The Best American Science and Nature Writing 2014

by Deborah Blum

  “We can see that human interactions with the landscape are increasing,” Philip Gibbard, a stratigrapher at Cambridge, told me. “No one disputes that. We build buildings. We build towns. We build roads. We drop plastic bags in the ocean. All that’s absolutely true. But from a geological perspective—and I have to speak as a geologist, not as a generally interested person—I think what’s happening now is just a logical continuation of something that began as human populations started to increase at the beginning of the Holocene.

  “It is quite exciting to pursue this new idea,” he added. “But I’m suspicious of it.”

  Other critics are skeptical of the idea for opposite reasons. They point out that human impacts on the planet are likely to become even more pronounced, and hence more stratigraphically significant, as time goes on. Thus, what’s sometimes referred to in geological circles as the “event horizon” has not yet been reached.

  For his part, Zalasiewicz is sympathetic to both lines of argument. Humans have been altering the planet for quite a while, though probably the impacts of the past were orders of magnitude more modest than they are today. And a few centuries from now the impacts of human activity may be orders of magnitude greater again. By the time people are through, Zalasiewicz told me, he wouldn’t be surprised if the earth were rendered more or less unrecognizable. “One cannot exclude a P-T-type outcome,” he observed, referring to the worst of the so-called Big Five, the end-Permian, or Permo-Triassic, extinction. In the meantime, though, he said, “we have to work with what we’ve got.”

  This past summer, I went with Zalasiewicz on another collecting trip, this one to Wales. Zalasiewicz has a special fondness for the country. He wrote his dissertation on the stratigraphy of northern Wales, and while finishing his research he drove around in a decommissioned postal van and lived in a camper that had been used as a chicken coop. He wanted to show me a spot near the town of Ponterwyd where he thought there should perhaps be another golden spike—in this case, marking the base of the Aeronian Stage of the Silurian. We set out from the town of Keyworth, in Nottinghamshire, where Zalasiewicz lives with his wife and teenage son, and drove through the West Midlands. In its day the West Midlands was the industrial heart of Britain. Now the industry is mostly gone, and people struggle to find work. “About as scary an advertisement for the Anthropocene as you can imagine” is how Zalasiewicz described the region.

  When we arrived at Ponterwyd, smirr was falling or, as the Welsh put it, piglaw. Again there were lots of sheep and green, sheep-shorn hills and rocks filled with fossils. Banging away at an outcropping, I soon found several graptolites. One, which Zalasiewicz identified as belonging to the species Monograptus triangulatus, looked like a tiny saw blade, with miniature triangular teeth. With characteristic tact, he told me that my specimen was “very lovely.” I stuck it in my bag.

  A few days later, I took the train back to London and then the Tube out to Heathrow, where I was spending the night at an airport hotel. Thanks to all the graptolites I’d gathered, my suitcase was overweight, and I decided that I was going to have to deaccession some of them. I took what seemed to be the least impressive examples and headed out through the lobby, only to realize that there was nowhere to go. The hotel faced a ten-foot wall, which was made of plywood and covered with billboard-size sheets of plastic printed with photographs of trees. The photos kept repeating, so that walking along was like getting lost in a dark monoculture. Beyond the plywood wall, there was a parking lot, and beyond that an access road. I figured that the parking lot would have to do. By this point I’d spent enough time with Zalasiewicz that the place appeared to me as a mosaic of human impacts. The lot was edged with a margin of dirt; this was filled with scraggly plants, many of them no doubt introduced species. Strewn among the weeds was the usual flotsam of travel: empty water bottles, crumpled candy wrappers, crushed soda cans, half-eaten packages of crisps. I recalled what Zalasiewicz had told me about aluminum, which is that until the late nineteenth century it did not exist on earth except in combination with other elements. So soda cans may provide yet another marker of our presence: the Dr Pepper spike.

