#it was so loud i couldnt hear the vet and she couldnt hear me

[traitormithos]

My dog has made me look like the worst person on the planet, see tags

[chikkou]

Tweak looks like he was such a sweetie. I'm sorry to hear that he passed :(

he really was, he was an amazing cat. he was taken from his mother too young when we adopted him (which we of course didnt know), so he imprinted on my mom and me from the jump. for whatever reason he was very much like a human baby - he LOVED being held like a baby, and also wearing bibs and sitting in my middle sisters highchair and swing, and hed deadass put bibs on himself (by sticking his head thru the hole kjgfdgdf) and get into the swing and just chill. he also LOVED baby food and ice cream, and the vet said it was fine to give him those as a treat so we did! he was definitely pampered LMAO

he was really skittish (thus the name) and would get scared off easily, but he was also really affectionate and loving, genuinely one of the sweetest fucking cats on the planet. ill never forget this time i was super sick and feeling like shit and for some reason my instinct was to just lay my head face first on his stomach - i was anticipating him scratching me bc i know cats dont really like that, but instead he let me sit there and even started licking me, like he knew i wasnt feeling good. he was always there for me when i needed him ♥

he was a very passive cat, but he was also very defensive - he once scratched the shit out of my aunt bc we were roughhousing and he thought she was hurting me. he also used to hover around my baby sister when she was born like he was keeping an eye on her, and even when she would get too rough with him (as kids do) hed never scratch or bite her, usually just a warning hiss and that was it

its crazy bc he actually had some neurological damage bc we unfortunately gave him hartz pills - this was WAY before anyone knew they were toxic for animals, so we of course had no idea. the vet told us hed developed brain damage from whatever was in that pill and that he was unlikely to survive longer than a few months because of it. that was in 2006, when he was a little under a year old - and he lived to be 15, a few months off from 16. i really cant overstate how grateful i am that i got so much time with him, and i sincerely think it was the love he had for us that kept him going.

right before he passed, and i will never forget this, he had stopped sleeping in my bed because climbing the stairs was too hard for him. but one day he forced himself to stagger up the stairs and when i saw him standing there i knew it was coming. i picked him up and put him in my bed and my sister and i just cuddled with him in silence for a while. he purred so loud then. we had been trying to get him to the vet for months, but my mom had lost her job and i had just started working earlier that same month, so we couldnt even afford the co-pay, let alone the cost of whatever treatments he would have needed. we did get him to the vet after this happened, but by that time it was basically too late.

when he passed, i was at work. i found out on the walk home. i cant really describe the feeling of it; i knew it was coming, but that didnt make it any easier. the worst part was the guilt that i felt for not being there, and not being able to see him one last time before he was gone. i told my mom this once, and she revealed something she had kept from me at the time - when she found him, he was sitting on my favorite robe that i wore all the time, and he refused to let go of it when she was trying to pick him up to take him to the vet. she ended up wrapping him in my robe, and he stayed in it until the end. its gonna sound weird, but knowing that the last thing he touched was something of mine that he fought to hold onto is so overwhelming. i know this all sounds super overly dramatic given that its about a cat, but i really cannot overstate the love that i had for him.

here he is, my big boy:

i love him and i miss him more than anything ♥

[beukefarm]

This is a rough one. Do not read if youre sensitive to the topic of animal death! I know, I usually keep this blog very positive, but I feel like not sharing this experience would be an insult to the purpose of this blog, which is primarily a diary for our garden.

Here we go.

--

tw animal death

Our chickens hatched last wednesday. It was a lot of work leading up to this point, and it really paid off. 8 eggs incubated, all of them hatched. But of course, theres always a catch.

Nothing will ever go completely right, thats just life.

8 hatched, only 5 of them without issue. The very first one had trouble getting out of the egg, and we decided to help. Its doing well, its healthy, aside from some slightly deformed feet. Those are easily fixed, some tape to keep the claws in the correct position.

The last two..

they both had problems. They hatched late, first of all, almost an entire day. Both of them had deformed feet as well, and the last one couldnt stand up no matter how hard it tried. It was heartbreaking. We would prop it up, put it underneath the heating pad, and we'd just hear it flop over instantly. We would look at eachother, and we both knew where this was going to end. This is our first time hatching, but we read a lot and watched a lot of videos. This wasnt a fixable issue.

The guy who sold us the eggs, lovely dude he was, he gave us lots of tips, also told us what to do with sick chicks: rip the head off. Quick, easy, painless.

And of course we couldnt do it, because this little fluffball was only a day old and we still gave it our entire heart, and so we went to the vet.

It was a long wait, a saturday and lots of people and animals with their own grievances.

And suddenly, we got called in, and the vet told us what we already knew. The chances of survival for our little angel were slim to nonexistent, it was most likely a neurological issue.

Do you know how small baby chickens are? Have you ever held one? These little bundles of fluff and undeterred peeping, tripping over their own feet, picking at everyone and everything they can get their little beaks on.

Even the sick ones were full of life. Loud, flapping their tiny wings, stumbling -or crawling- along.

It was the hardest decision Ive ever had to make. Not my college major, or cutting ties with a friend Ive known for over a decade. The decision to end a beings life, especially of one who you love so so dearly, one who was meant to live a long and happy life under the sun.

I have a fishing license. Ive caught and killed fish before. But they had a purpose, they were food for me and my partner.

This little bird was not meant for this earth, and its so, so unfair.

It deserved to live. I wish it could have lived.

We were holding the little guy throughout our entire discussion. It was always so cold, the only thing it ever wanted was warmth. It would cry and cry if we werent holding it with warm hands, and it would fall asleep almost instantly when it had made itself comfortable under our fingers.

It just wanted to be warm and comfortable.

We called the vet in, our decision being made long before we had ever even entered the building. Yet speaking the words out loud was the most raw, merciless feeling Ive ever experienced. I wasnt even the one to say them, it was my partner who carried the weight. I was already struggling to hold back tears, I couldnt have spoken a word even if I wanted to.

I was holding our treasure, and handing it over to the vet took all of my willpower. She had a syringe, and the baby cried as it was injected. No turning back. No undoing. I couldnt just let it die in unfamiliar hands. I grabbed it as soon as the medication was fully administered, took it in my hands and let it get comfortable. My hands were warm. It stopped crying. It was safe with me. I wept.

We sat down, the chick in my hands, slowly drifting away into endless sleep. Its so quick, god, it was over so incredibly soon. I could feel that the life had vanished almost as soon as I sat down.

It had died in my hands.

My partner and I silently cried alongside eachother. He wiped my tears for me. My hands were still cupping the body.

We sat there for mere minutes, and yet it felt like hours.

It was the right decision, rationally were aware of that.

I hope theres a heaven for chickens. Im not a believer, I dont think theres an afterlife. But if anyone deserves it, its the two little baby chickens that were simply here in the wrong place, the wrong time.

We didnt put the second one down. It had died while we were at the vet with the other one. It came as a shock, we were hoping it would make it.

We buried two little birds that day, and neither of them deserved it.

My thoughts are with both of them, the one whose limp body I held in my hands until I couldnt deny its passing anymore, and the one who we found laying head down on the ground, body still tucked underneath the heating pad.

At least it was warm.

At least they were warm.

[drchristineputnam]

Lol what's wrong with romancing the inventor? I've never heard of it and I love hearing people Go Off about books. Are there many ff books that youd reccomend people specifically not read?

*cracks knuckles* HO BOY this is gonna be petty

So to start off, Gail Carriger is Extremely Popular. She writes these... Quirky Steampunk(??) books  and she’s got this whole Quirky Steampunk image that is already lowkey irritating to me but hey, you do you, if it makes you happy. But people kept going on and on about her books and I saw one of them was f/f so i thought “alright, i keep hearing about this one, it must be good?”

ITS NOT. ITS NOT GOOD. The heroine is this bland characterless husk that is constantly, and I mean CONSTANTLY, described as extremely thin and white and ~beautiful~ by everyone, which again, irritating. All the vampires just want her, but oh no, shes but a measly maid! Honestly, the book starts of her being so horny for getting turned into vampire, i thought it was gonna be great, but it didnt really go anywhere, at least at the point where i had to drop the book. 

There is so much sexual harassment and assault! She gets constantly pawed at which was so gross!! The love interest was interesting in theory (a butch(??) mad scientist lady, or at least gail carriger’s idea of what a butch is lmao) but again, so bland. There was no chemistry between them either!!

But! What pissed me off the most was when the heroine from a previous series shows up and the protag of this one just mentally goes OFF about her. There's a scene where the protag, repeatedly described as beautiful and skinny and white meets the protag from the previous series and she describes her as 'too loud and too big with too big a nose and dark features' with this nasty tone and I was like 'oh you just described me'. She made a big deal of having a fat heroine in her series, and then she writes another heroine from a later series insult and fatshame her for her looks. What in the Actual Fuck!!!!!!!!! Fuck off!!! Also theres a thing in this series that italians have no soul(????????????), which uh, idk if you know anything about racial politics of europe, but its REALLY not a great look for a super pale white brit to write into her series that italians have no soul. Fucking yikes gail carriger, what the fuck

I dropped the book immediately after this because i was already bored and frustrated with everything else and then this bullshit!! And ever since then, any mention of this author makes me grit my teeth

Anyway here’s more f/f books Id warn people about:

Stormsong by CL Polk: read my review of the first book and tell me if you think the villainous sister is not only redeemable, but also deserving of her own book

Her Lady's Honor by Renée Dahlia: this is my biggest disappointment of this year. It promised a ww1 vet nurse and her captains daughter falling in love, and gave me miserable story with people being assholes to each other, and a terrifyingly blase treatment of violent parental abuse. I made it about 25% in before I had to bail 

The Lady and Her Secret Lover by Jenn LeBlanc: One of the most gorgeous covers slapped on probably THE most triggering book Ive ever read. I kept reading because I couldnt believe all the horrific things happening in this book. Read my review for more info 

Mrs. Martin’s Incomparable Adventure by Courtney Milan: in my experience, courtney milan’s books are on a VERY slippery sliding scale of quality, and this was a rock bottom. Written as a “stick it to the patriarchy, yeehaw!” “fun adventure”, it managed to make me literally sick with anxiety. Im not joking, this book made me so anxious my stomach started hurting. This book made me FURIOUS. Again, read my review for more details

[your-iron-lung]

The Unsolved Chapter

aka, the crossover absolutely no one asked for; also available to read on AO3 

Story Synopsis:  While investigating what remains of the infamous Léry’s Memorial Institute for their popular channel, two Youtube celebrity ghost hunters go missing overnight, vanishing in a freak occurrence that has decided to lay claim to their souls.

