Wall Street Journal article July 8, 2015: “Brain Stimulation May Give Hope to Coma Patients”

Coma is a term unfortunately often misused by the media to also encompass conditions like “persistent vegetative state” or “minimally conscious state” as it is in the title of this article.

The article “Brain Stimulation May Give Hope to Coma Patients” recounts how a 36 year old man, severely brain-injured for 6 years, was selected for a 2007 study of deep brain stimulation using an implantable device improved for 6 months.  According to the article:
“The patient regained voluntary movements of one limb. He also was able to chew, swallow
and speak again, conveying cognitive and perceptual responses.”

The author of the article, Patricia cites this as a potential breakthrough for the severely brain-injured whose

“Annual costs of care are in the double-digit billions.”

However, other measures have already helped such patients to improve or recover over the last two decades.

I first discovered this in the early 1970s, I worked in a top ICU with many people who were in comas from accidents or other brain traumas. I was teased by my colleagues for talking to these people, telling them what day it was, what I was doing to them, etc. “Do you talk to your refrigerator, too?” they laughed.

I told them that if hearing indeed was the last sense to go, perhaps these coma patients would be reassured by, for example, hearing that I was turning them to wash their backs instead of pushing them out of bed. Why not do it?

Then one day a 17 year old young man I will call “Mike” was admitted to our ICU in a coma and on a ventilator after a horrific car accident. The neurosurgeon who examined him predicted he would be dead by morning or become a “vegetable.” The doctor recommended that he not be resuscitated if his heart stopped.

Personally, I was shocked that the doctor said this in front of the patient.

But Mike didn’t die that night and, after a few weeks, he was weaned off the ventilator and could even move a finger on command and eventually he even said “Hi”. However, I was baffled when Mike didn’t respond at all to the neurosurgeon, even with deep pain stimulation.

After a few weeks and with much coaxing Mike finally did say “Hi” to the shocked surgeon. Soon after Mile was transferred out of our ICU to a nursing home where the whole staff assumed he would spend the rest of his life severely impaired.

However, two years later, a handsome young man strode into our ICU, announced he was Mike, and thanked us for saving his life. We were stunned and overjoyed. Laughing, I told him that he wouldn’t remember this, but he used to respond a little to some of us nurses but didn’t for the neurosurgeon. The laughter stopped when Mike revealed that he purposely hadn’t responded to the doctor because he had heard him call him a vegetable and it made him angry.

After that, every nurse was told to treat all our coma patients as if they were fully awake. We were rewarded when several other coma patients woke up and some even recovered.

Today, Mike would probably be dead because of his refusal to respond to a doctor because withdrawal of ventilators, food and water and basic medications have become almost routine when a patient is severely brain-injured unless the family objects. I have seen many people like this called “hopeless” and eventually warehoused in nursing homes to be forgotten.

Over the years, I’ve written about many other patients in comas, “persistent vegetative states”, etc. who improved or even woke up with verbal and physical stimulation instead of the brain stimulation explained in this article.

For example, doctors like Dr. Keith Andrews of the UK and US doctor Mihai Dimancescu did studies years ago that showed around 43% of patients in a so-called “persistent vegetative state” were misdiagnosed. In 1988, Britain’s Royal Hospital for Neuro-Disability developed the Sensory Modality Assessment and Rehabilitation Technique (SMART) is a clinical tool for the assessment and rehabilitation of people with disorders of consciousness following severe brain injury.” For decades, I’ve also recommended Jane Hoyt’s wonderful pamphletA Gentle Approach-Interacting with a Person who is Semi-Conscious or Presumed in Coma”.

People do need to know that there is ongoing research and hope for the severely brain-injured.
As Pope John Paul II wrote in his historic 2004 address to the participants in the International Congress on “Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas :
“The sick person in a vegetative state, awaiting recovery or a natural end, still has the right   to basic health care (nutrition, hydration, cleanliness, warmth, etc.), and to the prevention  of complications related to his confinement to bed. He also has the right to appropriate rehabilitative care and to be monitored for clinical signs of eventual recovery.” (Emphasis added)