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Comment by fernly | Hacker News Reader

Dubious about the "heart attack" diagnosis, at least as the phrase is usually understood. More likely "Sudden Cardiac Arrest"[1]: "In over half of the cases, however, sudden cardiac arrest occurs without prior symptoms." Like, the pump just stops. You'd feel faint and then be unconscious.

[1] https://www.webmd.com/heart-disease/guide/sudden-cardiac-dea...

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> "Sudden Cardiac Arrest": "In over half of the cases, however, sudden cardiac arrest occurs without prior symptoms." Like, the pump just stops. You'd feel faint and then be unconscious.

What a wonderful way to die. No sickness, no disability, no pain. Just turn off when the time comes. I wish everybody could die this way. Not too early preferably.

Speaking as somebody who lost a loved one this way ... it's very hard on the family. I often wonder about my father's last moments ... did he know what was happening? Did he have any regrets, or any last things he wanted to say to people? For us as a family it was like a bomb going off, and we spent many many years cleaning up the debris, and in some ways nearly two decades later we still are. There are plenty worse ways to go, but it's not something I'd like to inflict on my family if I had the choice.

I'm sincerely sad for you having lost a loved one whatever a way yet I still can't imagine a way which would be less sad. And that's not because all the ways are equally sad but because all the other seem worse. So I certainly wish me and everybody else in my family are going to die this way when the time comes as long as we can't just live forever healthily and happily. Of course it would be better if we could know exactly when this is going to happen, some people do, but that's so unusual it's hard to hope.

The death of any loved one is hard on any family, but IMO a quick, relatively painless, death is definately easier. My mother-in-law died from cancer a few years ago, and after many months of pain and constantly in and out of hospitals, when she was finally lying on her deathbed unconcious as her body began to give up, my wife was tasked with making the decision of whether doctors would administer a lethal morphine dose to end her suffering.

Very sad to read that. Yet, by the way, why do they always use lethal doses of morphine for euthanasia? I.e. I would strongly prefer a lethal dose of 5-MeO-DMT (which feels like spiritual ascension and dissolution in pure light, union with the universe and non-duality, and then you just forget to breathe in case of a lethal dose) for myself.

It sounds like death is the opposite of what you think it is. DMT is obviously highly activating and opens the neurological floodgates so to speak (as is any seratonin-based psychedelic). Death is the total opposite of this: the total shutdown of all processes, much more like an extreme and total sedation

Also is there even such a thing as a lethal dose of DMT?

There’s a lethal dose for pretty much anything.

Except you wouldn't want to die from overdosing on water.

I’d argue that suffering from water intoxication (what “overdosing on water” is called medically) is no worse than most other forms of ODing. Common symptoms are headache, nausea, cramping, and drowsiness.

For those wondering how much water it takes, it of course varies based on body weight and how much salt is in your body, but generally speaking, drinking over a gallon (~4L) of water in an hour is at high risk.

I don't know about n,n-DMT (which is a potent hallucinogen and for what simply DMT is a conventional shorthand for) but for 5-MeO-DMT (which is a distinct substance, very weak hallucinogen yet tremendously strong psychedelic) - it's not unlikely to die if you overdose. Doses above 25mg are dangerous, 100mg is probably an almost guaranteed physical death. You just experience being so free from the concepts of material (and mental) reality, one with G-d, Universe and everything, that you can (and will, if the dose is enough) forget about your physical body and it stops breathing.

Curiously enough this substance seems being safe and even very beneficial as long as the doses are reasonable and this attracts scientific attention. I.e. I've read the following paper recently: A single inhalation of vapor from dried toad secretion containing 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) in a naturalistic setting is related to sustained enhancement of satisfaction with life, mindfulness-related capacities, and a decrement of psychopathological symptoms (DOI: 10.1007/s00213-019-05236-w).

I’m not familiar with euthanasia in humans. In animals, phenobarbital is used, not morphine.

In humans, Morphine is used when withdrawing a ventilator. It’s not used to kill the patient. Morphine is very effective at quelling what we call “air hunger”, which is incredibly uncomfortable for the patient (if they can still feel it), and the family (because it sounds like the patient is gasping for air.)

I would assume it's because a lot of morphine plus a benzodiazepine is basically passing away in your sleep.

> Yet, by the way, why do they always use lethal doses of morphine for euthanasia?

Deniability.

