How painful is it to die from acute radiation poisoning?

[The_Absolute]

This question is being asked out of my sheer curiousity, but how painful is it to die from acute radiation poisoning? Such as the people whom cleaned up the Chernobyl disaster that died from this. How long does it take to die? What amount of radiation is considered lethal?

 

[QuantumPion]

I'm not sure how long the Chernobyl firefighters lasted but two physicists whom accidentally irradiated themselves with a nuclear bomb core in the Manhattan project took weeks to die. I imagine it would suck big-time as I believe the main cause of death is from your intestinal tract disintegrating and dying from dehydration/diarrhea/internal bleeding.

How much exposure it takes depends on the dosage and the person though. I think once you get up to 200 R and up acute is getting into the fatal range. However the radiation required to instantly incapacitate someone is probably in the thousands of R.

I don't think you can actually feel the radiation itself though, only its effects.

 

[Morbius]

This question is being asked out of my sheer curiousity, but how painful is it to die from acute radiation poisoning?

Absolute,

It all depends on how big the dose is. A big enough radiation dose takes out the nervous system
and you die almost immediately.

Dr. Gregory Greenman
Physicist

 

[Astronuc]

This question is being asked out of my sheer curiousity, but how painful is it to die from acute radiation poisoning? Such as the people whom cleaned up the Chernobyl disaster that died from this. How long does it take to die? What amount of radiation is considered lethal?

Much worse than a severe sunburn. People with that level of radiation exposure would get a morphine drip, or some type of palliative care.

As Morphius indicated, at some level of radiation exposure, the central nervous system is destroyed, and so one only feels pain from those nerves not yet dead.

 

[phyzmatix]

Absolute,

It all depends on how big the dose is. A big enough radiation dose takes out the nervous system
and you die almost immediately.

Dr. Gregory Greenman
Physicist

Much worse than a severe sunburn. People with that level of radiation exposure would get a morphine drip, or some type of palliative care.

As Morphius indicated, at some level of radiation exposure, the central nervous system is destroyed, and so one only feels pain from those nerves not yet dead.

I don't know if I should file this information as "interesting" or "horrifying"...Very scary...

 

[QuantumPion]

I don't know if I should file this information as "interesting" or "horrifying"...Very scary...

The chances of you coming into contact with a radiation source strong enough to kill you are practically nil, luckily. As far as I can remember, the only civilians (not working in nuclear-related job) to ever die from acute radiation poisoning were the crew on board the Japanese fishing ship which was downwind from the Castle Bravo nuclear test, and the http://en.wikipedia.org/wiki/Goi%C3%A2nia_accident" .

 

[Astronuc]

I don't know if I should file this information as "interesting" or "horrifying"...Very scary...

That's why radiation sources and the use of radiation sources is highly regulated and controlled, and why we have designations such as "special nuclear material".

 

[phyzmatix]

The chances of you coming into contact with a radiation source strong enough to kill you are practically nil, luckily.

That's why radiation sources and the use of radiation sources is highly regulated and controlled, and why we have designations such as "special nuclear material".

I guess we're talking predominantly nuclear powerplants and nuclear weapons when it comes to sources capable of emitting these doses of radiation?

Is this also why "dirty bombs" are considered so frightening, or am I totally on the wrong track here?

 

[Morbius]

I don't know if I should file this information as "interesting" or "horrifying"...Very scary...

phyzmatix,

The only people that would every be exposed to a radiation dose like that would be those outside
in a city that just got hit by a nuclear weapon. Perhaps one could also see this at the facilities
that use gamma radiation to sterilize medical supplies. However, such installations have protocols
and safety systems to insure that nobody is in the irradiation chamber when it is operating.

It's really no "scarier" than somebody working at a steel foundry. What do you think would happen
to someone who fell into a bucket of molten metal fresh out of a blast furnace?

The hazard is there and you avoid it.

Dr. Gregory Greenman
Physicist

 

[Morbius]

I guess we're talking predominantly nuclear powerplants and nuclear weapons when it comes to sources capable of emitting these doses of radiation?

Is this also why "dirty bombs" are considered so frightening, or am I totally on the wrong track here?

phyzmatix,

Those very high levels would be found in the detonation of a nuclear weapon.

There's really no place that a human would have access to in a nuclear powerplant that would have
radiation levels so intense.

