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You Won't Feel A Thing: Your Brain On Anesthesia.

Anesthesiologist Emery Brown explains what physicians know — and what they don't know — about the effects of anesthesia. Unlocking its mysteries, he says, will help scientists better understand consciousness and sleep — and could lead to better treatments for pain, sleep disorders and depression.

19:29

Other segments from the episode on April 25, 2011

Fresh Air with Terry Gross, April 25, 2011: Interview with Amy Stewart; Interview with Dr. Emery Brown; Obituary for Hazel Dickens.

Transcript

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Where To Find The World's Most 'Wicked Bugs'

TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Our guest, Amy Stewart, wrote a bestselling book a couple of years ago called
"Wicked Plants," about strange and dangerous inhabitants of the botanical
world. For her new book, "Wicked Bugs," Stewart has moved from flora to fauna,
detailing more than 100 species that creep, crawl, fly, sting, bite, infect,
invade and annoy us in ways that will fascinate and sometimes nauseate you.

Stewart writes that she knows that most of the 10 quintillion insects alive
today aren't harmful and do many helpful things, like pollinating plants and
controlling pests. This book, she says, is about the dark side of the
relationship between bugs and humans and about how bugs sometimes abuse one
another.

A word of warning: Some of the descriptions ahead might trigger your gag
reflex.

Amy Stewart has written four previous books on horticulture and the natural
world. She lives in Eureka, California, where she and her husband own an
antiquarian bookstore. She spoke with FRESH AIR contributor Dave Davies.

DAVE DAVIES, host:

Well, Amy Stewart, welcome to FRESH AIR. I read your book, and I'm all itchy.

(Soundbite of laughter)

DAVIES: Start us out with a good one here. Tell us about the Asian giant
hornet.

Ms. AMY STEWART (Author, "Wicked Bugs"): Yes, a large and fearful hornet that
we don't have to worry about too much, but if you were in Tokyo right now, you
might want to start keeping your eye out for.

It's - it injects a deadly neurotoxin. It actually can be fatal. They actually
call it - in Asia, they call it a yak-killer because it has such a potent
neurotoxin.

But the interesting thing about the Asian giant hornet is not just that it's
frightening for people but the way it goes after honeybees.

DAVIES: And how big is it?

Ms. STEWART: Well, you know, this thing, they call it a sparrow wasp because
it's about five centimeters or so. So it actually can look like a little, tiny
flying bird.

DAVIES: And what does it do to bees?

Ms. STEWART: Well, what it does to be is it goes after their colonies. It kills
them, and it steals their honey. So this is actually a very aggressive,
murderous, giant wasp.

And the honeybees have developed this interesting way to fight back, which is
that they can lure one of these giant wasps into their hive and sort of snuggle
up next to them and fly at such a fast pace right around them, just sort of
hover around them and tremble right around them such that they raise the
temperature to exactly 116 degrees, which is just hot enough to kill the wasp
without quite being hot enough to kill the honeybees.

So it's this totally bizarre insect defense with body heat that's otherwise
unknown in the insect world.

DAVIES: And when the Asian giant hornets kill the bees, I mean, how do they go
about that work?

Ms. STEWART: Well, usually they send out a scout first, and the scout will look
for a good hive and might grab a honeybee or two and take it back to feed it to
its young. And if it looks like a good one, they'll mark it with a pheromone,
and then a swarm of them will come and attack.

And they really do, like, tear through the hive, ripping the heads off of
honeybees and tossing their bodies around and robbing the honey. And the bee
larvae and taking them back to feed their own children. I mean, it really is
this brutal massacre of honeybees.

DAVIES: And the other fascinating thing about this creature is that it's - some
extract of it is actually a performance-enhancing drug?

Ms. STEWART: Yeah, this is the strange thing about these giant hornets is that
they don't actually eat much themselves. So they fly around a lot looking for
food for their young. They feed dead insects to their children. But they don't
actually eat much.

So the way they actually get their food is that after they have fed their
young, they bend over, and they sort of tap on their children, and their
children open their mouths and offer up this little drop of clear liquid that's
filled with amino acids and gives the parents energy to go on and do what they
do.

So it turns out that these amino acids are considered a performance-enhancing
drug and that Olympic athletes have actually used it. It's a natural substance.
So it's allowed to be used. And there's actually a sports drink that mimics the
amino acid component of these giant hornets.

DAVIES: Wow. A lot of people have talked about bedbugs. Early in the book, you
introduce us to bat bugs. What are they?

Ms. STEWART: Yes. The African bat bug is a very close relative of the bedbug
that we have all come to fear in this country. The bat bug would rather feed on
bats if it can.

