Apparently getting panicked calls from dentists was not unusual. In one particular case a 18 year old woman wouldn't wake up, he helped as much as he could, but she was never the same.
Morale of the story, don't let a dentist put you under without an actual anesthesiologist involved.
If you need a full anesthesia you need to go to a dentist clinic which has a anesthesiologist.
Or at last that's is the idea, in practice things might not always be that clean cut.
Also it says the patient only had local anesthesia, not general.
One way to improve this is to mix with a base to increase the pH.
I work almost exclusively with dentists, many of whom offer general anesthesia in their offices.
An anesthesiologist says anesthesiologists are indispensable? How shocking. There are plenty of horror stories when anesthesiologists are involved as well. The moral of the story is whenever possible, try and not to be put under.
It’s like when people assume I don’t know anything about databases because I’m currently classified as front-end developer.
Anesthesiologists are the ones who practice the skills most closely related to crisis situations in their everyday job. They will on average do massively better than anyone else, just because they're used to it.
Modern medicine, especially interventional, is still more a practical skill than it is science. You can't "know it better theoretically". If I had surgery and something happened, I'd trade an anesthesiologist or CRNA vs. Pretty much any other specialist anyday (except some ER/ICU guys, but not all of them by far).
This depends heavily on what "it" refers to. If something goes terribly south, I really don't want to be handled by an anesthesiologist who handles terrible anesthesia-related screwups every day. He's almost certainly causing those screwups.
Is everyone really missing the point?
Is it Postgres? SQL Server 2012? Mongo? Oracle? Sybase???
Is it one DB or a cluster? Is it replicating, and by what methodology? How much downtime is acceptable, if any?
That's a pretty limited set of possibilities because, you see, I'm also not a database expert. Maybe you think you can handle all of those situations, but I know I can't. So yeah, one of us is definitely missing the point.
Not to mention, what if things don't go according to plan! Have you ever even dealt with a situation where you have unreconciled data?! The more I think about it, the angrier I get about your insouciant ignorance!
But it's ok, at least I'm not the one hypothetically dealing with a database migration gone totally fucked :)
But keep in mind even if they both have the same knowledge, when a dentist is concentrating on the procedure, handling any surprises, bleeding, and other difficulties they might well not notice that your breathing rate or heart rate have gone too low, or too high.
If that were me, and I were just informed that my own little children had essentially disappeared, I would likely go catatonic. I mean, in a sense, even though they're still present as young adults, it's as if your children have died. I don't know how a person could cope with being told that even once, much less a thousand times.
Sometimes I ache with the desire to go back and time to visit those past selves, to cradle them as babies or hear their goofy mispronunciations one more time.
I cannot fathom the pain of having to experience all of that grieving in fast forward, every day.
Yes, I understand the feeling. You will get that chance when you have grandchildren!
In many ways, parenting is like a video game where you only get to play each level exactly once before you're dragged to the next one. As soon as you master one stage of your kids' development they've outgrown it and you're back to fumbling your way through unexplored territory again.
Having the chance to play "Human: Level 1" again sounds pretty amazing. Not to mention getting to hold and snuggle a baby again. Babies are amazing, especially when you only have to take care of them part-time.
Then it clicked for me one day: I miss their younger selves. Every new milestone is the end of a phase that I'll never get to see again.
If you don't mind a suggestion, take lots of video and get lots of audio recording of them. Their little-kid voices don't last forever. And once they're past the obnoxious teenage years, you may find you can't even remember their earlier voices.
(AFK to dry my eyes and go give my kids a hug.)
Totally agree. The firsts are a source of joy and the lasts make me melancholy.
At the same time, I don’t think we should ignore the experience in the moment just to take a video for later.
I suppose the good news is that it's like the first time every time.
Consider it happened to someone currently (and normally temporary) alone.
Now you are close to guaranteed to be alone for the rest of your live ...
Or you did.
