Gone

Death

Image by tanakawho via Flickr

I was gone for about an hour Wednesday.  I have no idea where I went and no memory whatsoever of the time lost, although I do have testimony from others about the missing hour.  They assure me that I did not disappear.

What happened to me is that pursuant to undergoing a colonoscopy (I have a family history of colon cancer) I was given the drug “Versed”, or midazolam injection, and that resulted in amnesia for the period of the procedure.  I had experienced this twice before, once for a previous colonoscopy and once for dental surgery.  This time I resolved to pay extra attention to the experience.

Dpx-fm-radio

Image via Wikipedia

I heard the nurse say that she was injecting the stuff and about 10 seconds later I heard the on-going conversation in the room rapidly diminish in volume and become less understandable.  It was just as though the sounds were on a radio that was being quickly turned down and simultaneously tuned a little off-frequency.  I estimate the period over which the transition occurred lasted not more than three seconds.  Then I immediately awakened in the recovery room.  It was about an hour later, but I had absolutely zero sense of any time lost.  The missing hour was not like sleep, it was a total blank.  It was as though that hour had not happened.

A nurse told me that “amnesia” was a common side effect of Versed and I shouldn’t worry, but I found this most curious.  I looked up Versed / midazolam in the world’s best medical reference, the NLM’s MedlinePlus site and found some interesting information.

First off, this is a very serious med.  It can cause you to depart this world permanently if staff aren’t there with the right equipment because it can stop your breathing.  Secondly, there was this statement about why Versed is prescribed:

Midazolam injection is used before medical procedures and surgery to cause drowsiness, relieve anxiety, and prevent any memory of the event (emphasis, mine).  It is also sometimes given as part of the anesthesia during surgery to produce a loss of consciousness. Midazolam injection is also used to cause a state of decreased consciousness in seriously ill people in intensive care units (ICU) who are breathing with the help of a machine. Midazolam injection is in a class of medications called benzodiazepines. It works by slowing activity in the brain to allow relaxation and decreased consciousness.

I find it most curious that intentional memory loss should be listed as a purpose for prescribing this medication.  It makes me wonder, under what ethical conditions might this be the driving purpose?  The only one I can think of might be to reduce later psychological reaction, as in nightmares, to some kind of traumatic experience.  Whether it is ever actually used this way is unknown to me.  Now I am wondering, did I actually experience the procedure as it was performed, only to have those memories erased, or if I was unconscious the whole time?  I didn’t get a chance to ask anyone in the OR.

The entrance to the Central Intelligence Agenc...

Central Intelligence Agency, via Wikipedia

My wife, Mollie, has had this procedure as well and her reaction to Versed was different:  she had no amnesia and her memory of the procedure was intact, including the discomfort.  I wonder if the CIA uses Versed?  Hmm.  Could you water-board someone under Versed, extract information, and then have them retain no memory of the event?  I guess they could me, but not Mollie.  Since this is a public blog, and just for the record, I know nothing.  Honest.

Death can not be different from that missing hour, it seems to me.  It invites thinking about the nature of self-awareness, a subject that has long fascinated philosophers.  I submit that there is a continuity of self-awareness in natural sleep that does not exist in this amnesia.

Decartes said, Cogito, ergo sum.  I think, therefore I am.  But, the corollary then must be, if you do not think, you aren’t.  You do not exist.  No lighted passage, no vision of angels, no departed relatives to greet you.  I would be wondering about my soul, except that my experience is typical of those who lose consciousness this way.  This kind of death is not to be feared as would hell, a different definition of death.  While the thought of going under, not to awaken, is disappointing in the extreme, but I can think of no better motivation to make the most of every day I have left.

PS, no trace of cancer or polyps, and I quit smoking 39 years ago.  I’m going for a record.

PPS, the biochemistry here is real.  Below is a related article on an enzyme that boosts or restores memory.  (I wonder if it could restore mine?)