So the way people run across bat bugs is if you were to have bats nesting in
the rafters of your house, maybe up in your attic, which happens, the bat bug
will sort of live in the rafters and just feed on the bats every now and then.
They only need to really eat once a year. So they're not - you know, they're
just on the bats occasionally.

But if the bats go, let's say you close up any gaps in your house so that bats
can no longer get in, then bat bugs will wander around the house and find you
eventually. They are going to find something to eat.

I mean, the interesting thing about bat bugs, too, is that they have this
violent, weird mating method. So even though I was trying not to be too hard on
bugs for what they do to one another, I was rather appalled with the ways in
which bat bugs mate.

DAVIES: Yeah, well, explain that.

(Soundbite of laughter)

Ms. STEWART: So what happens is that the males don't bother looking for any
particular, let's say, access point in the female's body. They sort of just
stab their way into the female's gut any place they can find to inject sperm.

And as you can imagine, the females don't like this very much. And it's
actually very hard on the females. And when you have colonies of bat bugs that
are isolated in a laboratory, so the females can't get away, it kills them
eventually. It's a very violent mating ritual.

So eventually the females developed this little false organ to accept the sperm
so that there would be some way for the sperm to get in without just them being
jabbed anywhere in their body.

And that kind of worked, but then what scientists discovered is that male bat
bugs will actually go after other male bat bugs, as well. So the males
developed a similar and even better false organ to receive the sperm, which
would of course be useless to them, so that they could also avoid being stabbed
anywhere in their body by their fellow male bat bugs.

And then the females, seeing that the males developed an even better version of
this little false organ, improved theirs, too. So there's all these strange
gender-bending changes going on in the bat bug world, as it turns out. And I
don't think it's over yet.

DAVIES: Let's talk about worms a little.

(Soundbite of laughter)

DAVIES: The pork tapeworm, tell us about that, how it gets into the human
intestine and the course it takes there.

Ms. STEWART: Oh, I'm so glad you asked me about the pork tapeworm. I'm totally
- I am totally fascinated with this, and no one wants to talk about tapeworms
with me. So I can't believe you actually want to hear this story. It's an
amazing...

DAVIES: Oh, I'm here, yeah.

(Soundbite of laughter)

Ms. STEWART: It's an amazing story. So here's how pork tapeworm infestations
work is that if a pig is infested with these tapeworms, they will have little
cysts inside of them that contain the larvae of the tapeworms. So those are
inside the pig's body.

And the way that they get into humans is if humans eat pork from pigs that are
infested with the tapeworms, and that meat has not been cooked properly. So
that would be its route into humans.

Now, the weird thing is that pork tapeworms have to get into the body of a
human in order to develop into the next stage of its life cycle. No other
animal works. We are what is called the obligate host of the pork tapeworm.

So once it gets into the human body, it kind of settles into the stomach. It
grows to adulthood. It finds another adult tapeworm and falls in love, and they
have a lot of babies. And the adults can live in the body for, you know, 10, 20
years.

And then the eggs - shall we say that the eggs leave people's bodies the way
that most things leave our bodies...

DAVIES: OK.

Ms. STEWART: ...and that adult tapeworms will eventually leave on their own or
die.

So, but here's the weird thing. So you can say: Okay, well, I don't really have
to worry about pork tapeworms because I don't eat badly cooked pork, and, you
know, pork in this country is - you know, our pigs are healthy and so on and so
forth.

But here's the thing: A person who is infected with tapeworms can spread those
eggs to other people directly, without having to bother with involving a pig in
the process. So this is why it's so important that we wash our hands when we go
to the bathroom.

These little eggs can - if someone handles food, they can get in food. And when
you swallow one of those eggs, instead of getting the larvae from the pig, if
you actually get an egg in you, then that little creature hatches and behaves
very differently.

It doesn't just settle down in your stomach and start laying eggs. It travels
all over your body. It sort of feels free to explore. It might get in your
lungs. It might get up into your brain. It might go sort of anywhere.

So you actually have cases of people being diagnosed with brain tumors only to
find out what they actually have is a tapeworm living in their brain. And what
really astonished me is that tapeworms in the brain are the leading cause of
epilepsy worldwide.

DAVIES: Really? Wow.

Ms. STEWART: Yeah.

DAVIES: Can people sense a tapeworm in their intestine?

Ms. STEWART: It does not appear so. I mean, pork tapeworms are actually pretty
widespread in places in the world where a lot of pork is eaten, and while it
might cause some digestive problems, a lot of people don't know that they have
them.

DAVIES: Our guest is Amy Stewart. Her book is "Wicked Bugs." We'll talk more
after a break. This is FRESH AIR.

(Soundbite of music)

DAVIES: If you're just joining us, our guest is writer Amy Stewart. She has
written a new book about scary, creepy, crawly things called "Wicked Bugs."

