One of my children nearly drowned in the bathtub. She was already unconscious and floating on the water. She had stopped breathing. My wife (who was sitting only 3 meters away in the living room and had talked to her the minutes before) revived her. She made a full recovery in the hospital.

I agree in principle. But: the aftereffects of nearly losing a child were already quite destabilizing to us, and still are, after several years. There is an overwhelming feeling that things can go catastrophically wrong, at any second, so why even do anything?

I cannot imagine the effect of actually losing a child. I would go insane.

What you and your wife and indeed child went through was immense enough to be fair I think it is understandable to be destabalized.

I feel you, I also unfortunately have experiences with that. It has profoundly changed my view on living, especially how I want to be treated when someday I'm heavily sick.

A family member in a coma takes a heavy toll on you, emotionally and financially. They are simultaneously there and not there. If they did not write down how they want to be treated you can never make a decision where you are sure what's right, or if they even want to be kept alive while not living. Eventually, when all your savings are burned through, when you might need to sell your house, you really wonder if that's what they wanted and if all that was worth it.

For me, the decision is clear: when I'm not able to make my own decisions turn everything off and let me die.

> For me, the decision is clear: when I'm not able to make my own decisions turn everything off and let me die.

And what if you might be able to make decisions again tomorrow. Or the day after? Or in two weeks time.. ? These things are never all that 'clear'.

The underlying idea here seems to be that if there's some chance of full recovery, one should not wish to be let go.

Is it better for 100 families to live for years with a vegetative loved one with the most realistic hope being that a few to emerge profoundly affected and never their full selves again, or is it better for those hundred families to get to grieve?

The pain of a loved one's continued quasi-existence, plus the difficulty of their life if they ever are to recover, make it so that the compassionate personal choice is to say "once the best estimated probability of my recovering robustly is clearly below P%, let me go". The value of P is a decision to be made carefully, and with deep consideration for ourselves, our loved ones, and for all of humanity.

That's exactly why you write your own decision down, so other people don't have to live with making them for you.

After a couple of months of coma they are pretty clear.

In my written will I have defined a clear timeframe. If I have not recovered by a measurable amount (GCS) in a timeframe of 4 weeks, it's time for me to go.

Edit: note this might be different for you. You are the only one who can make that call. You can also decide that you want to be kept alive as long as possible. But then at least your loved ones know that that's what you wanted.

Each person should be able to make their own decisions. You seem to wish to be preserved on the off chance of improvement. GP (and I) would prefer to be let go.

> Eventually, when all your savings are burned through, when you might need to sell your house, you really wonder if that's what they wanted and if all that was worth it.

I will never accept a country where things like this happen routinely as civilised.

In 1998, a 4-year old girl broke into a frozen pond in Austria [0]. She was found at the bottom of the lake after 30 minutes, with a body temperature of around 18 °C (so much higher than the case described in the article). She made a complete and full recovery (her story was filmed) and afaik lives a completely normal life as an adult now.

[0] https://www.kleinezeitung.at/artikel/3915285/Kaerntner-Wunde...

While I don't know, I suspect the boy's parents do not share your views. He is able to ride a tricycle and improving.

Neither of us knows. That's the difficult bit in topics like these. None of us is psychic and can tell what'll happen next. Will he be happy and healthy? Or will he have anger issues, meltdowns or exhibit destructive behavior to himself and surrounding loved ones due to neurological damage? We always hope for the best. I hope the boy recovers well. But there are no guarantees in life.

If you are a loving parent, all that crap you list is utterly irrelevant. I don't think I need to list in details why.

It sounds like you are speaking to someone who has actually experienced this and you have not. Trying to be civil here, I'll phrase it like this:

Try not to be so judgemental over a keyboard when you have no experience to speak from. Life is complicated.

The experience could easily run the other way around, you are doing the same thing you criticise.

But in a non judgemental way.

>Or will he have anger issues, meltdowns or exhibit destructive behavior to himself and surrounding loved ones due to neurological damage?

It's entirely possible for all of the above to occur even without any neurological damage. It wouldn't even be uncommon enough to point to neurological damage as an unambiguous cause.

That's all besides the point.

The paper has the warning phrased differently. "He can at least be an organ donor", basically, in the summary.

Your comment and the thread it started helps me a little with dealing with a close person's father's dementia.

When Breath Becomes Air was a great book that seems relevant here

I wish you strength in dealing with your situation. Neurological problems are really hard to deal with, especially when you come to realize it really is what it is and have to let go of futile hope.

