The Filling with Nothing

I

On 16 October 1846, at ten in the morning, in a surgical amphitheatre in Boston full of doctors who had come to watch the fiasco, a twenty-year-old printer had a tumour taken out of his neck without screaming.

His name was Edward Gilbert Abbott. The surgeon was John Collins Warren [sixty-eight years old, a whole career operating on people held down by assistants]. The one who administered the ether was a dentist, William Morton, with a glass apparatus he had prepared that same week.

Abbott breathed the vapour for a few minutes and went still. Warren cut, tied and closed. The patient moved a little and made some sound, but afterwards said he had felt no pain, only a sensation of his neck being scratched.

Warren turned to the room and said that this was no humbug.

It was the first time in history that a human body had been opened without its owner suffering: in the room there were people who had spent thirty years listening to screaming.

II

It has to be said what an operation was before that morning.

It was a race. A surgeon's skill was measured in seconds: the patient was awake and held down by three or four men, and every extra second was pain and the risk of them moving. A good surgeon amputated a leg in under a minute [there were those who did it in thirty seconds, and boasted].

That means anaesthesia did not only remove the suffering. It changed what could be done. With the patient still and asleep you could operate slowly, look properly, go to places nobody entered before because there was no time.

Almost all the surgery that exists today is the child of that change of pace.

Before 1846 surgery was external: amputations, bladder stones, skin tumours, open fractures. Nobody opened an abdomen for pleasure and nobody went into a chest [whoever tried, killed]. Not for lack of anatomical knowledge, which had been there since the Renaissance, but because no waking body withstands having its belly opened while four men hold it down.

III

In March I asked my dentist to do me a filling without anaesthetic.

It was a small one, in a lower molar, and no nerve had to be touched. I asked out of curiosity and because I had spent weeks reading about 1846. She said yes with the naturalness of somebody who has heard worse requests [she charges for the anaesthetic too]. She warned me of two things; that the moment I said anything she would stop, and that I would probably regret it.

I did not regret it, and it was not heroic either. The drill on the enamel does not hurt; it sounds [and the sound is half the fear]. When it reached the dentine something sharp began, electric, very specific [it appeared and disappeared with the contact], and perfectly bearable if you know it lasts twenty seconds.

It lasted twelve minutes in all —I watched them on the wall clock, which was behind her—. I clenched my fists three times and said nothing.

What I took away was not the courage, which has no merit whatever with a filling. It was the arithmetic. The whole time I was measuring how much was left, like somebody watching the clock at the dentist's, and that arithmetic took up the entire space of my head.

Multiply that by an amputation and by twenty minutes.

And take off the account the one thing I had and they did not: the certainty that it was going to end well and at a known hour. That is not a nuance of the experiment; it is the whole experiment, and it makes what I did count not as a comparison but as a scale.

The filling cost forty-five euros and the anaesthetic she did not give me would have cost twelve more.

I went out into the street with my mouth whole, without that dead lip that lasts three hours and makes you drink water sideways. I ate normally at two. I was odd the rest of the afternoon, with a sort of silly alertness in the body, as if I had done some exercise and did not know which.

IV

Inside, ether is the crudest drug in this series and it is still not fully understood.

There is no lock. There is no particular protein it hooks onto, no signal it interrupts, no receptor with its name on it. It is a small, volatile, fatty molecule that is breathed in, passes from the lung to the blood and from the blood to the brain in seconds, and dissolves in the membranes of the nerve cells.

In there it does what a solvent does; it changes the surroundings. The membranes become a little more fluid, and the channels embedded in them —the gates through which the charges that produce the impulses come and go— stop opening and closing with the same precision. Some open too much and others too little.

The result is not a clean block. It is a general derangement of the system, which disconnects in layers and in order; first the cortex, then memory, then voluntary movement, and at the end, if you keep going, breathing.

That last point is the reason anaesthesia is a profession. The difference between putting somebody to sleep and killing them is a question of quantity [a narrow margin, measured in breaths], and in 1846 that quantity was calculated by eye by a dentist with a bottle.

What the body does about it is little and fast: as soon as you stop breathing the vapour, the molecule leaves the way it came, goes off with the exhaled air almost entire, and the brain readjusts itself. That is why ether clears in minutes and why, badly measured, it kills in minutes.

There is besides a domestic detail that explains why it disappeared. Ether burns. It burns easily, and in a nineteenth-century operating theatre the light came from a flame; for decades people operated with an inflammable substance evaporating around a gas lamp. Operating theatre fires are not a legend of the trade [they are a line in the statistics of the period].

V

What was invented that morning was not a drug.

Ether had been known since the sixteenth century, was sold in pharmacies and was used at parties for a laugh. There were people who sniffed it at soirées and fell down the stairs without feeling it; they called it an ether frolic. It was there, available and cheap, for three hundred years. In any pharmacy. For a few coins.

What was missing was not the substance. It was the idea that the pain of an operation was optional.

That is the strange part of the business and what cannot be reduced to chemistry. For centuries, intelligent people who had the bottle in the cupboard watched other people screaming on a table and did not connect the two things, because the pain was part of the operation just as the blood was.

The invention was to take from pain its status as a natural thing.

That has a consequence that goes beyond medicine, and it is the one that interests me. From that morning on, any avoidable pain that is not avoided becomes somebody's decision. It is no longer the world: it is a budget, a service policy or an oversight. Anaesthesia did not only relieve; it handed out responsibilities that did not exist before.

VI

Against me, and this time it is concrete.

I had a twelve-minute filling and wrote six hundred words about it. Abbott spent twenty minutes with a surgeon inside his neck and the only thing anybody wrote down for him is that he felt as if he were being scratched.

Taking a tour of somebody else's pain with an anaesthetic at twelve euros waiting at the counter is a ridiculous position, and it was one the whole time I was in the chair counting seconds.

The difference between him and me is not endurance. It is that I could stop whenever I wanted, and I knew it, and that changes entirely what is felt.

VII

Abbott did not become famous. He died at thirty-six, tubercular, in 1855, and his neck tumour turned out to be benign.

From ether they soon moved to other, less inflammable things, because the stuff burned with a dangerous ease in operating theatres lit by flame. Morton ruined himself litigating over the patent for something that had been on sale for three centuries.

The amphitheatre where it happened still exists and they call it “the Ether Dome”. You can go in.

It is a small room, with wooden tiers in a semicircle and very little distance between the front row and the table. The first thing you think on seeing it is not the operation. You think about the acoustics: about how close the watchers were, and about what was heard from up there in the hundred years before that morning.

16 October 1846, a few minutes of vapour and twenty of operation.

Three hundred years of the substance in the pharmacies before that morning.

Filling without anaesthetic, twelve minutes, forty-five euros.

The anaesthetic I did not have: twelve euros.