Yep, I've had that. Sitting in a hospital bed after my appendectomy:

"Hey, I'm awake! That was easy."

"You've been awake for two hours."

"...Oh. Huh."

After my first knee surgery, I regained consciousness midway through speaking a sentence to my mother. I was literally listening to words coming out of my mouth and had no idea where I was, who I was, or what I was talking about. My very next sentence was a panicked question to my mother trying to figure out those things. Turned out I had 'been awake and having cohesive conversation' with her for over an hour. I still have no memory of that conversation.

As I was being prepped for my third knee surgery, my doctor asked if I had any problems with anesthesia. I told him about the memory loss after my first surgery. My friends who were accompanying me, and had been at my second knee surgery, started mumbling "um, huh, well, oh, actually". It turns out that after my second knee surgery, when the surgeon was giving me a summary of how the surgery went, he told me he botched up my knee, and I proceeded to make very coherent and precisely detailed threats against his life. (The threats were bad enough that the surgeon considered bringing security into the recovery area and restraining me. In the end, my friends, including a combat vet, convinced the doctor that I'm not actually a violent person and agreed to restrain me if I actually became violent.) Again, I have absolutely no memory of this!

I read this book "The Master and His Emissary: The Divided Brain and the Making of the Western World" and based on that I would say your left hemisphere were active when right one was suppressed for some time. I can't recommend this book highly enough - it's very comprehensive and it give you an opportunity to look at the world from a different perspective

I also highly recommend that book. I wonder whether I'd consider this a hemispheric situation.

It seems to me like the internal, autobiographic self being disabled, and then upon awakening this self immediately says "wait, discontinuity in the recording ... where was I?" and this feeds back into the rest of the brain creating the confusion.

He wasn't confused the moment before, because his autobiographical self wasn't recording.

For me the main sign is the different behaviour. Left hemisphere is vile, ignorant and selfish. Threatening a doctor with death because he hurt you falls in the being sociopathic bastard category. This is my highly uneducated guess

Sounds fascinating. Thanks for the recommendation!

Yeah, I've had that also. Very strange, like how does one recognize that one has "woken up" from being already awake? It's like, oh, the tape recorder turned back on.

Maybe we're just the tape recorder?

Yes, it's a popular view nowadays among psychologists and cognitive scientists that the conscious self is just a sort of a senior manager that receives reports and thinks he's in charge while in fact his subordinates work just fine even when he's temporarily not available at all.

Well, it's an interesting point, because apparently if the tape recorder never turns back on, you're just kinda stuck in time as the person you were. So it suggests at the least that the tape recorder aspect of consciousness, perhaps in the way it feeds back one's perception of oneself to oneself, is crucial in the sort of consciousness we humans see as critical to identity.

Clearly though, this guy is still "conscious" - it seems like a situation we don't have quite the correct terminology to describe.

Sounds like https://en.wikipedia.org/wiki/Philosophical_zombie

It's sort of a weak version of a P-zombie. Presumably the lack of conscious awareness would still be observable using a sufficiently detailed brain scan if not anything else, as opposed to a "real" P-zombie where the presence of consciousness is assumed to be completely epiphenomenal.

It's not that we're not aware, it's essentially that we may only be aware - aware of our thoughts once our subconscious thinks them, aware of our actions and their consequences once they're made.

The trick, seemingly is manipulating the focus of awareness to convince the subconscious decision-making apparatus to make different decisions, even though all we really have control of is our awareness.

Yes, this is the "weak" position. The original definition of a P-zombie is an entity that really does have no qualia, that is, subjective experience or "consciousness", but behaves exactly like it did, down to the neuronal level. It is a thought experiment and can be used as a reductio ad absurdum to argue that eg. uploads still have qualia.

The fact that anesthesiologists apparently deliberately induce amnesia with benzos scares the shit out of me, much more so than full general anesthesia does (which seems backwards, right, because general anesthesia is actually dangerous). Why do they want me not to remember anything? Is it that horrible?