You have a chapter about zombie bugs and some of the ways that they use and
abuse other species. Let's talk about the emerald cockroach wasp. This isn't a
cockroach, this is a wasp, a jewel wasp, right, but it has a special
relationship with a certain kind of cockroach, right? Explain this.

Ms. STEWART: Yes. This is a wasp that likes to actually lay her eggs inside a
particular species of cockroach. So what she does is she goes and finds herself
a good cockroach, and she stings it, and the sting kind of paralyzes it for a
minute. And she's able to get her stinger right into the brain of the roach and
inject a sting into the part of the cockroach's brain that actually sort of
disables it from any instincts to run away.

So it makes it this very docile, obedient cockroach, if you can believe this.
And so then the roach pretty much does her bidding, and she's able to grab it.
They have even been seen grabbing on to the antennae of a cockroach and leading
it around the way you'd lead a dog around on a leash.

And she can lead the cockroach around, park the roach wherever she wants it to
be, lay her eggs on the roach's belly, and it will just sit around and wait for
the eggs to hatch, and the larvae eat the roach. I mean, that's the whole point
of laying the eggs there.

And it very patiently puts up with that and basically allows itself to be
devoured. And it ends up becoming a protective cocoon for the larvae as they're
getting ready to emerge into adulthood.

DAVIES: Yeah, well, I guess some would consider that a fitting fate for
cockroaches.

Ms. STEWART: Right, yes, we all hate cockroaches.

DAVIES: But I'm fascinated that somebody somewhere has studied this wasp and
has actually observed it stinging the cockroach's brain in exactly the right
spot and then leading it around by this little antennae leash. This has all
been observed and studied.

Ms. STEWART: You know, you bring up a good point. Entomologists are my favorite
people in the world. For every bug, there is an entomologist somewhere who is
more than happy to tell you about the lifetime of research they've devoted to
that particular little insect.

I had such a good time tracking down people who have spent their whole lives
specializing in and studying these insects. I found two different entomologists
who study the insects of the Civil War, the insects that affected Civil War
soldiers.

And one of them is in fact himself a Civil War re-enactor, and he carries
around live examples of the kinds of bugs that would have lived on the soldiers
and lived in their food, as well. There were weevils in the hard tack. I mean,
bugs were a big part of the Civil War, and it's just fascinating to me that
someone has decided to make that their life. I love these people.

DAVIES: So someone is carrying weevils for their hard tack biscuits for a re-
enactment?

Ms. STEWART: Carrying weevils around but not just weevils, also lice and
bedbugs and all the other critters that actually inhabited the soldiers
themselves and not just their food.

DAVIES: Oh, boy. One more of these zombie creatures: the green-banded broodsac.
Do I have this right?

Ms. STEWART: The green-banded broodsac. So what I love about the green-banded
broodsac is how highly improbable a lifecycle like this actually is.

So this is a tiny, little flatworm that begins its life in the gut of a bird.
So the little eggs are excreted through bird droppings. They land on the
ground, and in order for them to move into the next stage of their life, those
little eggs have to get inside the body of a snail.

So those bird droppings sit there, and if a snail comes along and eats them,
then the little eggs can hatch, and they can grow into the next stage of their
life.

But then, in order for them to reach adulthood and mate and start the next
generation, they have to get back inside a bird. So they actually push their
way through the snail's tentacles and force the tentacles to wave around in the
open air, which is something that no snail in its right mind would ever do.

So they're sort of waving around like: Hey, bird, come get me. You know, and
the snail's like: No, no, don't do that. And so a bird spots them, sweeps down,
eats the snail, thereby swallowing these little larvae, which will grow into
adults and mate and lay eggs and start the cycle all over again.

DAVIES: Wow.

Ms. STEWART: I mean, who thought of that? Like, what are the chances? It just
seems so highly improbable, these intricate lifecycles that require you to move
from one to the next to the next to the next in order to survive. I mean,
you’ve got to give it to these bugs.

DAVIES: Yeah, well, they've been around for, what, a billion years or more?

Ms. STEWART: They've been around forever, and they are so tenacious, and they
manage to keep going in spite of our best efforts to get rid of them.

DAVIES: You write some about spiders, including the black widow, not as deadly
as people think, right?

Ms. STEWART: Yeah, there's not actually much mention in the news of people
getting bitten by a black widow or being harmed by a black widow until the 20th
century.

But the fact is that black widows don't want to bite you. It's painful. People,
their - people's nervous system will sort of, you know, go on the alert, and a
flood of pain will course through your body, and you can get kind of dizzy. You
can get some - you know, your heart will race.

