It could be something physical. My sense was it was something else in Lee's case: a change in his routine. I think the routine of coming into work kept him in a pattern that kept him from deteriorating quickly (or, at least, kept us from recognizing his deterioration). When he had heart surgery, he took several months off to recover. When he returned, he seemed dramatically different. I also noticed a dramatic change immediately after he took time off for his wedding/honeymoon. And, after he left Cloudflare, the article talks about how it seemed like the effects of the disease accelerated. I'm not a doctor, and there very well may be some other connection, but my sense in this case was the routine of work actually allowed him to hold the effects of the disease off and, at those times when he didn't have it, those effects accelerated.

I researched it at the time (I'd not heard of it when it occurred) and it is apparently quite common.

A quick search finds a few hits, e.g. from https://perioperativemedicinejournal.biomedcentral.com/artic...

> Delirium is associated with negative hospital outcomes including a tenfold increased risk of death, a fivefold increased risk of nosocomial complications (Inouye 2006), poor 1-year functional recovery, and postoperative cognitive decline (Saczynski et al. 2012). The long-term cognitive decline seen in some patients after the development of delirium is similar to that of Alzheimer’s patients (Pandharipande et al. 2013). With reports of up to 50 % of patients over 60 years old developing postoperative delirium following cardiac surgery (Rudolph et al. 2009), this patient population poses a major burden for healthcare.

When you go on bypass(needed if the heart is stopped to replace a valve) air emboli (very small air bubbles) go into the brain and can get lodged in capillaries cutting of blood flow. Personality changes are documented to occur after bypass and correlate with areas of the frontal cortex that die. Typically though this kind of injury is not progressive.

My suspicion would be that the general anesthetic is the primary cause.

I have been sedated a few times for minor procedures, propofol, I think, with no issues, and I’ve had a general once, for a laparoscopic cholecystectomy - about as trivial as abdominal surgery comes, only a few hours under.

It had side effects.

For the better part of a year afterwards, I kept finding myself unconsciously substituting completely incorrect words into written correspondence, I was irritable almost constantly, my short term memory was shot, and I had hallucinations and attacks of aphasia - I’d be walking down the street, or in the shower, or in a damn meeting, and I’d not only forget where I was but I’d lose object permanence and recognition - couldn’t tell taps from cats, cars from shoes.

It got better, over time, but there was very definitely a long mental hangover from it. I do have medical quirks, like I can’t tolerate opioids (they worsen pain and make me vomit), and I’m a carrier of a whole bunch of degenerative diseases (thanks, inbred aristo dad), and when I had surgery I was weakened from years of still mysterious illness - they thought my GB was the root cause, but no - stress - leaving tech fixed me.

Anyway. I can readily see how, with someone with a poised avalanche of genetic mental disorder, it can be enough to completely push them into the abyss.

I've experienced this too. I had a tumor removed from my head. It was pretty serious. I'm not sure if it's due to the anesthesia, physical stress of the operation, changes to brain blood flow or radiation that my brain was hit with.

Either way my memory has not been great since. My wife is disappointed when I forget meaningful conversions from a week ago. I struggle at times to notice trivial errors, really struggle. I can look over the same email and miss several mistakes. Other days I'm clear, I don't make many mistakes and I can spot them easily.

I still managed to get an Engineering degree and hold down regular employment as a software developer. But there are periods of time where my focus and productivity are just not there. I suspect this will hold me back in my career. But I'm thankful I can function as well as I can and have survived to this point.

I'm sorry, that sounds awful. I think it definitely could be any combination of those things. The brain is a very delicate and sensitive machine.

I don't have specific recommendations, but I think that the potential for recovery should be much higher than what people with neurodegenerative diseases suffer from, like what was described in this article.

There're a lot of risk and uncertainty trade-offs, and everyone reacts to things differently due to their genetics and what they're suffering from, but nootropic substances could potentially help here. They could possibly help as a short-term aid that improves memory and attention to detail while the nootropic is in effect, and some can actually potentially create long-term improvements.

They're very under-studied, and they definitely require a lot of careful research, gradual self-testing, and acceptance of some risk (some nootropics have almost no risk, and some have a moderate level), but it could be worth looking into.

> The brain is a very delicate and sensitive machine

Something as simple as a prion can completely destroy it and then there's Phineas Gage, someone whom all neurobio students learn about on day one of their course. Neuroplasticity can be quite amazing.

https://en.wikipedia.org/wiki/Phineas_Gage

Yep. A lot of it is personal biology and a lot is also chance. You can be shot in the head and survive with not much cognitive impairment, or you could hit your head against something and be unable to speak or feed yourself for the reset of your life. We are very pliable but it's sad that we're also still so fragile, at the level of the "mind" / "soul". Hopefully there'll eventually be a day where consciousness can be hosted in a much more safe way, for both biological and total immortality.

I don't think it's exactly correct to say "a prion" can destroy it. One single prion I don't think would cause significant damage in most cases, if there could somehow be only a single one. The issue is that it's believed a prion will gradually cause nearby proteins to misfold and also become prions, and then it probably starts recurring exponentially like a pathogen infection, and your brain physically deteriorates and falls apart with no way to stop or reverse it. A very similar deterioration process appears to happen with other disorders like Alzheimer's and the form of dementia discussed in this article, though the root cause still isn't understood.

I just wanted to say that I'm sorry you're going through this. It must be very difficult. I hope you do recover. Best of luck!

Neuroplasticity is an extraordinary thing. With proper consistent mental exercise and training, you can improve your working memory and focus back to what it used to be if not better.

Inspirational messages are good, and there's certainly a good chance that you're right in this case, but I also don't think it's a great idea to speak with such certainty.

I mean, they had a brain tumor which could've been causing damage itself, plus radiation to the brain, invasive brain surgery, altered brain blood flow during the surgery, general anesthetic... That's serious stuff affecting the most complex machine we're aware of.

The brain can be capable of amazing feats of recovery, but it's always going to vary based on someone's pre-existing genetics, environment, age, and the specific damage they might have incurred. Recovery back to baseline absolutely may be possible for them, but there's really no way to know that for sure when dealing with something so serious and without knowing many other factors. Hope is good, but sugarcoated false hope isn't.

Sorry, I didn't see this until just now. I wish HN had some kind of notification feature (cough dang save us please cough).

I don't think I'm sugarcoating, at least not in the sense of how the word is usually defined. We know neuroplasticity is real. It isn't just some placebo. Regardless of what part of the brain was affected, because of neuroplasticity, he/she can recover functionality through exercise and training. I agree with you that this won't always be the case, and at some point, brain dead is pretty much brain dead like in the case of survivors of gunshot wounds to the head for example. But given the eloquence of the poster's comment, I think the kind of situation we're looking at here is of a different class.

Omg. I've been under 4 times. I think the last two had similar impacts, and I still have a hard time finding proper words from time to time.

I think cardiac surgery is the worst offender because they often have to bypass the heart while performing the surgery, and this can result in blood supply issues while diverting/restoring flow through the heart.

It might be the anesthetic.

There has been, for several years now, concern that general anesthesia may have a negative impact on the brain and, in particular, Alzheimer's Disease but also general cognitive damage.

Here's a 2018 piece discussing research from the Mayo Clinic focused on apparent anesthetic damage in patients older than 70.

https://www.sciencedaily.com/releases/2018/07/180719112024.h...

Serious medical interventions can make a patient "age" quite a bit and this exacerbates other medical conditions they may have, I doubt there was any direct connection between the two conditions