While the world they were abruptly taken from grieves their absences and tries to figure out what befell the beloved comical duo, Ryan and Shane struggle to make sense of the new, terrible and violent reality they've woken up in. Drawn to a campfire that never seems to burn out, they meet others who have been condemned to the same, eternal fate and are forcibly taught how to survive in an attempt to keep their collective hope and souls alive.

Part 1 of 5

Chapter Word Count: 6031

Pairings: None; just a genfic

Genre: Survival Horror/Supernatural/Angst-y

Next Chapter: Part Two

Notes: uhh yep, here it is, a buzzfeed unsolved/dead by daylight crossover fic bc once i started to think about it, i couldnt stop. there will be temporary character death, lil bits of gore, and a fair amount of blood and violence in the story, just not in this installment. careful if you click the embedded link, as it might be loud

---------

‘Sometimes human places, create inhuman monsters.’ Stephen King, The Shining

1

Léry’s Memorial Institute was probably the filthiest building Shane had ever stepped foot in, which, when you took into account just how many foul, decrepit locations he’d been to in the past, was really saying something. The building itself was beautiful in its own haunting way, as most older buildings often were, but Léry’s took the definition of ruined to a new extreme he’d yet to see before now. It was an architectural thing of beauty to be sure, but the grit and grime that covered the entirety of the stonework did manage to dampen his enthusiasm for exploring the dilapidated structure.

And he had been excited for it, originally; a chance to fly back to Illinois to shoot the season finale of Unsolved on his home turf had been generally appealing, even if he hadn’t heard of Michaelstown or Léry’s before. But then they’d all gotten their first look at the Institute, looming horribly tall over the long horizon of pines as they drove up to it from the bumpy dirt road, and he felt all his excitement leave his body in an instant, evaporating like a cold drop of water on hot asphalt.

The silhouette had been menacing and boxy, regal in an old fashioned way that modern constructions had abandoned in favor of more modern designs. It was, perhaps, one of the most imposing feats of architecture he’d ever laid eyes on; it certainly ranked up there with Waverly in his mind, and perhaps that was why he felt so inexplicably nervous as he’d looked at it. Rather than dwell on it, he compartmentalized his anxiety away in his brain and turned to make a comment about how spooky the hospital was to Ryan, but whatever effects looking at the building had had on him appeared to have hit his co-host three times as hard; Ryan’s brain already looked like it was melting, an expression of mute terror written plainly across his face.

Shane couldn’t fault him for that, considering his own momentary scare, and was actually grateful for his silence. If Ryan had pressed him for a comment on whether or not he thought Léry’s was haunted in that moment, then Shane might’ve reluctantly admitted that, in the event that ghosts were real, he wouldn’t be surprised to find a few here, but Ryan had been too horror-stricken to ask. In all actuality, no one on the team had been up for much conversation after that first initial glimpse, an uneasy vibe settling into all of them as they parked. They had all taken a moment to appreciate how terribly ominous it looked against the backdrop of a sunset red sky before TJ ushered them into their usual business routine, unpacking their equipment and getting their bodycams set up.

“Man, I feel like Jack Torrance walking into the Overlook here. This building feels downright predatory, man,” Ryan said, voice already shaking with nervousness.

Evening was falling fast upon them as they shuffled around in the entrance hall, carefully avoiding the large panes of broken glass and other debris that littered the floor. The layer of dust on the ground was so thick, distinct footprints could be seen as clear as though they’d been walking through snow, their tracks leading around in circles as they got their first look at the interior.

Shane hummed a noncommittal response as he shined his camera light around, disgusted by the amount of dust on the floor and in the air; if he were an asthmatic, he’d probably have run through several inhalers just from walking in.

“So tell me what I’m looking at here, Ryan; what’s the history behind this magnificent pile of rubble?” Shane asked as he nudged a thick piece of wood with the toe of his boot.

They would cover most of the history of Léry’s Memorial Institute in the voice over, but that wouldn’t be done until they got back to California and Ryan had yet to tell him much about the place. Keeping Shane in the dark about the past of some the places they went to was a good way to get genuine reactions out of him, but he felt that if they didn’t start bantering soon then Ryan would lose whatever was left of his poor, impressionable mind.

“I feel really weird,” Ryan said instead of answering, glancing around the area with wide, uncertain eyes. “There’s like, some kind of an energy in the air in here; do you feel it?”

“No,” Shane replied calmly, though that wasn’t entirely true. He could feel something akin to static in the air around them, but he didn’t register that as a supernatural phenomenon. The air felt charged in a way that reminded him more of an impending thunderstorm getting ready to unburden itself than it did of something unearthly. “It is a little chilly, though; probably should’ve worn more layers.”

“Good Christ, I hate it here already.” Ryan shuddered and rubbed at one of his arms as he turned to look down the dark hallway that lead further in. “Right, so. Léry’s. I couldn’t find any information on who the original owners were, or who built it, but I did find out that the original building was built sometime in the 1800’s.”

“This isn’t the original?”

Ryan shook his head and reluctantly took the lead in guiding them down the long, narrow hallway, adjusting the straps of his bodycam rig subconsciously as he went.

“Well, yes and no,” he said, stopping every few steps to shine his light and camera into any rooms they happened to pass. “The original building was just a really big mansion the owners lived in before they donated their land to the government; all this hospital space was added onto it during the Korean War to help rehab returning vets.”

“This is one hell of a remodeling job; the Property Brothers would be proud with how many square feet they managed to pump into this thing,” Shane remarked, grinning a little when Ryan let out a slight laugh. “So, army hospital?”

“Yep, up until the CIA took possession of it in the 60’s, and that’s where all my research brought me to dead ends. I couldn’t find what they wanted it for or what they did with it after they got it, but boy, the conspiracy theories run wild with this one.” He turned to flash Shane a conspiratory grin.

“Are you gonna use the voice on me?” Shane asked with a roll of his eyes. “Don’t lay it on too thick now; save some for the voice over.”

“Some say that the CIA turned Léry’s into a black site in order to perfect ‘information gathering’ techniques they’d wanted to put into practice during the war,” Ryan began, easily slipping into the professional tone of voice he used for narrations. The familiarity with which he spoke seemed to restore some of his confidence as they continued down the hall, as he no longer seemed to shrink away from the darkness surrounding them. “They reportedly hired a large number of staff to run the medical facility, but no records of anyone working here exist- at least to the public-, though there are rumors of one particular doctor who was well known for his sadistic use of electro-convulsive shock ‘treatments’.”

“Torture, you mean,” Shane said, shining his light into a room of indeterminate purpose. Ahead of him, Ryan nodded in affirmation. “Great, a secret torture hospital. I’m sure you’ll get a lot of angry, resentful ghosts to talk to here.”

Ignoring his comment, Ryan continued his monologue, clearly having spent time rehearsing it. “Supposedly. As the rumors go, they began implementing experimental interrogation methods on American citizens first before moving on to actual spies, and oh- oh my god, that’s a fucking big rat,” Ryan sputtered, his Unsolved voice breaking as he skipped back down the hall and almost knocked into Shane, who barely managed to sidestep his panicked retreat.

He couldn’t help but chuckle a bit as he put an arm to Ryan’s shoulder to steady him before stepping ahead of him, shining his camera light into what looked to be a large reception area. It was wide and spacious, full of dark corners with plenty of dust and run down furniture covered in graffiti. The rat Ryan had stumbled upon was underneath one of the waiting room benches, turned over on its side and very clearly dead, though it was exceptionally large.

They stared at it together contemplatively for a moment before Shane said, “I gotta tell you, Ry, that I am not at all thrilled about spending the night here. I think I might ask my mom to call your mom to tell you I can’t come to your little sleepover.”

From behind, they could hear Mark laugh before stepping into the room, aiming the lens of his camera at the rat for a dramatic close-up they could potentially use to promote the episode.

“That’s disgusting, don’t film that,” Devon said, clicking her tongue in disapproval as she placed her hand in front of the camera lens until Mark lowered it off his shoulder. “This place is foul; I can’t say I envy you boys for staying here one bit.”

“Yeah, no kidding,” Ryan muttered. “Hell, I might cancel the sleepover myself, no moms involved.”

“You can’t, you already walked out of one overnight this season,” TJ cut in, to which Ryan responded with a quietly spoken ‘fuck’ under his breath. “Let’s just start filming, yeah? The sooner we get this done, the sooner morning will come, the sooner you can leave. Now, where do you think you’re gonna want the static cams set up?” TJ asked as Mark held up the bags he’d carried in with them.

2

Against Devon’s wishes, they decided to film the intro for the episode in the lobby with the dead rat, the compromise being that Shane and Ryan had to sit on opposite sides of the hallway that lead back the way they’d come so that the rodent’s body wouldn’t make it into the final shot. This was agreeable to all of them, but as Shane sat there, waiting for the camera to start rolling, he couldn’t keep his eyes from wandering back to its corpse occasionally, trying to deduce what it could have died from.

They tried to film with what little natural light they had left, but the sun had already been sinking when they’d arrived. Whatever light it managed to provide ended up fading away too fast for them to effectively use, eventually prompting TJ to insist on bringing in big, bright lights so they weren’t stuck filming in the dark. As Shane squinted into the newfound light source, his eyes adjusting poorly to the brightness, he managed to get a better look at the room they were set up in.

Based on his own opinion and how little he actually knew about Léry’s, it certainly didn’t look like the kind of place run by a malicious, CIA sanctioned group of sadists; to him, it looked like a hospital, plain and simple. The white paint along the walls was cracked and peeling, revealing discoloured splotches of drywall that furthered the eerie, run-down atmosphere the building had as a whole. Regardless of that and the dead rat, there was nothing in the general vicinity that implied Léry’s might have been used for something as sinister as torture- they even had what looked to be remnants of vintage motivational posters decaying behind the reception desk. Despite how foreboding the building had looked from the outside, inside it both looked and felt normal, which made him wonder again about where his original discomfort upon viewing the building might have derived from.

“This week on the season finale of Buzzfeed Unsolved: Supernatural, we’re investigating Léry’s Memorial Institute in Michaelstown, Illinois as a part of our ongoing investigation into the question, are ghosts real?”

Hearing Ryan’s voice pulled him from his thoughts. Unaware that they’d begun the segment, Shane turned to look at the camera Mark was holding and shook his head curtly on cue. The motion was well-practiced and concise, even if he was still squinting because of the lights.

He waited patiently as Ryan spoke of what he knew about Léry’s alleged history, repeating a lot of what he’d already mentioned to Shane earlier for the official intro. He went more in depth as he talked about the history of the building to the camera than he did with Shane, adding on some embellishments about the various conspiracy theories he’d dug up that involved what the staff at Léry’s might’ve been up to, and none of it sounded good.