As far as "dirty bombs" - they are frightening - but shouldn't be. From MIT's Technology Review:

http://www.technologyreview.com/energy/13651/

"The biggest danger from radiological weapons is the misplaced panic they would cause"

Dr. Gregory Greenman
Physicist

 

[phyzmatix]

It's really no "scarier" than somebody working at a steel foundry. What do you think would happen to someone who fell into a bucket of molten metal fresh out of a blast furnace?

Granted, that's at least as scary, but the reptilian part of my brain is going: "at least you can see the bucket of molten metal!" :tongue:

I just never really knew exactly what radiation poisoning entailed, or perhaps I should say that I never knew about the pain factor. For some or other reason I have in my mind concepts such as nausea, disorientation and loss of motor skills...(?)

[edit]I just saw your second post after I posted this one...will pop across to that article straightaway[/edit]

 

[turbo]

I guess we're talking predominantly nuclear powerplants and nuclear weapons when it comes to sources capable of emitting these doses of radiation?

Is this also why "dirty bombs" are considered so frightening, or am I totally on the wrong track here?

The Goiania incident came about because people scavenged a radiation source from medical equipment, so no, it's not just bombs and power plants, but as Astronuc explained, unregulated radiation sources. Strong gamma radiation sources are not only used in medical treatments, but also in the inspection of pipelines, especially in remote locales.

http://en.wikipedia.org/wiki/Goiânia_accident

 

[Astronuc]

The Goiania incident came about because people scavenged a radiation source from medical equipment, so no, it's not just bombs and power plants, but as Atronuc explained, unregulated radiation sources. Strong gamma radiation sources are not only used in medical treatments, but also in the inspection of pipelines, especially in remote locales.

http://en.wikipedia.org/wiki/Goiânia_accident

Importantly - http://en.wikipedia.org/wiki/Goiânia_accident#Legal_matters

In light of the deaths caused, the three doctors who had owned and run IGR were charged with criminal negligence. The main cause of this incident was the severe negligence of the facility's former operators who had left behind such a dangerous item. The accident demonstrated the importance of keeping an inventory and monitoring of all strong radiation sources by public authorities, which now is legally required in many countries.

In the US and developed countries, and theoretically all nations using radioactive materials, sources of radiation/radioactivity and their use are licensed.

What happened in Goiânia is an example of inappropriate use and control of a radioactive source.

The point of a "dirty bomb" is to spread radioactive material over a populated area in order to expose as many people as possible to radiation.

The biological effects of radiation are the result of the ionization of the water and molecules in various cells. The ionization (radiolysis) of water can produce hydrogen peroxide and free hydrogen gas. Hydrogen peroxide is a strong oxidizer which attacks/destroys molecules, e.g. DNA/RNA/proteins/enzymes/ . . . . basically those molecules that allow a cell to function. Cells die, and enough cellular damage/death leads to organ failure and possibly death.

 

[turbo]

The point of a "dirty bomb" is to spread radioactive material over a populated area in order to expose as many people as possible to radiation.

That Goiania source was quite "hot" and quite a few individuals were exposed it to it in a relatively concentrated form. If the caesium chloride had been well-dispersed in a dirty bomb, it would have effected more people, but at low doses. If a terrorist got hold of a small, potent vial of this stuff, he or she could get way more mileage out of it by hiding it in a place where people have to spend enough time (perhaps waiting for trains or buses) to get a serious or lethal dose. It would take a bit of time for epidemiologists to recognize the sicknesses, identify the locus, and remove the source. If the placement was not static, but movable, it might take the docs a bit longer to sort it out. Not as dramatic as a dirty bomb, but probably a lot more lethal in the long run.

 

[phyzmatix]

The biological effects of radiation are the result of the ionization of the water and molecules in various cells. The ionization (radiolysis) of water can produce hydrogen peroxide and free hydrogen gas. Hydrogen peroxide is a strong oxidizer which attacks/destroys molecules, e.g. DNA/RNA/proteins/enzymes/ . . . . basically those molecules that allow a cell to function. Cells die, and enough cellular damage/death leads to organ failure and possibly death.

If a terrorist got hold of a small, potent vial of this stuff, he or she could get way more mileage out of it by hiding it in a place where people have to spend enough time (perhaps waiting for trains or buses) to get a serious or lethal dose.

Do you not feel the effects immediately? If someone stands next to you with turbo-1's vial of caesium chloride, would you be aware of it?