The use of amnesiacs like midazolam in conjunction with unpleasant surgery has become common practice because it has been shown to significantly reduce the psychological trauma associated with surgical procedures and related changes in behavior as a result. You will still experience the trauma at the time whether you remember it or not, but the experience is not persistently encoded into your brain.

This is important because the psychological trauma of a surgical procedure will often cause people to avoid future procedures even when procedures are medically advisable. These drugs temporarily prevent strongly negative experiences from becoming a part of who you are mentally, subconscious or otherwise.

And that makes intuitive sense. I'm still left with the question: is the experience of surgery really that bad?

I'll say yes. For example, sometimes we have to run electrical current through someone's chest to correct an arrhythmia. Depending on the urgency, we will give a medication such as midazolam. Ideally you want the sedation to have taken effect, but you don't always have the time to wait for that before your hand is forced and you have to cardiovert. The amnestic properties will help reduce some of the traumatic memories.

Sure. That makes sense. You gave me enough keywords with that comment to look up electrical cardioversion and pain, and so now there's something new that I'm scared of (kale for dinner tonight!) (thanks!).

But that's actually something different than what I'm asking. I have no trouble understanding why I wouldn't want to remember a pain "similar to that of surgical incision". Similarly: I wouldn't want to remember an unanesthetized incision!

But before learning that surgical patients were routinely given midazolam to zap their memory, my impression was that surgical patients were completely zonked out by general anesthesia, and so there'd be no need to zap their memory, because they weren't going to consciously experience the incision in the first place.

Now I'm like, is all of general anesthesia a scam, and we're all enduring horrible pain, and we just don't remember it? J/K ONLY SERIOUS.

Midaz can be used as premedication before induction of general anesthesia, but it's not an induction agent itself. If you're getting general (as opposed to "twilight") anesthesia, once you're induced, you should be unconscious (to the best of our ability to understand consciousness).

I'm medicine, not anesthesia, so I don't use these agents all day and therefore referred to cardioversion which is more in my domain. Cheers!

I am noting with interest and a small amount of alarm the abruptness with which you've ejected yourself from this thread after my suggestion that all of anesthesia is a huge scam. :)

FWIW, unlikely. I specifically remember being asked to count down from 10, going like 8 7 6 ... 5 wait I feel weird and sleepy. That is, my first thought after being woken up was the next number in sequence.

It seems unlikely that would be the case if the time inbetween was spent thinking 'oh my god this hurts so much' rather than just blacked out.

Were you given a benzo specifically to erase your memory of the events? Because this thread is about the fact that many (maybe most) surgical patients are.

(Let me clear, I'm being deliberately silly about all this. I do not think there is a huge anesthesia conspiracy. I am, at the same time, seriously skeeved out by having my memory deliberately tampered with.)

> Were you given a benzo specifically to erase your memory of the events?

I don't remember! :P

Offering tptacek a dose of midaz: There is no thread.

I asked an anesthesiologist this question and am transcribing from memory (hehe), so I may have screwed some things up.

The answer to your question in is no, you aren't suffering enduring horrible pain while under general anesthesia. That doesn't mean you won't experience things you would rather not remember. Some examples: 1) patient may experience burning sensation from propofol (induction agent) entering the body 2) patient may see something disturbing before general has kicked in (e.g. a big saw before an orthopedic procedure) 3) in certain cases (e.g. emergencies) or due to human error, patient may not be fully under pre-surgery, e.g. patient may remember breathing tube being inserted.

The high level answer for why you are given midazolam (at least in the US) is because anesthesia is a "patient satisfaction" service and giving it increases patient satisfaction.

> is the experience of surgery really that bad?

It varies by person but - Yes, it certainly can be.

My grandma had to undergo hip surgery awake with only local anesthetic. She was too frail and had all these health conditions so she couldn't be put under or given much medication. At the same time they couldn't just leave her hip broken. It was an extremely traumatic event for her.

Of course others would think it wasn't such a big deal.

I can give you some idea. I've had two surgical procedures where something like midazolam was strongly recommend, but opted out for one of them. The one I opted out of was a four hour procedure sawing on bone and soft tissue.