“Léry’s was condemned and abandoned in 1983, and was even rumored to have been burnt down, but as you can see, since we are currently sitting inside the building, that clearly isn’t the case,” Ryan recited, shooting Shane a look that invited him in to begin a banter.

“Ryan, I swear to God if you’re trying to tell me that the building itself is a ghost, I will resign.” Shane forced his face into a serious expression that matched his disapproving tone of voice as Ryan laughed loudly. “You can get Brent back to be your new ‘ghoulfriend’ and you can just- the two of you can just run around these spooky places like a couple of headless chickens screaming about ghosts together.”

“No, that’s- that’s not what I’m saying,” Ryan said, a humorous inflection tinging his voice as he spoke. “What I’m saying is, is that someone either lied to cover up any potential future investigations into Léry’s alleged operations, or someone got it wrong; either way, Léry’s is still here.”

“And how’d you come to find that out?” Shane asked, honestly interested in Ryan’s answer. His friend had already admitted that researching the place had been hard and often netted him no real answers; if any and all official documentations surrounding Léry’s said it was no longer standing, then he wondered how Ryan was able to discover that it actually was.

“I looked up the coordinates on Google’s satellite image maps.” Shane raised his eyebrows at that, and Ryan shrugged in response. “There was a building here, and when I compared it to old images of the Memorial Institute I’d found dated pre 1980’s, they seemed to match. When I reached out to the current property owners, they agreed to let us look around as long as we didn’t try to ‘solve’ anything.”

“We never do,” Shane said wistfully, dramatically looking away for a moment, and again Ryan laughed, the sound of it echoing around the walls of the room.

“Alright, whatever, big guy; we can do all the ghost hunting we want, they said, but we have to let the sleeping dogs lie on whether or not Léry’s has a ‘tortured’ past or not; they don’t want any trouble with the government.” Ryan looked amused by his own pun, but Shane knew that his ability to find humour in little things like that wouldn’t last the night.

“Well, let’s get started then, shall we?” Shane said, slapping his hands to his thighs and beginning to feel his eagerness returning to him. He started to stand up, and Ryan sighed.

“Yeah, fuck, let’s- let’s get into it.”

3

“Is there anyone here with us right now?” Ryan spoke loudly and clearly as he addressed the spirit box, glancing around the room they were standing in cautiously as he held the small radio up between them. There was an overturned examination table and some rusted chairs in the room with them that Shane had initially tried to sit in, but found them too unstable to support him. “If there is, we’d really like to talk with you. My name’s Ryan, and my unnecessarily large friend here is Shane; I know he’s a little frightening to look at, but can you say either of our names?”

They waited for a response, Ryan pensively shifting his eyes around as though he might see a ghost hiding behind the old furniture while Shane did his best to not let his boredom show on camera. He waited silently for a moment, letting the spirit box spit out jumbled radio frequencies and broken fragments of words for Ryan to analyze later before deciding to chime in.

“Did you ever stop to think that the spirit box might be triggering these spirits you’re trying to contact?” he asked, voice drawling as he tucked his hands into the pockets of his denim jacket. “If that doctor you mentioned earlier really did exist, then don’t you think it stands to reason that the static from the box might be traumatizing them? Torturing them in their afterlife? Maybe that’s why they don’t want to talk to you.”

“You’re just saying that because it tortures you,” Ryan said, snickering. He opened his mouth to say something else in support of his use of the spirit box, but was hushed when it began to pick up an unusual, garbled sort of noise.

If Shane hadn’t been accustomed to the usual tones of static the spirit box produced as it skipped through radio frequencies, he would have chalked the sound that was coming through the speaker now as typical spirit box sounds, but innately he knew that it wasn’t. Whatever was coming through the radio now was different, in that it had cut through the previous channel of static to effectively broadcast the new sound.

He could tell from the stunned reaction on Ryan’s face that he, too, recognized the sound as something unusual. This wet, static noise that was coming through the receiver had been unheard by either of them before.

Ryan turned his head to look up at Shane, any trace of amusement he’d been displaying before now gone as he struggled to make sense of what he was hearing. Before either of them could properly process what they were listening to, the sound slowly tapered off into silence.

Shane stared at the box in Ryan’s hand, waiting for the usual sounds of static to come back through the speaker so he could explain the phenomenon away as some sort of malfunction. He was preemptively formulating a response to the questions Ryan was sure to start asking when the whispering began.

The voice was low and quiet, possibly male, and managed to speak uninterrupted for more than a few consecutive seconds. Shane felt his skin break out into goosebumps as he listened, leaning forward to try and get a better understanding of what was being said even as Ryan recoiled, almost dropping the spirit box in his fright.

If the voice was whispering in any known language, Shane didn’t recognize it; the words registered as garbled, barely distinguishable nonsense to his ears, but the tone with which it spoke, intent and persistent, had his hair beginning to stand on end. Everyone in the room was hushed, although Ryan was beginning to hyperventilate, his breath coming in fast, wheezing gulps. His hand was visibly trembling, but he resolutely did not drop or set the spirit box down, a small act of bravery Shane admired him for.

They didn’t have long to focus on what the voice was saying before a loud, burst of static tore out of the speaker, ending the strange noises abruptly and causing Ryan to shout in surprise. Shane blinked solemnly at the little box as it returned to flickering through regular radio channels before he met Ryan’s stupefied gaze.

“What the fuck just happened,” Ryan gasped out, quickly turning the box off and setting it aside to deal with his minor anxiety attack.

No one had an immediate answer.

“Did anyone recognize what it was saying?” Devon asked timidly. “Not trying to be an alarmist here, but that… didn’t sound human to me.”

Ryan moaned at the implication and sat down hard on the floor, uncaring of how dirty it was.

“Look, let’s just all calm down and take a minute to think about it logically,” Shane said, attempting to take control of the situation in order to soothe his companion’s panic, but he didn’t feel calm himself. His heart was thudding away rapidly in his chest, though he told himself that it was due in part to being taken off guard by the loud outburst of static that came through at the end of the transmission. “Do you know every earthly language that exists?” he asked Devon, who shook her head reluctantly. He repeated the question to Mark and TJ before directing it to Ryan, and all their answers were the same. “Neither do I; just because it spoke in a language we can’t immediately identify doesn’t mean it wasn’t human. Have we all forgotten we’re in an old, ex-governmental building that was run by the fucking CIA? The box probably just latched onto an old numbers station or something.

“And anyway, I’d expect you to be more excited about this, little guy,” he said gently to Ryan, trying to encourage a positive reaction out of him. “We caught all that on film, buddy.”

From the floor, Ryan had stopped his rapid breathing as he processed Shane’s line of reasoning. He still looked frightened, but his expression also seemed more speculative after listening to Shane deliver his cowboy speech. When Shane reached a hand down to help him up, Ryan took it.

“You’re right. We have evidence,” Ryan said slowly as he rose back to full height, his eyes lighting up as he clasped Shane’s hand tightly to his chest.

Shane winced and tried to pull his hand free, but the clammy grip with which Ryan held to it was strong. “It could be any number of things before it could be ghosts, Ryan, you know that.”

“But if it’s not any of those other things, then it- it’s real! We have actual, recorded evidence! Léry’s Memorial Institute is certified haunted, baby!”

He let go of Shane’s hand at last, his fear momentarily forgotten as he did a quick dance, pumping his fist up and down into the air in a celebratory fashion. Mark trained the camera on him to capture the moment, swapping from Ryan’s joyful expression to Shane’s look of bewildered amusement. Devon looked on with a congratulatory smile until TJ eventually spoke.

“You… do realize you still have to stay the night here, right?” TJ said somberly, knowing that what he had to say would was going to affect Ryan negatively, and already they could all see the impact his words had on him as he stopped dancing. “I’m happy for you and all, but don’t forget we have a whole episode left to shoot.” Fresh horror dawned on Ryan’s face, his excitement over finding proof of the supernatural immediately dying out when he realized it didn’t absolve him from fulfilling the rest of his contractual obligations.

“Oh, fuck, you’re right,” he said with a groan, his shoulders slumping at the remembered thought. He brought his hands to his face and dragged his fingers down, pulling at his skin. “Ohh, fuck, you’re right. Shit.”

“Certified haunted, baby,” Shane teased with a weak grin, knowing already that it was going to be a long, sleepless night for the both of them.

4

They explored the area a little further after the incident with the spirit box, but didn’t manage to capture or illicit any other supernatural responses to their presence, though not for lack of trying. Everywhere they went, Shane demanded that the ghosts repeat the strange audio they’d managed to capture before and called them out on their cowardice when nothing happened. Ryan grew increasingly upset with his behaviour, but Shane was out to prove a point: whatever they’d discovered through the use of the spirit box wasn’t something supernatural, and if the spirits weren’t willing to entertain them, then he wasn’t willing to entertain the notion that it could be ghosts.

The logical part of his brain demanded he debunk it immediately, even if it meant he had to poop all over Ryan’s parade in order to do so, and he planned on taking the mightiest shit he could before they wrapped up filming for the night.

5

Most of the upper floors of Léry’s were condemned and deemed too unsafe for them to explore, barring their ability to scope out the building in its entirety, but the ground floors were plenty big enough to take up hours’ worth of time to investigate.

With Mark and TJ’s help, they set up three static cams where Ryan thought they’d get the most activity: one in the room where they’d gotten the spirit box to communicate with them (with an EVP device they would leave on all night), one in the reception area pointing down the hall they’d entered through, and the final one in a room Ryan had called the ‘treatment theatre’, where they’d decided to bunk down for the night.

It was a circular room with one single, ominous examination table set up in the middle over a system of rusty, grated flooring. A large set-up of outdated lighting systems hung low and broken over it, hanging like an untended widowmaker’s tree waiting to collapse, and for the first time that night Shane wondered if perhaps Ryan’s torture theory might have some truth behind it. Copper stains could be seen leading from the table to the grated floors, and he resolutely decided not to focus on them.

On the floor above them, reached only by a set of stairs set into the back of the room, was a windowed viewing booth that jutted out from the wall. A sense of unease overcame him as Shane looked at it, wondering what the people of the past had need of to stand up there in a room such as this, but he knew in the back of his mind what the answer to that was.

He tried to tuck his discomfort away as he laid out his sleeping bag next to Ryan’s, and wound up unsettling some dust into the air as he smoothed it out and plopped his pillow into place. He grimaced and tried to suppress a cough, but doing so only made the urge to cough worse. Ryan watched him hack whatever he’d inhaled into the crook of his arm, a wry smile of amusement playing at his lips.

