What Brain Surgery Taught Me About the Fragile Gift of Consciousness

Versed/midazolam, almost certainly, was a part of the preoperative regimen.

I had jaw surgery and basically didn't sleep the night before, for obvious reasons, and they gave me a bit of versed in prep and had to wake me up on the table to put me under for anesthesia proper. Hey, not my fault the blankets were warm and the pillow was perfect.

It's a very useful medication both for anxiety, but also to reduce your seizure risk, which I imagine for cerebellar surgery was a definite factor.

Finding peace in such a situation takes courage, strength, and reflection, and you apparently have/found all of these.

How much did it help? Did you notice a change in your personality? How long did it take to recover? Did you lose vision in one eye?

Do you imagine the self being split into an "actor" who makes all the decisions, and an "observer" who can see what's going on but can't influence the actor?

That can not be the case, because the "actor" can catch the "observer" in the "act" of "observing". You can introspect, and you can speak about your introspections, or write them down, which means there is a feedback loop between the acting part and the observing part.

We're not simply observing "from the outside".

> I’ve been drafting a manuscript for a novel lately, trying to see how well llms can help.

> I recognize this prose immediately as OpenAI gpt 5.

Is it possible you are experiencing confirmation bias[0]?

In other words, by your own admission, you have been "trying to see how well llms can help" as it pertains to writing. With that degree of LLM intimacy, is it possible "the cadence and rhythm and word choices I’ve seen writing my manuscript" is a pattern you are predisposed to identify in other works?

0 - https://en.wikipedia.org/wiki/Confirmation_bias

If you don’t care about your craft as a writer to the extent that you can’t even realize how straight-out-of-a-LLM your writing sounds, I’m not going to care about it either.

"And yet, hours before surgery, with death still in the room, I didn’t feel fear. I felt something quieter. Stranger. I felt connected. To her eyes. To my breath. To the weight of my feet against the floor. To the wind brushing the window."

The usage of these short sentences (which, people do use, but sparingly) is a good marker. My hunch is this is because of how they call attention to themselves and are rewarded by human RLHF participants. I don't know if incentives including spending time on essays like this but if they don't and the rater is trying to do a speed-read, these stand out.

Have written about other markers here: https://saigaddam.medium.com/it-isnt-just-x-it-s-y-54cb403d6...

One along those lines: "Not just that we think. But that we feel. That we can marvel. That we can sit in silence across from someone we love and feel time slow down and become something."

Just like with music, random amatures may have just the same or deeper feelings than superstars, but they don't have the technical skills to put that into their music. We still prefer to listen to the technically competent music to get feelings from it despite it being less personal.

"Survivor’s euphoria.” A clinical term, woefully inadequate. It wasn’t just euphoria. It was revelation."

This made me slightly nauseous. What's ahead is going to suck so, so bad. We shouldn't have left the ocean...

That era is definitely over.

I speak for myself, although I know I am not alone in my trajectory. About a decade ago I was ill enough for long enough with an uncertain enough prognosis that I was getting my affairs in order. At the same time a close friend died of an agressivo cancer, aged 32.

I decided to choose quality over quantity. Fuck my business, fuck my career, fuck stupid status games and absolutely fuck climbing the infinite pile of skulls.

Sold up. Put everything on 00 and gave the wheel a spin.

It’s been almost a decade. I still live in the woods, start my days with a coffee and birdsong and “ein heiliges ‘ja!’”, still have zero temptation to return to my life before.

I can't recreate the exact feeling, obviously. Just remembering waking up in the world of the living is still powerful enough to improve my mood and put problems into perspective, even after more than a decade. The old me has a new mental tool, forever.

At the same time, I'm not walking around like an enlightened monk either. Whether something counts as life-changing must depend on perspective and personality.

I know from experience because I survived a brain hemorrhage. I had a state where I experienced the world differently for many years. I still do. Something cracked open in me and it has stayed that way, other aspects of my physiology are returning to a baseline state, like my nervous system changes which damped my fear responses.

A life-changing moment changes one's life by definition. Each time a person experiences one, they are changed in a way where who they were before they can remember, perhaps even look fondly upon, but know they are not that person anymore.

> Powerful story. But let's be real: after the "survivor's euphoria" fades, how do you actually keep that level of consciousness?

By living in the moment and remembering how you got there.

We can move the bar around but it always tends back toward that default.

He uses the example of this being why people who read self help book always seem to be reading a new self help book.

That little euphoric moment of clarity and fresh outlook only last a few months or so until you’re back at your regular old self and need a new epiphany.

