Bitcoin Surgery Complications

Post-Surgery Cognitive Recovery and Access Delays

This memo is published by CustodyStress, an independent Bitcoin custody stress test that produces reference documents for individuals, families, and professionals.

Expected Recovery Timeline and Planning Scope

A bitcoin holder schedules elective surgery. The procedure is routine with expected recovery of two to three weeks. The holder makes minimal delegation arrangements assuming they will resume normal custody access within a month. They inform their spouse about basic account information but do not transfer custody access because the absence will be brief.

Surgical complications emerge during or after the procedure. The expected two-week recovery becomes six weeks in the hospital followed by months of limited cognitive function. Bitcoin surgery complications surface delegation gaps when contingency planning sized for short predictable absence meets extended unexpected unavailability requiring access the holder did not delegate.

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Expected Recovery Timeline and Planning Scope

Preoperative consultations describe typical recovery timelines. A holder planning knee surgery is told recovery takes two to four weeks. They arrange for someone to handle physical tasks during this period. Bitcoin custody requires no physical capability so the holder assumes they can manage this themselves during recovery. They delegate bill payment and grocery shopping but not bitcoin access.

Planning reflects statistical likelihood rather than full risk spectrum. The surgeon mentions that complications occur in a small percentage of cases. The holder understands this statistically but plans for the typical outcome. Custody delegation for the statistically unlikely extended recovery scenario is not arranged. When complications occur, the holder lacks pre-positioned access delegation that seemed unnecessary when planning.

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Anesthesia Effects and Cognitive Recovery

General anesthesia temporarily impairs cognitive function. Most patients recover cognitive baseline within days. Some experience prolonged confusion or memory difficulty. A holder undergoes surgery. They wake from anesthesia confused. Days pass and confusion persists. They remember having bitcoin but cannot recall passwords or wallet locations. Family members know bitcoin exists but have no access information.

Postoperative delirium affects some patients, particularly older adults. The holder experiences delirium that lasts weeks. During this period, they cannot provide coherent instructions about custody access. They alternate between lucidity and confusion. During lucid moments, they try to explain access procedures but the explanations are incomplete or contradictory. Family members receive fragmentary information that does not enable access.

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Hospital Setting Access Barriers

Hospital environments limit access to personal devices and materials. The holder's hardware wallet is at home. Their phone is in their hospital room but they cannot remember the PIN reliably. Medications affect memory and concentration. They want to provide access to their spouse but cannot complete the necessary steps from the hospital bed with altered cognitive state.

Some custody information is stored in home locations. Recovery instructions are in a safe deposit box. The box key is in the holder's desk. The desk is in a home office the spouse rarely enters. The spouse knows general backup locations but not specific details. The holder tries to explain by phone from the hospital but becomes exhausted partway through and the conversation ends with incomplete information.

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Infection and Extended Hospitalization

Postsurgical infections extend hospital stays unpredictably. Expected one-week hospitalization becomes four weeks. The holder is treated with antibiotics that affect cognition as a side effect. They remain hospitalized and cognitively impaired throughout treatment. During this period, bitcoin custody needs arise. An exchange account requires periodic login to prevent dormancy. The holder cannot log in. The spouse lacks credentials.

Sepsis creates acute periods of unavailability. The holder develops sepsis requiring ICU care. They are sedated for days. Family members need to access funds for medical expenses. Bitcoin represents significant accessible wealth. Medical bills arrive requiring payment. Traditional bank accounts are depleted. Bitcoin holdings could cover costs but family cannot access them while the holder is sedated.

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Rehabilitation Facility Transfer

Recovery transitions from hospital to rehabilitation facility. The holder moves to a facility without their personal computer or custody materials. They have limited phone access. The rehab environment is institutional and lacks privacy. They want to arrange custody delegation but cannot securely transmit information in the semi-public facility environment. Sharing seed phrases or passwords over facility phones or in shared rooms creates exposure they want to avoid.

Facility discharge timeline uncertainty affects planning windows. The holder does not know when they will go home. Estimated discharge keeps being pushed back. They cannot plan for custody access resumption because the resumption date remains uncertain. This extends the period during which others need delegated access. The delegation that seemed temporary when first needed continues indefinitely as discharge timing shifts.

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Stroke or Cardiac Event During Surgery

Surgical procedures create risk of stroke or cardiac events. A holder suffers a stroke during surgery. They survive but experience lasting cognitive impairment. They understand that bitcoin exists and want family to access it but cannot remember procedural details. They know there is a seed phrase but cannot recall where it is stored. Family searches the home finding partial information but not complete access materials.

Aphasia from stroke creates communication barriers. The holder knows what they want to convey but cannot form the words. They try to write instructions but the writing is impaired. They attempt to guide family members by pointing and gesturing but cannot communicate complex procedures this way. The information exists in their mind but the stroke prevents transmission to others who need it.

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Medication-Induced Confusion

Pain medications affect cognitive clarity. The holder takes opioids for postoperative pain. The medications relieve pain but create mental fog. They attempt to provide custody access to their spouse while on these medications. The information they provide is internally consistent but factually wrong. They confidently give a password that is close to the actual password but not exactly correct. The spouse tries using the provided information and it fails. Clarifying requires waiting until the holder is off medications.

