By some accident of genealogy, I recently found myself flying to an Arabian Gulf state to act as the next-of-kin and surrogate advocate for a relative who had suffered a catastrophic brain stem infarction. My uncle, a 71-year-old lifelong bachelor still in active employment, had been admitted to a private hospital with massive bilateral vertebrobasilar artery thrombosis. CT scans showed widespread infarction of the cerebellum, brain stem, and occipital cortex. He developed coning, at which time my sister, who lived in the region, was contacted to give consent for surgery. Having already discussed the details with me, she attempted to refuse but was told that this was not an option and that surgery had to be performed.
The operation notes, which in part read like a Gothic horror novel, confirmed visible, widespread ischaemia with marked tissue oedema. The surgery report detailed debridement of visibly necrotic areas of the brain stem.
QUALITY OF LIFE
I attended to find a body totally unresponsive to any stimuli, immobile, externally ventilated, parenteral nutrition in place, bladder catheterised. The neurosurgeon greeted us amicably but did become slightly confused when …