“Need some water?” Devon asked, stepping forward with a water bottle already in hand.

Shane took it gratefully and drank until he felt his throat clear up. “Thanks,” he said as he capped it and set the bottle down beside his pillow.

“Should we see you guys out?” Ryan asked as Mark finished adjusting the camera that was set facing their sleeping bags, the red recording light already blinking with purpose.

Mark shrugged as he stood, taking his big shoulder camera back from TJ, who had had been dutifully holding it for him so he didn’t have to set it on the dirty floor.

“Nah, I think we can find our way out on our own,” TJ said as Mark wiped his knees clean of the grime. “I know you’ll probably just bolt if you get anywhere close to the exit anyway, Bergara.”

It was Shane’s turn to smirk as Ryan scowled, knowing that there was definitely some truth in that statement. Ryan had been unusually on edge throughout the rest of their investigation after their incident with the spirit box, and all Shane’s goading had done was make it worse.

“Have a good night, guys,” Devon said, looking uncertain about leaving them alone. She gave a little wave as Mark and TJ each said their goodbyes in turn. “We’ll see you in the morning; be safe, okay?”

“We’ll be fine; what’s the worst that’ll happen? A rat takes a nibble out of one of our ears?” Shane mustered up a smile he hoped looked assuring, but Devon didn’t seem comforted by it.

“The closest hotel we could book is 20 minutes away, but even still, don’t hesitate to call if you need something,” she said, and TJ nodded in affirmation.

“We’ll come as quick as we can,” he said, and Shane wasn’t sure why, but his words left a heavy weight in his stomach.

“Guys, we’ll be fine, this isn’t our first rodeo,” Shane said exasperatedly, and Ryan backed him up with a nod.

“The ghoul boys know how to behave themselves during a spooky sleepover,” he affirmed, but didn’t have the confidence required to back up what he was saying.

Still, Devon looked a little less doubtful and finally relented. She bid them goodnight once more before the three of them took their leave, carrying all the extra equipment Shane and Ryan wouldn’t need away with them to make packing up a little easier in the morning.

None of them knew it would be the last time they ever saw each other.

Shane sat down on his sleeping bag with a slight grunt and listened to their crew’s footsteps receding out of the room and away from them, echoing down the hall ominously. He waited until he couldn’t hear them anymore before he started getting ready for sleep, peeling away the opening of his sleeping bag to tuck his long legs inside.

“And then there were two,” he said rather cheerfully to Ryan as he got comfortable. He was met with a miserable sigh as his co-host begrudgingly slid into his own sleeping bag. He zipped it up promptly and stared up at the ceiling bitterly.

“You say that every time they leave, give it a rest already.”

“But it’s true every time it warrants being said,” Shane replied, drawing his phone out of his pocket and opening up Twitter. “We’re the only two people left in here; anyone else doesn’t exist, and you seem to need reminding of that fairly often.”

Ryan sighed shakily and turned his flashlight off, casting them both into the gloomy darkness, broken only by the glow of Shane’s phone as he scrolled through his social media feed.

6

“Shane? Are you awake? I’m kinda freaking out hardcore over here, buddy.”

It took a moment for Shane to register that he was being spoken to as he blinked the sleep out of his eyes, rolling over in his bag to face where Ryan was laid out. As his vision adjusted to the dark, he could see that Ryan was wide-awake, still staring up at the ceiling where the viewing booth stuck out like a sore thumb.

“What?” Shane asked, his voice heavy and tired, rumbling out of his throat in a low timbre. “Whatsit?”

“I- I can’t sleep,” Ryan admitted, his voice sounding small.

“Surprising absolutely no one,” Shane muttered before yawning loudly and rubbing the crust out of the corners of his eyes; he’d only been just been able to fall asleep before Ryan woke him up.

“Shut up,” Ryan grumbled. “It- I can’t sleep because it feels like- it feels like we’re being watched. I know it’s just the dark, but sometimes I think I can see people up there, looking down at us.”

Shane turned his gaze up to the viewing booth, but couldn’t see anything that looked like what Ryan was worrying about. His eyes did try to force shapes out of the darkness behind the window, but he intrinsically knew that it was just his mind playing tricks on him, trying to get him to see things that weren’t actually there. “There’s no one here but us, Ryan,” he reminded him, turning his attention back to his friend.

“But the voice on the spirit box-”

“-was just a voice,” Shane cut in. “And look, I’ll be honest with you- it was a little jarring, and I’ll admit to being a little unnerved by it myself, if that makes you feel any better.”

“Wh- no! Why would that make me feel better?” Ryan spluttered, finally tearing his eyes away from the booth above them to fix his wide-eyed stare on Shane. “You’re supposed to be my, my grounding rock, my calming spirit; how can you be scared? You’re not allowed to be afraid, I- I’m the one who fears!”

Shane stared at Ryan for one wordless minute before breaking out into a hearty laugh, his voice carrying around the room and making it sound louder than it was.

“Alright, calm down there cowardly Heisenberg; I didn’t say I was scared, just unnerved,” he clarified. His laugh seemed to ease some of Ryan’s worries, as his face cracked into a tentative grin at his words. “It was weird, yes, but nothing else strange happened while we were walking around, did it?”

“No, I guess not,” Ryan admitted, looking a little sheepish now. He contemplated Shane’s words quietly for a moment before he asked, “Do you really think it was just a numbers channel?”

“I think it’s a possibility, yes,” Shane said, picking his words carefully so as not to exacerbate Ryan’s anxieties. He honestly had no idea what it was or what it could be, but he wasn’t anywhere near ready yet to admit that it could’ve had supernatural origins. “We’re in a weird old government hospital; I think the most likely thing to have happened is that our little boxy pal picked up on a weird frequency we weren’t supposed to have access to and gave us a glimpse into something that wasn’t meant for us.”

“Yeah, but, we’re in Illinois,” Ryan began, picking at the zippered hem of his sleeping bag as he put the thoughts he’d been ruminating on into words.

“So? If you’re about to start shit-talking this wholesome state, so help me God, we’re going to have to start exchanging some serious words here.”

“No, that’s not what- Look, Illinois is in America; what possible radio frequency being broadcast here could we have picked up on that doesn’t speak English, or any other spoken American language, or even human?” Ryan asked, gesticulating around them as he spoke.

Shane sighed and rolled onto his back, adjusting his pillow to better support his neck. “You don’t know that it’s not any known human language, Ryan, we established that. It was probably just some kind of a looping cipher the CIA forgot to turn off when they moved out, not some- some demon speaking to us in tongues.”

Beside him, Ryan groaned loudly and quickly withdrew his arms back into his sleeping bag, as though he were afraid that by naming it, one would suddenly appear.

“Please don’t say demon.”

“You just did,” Shane said, unable to keep himself from speaking rather snidely. Ryan shot him a pointed look of annoyance, but he couldn’t help his uncooperative attitude in that moment. He was sleepy, and could feel all the dust they’d been breathing in coagulating deep in his lungs. He was irritated, and he let it show. “Look, Ry, we can discuss this all we want tomorrow, but I am incredibly tired right now. Just… try and get some sleep, okay? We’ll pick this up later.”

“I think we both know that’s not gonna happen,” Ryan muttered, but he mercifully let the issue drop.

Whether or not their conversation had helped or hindered Ryan, Shane couldn’t say. It had been a strange night for both of them, all things considered, and he wanted nothing more than to just be done with it. As he closed his eyes to try and go back to sleep, the last thing Shane would later recall seeing was the darkness taking shape in the form of a face looming behind the window pane of the viewing booth, looking down upon them intently. A strange metallic taste wouldn’t leave his mouth no matter how much water he drank to try and ride himself of it, and although Ryan had forsaken the notion of sleep for himself entirely, he too eventually drifted off unawares.

And that was all it took; by the morning they were gone, taken without a trace, everything they’d brought with them left behind and undisturbed.

[swampgallows]

i went to a “gifted” high school that was focused in the humanities and therefore made a lot of, looking back, clumsy attempts to be progressive. i had a fairly “SJW” curriculum before the term even existed or social justice had come into vogue; this was 2008 at the latest. a distinct example of this clumsiness, this well-meaning-ness, was when one of my teachers presented the DSM. it was the DSM-IV, the newest edition at the time, and they thumbed through it listing all of the average human traits that were considered—incorrectly, in their opinion—as disorders. a number of the paraphilias (cross-dressing, frotteurism) were ridiculed, but then my professor flipped to another page.

“Nightmare Disorder! Haha, apparently we’re all only supposed to have good dreams.”

She read off the list of criteria, laughing the whole way, and my peers were actively internalizing this as a fake diagnosis, something proclaimed as socially or behaviorally deviant for the purpose of shilling medication and shame and to exercise a totalitarian standard of health and behavior. but i sat there frozen in my chair as every criterion, few though they were, applied very directly to my life experience. throughout that year, actually, i had been suffering from such horrible, vivid nightmares that i couldn’t sleep at night and was showing up to school with less than three hours, all of which were fitful. my nightmares followed me into daylight as manifested hallucinations. I was fighting daytime sleepiness and the hypnagogia in tandem, struggling to appear normal (at least, as “normal” as my baseline would allow) and to be a good student and to act like i wasn’t seeing ten foot spectres staring at me from across the room and emitting low, muffled screeches.

i remember my coworker, just a year or so ago, commenting on a “very disturbing” dream she’d had. she and her daughter were in a parade holding up a giant Hello Kitty balloon, but it made her uncomfortable that she and her daughter were in the parade at all. That was the dream. This isn’t to say that the content of the dream has to be explicit to be disturbing, but I was a bit surprised to find that she was being bothered all day by a dream that was, from my perspective, seemingly tolerable. 

