Wednesday, June 7, 2017

Anaesthesia: what we still don't know about the 'gift of oblivion' - The Age (Australia)

I am in a smallish, whitish room in a hospital in Brisbane. It is night. On the wall opposite my bed I can dimly make out a crucifix with its limp passenger. Beneath it float wide blank windows through which I watch the synapses of city light: a web of tiny illuminations and extinctions that seem, when I loosen my gaze, almost to form patterns, as if they are about to make sense. I am surprised at how calm I feel.

In the weeks leading up to this moment I have set my affairs in order. Made a will, written letters for the children, waxed my legs. Said my farewells at the airport and boarded the flight from Melbourne with my mother. It is July 2010.

Today's specialist anaesthetists train for 12 to 13 years. The death rate from general anaesthesia has dropped from about one in 20,000 in the 1970s to one or two in 200,000 this century. Photo: Fuse
Some months before this, after decades of resistance, I gave in at last to the inevitability of major surgery. My capitulation was sudden and took place in a different wing of this same hospital, where I had come to consult a respected spinal surgeon. The surgeon had a quiet, almost diffident, manner and a moustache that put me in mind of a doleful Groucho. I am not sure what made my mind up, the moustache or the way his finger traced my wayward spine quite gently on the X-ray before him. But just as he began to tell me that I would not be a candidate for the non-invasive surgery we had been talking about, I realised with a small thud of certainty that, not only was I going to have this surgery – invasive though it might be – I was going to come back to Brisbane and he was going to do it.

In the aftermath of my decision, I was buoyed in a backwash of something like relief; a giving up of hope and its attendant efforts, a yielding to forces beyond my will. But when I lay awake at night, disquiet rose around me. It was not just the surgery that was worrying me – the cutting and drilling, the inevitable risk – it was that in some blank corner of myself I felt that I would not wake up afterwards. I knew logically, and during the day could convince myself, that for an otherwise healthy 48-year-old, the likelihood of calamity was low. But at night, in my bed in Melbourne, the conviction multiplied that even if everything went according to plan, the me who woke after surgery would not be the same in some essential way as the me who had been wheeled into the operating theatre beforehand.

I developed a dread of the moment when the anaesthetic drugs would take effect and I would cease to be. I pictured myself in a stark, poorly lit room with two doors, one in, one out, neither of which I could open from within. Otherwise the room was empty. No windows, no furniture. In this darkness – which I now realise had the same sinuous quality as the shadows beneath my childhood bed – I would be trapped alone. Perhaps forever. At least until such time as someone else chose to release, not me but some other version of me who would slip soundlessly into the life that had once been mine.

Shortly after making my decision, I rang a separate Brisbane medical practice. I asked to speak to the doctor whose job it would be to render me unconscious and keep me that way during the long operation. Halting, almost apologetic, I explained to the receptionist that I had spent some years researching the process known as anaesthesia, and that I was now rather nervous about what was going to happen to me. "I think I know too much," I said.

"Oh dear," they said. "That's not good."

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http://www.theage.com.au/good-weekend/anaesthesia-what-we-still-dont-know-about-the-gift-of-oblivion-20170511-gw2uhh.html?