  It was a lovely evening. A half-moon hung in a purple sky crisscrossed by jet contrails. I took out my graptolites. Most I couldn’t identify, but one, I thought, belonged to the species Rhaphidograptus toernquisti, which Zalasiewicz had described to me as among life’s great success stories. Rhaphidograptus toernquisti managed to persist, unchanged, for some five million years. I placed my fossils in a little pile next to a discarded cigarette pack. Nearby I noticed a plastic pouch with the word TOXIC printed in block letters. The pouch was torn, and some ominously bright yellow powder was leaking out of it. I tried to imagine a geologist in the year A.D. 100,000,000 stumbling onto the site. It was hard for me to picture what he (or it) would look like, but I got a certain satisfaction thinking about how puzzled he would be when he came upon my Silurian graptolites nestled amid the wreckage of the Anthropocene.

  JOSHUA LANG

  Awakening

  FROM The Atlantic

  LINDA CAMPBELL WAS not quite four years old when her appendix burst, spilling its bacteria-rich contents throughout her abdomen. She was in severe pain, had a high fever, and wouldn’t stop crying. Her parents, in a state of panic, brought her to the emergency room in Atlanta, where they lived. Knowing that Campbell’s organs were beginning to fail and her heart was on the brink of shutting down, doctors rushed her into surgery.

  Today removing an appendix leaves only a few droplet-size scars. But back then, in the 1960s, the procedure was much more involved. As Campbell recalls, an anesthesiologist told her to count backward from ten while he flooded her lungs with anesthetic ether gas, allowing a surgeon to slice into her torso, cut out her earthworm-size appendix, and drain her abdomen of infectious slop, leaving behind a lengthy longitudinal scar.

  The operation was successful, but not long after Campbell returned home, her mother sensed that something was wrong. The calm, precocious girl who had gone into surgery was not the same one who emerged. Campbell began flinging food from her high chair. She suffered random episodes of uncontrollable vomiting. She threw violent temper tantrums during the day and had disturbing dreams at night. “They were about people being cut open, lots of blood, lots of violence,” Campbell remembers. She refused to be alone but avoided anyone outside her immediate circle. Her parents took her to physicians and therapists. None could determine the cause of her distress. When she was in eighth grade, her parents pulled her from school for rehabilitation.

  Over time Campbell’s most severe symptoms subsided, and she learned how to cope with those that remained. She managed to move on, become an accountant, and start a family of her own, but she wasn’t cured. Her nightmares continued, and nearly anything could trigger a panic attack: car horns, sudden bright lights, wearing tight-fitting pants or snug collars, even lying flat in a bed. She explored the possibility of posttraumatic stress disorder with her therapists but could not identify a triggering event. One clue that did eventually surface, though, hinted at a possibly traumatic experience. During a session with a hypnotherapist, Campbell remembered an image, accompanied by an acute feeling of fear, of a man looming over her.

  Then, one fall afternoon in 2006, four decades after her symptoms began, Campbell met an anesthesiologist at a hypnotherapy workshop. Over lunch she found herself telling the anesthesiologist about her condition. She mentioned the appendectomy she’d had not long before everything changed.

  The anesthesiologist was intrigued. He told her about a phenomenon that had sometimes accompanied early gas anesthetics, particularly ether, in which patients reacted to the gas by coughing and choking, as if they were suffocating.

  The comment sparked something in Campbell. “I started having all these flashes,” she remembers. “The flashes were me being on the table. The flashes were of the room. The flashes were of the bright lights over me.” A man—the same one from her memory?—was there. At some point the roo
m went black. “And then I got to the place where I was on the table, and I just remember feeling terror,” she says. “That’s all I remember. I don’t see anything. I don’t feel anything. It’s absolute, abject terror. And the feeling that I am dying.” At that moment, Campbell realized that something had happened to her during her appendectomy, something that changed her forever. After several years of investigation, she figured it out: she had woken up on the table.

