Yesterday I saw my appendix. It was pink and tiny, quite hard to see, but how interesting to be introduced to it for the first time. In for a routine colonoscopy (my fourth, on account of a family history), I refused sedation as I always do, and I had the enormous thrill of witnessing parts of myself that I carry around with me every day, but never really know or acknowledge. I chatted with my doctor about many things, including the various justices of the Supreme Court, the details of my procedure, and, not least, the whole question of sedation and anesthesia. He told me that 99 percent of his patients have either sedation or, more often now, general anesthesia, since that is increasingly urged by the hospitals. (In Europe, he said, about 40 percent refuse sedation.) He listed the costs of this trend: financial costs that are by now notorious, lost workdays for both patient and whoever has to drive the patient (whereas a non-sedated patient needs no caretaker and can go right back to work), lost time for nurses and other hospital staff, and, of course, the risks of sedation and the even greater risks of general anesthesia.
And, I’d add, the loss of the wonder of self-discovery. You are only this one body, it’s all you are and ever will be; it won’t be there forever; and why not become familiar with it, when science gives the chance? I began refusing sedation out of a work ethic; I continued through fascination.
What are the countervailing benefits of unconsciousness? Naturally someone benefits from charging the notoriously high fees, and no doubt greed is part of the explanation for why U.S. hospitals increasingly push anesthesia. But what benefits might there be for the patient? There are no pain nerves in the colon, so any discomfort is due to pressure (unless one has done 300 sit-ups the previous day, and thus has inflamed abdominal muscles, a practice I have learned to avoid!) and, of course, to disgust and shame. On a scale of discomfort from 1 to 100, with childbirth way up there, colonoscopy ranks around a 5, much less uncomfortable than a facial peel, and it lasts only 30 minutes. So we must conclude that a great part of what motivates people to choose sedation, imposing great costs on society, on their loved ones, and on themselves, is disgust and shame. The way the nurses talked made it clear to me that patients are terrified that they might fart during the procedure—and of course it is the cleanest fart in town, since the colon has already been thoroughly cleansed.
Martha Nussbaum, in a short essay in the New Republic, on how we view our bodies.