Chapter 1: What types of black boxes are explored in this episode?
Hey, Lulu here. This week, we are bringing back an episode full of intrepid humans trying to access places that are off-limits, trying to solve the unsolvable, know the unknowable, see the unseeable.
I can't say much more than that without giving everything away, so I'm just going to buckle you into a time machine and beam you back to 2014, right into the studio with then-host Jad Abumrad and producer Tim Howard. Here we go. Wait, you're listening? Okay. All right.
Okay. All right. You're listening to Radiolab.
Radiolab. From WNYC. Rewind. Batting first, producer Tim Howard. Cool. Wait, I'm just going to get my level here. It is such a beautiful day. Beautiful. I think it's got to be like 75 degrees out or something. Sunny. This is Patrick Purden. He's a professor in anesthesia at Harvard Medical School and works at Mass General Hospital. You want to just tell me where we are?
We're standing right now in front of the Bullfinch building. And I went up to talk to him because in that building... This is the one with the ether dome? The ether dome is inside this building. Is... The story of the day that, you could say, humanity emerged from the dark ages. Oh, you laugh now. Just wait.
Okay, here we go. It's on the fourth floor. It's on the fourth floor of this building.
We headed in, up three flights of stairs, into this room. What a cool room. Oh my god. It's this like, how would you describe it? It's like a mini amphitheater, right? It's also got this awesome dome. It's this beautiful domed room with light streaming down from above. Like the acoustics in here are crazy. It must have been terrifying though if you actually heard somebody screaming.
I mean, it's so resonant in here. The screams would have been deafening and absolutely would have been terrifying. What is this place? Well, this was an operating room. And back in the 1800s, when this room was really in use... Being in an operation was so painful.
It was often permanently damaging to a patient's emotional state.
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Chapter 2: How did anesthesia change the experience of surgery in the 1800s?
I write about American history.
She wrote a book called Ether Day, which goes into a lot of detail about the dark, dark days of surgery in the early 1800s. Back then, during surgery, there were no painkillers, and patients were awake. probably more awake than they'd ever been in their whole lives.
Some of the patients remembered the sound of their limb dropping to the ground or the saw going through their sinew and bones. The smell of their own body being cut into. Usually, a surgeon would employ six burly men to hold a patient down.
And instead of having an operation, some people committed suicide before they would face going into an operating room, which were usually located on the top floor of a hospital, in part because the hospital really didn't do itself a lot of good to have the screams heard by passersby.
This is such a cool room. Here we are at the top of the ether dome. But then, everything changes. October 16th, 1846. It's a Friday morning. I assume the room is full? The room is absolutely full. The students were all lined up to watch. Crowded in the bleachers because they'd heard something big was going to go down.
And right there in the middle of the room is... The most esteemed surgeon in America, Dr. John Warren.
about to do an operation. He brought in a patient who needed a tumor taken out of his neck, and he was just about to slice into the guy. Just about to start the surgery. When this mustachioed fellow bursts in. A dentist. William T.G. Morton. And he basically said to Warren something that must have sounded completely nuts. I can erase that man's pain. He didn't actually use those words.
He actually had an appointment with Warren. But according to Julie, he did have a bag.
He had a bag filled with gas.
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Chapter 3: What was the significance of the ether dome operation in 1846?
Morton sets up his gear, fills up the inhaler. Puts it up to the guy's face. And actually, because the valve system had just been constructed and he hadn't tested it, he actually literally had to manually operate the valves with every inhale and exhale of the patient.
So he administers the ether using this inhaler. After about three or four minutes, the patient becomes unconscious.
And just at that moment, Morton turns to Warren and says, You're a patient, sir. Dr. Warren brings the scalpel down to the patient's neck and cuts. And really, for the first time in that room, you could hear the scalpel. You could hear the breathing coming.
The silence was far more deafening than all the screams that had ever been heard in that operating theater.
No squirming, no moving, no bulging eyes, no clenched fists. It must have felt like a miracle.
The news of the operation went around the world as fast as anything. News of war or peace didn't travel faster than this.
By the end of the year, doctors in Europe were using surgical anesthetics. In basically the blink of an eye, the most painful, horrible experience possibly imaginable became routine, even forgettable. But also deeply peculiar, as was made clear to us when we talked a while back with one of our regulars. Carl Zimmer. Well, my wife and I, we were watching this movie one night.
