Reflections On Anesthesia, Consciousness, Death, and Sushi
Death is not a big deal, because when you’re dead, you’re not there to notice it.
I fear anesthesia and deep sedation. I fear how they obliterate the mind. I fear being reminded of how fragile our mind is. How little it takes for it to disappear, for it to be no more. Wallop a brain, mush it, shake it with violence, or knock it out with powerful chemicals, and poof, you can no longer see a magician pulling a rabbit out of a hat; in fact, all the images of rabbits and magicians your brain could conjure up are gone. You go under, and you, or your mind, might never come back out again.
Which is why I was thinking of Ingmar Bergman when I entered the hospital lobby on September 20. No, not because of The Seventh Seal, a film inspired by his fear of death. I was thinking of Bergman himself on the documentary Bergman Island, where he talked about his own experience with anesthesia. Going under lessened his own “insane fear” of death. If being dead was like this complete lack of consciousness, he thought afterwards, death was “nothing to be frightened of” —as Julian Barnes, that other famous thanatophobe, phrased it in his memoirs on mortality. Death is not a big deal, because when you’re dead, you’re not there to notice it.
Yet, neither Bergman's realization nor Barnes' witticism were calming my nerves on Sept. 20. I knew Bergman abandoned the idea of death as nothingness later in life, after his last wife, Ingrid Karlebo, died in 1995. He reconsidered his experience as a mere chemical reaction, and he expected death to reunite him with Karlebo, whose presence he felt in Fårö island. And Barnes' stance didn't keep him from being seriously "pissed off" about dying1. Nostalgia can make you wish an afterlife, and knowing that you won’t notice death won’t keep you from furiously rejecting it anyway. Bergman didn’t have an epiphany, just a temporary observation; Barnes didn’t offer an insight, just a mere palliative.
Also, there’s no reasoning with anxiety. I’ve been diagnosed with generalized anxiety disorder, which I often experience as an intense fear of death, even when I’m miles away from an operating room. I used to suffer from frequent panic attacks brought up by the feeling I was dying, no matter how irrational I knew the feeling was. (I’ve curbed my panic attacks in the last two years. Thank you for asking.) Put me near an operating room, and the techniques I’ve learned to manage my anxiety start failing me. My mind starts asking questions designed for worry.
If they give me chemicals, will I wake up? And if I do, will the self I know as “Wilmer” come back with its full mind? When I get to this question, I think of eggplants. The only time I went under with the whole anesthesia cocktail, I woke up to find out that I could picture the damned vegetable, but I couldn’t connect the image with “berenjena” in Spanish (my native language) or “eggplant” in English (my second language). I spent an entire week panicking about my memory, expecting it to be shot for the rest of my life, worsening to the point my conscious self would be lost in the interstices of my brain.
So, when I got to admissions, I did what I always do to distract my nerves: I became chatty. After paying the receptionist (an ominous note at the counter announced you have to have your payment ready, although it doesn’t explain the consequences of not having the money to do so), I discovered she spoke Spanish and had done the “origins” DNA test. She was of Mexican descent, I was born in Venezuela, so we discussed how many continents our DNA came from (three for her, four for me), and the ethnic misclassifications on the admissions forms.
Once in the surgery center, after I removed my clothes and personal possessions and put them in the plastic bag I was given, I focused on the bracelet with my name, the date, and a bar code that contained —I supposed— whatever identity and autonomy I hadn’t shed along with my clothes. When the nurse came to put the IV in my arm, I focused intently on every pinch and maneuver they had to do to insert the angiocath into a vein. Left alone, I tried and failed to fall asleep, or to even feel sleepy. My mind kept jumping from a focal point to the next, obviously avoiding the long corridor that opened behind the doors right in front of my bed.
And then, I was being wheeled in my bed towards the surgery room. The spotless corridors were softly and evenly lit, as if whoever designed them wanted to inspire a sense of calm and confidence in the patient. But I felt my anxiety rising with every button the nurse pushed to open every automatic door in what was feeling like too long a trip. When the twin doors to the operating room opened, my mind unhelpfully conjured the inscription Dante reads above the Gate of Hell in Canto III of the Inferno: "Lasciate ogni speranza, voi ch'entrate" (Abandon all hope, ye who enter) which had been in my mind for a couple of days, after I told a teacher friend that it should be inscribed on the door of every classroom full of bad students.
I had time to count four people in the operating room after the doors closed behind me. My doctor, Korean American; the anesthesiologist, whose accent sounded Nigerian, but I’m probably wrong; the Korean nurse who’d wheeled me in; and a second nurse who looked Latina, doing some prep work I didn’t understand around the room. They masked me and flipped me face down right away (I guess time in an operating room is at a premium), fitted my face into a soft foam mold, and loosened my gown around the area they were going to work on, as they were discussing the procedure they were about to perform.