 

[Andrew Mason]

What amount of radiation is considered lethal?

It appears that the answer to that question may depend on the exposure history of the person/animal. It appears that prior exposure to radiation increases the tolerance of mice to higher, normally lethal, doses of radiation. See http://www.bioone.org/doi/abs/10.1667/0033-7587(2001)156%5B0195%3AROLIMF%5D2.0.CO%3B2" which shows this effect in mice.

The effects of radiation on human health is not well understood. The body has mechanisms to repair damage caused by low doses of radiation. There is a growing body of evidence that exposure to low doses can be actually beneficial.

AM

 

[Morbius]

The effects of radiation on human health is not well understood. The body has mechanisms to repair damage caused by low doses of radiation. There is a growing body of evidence that exposure to low doses can be actually beneficial.

Andrew,

Yes - we have a radiation damage repair mechanism not too dissimilar to the immune system. Also
like the immune system; it gets stronger when "challenged" or "vaccinated":

https://www.llnl.gov/str/JulAug03/Wyrobek.html

"The team also discovered that the human lymphoblastoid cells exhibit what is called an adaptive
response to ionizing radiation. An extremely low dose (also called a priming dose) appears to offer
protection to the cell from a subsequent high dose (2 grays) of ionizing radiation. The degree of
protection was measured by the amount of reduced chromosomal damage. A priming dose of
0.05 gray, administered about 6 hours before the high dose, can reduce chromosomal damage
by 20 to 50 percent, compared with damage to cells that were not exposed to the priming dose.

Dr. Gregory Greenman
Physicist

 

[QuantumPion]

Do you not feel the effects immediately? If someone stands next to you with turbo-1's vial of caesium chloride, would you be aware of it?

I don't think so. The radiation dose required to be immediately sensible is massive, such as a criticality accident. See the account of http://en.wikipedia.org/wiki/Louis_Slotin#The_criticality_accident". If you were exposed to a 500 R/hr source you would probably start feeling nauseous and vomiting after a period of hours.

 

[phyzmatix]

Yes - we have a radiation damage repair mechanism not too dissimilar to the immune system. Also
like the immune system; it gets stronger when "challenged" or "vaccinated":

https://www.llnl.gov/str/JulAug03/Wyrobek.html

"The team also discovered that the human lymphoblastoid cells exhibit what is called an adaptive
response to ionizing radiation. An extremely low dose (also called a priming dose) appears to offer
protection to the cell from a subsequent high dose (2 grays) of ionizing radiation. The degree of
protection was measured by the amount of reduced chromosomal damage. A priming dose of
0.05 gray, administered about 6 hours before the high dose, can reduce chromosomal damage
by 20 to 50 percent, compared with damage to cells that were not exposed to the priming dose.

I don't think so. The radiation dose required to be immediately sensible is massive, such as a criticality accident. See the account of http://en.wikipedia.org/wiki/Louis_Slotin#The_criticality_accident". If you were exposed to a 500 R/hr source you would probably start feeling nauseous and vomiting after a period of hours.

Thanks for the links! I find this all very fascinating. I guess, however, that research in these fields are done more from a medical perspective than from that of a physicist?

 

[QuantumPion]

Thanks for the links! I find this all very fascinating. I guess, however, that research in these fields are done more from a medical perspective than from that of a physicist?

Both actually. There is an entire field known as http://en.wikipedia.org/wiki/Health_Physics" which studies the biological impact of radiation.

 

[Morbius]

Both actually. There is an entire field known as http://en.wikipedia.org/wiki/Health_Physics" which studies the biological impact of radiation.

QuantumPion,

Yes - the professional society for the field is the Health Physics Society:

http://www.hps.org

The HPS at the University of Michigan has a very informative web site:

http://www.umich.edu/~radinfo/

http://www.umich.edu/~radinfo/introduction/index.htm

http://www.umich.edu/~radinfo/introduction/radrus.htm

Dr. Gregory Greenman
Physicist

 

[phyzmatix]

You see? Learning something new every day!

