Self Surgery Options

[mycerius]

This one is a little out there. Is it possible to "jump into" a drone rigged with surgical implements to perform surgery one yourself? Or even go into VR and issue commands to said drone, if the drone's programs are better than your skill? This doesn't just have to be surgery but could also apply to regular medical actions (ex: first aid) as well (with any appropriate wound penalties).

[BlackHat]

Hmm, I would probably say sure - the rules certainly would not forbid it - but I would want to handle it on a case by case basis. Brain surgery, for example, would be hard, as might other surgeries where you couldn't use any anesthesia. If the character needed to upgrade his cyberarm, or something, it seems like that would be how you would go about it (if you insisted on doing it yourself). Local anesthetic to the arm, drop into VR, then use the drone's arms to lop yours off and install the cyberarm.

[McCummhail]

The section on surgery in augmentation specifies that high end automated surgical equipment can be preprogrammed and thus would allow you to "perform a surgery on yourself".
I think it would be difficult to transfer your consciousness out of your body while unconscious as Blackhat suggested.

[Rotbart van Dain...]

Also keep in mind that most implant surgery in 2070 is performed by nanites.

[LurkerOutThere]

Really? Do you have a quotation for that?

[BlackHat]

I think its in Augmentation, in the chapter about advanced medical rules. A great deal of medical procedures can also be done through hormone cocktails, etc - although I don't think that is the sort of medical procedure the OP had in mind.

[Method]

I would say no both from a real life medical perspective and based on the fluff. Full emersion VR relies on a RAS over ride that blocks sensory input from your body to your brain so you would not be concious of pain (which is the subjective experience) but the body still responds reflexively to nosiception (the neurological stimuli) specifically involuntary movements and hemodynamic instability, both of which make surgery dangerous. IRL we get around this with deep anesthesia and paralytic drugs, but this obviously precludes consciousness.

[Starmage21]

I would say no both from a real life medical perspective and based on the fluff. Full emersion VR relies on a RAS over ride that blocks sensory input from your body to your brain so you would not be concious of pain (which is the subjective experience) but the body still responds reflexively to nosiception (the neurological stimuli) specifically involuntary movements and hemodynamic instability, both of which make surgery dangerous. IRL we get around this with deep anesthesia and paralytic drugs, but this obviously precludes consciousness.

Actually there are paralytic drugs out there that do not render you unconscious already. There is no reason at all you cant perform surgery on yourself via VR controlled drone.

[Method]

Actually there are paralytic drugs out there that do not render you unconscious already. There is no reason at all you cant perform surgery on yourself via VR controlled drone.

My wording was a little unclear- I didn't mean to imply that paralytics caused unconsciousness (at least not directly). But the problem with paralytics is that they paralyze all skeletal muscles including the diaphragm and more importantly the pharynx (which obstructs the airway requiring entubation).

But my point stands. You will still have issues with involuntary response to pain stimuli, especially hemodynamic instability without deep anesthesia.

[Stry]

Actually there are paralytic drugs out there that do not render you unconscious already. There is no reason at all you cant perform surgery on yourself via VR controlled drone.

I would think being unconscious would make hard to do anything except being a speed bump.

[Method]

I would also point out that it is unclear if/how RAS override is supposed to work with SR4's wireless matrix, wherein you do not need an implanted datajack to use full VR.

[Karoline]

I would also point out that it is unclear if/how RAS override is supposed to work with SR4's wireless matrix, wherein you do not need an implanted datajack to use full VR.

You don't need a datajack, but VR requires some kind of DNI, and a DNI suggests an ability to do a RAS override. Trodes form a DNI connection through the skull (somehow) and would thus (I presume) be able to override RAS.

Also, if you can't feel pain to your body because of a RAS override, I don't see how you can have a reaction to the pain. You could also use local anesthetics (like they do when you have dental work done).

