Anesthesia, page 19
But many were comforting.
“Dreamed that her boyfriend was by her side talking to her.”
“Dreamed that her family was surrounding her and supporting her.”
“Remembers being outside in a garden by herself. Remembers a swing and her sister being there. She hasn’t seen her sister in 9 yr.”
“Dreaming a game of cricket. Was playing with her three children and four grandchildren . . . It was a beautiful day . . .”
Five or six patients reported unpleasant dreams.
“Dreamed about teaching. She was teaching a junior class and she was in pain and wanted her mother.”
“A tiger was chasing me. I was in a glass room and felt scared. Every glass door I went through, the tiger was there. It kept roaring and chasing me. I was running.”
And oddly, several dreams involved food. “Dreamed about having a barbecue with lots of sausages. But she hates sausages. But she was really hungry.”
I am reminded of the nurse during the heart surgery I watched with Paul Myles who confessed that the smell of cauterized flesh could be distracting. “Sometimes, if we’re working before lunch, it makes me hungry.”
“What about people dreaming about barbecues and meat?” I asked Leslie.
As far as she could now recall, none of the patients she had dealt with had reported “olfactory dreams.” Social dreams, yes; meat dreams, no.
But what about that one . . . ?
Leslie spoke calmly. “You’re trying to draw an analogy between burning flesh and—I won’t support that.”
I persisted. What about other reports from other researchers, in which people did occasionally mention, you know, meat?
Leslie paused for a very small moment and then continued as if the barbecue conversation had not happened. “So, I mean I quite like my dreaming research, because I find it fascinating, it’s my—you know, you have to find your own little, your own niche, and many think it’s frivolous, but I think it’s something that 25 percent of people do—so I really enjoy exploring it further.
“In one way it would have been fantastic to find some spectacular connection between dreaming and being awake. But in fact the conclusion I’ve come to based on the research I’ve done is that it’s a harmless peripheral phenomenon of anesthesia.”
So that’s the science.
But people do have some striking dreams after surgical anesthesia. I met one woman, a screenwriter named Deborah Klika who, in the months after surgery, had a series of episodic dreams about driving a red car. In the first, she was at the bottom of a mountain; she was behind the wheel and with her in the car was the surgeon who had operated on her. In episode two, the two of them were driving up the mountain. In the final dream she was alone at the top of the mountain. The surgeon had gone. Her most powerful memory was of feeling abandoned.
Not long after my mother’s return home after having her cancerous kidney removed, she had another dream. In recent years she had become intrigued by floating grids, which she superimposed over her aerial landscapes to disconcerting effect. The grid lines hover over the land like some suspended equation whose answer is implicit in its form. Mostly I find these works harder to love than her more organic work. I am not sure why. Perhaps it is that it feels a little as if I am viewing it all through an intricate rifle sight, or from a prison cell. Perhaps it is simply that they feel cooler and more cerebral without the welling water of the earlier paintings. Anyway, in this dream my mother was working on a painting, or trying to, except that the painting had been taken over by a grid, which had imposed upon both the dream and the dreamer its own precise rules. It needed to be filled in a particular way, my mother said, and would only let her move her hand across from one square to another when she had fulfilled its requirements. She didn’t like it.
The first time my mother told me about this dream, this was pretty much all she said. The grid, the constraint, the unease. A month or so later, however, when we discussed it again, she remembered something else: on the other side of the grid was a group of men, watching her and smiling in a friendly way (“very benign”). Men in suits.
This conversation took place in my car on the way to find an upholsterer in Brunswick to refurbish two chairs that had been left to her by her own mother. Years before, when my mother’s Aunt Nance was dying, she asked Mum to have some chairs reupholstered for her. At the time, said Mum, it seemed ridiculous. But now, here she was, doing the same, and somehow it made sense. She wanted them in good shape for whatever came next. I was driving and Mum was talking in the dreamy way you do when you are being driven and are able to look outward and inward at the same time. Then she remembered another dream she had had sixty years before, as a girl at boarding school. (“I did have a men-in-suits dream years ago.”)
In this dream the suited men were in one of the school’s courtyards. The grass in the center was ringed by a brick walkway and the men were walking around it, sticking obediently to the path. In fact, Mum said, they probably hadn’t even noticed the grass. “They would have been absorbed in conversations that men in suits have.” My mother’s feelings about the men were mixed. “I actually saw myself as being in a much better position to the men in their suits because I could walk on the grass. And they wouldn’t be game . . .”
“It was very strange,” she said.
She paused, before adding: “But, then, my father always wore a suit.”
•
“Harold Love had at times what almost amounted to a phase of lethargy; but this was soon over, and normally his very considerable output of effective work was achieved with no apparent effort or hurry.” Obituary of Harold Russell Love, Medical Journal of Australia, September 1, 1956.
