The patient was seen by me in ventilator, gasping with dilated pupils. MRI of the brain showed huge cerebellar hematoma with secondary hydrocephalus. 

On examination: The patient is in ventilator with rapidly deteriorating status. A detailed discussion with the family that I can evacuate the hematoma, but not granted to improve his condition. They collectively agreed.

The patient was urgently transferred to the operative table and mini-craniotomy over the right cerebellar hemisphere and the dura was opened in x-fashion and the hematoma was evacuated and the still bleeding sources were coagulated until strict hemostasis was achieved and the cerebellar hemisphere regained pulsation and relax.  Routine closure of the wound. Smooth postoperative recovery. The neurologic status is the same. He was sent to the ICU in ventilator.

The patient the next days till in ventilator but the conning signs disappeared. One of his sons, who was absent in the preoperative time, showed great scandal, because without his permission. He was in Iraq. I looked to the other 4 sons and daughter, asking why you did not take his permission. They pushed him away.

After three days the patient was extubated and after 2 days sent to the ward. His troubleshooting son disappeared.

After 7 days he progressed signs of billiary problems and he was operated for that.

The patient after 2 weeks running in the corridor shouting that he want to die. His condition permit for discharge and I told his daughter to be discharged and run at to to die.

The patient after 8 years came to the ICU with cardiac problem and died after 2 days of admission.

This case confirm that the surgeon must do what his soul telling him, what is the best option to the patient. Selectivity is sometimes is hard to use and do what you can and the future of the patient will depend upon other factors.