The Mystery of the Unconscious

The Mystery of the Unconscious

"Comfortably Numb," written by John Travis (2004) for Science News online, is an article that I stumbled upon when searching for anesthesia related articles. I have a newfound curiosity and interest in the workings of anesthesia which was born from my recent shadowing experience in an operating room. I had expected the most interesting part of the OR to be the open cavity on the surgical table, but what attracted me most were the ominous looking machines that stood at the patients head. The tanks, gauges, lines, and wires had a mesmerizing effect on me. Even more intriguing was the calm, quiet individual who sat back and observed every motion, every breath, and every heartbeat that occurred. She had a very mysterious aura to her. When the site of bone shards flying out of an open body cavity became a little overwhelming, I found myself beginning my exploration of the world of anesthesia with her as my guide.

My churning stomach and lack of oxygenated blood to my brain (I had put my mask on a little too tight--was breathing in my own CO2) made it a little difficult to understand what the anesthetist told me about her career, but what I did catch sent me full-throttle into exploring anesthesia as a possible career. That week, in and out of the OR, I found myself weighing my options while trying to find my niche in health care. First, I was scared away from the psychiatric unit--where I initially envisioned myself--by the depressed, demented, and angry geriatrics. At the next option on my list, neurosurgery, I was thoroughly grossed-out at the sight of spinal juices flowing through decrepit seventy-year-old vertebrae (which were in the process of being replaced, hence the flying shards of bone). Just as I saw the options in my areas of interest dwindle before my eyes, anesthesia magically appeared.

As I investigated further outside of the hospital, I learned that the history of anesthesia is more magical than I ever would have imagined. That quiet anesthetist is one of many mysterious qualities in the field of anesthesia. As it turns out, the actual mechanisms behind how anesthetics work are not very well understood. Doctors just stumbled upon ether one day, discovered its magic, and have been using it--and its more modern derivatives--ever since.

"Comfortably Numb" explains some of the history of anesthesia, and the lack of research in the field. The author mentions the problem of anesthesia being filled with untestable hypotheses--until recently. Travis' article gathers several instances of cutting edge research in the field and summarizes it for the general public to understand. However, it does not appear that Travis had the general public in mind when writing his review, due to the highly technical aspects of the article. Based on the terminology that he uses, I assume the audience he envisioned would be at least somewhat proficient in biology. My biological education is limited to high school AP Biology, and it gave me just enough knowledge to struggle through and barely grasp the main points. Travis brought up a topic that is obviously very interesting to me, but I don't think he does a great job of making the article interesting to a slightly wider audience. Experts in the field of anesthesia will probably already have read or at least heard of the research that is uncovering the previously mysterious mechanisms of anesthetics. That doesn't leave very many people as an audience--it seems that only students with some knowledge of biology and an interest in the field are going to read this article.

Another aspect of the review that is lacking is the relevance of the discoveries that are being made. Travis goes into plenty of detail about GABA receptors, but doesn't give a general overview of what these discoveries mean for the understanding of anesthetics. I would like to know how this new research and information broadens our currently limited understanding. He does, however, include what these discoveries may lead to in terms of future research. These include improvements on the existing drugs that are used as anesthetics, as well as opening the door to understanding consciousness and other aspects of the mind that are unknown. Perhaps, if he wanted to broaden the audience for the article, Travis could go into more detail on these topics. Levels of consciousness definitely fall into the category of "sexy science" and would make for a great cover story in any science magazine or newspaper.

Despite Travis' shortcomings with audience and technicality, he did accurately convey the primary research. In fact, reading his article was very helpful for my understanding of the primary sources he was writing about. The research that was the main focus of the article, General anesthetic actions in vivo strongly attenuated by a point mutation in the GABAA receptor Я3 subunit (Jurd et. al. 2003), is very well summarized by Travis. Even though it is still too technical for me to understand completely, he remains true to the actual research while giving the general public an idea of what was going on. He was, perhaps, a little overzealous when he attempted to cover seven primary sources in one article--it would be impossible to include all of the main points accurately without generalizing too much. For taking on such a monumental task, Travis did a fairly good job of simplifying without grossly over generalizing.

To make his job easier, he could have narrowed down his primary sources a little. For example, Inhalational Anesthetic-binding Proteins in Rat Neuronal Membranes (Xi et. al., 2004) and Multiple Specific Binding Targets for Inhaled Anesthetics in the Mammalian Brain (Fazen Eckenhoff et. al, 2002) are journal articles covering very similar research. He could have used only one of these articles, especially because one is more recent. Another article that Travis references but doesn't use in his