In his unfinished manuscript, my grandfather discusses the patterns of association and inhibition that compete for expression first within the nervous system and later the psyche. These latter inhibitions he calls “thwartings.” Irritability, depression, physical malaise: these are some of the costs of thwarting. “The reactive disturbances to which normal people are subject may be profound and incapacitating.” A response perhaps to a failure of the normal person to adapt to an unfamiliar or inhospitable environment; or to a mismatch between the demands of that environment and their ability to meet them; or between what they desire and what they can actually have. Or between two equal but opposing circumstances or demands. Such as might be presented in army service.
My grandfather saw the results of such thwartings close up during the 241 days in 1941 in which he was under siege with a garrison of Allied troops in the Libyan city of Tobruk: the soldier in action who starts “running around wildly under fire”; the general who in a crisis remains “passive, inhibited and incapable of action.”
My grandfather did not remain passive: “Placed in charge of a large ward of physically exhausted and badly shaken men, his staunch outlook and vigorous personality restored their confidence and morale to such an extent that the great majority of them were soon back with their units.” Obituary of Harold Russell Love.
Perhaps this success in itself was a kind of thwarting. My grandfather doesn’t say. But, as he makes clear, you don’t have to go to war, or send others back into it, to be thwarted:
The civilised social structure imposes many such thwartings upon the human organism and not the least important quality of man as a social animal is his ability to repress or sublimate his thwartings. At all points his desires are hedged about with restrictions, and his sexual, economic, aggressive, and flight reactions, even his laughter and tears, are subject to extraneous inhibitions reinforced by threat of social and other penalties.
Of his own thwartings my grandfather did not write, although the besieged months in Tobruk and later his own failing health must have qualified. From my mother I had the impression that the comfortable conservatism of Brisbane society could be burdensome. Gregarious, inquisitive, a lover of company, conversation and the arts, my grandfather, she said, liked to drink at the less salubrious hotels where the journalists drank.
In between it all, he wrestled with the book.
•
I dream, or realize upon waking from a dream, that I understand the purpose and function of dreams. They are not neural static (or dark matter or junk DNA). Nor are they simply the random off-cuts of our waking lives; they have a purpose. The function of dreams (I understand in my dreamlike state) is to recruit and recycle the detritus and props of our day to day life to illuminate something enormous, much more than the individual unconsciousness. Something true. I feel very certain of this, without knowing how or why or what it even means.
Altered states
One day as I reluctantly pushed myself into my study, it occurred to me I had been working on the same chapter for more than a year. Every time I sat down I seemed to disappear. It was like being in one of those dreams in which you are trying to run but can only move in slow motion. Each thought seemed to take an infinity. Each connection felt like the forcing together of negative poles. My brain was cheesecake. “What you’re describing,” said a friend, “is resistance.” This resistance manifested in multiple ways: in walking, in talking, in shopping, in sleeping, in eating, in drinking, in a tight inky feeling in my chest. It manifested most vehemently and truculently in the endless heaving manuscript I was dragging around with me.
One day, I might, for instance, write this:
Australian philosopher David Chalmers has argued that a robust theory of consciousness will have to address two fundamental types of problem: the easy ones and the hard one. The “easy” problems, he says with deliberate understatement, concern the precise mechanisms by which the human brain, with its billions of neurons connected by trillions of synapses, produces conscious awareness. The hard problem is to explain how this infinitely complex machinery gives rise to subjective experience, what Chalmers calls “qualia”: the felt experience of the color blue, the precise ache of a Bach cello solo, or the cool suction of wet sand underfoot. While some scientists seem to be making progress on the first problem (identifying various brain sites and processes necessary for consciousness), Chalmers argues that a purely mechanistic model is unlikely to provide useful answers to the second question.
Then, alongside it, I might find myself writing something like this:
In my dream I am walking toward a cat in a basket at the base of a hill. As I get closer I become aware of a terrible smell and I think that the cat has gangrene. I know I should help it but I am repulsed by the stench. Then I realize it is not the cat that is smelling but an unhatched egg next to its basket. The egg has a tiny hole pecked through it, as if by something trying to get out, but the egg has gone putrid. Foul smelling stuff is bubbling around the hole. I notice now that the cat is in water, that it is almost submerged inside its basket. Suddenly, it gets up. It is big and black and supple. Without a glance it moves past me and swiftly away.
And there they would sit, two embattled thoughts, estranged from each other, and from me, until eventually I would move one, or both, and start again. This went on for years.
In the meantime, and with apologies to Chalmers, I wonder if his problems might usefully be hijacked to help examine unconsciousness—specifically the anesthetic unconsciousness. The easy problem in this context would be to establish how anesthetic agents interact with the human brain to bring about unconsciousness deep enough to enable a doctor to, for example, remove and replace your heart without your knowing about it. The hard question might be: what is the subjective experience of this unconsciousness? What, if anything, does anesthesia feel like for you, the person being anesthetized?
In Boston’s Countway Library of Medicine is a slender volume with faded blue fabric cover and thin gold lettering. The Anaesthetic Revelation and the Gist of Philosophy, published in 1874. In it, Benjamin Paul Blood, a sometime philosopher, poet and mystic fashioned a manifesto from the ephemeral insights gleaned through his experience with early anesthetic drugs.