last night i dreamed that i lost a handle on topaz and she struck at xena. i worried about hurting topaz by removing her but i was certainly more worried about xena. i struggled to get topaz off of her and my siblings were just yanking at her body, making her thrash against them and squeeze xena tighter. after finally removing the snake, i held xena in my arms. i could feel her heart slowing and the warmth leaving her little puppy body. i was fervently in denial, trying to feel one part or another for a pulse, and all the thoughts started flooding in about how young xena was, that i killed her, that this was all my fault, that i thought she would grow old with us, but it’s my fault, i killed her, she was dead because of me. and i became infuriated at topaz, thinking “you stupid fucking animal, why do i even have you still, you should be in a sanctuary, your cage is too small and nobody in this house pays attention to you except me, and i can barely do that anymore because i cant have the snake and the dog in my room at the same time, and im the only one who takes the dog on walks so she’s always paying attention to me”, and all of these real life things bled into the dream about my family’s shit approach to healthcare, that they complain about how much money they pay for healthcare and then never use it, they never take care of themselves, everybody is just in denial of how fucking sick they are, and then it extends to our pets. in real fucking life topaz still has the lump on her face that she got BACK IN MARCH and i still cant get the number from my mom of the surgeon she was recommended or whatever the fuck. xena’s been walking with a limp in one of her legs and ive been asking to take her to the vet. if i were driving more i could just do it myself but im afraid to drive with the dog in the car, and im afraid to drive because IM fucking sick too and i cant start anything until my medical gets approved and, anyway

so i dreamed my snake bit my dog and i held my dog in my arms while she fucking died. i havent had a nightmare this bad in weeks, partially because im not really getting enough sleep but im also not getting a lot of stimulus. but i used to have nightmares like this on the regular in high school. every fucking day i had to slog to school feeling like i had just held my dying dog in my arms, and having the weight of her and her petered breathing heavy in my mind while i tried to pay attention to the french revolution or some shit. and then the shadow people would be watching me, clicking and jittering and resonating with some kind of static sometimes so loud i couldnt hear the people talking in front of me.

but i guess to people who have never had dreams like this, and especially at the vividness and frequency that i do, sure, “nightmare disorder” sounds like a crock of shit. It’s just a dream, who cares!! you’re not SICK just because you have nightmares!! “if that were true, every child who ever crawled into their parents’ bed would be ‘crazy’!”

as of the DSM-V, “nightmare disorder” is now called “Sleep anxiety disorder”, a disorder for which i have been officially diagnosed and medicated. my bottle of alprazolam reads “take 1 tablet by mouth at bedtime as needed for anxiety”. 

every time i have a nightmare, i think about my entire student body and staff who were convinced that a life like mine was conjured up by big pharma to feed the panopticon or some shit. reminds me of björk and her debunked fear of CRT TVs. 

[trendingnewsb]

I could hear things, and Icould feel terrible pain: when anaesthesia fails

The long read: Anaesthesia remains a mysterious and inexact science and thousands of patients still wake up on the operating table every year

When Rachel Benmayor was admitted to hospital, eight and a half months pregnant, in 1990, her blood pressure had been alarmingly high and her doctor had told her to stay in bed and get as much rest as possible before the baby came. But her blood pressure kept rising this condition, known as pre-eclampsia, is not uncommon but can lead to sometimes-fatal complications and the doctors decided to induce the birth. When her cervix failed to dilate properly after 17 hours of labour, they decided instead to deliver the child by caesarean section under general anaesthetic. Rachel remembers being wheeled into the operating theatre. She remembers the mask, the gas. But then, as the surgeon made the first incision, she woke up.

I remember going on to the operating table, she told me. I remember an injection in my arm, and I remember the gas going over, and Glenn, my partner, and Sue, my midwife, standing beside me. And then I blacked out. And then the first thing I can remember is being conscious, basically, of pain. And being conscious of a sound that was loud and then echoed away. A rhythmical sound, almost like a ticking, or a tapping. And pain. I remember feeling a most incredible pressure on my belly, as though a truck was driving back and forth, back and forth across it.

A few months after the operation, someone explained to Rachel that when you open up the abdominal cavity, the air rushing on to the unprotected internal organs gives rise to a feeling of great pressure. But in that moment, lying there in surgery, she still had no idea what was happening. She thought she had been in a car accident. All I knew was that I could hear things and that I could feel the most terrible pain. I didnt know where I was. I didnt know I was having an operation. I was just conscious of the pain.

Every day, specialist doctors known as anaesthetists (or, in the US, anesthesiologists) put hundreds of thousands of people into chemical comas to enable other doctors to enter and alter our insides. Then they bring us back again. But quite how this daily extinction happens and un-happens remains uncertain. Researchers know that a general anaesthetic acts on the central nervous system reacting with the slick membranes of the nerve cells in the brain to suspend responses such as sight, touch and awareness. But they still cant agree on just what it is that happens in those areas of the brain, or which of the things that happen matter the most, or why they sometimes happen differently with different anaesthetics, or even on the manner a sunset? an eclipse? in which the human brain segues from conscious to not.

Nor, as it turns out, can anaesthetists accurately measure what it is they do.

For as long as doctors have been sending people under, they have been trying to fathom exactly how deep they have sent them. In the early days, this meant relying on signals from the body; later, on calculations based on the concentration in the blood of the various gases used. Recent years have seen the development of brain monitors that translate the brains electrical activity into a numeric scale a de facto consciousness meter. For all that, doctors still have no way of knowing for sure how deeply an individual patient is anaesthetised or even if that person is unconscious at all.

Anaesthetists have at their disposal a regularly changing array of mind-altering drugs some inhalable, some injectable, some short-acting, some long, some narcotic, some hallucinogenic which act in different and often uncertain ways on different parts of the brain. Some such as ether, nitrous oxide (better known as laughing gas) and, more recently, ketamine moonlight as party drugs. (If you have an inclination to travel, take the ether you go beyond the furthest star, wrote the American philosopher-poet Henry David Thoreau after inhaling the drug for the fitting of his false teeth.) Different anaesthetists mix up different combinations. Each has a favourite recipe. There is no standard dose.

Todays anaesthetic cocktails have three main elements: hypnotics designed to render you unconscious and keep you that way; analgesics to control pain; and, in many cases, a muscle relaxant (neuromuscular blockade) that prevents you from moving on the operating table. Hypnotics such as ether, nitrous oxide and their modern pharmaceutical equivalents are powerful drugs and not very discriminating. In blotting out consciousness, they can suppress not only the senses, but also the cardiovascular system: heart rate, blood pressure the bodys engine. When you take your old dog on its last journey, your vet will use an overdose of hypnotics to put him down. Every time you have a general anaesthetic, you take a trip towards death and back. The more hypnotics your doctor puts in, the longer you take to recover, and the more likely it is that something will go wrong. The less your doctor puts in, the more likely that you will wake. It is a balancing act, and anaesthetists are very good at it. But it doesnt alter the fact that for as long as anaesthetists have been putting them to sleep, patients have been waking during surgery.

As Rachels caesarean proceeded, she became aware of voices, though not of what was being said. She realised that she was not breathing, and started trying to inhale. I was just trying desperately to breathe, to breathe in. I realised that if I didnt breathe soon, I was going to die, she told me.

She didnt know there was a machine breathing for her. In the end I realised that I couldnt breathe, and that I should just let happen what was going to happen, so I stopped fighting it. By now, however, she was in panic. I couldnt cope with the pain. It seemed to be going on and on and on, and I didnt know what it was. Then she started hearing the voices again. And this time she could understand them. I could hear them talking about things about people, what they did on the weekend, and then I could hear them saying, Oh look, here she is, here the baby is, and things like that, and I realised then that I was conscious during the operation. I tried to start letting them know at that point. I tried moving, and I realised that I was totally and completely paralysed.

The chances of this happening to you or me are remote and, with advances in monitoring equipment, considerably more remote than 25 years ago. Figures vary (sometimes wildly, depending in part on how they are gathered) but big American and European studies using structured post-operative interviews have shown that one to two patients in 1,000 report waking under anaesthesia. More, it seems, in China. More again in Spain. Twenty to forty thousand people are estimated to remember waking each year in the US alone. Of these, only a small proportion are likely to feel pain, let alone the sort of agonies described above. But the impact can be devastating.

For Rachel, sleepless and terrified in her hospital room, it was the beginning of years of nightmares, panic attacks and psychiatric therapy. Soon after she gave birth, her blood pressure soared. I was in a hell of a state, she told me.

For weeks after she returned home, she would have panic attacks during which she felt she couldnt breathe. Although she says the hospital acknowledged the mistake and the superintendent apologised to her, beyond that she does not recall getting any help from the institution no explanation or counselling or offer of compensation. It did not occur to her to ask.

Things can go wrong. Equipment can fail a faulty monitor, a leaking tube. Certain operations caesareans, heart and trauma surgery require relatively light anaesthetics, and there the risk is increased as much as tenfold. One study in the 1980s found that close to half of those interviewed after trauma surgery remembered parts of the operation, although these days, with better drugs and monitoring, the figure for high-risk surgery is generally estimated at closer to one in 100. Certain types of anaesthetics (those delivered into your bloodstream, rather than those you inhale) raise the risk if used alone. Certain types of people, too, are more likely to wake during surgery: women, fat people, redheads; drug abusers, particularly if they dont mention their history. Children wake far more often than adults, but dont seem to be as concerned about it (or perhaps are less likely to discuss it). Some people may simply have a genetic predisposition to awareness. Human error plays a part.

But even without all this, anaesthesia remains an inexact science. An amount that will put one robust young man out cold will leave another still chatting to surgeons. More than a decade ago, I found this quote in an introductory anaesthesia paper on a University of Sydney website: There is no way that we can be sure that a given patient is asleep, particularly once they are paralysed and cannot move.

Last time I searched, the paper had been adjusted slightly to acknowledge recent advances in brain monitoring, but the message remained the same: just because a person appears to be unconscious, it does not mean they are.

In a way, continued the original version of the paper, the art of anaesthesia is a sophisticated form of guesswork. It really is art more than science We try to give the right doses of the right drugs and hope the patient is unconscious.

The death rate from general anaesthesia has dropped in the past 30 years, from about one in 20,000 to one or two in 200,000; and the incidence of awareness from one or two cases per 100 to one or two per 1,000. Obviously we give anaesthetics and weve got very good control over it, a senior anaesthetist told me, but in real philosophical and physiological terms, we dont know how anaesthesia works.

It is perhaps the most brilliant and baffling gift of modern medicine: the disappearing act that enables doctors and dentists to carry out surgery and other procedures that would otherwise be impossibly, often fatally, painful.

The term anaesthesia was appropriated from the Greek by New England physician and poet Oliver Wendell Holmes in 1846, to describe the effect of the drug ether following its first successful public demonstration in surgery. Anaesthetise: to render insensible. These days there are other sorts of anaesthetics that can numb a tooth or a torso, simply (or unsimply) by switching off the nerves in the relevant part of the body. But the most widespread and intriguing application of this skill is what is now known as general anaesthesia.

The first public demonstration of the use of inhaled ether as a surgical anaesthetic in 1846 by an American dentist, William Thomas Green Morton. Photograph: Design Pics Inc/Rex/Shutterstock

In general anaesthesia, it is not the nerve endings that are switched off, but your brain or, at least, parts of it. These, it seems, include the connections that somehow enable the operation of our sense of self, or (loosely) consciousness, as well as the parts of the brain responsible for processing messages from the nerves telling us we are in pain: the neurological equivalent of shooting the messenger. Which is, of course, a good thing.

