Politically Incorrect

In twilight sleep, dreaming: colonoscopy, the Pend Oreille Surgery Center and the gift of anesthesia

I can’t say it was high on my things-I-want-to-do list, but early on a snowy December morning I found myself standing as an observer at the Pend Oreille Surgical Center while Dr. Mark Savarise performed a colonoscopy on David.

Let’s take it as a given that once you reach a certain age, it’s a good idea to have a well-trained doc slide a camera up your butt to take a good look around. If you find yourself with the ability to be on the receiving end of this procedure, you probably should take advantage of the opportunity. And if you find yourself with the ability to observe such a thing—well, you may surprise yourself and discover you find it fascinating, as I did.

The lower bowels are an amazing structure and watching them on film is no more gross than, say, watching that alien eat its way out of Sigourney Weaver’s gut. Not everyone’s cup of tea, admittedly.

While Dr. Mark was a camera maestro, however, the true fascination for me was in the hands of Dr. Stuart Gall, who with his magic potions, ensured that David remained asleep during the procedure, and only during the procedure.

Oh, what a difference 163 years can make.

Back then, opium and alcohol were the main resources available to surgeons when physical intervention became necessary to healing, and both could only be used in moderation. (Occasionally, a quick punch to the jaw, inducing unconsciousness, was also used.) Those resources not only contained risks within themselves, they rarely served to keep a person unconscious throughout a procedure. Therefore the best surgeons around were the fastest—three minutes was about the maximum amount of time allowed for any surgery, given the agony involved for both the patient and for the doctor responsible for it.

It would be hard to describe what medicine was like before the invention of anesthesia, but writer Fanny Burney, who underwent a mastectomy in 1811, did it for us. She pictured it thusly: “When the dreadful steel was plunged into the breast, cutting through veins, arteries, flesh, nerves, I needed no injunction not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision, and I almost marvel that it rings not in my ears still! So excruciating was the agony... I remained in utterly speechless torture.”

It beggars the imagination to ponder what types of medical problems might have convinced a person to let the surgeon provide a solution. While we all have heard about “biting the bullet,” the sad reality was that the pain and trauma of surgical intervention itself prior to the gift of induced sleep often resulted in the death of the patient.

Then, in 1846, a dentist in Boston gave the first public demonstration of ether as an anesthetic; by the end of the year, its use had been observed by a quiet laborer’s-son-become-medical-man, London’s Dr. John Snow.

When used successfully, ether was much preferred to alcohol or opium, but successful use was intermittent. For every patient where anesthesia was victoriously induced, another would fail to go under at all, while some would wake up during the middle of a procedure and others would simply not wake at all. A better record than alcohol, opium or a hard right hook, but better was not best.

Snow began investigating how to best control the dosage given, and developed a chart that determined dosage vis a vis the temperature of the room, as  he knew the concentration of any gas varies by temperature. He also began work on developing an inhaler, allowing greater control over the dosage given, and explored the biology of the gas as well. He built a mastery of this subject through research conducted in his own home. “There is something wonderful—and more than a little ironic—in this image of Snow the teetotaler, arguably the finest medical mind of his generation, performing his research. He sits alone in his cluttered flat, frogs croaking around him, illuminated only by candlelight. After a few minutes tinkering with his latest experimental inhaler, he fastens the mouth piece over his face and releases the gas. Within seconds, his head hits the desk. Then, minutes later, he wakes, consults his watch through blurred vision. He reaches for his pen, and starts recording the data.”*

It’s hard to imagine finding a researcher as committed to his work today; Snow’s courage and insatiable desire to know allowed for medical advances likely undreamed of in his time. And as Dr. Stu pointed out to me, it undoubtedly also led to the existence of unknown numbers of people whose ancestors would otherwise have died without the interventions allowed for by a reliable anesthetic.

How times have changed since 1846. Dr. Steven Shafer, associate professor of anesthesia at Stanford University, began practicing in 1985, a time during which he believed anesthesia had reached its pinnacle. He writes of the state of anesthesia today, “For example, who would have predicted the introduction of Duzitol? This remarkable drug, derived from the urine of sheep fed shiitake mushrooms, has a remarkable spectrum of activity. Duzitol is an hypnotic, analgesic, anxiolytic, amnestic, muscle relaxant, and aphrodisiac. There are many other new drugs introduced... but only Duzitol does it all!” This is just one of the miracle anesthetic drugs in use at present, a lexicon that includes hyptiva (“...the closest thing to an anesthetic switch. You turn it on, the patient turns off. You turn it off, the patient turns on.), cycloflurane, dexsed and suxuronium.

David was wheeled into the operating room alert and undoubtedly apprehensive. Minutes later he was in twilight sleep and dreaming. And just moments after the conclusion of the procedure, he was waking again, with no memory of the interim. Shortly thereafter, he was headed home. Snow would have been amazed. Fanny Burney would have been envious. Sigourney Weaver might even have coveted the same. And I was quite simply enthralled.

You can learn more about the Pend Oreille Surgery Center and the services they provide by visiting their website. If you happen to stop by, tell them that Trish and David say hi.

Despite his work with anesthesia, Dr. John Snow is best known for his role in discovering the source of cholera. An excellent story about him and his achievement can be found in “The Ghost Map,” by Steven Johnson.