For the procedure on midazolam, I have virtually no recollection of the procedure except for about a minute in the middle where it apparently wore off. It was a completely neutral experience.

For the other procedure, it was extremely unpleasant for two reasons but I got through it like a stoic. First, they had trouble keeping up with the local anesthetic, too many nerves involved, so there was quite a bit of transient pain and it got sloppier over the length of the procedure as the doc got tired. Second, even when you can't feel pain, you can still feel them tearing up your tissues and rearranging your parts, which is disconcerting if nothing else. Overall, I strongly recollect just how unpleasant and painful (even under anesthetic) that procedure was. I probably would not be able to tell you any of this if I was on amnesiacs because I would not remember.

It is really about where your thresholds are. Like you, I find the loss of memory on the amnesiacs disturbing and the alternative, anecdotally, was far more unpleasant than I think some people imagine. The experience that I remember doesn't bother me that much because that is my nature but I can't deny that I have vivid memories of it. I can easily imagine that many people would prefer to not have those memories. That said, I would likely elect to forego an amnesiac again if I thought it would inconvenience me (i.e. by making you useless for several hours). I can deal with the experience.

I've always been afraid of intravenous sedation (="twilight anesthetic" in other English speaking countries) for the same reason.

The only time I experienced it was for an endoscopy. Because I was a heavy drinker at the time (probably the reason for the symptoms that lead the the endoscopy, ironically) the intravenous sedation had little effect, so I was awake through the whole thing. I didn't find it traumatic, merely unpleasant, but I think other people might have. The local anesthetic at the back of my throat wore off after some time, so I was dry retching every few minutes. At one point they pumped air into my stomach so they could take a sample with a needle (which was in itself painless), and that sensation was also unpleasant.

So while I doubt people undergoing intravenous sedation during routine surgery are in extreme pain, they may be in very uncomfortable situations that most people would rather forget. Also if it had been effective, it would alter your state of mind as well, so that the immediate experience was less bad.

I've had an endoscopy before, to push down some food stuck at the top of my stomach, with no sedation or numbing. Being held down by a couple of nurses and the doctor whilst the procedure was done three times - the first two times I pulled the endoscope out after having panic attacks - was the worst medical-related experienced I've ever had, and it still gives me nightmares. Turns out the doctor was known for being a sadistic bastard who enjoyed seeing his patients squirm; I wish I was making this up.

OTOH I regularly have a colonoscopy under heavy sedation, and never remember a thing.I know there are risks with any kind of sedation or anaesthetic, however anecdotally they've saved me a lot of trauma.

A friend of mine had a skin graft done under a local anasthetic. Debriding the wound was worst. Harvesting the skin was unpleasant. Attaching the graft was unpleasant. Dressing it all was not fun.

Given the procedure I was undergoing[1], I can understand the preference of doctors to make sure the patient doesn't remember it.

[1] (let's just say this was moving a camera in a....direction...against traffic)

Can you talk about the use of such meds in ITUs?

As I understand it there's an increased risk of PTSD if people are chemically restrained, which is why some ITUs (but not in England) use physical restraints when needed.

This is a different use case from surgery, where these meds are useful.

A very close relative died after a procedure similar to what had happened to Joan Rivers. I've had that procedure (prior to the death) but now I am really scared to have it done again.

Not to mention that they are free to literally ask you anything and you won't even know what the questions were or what your answers were.

I talk in my sleep and my father and some roommates have had full conversations with me, to include them asking me questions and me answering them. The upshot is that I apparently don't always give accurate answers. For example, one roommate recounted me insisting that I needed to fill up the water tank in my car. When asked what I was talking about, I responded along the lines of "you know, so it will have power to drive". Not only was the "water tank" portion problematic, I didn't even have a car at the time.

