Wisdom teeth, as many people are no doubt painfully aware, are the third set of molars found in humans. Because human jaws are smaller than other ape jaws, most of us don't have room for a third set of molars, and the teeth become impacted so they grow straight into the other teeth, requiring a painful, debilitating procedure to remove them.

Because recovering from dental surgery often entails a period of rest following the operation and the use of prescription painkillers (which have a tendency to make a person go a little loopy), Cueball prepares to play Minecraft the entire time. Minecraft is a PC game known for its addictive qualities; the game itself primarily revolves around a three-dimensional world in which the goal of the player is centered on the aspects of structural creation using blocks found in the environment and the creation of different materials for use in building these structures. Despite its addictive nature, the game doesn't provide the player with a goal, so most people take to building lots of nifty stuff, such as large cities, computers made from the game's built-in automation mechanics, massive scale replicas of Earth, etc.

Cueball's conversation with Megan indicates that he has previously decided against playing Minecraft precisely due to its addictive gameplay and lack of internal goal, deeming it unproductive. However, 'productivity' is not something that Cueball believes he can achieve post-extraction, and so Cueball decides that addictive gameplay and lack of internal goal "sounds like the perfect distraction".

Unfortunately for Megan (and any other users of her server), Cueball, while intoxicated with painkillers, has instead opted to flatten an entire continent and sort it into layers (by type of block, presumably). While there's no real indication of how big the continent is, as Minecraft worlds are randomly generated, sea level in Minecraft is at Y level 64, which means he sorted at least 65 layers of a continent large enough to be sufficiently developed, so it is clear that this task would take a lot of time. Collecting a block in Minecraft takes a certain minimum amount of time, depending on the block type, so even if he did everything as fast as he possibly could, there's still a substantial lower bound.

Ironically, in the second panel Megan says she'll set Cueball up on her server, which indicates she probably uses a whitelist to secure the server from griefers who might destroy structures created by others, not expecting that Cueball would do exactly that. The last panel simply illustrates that painkillers tend to make one loopy.

The title text refers to people waking up during surgery. Because anesthesia requires a lot of careful calibration and dosage - there's a reason anesthesiologists are paid hundreds of dollars an hour to be there, after all - it's possible to sometimes get it wrong, resulting in the patient waking up in the middle of the surgery. The three most important parts of anesthetics used for surgery are an analgesic (blocks pain), a sedative (puts you to sleep), and a paralytic (keeps you from moving). The worst-case scenario that most people hear about is when the analgesic and sedative are under-dosed, but the paralytic is correct, leaving the person awake, able to feel pain, but unable to alert the surgeons that anything is wrong. As a result, some countries and medical institutions have passed laws requiring surgeons to monitor brain activity so that these problems can be quickly remedied. The situation the title text is describing, with both the sedative and paralytic wearing out (leaving the person able to write notes), would be quite unlikely. As for confiscating all the pens, it was probably just to keep the patient from disturbing the procedure while the anesthesiologist corrected the dosage.

In reality, sorting a Minecraft map into layers (assuming the grass in the comic is at sea level—y=64 blocks) would take an unbelievable amount of time, even in creative mode, as you would have to mine away everything below that, and then sort it into layers. Minecraft maps are extremely big, so it would actually be almost impossible to sort the entire map into layers. Randall, like Cueball, has also tried to do weird things with Minecraft, see this for more details.

In the current version of Minecraft: there is a way to create a world flattened with the option superflat world. However, this option was not avaliable at the time the comic was published, so Cueball really flattened an entire world himself. Also, in the current version, by standard, worlds are almost infinite, again, this was not avaliable at the time.

Cueball, on phone: Hey! Know how you've been bugging me to play Minecraft for the past year? I'm game.

Megan, on phone: But you said you didn't want to "get hooked and spend days on end moving virtual cubes around while sitting motionless." What changed?

Cueball, on phone: I'm having my wisdom teeth out, and I'll be useless and doped up on painkillers for the next few days, so that actually sounds like the perfect distraction.

Megan, on phone: Oh. I'll set you up on our server!

72 hours later...

[Megan sitting at computer.]

Megan, on phone: Hey — starting to feel better? Enjoying the game? Let's see what you've... What the hell? Where IS everything?

[View of a Minecraft screen showing a vast empty expanse of land. In Cueball's hotbar is, from left to right, an stone pickaxe, sword, and shovel, seven feathers, 42 torches, a non-enchanted bow, a blank space, 64 blocks of stone and a clock. He has full health and 15 armor points.]

Megan, offscreen: ...You made the entire continent perfectly flat?

Cueball, offscreen: And sorted it into layers.

Megan, offscreen: ...

Cueball, offscreen: I feel good about things. This is a good game.

[Cueball sitting on the floor at his laptop, bleeding from the mouth, surrounded by bloody wadded-up tissues and holding a bottle of medication.]

Megan, on phone: ...What exactly is in the painkillers they gave you?

Cueball, woozy: I can't read the label because I'm a hologram.

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