  This experience is called “intraoperative recall” or “anesthesia awareness,” and it’s more common than you might think. Although studies diverge, most experts estimate that for every thousand patients who undergo general anesthesia each year in the United States, one to two will experience awareness. Patients who awake hear surgeons’ small talk, the swish and stretch of organs, the suctioning of blood; they feel the probing of fingers, the yanks and tugs on innards; they smell cauterized flesh and singed hair. But because one of the first steps of surgery is to tape patients’ eyes shut, they can’t see. And because another common step is to paralyze patients to prevent muscle twitching, they have no way to alert doctors that they are awake.

  Many of these cases are benign: vague, hazy flashbacks. But up to 70 percent of patients who experience awareness suffer long-term psychological distress, including PTSD—a rate five times higher than that of soldiers returning from Iraq and Afghanistan. Campbell now understands that this is what happened to her, although she didn’t believe it at first. “The whole idea of anesthesia awareness seemed over-the-top,” she told me. “It took years to begin to say, ‘I think this is what happened to me.’” She describes her memories of the surgery as being like those from a car accident: the moments before and after are clear, but the actual event is a shadowy blur of emotion. She searched online for people with similar experiences, found a coalition of victims, and eventually traveled up the East Coast to speak with some of them. They all shared a constellation of symptoms: nightmares, fear of confinement, the inability to lie flat (many sleep in chairs), and a sense of having died and returned to life. Campbell (whose name and certain other identifying details have been changed) struggles especially with the knowledge that there is no way for her to prove that she woke up and that many, if not most, people might not believe her. “Anesthesia awareness is an intrapersonal event,” she says. “No one else sees it. No one else knows it. You’re the only one.”

  In most cases of awareness, patients are awake but still dulled to pain. But that was not the case for Sherman Sizemore Jr., a Baptist minister and former coal miner who was seventy-three when he underwent an exploratory laparotomy in early 2006 to pinpoint the cause of recurring abdominal pain. In this type of procedure, surgeons methodically explore a patient’s viscera for evidence of abnormalities. Although there are no official accounts of Sizemore’s experience, his family maintained in a lawsuit that he was awake—and feeling pain—throughout the surgery. (The suit was settled in 2008.) He reportedly emerged from the operation behaving strangely. He was afraid to be left alone. He complained of being unable to breathe and claimed that people were trying to bury him alive. He refused to be around his grandchildren. He suffered from insomnia; when he could sleep, he had vivid nightmares.

  The lawsuit claimed that Sizemore was tormented by doubt, wondering whether he had imagined the horrific pain. No one advised Sizemore to seek psychiatric help, his family alleged, and no one mentioned the fact that many patients who experience awareness suffer from PTSD. On February 2, 2006, two weeks after his surgery, Sizemore shot himself. He had no history of psychiatric illness.

  Before the introduction of ether in the mid-nineteenth century, surgery was a rare and gruesome business. One of the most common operations was amputation. Surgeons used saws and knives to remove the offending appendage, and boiling oil and scalding irons to cauterize the wound. They resorted to a variety of methods, some more dangerous than others, to manage patients’ pain. James Wardrop, a surgeon to the British royal family in the nineteenth century, wrote of a procedure called deliquium animi, in which he bled patients into quiescence. Others used alcohol, opiates, ice, tourniquets, or simple distraction.

  The promise of painless surgery remained a preposterous idea in mainstream medicine until October 16, 1846. On that day, at the Harvard-affiliated Massachusetts General Hospital, a dentist named William Thomas Green Morton gave the first public demonstration of ether gas, administering it to a patient whose neck tumor was then removed by a surgeon. The event took place in a domed amphitheater now known as the “ether dome,” and earned Harvard Medical School a truly international reputation. Oliver Wendell Holmes Sr., who coined the term anesthesia(from the Greek word anaisthe¯sia, meaning “lack of sensation”), rejoiced that “the fierce extremity of suffering has been steeped in the waters of forgetfulness, and the deepest furrow in the knotted brow of agony has been smoothed for ever.” In 2007, when the British Medical Journal asked subscribers to name the most significant medical developments since 1840, anesthesia was among the top three, along with antibiotics and modern sanitation.