It's not fun, but there are really no reports of people being killed by black
widows. And brown recluse, same thing. You know, people love to hate the brown
recluse, and everyone insists that they have them, even where they don't.

You know, I live in California, and everyone is convinced they've seen a brown
recluse, and entomologists in California are so frustrated by this that some of
them actually got together and started a show-me-the-spider challenge and
offered a cash reward to anyone who could send them a brown recluse that they
had captured in California. And no one could.

They don't exist there, and yet we cling to this notion that they are out there
in our backyards and that they are out to get us, when in fact, you know,
they're really not.

DAVIES: Bugs have been used as weapons of war at times, right? Tell us some
examples of those.

Ms. STEWART: They have, yeah. I was really surprised by this. They have been
used in a lot of really interesting ways. So there are ancient examples of bugs
being used as war, you know, like the Greeks or the Romans filling up a hive
with angry hornets or with scorpions and lobbing it at their enemies.

But there have actually been some more recent and really more terrifying uses
of bugs in a war. And I think the most disturbing one was in World War II.
There were some experiments done by the Japanese with fleas infested with the
plague.

And their plan was to take clay bombs filled with plague-infested fleas and
drop them into enemy territory. And this is something they actually did.

They tried it out on the Chinese. They dropped some into China, and, in fact,
instances of the plague were found. I mean, it worked. And they had a plan to
do it in California. It was called - the operation was called Cherry Blossoms
at Night, and the plan was to drop these clay bombs filled with plague-infested
fleas over California. The war came to an end before that could happen.

But, you know, that's recent. And there's even actually, there's even a project
going on right now. So the Pentagon is working on a project where they would
like to embed computer chips into butterfly larvae and let those caterpillars
hatch into adults and with the hope that they can remotely control the flight
path of a butterfly using a little computer chip. So they could fly a butterfly
into enemy territory and do a little surveillance that way.

(Soundbite of laughter)

DAVIES: Well...

Ms. STEWART: Isn't that astonishing?

DAVIES: Now, you wrote the book "Wicked Plants," and I've read that you still
have a garden with some poison plants in it. Is that right?

Ms. STEWART: I do. You know, it's tough for me to write about plants that I've
never seen. And I really wanted to grow these plants if I could. Some of them
are really hard to get. So for instance, mandrake is not a plant that you can
just walk into a garden center and order up.

So if I found somebody, if I found some plant collector, some person off the
beaten path that happened to have any of these really poisonous, deadly,
strange plants, I wanted them.

So - and once I started collecting them, they couldn't live forever under grow
lights in my office. They really had to go outside. So I have a little section
in my garden that's gated off. I have chickens in the backyard, and they free
range. So, you know, the chickens couldn't get in. It was protected from the
neighbors who might be wandering past in the front.

And I planted about 35 or 40 species of poisonous plants in this garden. And I
decided to go ahead and make it a really creepy garden. Instead of having plant
markers, I actually made tombstones, little cement tombstones that had not the
name of the plant but what the plant did.

So there's all these tombstones that say things like kidney failure and madness
and asphyxiation and chemical warfare. And there's bones buried around the
garden and all kinds of, you know, all kinds of creepy, scary elements. So it
was a very fun garden to do, and it's one that's actually been imitated.

There are some botanical gardens who have sort of taken that idea and run with
it. So now everybody's doing it.

DAVIES: Well, Amy Stewart, it's been really creepy. Thank you.

(Soundbite of laughter)

Ms. STEWART: My pleasure.

GROSS: Amy Stewart is the author of "Wicked Bugs." She spoke with FRESH AIR
contributor Dave Davies. You can read an excerpt from "Wicked Bugs" and see
pictures of many of the bugs mentioned in the interview on our website,
freshair.npr.org.

I'm Terry Gross, and this is FRESH AIR.
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You Won't Feel A Thing: Your Brain On Anesthesia

TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Do you know what happens to your brain while you're under general anesthesia?
Well, anesthesiologists aren't completely sure either. My guest, Dr. Emery
Brown, is an anesthesiologist who's studying bring image – who's using brain
imaging to study what happens when you go under. Along with a sleep expert and
an expert on coma, Dr. Brown co-authored a study on general anesthesia and its
relationship to sleep and coma that was published last December in The New
England Journal of Medicine.

What they're learning can help doctors better understand consciousness and
sleep, and could lead to new treatments for pain and insomnia.

Brown is a professor of anesthesia at Harvard Medical School and a practicing
anesthesiologist at Massachusetts General Hospital. He's also a professor in
the department of brain and cognitive science at MIT.

Dr. Emery Brown, welcome to FRESH AIR.

When you say that anesthesia, when it puts you under you're not in a sleep-like
state, you're in a state more closely resembling a coma. I get scared, because
to me coma is something terrible. Coma is like when you're really ill or you've
been in a terrible accident. So first of all, calm me down about the comparison
to coma.

