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Dr. Leonid Rogozov operating himself to remove his appendix in Antarctica, 1961 (rarehistoricalphotos.com)
386 points by andrelaszlo on Oct 28, 2020 | hide | past | favorite | 112 comments

I am thoroughly impressed one could be mentally composed during such a routine. I have a medical condition that has resulted in many procedures and operations. Needles and blood do not cause me any anxiety. However, on one occasion I had to have my big toe nail removed. It was numbed up fine and I was reading a book during the procedure. However, I looked down at one point and saw my toe nail being pulled off in a bloody mess and, even with (a) no fear of blood and (b) no pain, I almost passed out. There was something deep in my brain that said “alert, that looks really bad so you need to immediately pass out!”

This is called "vasovagal syncope". [1] Certain emotional triggers, including the sight of blood, cause the brain to command the cardiovascular system to lower blood pressure. In some people this reflex is strong enough to cause loss of consciousness due to the decreased blood pressure.

There's a number of competing theories as to why this happens, possibly an evolved response to help control bleeding or vestigial tonic immobility (feigning death to hide from predators). [2] Either way, it's kinda fascinating.

[1]: https://en.wikipedia.org/wiki/Reflex_syncope#Vasovagal

[2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135249/

In July of 1974 I was in my first month of internship at LA County-USC Medical Center. I was on the Jail Ward rotation: anyone in the LA County Jail who needed to see a doctor was brought to this ward in handcuffs by sheriff's deputies in a van, uncuffed upon leaving the elevator, and from then on treated like any other hospital patient, though there were deputies scattered throughout the ward, which held perhaps 50 prisoner-patients. Deputies were required to deposit their weapons in a safe before entering the ward.

In my third week or so on the ward — three weeks after graduating from medical school — we got a man who'd been in a fight whose arm had been sliced open by a broken bottle down to the bone, the injury being about a foot long. The thing was, he was so drunk, he wasn't in any pain yet was perfectly conscious.

Me and a fellow intern spent 3-4 hours in the early morning suturing him up after copiously irrigating the wound with many liters of sterile saline. We'd NEVER done anything remotely like this in med school, so we simply did what we'd learned from watching and reading. We must have put in hundred of sutures, starting with deep muscle and then moving outward layer by layer. We worked from opposite sides of the surgical field. During the entire procedure the guy never complained of pain, but rather talked with us perfectly rationally.

When we were done, we were certain he'd become septic and require weeks of IV antibiotics, but darned if that wasn't the case: he was discharged back to the County Jail after a couple days, with no apparent infection.

"Either way, it's kinda fascinating."

I'd say it's very annoying rather than kinda fascinating. Cannot donate blood. Routine bloodwork can become a chore. Minor doctor procedures become gripping.

Doctors/nurses don't like it either, apparently they do not want you to pass out during these transacations.

And since it's a brain-based thing, thinking about the issue, "ok, I'm not going to let this bother me" actually just enhances how much it bothers me. ugh.

It’s bizarre, is what it is.

I live off grid, and barely a day goes by that I don’t cut myself and have blood dribbling out, somewhere - and it doesn’t bother me in the slightest - even some pretty gruesome injuries (like bifurcating my thumb with an axe) are just “well, crap, that’s going to need stitches”. Even when it was stitched up, the needle going “click” as it pushed through the underside of the nail, I just watched with fascination.

That all said, every time I have a phial of blood taken, I faint, like clockwork. I’m not convinced that it’s the sight or thought of blood, but perhaps a marginal drop in BP or available blood glucose triggering syncope - but I’m not a doctor, just confused as to why it’s triggered by blood being drawn, but never by accidental bloodshed.

I've had this happen once when I cut my thumb cutting glass tubes for a high school science class; I had to be semi-carried me to the nurse's office who got me to drink orange juice to recover. The weirdest thing is that I'm perfectly fine getting my blood drawn for tests and watching the nurse draw the IV or swap out vials; it's just that thumb injury that cause me to go lights out

I had this happen to me on several occasions. Once because I got a contact lens to protect a wounded eye. I told the doctor I could not imagine putting anything artifical in my eye while it is trying to heal. She insisted it would work for 80% of the patients. Once in, the world went black. It didnt even hurt. It was my brain refusing to accept this version of the multiverse. I make a point of mentioning my tendency to just pass out when I get slightly strange treatment from med personel. They seem to have it often enough, because they are always happy to hear in advance something might come up. Its strange, because I can not really predict if it will happen. I am not really afraid of pain. It is more like being afraid of loosing control or something.

