Not everyone goes to ‘sleep’ under a general anaesthetic, as Kate Cole-Adams concerningly informs us, while many people taking to their nightly bed have a similar problem with wakefulness, as American sleep expert Dr W. Chris Winter explains.
Superficially there may seem slight connection between induced unconsciousness and tucking in at night, yet the similarities are irresistible to explore, not least the potentially serious, even traumatic, health impacts of ineffective anaesthesia and insomnia.
The former’s work is the result of many years’ research and experience, written not by a health professional but by a (highly regarded) journalist, and blends the history of anaesthesia with an account of patients, including herself, who have experienced it in various ways, not always positively.
The latter’s, sub-titled ‘Why Your Sleep Is Broken and How to Fix It’, appears to be a self-help book, although it is just as relevant to professionals, with a variety of clinical content.
Dr Winter, a neurologist who writes for the US media and consults to high level sports teams and the military, focuses on what a lack of quality sleep can do to the body, listing one hundred illnesses, ranging from heart disease to brain malfunction, as well as the many possible causes. These include obesity, smoking, alcohol misuse and, although only to an extent, genetics.
Management strategies, from drugs to devices and doctors, are clearly discussed, with napping, snoring and apnea, rapid legs syndrome, sleep schedules and aids being among the topics covered.
While not immediately explanatory, the meaning of Cole-Adams’ sub-title, ‘The Gift of Oblivion, The Mystery of Consciousness’ becomes clear the further one reads, the conclusion, if that be the term, being that no one, including anesthetists, knows exactly why ‘An-es-thee-zha’ - “Most of us can barely pronounce it” - works, nor why it doesn’t work well, and sometimes not at all, on a significant cohort of patients.
Some of them, as the author notes, are conscious throughout their procedures yet unable because of muscle blocks to inform the surgical team of the pain they are undergoing. I recall a ghastly experience during surgery at a Sydney hospital as a late teenager, feeling every slice and stitch, yet being unable to move or whimper.
Far worse, as we hear, was the experience of Rachel Benmayor whom the author met at a dinner party in the Blue Mountains. She had been fully conscious throughout a caesarean birth, “paralysed and in agony”. As Cole-Adams writes, her “near-death encounter” became the starting point for the book.
The finishing point sees the author in a Brisbane hospital being operated on for her scoliosis, a procedure that, unlike the experiences of many on her study, she mercifully does not remember: no recall of banter amongst the surgical team, or out- of-body experiences, or pain because of anaesthesia failing to do its job. Should this last happen, she is quick to stress, it is rare that the specialists are to blame. They tread a fine line between giving too little and too much, and it is not only the second that has potentially fatal consequences.
“Every time you have a general anaesthetic, you take a trip towards death and back. The less hypnotic your doctor puts in, the more likely that you will wake. It is a balancing act, and anaesthetists are very good at it. But it doesn’t alter the fact that people have been waking during surgery for as long as other people have been putting them to sleep.”
In the broad surgical mix, she explains, “It is anaesthetists… not surgeons who decide which patient is in most need of and most likely to survive emergency surgery: anesthetists increasingly oversee the pragmatic hierarchy of triage.”
Yet some patients never get to see their anesthetist, or not until the last moments before the surgical procedure. The quality of this connection has been found to improve the chances of the anaesthetic experience - the bedside manner is not an outdated concept.
“I have witnessed operations in three continents and interviewed some of the world’s best-known anaesthetists,” she writes.
“I have sat through conferences, scoured professional journals and medical libraries for reports and studies, hounded psychiatrists and psychologists, and cornered dozens of friends and strangers and asked them to talk about their own experiences of surgery.”
Her efforts have paid off. After its “long gestation” this book has delivered an important contribution to medical literature in Australia and internationally. Despite the detail and the intensity of the experiences described, it will never put you to sleep.