The times we tend to adopt changes quickly and consciously are most often with circumstance and external pressures, and the shortcomings implicit with such rapid adaptations can manifest as neuroses/complexes. In traumatic scenarios this might be something like PTSD, but it isn’t necessarily all downsides, either. People taking therapeutic amounts of MDMA or psilocybin (as in, occasionally, not “micro dosing” or whatever Elon Musk seems to be doing) might experience a durable improvement in subjective happiness and optimism.

Disclaimer: this is my own intuitive and wholly unqualified understanding of this, which was arrived at via discussions with behavioral therapists, but I’m an IT consultant, wtf do I really know about it?

I will say that I’ve found mindful meditation highly effective for treating mild to moderate PTSD. It isn’t fast to get started, but after a few weeks of training, you can deploy your own chemical Xanax directly within your own brain using breathing patterns. It really worked for me. I used the app “Headspace” to start out.

My observation is that whatever story people believe will happen after their death will deeply influence their current life in this reality, so I disagree that it is “just wasted time“. For most, it’s not simply a mind exercise but defines their values and existence.

It’s arrogance and ignorance of the “West“ to assume everyone wants to “live a long life“. You very distinctively have other priorities if you believe in reincarnation and karma. Belief in rebirth strengthens dynasties and collectivism in very real ways, the belief in no afterlife or one that is not influenced by your current behavior strengthens individualism.

> What always amazes me is how there’s absolutely no sense of time having passed once I wake up.

My experience is that this depends on the med. With propofol, indeed it's like an editor took a razor, cut a few inches of memory tape out, and spliced the remains back together. I'm signing a consent form, and then a second later I have teleported to the recovery room where I'm having apple juice.

What's wild about propofol is that lost time does not mean you were unconscious the whole time. With twilight anaesthesia, you are often semi-lucid and able to respond to commands from the doctors. You are aware and having an experience. It just gets erased afterwards.

With midazolam, it was a much stranger experience. After the procedure, I can remember telling my wife that I remembered everything. She said I seemed totally lucid. But I no longer remember what I did remember then. Throughout the day after the procedure, memories faded out. Now it's almost all gone, including much of the time after the procedure was done.

> I've never felt as much peace as I do right before going under anesthesia. It’s probably just the drugs, but honestly it felt like coming home, even though no such home exists, and no one is there to return to it.

It's the drugs. Specifically, it's fentanyl.

For my second surgery, the anaesthesiologist pushed the fentanyl before the propofol, and told me he was doing so. When he said we was going to, I remember telling him. "OK. Oh! OK." It feels like every worry in the world has disappeared. Everything is cozy. Everything is fine. It's like being in the womb again.

I understand how people can get addicted to it.

I have been under general anesthesia three times, and this is the thing that sticks with me too: it’s a dress-rehearsal for death. The conclusions you come to by going through it are obvious in retrospect but nonetheless interesting:

You have no conscious experience or memory of the moment when you go under and your consciousness is severed. There is only the lead-up, usually the anesthesiologist saying they’re about to start putting the drugs into your arm, or asking you to count down. The next conscious event in your life is waking up in the recovery room. It’s obvious to say, but you could die while under anesthesia and you would never know. Your conscious life up to the moment you went under would be the same. I think it was Wittgenstein who said that Death is not an event in life, and after experiencing anesthesia I suppose I get what he meant.

> I've never felt as much peace as I do right before going under anesthesia.

Same, but I don’t place a lot of stock in it - like you say, it’s the drugs. I asked my anesthesiologist what he’d be giving me to relax me before I went under and he said fentanyl.

> any assumed meaning of our existence only matters while we're alive. [...] The world can and will go on without us, and that includes the people closest to us at our final hour.

Such a self-centered and cynical way of looking at life. The world does not go on without "us". We are the utmost expression of nature and, quite literally, the legacy of those who came before.

I hope we can figure out a way to stop this self-indulging materialism. I understand that believing that nothing truly matters is quite freeing for the selfish hedonist, but it's about time we regain a sense of transcendence.

> but honestly it felt like coming home, even though no such home exists, and no one is there to return to it.

Truly, this is a load of non-sense. You have no way of knowing. Why be so deliberately obtuse on that we don't have answers for? Why have we stopped asking the important questions?

What do you mean by this? It is obviously possible to have an impact that lasts after you die and that people view as meaningful long after you die.

If the meaning of your life is to raise your kids well, that still matters after you die. Or if you invented calculus, or general relativity, or conquered Egypt and Persia, or wrote an epic poem read for thousands of years.

The world will go on without you, but it will be different, and maybe meaningfully so to those left.

   ― Robert Frost