Sue Laska lives in Gates Mills Ohio, but she's held on to her Pittsburgh roots. She knows what'll be on her mind as she drifts off before surgery.
LASKA: Now I can go into lala land and dream that the Steelers are winning the Superbowl.
Laska's slated for knee surgery. Pretty minor stuff, but she hopes it'll help with her pain and get her running again.
LASKA: I have to get up like an old lady, and it's like, ahh.
She's had surgery before and is not that nervous. And the anesthesia? No big deal.
LASKA: Ah yeah, it's just like, give me your arm and then "goodnight."
She's got a team of doctors and nurses at University Hospitals checking in and prepping her for the surgery.
Nurse anesthetist Chaity Roy pushes a valium-like drug into her IV.
ROY: It'll just take the edge off, that's all.
It's the first of many drugs that the team will use to put Laska to sleep and keep her unconscious.
Dr. David Wallace is the anesthesiologist in charge of this surgery and he lets Laska's husband know, it's time to move.
WALLACE: If you want to wish her good luck, we're ready to go.
HUSBAND: Ok, we'll see you later ok, have fun (kiss). Don't scream too much.
The relaxant drug is certainly doing its thing: Laska's cracking jokes about funny town names near Pittsburgh as doctors wheel her to the OR.
Once inside, doctors hook her up to lots of monitors. They're tracking her blood pressure, her oxygen levels, her heartbeat. They can -- and must be able to -- control all of these essential functions during surgery.
Dr. Wallace gives Laska intravenous lidocaine and then a milky-white drug called propofol. This name might ring a bell…it's the one Michael Jackson overdosed on. In proper amounts though, it's a highly effective "induction agent," that is, it knocks you out fast.
WALLACE: You're going to feel a warm pleasant sensation then you're going to go off to sleep.
Propofol plus the narcotic fentanyl put Laska to sleep in less than ten seconds.
And now she's ready for the surgeon.
SURGEON: Skin incision. 9:30.
As he gets to work, nurse anesthetist Roy monitors Laska's vitals and puts her on an anesthetic gas which flows continuously throughout the surgery to keep her asleep.
While Laska's under, I chat with the head of anesthesiology, Dr. Howard Nearman about the drugs that are at work here.
He says they use a cocktail of meds to put a person to sleep, block memories and pain, and relax muscles.
NEARMAN: There's no one wonder drug that does all of those so we use a whole bunch of different ones.
The practice of anesthesiology dates back to the 1800s.
NEARMAN: Even I am not old enough to remember ether.
Ether was one of the original agents.
NEARMAN: The way it was administered, you just put a cloth over and had people breath in. Course you had no control over how much they breathed or how much you dropped on the cloth, and how they reacted to it.
We've come a long way since then; anesthesiologists keep a tight leash on the drugs they use.
NEARMAN: What anesthesiologists are are basically control freaks.
They need to be.
NEARMAN: The risks are you die. We give drugs that can potentially stop patients from breathing.
Hence the constant monitoring.
Though the stats are good - Nearman says the risks of anesthesia have gone down 10-100 fold over the last thirty years.
But here's the curious thing: Doctors give these drugs…they can control them, they've been tested and they're known to work but…nobody really understands how general anesthetics work.
Are they changing cell protein structure, energy levels or cell to cell signaling?
These drugs produce sleep, but not "natural sleep." Probably.
NEARMAN: And the question was, and is, and will be, is how do we do it? How does that drug work? You know, nobody knows.
ROY: Susan, can you open your mouth, surgery's all done.
Back in the OR, Laska's waking up.
WALLACE: How you doing? LASKA: Um, a little foggy.
The drugs wear off pretty quickly and she's soon sitting up and chatting.
LASKA: Yeah, I can actually see faces.
Her knee's cleaned out; she's looking forward to travel and trips without a stiff leg; and how was the surgery? Went by in a flash.