Dr. EMERY BROWN (Harvard Medical School): Well, I think you've hit at one of
the key point of why it's been a challenge to explain exactly what we do.

When anesthesiologists typically talk with patients, we very often say - well,
we virtually never say we're going to put you in a state of coma. We say we're
going to have you go off to sleep. The only difficulty with that is that sleep
is not the state you're going to be in, nor would it be the state in which
someone could actually perform an operation on you.

So let's just define general anesthesia clearly. So it has, let's say, five
components. So you're supposed to be unconscious, you're not supposed to hurt,
you're not supposed to have pain, you're not supposed to remember, and we want
to not move while someone is operating on you. And in addition to that, we want
you be in stable – physiologically - stable heart rate, stable blood pressure,
temperature, breathing.

So the anesthesiologist takes over the physiology of the patient and controls
it for the duration of the time that the patient is having surgery. Then by
titrating very carefully the way the medications are given, when the surgery is
over we can reverse the coma.

GROSS: So you've been doing imaging studies on the brain under anesthesia. The
brain's under anesthesia, not you.

(Soundbite of laughter)

Dr. BROWN: Yes, exactly. Right, right.

GROSS: So what are you learning about what anesthesia actually does to the
brain - which parts of the brain are shut down, which parts of the brain are
still active?

Dr. BROWN: One of the most interesting things that we've noticed is that in
addition to certain areas being turned off, certain other areas are, let's say,
you know, turned on or more active. So for example, imagine to communicate
between two brain regions you have like feedback loops. One area talks to the
other and vice versa. So if you decrease the activity in one, what you may end
up doing, if one area was inhibiting the other, once the first area's activity
is decreased, the second area's activity could increase because it's no longer
receiving that inhibition.

By the same token, you could have noise. In other words, you've turned off so
many things that now there's effectively noise going between different brain
regions and you couldn't communicate.

GROSS: Do different anesthetic drugs create different patterns in the brain?

Dr. BROWN: Oh, they certainly do. So let me just give you a couple of examples.
So the standard drug, propofol, that is probably the most used anesthetic...

GROSS: Could we stop and say that's the one that Michael Jackson was using to,
quote, sleep?

Dr. BROWN: That's the one that, as I understand it, he was supposedly taking to
sleep. It is a very, very potent drug, and when you look at how it affects the
brain, low doses of it actually cause a state of excitation. Then what you
actually see next is the brain start to slow. So a period where the brain is
actually active and then with higher doses, the brain starts to slow. All
right?

So let's contrast that with ketamine. Ketamine is a drug that we use a lot in
anesthesia and it's especially useful for reducing the amount of drugs that we
have to give, let's say like the opioids to treat pain. In this case, ketamine
actually causes an excited state, even at higher doses.

GROSS: I should say that ketamine is also used as a street drug, and as a
street drug it's known as Special K.

Dr. BROWN: That's right.

GROSS: What kind of effect do people using it as a street drug get from this
anesthetic drug?

Dr. BROWN: Well, that's just it. You see, it works by causing this excited
state in the brain. So the level of the state of unconsciousness that you get
with ketamine is created by making the brain active. Well, as you transition
through this active state, you very frequently hallucinate. And it's these
hallucinations or sense of euphoria or sometimes what's called a dissociative
state that people who are using it a drug of abuse are seeking.

GROSS: Ketamine is also being researched for having possibilities with treating
depression and chronic pain. How is ketamine being used in those settings now?

Dr. BROWN: Seemingly(ph) low doses of ketamine can be quite effective in
treating patients that have chronic depression. And you know, if this turns out
to be reproducible, you know, and every indication is that it will be, this
could change tremendously how chronic depression is managed. Chronic depression
is a very challenging disease because it takes often several months to get
improvement in symptoms. And the thinking is it takes several months for the
drug levels to reach where they need to be in order for the patient to feel
better.

So with ketamine, for 70 to 80 percent of these patients, they felt better
almost immediately and its effect could have lasted seven to 10 days. And this
is an exciting finding because right now there is no way to make a chronically
depressed patient feel better, you know, immediately.

GROSS: Now, some people who have had surgery under general anesthesia or who
have had colonoscopies with - in a sedated state - swear that they were
actually awake during the surgery or during the procedure, that they were in
pain but they weren't able to communicate that because they were paralyzed by
the drug.

And I always wonder, do they dream that, or did that really happen? And how
often does that really happen, and how do you know whether it actually happened
or whether it was a dream?

