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Discussion (80 Comments)Read Original on HackerNews
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...
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.
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'.
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.
Your comment and the thread it started helps me a little with dealing with a close person's father's dementia.
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.
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...
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 ...
He didn't come out unscathed though. They describe his progress:
> At 6-month follow-up, he was giving short commands, standing without support, riding a tricycle, eating soft foods, and relearning simple tasks. Peripheral neuromuscular weakness continued to improve.
which is quite limited for an 8-year old, but remarkable considering the circumstances.
They say you're not dead until you're warm and dead.
News article https://www-nrk-no.translate.goog/vestland/nye-tal_-turgaare...
Recount of the story https://www-nrk-no.translate.goog/vestland/xl/turgaaren-var-...
Actual mountain rescuer slogan/wisdom.
Direct link to the write-up of the previous such record: https://www.sciencedirect.com/science/article/abs/pii/S01960...
By "fine" I mean alive, for months her character was much different. It took almost a year to return to its true behavior and enjoy the things she used to enjoy before. Even then she has much lower tolerance to unsolicited cuddling than before.
The vet speculated that the low temperature was what kept her brain alive since the blood almost completely lost the ability to carry oxygen as a result of parasite attacking the blood cells(her initial symptoms were shortness of breath).
The case below had a person conscious in the water for 40 minutes (with an air pocket under the ice) before going into circulatory arrest, and then spent another 40 minutes clinically dead in under water. The combined 80 minutes in the water lowered her body temperature very dramatically, and played a large part in her almost complete recovery.
https://en.wikipedia.org/wiki/Anna_B%C3%A5genholm
> As rescue divers searched for the boy's body, we deliberated whether to attempt resuscitation and likelihood of meaningful neurologic recovery of a child submerged for at least 90 minutes. We reviewed literature for guidance2-4,6 and drew from institutional experience with a 2-year-old submerged in ice water for 40 minutes who received 101 minutes of CPR.3 The toddler recovered with no sequelae. For our current patient, the decision was made to resuscitate and rewarm the boy because of his young age and protective effects of ice water submersion. We reasoned that if meaningful neurologic function were not observed after rewarming, end-organ preservation on ECMO may allow family goodbyes and organ harvest for transplantation to give other sick children the gift of life.9 This important point should be considered by providers faced with the difficult decision to attempt resuscitation of a patient with asystolic hypothermia >90 minutes.
They made a movie about it: https://en.wikipedia.org/wiki/Last_Breath_(2019_film)
Dunno about you, but this does things to me.
This. You literally can’t evaporate all the thawing agent out of the blood of the organism without substantial burns by sheer volume
[^1]: It was only relatively recently that I learned you can't shock an asystole heart. e.g. https://medicalsciences.stackexchange.com/questions/5874/can...
That passage bears quoting at length, it's where I really teared up:
> At initiation of ECMO, the boy's rhythm was asystole. The boy was rewarmed with an ECMO heat exchanger-patient gradient ≤10 °C. [...] As the patient's temperature approached 22 °C (72 °F), low-frequency and low-amplitude sinusoidal electrical deflections were noted on his electrocardiogram. As the patient continued to rewarm, these phasic electrical deflections slowly increased in frequency and amplitude. At approximately 28 °C (82 °F), sinusoidal deflections organized into more classic cardiac electrical activity reminiscent of sinus bradycardia with a wide complex. Amiodarone, calcium gluconate, magnesium sulfate, bolus epinephrine, and epinephrine and norepinephrine infusions were administered. After further rewarming, sinus bradycardia developed and ultimately progressed to normal sinus rhythm...
Parents discovered sled tracks from home onto broken pond ice through which he fell.
He left the house at 16:00, which is why they give the range of 147 to 177 minutes.
Interestingly, the case report notes that "classic cardiac electrical activity" started once the patient reached 82°F.
Survivors of Titanic would say that the shouts of people clinging to something in the water died off pretty fast.
"It includes claims that Hof was sentenced in 2012 by the Amsterdam magistrates court to community service and a fine for assaulting Caroline’s oldest son, then 18. The Amsterdam court confirmed that Hof went before the magistrates court in 2012 and was given a sentence of 40 hours of community service and fined €350.
Enahm Hof said the domestic violence conviction related to “a single incident involving Caroline’s son, adult at the time, for which Wim Hof expressed regret and offered an apology. Wim clarifies that no physical violence occurred, but a struggle, which nonetheless should not have happened.”
that "no physical violence occurred, but a struggle" is an oxymoron for me. maybe no physical injury...