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Anaesthesia focuses on the brain, requiring the brain to focus on Anaesthesia. This makes for a challenging, fascinating, disquieting read, in no small part due to the underlying theme of uncertainty. There are still many unanswered questions about how anaesthetics work, how an individual brain will react, and what an adequate level of anaesthetic actually is. A line from page 126 sums up the experience of some patients very well: It was all, says author Kate Cole-Adams, very Lewis Carroll.
You don’t have to be a medical professional to read this book, only someone who – like Cole-Adams – is ready to be captivated by the mysteries of anaesthesia. She’s a writer and journalist who spent years carrying out research for this book, drawing on both personal and professional networks. She talked with anaesthetists around the world, observed operations, and attended conferences. She read widely, at times bewildered and frustrated by medical jargon. She entered the realms of psychiatrists, psychologists, hypnotists, neuroscientists and others skilled at studying and influencing how our minds and brains react. She also spoke with people willing and keen to share their personal (and sometimes dreadful) experiences with anaesthesia.
Cole-Adams suggests that the lines between anaesthesia, dreams and reality are indistinct and permeable. Consciousness, she suggests, is a small boat on an immense sea. She explores in detail how and what we are aware of, and under what conditions. She’s open about her own involvement with, and attitudes towards, anaesthesia. She also reflects on some of her past relationships and life choices, analyses recurrent dreams, and describes living with both physical and emotional unease including her anxiety about being put under.
There are numerous philosophical challenges for readers to engage with, particularly around the ‘interruption of self’ that occurs during anaesthesia. Cole-Adams encourages us to consider (and then reconsider) what consciousness is. Be prepared to confront your existing beliefs about what happens when you are anaesthetised, and the critical role that memory – or the absence of memory – plays. And yet despite the knowledge of what can and does go wrong, who among us will not choose to be comforted by the confidence and relative reassurance of the anaesthetist who visits our bedside before surgery?
There are lessons for medical staff too, with confirmation that hearing is likely to be the last sense to switch off under anaesthesia. Although some anaesthetics apparently suppress sound well, others are less effective. There is no easy way to tell how unconscious an individual patient may be, especially during the time that they are going into or emerging from an anaesthetic.
Cole-Adams is a keen observer of personalities, clothing, sights and sounds. She describes a no-nonsense professor of psychiatry who ate party pies doused with sauce as he strode along interrogating her about the purpose and funding of her book. She tells us about the tins of oatmeal cookies perched on the desk in the den of a world-famous anaesthetist, whose interview outfit included a tie decorated with colourful butterflies. And she – a sun-loving Australian – writes about her underwhelming visit to a bleak and gloomy corner of far-off Hull to attend yet another medical conference.
Questions of ethics abound. It’s alarming to learn about some of the experiments carried out on anaesthetised patients – and the dubious rationales for conducting some of the experiments. The terms that Cole-Adams uses to refer to patients are often sobering: deflated, panicked, wilted, overwhelmed, even crucified. Perhaps it was inevitable that the word vulnerable would appear so frequently throughout the book.
Section and chapter headings hint at the strange and beautiful world we enter under anaesthesia: Denial, Moonless nights, Regression, Blood and blushing among them. Woven around the compelling and often disturbing stories, Cole-Adams offers anecdotal evidence, arguments and counter-arguments, new terms coined by scientists for states of anaesthesia, theories and hypotheses. She includes suggestions for further research – so much still remains unknown.
I’d be cautious about reading this book before a planned anaesthetic. Chances are nothing will go wrong, but the ‘what ifs’ may linger long after you read the final page.
Reviewed by Anne Kerslake Hendricks
by Kate Cole-Adams
Published by Text