This next anecdote deals with a moment in a series of medical events. The decision to proceed with heart surgery had actually been made a few years earlier but before they could get down to it I was diagnosed with cancer. On that hangs another tale but this one is pretty good on its own.
Ed and Me
When Donna, and I first met with the heart surgeon he said with neither wink nor nudge: “Having surgery at this point may seem strange to you since you have no symptoms. However, it is not uncommon in cases such as yours that the first symptom with which the patient presents is sudden death, and we would like to avoid this complication if we can.” So on October 5th 1993 I entered the Toronto General Hospital for heart surgery that was scheduled to take place the morning of the next day.
I had opted for a surgical procedure whose promise of perhaps being more durable – hence delaying if not avoiding another go round – was offset by its being both experimental and more difficult surgery. Being a more complicated procedure implied being on the heart-lung machine for longer, being under anesthetic longer, more of all kinds of nasty stuff. The operation took more than 5 hours, which was a couple of hours longer than anticipated. The surgeon later said this was because the damage was much more advanced than had been anticipated. In any case the operation has been deemed successful. While the operation and recovery have, so far, been relatively uneventful from a medical standpoint they have been accompanied by some curious events.
Projection of the Double
In the weeks before the surgery besides developing a few mild symptoms, shortness of breath and fatigue (that may have just as likely been psychogenic) I also started to imagine what might happen during the surgery. I don’t mean all the horrible slipups that might occur. That was not the issue. What held me enthrall were the great stories that one hears about people who during surgery claim to hear the doctors talking; claim to see the surgery underway; claim to see themselves from outside. They explain how, during some surgical procedure, and with the assistance of a general anesthetic, they found themselves looking down from the ceiling of the operating theatre at the action unfolding around their recumbent form. They tell us in great detail and with wonderful precision what they saw, what they heard, and what could be more exciting than that?
Facing the cruel certainty of the surgeons blade who could resist the promise of a life not limited to the, apparently, too weak flesh. Imagine if your mind could reach out beyond the confines of your body, if life wasn’t dependant on the vagaries of neurochemistry. Anyway the idea of ‘tearing around outside of my body’ was very appealing and I thought quite a bit about how I might pull this off. After all I knew something about flying about.
As I mulled it over it seemed to me that the major problem with my plan oftemporary liberation from the suffocating confines of the flesh was, the likelihood being overwhelmed by the anesthetic; I would almost certainly be unconscious before I managed to figure a way to slip the mortal coil. My only chance lay in the possibility of preparing—of rehearsing the image and intention in such a way that at the crucial moment before losing consciousness I might, perhaps, with luck, slip away….
And come back… of course.
I spent the day before the surgery asking the doctors, nurses, and attendants about what I should expect. If they thought this was just normal apprehension from someone who was about to have their chest split open, pried apart, their heart stopped and…. If that’s what they thought they must have soon begun to suspect there was more afoot. I grilled them for every detail: What does it look like? What happens then? Where? Who does it and what does it smell like? I would construct the most precise picture possible and then imagine the process, rehearsing it over and over so that I might produce a new kind of reflex that would, paradoxically, be set in motion by my loss of consciousness.
Once the end of visitor’s hours had dispatched the friendly distraction of concerned faces I was able to turn my attention to the task at hand. Lying in my narrow hospital bed I starred at the walls, which were appropriately painted a slightly queasy hospital green. I reviewed the images letting them play out in my imagination searching for when, and how, I might find my way out of the constraints of my own body.
Tomorrow very early they would wash me twice, I couldn’t quite imagine the smell of the special antiseptic soap but I could almost feel the razor, hear it as they shaved my arms and chest. I knew that they would wash me for a third time before the anesthetist came around to insert the IVs in each arm and then administer some delicious narcotic. I would then be wheeled down to the surgery. They told Donna that she could accompany me as far as the surgery doors but then she would have to wait in the designated area.
Sickness Unto Death
I had been rehearsing my images of the surgery for some weeks already, adding details as I discovered more about the procedures but concentrating on forming a clear intention to ‘fly’ as the anesthetic kicked in. And if it worked? What would it mean if afterward I remembered leaving my body and gently drifting upward? Would it just be a dream that I had managed to preprogram? Would it mean I had actually been outside myself? How would I know what to believe?
The days preceding my surgery brought with them other occurrences that came to pressure me more than the upcoming event. My friend Ed had at this same time been informed that he had an untreatable and terminal cancer (at the same time his wife was told she had a uterine growth that maybe cancerous — it ended up being benign, but at the moment it added to the general climate and the sense of improbability).
