s perspective it is irrelevant at which stage of the process the information was obtained. What is relevant is that they now carry it with them.
I should state now that, like Ted Eger, I am a believer in science. I come from a family that favors it. My mother chose to practice art but her father was a doctor. My father, like me, has made a career trying to balance the chaos of lived life within the constraints of journalism. When the 2004 film What the Bleep Do We Know? came out on DVD I watched it at the behest of friends and cringed: the tone, the broad vague assertions, the hokey music and graphics.
That said, I did later travel to Tucson to interview one of the scientists who appeared in that film. His name was Stuart Hameroff and he was a respected anesthesiologist. He believed that consciousness was a quantum process arising through the interplay of tiny assemblies of proteins known as microtubules that organized activities within the neurons of the brain. He had previously teamed up with famed British physicist Roger Penrose to suggest that it (consciousness) existed in spacetime geometry (what Hameroff described as “the fine scale structure of the universe”) and was connected to the brain through the strange things happening in the microtubules. Hameroff was fascinating and might for all I know have been a genius. I didn’t understand most of what he said. We didn’t talk much about hidden unconscious processes or about what Bernard Levinson has described as the “flamboyant charade” of dreams—though Hameroff did speculate that dreams might follow quantum logic, “with bizarre multiple co-existing possibilities and deep hidden connections.”
None of this is quite what I was getting at, but, thinking about Bernard Levinson now, one of the things I realize I loved about reading and speaking with him was the way he talked about things. The raging, rock-strewn river; the current of anxiety flowing between the surgeon and himself; the layering and linking of things. These are the tools of storytelling. Models of quantum computation, by contrast; the statistical analysis of dreams—these are the instruments of science: the systematic attempt, through precise and rigorous measurement, to know the world not as we feel it to be but as we can prove it to be. Or not to be. There can be few more necessary endeavors. But—and this might be what I was trying to say to Kate Leslie that day—I can’t help knowing that between science and lived experience is a gap that wavers and widens depending on which bit of the world we are in the process of observing or testing, and that it is here, in this uncertain space, that many of the processes that make us most particularly human take place.
It is intriguing at any rate to look at the sorts of things people did remember dreaming. Of the forty-seven dreams detailed in Kate Leslie’s 2007 study, five (a little over 10 percent) involved water or fishing.
“Camping on beach, went for a walk, saw a dam on the river high above the river. Was checking out the dams because the river was dammed up. It was still beautiful and he was with nice people.”
“Dreamed about a fish in a tank and seaweed surrounding her. Splashing around and the color blue.” (This was from a patient suspected of having been aware.)
Several dreamed about work, and others also reported holidays: a school trip to the beach (“lots of fun”).
But the most commonly reported dreams, by far, were ones involving family and friends. A third of dreamers conjured parents, children, siblings or partners. Occasionally these dreams were troubling (“Dreamed of his girlfriend. He had lost her and was trying to find her . . .”).