Different medications interact creating cumulative cognitive effects. Pain medication combines with anti-anxiety medication and sleep medication. Together these create more impairment than any single medication. The holder has brief windows of relative clarity but these do not align with when family can visit to receive custody information. By the time family arrives, another medication dose has been taken and clarity is gone.

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Multiple Procedures and Cumulative Recovery

Complications require additional surgeries. One procedure becomes three. Each procedure has its own recovery timeline. The cumulative effect is months of reduced capability. Initial planning assumed one recovery period. The reality is multiple overlapping recovery periods. Each new procedure resets cognitive recovery. The holder alternates between improving cognition and being set back by another procedure.

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Family Conflict Over Access Attempts

Extended unavailability creates pressure for family members to access bitcoin. One family member wants to access holdings to pay medical bills. Another fears that accessing while the holder is incapacitated exceeds proper delegation. They disagree about whether the situation justifies forcing access without the holder's explicit permission. The holder is unavailable to resolve the disagreement. Family members must decide whether medical necessity outweighs respecting the holder's custody independence.

Some family members know partial information. An adult child remembers seeing the hardware wallet in a drawer. A spouse knows an email password. Neither alone can access holdings. They must coordinate and share information. This creates vulnerability beyond what the holder intended. The holder deliberately kept information separated. Medical crisis forces the separation to collapse.

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Power of Attorney Activation Delays

The holder has a durable power of attorney naming their spouse. The POA was intended for permanent incapacity. The spouse hesitates to activate it for what might be temporary surgical recovery. Weeks pass with uncertainty about whether activation is appropriate. During this uncertainty period, bitcoin custody access is needed but the spouse is unsure whether they have authority to act without formal POA activation.

POA activation sometimes requires physician certification of incapacity. The holder is in and out of lucidity. Their surgeon states they are temporarily impaired but not permanently incapacitated. Whether this satisfies POA activation requirements is unclear. The POA document references incapacity without defining whether temporary surgical recovery qualifies. The spouse needs access now but activation procedures are sized for permanent conditions.

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Exchange Account Security Measures

Exchange accounts use device-based authentication. The holder's phone is the authenticated device. Family members have the holder's phone password but the exchange app requires biometric authentication. The holder's fingerprint still works. Family members must bring the phone to the hospital and have the holder authenticate. The holder is sometimes too sedated or confused to complete this process. Windows for authentication are brief and unpredictable.

Some exchanges freeze accounts after extended inactivity. The holder cannot log in during recovery. The account is frozen. Unfreezing requires customer service contact and identity verification. The holder is too impaired to complete verification processes. The account remains frozen extending unavailability beyond the holder's medical recovery timeline.

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Memory Loss and Reconstruction Attempts

Some surgical complications include permanent memory effects. The holder does not regain full memory of pre-surgery custody arrangements. They remember having bitcoin but not the specific procedures they established. Family members attempt to reconstruct arrangements by searching for documentation. They find partial records that raise questions without providing complete answers. The holder cannot resolve uncertainties because the memories are gone.

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Insurance Claims and Financial Pressure

Medical complications create large bills. Insurance covers some costs. Family faces tens of thousands in uncovered expenses. Bitcoin holdings represent available liquidity. Medical billing departments demand payment. The family faces choices between accessing bitcoin without clear authority or allowing bills to go into collections. Financial pressure accelerates decision timelines beyond what custody delegation planning contemplated.

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Return to Baseline Uncertainty

Recovery trajectories are uncertain. Doctors cannot predict when or if the holder will return to pre-surgery cognitive baseline. The holder might recover fully in another month. They might never fully recover. This uncertainty affects whether delegation arrangements are temporary or permanent. Temporary measures seem appropriate initially. As weeks become months without clear recovery trajectory, temporary delegation may need to become permanent. The transition point is unclear.

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Outcome

Bitcoin surgery complications expose delegation gaps when custody planning assumes typical recovery timelines. Holders arrange for short absences expecting to resume access within weeks. Surgical complications extend unavailability beyond planning horizons. Anesthesia effects and postoperative delirium create cognitive impairment that prevents providing access instructions even when the holder is conscious. Hospital environments limit access to custody materials and secure communication.

Infections and sepsis create acute periods when the holder is sedated or too ill to participate in custody decisions. Rehabilitation facility transfers remove the holder from their normal environment where custody materials exist. Stroke or cardiac events during surgery create permanent cognitive impairment distinct from expected recovery trajectory. Medication-induced confusion creates windows where information transmission is attempted but unreliable. Multiple procedures create cumulative recovery periods that multiply expected absence duration.

Family conflict emerges when medical necessity pressures access attempts against respect for the holder's custody control. Power of attorney activation is sized for permanent incapacity not temporary surgical recovery. Exchange account security measures require the holder's participation that surgical complications prevent. Memory loss prevents reconstruction of pre-surgery arrangements. Insurance claim pressures and financial obligations create urgency that outpaces delegation procedures. Understanding these dynamics explains how bitcoin surgery complications can transform planned brief absence into extended unavailability that custody contingency planning did not address.

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