Short clip: https://www.youtube.com/watch?v=Vwigmktix2Y
Extended documentary: https://www.youtube.com/watch?v=k_P7Y0-wgos
I learned of him through neuroscience classes. That was plenty of years ago, and I still think of his condition every now and then.
One thing that amazes me is that he keeps stacks of diaries where he keeps erasing the previous entry, adding the current date and time, and writing "first entry I made consciously" (https://youtu.be/k_P7Y0-wgos?t=1113). But also, it seems that over time he does learn something new, somehow. For example, he can now reliably "predict" the ending of movies he has seen a great amount of times after the amnesia started, without remembering of having ever seen the movie. And, of course, it's touching to see the relationship with the wife.
I've gotten extremely rigorous at writing notes for myself, doing sketches which I never used to need, and otherwise compensating. I hold it together on a professional note, but personal relationships have suffered badly. I guess I need to take better notes about them, which I don't currently do.
As horrific as this story is, I guess it's good to know that I'm not alone?
Before my father-in-law was diagnosed, he had had a couple of unrelated surgical procedures. Each time, he came out of anesthesia a changed man. We had no idea what was going on at the time, but the difference before and after was striking. He came out short-tempered, easily confused, and less mentally present.
Only years later did we realize it was probably because of the DLB. I don't know your age or if it is at all likely similar for you, but it's something to be aware of.
YES! Nail on the head.
It's like if I take a car to the mechanic and they say "Well, its performance hasn't fallen below that of a '93 Escort, runs 0-60 in 12 seconds just like it should", and I say "But it's not an Escort, it's a Taycan Turbo S and it used to do it in 2.42, and there's something severely wrong with it!" and they say "Sorry sir, our diagnostic criteria only allow us to work on it when it's no longer roadworthy"
What a crap mechanic.
I never played enough chess to have that sort of comparison, but at work, there's a machine I built several years ago, in an afternoon, didn't bother writing anything down because it all went together in my head with room to spare. Recently I had to build another identical unit, and even with the first one to look at, I spent a day and a half tracing it out and writing things down to try to figure out how it worked. My brain just wouldn't do the thing. I constantly feel trapped in a fog, some deranged medley of Comfortably Numb and Keep Talking.
I never would've consented to anesthesia if I'd had any idea this could happen. Fuckit, I'll live with weird digestive issues, just give me my mind back.
Yeah, I see what you mean. This definitely sounds like some form of humble brag :)
†I recognize that everyone is different and this option may not work for everyone. I also think that I got a talented doctor. So your pain mileage may vary.
Many people died on the table in minor anorectal procedures in the past due to bad parasympathetic reactions.
Even certain routine procedures risk doing this.
My memory and cognitive function were completely crap.
Eventually figured out I had a genetic disorder that got activated by the gas.
“factor 5 “Leiden” which is fairly common and usually not an issue, but environmental toxins can trigger it.
Result is my blood went very “sticky” So I was suffering micro clots / minor strokes multiple times week.
Went on blood thinners and my cognitive problems resolved.
Was an insane road to figure this all out.
But yes, general anesthesia is really wild stuff. Even more wild when you learn that we don't know how they actually work, other than that they work.
For those fretting about getting a colonoscopy, like I was, let me tell you it's no big deal. I've had dental cleanings that were more uncomfortable. In fact, there was nothing about my colonoscopy that was uncomfortable. Getting your guts cleaned out in preparation for the colonoscopy? Yeah that's a different story but the actual procedure itself is a big nothing burger.
The definitive reference.
Patients don't always notice they're semi-awake, and most don't remember the procedure. It's perfectly normal. I you had an airway in place and were mechanically ventilated, then that's general anesthesia.
Having said that: people w/ MTHFR mutations are cautioned against nitrous during general anesthesia:
It's funny, most people, even doctors, don't yet seem to know anything about MTHFR, but my son's dentist knew this (he has heterozygous mutations on 677 and 1298; I am homozygous 677) - so when I brought up MTHFR, she knew what to do - give him kiddie xanax rather than nitrous. I thought I was going to have to fight her about it, but nope.
