I'd be curious to read about 1, 2, 5, 10, 20 year follow-up.
Party pooper warning.
I'm afraid I don't have rose tinted glasses, due to personal experience with a family member with TBI (accident at age 16, 3 weeks in a coma). The aftereffects are profoundly destabilizing to his environment. I sometimes have quite a dark view of people's need to be a rescuer and celebrate the "alive!", when they don't have to deal with the next 40-60 years of living...
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.
> 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.
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.
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.
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.
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.
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.
>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.
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.
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 have a similar view on general anesthesia now, everyone i know(including myself) that has had operations have been permanently affected by anesthesia.
Turning yourself off breaks far more than doctors realize i fear.
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.
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.
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
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.
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.
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.
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.
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.
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
You know, many eastern countries apparently intuitively think in cycles. The west tends to think linearly: "We're trending upwards, argh argh overpopulation, famine, death. We're trending downwards, argh argh population collapse, famine, death".
Same with the perception of time. My country sees time as a line. I once had an interesting training where the instructor pointed this out. She went on to say that seeing time as a circle or a point is also an option. It wasn't until I hit the second half of life that I got a glimpse of what that looks like, personally.
Perhaps subconsciously, Japan envisions that the birth rate will go up again sometime in the future and they will have preserved their identity and culture from which to build again.
I do find it funny that some folks treat this is like the complete end of Japan (or whatever) nation, like you said a straight line down. But eventually it will bottom out and potentially rebound a bit. It find on the way up or at the top, and it will be fine at the bottom once the trends return but the issue really is the pain of the phase shift.
you can still grow even with smaller richer more productive population, actually you are encouraged to be more productive with smaller population than vice versa
Maybe unrelated but this memory pops up: I once worked with a mechanical engineer who could not visualize anything in his mind and had quite some trouble with word finding and explaining his ideas. He just couldn't say what needed to be built, he could only evaluate after it was built (often "argh, no not that").
It's as if his training had centered so much on 3d modeling and tangible tweaking as you go, that he hadn't learned to simulate anything with his thoughts before starting. He had to start building it to figure out what he meant. Incredibly creative person, out of the box thinker and big picture visionary, but with difficulty translating his ideas to verbal concrete steps. But nobody realized this, which resulted in a lot of frustration both ways:
"Why didn't you build what I said?"
"I did. This is exactly what you said."
"No it's not! I said x y z"
"Yes you said x y z, this IS x y z"
Silence.
"Then that's not what I meant"
Same, but not sure it's his training and just the way his head works. Have met a lot of people in software who can't draw or understand (very) simple block diagrams of systems. Some people don't have an inner eye.
> The stories the kids always loved most were the Grimms, the violent ones. I think they allowed them to process and in some weird way make sense of what was happening in the real world around them, if such a thing is possible in that environment.
I once read somewhere that after an earthquake, the children who drew pictures of the injuries and catastrophe, later showed fewer symptoms of stress and anxiety than the children who drew happy happy sunshine butterfly rainbows after the event. Seems like it's more beneficial to acknowledge the bad stuff than to encourage positive thinking.
> Seems like it's more beneficial to acknowledge the bad stuff than to encourage positive thinking.
Psychologists are sure it is. You should get all your traumatic experience and deal with it. You'd better learn how to remember these things without panic attacks or whatever. And the methods they use is replaying the traumatic memories multiple times while controlling the emotional state. The controlled emotional state sticks to the memories and replaces the one that was remembered before.
Well, that's the theory at least. I tried it and it kinda work but not perfectly, it may require some recurrent sessions over time if the effect fades. Though if you practice it a lot, it becomes a habit, an automatic response to traumatic memories, so any memory replay reduces the strength of the memory.
It is like a positive thinking (you get your negative reaction to the memories and replace it with a positive one... well, maybe just less negative), but it is definitely not burying unprocessed memories deep inside your mind.
