In neurosurgery, time is brain. Making quick decisions is critical in many cases to saving the life of a patient. Before doing any invasive procedure, surgeons must obtain the consent of the patient and or legally designated decision maker (closest family member if not specified). But what happens if the patient is too sick to be able to understand or communicate, and no family members are available? In order to make sure patients get timely care in these life-threatening situations, we have systems in place to keep patients safe. It is not a perfect system, but when time is short, as doctors we have an obligation to do what we think will save the life of the patient unless we have documentation telling us not to. What do you think about this system? Have you encountered these situations? #neurosurgeon #emergency #informedconsent #brainsurgery #oncall