A friend of mine just had some open heart surgery (isn’t modern medicine amazing!?) and is recovering nicely. His wife is a great and brilliant artist with a fantastic memory, and she recalled a discussion we’d once had about Fentanyl…
So, apparently he’s in the recovery room now, and she tells him a joke that she knows he’s going to think is really funny. Then, a couple minutes later, she tells him again. Apparently it got to the point where the nurses were also cracking up, because he kept reacting more or less the same way, each time: same laugh, same gesture, same timing, each time. She got up to about 6 times and it was starting to hurt to make him laugh.
Adam Savage told a funny anaesthesia story on his podcast, about a time when he was going in for a procedure under a general. Apparently the anaesthetist recognized him and said, “normally I don’t play with my patients, but would you like to see something really interesting? He said, “Sure!” and she told him to count backwards from 10, and that she’d count along with him.
“10… 9… 8… 7… 6… 5… 4… 3… 2… 1…”
OK, open your eyes
… and he was in a completely different room. She explained that when you go under, there’s a little flicker of the eyelids that anaesthetists learn to recognize as the patient losing consciousness. And there’s a similar flicker when they come out from under it, on the other side. All she did was synchronized his illusion of consciousness and location with the count-down, she remembered that he went out at 7, and resumed the count at 6 when he came out from under it. Very cool.
If you’ve ever taken Ambien to go to sleep, it also has an interesting effect: it eradicates your memory leading up to when you went to sleep. Normally, when I go to sleep I have little things I do that – it turns out – are important to my sense of resuming consciousness when I wake up. I don’t know how to describe it, but it’s a sense of continuity (kind of like what the anesthetist broke in Adam’s case) where my glasses are, what I need to do when I wake up, where I left my clothes on the floor – all the stuff I did right up to the point where I shut down. When I take Ambien to go to sleep, all of the things I did before I shut down – they’re gone – completely gone. Instead of feeling like I have resumed where I left off, I feel like I need to reconstruct my state prior to shutdown. It’s a very unusual feeling: “who left my bathrobe on the floor there?” Normally I would know that I had left it there, and in fact the continuity of finding my bathrobe there would be comforting – now it’s all vaguely unsettling, as if unknown people moved things around behind my back.
There is probably something about “free will” in all of that. Imagine if someone asked you to pick out a carry-out lunch selection from a menu, and you were on fentanyl: are there some people who would always pick the same thing? (I’ll have the chicken pho and garden rolls!) and are there some people who don’t? Could we experiment with the degree to which we pattern-program and where? Would we find that people tend to always pick the same food, but if you asked them to pick – perhaps – clothing, they would change things up? What would happen if we then asked a person “which is more important to you, what you have for lunch or the outfit you wear?” Naturally, the subject would forget that they gave consent so that brings in all sorts of human factors in experimentation.
ah, the internet.
Need I mention: Fentanyl is not a toy. It can be lethal, so don’t use it recreationally even if under medical supervision (that’s what killed Michael Jackson) Fentanyl is particularly problematic because it’s very very powerful and the difference between a correct dose and a lethal one is very narrow.
It’s unsettling how fragile the “self” is, isn’t it? I’ve always said that it’s mildly surprising that we work as well as we do, given what a house of cards brain chemistry is.
Completely unrelated: what’s with the background of that screenshot? It looks suspiciously similar to some of the confusing patterns used to make OCR harder for CAPTCHA. The harmful/irritant CHIP symbol (orange square with black X) on the 1 kg (!) bag of Fentanyl is a nice touch, though.
cvoinescu@#1:
It’s unsettling how fragile the “self” is, isn’t it? I’ve always said that it’s mildly surprising that we work as well as we do, given what a house of cards brain chemistry is.
That’s a good way of putting it. It’s so fragile and it takes just a tiny nudge to make the whole thing go awry for a while. Fortunately, it appears to be pretty good at resetting itself. Or appearing to. As I mentioned before, I’ve experimented with some of these things in my past, and it really does make my sense of self wobble when I realize that I can eat a little pill and have my subjective mood-state radically altered. Who am I? Which me am I? When you start throwing things like ambien and fentanyl into the mix you credibly can cook up a scenario where someone could be framed for murder and have no idea if they had done it or not.