Anyway, thanks for giving the phenomenon a name.

It is real. I have never been frightened by the sight of blood, do not think it is gross etc., but a couple of years ago I was having blood drawn for some lab testing and glanced down at the tube while the nurse filled the vial. The vial was super dark red but quite frothy and bright pink colored at the top. Anyways the colors were much more vibrant than I expected and I rapidly felt myself slipping away? I don't think I completely passed out but I started to fall or something and caught myself. I think the nurse asked if I wanted to lie down for five minutes after that and rest before leaving, haha.

"he slowly pulled off my fingernail with a pair of pliers"

Any idea what you call the feeling in your belly/spine when someone describes a nasty injury?

cringe? Almost like nails on a chalkboard sort of feeling. I don't really get grossed out by reading about stuff though.

I don't, but there was an Every Little Thing podcast episode about it, lots of people get it.

I have often heard the feeling called "squick". Or being "squicked out".

The only similar thing I experienced was working on my own ingrown toenail and fixing it, forever. I did it as a teen.

I was totally not able to do that when I started having issues with it, the bare thought of touching it made me feel uncomfortable. But after like 5 or 6 different treatments under local anesthesia or involving ridiculous molded acrylic concoctions that _were not doing anything_ I got tired, bought a scalpel and grabbed some cotton and a napkin and spent like one hour carefully cutting and shaving the thing and using cotton balls to lift it around in a way were it looked like it will grow well after my massacre.

That was probably twenty years ago and I never had any issues with it since then.

Years ago I tore open my arm at work down to the bone (cut sheet metal corners are sharp!), while it was been stitched up at the hospital I was fascinated and watching closely to the point the nurse commented that most people would look away.

Funny how different people are I guess.

I'm the same way: needles, incisions, whatever; I like to watch.

I'm somehow in both - I'm interested, think I'd like to watch; but don't out of fear that maybe I would faint or whatever and find that embarrassing! (Which I probably shouldn't, don't mean to say that anyone who does should, etc.)

The frustrating part is, I definitely faint due to blood being drawn for example, but something about the sight of the procedure makes it hard to look away

I was curious, so I took a look, but it didn't go so well.

I guess this explains why they wouldn't let me watch when I had the same thing done. It's not the sort of thing that bothers _me_, but they wouldn't have exactly screened for that ahead of time.

Less crazy but also very cool: the first coronary catheterization (insertion of a tube through a peripheral vein into the heart) was performed by doctor William Forssmann on himself. Forssmann's colleagues did not believe a coronary catheterization was possible without injuring the heart and possibly killing the patient, so he cathed himself, walked to imaging while cathed, and got X-rayed to prove the catheter was in his right atrium and that it could be done.

Great story! I really admire those who dare to make such bold move. I also feel sorry for those who did similar things but failed and ended up as a forgotten tragedy. They are all heroes.

I’m not certain that doing something like that voluntarily in the absence of an emergency is _less_ crazy. Great story.

There's an interesting book called "Who Goes First?"[1] about something that used to be much more common than it is today: self-experimentation in medicine.

[1] - https://www.amazon.com/Who-Goes-First-Lawrence-Altman/dp/052...

Ethics is great and all but makes it hard to do much original research. This sounds crass but try getting a very routine IRB proposal passed, and you'll see what I mean.

Self experimentation remains relatively out of reach of the ethicists and so should be kept in mind for the more creative researcher types.

Yes, amen. And what better reason to have children than to have accessible human subjects?

Preferably twins, so you can have a control group.

See also, an old story by Scott Alexander: https://archive.fo/eSbZb.

Hadn’t heard of this. Just got a used copy for myself through Bookfinder!

Hey... Thanks for mentioning Bookfinder. Seems like a great resource. I ordered a copy myself as well. :)

This. 20 years on the internet and right now is when I first learn of Bookfinder, which looks like a wonderful resource. Just like HN, where I was just reading and learning from the comments on this remarkable self-operation when, like you, I serendipitously stumbled on Bookfinder. HN is one of the few places online where I can count on finding an unexpected wormhole into a different knowledge universe. My favorite website of them all.

