Monday, February 27, 2023

Anesthesia by Kate Cole-Adams

Source of book: I own this


This was this month’s selection for our “Literary Lush” book club. One of the things I enjoy about this club is that I end up reading interesting books that I never would have discovered on my own. Unfortunately, this book ended up being the biggest disappointment I have read in a long time. And the club concurred.


In fact, what I would say is that this book relies on false marketing promises, because it wasn’t much like it was advertised to be. 


The book is about anesthesia, yes, but the science content is seriously dumbed down, ill organized, repetitive, and misleading. Yes, I said misleading. 


The reason for this is that it buries the lede so far at the end, after having spent most of the book creating the impression that anesthesia traumatizes tens of thousands of people. In reality, while waking during anesthesia is fairly common (although still statistically low), most of the time it is brief and quickly corrected, and no lingering issues result. 


I think the reason that the author wrote the book the way she did is that she suffers from some sort of anxiety disorder - not just a fear of anesthesia, but a general mental illness that makes her dread a plethora of things. The book is at least half about her anxiety, and that is not how the book is marketed. Here too, the lede is buried. After pages and pages of all the things she thinks may go wrong with her anesthesia (for back surgery), it ends up being a nothing-burger. She goes under, the surgery goes reasonably well, she wakes up. She remembers nothing. So, for all that, eh? 


There are some interesting stories and interviews in the book. Although the stories my wife can tell are, honestly, better and more compelling. The interviews with anesthesiologists and psychologists are worth reading - indeed, their far more measured and scientific approaches to their research are quite a contrast to the author’s anxiety-driven approach. (Psychiatrist Bernard Levinson is mentioned as a “wonderful storyteller,” and his stories are indeed some of the most fascinating in the book.) They mostly do not tell her what she wants to hear; that is, what she actually wants to hear, not what she says she wants to hear. 


So, you want what is interesting and useful in the book? Here is your quick summary:


Anesthesia is a difficult art - and it is art more than pure science - because we do not actually know how it works. What does happen when we are knocked out? Where does the self go? Since we cannot remember anything, particularly pain, did we not experience it? This all makes it wicked-difficult to research and understand. 


But, we do know some things. In general, lighter anesthesia means better recovery - faster wakeups and fewer lingering complications. But walking that line means more likelihood of waking up, or of other issues such as movement during surgery. (That’s never a good thing.)


Modern anesthesia isn’t just a bit of ether, but rather a cocktail of drugs. These include anesthetics both intravenous and breathed, a paralytic, and memory blockers. The skill of an anesthesiologist is partly in keeping all of these in proportion in a way that works for the individual patient. 


Because of these challenges, people do occasionally wake up at least partly during surgeries, and in other cases have memories of things said and done that may appear later. For the most part, these are not a problem. 


Modern monitoring technology and practices can help determine how far under a person is, and these tools can help improve outcomes. 


But what perhaps makes for the best outcomes is appropriate communication before, during, and after surgery. Patients who understand how paralytics work, and the potential for brief waking, as well as the things that will be done to put them back under, are far less likely to feel negatively about waking up. (Hey, actual humanity in medicine seems to work every time it is tried!) Doctors and nurses should watch what they say during surgery, in case there is recall. (Again, don’t be an asshole.) 


There. That’s the book. At least the good parts. 


And I do have a few quotes. 


In humans, the clever front parts of the brain, tucked behind the forehead, can get us into trouble by trying to override this response. Among the complex mores that govern most human societies are sanctions against showing fear and its physical manifestations such as shaking and crying. We are embarrassed by our animal responses and work hard to hide them and their connotations of weakness by suppressing our natural recovery mechanisms. 


This is true, particularly about how we socialize males in our society. It does lead to negative outcomes. This is also only tangentially related to the topic of the book, in this case, the question of whether anesthesia utilizes our own defense mechanisms. 


Likewise, it is an aside about the subconscious that leads to an interesting observation that I wish the author had understood better in relation to the choices she made in writing the book. 


Yet the evidence of my own life tells me there are parts of myself that I do not recognize or necessarily welcome, but which influence the choices I make, the interests I pursue, the people I love and the way I love them. 


Another example of the buried lede problem is a passage during which she talks about buried memories supposedly retrieved during hypnosis. It is buried in a long paragraph, but the author concedes that it is probably impossible to know (when dealing with studies done long ago, and not duplicated) how many of the memories were genuine versus which ones were the product of suggestion during hypnosis. At least in this case, nobody went to prison for child molestation they didn’t commit. 


And that is before you get to the problem (as she later notes) of the role of memory. It isn’t a photograph, but more of a modeling that we can use for the future. We are a cludge, and our mental processes are about being good enough for what we need to do, not perfect. 


The book does include positive experiences among the anecdotes, which kind of undermines the author’s premise. Including the weird one where propofol gave a patient the subjective experience of a half hour orgasm. 


Perhaps one of the most intriguing speculations is that supposed memories of alien abduction seem as if they might be explained by subconscious (or semi-conscious) memories of anesthesia. I mean, the bright lights, the mucking around with the body, loss of control, and so on. But nobody appears to have done a study about this. 


Also plausible is the idea that the beginning stages of anesthesia can, for some people, grant access to emotions they have been defending against. (True story: one of my kids had a minor surgery at age three. They were downright hilarious after the Versed kicked in.) 


So, as I said, a disappointing book, one that could have been a lot better. What I personally would have preferred was a bit more respect from the author. Give me actual science - I’m fine with statistics and studies and so on. Explain things in more detail. Explore the topic, rather than going only deep enough to find your own anxiety. And, for goodness sake, find an editor to cut down the repetition and duplication of ideas. This book should have been half as long to say the same thing, and a quarter as long if there was less of the personal drama. 


As my wife put it, it would have been a much better book if Sam Kean or Mary Roach had written it. 


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