Before an operation I was given a pre-med that also induced something like amnesia. About two hours before the op. Everything after taking that pill is a blur - I can recall maybe 5mins out of like 8 hours (short operation, so most of those 8 aren't op)

Your story (and others in the reply) sound a lot like experiences of people taking Ambien (Zolpidem) - sometime, they "wake up" in the middle of being awake, and more - sometimes, they do things (like eat, drive, email, etc.) without any recollection. Often, just as sharp as when they are really awake, but sometimes, very weirdly (people driving naked, stuff like that).

To me, that (and experiments of Gazanigga etc) indicate that Jaynes was onto something with the "bicameral mind" theory, as crazy as it sounds.

That's interesting and supports the idea that it might be related to genetic factors. I've had two twilight anesthesia procedures done about two months apart and remember the events before and after waking up in a lot of detail. I've also had regular general anesthesia once in my life, with the same result. As a bonus, I seem to resist local anesthetics to a degree that requires 2-3 times the amount a normal person does (and even then, the pain finds a way through).

Oh yeah, conscious sedation. It's 9am, I am in the dentist chair and getting pills. Next it's 5pm and I am in my bed at home and I have zero idea how we progressed from event1 to event2 yet I am told I was talking to people. WTF.

Yep - had my wisdom teeth out, same deal - I remember counting backwards, waking up in the chair, magically getting to waiting room, I blinked and my flatmate was magically there, then I magically was upstairs at home. Definitely would repeat that again rather than recall the procedure!

I've been through that as well. It was incredibly unnerving(to me anyway). The frightening part was more how would I ever know if it happened again. I've been a little paranoid trusting myself after it.

I _believe_ I had the same anesthesia done when I went in for an endoscopy procedure roughly a year or so back. Supposedly the doctor had told me how often to take the prescription, I had sent iMessages/SMS' to people as well. Later that day I had nearly no recollection of any of it.

It's a very odd feeling for sure. Nothing serious and I doubt it caused any damage, but it was the first time I'd ever just had a blank set of time that I just couldn't answer for. I did have family nearby though.

That blank period, where you know things happened but have absolutely no recall, is horrifying. I have a period like that, and it still bothers me a lot.

This is a problem with some of the drugs they use during C-sections, too. When my son was born by surprise Caesarean, I think that was one of the things my wife and I were most worried about - that she would have no memory whatsoever of our son's first few hours of life.

FWIW that happens even when no surgery takes place. The women have just gone through a pretty traumatic effort. It's funny how terribly my wife recalls the first hour after she gave birth.

No, this is more than that. It's certain sedatives that have anterograde amnesia as a side effect.

I have seizures in which I lose as much as a month of memory. The first one that I know about I suddenly found myself driving a car as if the universe sprang into existence that very instant.

After a while I decided that I dont have month long seizures rather I have brief seizures in which I lose a month of memory.

For this and other reasons I am concerned I have a brain tumour. That would totally suck.

Two concerns:

- You should definitely have imaging done to see if you can identify a cause.

- If you have seizures, you should definitely NOT be driving a car, for your safety and the safety of everyone around you

Please get this checked out immediately...

You're absolutely right, but there's one problem: it's hard to get in for an immediate checkup and there's a good chance he'll forget about scheduling one.

Instead, he should tell a family member or close friend right away. Then they can help him make the proper medical appointments, etc.

When I got home from the hospital after the worst of my seizures, I found the instructions that were given to my mother. She was advised not to permit me to go outside unescorted.

She had put it with my stuff then never mentioned it.

Mom is actually quite an intelligent woman but sometimes she can be a little daft.

IANAMD. Go to medical doctor and get a NMR. It provides a lot of information and is very little invasive. Perhaps it's not a tumor but a small cerebral stroke or some other cerebral problem. It may be easy to cure with the correct medication + diet. Even if it's a tumor, some of them are easier to treat than others.

Meanwhile, driving a car seam to be potentially dangerous.

Agree. While it's possible he's still fully functional and able to drive during these episodes (maybe even likely -- a driver having a full-on seizure or in some kind of black-out would crash pretty quickly) it's not worth taking a chance of killing someone or yourself.

Also sounds like he could have had a fugue state episode https://en.wikipedia.org/wiki/Fugue_state