I really recommend the book "Being Mortal" by Atul Gawande. It helped me process the drawn out and unpleasant death of my grandfather and look at end of life care in a different light. There's an important difference between extending life and providing quality of life that a lot of patients and doctors both misunderstand.

The book is written from the author's own experience as a doctor but also includes his experience with his own father's death from cancer.

> profoundly destabilizing to his environment

This is such a dark and dehumanizing take. I am disabled. I definitely had "destabilizing" effects on my environment when I grew up. These days, am as independant as possible. People from your train of thought would have aborted me. Your train of thought leads to what nazi germany already did. Yeah, an extreme example, I know, but following your attitude inevitably leads to very dehumanizing and egotistical takes. In fact, if you consider a family member a burden, please leave, you're the problem, not them.

Please don't put words in my mouth

You already put them into your own mouth, maybe wash 'em out if that feels uncomfortable to you.

I'm not sure what you mean. I've been under general anesthesia a few times and not had any negative consequences. My dad has had multiple brain surgeries, and he's fully functional. Most people I know have been under at least once.

I think before you blame anaesthesia it's worth wondering what else happened to you on the table, or whether something else might be causing you the problems. A lot of other things happen during a surgery that can screw you up pretty badly. I'm pretty sure I was dropped off a table once.

Well, there's a small chance anesthesia can affect you negatively. Like all medical interventions, it can have side effects.

I don't think anyone would debate that. But if someone is going to go with a completely unverified "everyone I know" scare tactic about a common medical procedure, then I might as well respond with the fact that everyone I know hasn't had any problems with it. It would be completely different if they said they had suffered a rare side effect which only affected them. Instead, their point seems to be that it's widely dangerous, and their only evidence for that is a vague set of symptoms they experienced which, even more vaguely, "everyone" experienced "some of".

So we've departed from the realm of clinical analysis and entered the realm of hearsay and feelings. And on that level, such a claim cannot be challenged with facts or statistics. But what an irrational claim can be challenged with is equal assertions of irrational feelings toward the opposite.

In other words, I would challenge a rational claim with another rational claim, but I won't bother with that for people whose arguments aren't based on reason. In that case, it's best to throw out a hearsay claim in exchange for a hearsay claim, and save your facts for people who care.

The goal of winning an argument isn't to convince someone that they're wrong (if this person is even real or believes what they say), it's to show the flaws in their reasoning to whoever they're trying to convince.

Yes, some people are irrationally afraid of certain medical procedures.

I think if there was such a side-effect with such a commonly-used tool, someone would have noticed by now.

Could you elaborate on specific effects?

Lots of replies to this comment so i won't reply to everyone.

brain fogs, migraines/headaches, memory problems. sudden attitude changes, lifestyle changes. divorces from a partner suddenly hating everything about the other partner. fatigue, mental fatigue. Just to name a few.

Not everyone i know has the same issues, some are worse then others. If its so rare i don't see how everyone in my small circle all got permanent side effects.

Thank you, some of the effects I felt, and I have even worse stuff, and even though I had been anesthetized multiple times in my life (also naturally with a concussion), but how could I prove cause and effect? There is no second me who did not go through the same procedures to compare myself.

Anesthesiologist here: what you are referring to exists, but is rare and is not related to general anesthesia (equally likely in operations performed while patients are awake with regional anesthesia or under general anesthesia). It is more people with pre-existing cognitive dysfunction that are elderly do not handle the inflammatory milieu generated by surgery. You can Google “postoperative cognitive dysfunction” for more information.

Any phenomenon more widespread than the above is simply not supported by scientific studies to date.

I’m honestly a bit disappointed to find this comment on hacker news, as I feel the level of discourse here is usually higher. I wish you all the best and hope you recover from whatever you’re experiencing, but this is frankly fearmongering.

If I'm understanding the "inflammatory milieu generated by surgery" part correctly, does this imply that the cognitive effects would be equally likely if surgery were performed without any kind of anesthesia? (Or to put it another way: the anesthesia isn't directly implicated, it's just that anesthesia and surgery tend to go hand in hand...?)

Right, there are operations that are sometimes performed with minimal (or sometimes even 0 sedation) with just a nerve block (regional anesthesia) which impairs sensation locally (like you get when a dentist numbs up your mouth, but you’re still awake). They have the same rates of cognitive dysfunction afterward.

I know its not meant to be common, but literally everyone i know that has had to go under woke up not the same person anymore.