Heck, there are plenty of ways even in modern times to paralyze someone and stop them feeling any pain without knocking them unconscious, I'm sure by 2072 there would be no problems cutting off pain from the neck down so you can preform surgery on yourself (Heck, isn't there a medical patch that you can buy that acts as a pain editor? Basically an anesthetic patch)

[Method]

You don't need a datajack, but VR requires some kind of DNI, and a DNI suggests an ability to do a RAS override. Trodes form a DNI connection through the skull (somehow) and would thus (I presume) be able to override RAS.

Which was kind of my point. In SR1 thru 3 you needed a piece of hardware implanted in the reticular activating system of your brain to override your concious awareness of real world sensory stimuli so your brain wouldn't get confused with all the VR stimuli coming in. Apparently, trodes (which IIRC also existed in previous editions) now magically do this without the need for an implant, but they haven't really clarified how that works to my knowledge.

Also, if you can't feel pain to your body because of a RAS override, I don't see how you can have a reaction to the pain.

The key is that there is a difference between pain (the subjective feeling of distress which involves the brain) and nociception (the neuro-physiological conduction of pain stimuli). The movements are involuntary (meaning you have no control over them) and reflexive (the stimuli is conducted to the spinal cord and the response is sent back to the muscles before any signal reaches the brain). This is the reason why if you touch a hot burner you will withdraw your hand before you consciously realize the burner is hot and before you experience pain. It may sound weird but people under general anesthesia (unconscious) still react to painful stimuli (like incisions). They still move and their heart rate and blood pressure increase (which as you can imagine makes hard to control bleeding). Thus you need deeper anesthesia to keep them still. In effect you are killing the person- if the anesthesiologist didn't entubate them and hook them up to a ventilator they would be dead in a matter of seconds.

You could also use local anesthetics (like they do when you have dental work done).

These may help but they have their limitations, and can cause cardiac arrhythmias and seizures in high doses.

Heck, there are plenty of ways even in modern times to paralyze someone and stop them feeling any pain without knocking them unconscious

I wouldn't be so sure about that.

(Heck, isn't there a medical patch that you can buy that acts as a pain editor? Basically an anesthetic patch)

You mean IRL? No. You can get fentanyl patches, which is a narcotic, but I don't think sedating yourself before performing self surgery is a good idea.

I'm sure by 2072 there would be no problems cutting off pain from the neck down so you can preform surgery on yourself

I think this is the key. If you really want it to work in your game, then you can certainly come up with a fancy futuristic machine chock full of nanotechnology fueled by mixture of midichlorians and purified handwavium and call it a day. I don't think it would really unbalance the game (not in any way I can think of) but I would apply a DP modifier for sure and limit the net hits you can achieve on your Medicine+Agility test (yes I would use agility for surgery) to no higher than your Pilot [Exotic Surgery Robot] skill. Note also that damage modifiers (in a trauma scenario) would still affect the rigger/surgeon as he tries to save his own life.

[wanderer_king]

I am pretty sure that rigging makes you lose neural control of your body (which is why my rigger can't rig a bike.)
If doing surgery to yourself (esp brain surgery) don't glitch....

[The Dragon Girl]

This is the reason why if you touch a hot burner you will withdraw your hand before you consciously realize the burner is hot and before you experience pain.

Speaking as someone who's given myself third degree burns because I've grabbed something and not realized it was hot till I smelled my own flesh cooking, this is not always the case. I have a high pain tolerance, and a small amount of desensitization in my fingertips. I don't and my body doesn't realize I'm in enough pain to care till its too late.

Really it depends on the kind of surgery you're talking about, and what the local anesthetics are like.

[Karoline]

Which was kind of my point. In SR1 thru 3 you needed a piece of hardware implanted in the reticular activating system of your brain to override your concious awareness of real world sensory stimuli so your brain wouldn't get confused with all the VR stimuli coming in. Apparently, trodes (which IIRC also existed in previous editions) now magically do this without the need for an implant, but they haven't really clarified how that works to my knowledge.