I freaked out when I felt my oxygen mask softly pressing against the foam mold, and complained to the anesthesiologist about the mold collapsing. He adjusted it. I said that it was still difficult to breathe. ButI knew it was neither the mold nor the mask that made it difficult. It was my panic. I was drawing quick breaths, thinking, “Oh please I wanna wake up afterwards,” listening to the beeps of the heart monitor, noticing how my heart rate was distinctly increasing, and panicking even more as the beeps from the heart monitor became more frequent. And suddenly, the most unexpected symptom occurred: I felt the roaring burning and intense itching of my hemorrhoids aggressively radiating outwards from my anus, and an urgent need to scratch, and the beeps coming closer together, before a calming voice spread within my diminishing consciousness like a tinted liquid in clear water, saying: Everything is just fiiine.
I stayed sort of awake but barely aware. Thoughts slipped through the chemical cocktail and landed somewhere on the surface of my shrunken consciousness. Wait, what? They’re injecting my neck already? How come the neck first? What about the… What about the… iliac crest! Shit, I remember. These drugs are not so bad. The iliac crest, yes, they were supposed to take some bone marrow and put it in a blender or something. Did they forget? What’s that? Another injection? The doctor said injection, not injections. They’re flipping me again? That was like five minutes. I thought it was gonna take 30 minutes at least. Where’s the hallway?
The hallway had been edited out by the drugs, and I found myself in the room at the surgery center. The wall clock confirmed 45 minutes had elapsed since I was wheeled out of it. There was another nurse, and I felt compelled to smile at her by the pleasant sensation of my floating brain. She smiled back.
“How are you feeling?”
“Feeling goooood.”
She offered water, and I accepted. I drank slowly, holding the bottle in a way I thought would hide my clumsiness. Some time elapsed before I could perceive time as something more than discontinuous patches of awareness. I can’t remember how, but the nurse and I struck up a conversation about sciatica. She’d suffered from it for 13 years, and in the last few has been receiving injections about three times a year to manage pain crises. I didn’t share as much — I think — as I am a new arrival in the land of sciatica.
I can’t remember how the issue of going to the bathroom was raised. Did I say I needed to pee? Or did she say I needed to go before I was discharged? Or did both things happen and now they are conflated in my memory? I don’t know. Either way, the nurse said she’d called my friend B, who was picking me up, and added I had to stop at the bathroom first. I moved my legs off the bed and towards the floor. She was observing me.
“Need help to walk?”
“No, I’m good. I can walk.”
I staggered, and she caught me by the left elbow. I giggled. I felt like laughing. I thought I was staggering because it was funny, and I was just being playful, and my balance was all right.
“I’m good. I’m good. I can walk,” I told her.
The nurse didn't believe me. She bunched a back portion of my gown in her right hand, and steadied my wobbling body to the bathroom like a jockey reining a horse. I pissed without modesty or restraint. Don’t judge me. Drugs are known to remove inhibitions.
I don’t know how much time I took to complete the considerable task of getting dressed. It must have been plenteous: the nurse felt compelled to check twice and ask if I was all right. I foggily remember scrutinizing each item of clothing at length, as if doubtful of their authenticity, and examining my documents twice as long, as if making sure they didn’t belong to a doppelgänger.
When the nurse (was it the same one or another one?) showed up with the wheelchair, I said, or I thought I said, that I could walk but understood the liability issue and would go in the wheelchair. I caught a glimpse of myself on some polished surface (perhaps the elevator door). I looked like a happy fool.
Los Angeles weather prevailed outside: sunny, mid-seventies at mid-afternoon. My friend B was waiting in the pickup lane of the circular driveway. She got out of the car and approached as I was putting my hands on the wheelchair armrests.
“Do you need help?”
“Nah. I can walk.”
It was a little truer than before, but I put one hand on the roof of the car to make sure I was not lying. I got in. As she pulled out, she asked:
“How’re you feeling?”
I felt the question was funny. I started laughing. I almost couldn’t control myself. Yes, the question was funny. The weather was funny. Downtown L.A. traffic was funny. My previous panic was funny. B started giggling with me.
“You know, B, I don’t know what they gave me, but whatever it is, they gave me the good stuff.”
We guffawed in a silly chorus. Then, in what can be construed as a non sequitur or a logical consequent, I raised my voice and almost screamed:
“La vita è bella! La vita è bella!”
And without transition, I took my smartphone out and opened ChowNow.
“Fuck it. Let’s order sushi.”
Barnes considers Montaigne’s main arguments for the “modern, grown-up, non-religious acceptance of our inevitable end” (p.40) and argues — or merely protests — against them in parenthesis: “And you complain of being taken, when all are taken? Think of how many others will die the same day as you. (True, and some of them will be as pissed off as I am about it.)” p.43. Nothing to Be Frightened Of. 2008.