I am one of the hundreds of millions of humans alive today who have undergone a general anaesthetic. It is an experience now so common as to be mundane. Anaesthesia has become a remarkably safe endeavour: less an event than a short and unremarkable hiatus. The fact that this hiatus has been possible for fewer than two of the 2,000 or so centuries of human history; the fact that only since then have we been able to routinely undergo such violent bodily assaults and survive; the fact that anaesthetics themselves are potent and sometimes unpredictable drugs all this seems to have been largely forgotten. Anaesthesia has freed surgeons to saw like carpenters through the bony fortress of the ribs. It has made it possible for a doctor to hold in her hand a steadily beating heart. It is a powerful gift. But what exactly is it?

Part of the difficulty in talking about anaesthesia is that any discussion veers almost immediately on to the mystery of consciousness. And despite a renewed focus in recent decades, scientists cannot yet even agree on the terms of that debate, let alone settle it.

Is consciousness one state or many? Can it be wholly explained in terms of specific brain regions and processes, or is it something more? Is it even a mystery? Or just an unsolved puzzle? And in either case, can any single explanation account for a spectrum of experience that includes both sentience (what it feels like to experience sound, sensation, colour) and self-awareness (what it feels like to be me the subjective certainty of my own existence)? Anaesthetists point out that you dont have to know how an engine works to drive a car. But stray off the bitumen, and it is surprising how quickly pharmacology and neurology give way to philosophy: if a scalpel cuts into an unconscious body, can it still cause pain? And then ethics: if, under anaesthesia, you feel pain but forget it almost in the moment, does it matter?

Greg Deacon, a former head of the Australian Society of Anaesthetists, told me about a patient who was waiting to have open heart surgery. Deacon had been preparing to anaesthetise him, he said, when the man went into cardiac arrest. The team managed to restart the recalcitrant heart, then raced the patient into surgery, where they operated immediately. It was only once the operation had begun, the mans heart now beating steadily, that they could safely administer an anaesthetic. It all went well, said Deacon, and the man made an excellent recovery. Some days later, the patient told doctors he remembered the early parts of the procedure before he was given the drugs.

That is a sort of incidence of awareness which was thoroughly understandable and acceptable, Deacon told me: he had not even known if the mans brain was still working, let alone whether he would survive an anaesthetic. We were trying to keep him alive.

This is not denial. This is the tightrope that anaesthetists walk every day. They just tend not to talk about it.

In 2004, and against a backdrop of growing public and media concern, Americas Joint Commission on Accreditation of Healthcare Organizations finally issued an alert to more than 15,000 of the nations hospitals and healthcare providers. The commission, which evaluates healthcare providers, acknowledged that the experience of awareness in anaesthesia was under-recognised and under-treated, and called on all healthcare providers to start educating staff about the problem.

The American Society of Anesthesiologists subsequently acknowledged, in a 2006 practice advisory, that accidental intraoperative awareness, while rare, might be followed by significant psychological sequelae and affected patients may remain severely disabled for extended periods of time.

Before that acknowledgment was published, however, then ASA president Roger Litwiller made a small but telling observation. Despite his organisations concern about anaesthetic awareness, he did not want the issue to be blown out of proportion: I would also like to say that there is a potential for this subject of awareness to be sensationalised. We are concerned that patients become unduly frightened during what is already a very emotional time for them.

This is the anaesthetists dilemma. Under stress which affects just about everybody facing a general anaesthetic we lose our ability and often desire to process complex information. More than half of all patients worry about pain, paralysis and distress. High anxiety or resistance to the idea of anaesthesia may even contribute to anaesthetics failing, or at least increase the chances that we will remember parts of the operation. The more anxious we are, the more anaesthetic it may take to put us to sleep.

This creates a quandary for doctors: how much to tell? When we are anxious, our bodies increase production of adrenaline-type substances called catecholamines. These can react badly with some anaesthetic agents. So what does an anaesthetist tell a patient who, because of the type of operation, or their state of health, is at higher than average risk?

I mean, were trying to make people not worry about it, said one Australian anaesthetist I spoke with, but in the process I think we blur it so much that people hardly ever think about it, and thats probably not right either Should I be telling you that youve got a high risk of death? Is that going to frighten you to death?

Today the profession makes much of the emergence of a new generation of anaesthetists who are more attuned to the experiences of their patients. But the reality is that anaesthetists remain for the large part the invisible men and women of surgery. Many patients still dont meet them until just before or sometimes after the operation, and many, muffled in a fug of drugs, might not even remember these meetings. Nor do anaesthetists generally leave anything to show for their work: no scars or prognoses. When they do leave evidence, it is invariably unwelcome nausea, a raw throat, sometimes a tooth chipped as the breathing tube is inserted, sometimes a memory of the surgery. It is unsurprising, then, that by the time an anaesthetist makes it into the popular media, he or she is generally accompanied by a lawyer.

For the doctors who each day make possible the miraculous vanishing act at the heart of modern surgery, this invisibility can be galling. It is not surgeons who have enabled the proliferation of surgical operations numbering in the hundreds 170-odd years ago and the hundreds of millions today. It is anaesthetists. In hospital emergency rooms in Australia and other countries, it is not surgeons who decide which patient is most in need of and mostly likely to survive emergency surgery: anaesthetists increasingly oversee the pragmatic hierarchy of triage. And if you have an operation, although it is your surgeon who manages the moist, intricate mechanics of the matter, it is your anaesthetist who keeps you alive.

One of the first articles I came across when I started researching this subject was a 1998 paper by British psychologist Michael Wang entitled Inadequate Anaesthesia as a Cause of Psychopathology. Wang pointed out that pain even unexpectedly severe pain did not necessarily lead to trauma. Post-traumatic stress seldom followed childbirth, for example. What could be devastating, he said, was the totally unexpected experience of complete paralysis.

Even today, most patients undergoing major surgery have no idea that part of the anaesthetic mix will be a modern pharmaceutical version of curare, a poison derived from a South American plant, which causes paralysis. Few will be aware, either, that during surgery their eyes will be taped shut, that they may be tied down, and that they will have a plastic tube manoeuvred into their reluctant airway, past the soft palate and the vocal cords, overriding the gag reflex, and into the windpipe.

An anaesthetist checking a patients pupil to gauge the effect of an anaesthetic. Photograph: Cornell Capa/The Life Picture Collection/Getty Images

For the patient paralysed upon the table, said Wang, [t]he realisation of consciousness of which theatre staff are evidently oblivious, along with increasingly frenetic yet futile attempts to signal with various body parts, leads rapidly to the conclusion that something has gone seriously wrong. The patient might believe that the surgeon has accidentally severed the spinal cord, or that some unusual drug reaction has occurred, rendering her totally paralysed, not just during the surgery, but for the rest of her life.

As soon as anaesthetists explain to patients how the process works, it all starts to seem a lot less mysterious. And talk, it turns out, is not only cheap but effective: a preoperative visit from an anaesthetist has been shown to be better than a tranquilliser at keeping patients calm. I know from my own experience I had surgery on my spine how reassuring such a conversation can be. For me, it was not just the information; it was the fact of the human contact, of being treated as an equal, of being included, rather than feeling like an appendage to a process to which I was, after all, central.

Hank Bennett, an American psychologist, remembers a young girl whose mother brought her to see him some time after the girl had her adenoids removed. The surgeon referred the mother to Bennett after she had returned to him in a state of anxiety about her child. The surgery had been straightforward, but the mother felt that something was very wrong with her previously happy daughter: the child had withdrawn from her family and friends, and had stopped working at school. She could no longer fall asleep without her mother sitting with her, and was afraid of the dark.

Bennett spoke with the girl. He told her there must be a reason she had changed her behaviour, and asked if it might have something to do with the operation.

Bennett recalled: And she said, Yes. They saidthat they were going to put me to sleep, but the next thing I knew, I couldnt breathe. Now, she was only momentarily like that she does not remember the breathing tube going in but when I asked why she was doing these things differently at school and at home, she said: Well, I have to concentrate and I cant be bothered by anything. Ive got to make sure that I can breathe.

Bennett referred the girl to a child psychologist, and within weeks she was back to herself. Today she would be approaching middle age. But lets say that was just luck, Bennett says now. What if nothing had been picked up about that? Would she have been permanently changed? I think that you would say, yes, she probably would have been.

So if you were my anaesthetist and I your patient, there are some other things Id hope you would do in the operating theatre. Things that many already do. Be kind. Talk to me. Just a bit of information and reassurance. Use my name. Patients who remember waking are often greatly relieved at having been told what was happening to them, and reassured that this was OK and that they would now drift back to sleep.

The Fifth National Audit Project on accidental awareness during general anaesthesia states: The patients interpretation of what is happening at the time of the awareness seems central to its later impact; explanation and reassurance during suspected accidental awareness during general anaesthesia or at the time of report seems beneficial. Hospital staff could put a sign on the wall of the operating theatre: The patient can hear. Because one of the strange things about anaesthetic drugs is that they can exert their effect in each direction not just upon the patient, but upon the doctors and theatre staff performing the procedure.

After the teenage son of a good friend was badly burned in an accident some years ago, he had to endure weeks of intense pain, culminating each week in the agonising ritual of nurses changing the dressings on his chest and arms. They did this by giving him a dose of a sedative drug designed to distract him from the pain and prevent him remembering it. My friend would attempt to comfort her son as he yelled and as the nurses got on with their difficult task. What she observed was that while the drugs did give her son some distance from his pain, and certainly his memories of it, they also gave the nurses some distance from her son. It was an understandable, perhaps necessary, distance; but inherent in that tiny retreat (the lack of eye contact, the too-bright voices) was a loosening of the tiny filaments that connect us one to another, and through which we know we are connected.

It is a process inevitably magnified in the operating theatre, where the patient is silent and still, to all intents absent, and where their descent into unconsciousness is routinely accompanied by the sounds of the music being cranked up (one prominent Australian surgeon is said to favour heavy metal), and conversation. It need not take a scientific study to tell us that this deepening of respect and focus is good not only for patients, but for doctors, too. In the end, it might not even much matter what you say. During an operation, a soothing voice may be more important than what the voice says, writes psychologist John Kihlstrom, who still encourages anaesthetists to talk to their anaesthetised patients (about what is going on, giving reassurance, things like that) but acknowledges that he doesnt expect them to understand any of it not verbally at least.

