By Kate Cole-AdamsNon-fictionText Publishing

Anaesthesia: The Gift of Oblivion and the Mystery of Consciousness

You know how it is when you go under. The jab, the countdown, the –
– and then you wake.

This book is about what happens in between.

Until 170 years ago many people chose death over the ordeal of surgery. Now, hundreds of thousands undergo operations every day. Anaesthesia has made it possible.

But how much do we really know about what happens to us on the operating table? Can we hear what’s going on around us? Is pain still pain if we are not awake to feel it, or don’t remember it afterwards? How does the unconscious mind deal with the body’s experience of being cut open and ransacked? And how can we help ourselves through it?

Haunting, lyrical, sometimes shattering, Anaesthesia leavens science with personal experience to bring an intensely human curiosity to the unknowable realm beyond consciousness.

Portrait of Kate Cole-Adams

Kate Cole-Adams

Kate Cole-Adams is a Melbourne journalist. Her novel Walking to the Moon is published by Text.

Judges’ report

Extraordinarily well-researched and delicately structured, this is a book with few parallels. Exceptional writing illuminates a topic that affects most of us, but that few of us understand. Questions raised are various: what was surgery like before anaesthesia? How was anaesthesia discovered? Does pain matter if we can’t remember it? Likewise, do the things said in our hearing, when we’re unconscious, matter if not remembered? What actually happens to us in those minutes and hours in which we are nudged gently towards death so the doctors can do their work? And what is it like to wake up during a procedure, but be unable to communicate at all?  

Cole-Adams draws on the experience of many who’ve had traumatised experiences when ‘under’ anaesthetic over the decades, as well as in-depth interviews with anaesthesiologists in an attempt to understand a craft that is, in fact, not able to be completely understood.

Cole-Adams's capacity to intertwine life story alongside deep research is quite extraordinary and her use of personal detail deftly allows her to take her material one step further, moving from science to philosophy. What do our bodies remember and what does it do with those memories. What, indeed, is memory? Can our body ‘think’ for us?  What is the conscious and what is the subconscious?

Extract

Awake

Many years ago now, in the Blue Mountains outside Sydney, I was invited to a dinner to celebrate the birthday of a friend. There were eight women at the dinner, some of whom I did not know, around a long trestle table covered with a white sheet and many small candles. Between courses one of the women, Rachel, told us the story of the birth of her second child. After she finished, there was silence; it was hard to know what to say.

Not long after that dinner I moved with my family – my partner, our son and me – back to Melbourne. But I kept thinking about Rachel’s story. I did not know why, but it was like a bit of grit: I found myself growing ideas around it. I spoke to the friend who had hosted the dinner, who gave me a phone number. For months afterwards I put off calling, afraid she would not want to talk publicly about what had happened. But when I rang her one April evening from my home in Melbourne, she said yes.

Rachel Benmayor’s story – of a general anaesthetic that failed; a caesarean birth endured conscious, paralysed and in agony; and a near-death encounter with what she saw as a great, implacable consciousness – became the starting point for this book, although the story had, in the way of all stories, begun long before.

We spoke by phone over two nights: Rachel in the house that she and her husband, Glenn, were renovating in the mountains, me squatting on the floor next to the filing cabinet in our Melbourne home office; she in her soft New Zealand lilt—the flattened vowels and unexpected upward inflections – me in a series of vague half-forays, repetitions and mmmms. It didn’t matter. She wanted to talk. She spoke at a rhythmic, even pace, as if describing a familiar dream or film, slowing sometimes, at others clearing her throat or coughing, but rarely stopping except when I interjected. I could not quite remember what she looked like except for an impression, incomplete as it turned out, of softness – brown curls, a shortish figure, an open, appealing face. Something quiet about her, almost arrested. All of which merged over the phone into the steady forward tread of her voice.

‘So,’ said Rachel, ‘I remember going onto the operating table. I remember an injection in my arm, and I remember the gas going over, and Glenn and Sue [her midwife] standing beside me. And then I blacked out. And then the first thing I can remember is being conscious, basically, of pain. And being conscious of a sound that was loud and then echoed away. A rhythmical sound, almost like a ticking, I guess, or a tapping that was just like a march and it just went round and round and round and I could hear it. ‘And pain. I remember feeling a most incredible pressure on my belly, as though a truck was driving back and forth, back and forth across it.’

Rachel had been admitted to hospital, eight and a half months pregnant, a few days earlier. Her blood pressure had risen rapidly and her doctor had told her to stay in bed and get as much rest as possible before the baby came. But her blood pressure kept rising – the condition, known as pre-eclampsia, is not uncommon but can lead to sometimes-fatal complications – and the doctors decided to induce the birth. When her cervix failed to dilate properly after seventeen hours of labour, they decided instead to deliver the child by caesarean section. Rachel had hoped to have an epidural injection into the base of her spine so that she could be awake for the birth. But she was in a smallish country hospital and that day there was no one available to perform the procedure. Instead she was told she would have to have a general anaesthetic. She remembers her disappointment. She remembers being wheeled into the operating theatre. She remembers the mask, the gas. And then she woke up. 

A few months after the operation someone explained to Rachel that when you open up the abdominal cavity, the air rushing onto the unprotected internal organs gives rise to a feeling of great pressure. But in that moment she still had no idea what was happening. She thought she had been in a car accident. ‘All I knew was that I could hear things … and that I could feel the most terrible pain. I didn’t know where I was. I didn’t know I was having an operation. I was just conscious of the pain.’

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