Dr. BROWN: Now, that's a good question, and in fact I think it's one of the
major concerns that patients, you know, often have. Now, does it happen despite
our best effort sometimes? Yes, I think that's the case. The times when it
happens more predictably is usually in emergency settings. So perhaps, you
know, maybe a woman coming to have an emergency cesarean section, and there's
concern about how to titrate the level of anesthesia so you can take care of
the mother, as well as the baby.

Or another case is, someone comes in with, you know, massive trauma, maybe from
a car accident, maybe a gunshot wound. And again, you're trying to balance the
perhaps side effects of the anesthetic on the heart, maybe the lungs, against
trying to give the person appropriate level of anesthesia so he or she would
be, you know, can tolerate the surgery that's necessary.

Now, there is one situation where historically there had been a fair amount of
recall or awareness under anesthesia, and that was with heart surgery, because
up until, you know, a few years ago it was done primarily using large doses of
opioids. And even though patients were quite comfortable and there was no
evidence of stress overtly, they would report having recall or having been
aware of parts of the surgery.

GROSS: Well, if you're just joining us, my guest is Dr. Emery Brown. He's an
anesthesiologist at Massachusetts General Hospital and a professor of
anesthesia at Harvard Medical School. And he's using imaging to study how
anesthesia affects the brain to produce a coma-like state.

Let's take a short break here, and then we'll talk some more. This FRESH AIR.

(Soundbite of music)

GROSS: We're talking about anesthesia and what we're learning about the brain
and how the brain responds to anesthesia. My guest is Dr. Emery Brown. He's an
anesthesiologist at Massachusetts General Hospital and a professor of
anesthesia at Harvard Medical School. And he's been doing studies using imaging
to see how anesthesia affects the brain to produce a coma-like state.

When you're administering anesthesia, do you have the patient count down
backwards from a hundred?

Dr. BROWN: You know, actually I do, because I've been using it recently to
demonstrate to the residents how quickly people lose consciousness under
anesthesia and to give them a sense of how profoundly it occurs. So it sounds
like something you see in the movies, but I actually do it because it's fairly
impressive, and people rarely get beyond 90.

GROSS: And besides impressing people, why do you have them count down from a
hundred?

Dr. BROWN: Oh, because - in other words, you can actually get a sense of how
the drug - it's a little bit crude. But you can start to get a sense of how the
drugs are actually affecting the brain. So some people start counting. They'll
go 100, 99, 98, 97, um, um, 95, 94, 90. So they'll stop remembering. And so if
you think about it, counting we think of as a very simple process, but it's
actually fairly complex because you have to remember what you just said and to
remember what the next number in sequence is and actually say it. So you can
actually start to see the memory process even in that small time frame break
down.

GROSS: Since you've been the studying the anesthesia-produced coma-like state,
what are you learning about what happens to people in a coma-like state? And I
guess what I'm specifically interested in hearing about here is, you know, a
lot of people visit patients, visit loved ones who are in the hospital, in the
coma, and want to know like if I talk to them, will they hear me? If I hold
their hand, will they know I'm present? And I don't think we have any real
evidence one way or another, but a lot of people just feel like they know, they
know I'm here.

Dr. BROWN: Uh-huh.

GROSS: During the studies that you're doing, have they given you any insights?

Dr. BROWN: Well, when people have brain injuries, not all of the brain is
damaged. And the brain is a very plastic entity, so areas that are not damaged
may be able to take over, you know, certain functions, and certain functions
can be rerouted. So what you could imagine is that if you had some sort of
innovative way of communicating with a person, first looking to see what areas
may be damaged and what areas are still functional, you might have some new
ways of probing them so that you could communicate.

And there was a study that was done a few years ago in which a patient who used
to be a tennis player was, you know, in a – you know, one of the various levels
of coma and they learned what areas of the brain are activated when let's say a
serving motion is executed. And what they did was, with the same sort of
perception you were talking about before, the perception that maybe this person
was understanding the people around him, they asked him to think about
executing the serve.

And they did a series of studies to understand like when they asked him to
think about executing the serve, that was different from, let's say, you know,
driving a car, executing some other motor task. And then they looked at other
people doing the same thing and they were able to use that to demonstrate that
they could communicate with this person because reliably on cue they could get
this person to think about that particular activity and then demonstrate that
he was understanding what the request was.

So in that sense now that you realize that you could, you know, that's one way,
you know, one way of perhaps communicating with someone who is in a coma-like
state if, again, there are areas which could be sufficiently activated or used,
you know, to carry out that communication.

GROSS: So let me see if I understand this. You're saying if you said to this
patient, imagine that you're serving the ball, and the part of their brain
would light up on the imaging that they would use if they were serving a ball.

Dr. BROWN: Exactly.