Not an operation but:

Barry Marshall drank the bacteria Helicobacter pylori to prove it's involvement in gastritis and ulcers.

Before that everybody assumed bacteria wouldn't survive stomach acid and these sicknesses were causes by stress.

He treated with antibiotics afterwards and got the nobel-price.

Was the Nobel prize for the discovery of helicobacter in the stomach lining, which had essentially been rediscovered as he found it in some old analysis

Surely he experimented on some animals first?

So he inserted the catheter blind??

I just read through the story, and not quite - he got the catheter started partway, and then the nurse who he'd tricked into thinking she would be the test subject (he needed her to get supplies) walked him to radiology so he see what he was doing when he got to the tricky parts.

Yes. I read about this when I was in medical school and was astounded at his boldness. FWIW he won the 1956 Nobel Prize in Physiology or Medicine for his accomplishment.

Fun fact, all doctors who plan to winter at an Antarctic station must have their appendix removed beforehand [1]. The reason is that they're usually the only doctor available.

[1]: https://www.antarctica.gov.au/about-antarctica/people-in-ant...

> The answer is no, however doctors who are wintering at Australian Antarctic stations are required to have their appendix removed.

Sounds like it’s only an Australian rule.

You're right. There is also Chilean town / research station that requires all residents to have their appendix removed [1].

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

I'm not sure I'll debate your source. It looks legit. But wow is that hard to believe. Is appendicitis really that prevalent?

It feels like it's an overreaction to a specific event.

> Is appendicitis really that prevalent?

It's not incredibly prevalent, but it's a death sentence if not treated immediately.

Sepsis from a burst appendix is.

There have been studies where a large percentage of cases of appendicitis were successfully treated with antibiotics (which is treatment of course, but not immediate surgery).

It’s seems like an excessive requirement considering antibiotics were found to be non-inferior to surgery in acute appendicitis.[1]

Sure, antibiotics don’t work for every case, but doing abdominal surgery just in case sounds risky. [1] https://www.nejm.org/doi/full/10.1056/NEJMoa2014320

For the individual patient the risk numbers look very different if they're the only medic at an Antarctic research station compared to say, a medium sized Australian town. I'm confident my risk of dying from acute appendicitis in a major city in an industrialised country with universal healthcare is negligible, but if I was in the middle of the Antarctic (actually I'd guess Amundsen-Scott has more than one medic, but not say the Russian base Vostok) and there is nobody qualified to operate? Not so much.

Also, the PR is very bad, and while ethically that's no reason for a medic to recommend this surgery to their patient it might be enough reason for a government to make it policy anyway.

Well I misread that. This is for the doctor stationed there. That makes more sense in terms of risk level. I read that as anyone stationed there.

Apparently 20-30% of cases have an imminent rupture requiring surgery.

Of those who take antibiotics, 40% require it to be removed via surgery within 5 years.

Source: https://www.webmd.com/digestive-disorders/news/20180925/anti...

This seems unbelievable, but I've had some bad bloody wounds in circumstances where I was fully aware third party assistance was nowhere to be had.

The mind/body enters an interesting mode in my experience, where I become disassociated from the situation and can focus on what needs to be done. The pain strangely suppresses temporarily, until a sense of completion/achieving stability is restored.

Living things are inherently survival machines.

> The pain strangely suppresses temporarily

Pretty sure that's called shock.


I'm pretty sure it isn't.


To elaborate, I've had other experiences medical professionals assessed as shock. They were paralyzing, and usually involved uncontrolled involuntary shaking and tears.

This is something quite different. If I entered into such states of shock in the survival situations I'm referring to, I would have bled to death.

My assumption is it's a massive release of adrenaline and endorphins.

Where do you see reduced pain on that page? I would have guessed adrenaline to be suppressing the pain, but that link talks about adrenal insufficiency. “Pain” is only mentioned in the context of experiencing new pains in the abdomen.

Hmm, I think I needed to read that a bit closer. Maybe neuralgic shock is the term then. I hadn't realized they had broken shock up into so many categories now. Thanks for the second-check.

"Living things are inherently survival machines."

How fascinating, then, how despite this so many people manage to voluntarily give up their own lives.

If life feels for too long more like surviving than living one might get tired of it.