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About Jim Wheeler

U. S. Naval Academy, BS, Engineering, 1959; Naval line officer and submariner, 1959 -1981, Commander, USN; The George Washington U., MSA, Management Eng.; Aerospace Engineer, 1981-1999; Resident Gadfly, 1999 - present. Political affiliation: Independent, tending progressive as the GOP recedes from its Eisenhower roots.
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14 Responses to Gone

  1. It sounds vaguely like stories of alien abductions.

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  2. ansonburlingame says:

    Jim,

    Along different lines of thought, what you experienced is similar to what addicts (drugs or alcohol) SEEK. Life is too ‘hard” thus they seek to “turn it off”. In my view that is the physcological part of addiction as opposed to the physcial addiction experienced in withdrawal from drugs or alcohol (shakes, DTs, sweats, etc). And that physcological part of addiction is the part that can last for a lifetime, long after physical addiction is “cured” in detox and rehab.

    And the current inability of addicts and the mental health community to treat the physcological part of addiction is why the relapse rate is so high with drug or alcohol addicts. They never forget the at least partial oblivion achieved by use of drugs or alcohol and want it from time to time for the rest of their lives.

    And I bet even after 39 years you might occassionally want a cigarette. Same thing.

    Anson

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    • Jim Wheeler says:

      I understand addiction, Anson, and I agree with your analysis of it. However, there is nothing in Versed to be addicted to, nor is there any addiction warning in the NLM listing for it. I see nothing to be liked to experience a loss of time, but for sure there are plenty of other substances to abuse these days. I saw an item on the news the other night indicating that abuse of prescription pain killers like Oxycontin and Vicodin is now more common than heroin, marijuana and the like. In fact, they said Vicodin abuse is epidemic.

      As for smoking, I was chain-smoking cigars when I ran out while returning from a trip to the Med in 1972. Having gone without a smoke for 10 days I made a conscious decision to quit. There were pangs for the first few weeks but I was able to make a psychological shift that turned into dislike of even the smell of the weed. I’m fortunate in that regard because I know many people have to fight the addiction indefinitely.

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  3. ansonburlingame says:

    Jim,

    I would also add that if you believe Ann Richards, former governor of Texas and a long time recovering alcoholic, around 80% of the prison population in Texas (during her 8 year term in office) suffered from that physocological addiction and soon after leaving prison were compelled to return to drug or alcohol abuse.

    Just imagine if the mental health community could find a “cure” for such a disease how much better off society would become. A lot of folks that concern Duane so much also suffer from the same disease (addiction), statistically at least 10% of the population in America (or anywhere else) which accounts for around 30 million people right here at “home”.

    Does that number simply “accidentally” come close to those whom Obamacare targets to provide medical care, those really distitute?

    Anson

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  4. ansonburlingame says:

    Jim,

    I keep thinking of ways to put your thought provoking blog in a current social context.

    You found real oblivion for an hour for a short and relatively painless procedure.

    Now what if you were suffering from incurable cancer and in great pain. Your chances of recovery were slim to none and Mollie had to sit, watch your suffering and pray. Medicare and Tricare would continue, at great cost, to sustain your life to the extent that the medical profession was capable.

    Would a lethal dose of the above drug become appealing to you at some point and perhaps even to Mollie. That is exactly what Kevorkian provided, illegally.

    Should that change; remove the illegality and let it become the patient and the patient’s families choice to allow for medically and thus painlessly assisted suicide?

    What holds us back from such political actions other than religion? And church and state are supposed to be separate in this country.

    Anson

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    • Jim Wheeler says:

      If I were “suffering from incurable cancer and in great pain” I would definitely want to end it as cleanly as possible. From what I read, hospice allows you to do that very well. Mollie and I both have complete “advanced directives” (as should everyone, IMHO) that make it clear we do not want any exceptional efforts made to prolong life when there is no significant hope of recovery in such circumstances. I would like to have the option for assisted suicide but from what I hear, hospice can suffice nicely in most cases. I do hear, though, that there are a few doctors still around who foolishly worry about terminal patients getting addicted. People should discuss the situation ahead of time with their doctors and make sure they have one with his head on straight. (Much can be done without a lot of fuss.) Organized religion is, IMO, a big part of the problem. They think God is in charge of our health, but they condone maximum technological intervention including keeping people on respirators when all reasonable hope is gone. (If God intervenes, then why do we need respirators?) They also condone completing the birth cycle for fetuses known to be severely damaged. Totally nutty to me.