These, and a number of other, unlikely and unfortunate situations weighed heavily on our circle of friends. It felt like one more link in a chain of deaths and illnesses in which we’d somehow become entangled. Besides those friends who formed part of this stochastic improbability there were a number of cases that I brought to my personal version of ‘the list’. There was the suicide of a childhood friend, a death made more poignant since I was perhaps the last person he spoke to before he killed himself; a young woman dead from breast cancer, another dying. Around the time I began chemotherapy an old friend and mentor died in the hospital after receiving minor surgery to his hand. Then my oldest friend (we had grown up together) died unexpectedly of a massive heart attack. The deaths and near misses included, my own bout with cancer only a couple of years earlier.
Now there was this situation with Ed, an old comrade, and recently promoted to the status of my oldest living friend; the likelihood of his imminent death weighed on me. Is there something I could do to help him live? Is there something I should do to help him prepare to die? When I entered the hospital in Toronto for heart surgery he entered a hospital in the city of London Ontario some 300km to the west. I would be undergoing heart surgery and he would be having the sack around one lung drained of fluid. Then through a process of irritation the pleura would be forced to bind to the lung so no more liquid could accumulate there. This was not meant to affect the course of his disease in anyway — it was only to make him a little more comfortable as he waited to die.
The Tricks Of Memory
I recall clearly how on the morning of my surgery the orderly showed me the way to the shower; he handed me a squeeze bottle of antibiotic soap and a towel. I remember the colour and smell of the soap, the rough texture of the towel. I can vividly recall the orderly’s face and mannerisms but not as clearly as his sure and decisive movements, when, back in my room, he shaved my arms and chest. It is here that things get a bit strange. I know certain events took place after these minor indignities and before I received any drugs, but I can’t recall any of it clearly; in fact was only sometime later, and after talking with people who were there that I started to ‘remember’ any of it.
I remembered being shaved; I didn’t remember my wife coming in and chatting with me for the next hour or so. I didn’t remember joking with her and the doctor as I was taken to the operating theatre. I didn’t remember that a friend working at a hospital nearby dropped by to see me. I didn’t remember the anesthetist coming in talking with me or starting my medication. In other words it’s not just that I don’t remember ‘flying’ or anything else after the anesthetic I don’t remember events that took place before I was ‘medicated’. In fact over the next days the question of what I remembered and, even more troubling, who was remembering it, were to become pretty serious problems for me.
After the operation I was taken to intensive care where I spent the next day or so under the watchful eye of monitors both electronic and human. Intensive care meant one nurse per patient, it also meant being hooked up to a number of machines. Some of them monitored vital functions others substituted for those functions — like the machine, which, through a tube down my throat, breathed for me. That tube came out some hours after the surgery, others like the tube in the side of my neck or those in my legs and chest came out later, some like the catheter for my bladder came out the next day. The thin silver wires that lay neatly in two small coils on my chest were left in for a few days. These bare metal wires ran directly into my heart and were there in case something needed zapping in a hurry. All these tubes came out on time — no problem. My first post-operative memory has nothing to do with them but with something that may seem much less intrusive, the triangular oxygen mask that covered my mouth and nose. I felt as if I couldn’t breathe and the sweat and irritation from this respirator only seemed to make things worse. The nurses were great, very kind, very compassionate, but with no pity, hard as nails… an interesting combo.
Besides moments of worshipful admiration for the nurses who took turns watching me, my major concerns were the twin problems of how to remove the mask that I felt was asphyxiating me and how to get out of bed. I kept pulling the respirator off and the nurse would gently but firmly insist I put it on. As for the bed I just kept trying to get up, not having much control of my body at this point that intention ended up with my body just tossing and turning or writhing about. The bed was somehow associated with the discomfort I felt and I just knew I should get away from it.
Only A Small Digression
Years ago I was in an accident where the truck I was driving spun out of control on a wet highway and ended up rolling over a number of times till ending up in a ditch. I remember a similar feeling as I stumbled away from the truck and collapsed on the side of the road, the only thing I could ‘think’ was that the truck had hurt me and I should therefore get as far as possible away from it. Same with the bed in intensive care I just wanted to get up. I remember feeling nauseous, I’m told I vomited. A few hours later they brought in a chair and let me sit there. Soon the mask was replaced with a smaller device that delivered oxygen to my nose and didn’t cover my mouth. Things got a bit more comfortable and I was slightly less altered, but still in a twilight world far from daily life. From that point on I remember more things clearly, both external events and certain internal considerations or preoccupations.
