Thread by @RubenLaukkonen

I have a wild ambulance IV #ketamine story that I feel like I have to share. I told it to my students in a class on the plasticity of #consciousness and they insisted it needs to be public knowledge. So, somewhat apprehensibly, here it is. Strap in 📜:

So, it’s 9am on a Tuesday morning (3rd of May this year). I’ve just returned to Amsterdam from a conference in Switzerland. I haven’t slept much. I’ve been hiking. My back feels tense. I’m lying on the couch in our houseboat, laptop on lap. And I start coughing…

First it’s a little pinch in my lower back. Ouch… but whatever, I have deadlines. Moments later I cough again. This time my upper body spasms forward. Now I know I’m in dangerous territory. I recognise the nerve pain. I have two bulging discs - old kickboxing injuries.

But then I cough again. This time pain electrocutes its way down from my lower back through to my toes, along the outer edge of my left leg. Now it’s serious. I’m not gonna be walking for a few days. But, even that’s not the end of the world. I’ve been through this before.

Just have to rest. I can still work, it’ll be a good mindfulness practice. Then, I coughed again. Now I start to get lost for words.

I haven’t experienced pain like this before. I’ve broken ribs, knees, arms, and torn both my pec muscles. Nothing even comes close. And this, incredibly, was just the beginning.

My cough escalated and a torturous cycle was born: I cough, back muscles contract, then some exposed (apparently sharp) piece of my spinal disc would hit the nerve, and, well… like I said, I have no words. Ineffable pain.

If you haven’t had serious nerve pain, you’ve probably had a taste of it at the dentist when they hit the nerve root of your tooth. Yeah, you want to be anaesthetised for that, right? It’s bad. Imagine that, 10x worse, on repeat, running from your lower back to your toes.

Chronic nerve pain (especially the CRPS type) has a super high suicide rate. My sister suffers from it chronically after a horse stepped on her foot. Really understudied thing. Thank God I don’t, or rather, thank ketamine.

This went on for 3 weeks. Again, this wasn’t like my previous disc injuries. The nerve was being hit with some piercingly precise ruthless razor-like strikes of terror; insidiously, incessantly, and with bad intent.

There was a direct highway to my nervous systems pain centre, just banging the pure-pain button over and over again.

Here’s an eventual MRI in Australia about six weeks later. The disc actually broke and fell somewhere between the spine and the nerve. On the right is a picture of the notes from my med-school buddy. He said it’s the worst he’s ever seen, but then again he hasn’t seen that many.

So, back to the boat. This thing just keeps getting worse as the days go on. My cough doesn’t leave (apparently not covid) and I gradually become completely bedridden. The cycle just repeats. Cough, contract, pinch, hell.

A few weeks in, I can’t sleep, I can’t get out of bed. My girlfriend—an angel—has to do everything for me. The doctor comes to my house and gives me the highest doses of oxycodone she can. It doesn’t help. Literally does not help. I’m just high as hell (notably, still in hell).

Another week later, on a Saturday night, around midnight, I’m starting to lose it. I can’t even open my eyes any more. It’s that bad. I’m considering chopping off my leg, but I wouldn’t be able to get my hands on a knife. I call out for my girlfriend to call an ambulance.

When the ambulance arrives, I can’t even tell them what’s happening. My gf’s in a panic. They’re confused, and I’m in some kind of dark void, where anywhere my consciousness dares to land it finds only unbearable pain. Pain looped in with anticipatory fear of the next cough.

You know, I’ve been meditating daily for 12 years. Dozens of retreats. And I was just totally humbled by this experience. There are states where there’s nowhere to rest. Except, perhaps, resting in the no-where. But that’s another story.

So, any way, just before they manage to roll me onto a stretcher, the pain reaches some kind of unspeakable threshold. And suddenly I receive a wave of endorphins and part of my leg goes numb. I was both relieved and very disconcerted by this development.

It was a brief respite, though, since as soon as they started moving me I was back in the torture chamber. They do their best to carry me gently over the bridge/walkway connecting to the boat—a tricky terrain with a stretcher. They take me outside, and into the ambulance.

And we start driving. Some minutes later, the paramedic says: “Hey man, I want to give you ketamine, is that okay?”. This caught me off guard, I struggled to speak, and at first I said no, I thought something that psychoactive would be too weird in this context.