      I believe the provision in the ACA for free counseling is an excellent step, and not a Death Panel as Sara Palin would have us believe. She contributed significantly to an already-paranoid culture. Shame on her. From everything I read, most people are in denial about the realities of end-of-life care and hospice and the clergy are complicit in the idiocy by insisting that God will step in and take care of things. They need educating. Nobody is forced to undergo chemotherapy, but desperate people who have declined to think the problem through will grab at any straw.

      Jim

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      • Jim,

        I’ve thought about your presentation here and I must say I don’t think I would want to take the drug, although with my medical-related anxiety, I would be a prime candidate for it. I don’t like the missing time element of it. Sounds horrible. The brain is essentially dead for a period of time.

        In any case, the comment above is outstanding. I have had little success in making the case to true believers that it makes no sense to both believe in divine intervention and technological intervention. The response is always, “God uses technology to intervene, sometimes.” And I have had no success in convincing such folks that God, or Nature, is the biggest abortionist of all. Some sources say about half of all pregnancies end in miscarriages, before the woman knows she is pregnant in most cases. And almost one in seven known pregnancies will end in miscarriage.

        Thanks for mentioning your experience with being, essentially, dead.

        Duane

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        • Jim Wheeler says:

          Don’t mention it, Duane. Always glad to brighten someone’s day! 😆

          BTW, I did not find it “horrible” at all, having been safely through it twice before. I thought it fascinating and somewhat depressing.

          Your comments on abortion are surely germane and I have wondered about that topic for many years. It is of course often claimed by the religious right that life begins at conception, but I disagree. The basic problem with that is the one you bring up – that spontaneous abortions happen so very often, and I’m sure it’s because something is physically (or bio-chemically) wrong, either with the fetus or with the mother.

          There is another factor to consider: studies of human memory indicate that accessible, specific memories are not available before the age of about 4. This makes sense in terms of brain development, and it also correlates with the FACT that humans in oral cultures are fundamentally different from those in literate cultures, i.e., the ability to think abstract thoughts. Bottom line, the POTENTIAL for life starts with a fertilized egg and eventually grows into a real human over a continuum of about 4 years, but there is no finite point in time at which it becomes a human, a concept borne of wishful thinking for things to be simple. IMHO.

          Jim

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  5. ansonburlingame says:

    Jim,

    Here is a brief, personal experience. I had a brother-in-law whom I had never met. He was dying and Janet and I drove to Ft. Worth for his final hours (we arrived in time). He had cancer and was in great pain in a hospital. He was only allowed X amount of morphine per Y period of time and it did little to relieve the pain.

    I watched him die in agony because Y period of time had not expired!!!

    Addiction my ass.

    Anson

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    • Jim Wheeler says:

      A true horror story indeed, confirming others I have heard. Was Y period of time set by the doctor’s discretion, or by bureaucratic policy? If the latter, remind me not to die in Texas!

      Jim

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  6. ansonburlingame says:

    According to the nurse it was the attending physicians direction. He was concerned about causing addiction.

    And the reason I had never before met my brother-in-law was because he had long been estranged from the family because he was an ADDICT for years!!

    But whatever ones faults may be NO ONE today deserves to die in agony such as I watched for about two hours while cancer did its work and a doctor withheld pain medication.

    Now tell me why any of all that makes any sense.

    Anso

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    • Jim Wheeler says:

      Obviously, Anson, it makes no sense at all, but I am relieved to hear that this was not a bureaucratic problem, but rather one of having the wrong doctor. It also occurs to me, given that he was previously an addict, that the prescribed analgesics were less effective because of his previous addiction. Tolerance build-up is a well-known consequence of addiction.

      Jim

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  7. Assissted suicide is legal in Oregon, but has been used in only a few hundred cases in the almost 20 years of legality.

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    • Jim Wheeler says:

      This makes sense to me, Bruce. Assisted suicide ought to be reserved for those few instances where the quality of life is so poor as to not justify continuance, but where the body endures. The moral difficulty of the decision might be epitomized by the condition and mental state of Stephen Hawking, but at least he is capable of making that decision for himself. The real dilemma is in the case of someone not mentally fit. But for the great majority it seems to me that hospice suffices.

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