Mix of science, medicine, philosophy, and memoir. The memoir part reminded me a little bit of the Henrietta Lacks book, I enjoyed it, but there was maybe too much of it for my taste. I love the subtitle: “The Gift of Oblivion and the Mystery of Consciousness.” ( )

After rave reviews in many magazines I am profoundly disappointed. I have found the mixture of personal reminiscence and scientific fact rather annoying. In fact it has been very hard going and in many cases rather boring. Her prose style is turgid. At the end I am no wiser about 'The Mystery of Consciousness'. How I wish that it had come across as a mystery. ( )

Kate Cole-Adams’s book is ostensibly about anesthesia—the kind you typically undergo for surgical procedures. In fact, the first half of the book, give or take a bit, really is mostly about anesthesia, albeit with an almost obsessive focus on awareness/waking up during anesthesia. The second half of the book, starting with chapters entitled “Dreams” and “Ghosts”, however, is largely about the author’s preoccupation with her own psychological processes. More about that later.

Eighteen years ago, Cole-Adams states, she knew and cared nothing about anesthesia, but all of that changed when she heard Rachel Benmayor’s story. Benmayor’s general anesthetic failed during a caesarean section to deliver her second child: she was conscious, paralyzed, and in agony, and experienced a near-death encounter with “a great, implacable consciousness.” This compelling story, along with the author’s own overwhelming fears around much needed surgery--deferred over and over for years (until middle age)--for worsening spinal scoliosis apparently fueled Cole-Adams’s investigation into anesthesia.

Early in her book, Cole-Adams briefly addresses the first successful medical anesthetization. In 1846, American dentist William Morgan demonstrated how ether could be used to render a patient unconscious in order to facilitate removal of a painful lump in the jaw of a 20-year-old patient. News of ether’s miraculous powers quickly spread. In no time at all, it was being employed in London and Paris. Nowadays, other less odorous, less flammable gas anesthetics (related to ether) are employed, and the twentieth century ushered in the use of powerful intravenous anesthetics (such as midazolam and propofol). In 1942, Canadian anesthesiologists recognized the value of a second “element”: curare, a chemical extracted from a species of South American tropical plants, traditionally used in hunting by the indigenous peoples of that continent. By incorporating curare in anesthetic protocols, anesthesiologists could ensure that patients would remain completely still during surgical procedures. In short, patients were paralyzed. This meant that less anesthetic was used and that deaths due to anesthesia dramatically declined. In fact, anesthetic mortality dropped by a full 1/3 within ten years.

The third “tool” in modern anesthesia is analgesia—chemical pain control. According to Cole-Adams, who interviewed numerous medical specialists for her book, many anesthesiologists continue to administer inhaled gas anesthetics with little or no intravenous painkiller, often only providing small, incremental doses of pain medication as the patient emerges from general anesthesia. This is highly problematic because anesthetic gas provides no pain control, and there is evidence that the central nervous system still registers pain (even though the patient isn’t conscious of it at the time) and can become “sensitized” to it. Chronic pain that lasts months, even years, after the surgery can ensue.

To my disappointment, Cole-Adams is not terribly interested in the physiological effects of anesthesia—the impact of powerful sedating drugs on various organ systems, nor does she spend any time discussing how anesthetic complications can and do occur. As the subtitle of her book suggests, she is almost exclusively focused on psychological aspects of anesthesia. I think it is fair to say that her interest in waking during anesthesia borders on the extreme.

Recent studies suggest that the number of patients who awaken during general anesthesia may be higher than the “1 to 2 in a 1000” figure that is typically quoted. The number may be as high as 4 to 5 %. It appears that women, the obese, redheads, and drug abusers are more likely to wake up and that some people may have a genetic predisposition to awareness while under anesthesia. Patients undergoing caesarian sections, heart, and trauma surgery tend to be provided with lighter anesthesia, and their risk of being aware may be ten times that of patients undergoing other procedures. Waking and experiencing pain is apparently far less detrimental than waking to absolute paralysis. Patients who are aware of their paralysis are predisposed to being troubled by mental health issues afterwards. PTSD can even result.

Cole-Adams has certainly done her research on awareness during anesthesia. She provides details of a multitude of studies on the topic, many of whose conclusions are suggestive and speculative rather than definitive. I wish she had been more judicious in her selection of studies to present in her book and more restrained in her reportage of the details of those studies. Less would have been more here.

While I learned a lot from Cole-Adams’s book, I can’t deny that it was pretty hard going at times. The main problem is that the author is very concerned with her own experiences and psychological states. Why, she asks several times, has the topic of anesthesia taken hold of her, a journalist, in this manner? What is that feeling of grief—the constriction in the chest and throat, the physical unease--that lingers just beneath the surface of her everyday self? Will undergoing hypnosis help her understand where that sense of loss comes from? Why do tears flow when the author tells a therapist the story of herself, at age two, being left behind with kind family friends while her parents vacationed? The thoughts that flit through her head while she swims, including observations about dappled light and grungy pool-bottom ceramic tiles, are recorded. The poor reader is mercilessly submitted to seemingly endless quite-personal details--about failed romantic relationships, the author’s anxiety and self-loathing, her writing process, her artist mother’s paintings, and her elderly parents’ illnesses. Even excerpts from an unpublished manuscript on consciousness by her grandfather are included because . . . well, consciousness is sort of related to anesthesia, isn’t it? Cole-Adams goes on and on. I must admit that at the three-quarter mark I regularly wondered if she , , including a ever stop.

Yes, in the second, mostly autobiographical, half of the book, there are occasional nuggets of interesting material about anesthesia, but it is hard work indeed wading through the sometimes ostentatious writing and self-absorption to get to them. I don’t mind an authorial aside, a relevant anecdote or two, but too much of this book read to me like therapeutic journalling.

An Australian psychiatrist, an expert in hypnosis, upon first hearing Cole-Adams’s research interests tellingly comments to her that it all sounds a bit like “gobbledygook”. “I’m not certain,” he says, not unkindly, “whether you’re trying to sort yourself out, or whether you’re trying to sort out other things.” Amen, I say.

“You think too much,” the author’s son says to her, but that’s not quite accurate. What seems closer to the truth is that the author really just talks too much (and writes too much) about matters that no one but herself should be expected to be interested in. That is the main failing of a book which I commenced with the understanding that it was about anesthesia. It far too frequently is not. Ms. Cole-Adams’s editors would have greatly assisted future readers by demanding that the author slash at least a third of her unwieldy tome. Huge amounts of the biographical stuff—the ongoing ruminations, the family history, the recounting of dreams (oh, dear!)—just needed to be cut. Ruthless revision, including better organization, would have allowed the author’s research findings to really shine. ( )