You probably don’t want to follow this link: [research chem vendor, pharma product category] unless you want your XKeyScore to jump. As far as I can tell, it’s just a plain screen background intended to look pretty. That vendor appears to be out of China – the Chinese government doesn’t seem to care a whole lot about black labs there shipping stuff to US customers – it’s one that exists in both the real internet and on the dark web.
I don’t think they make any effort to hide. I’m very curious about this kind of stuff but I don’t think there is any way I’d try to buy any of this unless I had an FBI agent’s home address and credit card number, so I could have it shipped someplace where it’d be appreciated.
A few years ago I knew a silicon valley big shot type who was very into dark web stuff, who was buying large quantities of crazy stuff from places like this. My fragile mind looks at that and screams “NOPE!”
There was a store in State College – a head shop called Dragon Chaser’s Emporium I dipped in there once and they were selling “bath salts” – basically, these Chinese-made amphetamine-analogues or LSD-analogues – over the counter. I got the hell out of there but I’m sure I was on some camera somewhere. A year later the place was raided (natch) and the owners got a lot of trouble (natch) and criminal charges all around. Bits of the story appeared in local papers. It turned out that the owners claimed, in their defense, that they had it on good authority that the stuff was all perfectly legal.
Hey, it says it right there on the website: “non-regulated by law” so it must be OK. The mind boggles.
I’ve had anaestisia twice, both times it went:
10, 9, 8…. Oh shit! I forgot to continue counting, am I in trouble now?
I’ve always thought the “oh shit!” thought was just before I went under, cause it has the general feel of knowing you had to do something, but lacking the concentration of being able to do it. Now I’m suddenly starting to doubt that.
I could have sworn Michael Jackson died from Propofol, not Fentanyl.
Thanks for these posts. The more I learn about Fentanyl, the less I want anything to do with it. After my accident in June, I was given two doses of it. And my memories of that day consist of a few memories I trust and a whole bunch of memories I probably created.
Which is going to make it real interesting next week. The management team is going to hold an accident review so we can figure out what happened and how to prevent it happening again. And I, of course, since I was the only one present when it happened, will be providing the narrative. And my few memories — the soggy cigar still in my mouth after I hit the river, reaching for the rope, joking with the rescue workers who were balls deep in cold water — are useless memories. The parts I think I have filled in to explain to me what happened are extremely unreliable.
I plan to point out that, with the massive doses of both morphine and fentanyl, my memories of what happened are not, and cannot be, reliable. Not sure how that will go over.
I had fentanyl the first time in December, after the ostomy. I wasn’t impressed. The anesthesiologist who had me in recovery was a bit boggled by the lack of pain reduction, too. It took 3 IV pushes of the stuff for the pain to begin lessening so my breathing could steady out; the stream of tears didn’t slow though, and kept going until well after I was back in my room. Those didn’t stop until another fentanyl push and a patch. I told them “next time, stick with morphine please.” For whatever reason, plain old morphine works much faster and more effectively with me.
ahcuah@#5:
I could have sworn Michael Jackson died from Propofol, not Fentanyl.
Good catch. At the time I believe fentanyl was said to be involved but the wikipedia page now says it was propofol and benzodiazapenes. That actually makes a lot more sense – but, wow, you gotta wonder how he backed his way into that cocktail for recreational use.
Ogvorbis wants to know: WTF!?!?!?!@#6:
I plan to point out that, with the massive doses of both morphine and fentanyl, my memories of what happened are not, and cannot be, reliable.
Generally, our memories of traumatic things tend to be a weird mix of razor sharp and patchy; it’s just how our brains and bodies respond to shock and stress. Morphine and Fentanyl just muddy that up in more interesting ways!
I hope none of this is unsettling your sense of your grip on reality. That’s my particular nightmare (which is exactly why I am so fascinated by, and inclined to play with this stuff)*
(* that is not to say I play with Fentanyl. Turn the “nope” valve to 100% on that one)
robert79@#4:
I’ve always thought the “oh shit!” thought was just before I went under, cause it has the general feel of knowing you had to do something, but lacking the concentration of being able to do it. Now I’m suddenly starting to doubt that.
Maybe you feel that you felt that way, when you’re coming out. Either way, it’s reality.
At least your brain isn’t going “Oh My God I left the stove on!” and panicking.