After experiments ranging over nearly fourteen years I affirm—what any man may prove at will—that there is an invariable and reliable condition (or uncondition) ensuing about the instant of recall from anaesthetic stupor to sensible observation, or “coming to,” in which the genius of being is revealed; but because it cannot be remembered in the normal condition it is lost altogether through the infrequency of anaesthetic treatment in any individual’s case ordinarily, and buried, amid the hum of returning common sense . . .
Sarah Schmidt was thirty-two when she went to the hospital to have surgery on an errant ovary. She felt unsettled right from the start, she told me, vulnerable and intensely exposed: “I remember saying to them, please don’t look at my body, don’t look at my body.”
The anesthesiologist tried to reassure her. “It’s OK, we’re professionals.”
Sarah was not convinced, although when she woke, the operation over, she felt strangely calm. A couple of days later, however, back at home, she began to have the feeling that her surgical experience was insinuating its way into her waking life. First she started having fragmentary images. “Just little spurts of memory.” Doctors talking. Then came a different and unexpected sensation. “I had memories of coming out of my body—not having an overview of things, but just being in and out of my body the whole time while the operation was happening . . . I felt like I could just walk in and out of my body. Walking in and out. Like—it’s a body, it’s open for business [she laughed], you can just walk in and out of it.”
“You know when you get deja vu?” she said. “You get that kind of unsettling rattling in your body—it was like that. That was the actual physical feeling. And if I thought about it a little more, it felt like I was just like a moveable person, I could be taken in and out of situations that I’d have no control over. Does that make sense? There’s no other way to describe it.”
It wasn’t disturbing at the time, she said, but the experience did disturb her now. Mainly because it kept coming back. The last time it had happened was a few months before we spoke. “I was lying in bed and I got these really sharp pains in my ovaries and it just triggered off this thing, at night, and I had this, almost like being on a ride—whoa, I’m coming out, and then coming back in again. It was very strange.”
Anesthetic drugs are very strange.
“Truth lies open to the view in depth beneath depth of almost blinding evidence,” wrote William James, American philosopher and psychologist, who was inspired by Benjamin Blood to experiment with nitrous oxide (still among the most widespread anesthetic drugs in use today). He too wrote of the fleeting but vivid insights—“an intense metaphysical illumination”—that followed.
The mind sees all logical relations of being with an apparent subtlety and instantaneity to which its normal consciousness offers no parallel; only as sobriety returns, the feeling of insight fades, and one is left staring vacantly at a few disjointed words and phrases, as one stares at a cadaverous-looking snow peak from which sunset glow has just fled, or at a black cinder left by an extinguished brand.
These days anesthetic drugs are administered in combinations and quantities that ensure experiences such as James’s are rarely if ever reported in the anesthetic literature—although if you search “laughing gas” on YouTube you will find plenty of very high dental patients.
But hallucinations after surgery, sometimes benign, sometimes terrifying, are remarkably common, particularly in older patients. My former French lecturer Colin Nettelbeck told me shortly after he retired about the day, several years before, when he nearly died of meningococcal disease. He fell ill just after dinner and deteriorated rapidly. By the time he got to the hospital next morning he needed a wheelchair. He recalls a doctor asking his name; his own unsuccessful attempt to reply; the aching head—“Almost as if it had been laminated into different layers of pain.” He woke the next day in intensive care with a tube down his windpipe.
A few days later, in another section of the hospital, he became delirious. In this peculiar state, he felt vividly that he was doing battle with weird humanoid figures, and that he was losing strength. (“The space was how you might imagine Dante’s circles of hell.”) In another scenario he was on a beach defending a family who were being attacked by hoons with baseball bats. “My own weapon was a pickaxe.” The dream/visions morphed, mutated and sometimes repeated. “I’m wearing my long blue London Fog raincoat and I’m on the beach . . . and I’m very, very tired. I can barely walk . . . I’m looking for help from the people around me but they’re all terribly feral and ugly people. They’re looking at me scornfully.”
The causes of such hallucinations are unclear. Some researchers point to an inflammatory response that can affect the brain, particularly in older and less robust surgical patients. But while anesthetic and pain drugs are among the likely triggers, the experiences seem to involve a melding of circumstances that surround our experience of surgery: events in the recovery room; our level of pain and anxiety; interactions with staff; as well as whatever it is we bring with us, the prisms and perspectives through which we experience our own worlds. It is a process that involves both the medical procedure and the person to whom the procedure is happening. The lines are blurred.
Which brings us back in a roundabout way to Rachel Benmayor, the woman who woke on the operating table feeling her child being cut out of her but unable to call for help. What happened to Rachel that day—the consciousness, the paralysis, the terrible pain—was just the beginning.
“And then I realized that I was in a really amazing place. And I realized that I was very close to dying.”
It was at this point that she shouldered through the flimsy threshold that marks the furthest reaches of science, and entered another realm altogether. I have no idea what to make of her experience. I can only tell you what she told me. Her story is neither reliable nor valid nor repeatable. Here, while she could still feel everything happening in her body, she was also distracted from it. She found herself in a vast room. A library.