(also: i know this article is about local anesthesia, i'm making a more general comment about anesthetics and complications)
> Having said that: people w/ MTHFR mutations are cautioned against nitrous during general anesthesia:
That's not exactly what those studies are saying. The latter is a single case report of an isolated incident which the authors hypothesized to be related to her rare homozygous MTHFR mutation. The former paper cites the latter paper as one of only two references.
Needless to say, the evidence is quite weak. Moreover, the first paper recommends alternative methods that have their own downsides.
It's remarkable that people are so quick to assume entire professions have overlooked something so obvious as the MTHFR mutation based on a pair of linked papers. In fact, the latter paper even goes so far as to say they are not advocating for removal of nitrous oxide nor for preemptive screening for the MTHFR mutation.
Rot13 after you've thought of an answer:
Abj nfx lbhefrys, ubj uneq jbhyq vg ernyyl or sbe gung gb or snxrq?
The next thing I knew, my uncle was waking me up frantically, telling me I’d be late for work. It felt like I’d barely slept. I looked at the clock and it said 4:30. I jumped out of bed, grabbed my uniform, brushed my teeth and glanced at a different clock, kind of in disbelief and wondering how I was going to make it though this shift so tired. It was 4:40. I ran towards the kitchen ready to go and looked for my keys, glancing again at yet another clock to make sure I was leaving in time. 4:45. I was going to just make it.
That’s when I noticed The Price is Right playing on the television. I don’t know what time it’s on now, but then it had been running from 10-11 am as long as I had been alive. My uncle had changed every clock in the house in preparation for this prank. I wanted to kill him but instead just collapsed in bed, uniform and all.
Looking in the mirror? Even getting out of bed? I mean seriously, it seems straight forward, albeit with a minor complication. On the simple side, well 15 years quite a while right? A mirror and the feeling of moving around and my own body alone would drive home it wasn't 2020 quite directly. My significant other/kids/family will be changed (this may also be immensely painful, beloved pets will certainly be gone and maybe some family too). Friends, jobs, companies, all will be different. Not just the news but the environment in general will probably be pretty different in many places. And of course as this is HN, by 2035 there will be fairly massive technology changes one way or another too. Wearable displays, far more ubiquitous connected stuff, etc., or if not only because of devastating societal changes which themselves would be fairly obvious.
I guess one minor complication though is that an inability to form long term memories would mean that new things and tech couldn't be persistently learned either, and in turn there'd be direct reason to keep much of your home frozen in time to keep things more comfortable, which might slightly disrupt belief for a short period (before aging made it impossible to ignore). Anything that couldn't be relearned in a matter of minutes would probably be disfavored. Even in theoretical future shock type scenarios where somebody wakes up after being frozen or something, there is the inherent fact usually that they can at least start learning about what they missed and begin building a new life. Not being able to do that would be particularly painful, so much incredible cool stuff but not being able to hack on it. Future shock every single day. Somebody talked about checking their phone, but in 2005 we didn't have smartphones at all, and in 2035 we may not either (because they'll all have been obsoleted by advanced WDs or implants or who knows).
Far better AI assistants though could probably be a big differentiator. Full human quality natural language interaction, a full daily rundown and routine, explanations and handling advanced tech, it'd be a clear change that could be experienced and probed conversationally.
But my real hope would be that by 2035 neuroscience has advanced enough to be able to deal with it!
If not I doubt it'll fail with a cert error.
"Oh, that's about it. We have iPhones now. And to be honest, they are kind of a problem."
I’ve since come to terms with the glass keyboard of my iPhone, but I maintain that it was not progress. Besides, the person in the story was only two years out from seeing an iPhone for the first time, like everyone else at the time.
