Writing about pain relief brought Kate Cole-Adams face to face with the big philosophical questions. By Sarah Price.
‘Anaesthesia’ author Kate Cole-Adams
In a small waiting room, I’m lying on a metal hospital trolley. I am alone. There’s a cannula stuck in my hand, and where they’re about to slice into my knee, iodine washed over my skin. A nurse has covered me with a starched white sheet, but the air in the sterile room is very cold and I shiver. Through the swing doors into the operating theatre, where they are running an hour late, I can hear them preparing for me: muffled voices, clanging and scraping, the sound of metal. Blurred images move past the thick plastic, ghost-like. Watching the clock above the doors, I begin to think about Kate Cole-Adams. Twice we’d been together at Varuna, The National Writers’ House. For two weeks, at different stages of its gestation, I’d heard stories from her book: people waking under anaesthesia, pain and paralysis, time lost, memories that were confused or warped; or memories intact but disbelieved.
Lying under the white light – harsh like that in a shopping centre, but closer, even more artificial – it is hard to know what is real and what is imagined. But Kate feels real. I remember her reading aloud in front of the fire at Varuna, standing tall and erect, her spine freshly operated on. The soothing tone of her voice, measured and penetrating. I can remember being carried away by her words, by the beautiful clarity in her writing. The reference to the hospital’s crucifix, to its limp passenger. Kate’s tenacious, methodical research. Her decade-long commitment to the book. I remember how I felt hearing her stories: shocked, intrigued, apprehensive. I can even remember the wine we all drank: The Procrastinator, a source of wry amusement. Yet, I can’t recall the book’s facts or statistics, or Kate’s answers to its questions. Where do we go when we are anaesthetised? Will I be the same when I wake? Could I wake too early, during the operation? I realise, with slight panic, that before now I should have asked more questions. Why hadn’t I better informed myself? Why had I not called Kate?
On a bright winter’s day in inner Sydney, Kate sits opposite me in a friend’s back garden. Now complete, her book, Anaesthesia: The Gift of Oblivion and the Mystery of Consciousness rests on the table between us. “You lived with this book and these ideas for a long time,” I say, and Kate laughs. “Yes, it was a huge endeavour. When I started I thought I was writing a book about general anaesthesia, but then I started to wonder: What even is anaesthesia? And it turns out even anaesthetists don’t agree on that. Then came the question of what does anaesthesia take away? Ideally it takes away pain; often it takes away your ability to move and to remember. And it takes away consciousness. So, what’s consciousness then?”
Suddenly, Kate found herself trying to think her way through one of the biggest mysteries in science and philosophy, where there’s no agreed definition about what consciousness is. Is it a necessary result of what happens in the mechanics and structure of the brain? Or is it something that happens beyond that? Is consciousness intrinsic to the universe, like time and space? “The borderlands between consciousness and unconsciousness is where the most interesting stuff happens, but it also doesn’t get talked about,” she says. “A lot of the book is focused on the strange areas where questions arise of what’s conscious and what’s unconscious.”
Is anaesthesia, then, unconsciousness, or is it altered consciousness? And what’s the difference? “They’re weird and fascinating questions, and those grey areas have potential practical significance for patients, so it’s worth looking into them.” It matters most in a small number of cases (about one in a thousand) where people remember waking during anaesthesia, she says. Often those patients will drift back to sleep, unconcerned. But sometimes they don’t. “While many seem not to mind, the sensation of unexpected paralysis, particularly if you have no idea what is happening, can be devastating and can trigger post-traumatic stress disorder.”
Kate says her aim in the book is not to alarm but to empower. What she tried to do, she explains, was to understand the human experience of anaesthesia. “The thing that fascinated me most was: what happens to us, to me and to you, when we go under? There’s this great euphemism that our anaesthetist puts us to ‘sleep’, or ‘under’. But it’s not sleep,” she pauses, leans forward. “And under what?”
She points out that we lose consciousness of what’s happening to us well before our bodies stop reflexively reacting to being cut open. On the operating table, we can frown and flex, our bodies may flinch, tears sometimes run out of our eyes. “There’s evidence that people’s level of consciousness goes up and down during surgery. Patients can learn information under anaesthetic. Doctors and nurses say that people quite often wake up in the middle of surgery, and they put them back to sleep. Once you start looking at the boundaries between conscious and unconscious, you realise it’s not a binary conversation.
“If you do take in information under anaesthetic, or if you wake under anaesthetic, even briefly, might that affect your ongoing personality? Can it matter to your psyche? Can something get in under your skin and act as a kind of psychic irritant?”
What is clear is the enormous vulnerability of the anaesthetised patient, she says. To an anaesthetic, we bring our conscious and unconscious preoccupations. Our personality, history, fears and hopes, level of optimism or pessimism, our culture. All of which can affect our experience. “In all this, a good anaesthetist is like the advocate for the patient. He or she is the one who has to hold that person together, hold the space for them while they are under.
“Doctors do this extraordinary thing where they take away the part of us that is most identifiably and crucially ourselves: our conscious self. And in order that they can enter our bodies and do the thing that will improve or save our lives, we hand ourselves over to them, without even thinking.”
These days, doctors are very good at doing anaesthetics, Kate says. Yet, despite all their sophisticated monitors and drugs and systems, they still know so little about what it is to be “us”. “Anaesthesia touches on the big philosophical mysteries about consciousness, about who we are. It is a portal through which we can explore some of humanity’s biggest mysteries: Who are we? What’s life? What is it like to be us?”
This article was first published in the print edition of The Saturday Paper on Sep 2, 2017 as "Into oblivion".
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