I remember one of my early patients. Her name was wither Ida or Violet, and it was 1990. I don't even remember her admitting diagnosis...was it an aneurysm? Probably. She was in her 90's.
In any case, they had removed a large part of her parietal, and there were various problems after surgery with a CVA and infection. In the end, this poor woman was still missing a large chunk of her skull, but the skin and dura matter had grown back. And she just lay there in the rehab unit, the hole in her skull moving with her pulse and even her breathing. Nobody wanted to open her back up and try to close the hole with any prosthetic, there was no way she would survive it. And as an elderly female with zero activity, she did not grow bone well at all.
Her frontal lobes were a train wreck. She was not aware of anything. Not on a vent, but on a J-tube. She just lay there, waiting to die. We had excellent care at that time, and thankfully when I last saw her she had no bedsores, but she did not have anything else, either.
I used to worry that perhaps Ida was trapped down in that brain, somehow able to think deep inside, so I always talked to her and explained everything to the level I would want it explained to me. As I recall, they did some sort of scan in nuc med and could not see any sort of higher brain function at all, but it always worried me.
Imagine being trapped, staring at a drab wall for months or years while you wait to die.
In Ida's case, pulling the vent was not an option. I thought that rather sad. She's still one of the cases I think of when I question if we're doing the right thing for our population.