Honestly, i doubt its as rare as you think.

My bet is just poor training in my country.

Would you be willing to share more details, instead of this rather vague claim? I've had three at least 2 hour long operations last year. I kind of wondered if I'd notice any aftereffects, but apparently didn't. Even waking up was pretty uneventful, consciousness just coming back like a light bulb being turned on again.

So either I am an exception, or your "everyone I know" needs qualification. In any case, I'd be very interested in what aftereffects you noticed, maybe that helps me reflect.

For me and others(in my circle with operations, 5) the waking up part is multiple hours of a drugged feeling, like you really aren't on the same planet anymore.

Currently have a family member in hospital and 4 days later they are still dealing with the effects.

I assume this is probably a regional/country issue, australian public hospitals are pretty sub-standard.

I mean, maybe what do you think about 4 weeks later? If I'm being put under I think more than 4 days is reasonable to expect my mind to recover. If I have a terrible flu I could be in a fog for as few.

However this is not to diminish your report specifically, just that in terms of what I care about long-term it is the >2 weeks effects

Oh yes, I'm in agreement with you there

Evidence?

there is litterature on that. you need to assume that no medical intervention has no effect, by default.

Exacerbated by astonishing overuse for anything from a 2-minute endoscopy to a 15-minute hand surgery. The pursuit of “comfort” at the cost of fractional lobotomy.

One of the joys of private healthcare: I've seen general anaesthesia used to allow the patient to claim on their inpatient cover instead of their (exhausted) outpatient cover.

You're suggesting people undergo endoscopy without anesthesia? You go first, bud.

Conscious sedation, which is not the same thing as general anesthesia, is often used for endoscopy:

https://www.northerncarealliance.nhs.uk/patient-information/...

And sometimes it doesn't work. Patients are then given the option of going ahead without sedation, or rescheduling for general anaesthesia.

Hmm, I got one and they used ketamine and an amnesiatic. Not considered general anesthesia but I don't remember a thing. This was in the US.

But even "general anesthesia" still has differing categories.

Surgery uses propofol plus a gas anesthesia for "general anesthesia", but it is considered "general anesthesia" even if only propofol is used.

Which end are we scoping? Colonoscopy is often done without anaesthesia but tends to take longer than 2 minutes, so I'm not sure if that's what OC is referring to. It's uncomfortable, but that's ok. Scoping nose/mouth->stomach also doesn't come with any drugs, just some lube.

I've done it (it's standard in many countries). Honestly, it's a bit horrifying because you are completely at the mercy of someone else but it's bearable. Colonoscopy is definitely easier.

My only experience with global anesthesia was as a child waking up with a massive asthma attack unable to breathe so I try to avoid it.

> Honestly, it's a bit horrifying because you are completely at the mercy of someone else but it's bearable.

Probably not as horrifying as brain surgery or getting your eyes lasered.

very common. doing it routinely. you never heard of it?

>40-60 years

Oh shut the hell up! We are in the midst of massive technological revolution year on year especially related to biology and brain function. Yes, ALWAYS rescue someone. Treatment progresses it never stops or moves backwards.

If a patient has "sequelae of hypoxic ischemic changes" in their brain like in this case, that means a significant amount of their brain cells have died. The surviving brain cells may or may not be able to take over some of the function of the dead ones, but I'm not aware of any current or future technology that can significantly improve the chances of a positive outcome here.

Then again, I agree with you on principle: if such a patient is brought into the ER, the Hippocratic Oath compels doctors to do everything they can to save them. And since ECMO is widely available (thanks Covid, I guess), they can really do a lot, even if the patient's heart is stopped for extended periods of time. If, like in this case, the patient's heart starts beating again, there's "only" the recovery of brain function to worry about. But there are also patients whose brain is working, but their heart doesn't anymore, so they only live as long as they're connected to the ECMO machine (until they hopefully eventually can get a heart transplant), which presents a whole new set of ethical questions...

> Treatment progresses it never stops or moves backwards.

Unless the episode gets buried at the bottom of the medical file. Unless treatment is "completed" because no more progress can made. Unless insurance doesn't cover it anymore. Unless one bad doctor discourages the patient from ever seeking out another doctor again. Unless the patient himself has only dim awareness, if any, of the fact that this happened and impacts their behavior on a daily basis.

Unless it really can't be fixed, no matter how hard everyone insists that in this day and age it should

Unless they're "Lost to follow-up".

Unless Unless Unless ...

What is TBI?

Traumatic brain injury.