The external events were simple: the next day I was moved to a less intense observation room called a ‘step down room’ and a day or two later to a normal room for the rest of the week. I started to walk around and people came to visit me. I didn’t sleep much but I could concentrate, I could converse, the second night after the operation I read an entire novel. But none of this corresponded exactly to my internal situation, which seemed to gravitate solely around questions of identity and location. As soon as I started to wake from the anesthesia as I lay in the intensive care ward I kept wondering whether I was finished with the surgery or waiting to go into surgery. My chest hurt, I could feel the cut and the bandages, on one hand I knew that meant the operation was over, but I didn’t really believe it; I couldn’t remember so I was sure I must be waiting to go into the operating theatre. The only certainty I had in all of this was the feeling that it would not be a good idea to ask the doctors or nurses because they would think I was confused and keep me in the hospital longer.
The question of whether I was waiting for the operation or recovering from it was one that kept reoccurring over the next few days — as well as the feeling that it would be better not to let anyone know that I didn’t know what was going on. This was not my only preoccupation however, not even the major one. Much of the time I thought about Ed and the situation he was in, suddenly I would realize that I was not in the same hospital that he was. It would dawn on me that I was in Toronto and he was hundreds of kilometers to the west in a different hospital, in a different city. At other moments I would realize I wasn’t in London but I would find myself either in a hospital to the northwest of where I actually was (a non-existent hospital) or in another (non-existent) city. These places not only seemed real but familiar; it seemed perfectly normal to be there – wherever there was at that moment.
I suppose I must plead guilty to a certain paranoia, for example It seemed obvious to me that I shouldn’t let anyone know that I didn’t have a clue whether I was going in for an operation or recovering from one. If they knew they’d want to investigate my confusion and probably keep me there longer. In the same way it seemed obvious to me that I shouldn’t tell a doctor that I didn’t have any idea where I was or even who I was. In any case what would I say to the doctor, that at moments I thought I was at some hospital visiting my poor friend Ed? That a few times I thought I was in the hospital not for heart surgery but because I had incurable lung cancer. Or that sometimes I would vanish or perhaps I should say transform. I would be lying on my bed (or shuffling along the hallway, or sitting watching television) and then the ‘I’ that was a moment ago me was now Ed. It wasn’t that I thought I was Ed, anymore than you sit around thinking you are you. It was just that I was him. Trying to clarify ‘who’ was feeling all this would be difficult, but there it is – I would wake up, and as I waited to see my doctor at the same time I was Ed waiting in his hospital for the result of some test. Or perhaps I would just be sitting in bed and I would suddenly realize that I had, a moment ago, been Ed lying in his bed in his hospital room
And Recuperation Continues
Within a week after the operation these ‘delusions’ were pretty well gone. It was also around this time that I started almost inadvertently, in conversation with those who had been there, to ‘reconstruct’ some of the memories of what happened before the surgery: who had visited me, who I had spoken to, what we joked about etc. Still even now those delusions, those strange displacements of time, place and identity seem more real than those reconstructed memories of what I know must have happened.
These descriptions don’t capture the strangeness or the ordinariness of these moments. They were strange after the fact, in that they revealed a great confusion. They were also strange because they kept occurring over the next days in a range of variations. All this however seemed very ordinary in the moment—it was obvious I was me (who ever that was) here (wherever that happened to be); in one hospital or another in Toronto, in London or in some other place, I was myself (?) recovering from surgery or waiting to go under the knife, dying of untreatable lung cancer or visiting a friend in the hospital. I, maybe I was not me at all, I was my friend Ed.
While I started to recover quickly they kept me in the hospital a few extra days, not because they’d discovered that I’d lost my mind but simply because of a mild infection. Had I mentioned my strange symptoms it might have been dismissed as a consequence of the anesthetics. A bright young medical student might have, however, scribbled ‘pump head’ on their notes. It’s a term that’s sometimes used for those whose brains are affected as a consequence of the heart-lung machine. The machine that’s used to keep the blood flowing, it can have some pretty serious –sometimes-permanent – neurological consequences.
Oh yeah, as for flying out of your body. You can imagine what a great relief it was for me when a researcher in Virginia recently offered scientific reassurance regarding those cases where patients reported finding themselves out of their bodies during surgery. His report maintained that these experiences were in fact nothing to worry about. According to this diligent scientist what we are dealing with here is not a symptom of mental disease and should not be treated as such. It is simply a reaction to stress.