Consciousness Behind the Veil of Anesthesia

As early as 1934, Wilder Penfield, a Montreal neurosurgeon, commenced brain-mapping surgery on epileptic patients. He aimed to locate the brain regions and mechanisms that produced "aura," the physiological, cognitive, and emotional warning signs of seizure. By administering a local anesthetic, Penfield removed a section of the skull to expose the cerebral cortex and probe the brain with electrodes. The patient, fully conscious and free from pain, would report experiences. As Winter describes in her book Memory: Fragments of a Modern History, a curious thing occurred in which electrocortical stimuli in regions and patterns of a patient's temporal lobe would activate a vivid life-like memory for patients - including memories that were long suppressed, forgotten, or seemingly insignificant. Patients reported fully experiencing those memories as if they were authentically occurring, perhaps akin to the dream simulations we nightly experience that convince us of their ultimate reality. Meanwhile, they were also fully cognizant of being in the operating room under Penfield's exploratory eye and instrumental precision. Consciousness seemed to double itself. Both present and immersed in memory. A dual ontological commitment, a double exposure, and a simultaneous reality incongruence. How did we get here? What questions does the above short scene raise regarding consciousness? Consciousness splitting and experiencing the fullness of memory, reliving anew an experience while simultaneously being present to Penfield's surgical design and probing. Consciousness doubles and dislodges itself from spatio-temporal constraints. Winter describes Penfield as "poised between two brains." The one brain below, a pulsating mass, with an exposed window to the cerebral cortex; the other was the institute, which functioned as Penfield's extended mind. He could call upon assistants and clinic departmental experts to join in the amphitheater of surgery whereby his scientist liturgy, the ritual of probings, questions, and patient responses, commenced and demarcated for Penfield the taxonomy of memory and, by extension, consciousness. Just a century before Penfield's brain mining, ether, commonly known as laughing gas, was discovered. Surgery was barbaric prior to its discovery. Screams of horror played out cacophonously as burly men held a bed-strapped patient down under the banner of preserving life at all costs. By doctor's decree, archaic medical procedures were conducted, including bloodletting, pus draining, lesion removal, and amputations. Patients' harrowing cries of anguish were stark opposites to Penfield's patient complicity. Pernick, in his essay "The Calculus of Suffering in the Nineteenth-Century Surgery," cites a medieval witness who shared that along with the dispassion required to enact surgical procedures, the surgeon had to have the proclivity to "cut like an executioner." By the 1930s, medieval surgical saws, lancets, forceps, and other items resembling torture devices in the name of salvaging life were replaced with Penfield's instruments of precision. Screaming patients resembling primeval animal sacrifices were eschewed for agent responder patients. Pain, leading to delirium and unconsciousness, was replaced with patient cognizance and scientific reliance on their feedback. The formal attire of surgeons and the tavern wear of the men incapacitating patients was replaced with aseptic white lab coats worn like ecclesiastical stoles. Penfield, as liturgist, divined mysteries of consciousness, installing the brain and mind in the seat of the soul and psyche. Camera, lighting, and assembly of team supporters, like the ancient chorus, procured learning. As the theater of surgery became an initiatory space, the indecipherable mysteries of consciousness became data modules that were transmittable to the general community. Penfield believed that memory was stored in "ganglionic strips," or neural pathways in the temporal lobes in one-to-one symmetry. Electrically stimulating patients' neural engrams would activate a memory like the unspooling of a film reel or playing an LP. However, Penfield's engram hypothesis of memory permanence was challenged by the constructivist models of memory, where memory is viewed as a rehearsed, reworked, fluctuating process of schemas and concepts. In the constructivist view, there is no "central" theatre of mind where memory is stored and activated. Constructivists, like the philosopher Daniel Dennett, believe memories are distributed throughout the brain in dynamic neural assemblages. Memory and consciousness are elusive processes. As we follow consciousness’s path forward in time, we now land in the contemporary surgical space, where the patient is fully anesthetized and seemingly dissociated from the surgical interplay. General anesthesia, as Rothman writes in his essay, "Awake Under Anesthesia," renders the patient in a coma, much like flipping an off switch, rather than a gradual receding into a sleep state. Patient vitals are fully sustained through a litany of instruments, such as infusion pumps, endotracheal pumps, and anesthesia delivery machines that deliver anesthesia, monitor vitals, and enable life's continuance in the liminal dimension of surgery. Unlike Penfield's patient-respondent relationship, the patient's consciousness is seemingly wholly disconnected, described as a disassembling of mind. The instruments, extensions of the surgeon, and the immobilized patient are now far away from the archaic pain crescendo screams and yelps of medieval surgeries. The artificial liminal state seemingly suspends consciousness. However, Rothman refers to research that indicates that, on some level, the organism responds to surgery. For example, during cardiac surgery, the anesthetized patient's vitals increase in heart rate and blood pressure with each incision, and sometimes body parts twitch. Are these instantiations of sentience or purely trace physiological reflexes? Rothman shares Ian Russel's research in which he applied a tourniquet to the upper right and left arms of 32 patients. The tourniquet thwarts absorption of the neurological blocking agent, thus preventing immobility of the arms during general anesthesia. This lets patients respond to clinician commands by clenching their fists. To Russell's astonishment, through a series of command-response scenarios, 23 of the 32 clients opened and closed their fingers, and subsequently, 20 squeezed his fingers to signify that they were in pain. Upon awakening, the clients had no memory of the event. Is it possible that consciousness abides in the non-memory spaces of the artificially induced comatose patient? Can there be a conscious experience without a phenomenological chronicle? Is memory wiped away or stored in inaccessible "places” to the post-anesthetized consciousness? From behind the veil of anesthesia, could there be a conscious experience of surgery that leaves no memory traces? Do content-free awareness states where sensation processing and inter-environment agency are suspended constitute consciousness? Perhaps the anesthetized patient responder resembles the lucid dreamer who responds to the dream researcher through predetermined eye movements. In Russel's case, the artificially induced coma space replaces the dream space. Consciousness seems to possess the secret power of spatio-temporal pliability. To paraphrase the science historian Anne Harrington, the hallowed spheres of consciousness are epistemically fraught. Are our consciousness probing tools and conceptions limiting our understanding of consciousness?