I've yet to meet a HipTop user who thinks that the modern smartphone is an across-the-board improvement.
> Abj nfx lbhefrys, ubj uneq jbhyq vg ernyyl or sbe gung gb or snxrq?
Vastly more money than anybody is going to spend trying to fool me.
See, all you HN crypto-haters, it's good for something after all! ;)
Professor Layton games have this thing where, the explanation seems to be supernatural (or involve far future technologies), but then you discover the truth, and it's always, always something completely unbelievable and incredibly unsatisfying.
How would you accomplish this part?
Now he's fine, as if nothing happened, and we laugh every time we remember this.
That’s some real-life eternal Groundhog Day stuff right there. Hellish :(
> Today, he only knows that there is a problem because he and his wife have written detailed notes on his smartphone, in a file labelled “First thing – read this”.
This is more positive, and reminds me of the movie 50 First Dates with Adam Sandler.
Also, am glad to hear he has someone in his life that is by his side.
In Memento, Leonard also wakes up each day to the "same" day because he (arguably) has anterograde amnesia and cannot form new memories. He keeps tracks of new developments he wants to remember by writing on his own body and on the backs of polaroids (a bit like writing a note with his smartphone! Memento was filmed in 2000, and smartphones didn't exist yet).
e: I forgot, in the movie she has a fictitious disease that's sort of like ante-retrograde amnesia, but wipes her memory when she sleeps.
I think the main difference sounds like... is 50 first dates involves someone else writing things down and using a VCR for when the Amnesia victim wakes up. Friends, family do the "heavy lifting".
Sounds like Memento is self descriptions? Doesn't sound like there's anyone else to write things down for him.
Memento was 2000. 50 first dates was 2004. So they are more comparable than someone with a smartphone - obviously.
But it sounds like the smart phone plot item is more of a twist on doing stuff for yourself - IE Memento.
Whether the notes and the character's understanding of his situation are accurate is the main gist of the movie (and as its tagline says: "some memories are best forgotten"). I can't recommend it enough: it's a great movie with some excellent acting, and it manages to be both cerebral and emotional.
There's a scene that starts with Leonard in a hotel room, sitting on a closed toilet, fully clothed, with a bottle of alcohol in his hands. He wonders why is he sitting there and if he's drunk. He then takes a shower. Because he doesn't know why he's in the hotel, he doesn't know why he's in the bathroom, etc. He literally forgot he broke into the room to ambush a guy as he was doing it.
Whereas in 50 First Dates, it is how you described. Lucy replays the same day, she resets when she sleeps. But during the day, she can recall what happens. She can tell you what she had for breakfast, where she got her pineapple, who she met, etc.
That scene you describe is brilliant, I still remember the monologue: "I don't... feel drunk".
It also gives a nice twist on a noir murder mystery. Because the story starts with a murder, then instead of making us guess who did it, it makes us figure out why he did it. With every step giving another piece to that puzzle. So the mystery unfolds linearly while the narrative goes both backwards and forwards to meet back at the beginning of the movie.
While I haven't watched Dunkirk or Tenet yet, Memento remains my favorite Christopher Nolan film.
Hard to decide who has it more hellishly. Can you imagine having a partner who will forget every single new experience you ever share together. Can you even be said to have a relationship in any meaningful sense then?
Short term versus long term memories is one distinction (and seems intuitive), but you'll see things like selective long term memory loss - they might forget where they've lived for 10 years, but remember people they met back then.
It's really fascinating as it gives some insights into how memory is organized and stored within the brain. Things that you'd imagine are processed the same (what your home looks like versus your spouse's face), are actually very different memories and handled in different parts of the brain.
This one was wildly popular in Europe, earlier models had similar functionalities: https://en.m.wikipedia.org/wiki/Sony_Ericsson_K750
I think it would be fascinating to read the "First thing - read this" file on his phone. I can see why they don't go into more detail it would probably be pretty personal info in there.