Yes. A retired professor emeritus of anesthesiology in my department, in his 80s, bedridden, and on dialysis, told our department chair that his life had become too unpleasant and boring to continue with the round the clock routine of treatments and tests that would be his lot until he died. He directed that the dialysis machine be disconnected and died comfortably shortly thereafter.

>A natural death from kidney failure does not hurt. As toxins build up in your blood, you will start to feel sleepy.


My childhood cat died of renal failure in our home.

It was anything but painless if her cries throughout the night, too weak to stand, until finally succumbing were any indicator.

This is so succinctly profound. Thank you

I guess, if you find it fascinating that we're capable of overriding our instincts.

As someone fertile who has managed to avoid reproducing for >40 years, I don't find that particularly fascinating.

That is some serious mental grit. I'm getting woozy just thinking about photo. I don't have that big of a problem with blood or needles—I find it fascinating to watch when I get blood sample taken from my arm. (Did you know the vials are evacuated? That's why the blood spurts into them!)

But this… I swear, if I were born in an earlier century, I would have died long before now. I am soooo grateful for the medical technology we have in this age.

Future headline, “Man removes own appendix by watching YouTube video to avoid unnecessary medical expense.”

"Latest craze - teens are now conducting the appendix removal challenge. Here's how you can protect your tweens."

DIY appendectomy? Fine, suture self.

Well done, sir. Well done.

There's a lot of information freely (or inexpensively) available, and enough people in the biohacking community that have demonstrated a willingness to perform (at least) small self-surgeries, that a more critical surgery being self-performed would not be surprising.


It's amazing what the threat of bankruptcy can make people do.

"Millennials are depriving hard working Doctors of their retirement mansions by cutting corners on healthcare expenses"

I have already seen mutual aid folks talking about what they'll do if abortions become illegal in the US.

The longer I am in medicine, the more I am stunned by this. The likelihood of losing consciousness during the procedure is quite high. The time needed to tell people in advance what to do if that happens is not likely sufficient. I’m glad he was skilled and fortunate enough to live to tell his story for the ages. I wonder how many physicians/surgeons have been in similar situations and not been so fortunate.

That reminds me, I need to re-read Survivor Type by Stephen King...

Saw a photo of a surgeon removing his own gall bladder. This from the 1920s. The reason he did this was to further his belief that general anesthesia was being over used.

It maybe is. The surgeon was surprised when I declined general anesthesia for surgery on my wrist bones. Apparently nearly everyone wants to be put under if they're going to cut.

Objectively sedation would be the riskiest part of the procedure. And I wanted to see what it looked like. It was completely painless, but also quite unsettling. I'm pretty distant and cold about things in general, and I would imagine other people might find it distressing or even traumatic.

There are mild sedation techniques. People think they are "put under" because there tends to be no memory of the procedure, but it is not like general anesthesia in the strong sense.

There have been studies on babies with and without anesthesia.

From memory, with anesthesia was better for the baby.

But being one of the many political biologies I'm not sure I'd trust the result.

Do you mean anesthesia for the mother during a delivery?

My grandfather was a young man in Ireland around then. His job was to hold un-anesthetized surgical patients still.

When he was old and in the U.S. (late 1960s?) he chose suicide over surgery.

On the topic of performing your own surgery, let's not forget the untrained self-caesarean: https://www.thehealthy.com/pregnancy/woman-performed-own-c-s...

Do you have a link? I'd love to read more about that.

Many thanks. That's incredible to read about, I have to respect him a lot for being willing to try his theory on himself first.

Did this change his mind about general anesthesia?

the psychological stress aside this is also crazy

"I worked without gloves. It was hard to see. The mirror helps, but it also hinders—after all, it’s showing things backwards."

Fumbling around in your intestines backwards lying awkwardly on a table while you're already fucked up due to the appendicitis and fever. Pretty incredible.

This is also crazy:

> Opening the peritoneum, I injured the blind gut and had to sew it up.

Removing the appendix is relatively straightforward, and not too delicate (in a normal surgical situation!) Stitching damaged bowel is a lot more delicate. The idea of doing it mostly blind, via a mirror at best, to yourself... wow.

Jerri Nielsen treated her own breast cancer at south pole station in 1998 https://en.wikipedia.org/wiki/Jerri_Nielsen

Meta: It’s peak web 2020 when tapping a photo on “rare historical photos” results in a black screen with a caption and a microscopic “x”. They couldn’t just link to the damn jpeg and let my browser display it could they?