> the children who drew pictures of the injuries and catastrophe, later showed fewer symptoms of stress and anxiety
I believe it is easier for kids, they are more focused on "here and now", and just replaying a memory in a safe environment has much stronger therapeutic effect than for adults. It is easier for adults to ignore the present safety and to dive deep into their past memories with all the associated emotions, so replaying memories can easily make them worse by intensifying remembered emotions.
Adults have crystallized worldviews, which were probably shaped by their traumatic memories, and it shapes their automatic emotional response, and makes matters worse, harder to change. Children are more fluid, they have more plasticity.
Europeans hate making money and hate anyone who makes money. The preferred solution is putting a torch to the person or whatever they built up. Preferably with a nonprofit and shit like GDPR. Because obviously destroying something means you've put one over someone and are therefore superior to them. Bunch of bullies.
Edit: I'm European, I'm allowed to complain about the mentality I grew up in.
Please don't post national/regional slurs to HN. I agree that it's different when you're part of the group, but from a moderation point of view the effect on the threads ends up being bad anyway.
Don't worry! it happens naturally because it's the way people speak in small conversations, and in that context perfectly ok.
The unnatural part is us trying to steer this large/public conversation away from the standards of small/private conversation, which is basically impossible but also a must, if HN isn't to self-destruct.
Edit: there's an additional twist, too, which is that HN's form factor feels like a smaller and more intimate conversation than it really is. That's great in many ways! But it obscures the fact that when people post here, they're really broadcasting to a large audience.
Correction, we hate making money at the expense of other peoples rights and liberties. It's kind of frustrating to have to explain that to US folks over and over again... all that "freedom" in their things is apparently very decorative.
I'd say instead that we value the commons and don't like companies making money by externalising all their problems to the general public.
If company Foo leaks my personal data, I suffer, they don't, so without regulation there's no reason for them to invest in protecting it. Same with pollution and similar
It must be rememebered that this is the forum of an American investment company. There are far too many here who would love to be the corprate boot crushing us underfood.
I'm european (what a vague term...) and I disagree completely. I have never seen this attitude you apparently have. I've seen lots of celebration of innovation and entrepreneurship, I've seen less appreciation for the american style "anything goes as long as the stock price goes up" business environment.
I don’t agree. I run a startup in Europe for a couple of years. I never had once someone hating in me because we are successful. Literally everyone I talked with abiut it thinks its super cool what we do and supported the efforts and wished us best of luck or offered actual help.
The Europeans are very aware of the externalities of businesses. This translates to more bureacracy and often also into pretty dumb “solutions” (cookie banner). Gdpr is not one of those dumb solutions btw. Its annoying to implement, true, and it puts EU business at a disadvantage compared to US businesses, but it gives also power to the people. And that is what counts in the end.
Ask yourself: do you really want to live in a Jarvinian techno-monarchy, where companies are the ultimate power holders? I am not so sure I want that.
My hope for the future is that Europeans will eventually build proper alternatives to US companies and escape the chokehold. Then we all play by our own rules and no one is at a disadvantage. Seems like a pipe dream now, but then I remember that England ruled the world not so long ago and China was a third world country nit worth mentioning. Things can turn quickly!
One more thing: Brussel really goes too far, too often. So I am always crossing my fingers for more market liberal parties to gain influence. I dont like a huge government. Not at all. But i dont believe in the nightwatch government idea either.
"In Ireland, people have an interesting attitude toward success—they look down on it. In America, you look at the mansion on the hill and think, 'One day that will be me.' In Ireland, people say, 'One day, I'm going to get that bastard!'"
"Cultural conservatives might try to explain the Tragic Twenties by citing the rise of secular individualism among American liberals and pointing to the fact that religion seems to be a tonic for unhappiness. But the rise of religious non-affiliation in America has been a steady 30-year trend, whereas this falloff in well-being started in 2020, when secularism reached its recent peak. So, that explanation won’t do."
There are tribes where the mom cares for the sons until they're eight and then the boys are raised by the men from there on. Joining in the tasks the men do daily.