No idea about trodes in previous editions. I would imagine it makes use of the same tech from skin linking to go directly to your brain or perhaps down to your spinal column and doing it around there. No idea really. The point however is that it is done somehow. I also don't know how cyberware or bioware or nanoware or geneware really works, but that doesn't stop me using it.

The key is that there is a difference between pain (the subjective feeling of distress which involves the brain) and nociception (the neuro-physiological conduction of pain stimuli). The movements are involuntary (meaning you have no control over them) and reflexive (the stimuli is conducted to the spinal cord and the response is sent back to the muscles before any signal reaches the brain). This is the reason why if you touch a hot burner you will withdraw your hand before you consciously realize the burner is hot and before you experience pain. It may sound weird but people under general anesthesia (unconscious) still react to painful stimuli (like incisions). They still move and their heart rate and blood pressure increase (which as you can imagine makes hard to control bleeding). Thus you need deeper anesthesia to keep them still. In effect you are killing the person- if the anesthesiologist didn't entubate them and hook them up to a ventilator they would be dead in a matter of seconds.

Once again, local anesthetics will take care of this. Muscle paralysis would also help with any sort of movement, but wouldn't be able to stop the increased blood flow I suppose, but that seems like a potentially limited problem.

These may help but they have their limitations, and can cause cardiac arrhythmias and seizures in high doses.

I'm not in medicine or anything, but I've felt the affects of local anesthetics first hand, and they are quite effective at stoping you from feeling any pain. They also stop any subconscious reactions since the pain signal is simply never sent out.

I wouldn't be so sure about that.

Sure there are. Heck, there are natural venoms out there that will do that. I'm reasonably confident that if some artificial equivalent doesn't exist yet, it will with SR level tech.

You mean IRL? No. You can get fentanyl patches, which is a narcotic, but I don't think sedating yourself before performing self surgery is a good idea.

No, I was thinking of stim patches which provide HPT equal to the patch rating which can go up to 6. Only for stun damage though, so I guess it isn't acting as an anesthetic like I thought it might.

I think this is the key. If you really want it to work in your game, then you can certainly come up with a fancy futuristic machine chock full of nanotechnology fueled by mixture of midichlorians and purified handwavium and call it a day. I don't think it would really unbalance the game (not in any way I can think of) but I would apply a DP modifier for sure and limit the net hits you can achieve on your Medicine+Agility test (yes I would use agility for surgery) to no higher than your Pilot [Exotic Surgery Robot] skill. Note also that damage modifiers (in a trauma scenario) would still affect the rigger/surgeon as he tries to save his own life.

Given that physical stats are irrelevant when working in VR, I don't see why you would base remote surgery on agility. I agree a steady hand is important, but knowing what the heck your doing in the first place (logic) is far more important. It's kind of like knowing how to lead your target with a gun (logic) is important, but good hand-eye coordination is more important (agility). I also see no need to limit it to a piloting skill. Among other things this has such limited applications that I wouldn't smack a player with an added penalty like that for doing this. There is also no mention of a piloting skill being needed for normal remote surgery, so I see no reason to add this requirement for self remote surgery. Piloting is much different than fine manipulation.

As for damage modifiers... Well, if you're under local anesthetics (which you would basically need to be) then I don't imagine wound modifiers would affect you at all. If however you are trying to do this without anesthetics (Which is possible and done, just not often) then... well, I'm still not sure because RAS override means you aren't feeling the pain, but I don't think the books have anything about being in VR canceling out wound modifiers (Stun mods should carry through I think though)

And no, I'm not talking about some magical handwavium device, I'm talking about the sort of technology that is largely in existence in modern times. Surgeries have been performed remotely in modern times. Surgeries have been performed on conscious people in modern times. If the remotely done surgery could be done purely with the brain without having to operate physical controls or anything (Which is being worked on with varying levels of success I should add. Not surgery but getting (meaningful) responses purely with your mind.), I don't see why surgery couldn't be performed on the person performing the surgery.