  The miracle of anesthesia transcends pain. Painkillers—mainly opiates and alcohol—existed before ether, but they weren’t sufficient to quell the nightmare of surgery. Ether accomplished something altogether different: it eliminated both experience and memory. When the drug wore off and patients woke up, their bodies stitched together and their minds intact, it was almost as though the intervening hours hadn’t happened. The field that emerged from that historic moment in the ether dome was less concerned with the broad goal of curing disease than with a single task: the mastery of consciousness.

  Anesthesia is often taken for granted in the daily routine of medicine today, both by health professionals and by the tens of millions of Americans who undergo surgery each year. Anesthesiologists are imbued with an almost heavenly power: with a mere push of their thumb on a clear plastic syringe, you go under. But in the past decade or so, several highly publicized cases, including Sherman Sizemore Jr.’s, have brought anesthesia awareness into the public forum. In 1998 a woman named Carol Weihrer, who claimed to have suffered awareness while having her eye removed, founded the Anesthesia Awareness Campaign, an advocacy group and resource for victims, and made the talk-show rounds. In 2007 the Hollywood thriller Awake intended, according to a producer, to “do to surgery what Jaws did to swimming in the ocean.” Fearful of malpractice lawsuits, the profession grew defensive. The American Society of Anesthesiologists promised to find the cause of and solution for awareness. “Even one case is one too many,” wrote the society’s president in 2007.

  This promise, however, is not so easily fulfilled. Despite 167 years of research, anesthesiologists still have little idea how their drugs unlock the mind. Which gears turn and unwind to produce oblivion? How do they turn back into place? These questions, as important as they are for preventing anesthesia awareness, are dwarfed by a central riddle that has puzzled scientists and philosophers—not to mention most mildly introspective people—for hundreds, if not thousands, of years: What does it mean to be conscious?

  Doctors began investigating how anesthesia affects consciousness during the 1960s, shortly after the first reports of awareness. One South African researcher was especially curious about whether and how one might recall memories from a surgery. Perhaps a near-death experience? Pushing well beyond the limits of what would today be considered ethical, he collected ten volunteers undergoing dental surgery. The procedures went along as normal until, midway through, the room went silent and the medical staff reached for scripts.

  “Just a moment!” the anesthesiologist would say. “I don’t like the patient’s color. Much too blue. His [or her] lips are very blue. I’m going to give a little more oxygen.”

  The anesthesiologist would then act out a medical emergency, rushing to the patient’s bedside to ventilate his or her lungs, as if this action were necessary to save the patient’s life. After several moments, the team would breathe a collective sigh of relief.

&
nbsp; “There, that’s better now,” the anesthesiologist would affirm. “You can carry on with the operation.”

  A month later, the patients were hypnotized and asked to remember the day of the surgery. One female patient said she could hear someone talking in the operating theater.

  “Who is it who’s talking?” the interviewer asked.

  “Dr. Viljoen,” she said, referring to the anesthesiologist. “He’s saying my color is gray.”

  “Yes?”

  “He’s going to give me some oxygen.”

  “What are his words?”

  A long pause followed.

  “He said that I will be all right now.”

  “Yes?”

  “They’re going to start again now. I can feel him bending close to me.”

  Of the ten volunteers, four remembered the words accurately; four retained vague memories; and two had no recollection of the surgery. The eight patients who did remember it displayed anxiety during the interview, many of them bursting from hypnosis, unable to continue. But when out of hypnosis, it was as though nothing had happened. They had no memory of the incident. The terror and anxiety seemed permanently buried in their subconscious.

  This experiment revealed a fundamental problem for the study of awareness, the frequency of which can be measured only through reported accounts. For some victims, it can take weeks for memories to surface. For Linda Campbell, it took forty years. But what if no memory remains? Did awareness happen? Does it matter?