 

[Andrew Mason]

The UN Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) has compiled virtually all of this information in it 2000 (vol 1 and vol 2) 2006 report (vol 1 only appears to be available):

http://www.unscear.org/unscear/en/publications/2000_1.html
http://www.unscear.org/unscear/en/publications/2000_2.html
http://www.unscear.org/unscear/en/publications/2006_1.html

AM

 

[Tandem78]

I notice that no one mentioned the case of Alexander Litvinenko, a Russian who died in 2006 in London as a result of Polonium poisoning, and was apparently murdered by the Russian secret service. Apart from the notoriety associated with this political murder, the poisoning also differs from accidents involving gamma radiation exposure in that Polonium emits alpha particles which are absorbed directly in the tissues of the body organs. The symptoms led doctors to suspect Thallium poisoning.

 

[Mhints]

I have sended a question to Dr. Greenman, and I got a answer.
The case I bring to the subject here is about pain when a X-ray is taken.

I had my long checked, but when he took the picture, at that very moment the machine unloaded, I got a painfull impact on the side of my chest which was facing the positioningmachine in the patientroom. The pain stayed for perhaps two days. What the hell has happened to me at that very x-ray-ing moment?
btw: This was about 3years ago.
Thanks for answering

 

[Mhints]

Sorry, forgotten to give the answer; You must have pulled a muscle.
Does not sound very impact notice atall.

 

[Dr_Zinj]

Delayed death from radiation is a nasty way to go.

As for pain from medical radiation treatment:

QUOTE
Horrifying deaths caused by "medical" radiation
For example, Bogdanich reported on the heartbreaking tale of Scott Jerome-Parks who was literally irradiated to death. While he was being treated for tongue cancer, staff in a New York City hospital didn't notice a computer error was directing a linear accelerator to zap Jerome-Parks' brain stem and neck with off-target beams of high-dose radiation on three consecutive days.

He was left deaf, almost blind, burned, and unable to swallow. His teeth fell out among the ulcers lacing his mouth and throat. He died, in excruciating pain, weeks after his radiation "treatment" at the age of 43.

The very day a warning was issued to other hospitals to be more careful with radiation, Bogdanich pointed out in his report, at the State University of New York Downstate Medical Center in Brooklyn a 32-year-old woman with breast cancer was subjected to a huge radiation overdose -- three times the prescribed amount. And it didn't stop there. This intense irradiation of her body went on for 27 days until it burned a hideous, open hole into her chest. The young mother of two young children suffered horrendous pain and then died a month after Jerome-Parks.
UNQUOTE
http://conversations.blackvoices.co...x-ray-errors/ec37e65b36754153a7e704bdef17ea65, 22 Apr 2010.

The "burns" suffered by these two people are more of an ionizing radiation induced necrosis of tissue rather than oxidation of the tissues under application of heat. And these were from therapeutic radiation machines, not a diagnosic imaging x-ray. Looking through medical mistake literature; I'm unable to find a single report of a patient reporting a "blow-like sensation" from any radiation device. However, there are numerous reports of patients feeling a burning sensation at the point of aim.

An even better account is of Louis Slotin's death at Los Alamos during the Manhattan project.

QUOTE
Louis Slotin had been exposed to almost 1,000 rads of radiation, far more than a lethal dose. Kline, who had been three or four feet away from Slotin, received between 90 and 100 rads, while Graves, standing a bit closer, received an estimated 166 rads. A surge of heat "swept over the observers, felt even by those some distance from the source," writes Thomas D. Brock, a retired University of Wisconsin biologist who has done extensive research on early atomic-era accidents at Los Alamos. "In addition to the blue glow and heat, Louis Slotin experienced a sour taste in his mouth [and] an intense burning sensation in his left hand. As soon as Slotin left the building, he vomited, a common reaction from intense radiation." Another commentator suggests that it was as though Slotin had been fully exposed to an exploding atomic bomb at a distance of 4,800 feet.
...
Many volunteers were ready to donate blood for the transfusions doctors deemed necessary. Sadly, all efforts to save Slotin were futile. He died on 30 May after an agonizing sequence of radiation-induced traumas including severe diarrhea and diminished output of urine, swollen hands, erythema (redness) on his body, massive blisters on hands and forearms, paralysis of intestinal activity, gangrene and a total disintegration of bodily functions. It was a simple case of death from radiation, similar to what American scientists and medical personnel saw in Japan among A-bomb victims.
UNQUOTE
http://www.atomicheritage.org/index.php?id=92&option=com_content&task=view, 22 April, 2010.