Caine@#7:
It took 3 IV pushes of the stuff for the pain to begin lessening so my breathing could steady out; the stream of tears didn’t slow though, and kept going until well after I was back in my room. Those didn’t stop until another fentanyl push and a patch. I told them “next time, stick with morphine please.” For whatever reason, plain old morphine works much faster and more effectively with me.
Oh, yipe.
You’ve got a lot of pain, right? I wonder if your brain chemistry adapts to it, and if that changes the characteristic response of some drugs. I dunno.
I know one person who throws up if they get oxycodone. Me, I’m the happiest clam on planet clam when I have oxycodone. It’s weird how we react to these things. Maybe scientists will have a better idea how it all works, in a couple decades. My bet is, if they do, they’re going to be forehead-slapping and going, “oh my god back in the 00’s they used to give people that for that…”
Yeah, that’s something that had been really bugging me. Other traumatic incidents — a major skiing accident (dislocated neck), near misses of major car accidents (sudden snowstorm on I-81 near Harrisburg), the most painful (or pleasurable) encounters with my abuser) — are all razor sharp. I couldn’t figure out why so much of that day (hell, the month of June) was so fuzzy, so ‘I need to fill in this gap, here’s what I think happened’, so not razor sharp.
Not to mention a solid month on large doses of oxycodone and flexerol (a muscle relaxant).
It really hasn’t. Then again, how would I know?
The stuff does very little for me. It just takes the edge off. Just enough that I can sleep (without getting any actual rest). And I was taking two doses every four hours for about two weeks. And had to use an alarm clock to avoid taking my next dose too early.
Had no problem reducing the dosage as I healed. Which is good.
Morphine, however, makes me happy as a rudist clam (pre-PT extinction, of course).
Being a screaming sissy when it comes to dentistry (and the shots don’t work very well) I pay the out of pocket costs for “conscious sedation. You take six little pills the night before and six the morning of. You are theoretically conscious, but I don’t remember a single thing about the procedure or the time under the drill.
Weird stuff!
I’m sorry I missed this thread.
Raucous Indignation@#15:
I’m sorry I missed this thread.
You didn’t!
bmiller@#14:
“conscious sedation”
I had never heard of that before! A little research says that you’re usually on a teeny bit of fentanyl (why you remember nothing afterwards!) and something like midazolam, which is a disassociative used as a sedative. I can imagine that you’d feel woozy, a bit warm and verrrrrrry relaxed and would mostly forget everything.
Yes, conscious sedation. It’s what used as anesthesia for short procedures such as colonoscopies or biopsies. An anesthesiologist administers a cocktail of short acting pain meds and sedatives, e.g. intravenous fentanyl and propofol. If the procedure takes a few minutes, then the patient is awake a few minutes after it’s completed. All under the close supervision of an anesthesiology team. It’s NOT when you’re whacked outta your mind on a handful of goof-balls.
Oh, Marcus, we have a pretty good idea of how all this does work. That’s not the problem. The problem lies in the fact that there are a large number of genetic variants for each of the μ-opioid receptors, and the μ receptors are only one of four classes of opioid receptors, all of which are variably expressed in each individual. Giving each individual different pain responses to different opioids. Tolerance is completely another thing, with variability in nausea producing chemo-receptors and histamine release and constipation and and and …
See? I did miss all the fun.
Raucous Indignation@#20:
See? I did miss all the fun.
Maybe it sounds like we did.
I had no idea there are genetic variants for how we respond to opioids – which totally makes sense because I know people who react very differently to different versions. I have a friend who gets the heaves from morphine but not oxycodone, etc.
Yeah, there at least 10 genetic splice variants for the μ1-opioid receptor alone. And that doesn’t take into account post-translation glycosylation or up and down regulation of the receptors.
There are charts and formulas to help, but we use quite a bit of Kentucky windage when converting a patient from one opiate to another.
Raucous Indignation@#23:
There are charts and formulas to help, but we use quite a bit of Kentucky windage when converting a patient from one opiate to another.
Fascinating!
I assume you’ve read the OP and some of the other comments in this thread. Do my non-expert subjective observations about Fentanyl match your more professional understanding? Ogvorbis wants to know: WTF!?!?!?!@#6: appears to have had some memory dropouts during an injury and I don’t want him concluding anything wrong from my remarks here.