Still as a mental exercise, its interesting to think about what I would write down in that file for myself.
That being said and knowing that root canals can get inflamed and that inflammation can spread trough nerves to brain how lightly is the cause of his amnesia has a similar cause?
Neurologist among you what is the brain region that is most probably first to be affected if that would happen?
So little we know I suppose.
Doctor's claimed dementia, turned out to be a tooth infection.
I had gotten the local anesthetic several times without issue, it was just that one time that I got unlucky. Supposedly if the sense of taste doesn't come back after two years it's not likely to, so I guess this is my life now.
> Anterograde amnesia caused by bilateral hippocampal or diencephalon damage manifests in characteristic symptoms of preserved intellect and implicit learning, and short span of awareness with complete and rapid forgetting of episodic material. A new case, WO, 38-year-old male with anterograde amnesia, in the absence of structural brain changes or psychological explanation... amnesia onset coincided with anesthetic injection and root canal procedure, with extended vasovagal-like incident.
> WO attended a routine dental appointment for root canal treatment at 13:40 hours. He was injected with the anesthetic, Citanest with Octapressin 3% just prior to the beginning of treatment. He wore tinted dental glasses, obscuring a view to his level of responsiveness. The procedure was completed at 14:30 hours, and at this time it became apparent that WO was pale and faint, and could not get himself up when re-positioned from the supine to the upright position.
So after the 50 minute dental surgery, the patient was still suffering from something similar to an extended fainting spell (vasovagal syncope). This resulted in permanent brain dysfunction isolated to the parts of the brain associated with forming long-term memory without any measurable structural damage.
A weird but fascinating puzzle. Question 1: does oxygen deprivation in the brain result in measurable structural damage? Question 2: can an anaesthetic selectively impact one artery servicing the brain?
 : https://en.wikipedia.org/wiki/Anterograde_amnesia
This almost perfectly captures the premise of the movie Memento.
I was reading the other day about a study that's checking to see if injecting BDNF  into a patient's cochlea will help improve their hearing. In animal studies it helped rebuild broken synapses and led to better hearing. I wonder if injecting the brain with the missing proteins (or as the article refers to them, "ink") would help with the formation of memories? Though maybe this is too simplistic of a view.
At the time of release it seemed to be a medical condition that wasn't real, however there have been a couple of instances diagnosed since then.
<SCARY DENTIST PHOTO; FULL-WIDTH>
Somewhat interesting story
<RANDOM PSEUDO-RELATED STOCK PHOTO>
More of the story
<RANDOM PSEUDO-RELATED STOCK PHOTO>
Some more story
<RANDOM PSEUDO-RELATED STOCK PHOTO>
Some more story
<RANDOM PSEUDO-RELATED STOCK PHOTO>
(Scroll down to far)
<COMPLETELY DIFFERENT STORY STARTS>
Stories about construction projects will feature stock photos of people in hardhats, taken years ago and half a world away.
I guess people like pictures and it's expensive to go take relevant ones. My mind still boggles. Can you imagine newspapers doing this 30 years ago?
Long running narratives are usually not the place for this.
If the BBC is going to use a stock image, at least use the one of a real dentist.
(I can forgive the faked scratches on the glasses. That was probably done so we don't see the reflected image of the camera lens.)
Why is this so concerning to you? Do you feel deceived? Most stock photos use actors and this shouldn't be surprising.
Because this is the BBC. I hold them to the highest standards. Everything they use should be legit, even stock images.
Something more like "Man suffers anterograde amnesia after routine dental surgery"
"... he'll never know what happened next"
I considered changing the title when I submitted this but went with the HN guidelines that prefer the publisher's title. Admittedly the article's header might be a bit better than the slug in this case (but I was lazy).
Possibly this event was bound to happen and it just so happened that the subject was visiting a dentist.
At least I hope people won't get even more scared of dentists after reading this... but I guess BBC succeeded in that.