“Consciousness.” What is it? Are we aware of it? We deal with it every day as surgeons. We are on the other side of the drapes while our anesthesia colleagues put our patients out of “consciousness” and under anesthesia. The other day, I had a young, nervous, 41-year-old patient call to ask me: “Will I be asleep or awake for surgery?” I replied to my nurse that it would be general anesthesia and that he would be “asleep” for surgery and would feel no pain and or have any awareness of what was going on during surgery. I was trying to use words to make them understand me and that it would ease their fears about the surgery (which is usually pain). I recently read an article from Dr. Marion Mass. She is a pediatrician, a writer, speaker, activist, leader, and physician advocate, who speaks about health care costs, transparency, and physician advocacy, to name a few topics. At the end of one of her articles talking about the players that drive health care costs and inflation, she wrote, “It is we who have remained anesthetized and in the dark.” She was explaining the lack of transparency of how a strep test can be $25,000 and the cost of an ultrasound can be up to $60,000 in today’s health care system, which lacks cost transparency. When she said the word “anesthetized,” it just struck me. Like a bell ringing in my head — ding, ding, ding. Why do physicians not say anything? Why don’t we do anything about the rising lists of injustices that are now plaguing a broken health care system? It does not need to be the enormous structural issues, but even just everyday issues that arise day-to-day. Are physicians sheep that just follow, are they tired, are they just on autopilot (eat, poop, pee, drink, work, sleep, rinse, repeat)? Are they conscious? Or are they “anesthetized”? The goal of anesthesia is to provide pain relief, keep us paralyzed, comfortable and prevent us from vomiting while intubated, is it not? That is why a cocktail of painkillers, paralytics, and antiemetics are given during anesthesia. Is it then, the alternative of living a conscious life is to live an anesthetized one? Is the purpose to live a life in which there is no pain, there is no movement, and we just navigate comfortably while we go through the motions of everyday routine? What happens when you are in the middle of your surgery and your patient starts moving? We angrily send a death stare and say: “The patient is moving!” Please increase the anesthetics. Please decrease the consciousness of the patient. Who is your anesthesiologist decreasing your consciousness? Is it the health care system, is it administrators, or the EMR, or the lack of autonomy that has given you a dose of propofol, so you can go back to sleep and not move? After all, the purpose of propofol is to provide “a decreased level of consciousness and a lack of memory for events.” Are you getting your dose of propofol so that you do not act, so you do not see what is happening around you, and avoid unpleasant feelings? Is being conscious and awake in life and experiencing feelings or pain such a terrible thing? Are we afraid of any feelings? Or just the negative ones we try to avoid by being anesthetized like your patient in the operating room? Someone smarter than I, Brooke Castillo, says that life is 50% pleasant and positive feelings, and the other 50% are negative ones. And when we accept and understand this concept, we will stop being so disappointed and have less suffering because we realize life is not 100% bliss and joy. To feel pain, you will have to be awake and conscious. You will not be able to feel it if “anesthetized,” just like your patient in surgery. While awake, you will have pain and suffering, but you will also have joy. More importantly, if you do not have pain in your life or negative emotions, you will not be able to appreciate happiness if you have no concept of the contrast of negative emotion. My daughter has a book called “Infinity and Me” by Kate Hosford. It is a cute short story about the word “infinity.” In one of the pages, the main character wonders what she would want to do for infinity? Would she want to eat ice cream all day? Or would she want to have recess all day? However, she realized that “If there’s no school before recess, and no school after recess, is it really recess anymore?” Something infinite does not have contrast. Without the contrast, you cannot appreciate the difference. Infinite happiness cannot exist because you need contrast to experience the difference, just like an idea of infinite recess. So, choose contrast in life. Because to appreciate the good, the happy, the joyful, you will also need to experience the sadness and the pain. So choose to experience both feelings. Choose to be conscious and awake. Diana Londoño is a urologist. Source