Japanese anaesthetist Jiro Kurata calls this care of the soul. In an unusual and rather lovely paper delivered at the Ninth International Symposium on Memory and Awareness in Anaesthesia in 2015, he wondered if there might be part of our existence that cannot ever be shut down, which we cannot even conceive by ourselves a subconscious self that might be resistant to even high doses of anaesthetics. He called this the hard problem of anaesthesia awareness. I have no idea what his colleagues made of it. But his conclusion seems unassailable.

Any solution? Science? Yes and no. Monitoring? Yes and no. Respect? Yes. We must not only be aware of the inherent limitation of science and technology but, most importantly, also of the inherent dignity of each personal self.

Anaesthesia: The Gift of Oblivion and the Mystery of Consciousness by Kate Cole-Adams (Text Publishing Company, 12.99) is published on 22 February. To order a copy for 9.99, go to guardianbookshop.com

Follow the Long Read on Twitter at @gdnlongread, or sign up to the long read weekly email here.

Read more: https://www.theguardian.com/news/2018/feb/09/i-could-hear-things-and-i-could-feel-terrible-pain-when-anaesthesia-fails

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I could hear things, and Icould feel terrible pain: when anaesthesia fails

The long read: Anaesthesia remains a mysterious and inexact science and thousands of patients still wake up on the operating table every year

When Rachel Benmayor was admitted to hospital, eight and a half months pregnant, in 1990, her blood pressure had been alarmingly high and her doctor had told her to stay in bed and get as much rest as possible before the baby came. But her blood pressure kept rising this condition, known as pre-eclampsia, is not uncommon but can lead to sometimes-fatal complications and the doctors decided to induce the birth. When her cervix failed to dilate properly after 17 hours of labour, they decided instead to deliver the child by caesarean section under general anaesthetic. Rachel remembers being wheeled into the operating theatre. She remembers the mask, the gas. But then, as the surgeon made the first incision, she woke up.

I remember going on to the operating table, she told me. I remember an injection in my arm, and I remember the gas going over, and Glenn, my partner, and Sue, my midwife, standing beside me. And then I blacked out. And then the first thing I can remember is being conscious, basically, of pain. And being conscious of a sound that was loud and then echoed away. A rhythmical sound, almost like a ticking, or a tapping. And pain. I remember feeling a most incredible pressure on my belly, as though a truck was driving back and forth, back and forth across it.

A few months after the operation, someone explained to Rachel that when you open up the abdominal cavity, the air rushing on to the unprotected internal organs gives rise to a feeling of great pressure. But in that moment, lying there in surgery, she still had no idea what was happening. She thought she had been in a car accident. All I knew was that I could hear things and that I could feel the most terrible pain. I didnt know where I was. I didnt know I was having an operation. I was just conscious of the pain.

Every day, specialist doctors known as anaesthetists (or, in the US, anesthesiologists) put hundreds of thousands of people into chemical comas to enable other doctors to enter and alter our insides. Then they bring us back again. But quite how this daily extinction happens and un-happens remains uncertain. Researchers know that a general anaesthetic acts on the central nervous system reacting with the slick membranes of the nerve cells in the brain to suspend responses such as sight, touch and awareness. But they still cant agree on just what it is that happens in those areas of the brain, or which of the things that happen matter the most, or why they sometimes happen differently with different anaesthetics, or even on the manner a sunset? an eclipse? in which the human brain segues from conscious to not.

Nor, as it turns out, can anaesthetists accurately measure what it is they do.

For as long as doctors have been sending people under, they have been trying to fathom exactly how deep they have sent them. In the early days, this meant relying on signals from the body; later, on calculations based on the concentration in the blood of the various gases used. Recent years have seen the development of brain monitors that translate the brains electrical activity into a numeric scale a de facto consciousness meter. For all that, doctors still have no way of knowing for sure how deeply an individual patient is anaesthetised or even if that person is unconscious at all.

Anaesthetists have at their disposal a regularly changing array of mind-altering drugs some inhalable, some injectable, some short-acting, some long, some narcotic, some hallucinogenic which act in different and often uncertain ways on different parts of the brain. Some such as ether, nitrous oxide (better known as laughing gas) and, more recently, ketamine moonlight as party drugs. (If you have an inclination to travel, take the ether you go beyond the furthest star, wrote the American philosopher-poet Henry David Thoreau after inhaling the drug for the fitting of his false teeth.) Different anaesthetists mix up different combinations. Each has a favourite recipe. There is no standard dose.

Todays anaesthetic cocktails have three main elements: hypnotics designed to render you unconscious and keep you that way; analgesics to control pain; and, in many cases, a muscle relaxant (neuromuscular blockade) that prevents you from moving on the operating table. Hypnotics such as ether, nitrous oxide and their modern pharmaceutical equivalents are powerful drugs and not very discriminating. In blotting out consciousness, they can suppress not only the senses, but also the cardiovascular system: heart rate, blood pressure the bodys engine. When you take your old dog on its last journey, your vet will use an overdose of hypnotics to put him down. Every time you have a general anaesthetic, you take a trip towards death and back. The more hypnotics your doctor puts in, the longer you take to recover, and the more likely it is that something will go wrong. The less your doctor puts in, the more likely that you will wake. It is a balancing act, and anaesthetists are very good at it. But it doesnt alter the fact that for as long as anaesthetists have been putting them to sleep, patients have been waking during surgery.

As Rachels caesarean proceeded, she became aware of voices, though not of what was being said. She realised that she was not breathing, and started trying to inhale. I was just trying desperately to breathe, to breathe in. I realised that if I didnt breathe soon, I was going to die, she told me.

She didnt know there was a machine breathing for her. In the end I realised that I couldnt breathe, and that I should just let happen what was going to happen, so I stopped fighting it. By now, however, she was in panic. I couldnt cope with the pain. It seemed to be going on and on and on, and I didnt know what it was. Then she started hearing the voices again. And this time she could understand them. I could hear them talking about things about people, what they did on the weekend, and then I could hear them saying, Oh look, here she is, here the baby is, and things like that, and I realised then that I was conscious during the operation. I tried to start letting them know at that point. I tried moving, and I realised that I was totally and completely paralysed.

The chances of this happening to you or me are remote and, with advances in monitoring equipment, considerably more remote than 25 years ago. Figures vary (sometimes wildly, depending in part on how they are gathered) but big American and European studies using structured post-operative interviews have shown that one to two patients in 1,000 report waking under anaesthesia. More, it seems, in China. More again in Spain. Twenty to forty thousand people are estimated to remember waking each year in the US alone. Of these, only a small proportion are likely to feel pain, let alone the sort of agonies described above. But the impact can be devastating.

For Rachel, sleepless and terrified in her hospital room, it was the beginning of years of nightmares, panic attacks and psychiatric therapy. Soon after she gave birth, her blood pressure soared. I was in a hell of a state, she told me.

For weeks after she returned home, she would have panic attacks during which she felt she couldnt breathe. Although she says the hospital acknowledged the mistake and the superintendent apologised to her, beyond that she does not recall getting any help from the institution no explanation or counselling or offer of compensation. It did not occur to her to ask.

Things can go wrong. Equipment can fail a faulty monitor, a leaking tube. Certain operations caesareans, heart and trauma surgery require relatively light anaesthetics, and there the risk is increased as much as tenfold. One study in the 1980s found that close to half of those interviewed after trauma surgery remembered parts of the operation, although these days, with better drugs and monitoring, the figure for high-risk surgery is generally estimated at closer to one in 100. Certain types of anaesthetics (those delivered into your bloodstream, rather than those you inhale) raise the risk if used alone. Certain types of people, too, are more likely to wake during surgery: women, fat people, redheads; drug abusers, particularly if they dont mention their history. Children wake far more often than adults, but dont seem to be as concerned about it (or perhaps are less likely to discuss it). Some people may simply have a genetic predisposition to awareness. Human error plays a part.

But even without all this, anaesthesia remains an inexact science. An amount that will put one robust young man out cold will leave another still chatting to surgeons. More than a decade ago, I found this quote in an introductory anaesthesia paper on a University of Sydney website: There is no way that we can be sure that a given patient is asleep, particularly once they are paralysed and cannot move.

Last time I searched, the paper had been adjusted slightly to acknowledge recent advances in brain monitoring, but the message remained the same: just because a person appears to be unconscious, it does not mean they are.

In a way, continued the original version of the paper, the art of anaesthesia is a sophisticated form of guesswork. It really is art more than science We try to give the right doses of the right drugs and hope the patient is unconscious.

The death rate from general anaesthesia has dropped in the past 30 years, from about one in 20,000 to one or two in 200,000; and the incidence of awareness from one or two cases per 100 to one or two per 1,000. Obviously we give anaesthetics and weve got very good control over it, a senior anaesthetist told me, but in real philosophical and physiological terms, we dont know how anaesthesia works.

It is perhaps the most brilliant and baffling gift of modern medicine: the disappearing act that enables doctors and dentists to carry out surgery and other procedures that would otherwise be impossibly, often fatally, painful.

The term anaesthesia was appropriated from the Greek by New England physician and poet Oliver Wendell Holmes in 1846, to describe the effect of the drug ether following its first successful public demonstration in surgery. Anaesthetise: to render insensible. These days there are other sorts of anaesthetics that can numb a tooth or a torso, simply (or unsimply) by switching off the nerves in the relevant part of the body. But the most widespread and intriguing application of this skill is what is now known as general anaesthesia.

The first public demonstration of the use of inhaled ether as a surgical anaesthetic in 1846 by an American dentist, William Thomas Green Morton. Photograph: Design Pics Inc/Rex/Shutterstock

In general anaesthesia, it is not the nerve endings that are switched off, but your brain or, at least, parts of it. These, it seems, include the connections that somehow enable the operation of our sense of self, or (loosely) consciousness, as well as the parts of the brain responsible for processing messages from the nerves telling us we are in pain: the neurological equivalent of shooting the messenger. Which is, of course, a good thing.

I am one of the hundreds of millions of humans alive today who have undergone a general anaesthetic. It is an experience now so common as to be mundane. Anaesthesia has become a remarkably safe endeavour: less an event than a short and unremarkable hiatus. The fact that this hiatus has been possible for fewer than two of the 2,000 or so centuries of human history; the fact that only since then have we been able to routinely undergo such violent bodily assaults and survive; the fact that anaesthetics themselves are potent and sometimes unpredictable drugs all this seems to have been largely forgotten. Anaesthesia has freed surgeons to saw like carpenters through the bony fortress of the ribs. It has made it possible for a doctor to hold in her hand a steadily beating heart. It is a powerful gift. But what exactly is it?

Part of the difficulty in talking about anaesthesia is that any discussion veers almost immediately on to the mystery of consciousness. And despite a renewed focus in recent decades, scientists cannot yet even agree on the terms of that debate, let alone settle it.