It was called Birth, starring Nicole Kidman. Did you like it? I hated it. No! It's one of my favorites. Well... Okay, I'm sitting there and I'm hating the movie. You're hating this movie? Well, I'm just wondering, like, why am I reacting so negatively to this movie? I'm just in such a bad mood. I'm feeling lousy and I think it's the movie. And I stand up and I say, oh, wait a minute.
My abdomen is in incredible pain. Oh, so it's not the movie. It's not the movie. It's me. Appendix about to burst. We go to the hospital, and maybe 4 in the morning, 5 in the morning, they're prepping me for surgery. They put an IV in me, and then they're like, okay, now we're going to be putting in the anesthetic. So just relax, and this will be taking effect.
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Chapter 4: What are the mysteries surrounding consciousness and anesthesia?
I'm not feeling anything. You're going to have to do something more. I just want you to know that I'm not.
And then I was in another room and there was no one else there.
Where did they all go? Yeah. Like they had all left. And then it occurred to me like, no, oh, oh, oh, the whole surgery has already happened. Wow, that is weird. It's happened to me. It's as if they splice time, take the time that you were in and the time that you are in subsequently, and the middle is totally missing. No experience whatsoever. It's not like sleep. No.
There was no like, oh, I'm getting sleepy. I was arguing with my doctors that they didn't know how to do their job. And the next thing I'm in a hospital room with my appendix out and it's 10 hours later. It sort of implies that it's like a switch. It is. And that's what happens.
I mean, when you raise the level of anesthesia in someone and they've done studies on this, it isn't a gentle gradation down. You just you raise it up, you raise it up and then you are into this other state. Do people who do this for a living know exactly why this happened? You'd think that something that's been around since 1846 would be hammered out. Solid.
But it's still almost a philosophical kind of mystery.
There's a term for this in physics.
It's called a black box. It refers to a system where you can see what goes in. You can see that something different comes out. And you wonder, like, what happened there in the middle? But you can't see it. Yeah. It's a mystery. It's black, and it's closed up, therefore the box.
I mean, it may not literally be a box, but today we have three different attempts to open three very different black boxes. Starting with the box that's in front of us now, that gap that Carl talked about where you go, boom. You're gone. And then, suddenly you're back. What happens in that gap? That's what's crazy.
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Chapter 5: How do modern anesthetics differ from historical methods?
All right. I'd like to hear about it. No. I'm just saying. Here, I'll just play you one. No, I didn't. No. All right, all right, all right. You aren't going to regret it. Well, anyway, the larger point is that if you can't understand how and why anesthesia works, then you're not going to be able to explain why every so often it just doesn't work. Really? How often is every so often?
I've heard different numbers, anywhere between 1 in 10,000 to much more often, like 1 in 1,000. Wow.
But luckily, let's take a look at these brain signals.
In the last few decades, scientists have begun to shine a little pin light into this black box. And Patrick and his team in particular have found something pretty cool. This experiment that we did in the, I guess, late 2000s. A couple years ago, they wanted to know what happens in the brain right when that switch flips. So they got a bunch of volunteers.
Healthy volunteers.
They hooked them up to an IV and started to very, very slowly give them propofol, which is a big anesthetic. And as they did, they told the subjects to click a button every time they heard a sound or a word that they recognized.
You know, something like that.
In addition, we had the subject's name, too. Tim. Patrick. So the subjects would just sit there and listen and click. On and on.
Patrick.
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Chapter 6: What does the metamorphosis of caterpillars reveal about transformation?
Okay, let's stand up, raise our arms, sit back down. And just a moment later, you're like, oh, my God, I've got to stand up again. And you're waiting. Oh, dude, it's back again.
And the thing is that when the wave is going on in the stadium, you can't really carry on a normal conversation. You can't have a normal interaction. You may not even be able to have a normal thought because the thing is just coming by every couple seconds to interrupt you. That is sort of the rationale for how these oscillations disrupt brain activity.
I dig the analogy, but I'm not quite following. It helps to zoom in on the brain and look at a smaller number of neurons, which is what he did. Now check this out. We conducted this study where we measured brain activity in individual neurons. They got some patients, planted these tiny little electrodes deep into their brains so they could hear the individual neurons.