Euthanasia is still illegal in most of the world (and yet is the moral thing to do at times). To avoid tangling with the long arm of the law, the medical staff overseeing a terminal patient will hint at what a deadly dosage would be, and leave the dosage control with a family member. So what if the coroner finds morphine - it's supposed to be there. 5-MeO-DMT (or any other non-medical compound), is far less innocuous, and could potentially open a legal can of worms for everyone involved.

It varies. My mother and my wife's father died in the same year. He died suddenly of a heart attack. He was gone, no chance to say goodbye.

My mother was diagnosed in the summer with pancreatic cancer, and had only a few months to live. She didn't want chemo, as it was unlikely to do much good, and she didn't want to spend the rest of her life in hospitals. It surprised me how calm she became about everything. She's always been a bit worried about everything, including her health, but now that her health was gone, she found peace. It was just before my parents' 45th anniversary, and she wanted the entire extended family to be there, and they were. We also planned a family weekend away. Originally the third weekend of October, but after my friends warned me that pancreatic cancer can move really quick, we moved it to the first weekend of October. We had a great time, she was fully conscious and happy, and just needed a bit more rest. On the second weekend of October, she was delirious in the hospice where she would die a few days later.

I was very glad we could say goodbye like that.

I would never wish pancreatic cancer on anyone, and the thought of passing away suddenly without being able to tell my loved ones good bye is equally awful sounding to me. I suppose it highlights the importance of making sure that your friends and family always know how you feel about them.

Exactly this. If nothing else my experiences taught me the importance of biting the tongue on one hand, and not leaving things unsaid on the other.

And don't postpone spending time with them. We knew we had little time, so we used our time well. But it's often much too tempting to postpone these things, to neglect our family, and then something happens and it's too late.

If I could have chosen whether to let my mother die from colon cancer over 18 painful months, or drop dead from a heart attack, I would rewrite history to the heart attack every single time. There is no way being able to say goodbye would overvalue the dignity of being so instantly gone.

18 months is a lot. For my mom it was only 3 months, and she was surprisingly at peace with it. More than she's ever been before, actually. But every case is different.

On the other side of this, I had a relative slowly waste away from cancer. There were no lingering questions, possessions were given away, goodbyes were said, and when the day came, everyone in the family had made peace with it, with the exception of her partner who had to endure the daily emotional burden of her suffering and care. I didn't cry at the funeral: it was as if she had died while still alive. For my relative though, the process was extremely expensive, painful, and undignified: in the end she basically starved to death in anguish, and frankly I think all of the family would have preferred her not to go out in this way.

You don't get a "don't die" choice. Only a spectrum of how.

Totally. There’s not really any easy way but would be nice to be able to get ones affairs in order and get those last things said, and make peace. Not that you get much of a choice anyway ...

> would be nice to be able to get ones affairs in order

Do that now and always keep your affairs in order ever after. Always remember the death is right behind you and live your every moment like if you knew it's the last one. This idea Carlos Castaneda taught is extremely valuable once you get it.

> I often wonder about my father's last moments ... did he know what was happening?

It's possible that he had no warning whatsoever before the event. From another article[1], a person who survived said he had no warning or memory of the event.

[1] https://www.bbc.com/news/uk-scotland-51181230?sa=X&ved=2ahUK...

I imagine it depends on the age/life circumstance of the person dying too. You didn't say, but sounds like your father was fairly young? I'm sorry.

My grandfather died this way, in his 80s, healthy and active up to then... very different thing.

My condolences. If I can just add two cents through - my father spent the last few months of his life dying from cancer, with the final week being nothing but a morphine-induced coma, with his entire body slowly shutting down, him only waking up every now and then to beg for some water(Which he couldn't drink anyway). It was the most horrendous experience I can imagine anyone going through, both for himself and for us as the family. If I had a choice I'd much rather just die than go through this hell. It would have been much easier on us all as well, those days spent sitting next to his bed and knowing that no, it won't get any better and we can't help in any way, will haunt me to the end of my days.

I second this. My grandfather’s slow painful leukimia death found me relief when he actially passed. I was relieved that he was no longer suffering, it was an experience that no human should go through..

Maybe there's nothing worse than suffering, but suffering is better than nothing. I would rather suffer an extra week than die.

Have you ever suffered enough to make that comment though? It is hard to understand how an individual feels when they are on their last days fighting with cancer.

I would like to be able to go, when I no longer want to suffer. Keeping people alive seems kind of sadistic to me.