[Rotbart van Dain...]

Really? Do you have a quotation for that?

Indeed. p. 103, Augmentation.

[LurkerOutThere]

Thanks! I find it odd that regular surgery got phased out so fast between editions, I guess they are trying to have a more clear break in setting. Of course it occurs to me, would that effectively destroy the second hand ware market? Not that such a scenario doesn't have benefits from both an in world line of thought and an external benefit of one lest thing to track when it's time to fence swag.

Also yea the improvement of trodes without any improvement for datajacks and such rubbed me wrong as well, but that's a different thread.

[Karoline]

Thanks! I find it odd that regular surgery got phased out so fast between editions, I guess they are trying to have a more clear break in setting. Of course it occurs to me, would that effectively destroy the second hand ware market? Not that such a scenario doesn't have benefits from both an in world line of thought and an external benefit of one lest thing to track when it's time to fence swag.

Also yea the improvement of trodes without any improvement for datajacks and such rubbed me wrong as well, but that's a different thread.

Hmm, why would it destroy the second hand ware market? People would still need to sell off their old ware when they got upgrades, or people might need to sell of their ware post-mortum to make up debts and bills and such that they left behind. Or they might just need to sell it off to free up essence for some different toy. I don't see new surgery practices affecting the second hand ware market at all.

[crash2029]

Personally here's how I see it:

Is it possible to perform surgical procedures upon yourself? Probably.

It it a good idea to perform surgical procedures upon yourself? Most likely not.

[Rotbart van Dain...]

Thanks! I find it odd that regular surgery got phased out so fast between editions [...]

Uhm... it didn't. That's what M&M stated, too - even ShadowTech mentioned it as a baseline.

If you think about it, it's not that surprising: Doing neural connections by hand is a bit... tricky.

[explorator]

I imagine it depends on what you are operating on. I had surgery on an in-grown toe-nail, and I asked the DR. if he thought he could do the same surgery on himself if needed, and he said it would be no problem. Then he told me that something like 3 of 5 dentists do most of their own dental work on themselves. :o

[Ascalaphus]

Personally here's how I see it:

Is it possible to perform surgical procedures upon yourself? Probably.

It it a good idea to perform surgical procedures upon yourself? Most likely not.

Why not? If your drone is medical quality, it's got better precision (steadier "hands") than any living person could hope to have. If it's control software is also adequate, it all depends on your own ability to correctly specify the operation you want performed.

I imagine drone surgery is mostly a matter of human analysis & simulation of the problem and then drone programming , to be executed by the drone afterwards.

[crash2029]

Why not? If your drone is medical quality, it's got better precision (steadier "hands") than any living person could hope to have. If it's control software is also adequate, it all depends on your own ability to correctly specify the operation you want performed.

I imagine drone surgery is mostly a matter of human analysis & simulation of the problem and then drone programming , to be executed by the drone afterwards.

I say it's probably not a good idea to perform surgery on yourself because the drugs necessary for keeping the body complacent would probably have an effect on judgement. Even though a RAS override prevents the brain from moving the body it does not stop chemicals in the blood from interacting with the brain. Combine that with the psychological impact of operating on yourself and you have a really good chance of impaired judgement. Just my 0.02 (IMG:style_emoticons/default/nuyen.gif)

[Karoline]

I say it's probably not a good idea to perform surgery on yourself because the drugs necessary for keeping the body complacent would probably have an effect on judgement. Even though a RAS override prevents the brain from moving the body it does not stop chemicals in the blood from interacting with the brain. Combine that with the psychological impact of operating on yourself and you have a really good chance of impaired judgement. Just my 0.02 (IMG:style_emoticons/default/nuyen.gif)

Agreed. There might be some retardation from the various drugs you would need to take. I'd say it isn't a wonderful idea, but certainly seems like it would be quite possible.

Great if you need to get a bullet out of your own stomach, bad if you want to install cyberware on yourself.