So let's imagine that we zoom in to like tens to hundreds of neurons firing. And he says when they give that patient propofol, an anesthetic, what we notice is that right at the point of loss of consciousness, sure enough, they see those big slow waves sweeping through. And just like in Fenway, when the wave hits you, you have to stop your conversation.
But what that wave is really doing is it's only allowing each little cluster of neurons to talk once in a while. They can only fire once. at a particular moment in this slow oscillation. Like, you know how the wave goes up and down, up and down, or round and round and round if you're on Fenway? It's only at this moment, say, that one group gets to talk.
The problem is his buddy, he can only talk at this moment. And the neurons next door, they can only talk at this moment. Next group, same deal. Everybody gets a turn to talk, but they can't talk to each other because they're on slightly different schedules. When they're talking, the others can't listen.
So there's still a lot of talking going on, but consciousness seems to be the brain talking and listening to itself. So when that slow wave rolls around, the neurons can't all fire at the same time and talk to one another. And in that state, it would be impossible to be conscious. It might be early to say, but does it feel kind of like you cracked the code?
Well, I think we are in the process of cracking the code for anesthesia. You don't ever want to get too far out of the limb. But honestly, I mean, I feel if we could educate people about these rhythms, I'd be willing to say it. Sure. I think we have. I mean, I think this is going to be huge. I'm not going to lie to you. I think this is just going to be absolutely huge. Yeah.
I'll take the bait on that. Sure.
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Chapter 7: What experiments did Dr. Martha Weiss conduct with caterpillars?
You can see the slow waves, right? Now she's got some slow oscillations. If you imagine the screen as like this field of blues and yellows and greens, suddenly these bands of red just extend right along the bottom. And considering that for the last 160 years, anytime somebody like Doris has been put on a table and cut open, the doctors basically couldn't be sure what was going on in their head.
Are they awake? Are they okay? And so with that in mind, Being there in the operating room and seeing that band of red appear on the screen and hearing Emory Brown declare without hesitation. This patient is unconscious. It's kind of cool.
And you say that with a what percent confidence? Oh. 99.99. Nine. Nine.
Nine. Nine.
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Okay, I'll do that. Okay, let me do it one more time. Three, two, one. This is Tim Howard, and today on Radiolab, we've been talking about black boxes. And the next story started with a radio piece that I heard at the Third Coast International Audio Festival.
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Chapter 8: What philosophical questions arise from the metamorphosis process?
And my grandma was hesitant. She was like, oh, I'm not sure. I'll be very good. I can try and remember. And they came and interviewed her. And when it went to air, when it got broadcast, we all drove up to his grandma's house and listened to it around the radio like they would have back in the 1950s and heard the story.
And that's when Jesse discovered that his grandparents, Leslie and Sidney Piddington, one time had an audience of 20 million people. Yeah, yeah. Basically, the population of Australia was listening to my grandparents back in the 1950s. No way. I was like, yeah, why don't I know this? This is in my family and why don't I know it?
But he says it was really when he sat down and listened to the original broadcasts, what's left of them. Two hours of old BBC recordings that survive today because my grandparents pirated them from the BBC back in 1950. He says it wasn't until he heard those tapes that I went, wow. You should now tell us this story. Tell us what you heard that made you go, wow.
Well... You hear this very dramatic theme song. And this old BBC voice comes onto the tape and says... Good evening, ladies and gentlemen.
We present the Piddington.
And the music goes up. All very, very dramatic. And then the narrator sets the scene for you.
Good evening to you all, both at home and here in the number one Piccadilly studio right in the middle of the west end of London. It was done in front of a live audience.
And then you hear my grandfather's voice. Well, as Stephen Grenfell has just told you, life's been quite exciting for us. He was a stutterer. We've had a lot more letters. There were all these things that meant it should never have worked on radio. Anyhow...
my grandfather is in the studio on the stage and my grandma i'm sorry to say leslie isn't here she was often somewhere dramatic as a nut in the studio somewhere exotic one time she was in a diving diving bell she was underwater at the bottom of a test tank one time she was in the tower of london are you there leslie in the tower yes i'm here
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