Interesting, but hopefully not applicable in your case is this Wikipedia entry on visibility to the naked eye of X-rays (I can't believe I'm quoting them as a source):

QUOTE
"Visibility to the human eye
While generally considered invisible to the human eye, in special circumstances X-rays can be visible.[18] Brandes, in an experiment a short time after Röntgen's landmark 1895 paper, reported after dark adaptation and placing his eye close to an X-ray tube, seeing a faint "blue-gray" glow which seemed to originate within the eye itself.[19] Upon hearing this, Röntgen reviewed his record books and found he too had seen the effect. When placing an X-ray tube on the opposite side of a wooden door Röntgen had noted the same blue glow, seeming to emanate from the eye itself, but thought his observations to be spurious because he only saw the effect when he used one type of tube. Later he realized that the tube which had created the effect was the only one powerful enough to make the glow plainly visible and the experiment was thereafter readily repeatable. The knowledge that X-rays are actually faintly visible to the dark-adapted naked eye has largely been forgotten today; this is probably due to the desire not to repeat what would now be seen as a recklessly dangerous and potentially harmful experiment with ionizing radiation. It is not known what exact mechanism in the eye produces the visibility: it could be due to conventional detection (excitation of rhodopsin molecules in the retina), direct excitation of retinal nerve cells, or secondary detection via, for instance, X-ray induction of phosphorescence in the eyeball with conventional retinal detection of the secondarily produced visible light."
UNQUOTE
http://en.wikipedia.org/wiki/X-ray, 22 Apr 2010.

 

[minerva]

Brandes, in an experiment a short time after Röntgen's landmark 1895 paper, reported after dark adaptation and placing his eye close to an X-ray tube, seeing a faint "blue-gray" glow which seemed to originate within the eye itself.

Ooh, file that one under the really impressively unsafe experiments that will never be repeated.

Maybe it's due to some kind of scintillation occurring within the humor of the eye?
I recall that some Apollo astronauts used to report flashes of light in their eyes when passing through the van Allen belts, possibly due to some kind of scintillation, or Cherenkov radiation.

Do you not feel the effects immediately? If someone stands next to you with turbo-1's vial of caesium chloride, would you be aware of it?

No, you wouldn't. It takes time, and unfortunately, the radiation source is doing damage before you will feel it. The people at Goiana didn't feel it straight away; if they did, they would have probably realized the danger of the source earlier.

Also - there have been several incidents involving acute ionising radiation injury throughout history - other than the two early Los Alamos criticality accidents and the Goiana accident, there have been several cases of uneducated workers ignoring safety instructions to climb inside irradiation rooms used to irradiate food and medical materials, giving themselves large gamma doses.

There have also been a couple of accidents with powerful Ir-192 gamma sources for industrial radiography being dropped and later picked up by someone with no shielding - these little things are dangerous, since they're very hot but small and innocuous looking.

There was also the Tokaimura criticality accident, involving a solution of highly enriched uranium.

 

[dgtech]

isn't what the astronauts see cosmic rays? they pass through the hull of the craft, and the eyelids, ISS astronauts complain they see them even with eyes closed, and the ISS is not crossing the radiation belts

 

[Norman]

isn't what the astronauts see cosmic rays? they pass through the hull of the craft, and the eyelids, ISS astronauts complain they see them even with eyes closed, and the ISS is not crossing the radiation belts

There is currently some speculation about the actual mechanism of how the ionizing radiation causes the flashes that an astronaut sees. The possible mechanisms are: activation of the retina, direct activation of the optic nerve, direct ionization of the brain (likely the visual cortex).

EDIT: but yes, they are "seeing" cosmic rays

 

[nismaratwork]

I believe that several elements contribute to the fear of radiation exposure:

First, Hormesis is not a sure thing, so if you survive the acute phase, you may well be living with the Sword of Damocles called cancer. Second, there is the "walking ghost" phase for higher doses, properly the latent phase, which is spooky on a basic level. We don't want to die, but we especially don't want to see our deaths coming, having had a taste of the pain to come. Finally, you can't see it, you can't smell it, or fight it, and that scares people. For the average person, germs and radiation are about as scary as scary gets, even if they are more likely to die with a broiling engine block in their lap.

This being said, in terms of pain experienced, compared to some forms of late stage cancers, burns, systemic infection, and a number of other ways to die, radiation poisoning is not the most painful by any measure. Remember though, that we fear death, but we especially fear DYING. The anticipation of death, and the pain to come that has already been felt during the acute phase, and will return after the latent phase is surely hell. Why do we fear aircraft accidents so much? Is it a worse way to die than being shot, or a car accident, or is it that you spend you last minutes completely out of control, in horrible terror?