That said, a lot of people don't bond for the sake of bonding, but bond over a shared task (one that really needs doing, not an invented game that mimicks a task..)
Four things are needed. Stereotypically they're divided
Dad: Protect and provide
Mom: Nurture and nourish
You could do it differently, but that only works if you swap one, not share half half.
Both have been eroded. Kids are raised by strangers, our food is crap, you can't warn each other about dangers cause that's somehow an insult and a single income doesn't pay the bills.
The goal seems to be to set men and women against each other.
> Four things are needed. Stereotypically they're divided Dad: Protect and provide Mom: Nurture and nourish
> You could do it differently, but that only works if you swap one, not share half half.
I disagree. But I started nurturing early by planning and orchestrating all our births (home, birth center, birth center, twins/hospital) and her prenatal care.
Much later, my wife developed psych issues and in the end I was performing all roles to our 5 sons. But well before then I was deeply into nurturing our sons as infants, toddlers, PreK and grade schoolers. I changed most of the diapers (cloth! for sons 1 & 2.). I packed lunches, did cub scout leadership, cleaned up the wounds and encouraged them to go get more.
Compared to competent moms and dads, I wasn't substandard, insufficient or compromised in any way.
If I may attempt to clarify my stance. Stereotypically, on average, interpolate for your marriage and all that, if a man does a task/role, he has the ball. He doesn't share the ball. Doing X is my job? Aight, my job. No touchy. Mine. I've got this.
Wife starts doing X. Boom, clarity lost.
I know, I know, shades of grey and all that. But on average, divide it clearly and you know who is responsible for what.
You did all of it, while your wife was sick. Kudos man, tough job done well.
My point wasn't about the heaviness of the task, or about how well each could do it, but about clarity and role division.
> if a man does a task/role, he has the ball. He doesn't share the ball. Doing X is my job? Aight, my job. No touchy. Mine. I've got this.
> Wife starts doing X. Boom, clarity lost.
These seems to reflect a strong division of labor. And it has me wondering if that work might be ever divided on ideological grounds. Either of those would be the opposite of what works for me.
They're also the opposite of what I want. Which is a more seamless integration, one where we are fairly interchangeable - where either of us can do what reasonably needs doing.
Reality is the final judge. If you get the seamless integration to work well and it's what you want, go for it. If it doesn't, revert to the default setting. Vanilla grows on you, it really does
Who is the disciplinarian in the house? I get it, there does tend to be a "role" there (not clear which sex gets that one–it seems to be dependent on a lot of factors—perhaps who is the less patient being the top one).
It just seems odd that anyone would see "nurturing" as assigned to one or the other parent.
If you've never bought into it, that the other sex is to blame, then I'm sure you teamed up quite smoothly.
But I've seen numerous examples, and in my own marriage we also had to figure this stuff out because as kids we had bought into a lot of (never quite spoken out loud but loudly hinted at) unhealthy messages...
I mean, how you clearly point out the immovable constraint and blow past it as if the whole thing is just a cultural fad is somewhat shocking.
Single income doesn’t pay the bills. Period. Everything else is downstream.
One could argue that your talking about the dangers of these downstream effects is insulting and classist. Who is gonna pay these bills? Do you think we prefer that strangers raise our kids?
If we had a trust fund, we would raise our kids ourselves, and backhand brag on forums about how it is the right way. Sadly, we don’t.
Where did I say anything about a cultural fad? Where did I mention "dangers of downstream effects"? Where did I claim that I think "we prefer strangers raise our kids"?
You're pulling your reply straight from the offended-rack
Party pooper warning.
I'm afraid I don't have rose tinted glasses, due to personal experience with a family member with TBI (accident at age 16, 3 weeks in a coma). The aftereffects are profoundly destabilizing to his environment. I sometimes have quite a dark view of people's need to be a rescuer and celebrate the "alive!", when they don't have to deal with the next 40-60 years of living...
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