I highly recommend anyone watch documentary about Masahiro Tanaka. He was a palliative care doctor who treated dying patients, and was diagnosed with a cancer himself. He asked his wife who is also physician to ease his suffering and help him pass. The film crew wanted to film the ideal way to pass. What they witnessed was much more interesting. His wife kept him alive against his wishes, just to prolong his existence. It was quite sad.

The day before he died my father told a visitor "I just want to go".

I've no idea whether I'd feel like that or not, but consider that your guess as to how you'd feel is quite possibly only a guess.

From what I've heard, it's relatively common in hospice care for people to ask to be "helped along" on their way out. All it takes is a little Xanax on top of a lot of morphine; and honestly it sounds like a pretty peaceful way to speed up the inevitable.

Death is evil. It must be eradicated, like other nasty diseases. https://www.kurzweilai.net/death-is-an-outrage

I thought this was satire on first read, but given the context of Alcor (which makes its money cryogenically preserving heads), I'm not so sure.

Without death, progress becomes impossible as power is concentrated in the people who were there first. Without death, consumption is infinite but resources are zero-sum. Without death, life for a young person becomes increasingly bleak. Bleak prospects for young people are how big, destructive, and deadly wars happen. So I don't think eliminating death through biological means would significantly reduce the number of deaths in the long run, it would just change the means.

It goes both ways. I had a relative die of unknown causes just shy of her 90th birthday; she was working in her garden in the springtime and basically just dropped dead. It definitely was a terrible shock for us, but I really can't think of a better way to go.

For what it’s worth:

I lived through just such a thing. It was a wonderful experience - head went light, everything suddenly breezy and far away, too fluffy to cogitate on anything. If my sister hadn’t been there I would have for sure passed, because I certainly wasn’t calling for help.

I imagined for a long time afterwards that that’s probably what heroin feels like, and why it’s so addictive. I was a little wrecked by the fact that the single most peaceful, pleasant experience I’d had in living memory was of dying.

Wow, that is an amazing experience. Did it change your perspective on religion at all?

It did not. I was a secular humanist before and after, and drew no relation between that event and my beliefs.

What does this have to do with religion?

I still don't think it's worse than a slow, painful death (e.g. some types of cancer). One that occasionally gives you hope, and then plunges the patient into yet another deeper chasm, until there is one from which there is no return.

In my country, the majority religion is Lutheran, and the church has a liturgic prayer which includes a line like "save us from the wicked sudden death", with the idea that people should be able to say goodbyes to their loved ones, arrange their lives and possessions and get their last rites before death; I think that is somewhat outdated by the availability of modern social security (like, a father/mother who dies does not need to agree about who cares for his/her children so that they don't starve). And it looks like deaths are slower than before (people live older, but still, the last years are long and may not be so good).

Seriously. I'm hard pressed to think of a better way to shuffle off this mortal coil.

I was near death once - internal bleeding on the sidewalk while waiting for the ambulance. I was contemplative of my life, but it was very peaceful and I wasn't scared. So much so, that I hope I get that opportunity again when my time runs out.

Does this happen in young, healthy individuals?

I was reading the Wikipedia article linked in another thread [1], and several of the "sudden" deaths were people in their 40s that appear to have been healthy.

Do you feel symptoms, eg. during exercise, that you should listen to so as to inform you to stop whatever activity you're doing? Feeling light-headed, short of breath, blurry vision, etc.?

I run and also perform in theater, so I'm a little anxious about this. (Not to be a hypochondriac.)

FWIW, I'm going to do some research on my own, but I'm always impressed with the well-informed audience on HN that spans many disciplines.

[1] https://en.wikipedia.org/wiki/List_of_entertainers_who_died_...

I think some people are born with heart defects that can result in sudden cardiac death as a young adult. Also strokes. In half a century I doesn't know of any friends or friends that had that happen. But then again I know of three people that died when the car they were working on fell off the jack.

> But then again I know of three people that died when the car they were working on fell off the jack.

Yikes. I had my car fall off once when I was standing next to it getting ready to go under. Now I put two sets of jackstands under it, and give the car a hard shake first.

I've had it happen twice, once with a trolley jack and once with the car jack. In both cases the ground was a softer than I realised. There is no way I would crawl under without axle stands.

Good idea. Never assume the jack is enough.