Is consciousness one state or many? Can it be wholly explained in terms of specific brain regions and processes, or is it something more? Is it even a mystery? Or just an unsolved puzzle? And in either case, can any single explanation account for a spectrum of experience that includes both sentience (what it feels like to experience sound, sensation, colour) and self-awareness (what it feels like to be me the subjective certainty of my own existence)? Anaesthetists point out that you dont have to know how an engine works to drive a car. But stray off the bitumen, and it is surprising how quickly pharmacology and neurology give way to philosophy: if a scalpel cuts into an unconscious body, can it still cause pain? And then ethics: if, under anaesthesia, you feel pain but forget it almost in the moment, does it matter?

Greg Deacon, a former head of the Australian Society of Anaesthetists, told me about a patient who was waiting to have open heart surgery. Deacon had been preparing to anaesthetise him, he said, when the man went into cardiac arrest. The team managed to restart the recalcitrant heart, then raced the patient into surgery, where they operated immediately. It was only once the operation had begun, the mans heart now beating steadily, that they could safely administer an anaesthetic. It all went well, said Deacon, and the man made an excellent recovery. Some days later, the patient told doctors he remembered the early parts of the procedure before he was given the drugs.

That is a sort of incidence of awareness which was thoroughly understandable and acceptable, Deacon told me: he had not even known if the mans brain was still working, let alone whether he would survive an anaesthetic. We were trying to keep him alive.

This is not denial. This is the tightrope that anaesthetists walk every day. They just tend not to talk about it.

In 2004, and against a backdrop of growing public and media concern, Americas Joint Commission on Accreditation of Healthcare Organizations finally issued an alert to more than 15,000 of the nations hospitals and healthcare providers. The commission, which evaluates healthcare providers, acknowledged that the experience of awareness in anaesthesia was under-recognised and under-treated, and called on all healthcare providers to start educating staff about the problem.

The American Society of Anesthesiologists subsequently acknowledged, in a 2006 practice advisory, that accidental intraoperative awareness, while rare, might be followed by significant psychological sequelae and affected patients may remain severely disabled for extended periods of time.

Before that acknowledgment was published, however, then ASA president Roger Litwiller made a small but telling observation. Despite his organisations concern about anaesthetic awareness, he did not want the issue to be blown out of proportion: I would also like to say that there is a potential for this subject of awareness to be sensationalised. We are concerned that patients become unduly frightened during what is already a very emotional time for them.

This is the anaesthetists dilemma. Under stress which affects just about everybody facing a general anaesthetic we lose our ability and often desire to process complex information. More than half of all patients worry about pain, paralysis and distress. High anxiety or resistance to the idea of anaesthesia may even contribute to anaesthetics failing, or at least increase the chances that we will remember parts of the operation. The more anxious we are, the more anaesthetic it may take to put us to sleep.

This creates a quandary for doctors: how much to tell? When we are anxious, our bodies increase production of adrenaline-type substances called catecholamines. These can react badly with some anaesthetic agents. So what does an anaesthetist tell a patient who, because of the type of operation, or their state of health, is at higher than average risk?

I mean, were trying to make people not worry about it, said one Australian anaesthetist I spoke with, but in the process I think we blur it so much that people hardly ever think about it, and thats probably not right either Should I be telling you that youve got a high risk of death? Is that going to frighten you to death?

Today the profession makes much of the emergence of a new generation of anaesthetists who are more attuned to the experiences of their patients. But the reality is that anaesthetists remain for the large part the invisible men and women of surgery. Many patients still dont meet them until just before or sometimes after the operation, and many, muffled in a fug of drugs, might not even remember these meetings. Nor do anaesthetists generally leave anything to show for their work: no scars or prognoses. When they do leave evidence, it is invariably unwelcome nausea, a raw throat, sometimes a tooth chipped as the breathing tube is inserted, sometimes a memory of the surgery. It is unsurprising, then, that by the time an anaesthetist makes it into the popular media, he or she is generally accompanied by a lawyer.

For the doctors who each day make possible the miraculous vanishing act at the heart of modern surgery, this invisibility can be galling. It is not surgeons who have enabled the proliferation of surgical operations numbering in the hundreds 170-odd years ago and the hundreds of millions today. It is anaesthetists. In hospital emergency rooms in Australia and other countries, it is not surgeons who decide which patient is most in need of and mostly likely to survive emergency surgery: anaesthetists increasingly oversee the pragmatic hierarchy of triage. And if you have an operation, although it is your surgeon who manages the moist, intricate mechanics of the matter, it is your anaesthetist who keeps you alive.

One of the first articles I came across when I started researching this subject was a 1998 paper by British psychologist Michael Wang entitled Inadequate Anaesthesia as a Cause of Psychopathology. Wang pointed out that pain even unexpectedly severe pain did not necessarily lead to trauma. Post-traumatic stress seldom followed childbirth, for example. What could be devastating, he said, was the totally unexpected experience of complete paralysis.

Even today, most patients undergoing major surgery have no idea that part of the anaesthetic mix will be a modern pharmaceutical version of curare, a poison derived from a South American plant, which causes paralysis. Few will be aware, either, that during surgery their eyes will be taped shut, that they may be tied down, and that they will have a plastic tube manoeuvred into their reluctant airway, past the soft palate and the vocal cords, overriding the gag reflex, and into the windpipe.

An anaesthetist checking a patients pupil to gauge the effect of an anaesthetic. Photograph: Cornell Capa/The Life Picture Collection/Getty Images

For the patient paralysed upon the table, said Wang, [t]he realisation of consciousness of which theatre staff are evidently oblivious, along with increasingly frenetic yet futile attempts to signal with various body parts, leads rapidly to the conclusion that something has gone seriously wrong. The patient might believe that the surgeon has accidentally severed the spinal cord, or that some unusual drug reaction has occurred, rendering her totally paralysed, not just during the surgery, but for the rest of her life.

As soon as anaesthetists explain to patients how the process works, it all starts to seem a lot less mysterious. And talk, it turns out, is not only cheap but effective: a preoperative visit from an anaesthetist has been shown to be better than a tranquilliser at keeping patients calm. I know from my own experience I had surgery on my spine how reassuring such a conversation can be. For me, it was not just the information; it was the fact of the human contact, of being treated as an equal, of being included, rather than feeling like an appendage to a process to which I was, after all, central.

Hank Bennett, an American psychologist, remembers a young girl whose mother brought her to see him some time after the girl had her adenoids removed. The surgeon referred the mother to Bennett after she had returned to him in a state of anxiety about her child. The surgery had been straightforward, but the mother felt that something was very wrong with her previously happy daughter: the child had withdrawn from her family and friends, and had stopped working at school. She could no longer fall asleep without her mother sitting with her, and was afraid of the dark.

Bennett spoke with the girl. He told her there must be a reason she had changed her behaviour, and asked if it might have something to do with the operation.

Bennett recalled: And she said, Yes. They saidthat they were going to put me to sleep, but the next thing I knew, I couldnt breathe. Now, she was only momentarily like that she does not remember the breathing tube going in but when I asked why she was doing these things differently at school and at home, she said: Well, I have to concentrate and I cant be bothered by anything. Ive got to make sure that I can breathe.

Bennett referred the girl to a child psychologist, and within weeks she was back to herself. Today she would be approaching middle age. But lets say that was just luck, Bennett says now. What if nothing had been picked up about that? Would she have been permanently changed? I think that you would say, yes, she probably would have been.

So if you were my anaesthetist and I your patient, there are some other things Id hope you would do in the operating theatre. Things that many already do. Be kind. Talk to me. Just a bit of information and reassurance. Use my name. Patients who remember waking are often greatly relieved at having been told what was happening to them, and reassured that this was OK and that they would now drift back to sleep.

The Fifth National Audit Project on accidental awareness during general anaesthesia states: The patients interpretation of what is happening at the time of the awareness seems central to its later impact; explanation and reassurance during suspected accidental awareness during general anaesthesia or at the time of report seems beneficial. Hospital staff could put a sign on the wall of the operating theatre: The patient can hear. Because one of the strange things about anaesthetic drugs is that they can exert their effect in each direction not just upon the patient, but upon the doctors and theatre staff performing the procedure.

After the teenage son of a good friend was badly burned in an accident some years ago, he had to endure weeks of intense pain, culminating each week in the agonising ritual of nurses changing the dressings on his chest and arms. They did this by giving him a dose of a sedative drug designed to distract him from the pain and prevent him remembering it. My friend would attempt to comfort her son as he yelled and as the nurses got on with their difficult task. What she observed was that while the drugs did give her son some distance from his pain, and certainly his memories of it, they also gave the nurses some distance from her son. It was an understandable, perhaps necessary, distance; but inherent in that tiny retreat (the lack of eye contact, the too-bright voices) was a loosening of the tiny filaments that connect us one to another, and through which we know we are connected.

It is a process inevitably magnified in the operating theatre, where the patient is silent and still, to all intents absent, and where their descent into unconsciousness is routinely accompanied by the sounds of the music being cranked up (one prominent Australian surgeon is said to favour heavy metal), and conversation. It need not take a scientific study to tell us that this deepening of respect and focus is good not only for patients, but for doctors, too. In the end, it might not even much matter what you say. During an operation, a soothing voice may be more important than what the voice says, writes psychologist John Kihlstrom, who still encourages anaesthetists to talk to their anaesthetised patients (about what is going on, giving reassurance, things like that) but acknowledges that he doesnt expect them to understand any of it not verbally at least.

Japanese anaesthetist Jiro Kurata calls this care of the soul. In an unusual and rather lovely paper delivered at the Ninth International Symposium on Memory and Awareness in Anaesthesia in 2015, he wondered if there might be part of our existence that cannot ever be shut down, which we cannot even conceive by ourselves a subconscious self that might be resistant to even high doses of anaesthetics. He called this the hard problem of anaesthesia awareness. I have no idea what his colleagues made of it. But his conclusion seems unassailable.

Any solution? Science? Yes and no. Monitoring? Yes and no. Respect? Yes. We must not only be aware of the inherent limitation of science and technology but, most importantly, also of the inherent dignity of each personal self.

Anaesthesia: The Gift of Oblivion and the Mystery of Consciousness by Kate Cole-Adams (Text Publishing Company, 12.99) is published on 22 February. To order a copy for 9.99, go to guardianbookshop.com

Follow the Long Read on Twitter at @gdnlongread, or sign up to the long read weekly email here.

Read more: https://www.theguardian.com/news/2018/feb/09/i-could-hear-things-and-i-could-feel-terrible-pain-when-anaesthesia-fails

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