In this episode, we dive into a critical and controversial aspect of rapid sequence intubation (RSI)...the optimal order of administering rocuronium, a paralytic, and ketamine, a sedative. We explore recent research, including a Monte Carlo analysis that quantifies the risk of anesthetic awareness when rocuronium is given before ketamine, highlighting the chilling possibility of patients being paralyzed yet conscious. We also examine an observational study that suggests giving the paralytic first may modestly reduce apnea time, but with the crucial limitation that patient awareness was not assessed. Through scientific insights and a deeply moving personal account of anesthetic awareness, this episode underscores the urgent need for further research and the high stakes of drug sequencing in critically ill patients.