GROSS: And you'd be able to see that so that you'd know that they were
comprehending what you were saying when you said imagine you're serving a ball.
And you'd know that some part of their brain is actually functioning and that
they could hear you and interpret you.

Dr. BROWN: Right. Exactly. So now you could use that even just as set of binary
choices. You could say, think about serving a ball if you would like me to call
your mom, or something like that. Think about serving a ball to tell me that
you want me to leave you alone. So now you have a way of actually - in sort of
a binary sense - of being able to carry out a conversation to communicate with
this person.

GROSS: In conducting this interview, I'm thinking about - the first time I was
under anesthesia was when I had my tonsillectomy. I think I was probably around
10. And I was knocked out with ether, and I still remember what it smells like.

Dr. BROWN: Oh, really? Uh-huh.

GROSS: Yeah. And do they still use ether for...

Dr. BROWN: Well, we don't use...

GROSS: ...surgeries like that? Yeah.

Dr. BROWN: ...we don't use ether itself, but we do have inhaled drugs. And the
inhaled drugs that we use today are derivatives of ether.

GROSS: Uh-huh.

Dr. BROWN: So in that sense we still do use ether-like compounds. You know,
they've been made more stable, they are actually far less flammable than ether
was. But we still use ether-like compounds.

GROSS: So ether was the first real anesthetic drug. You tell a great story
about how ether was discovered.

Dr. BROWN: The first public demonstration of ether anesthesia took place at
Mass General Hospital. That was October 16, 1846, by William Morton. What was
transpiring at the time was that Morton himself was a dentist who was looking
for a way to take care of his patients if he give them like a full set of
dentures. But to do that he had to remove all their teeth.

So he was looking for a way to provide anesthesia for that. And you know, at
the time ether was - it was around. In fact, there is a practice called ether
follies, in which people would sniff ether for the purpose of getting high. And
Morton, you know, realized that someone had gone too far at one point and had a
cut and didn't perceive the cut because of the ether and he reasoned that
perhaps he could use this as an anesthetic. And he proposed it to John Collins
Warren, who was the surgeon at Mass General at the time, and he proposed trying
this.

And so this is the famous, you know, public demonstration of ether that took
place in 1846, where Morton built this flask, which is this sort of glass
structure with a sponge inside and which, you know, he used to deliver the
ether vapors to Gilbert Abbott, who was a gentleman who had a tumor on his neck
that Dr. Warren wanted to remove. And he did this, he delivered the ether, the
surgery was a success, and afterwards Dr. Warren said this is no humbug, and
that was heralded in as the start of the use of the practice of ether for
anesthesia.

GROSS: So have you ever been in state of general anesthesia for surgery?

Dr. BROWN: No, I haven't.

GROSS: Aren't you curious?

Dr. BROWN: Uh...

GROSS: I don't mean that you should have surgery.

(Soundbite of laughter)

Dr. BROWN: No, I mean I see it enough. I mean, so...

(Soundbite of laughter)

Dr. BROWN: I see it enough to have a good perspective on what's going on. I
mean, I am part of the over 50 club, so I have had a colonoscopy. So I've had
the sedation.

GROSS: Now, in an interview with you in The Boston Globe, you were asked why
you chose anesthesia as your specialty, and you said you always knew you wanted
to be a physician, and then you added: I know this sounds corny but some of the
best times I had as a child was going to see my pediatrician. And I thought,
what? I never enjoyed that. What did you like about seeing your pediatrician?

Dr. BROWN: Oh, my pediatrician in particular, ironically his name was Dr.
Butcher(ph).

(Soundbite of laughter)

Dr. BROWN: He didn't spell it as butcher. There was actually an extra S in
there.

GROSS: Uh-huh.

GROSS: But what just - I remember to this day he always listened. I mean, he
made me feel like I was, you know, a young adult, as opposed to a kid coming to
see him. And as well, his partner, Dr. Richardson, who was exactly the same
way. I mean, I just have very, very vivid memories of that. (Unintelligible)
that little tidbit - one of my true confessions there.

GROSS: All right. With that concession, I want to thank you so much for talking
with us. It's really been interesting.

Dr. BROWN: Oh, thank you very much for having me.

GROSS: Dr. Emery Brown is a professor of anesthesiology at Harvard Medical
School and is a practicing anesthesiologist at Massachusetts General Hospital.
On or website you'll find a complete text of the article he co-authored,
"General Anesthesia, Sleep and Coma," which was published in The New England
Journal of Medicine. That's freshair.npr.org.
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Remembering Hazel Dickens: A Feminist Bluegrass Voice

TERRY GROSS, host:

The Appalachian folk singer Hazel Dickens died Friday of complications of
pneumonia. She was 75. We're going to listen back to an excerpt of my interview
with her.