@Morbius: Radiation Hormesis is not confirmed, but it does seem likely. Fractional doses are clearly less immediately lethal than single large doses however. I think "avoid the blue glow" is just a good way to live.

 

[rod_worth]

My job in the nuclear navy was a radiation health physicist. It's been several years so my estimates might be a little off, but in the ballpark.

22-24 Rem is when we require medical monitoring because your blood will start to show significant mutations.

~50-100 Rem is enough you give you radiation sickness, which is a more severe version of having sun-poisoning from being outside in the summer sun too long. This is the point where you get 'sun-burned' and you begin vomiting. Death is low.

~100-300 Rem. Damage to internals becomes significant. We're usually concerned with gastric intestinal tracts (spelling?), esophagus, lungs, ect. Death is at 'I think' 40% over the course of a few weeks to a few months.

~300-500 Rem. Severe damage to internals. Death rises to 60-90% in a few days to a week or two.

>500 Rem. Death occurs at >90% in a day or two (less than a week).

I hope this helps. Just for a comparison, the average person gets ~0.4-0.6 (I can't remember if it's .35 or .6)Rem/year from the Sun. I used to take reactor samples, and had to make several emergency reactor compartment entries (@ 1 hour post shutdown), and my 'lifetime' accumulated dose was 0.100 Rem which by industry standards is considered 'high', so most other people receive way less than that; working around reactors is inherently safe with respect to day-to-day radiation accumulation. If you want a really good 'picture' of the pain involved however, in my opinion, try watching the movie "K-19: The Widowmaker" with Harrison Ford. It's a true story about a Russian nuclear submarine that develops a severe reactor plant leak/rupture and the Men that tried fixing it.

 

[mjlaris]

The LD 50/30 (the lethal dose that will kill 50% of the population in 30 days with no medical treatment) is 450 REM. With medical treatments like blood transfusions and bone marrow transplants, you can survive up to about 1000 REM. Beyond 1000 REM, they can keep you alive for a while but you'll eventually die. The Shift Manager at Chernobyl got over 1000 REM the night of the accident and died about a year later. As for pain, it is not a death that I choose. Your brain swells, as do your other limbs, you vomit, etc. Exposure to several thousand REM will kill you in a matter of minutes to seconds.

I used to teach a nuclear engineering class where, to impress upon students the need to be careful, I had them calculate how long it would take them to die if a commercial nuclear power plant spent fuel bundle were to be brought to the surface of the spent fuel pool. The answer was about 0.4 seconds. A spent fuel bundle gives off about 2 million REM.

Mark Laris
Chief Nuclear Engineer
Reactor Engineering Associates

 

[nismaratwork]

The LD 50/30 (the lethal dose that will kill 50% of the population in 30 days with no medical treatment) is 450 REM. With medical treatments like blood transfusions and bone marrow transplants, you can survive up to about 1000 REM. Beyond 1000 REM, they can keep you alive for a while but you'll eventually die. The Shift Manager at Chernobyl got over 1000 REM the night of the accident and died about a year later. As for pain, it is not a death that I choose. Your brain swells, as do your other limbs, you vomit, etc. Exposure to several thousand REM will kill you in a matter of minutes to seconds.

I used to teach a nuclear engineering class where, to impress upon students the need to be careful, I had them calculate how long it would take them to die if a commercial nuclear power plant spent fuel bundle were to be brought to the surface of the spent fuel pool. The answer was about 0.4 seconds. A spent fuel bundle gives off about 2 million REM.

Mark Laris
Chief Nuclear Engineer
Reactor Engineering Associates

I think in the 1000-1500 REM range too, you have the horror of the walking ghost period. There is a lot of thinking that while people fear death, the concept of protracted horror facing an inevitable end is torment. It goes a long way to explaining why 2 minutes falling in a airplane with a rapid death at the end is seen as torturous, but being ejected from a car and lingering is less so. The fear you experience in a given situation is a function of the exotic nature of that situation, your level of control or perceived control over events, and then pain and suffering. The complete breakdown of your body's function at a cellular level followed by multiple organ failure is horrendous, painful, and out of control. I would consider it a truly gruesome way to die, and I for one would eat a gun once symptoms re-emerged after the latent phase.