Not a great set and setting, and all that. He asked again, “look man, I think it’ll help”. Then I thought: At this point, what’s the worst that could happen. So I agreed. They needled me in and began the procedure. And then…

I recall this moment so vividly. My attention was fixed on my lower back, where all the muscles felt like rocks and the pain emanated down my left leg. I wasn’t aware of anything else, the pain and the contraction was all-encompassing.

That’s why the moment is so clear. The moment when the ketamine hit. In just a few seconds, every bit of tension in my back softened, like an ice-cube melting. Not just the feeling tone changed, but literally the muscles that had been contracted for weeks just totally “let go”.

I was an ice-cube melting. Muscles that were red-hot stones a moment before were suddenly tranquil mountain streams. The electricity burning my skin turned into a cool wet towel wiping away my sweat.

My mind slowed to a standstill and in full awareness I could feel my body and there was… no pain… no tension. And eventually… no body at all. Nobody. Just lightness. Just light...

The space opened into an expanse of presence without a person. The body was totally clear of any suffering, and was only barely even noticeable anymore, somewhere in the periphery. Just the very soft edges of the forms were there… just barely.

Occasionally a thought would arise “Where am I? What’s going on?” — never mind that — whooosh back into the empty light.

Then I’d return back to my body just momentarily. Open my eyes long enough to say— “thank you, you have no idea, you saved me”. WHOOSH [whispering tone] and I’m gone again.

I can’t describe the relief. All encompassing relief. At the level of body, mind, energy (or whatever you want to call those channels for the torture signals). All pervading peace. Delicious.

Fast forward, I’m still high but coming back as we approach the hospital. I sort of know what’s going on. I tell them, “wow, that was amazing, thank you, all my pain is gone”. With stereotypical Dutch stoicism they nod along “yep, that’s what we can do for you, happy to help”.

Now I’m in the hospital bed. A neurologist comes and I try to explain what happened. It’s a miracle. I can cough and I have no pain. I don’t think you realise how big this shift was. Night and day don’t contrast well enough.

She says, “yes, sometimes people feel better just by coming to the hospital”. I’m speechless, the condescension. I try to tell her I have a PhD in vaguely this stuff but it’s not convincing in my underwear.

The ketamine wears off and I’m fine. I walk by myself to the bathroom. It’s inconceivable how different my state is.

I still have some fear, though, and my body is tender and I’m careful—but I already know that the central issue has been resolved. The contracted muscles pinching the nerve have relaxed. The loop is broken.

The cycle is relinquished. “Will anyone believe me”, I wonder? There must be thousands of people in this kind of pain right now, that could be helped (healed, even). Those opioids did nothing! I can’t emphasise that enough—at a certain level of pain they’re utterly useless.

I feel so much relief but also a bit of helplessness. I’m a scientist. I know how this works. My story won’t change things, and collecting data is so slow. For good reasons. But damn… experience can be persuasive, and that’s where many good research questions start.

The reset to my nervous system was so concrete. It was like walking into a new body. Total non-linearity. Total phase shift. A freaking quantum leap.

I’ve just been getting better ever since. My leg was initially numb for a few weeks, and I was limping, but the nerve is mostly recovered. Im surfing again. Last week I did a backflip.

Doc who saw my images suggested surgery, and was very surprised by my progress. I honestly don’t know what would have happened. Ongoing prescriptions of opioids, at what cost? Permanent nerve damage? I’m sure I was close to losing feeling and control of my entire left leg.

So this goes out to the creative impulse underlying the generation of research questions. May it trigger an insight for someone clever and with the resources. Or provide a direction-to-look for someone suffering.

Ketamine has known analgesic effects, but with worrisome side effects, according to most published research. One main issue is that it can be psychedelic. But what if we combined what we know about set and setting into a ketamine neuropathic pain management protocol?

Any way, it’s just one person’s experience.

Honestly can’t believe I just thought of this a few hours after tweeting the thread. The basic mechanisms of meditation outlined in our paper could potentially explain the deconstruction of my neuropathic loop, albeit ketamine induced:

https://twitter.com/rubenlaukkonen/status/1407245296921460737?s=46&t=rUxpDrx50BDLCqeVNd5r9Q

https://twitter.com/RubenLaukkonen/status/1407245296921460737