Last year med student here, sudden cardiac arrest commonly occur in young people. Apart from infectious myocarditis which you might notice as fatigue and reduced performance after you’ve suffered a respiratory infection, hypertrophic myocardiopathy and especially hypertrophic obstructive cardiomyopathy is often hereditary and can be mortal without showing prior symptoms. That’s why after a patient’s death you usually examine their broader family if HOCM was the cause as it can be detected via ultrasound and treated pharmacologically or interventionally (injecting alcohol in the obstructive parts or implanting a defibrillator).

I'm adopted. Can I find out if I'm at risk from a DNA mapping service like 23andme?

> it can be detected via ultrasound and treated pharmacologically or interventionally

To me that sounds like a more reliable way to find out.

Prevalence is 200 per 100k so you’re almost certainly not affected. If you want to be sure a routine ECG and a trans thoracic ultrasound usually is sufficient to diagnose / exclude cardiac myopathy. 23andme doesn’t even look at the whole genome, they just look for common disease associated polymorphisms. No way of telling if you have a mutation that’s not in their database and even if you have a mutation it could be deactivated epigenetically or other factors could lead to you not suffering the disease.

> Last year med student here, sudden cardiac arrest commonly occur in young people.

I think you mean that in the population of people who experience Sudden Cardiac Arrest/Death, many of them are young people. SCD is definitely not "common".

Yes, sorry, should have clarified that. Although generally speaking HCM/HOCM is not a rare disease either and definitely not a negligible cause of non-traumatic mortality cause in younger people.

Had it happen to a classmate in school.

I seem to remember it's either second or third most common cause of death in young people (in rich countries), usually behind traffic accidents.

But that has to be considered together with the fact that, generally speaking, young people just don't die.

Oh, and to fuel your paranoia: had a friend die in Moscow from a stroke. Death could have easily been prevented, if they had called paramedics and not the police, who thought he had taken drugs and just locked him in a cell where he died 8 hours later.

That is pretty horrible. Of course the police would suspect drugs. Maybe they should mandate medical personal being available in every police station.

One of our teachers went jogging and just dropped dead from an aneurysm in the brain. His wife told us that he wasn't feeling too well that day, but good enough for a little bit of exercise.

He was 33 when he passed and was the youngest teacher we had. His condition was only detected after his death. I don't know if it could have been prevented and if this form of atery damage could have been repaired.

I'd say nobody should even end up in a jail cell if all that happened is that person complaining of nausea, pain, and blurred vision. Or really any medical symptoms.

I'd go as far as saying even someone yelling "I have taken drugs", or having needles stuck in every visible vain should get medical treatment first. In most countries, taking drugs (as opposed to possession and/or sale) just aren't crimes, anyway.

Yes it mostly happens in young-er individuals because the reasons behind it are most likely genetic/hereditary and thus these people often don't live long enough to die from them later on. Some reasons include hypertrophic conditions( I'm not 100% sure on the english terms and I'm still an undergrad). Other reasons have to do with problems on ion channels which cause issues with electrical signals traveling through the heart resulting in ventricular fibrilation( e.g. Brugada, but you might have had episodes of passing out in the past). Some of this stuff is detectable but it's hard and there's no effective screening of the population. You might want to get checked by a specialist if you have a family history of early sudden deaths.

Environmental factors include things like steroid abuse( often in conjunction with amphetamin usage, see Rich Piana suspicions).

Famously footballer Fabrice Muamba had a cardiac arrest while playing.

https://en.wikipedia.org/wiki/Fabrice_Muamba#Cardiac_arrest_...

I'm not a doctor but for some reason I get anxious about this as well. You said you run? My logic is that if I had a heart defect it would have showed itself playing sports growing up or during my time in the service.

A friend of mine knew someone who dropped dead on a hump to the range at Twentynine Palms.

In my particular case, Wolf-Parkinson’s has been known to kill young people (a college basketball player about 20 years ago comes to mind). My case was fixed with ablation. I asked the cardiologist, “isn’t that what killed that ball player a few years back?”

“Yup. And if it hasn’t killed you by now (in my 40s), it probably isn’t going to.” Didn’t make the tachycardia (rapid pulse) anymore fun when an incident occurred, but at least it wasn’t probably going to be fatal.

And as additional anecdata, I’ve seen a Cat 1 bicycle racer in his mid-30s drop dead mid-race from a heart-related thing. Just kind of quit riding and fell over; from my non-professional observation, it was a literal case of “dead before he hit the ground”.

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