She built her career singing about the struggles of the poor, women, coal
miners, and other workers. She first became known as half of the duo Hazel and
Alice, with Alice Gerrard. After they broke up in 1976, Dickens continued
writing songs and performing. Her songs "Cold Tattoo" and "I'll Never Keep Us
Down" were used in the Oscar Award-winning documentary about coal miners,
"Harlan County, U.S.A." In 1994, Dickens was the first woman to receive the
International Bluegrass Music Association's Merit Award.

I spoke with her in 1987, after she sang in the John Sayles film "Matewan,"
about a 1920 coal-mining strike in the early days of the union. The film was
set in Matewan, West Virginia, not far from the coal town where Dickens grew
up. Here's a song from the soundtrack.

(Soundbite of song)

Ms. HAZEL DICKENS (Singer): (Singing) You can tell I'm in the country, tell I'm
in the town. The miners down in Mingo lay their shovels down. We won't pull
another pail out, (unintelligible) another ton. Or lift another finger till the
union we have won. Stand up boys, let the bosses know. Turn your buckets over,
turn your lanterns low. There's fire in our hearts and fire in our soul. But
there ain't gonna be no fire in the hole...

GROSS: Hazel Dickens told me that when she was 16 she left her large family and
headed north.

Ms. DICKENS: I didn't intentionally reject that part of my life. Since some of
the mines had started to close down around there, there was not a lot of work,
which meant there was even less work for women, you know, because women usually
did - if there was a factory or waitress work. If you were lucky, you got
office work, but I didn't have that much education.

GROSS: Were all the men in your family mine workers?

Ms. DICKENS: Almost all of them. My father had a truck and he hauled timber for
the mines, and I guess the larger part of my brothers became coal miners and
all my brother-in-laws were coal-miners.

GROSS: Were they in unions?

Ms. DICKENS: Oh, yes. Yeah, everybody was in unions. And they were very, very
strong, staunch supporters of the unions, and everybody was a Democrat. And
almost everyone was a Baptist.

GROSS: What kind of music did you grow up listening to in the house?

DICKENS: Hardcore country. I mean, very primitive stuff, because that's what -
my father was a very dominant person and that's the kind he liked and he didn't
want us to listen to anything else.

GROSS: So when did you start getting exposed to other music?

Ms. DICKENS: Probably not until I left home and came to the city. And it was
quite a while, I guess, that I began listening to the radio in the city, and
then were then playing, you know, like top 40. And I began listening to more
country-western that was updated.

GROSS: When you started to sing, was it a local bars?

Ms. DICKENS: Yeah. Uh-huh.

GROSS: Did you have to learn how to handle yourself at those bars? It can get
rough.

Ms. DICKENS: Yeah, I would just run in the restroom and hide.

(Soundbite of laughter)

GROSS: Did you ever have any trouble with the male customers?

Ms. DICKENS: Yeah. Actually, as much by some of the musicians as I did the male
customers, you know, being chased around the back room by fiddle players and
all that. But I was - even though I was very small, I was probably like maybe a
hundred and - weighed about a hundred and five or 10 - I could hold my own
really well. I was very quick-tempered and a real smart-aleck. Although I was
shy, I still would defend myself.

GROSS: Physically or verbally?

Ms. DICKENS: Both.

GROSS: Right.

(Soundbite of laughter)

GROSS: I mean, if they came too close. I mean, I wasn't above hitting somebody
if they needed it.

GROSS: You eventually started singing songs that updated the musical tradition
that you were part of, and some of those songs are songs that you wrote, like
"Don't Put Her Down, You Helped Put Her There" and "Working Girl Blues." Were
the traditional songs not expressing what you wanted to say?

Ms. DICKENS: Well, many of them did not. They just weren't songs written for
women and - not that, you know, a lot of the traditional songs women can sing.
And I love singing the traditional songs. I've always tried to show a lot of
respect for the tradition from which I came and to help keep it alive. But they
did seem to be, you know, at least a large space there that women like me and
other women that were coming along could feel. And that was to give other women
that didn't want to sing all the old traditional songs, give them something
that they could identify with and something that they wanted to, you know,
could sing.

GROSS: Hazel Dickens, recorded in 1987. She died Friday at the age of 75. We'll
close with her singing her song, "They'll Never Keep Us Down."

(Soundbite of song, "They'll Never Keep Us Down")

Ms. HAZEL DICKENS: (Singing) United we stand, divided we fall. For every dime
they give us a battle must be fought. So working people, use your power, the
key to liberty, don't support that rich man's style of luxury. There ain't no
way they can ever keep us down. Oh no. Ain't no way they can ever keep us down.
We won't be bought, we won't be sold, to be treated right, well, that's our
goal. And there ain't no way they can ever keep us down.
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Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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