How to take your appendix out on the Piccadilly Line...

— Monty Python, 1974


A family I know here in Washington are legendary woodsman. They've worked in the woods for at least 3 generations that I know of. There is a story (quite true, not a legend- people who were there attest to it) that when the elder woodsman had an accident and sliced his forearm open (a clean slice, not sure how it happened) he went to his truck, cleaned it, and stitched it up with fishing line.

And went back to work.

Holy cremoly. I had appendicitis when I was about 7, back in the 1980s, it was awful and after surgery in an actual hospital with actual doctors I was still out of action for six weeks. I have no idea how anyone could be in a fit mental state to be able to do this to themselves, and I imagine this could have gone completely wrong very easily, it's beating the odds that is just as impressive too.

The 80s weren't Medieval in technology. Is it because it burst?

Yeah I remember a friend had appendicitis in the late 80s and she only spent one week in hospital and one week recovering at home.

The threat of death will do that to you. Either he steeled himself and did it, or he'd probably die.

I have a chronic medical condition which often causes prolonged, severe abdominal pain.

There have been times where, if I had the training and knew that self-surgery would lead to quick relief after only another few hours of excruciating sensation, I might have been willing to give it a go.

And I would have probably passed out from the pain and bled to death.

>There have been times where, if I had the training and knew that self-surgery would lead to quick relief after only another few hours of excruciating sensation, I might have been willing to give it a go.

i've had similar thinkings about dental surgery during intense oral pain.

Tooth pain is pretty bad -- it's amazing that anything can make a human come to the conclusion of : "Well, if I ripped all the bad teeth out of my head..."

The lead in Darren Aronofsky's 'Pi' comes to a similar conclusion before self-trepanning due to intense migraines, although in that movie it is made intentionally unclear whether or not the peace the lead comes to is due to the hole in his head, or something else.

I have a similar medical condition in its effects, access to really frightening levels of painkillers, and I have often -- in the less pleasant moments -- had similar impractical "daydreams."

I find it incredible some of the length's people are willing to go to in order to survive.

This case in particular is incredible to me, partially because I am freaked out (irrationally) by the idea of surgery at all. Being awake during surgery is impressive enough, but doing it on yourself is a whole new level of amazing.

It's a no brainer if the only alternative is death.

Suicide rates would argue otherwise.

For me personally, there's not a lot of things that I think would stop me, but I don't think I would operate on myself.

Possibly, if I had the skills I would feel differently, but honestly, I think I would feel the same way.

Suicide is largely based on anguish or some internal factor rather than due to imminent death or acute but transient pain.

The typical person is not actively suicidal. So conditional odds suggest in most cases a person would prefer to live



I recognize that suicide is not particularly related to the operating on oneself. I was using it as proof that sometimes avoiding death is not a no brainer, as is suggested above.

Edit to clarify: There exist situations which would drive one actively toward death, I could understand a refusal to do surgery on oneself being a passive decision leading toward death.

Well the point is it’s a completely different sort of phenomenon. In a normal human (and normal animal) the will to survive is extremely strong.

The situations you allude to are almost exclusively mental situations. Having to operate on oneself, while mentally taxing, is a fundamentally physical dilemma. It produces fear and stress, but not existential ennui.

A good point. I have no contest, except for that I would have described the idea of operating on myself with the same sort of feeling as the other situations.

After having read the OP and the other cases people have linked, I no longer feel that way.

Thanks for the great conversation, it's caused me to think quite a bit!

I can see a more passive person preferring death easily.

For some of us the idea of cutting into ourselves is definitely not a no brained. I could easily see myself be paralyzed by fear in such a situation.

Amputated his own hand to survive: https://en.m.wikipedia.org/wiki/Aron_Ralston

> his own hand

...if only:

> prepared to amputate his trapped arm at a point on the mid-forearm in order to escape.

Brought this to mind, which I first saw in redacted form in The Best of Creative Computing:


This similar article has more fascinating details https://www.bbc.com/news/magazine-32481442

I remember reading about a dentist in similar conditions who cleaned his(her?) root canal. I've recently tried to googling it but wasn't able to find source though.

My grandfather had to have an appendectomy without anesthesia.... But obviously he didn't have to self operate!

You don't get much more hardcore than that.

he died from lung cancer? wonder if that was because his inability to quit smoking. ma man.

I do this by my own hand

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