New Delhi: The diagnosis of coma has become one of the biggest battlegrounds in medical care. While some doctors insist that comatose patients will never recover and should be starved or dehydrated to death, examples of people who have emerged from comas to live full and productive lives can be found across the country.
Such diagnoses are fraught with subjective interpretations and can be used as justification to withhold treatment and care from helpless patients.
"Coma" is actually a very broad term that indicates the patient is unable to respond to his or her environment. Dr Mihai Dimancescu, chairman of the board of the Coma Recovery Association, writes on the group's web site that coma should be defined as "a state of unresponsiveness from which an individual has not yet been aroused." Many patients emerge from comas, even after months in the condition.
Dr Dimancescu explains that the characteristics of coma vary from patient to patient, with some people able to hear what is going on around them even if they cannot interact with anyone. "While a person described as being in a coma may be totally unaware of his or her state or environment," he writes, "others may have some or even full awareness, contrary to our own perception of their condition." Medical science has not yet advanced enough to be able to determine exactly why most comas occur or which patients will survive and which will not.
He tells of 23-year-old Judy, who was in a coma for three months. A professor, making daily rounds with his medical students, would pass by Judy's bed every day, saying, "Judy is in a coma. She'll never wake up." According to Dr. Dimancescu, Judy came out of her coma and told him she "always remembered that darn professor refusing to stop by her bed, saying that she would not wake up!"
Patients like Judy, dismissed by medical caregivers as all but dead, can and do wake up. The St. Louis Post-Dispatch published an extensive profile of Brian Cressler, who spent 18 months in a coma caused by a car accident a few weeks after his high school graduation in June 1991.
Cressler's parents, Don and Fran, took him home from St. Louis University Hospital in January 1992. Brian couldn't move or talk, his eyes locked in a blank stare. "It was a look that went right through you," said Fran Cressler, according to the Post-Dispatch.
The Cresslers cared for him, hired a physical therapist to keep his muscles from atrophying, and didn't stop hoping. A year and a half after the accident, they noticed a change.
"You could see a slow awakening," Fran Cressler told the Post-Dispatch. "It was like he was talking through his eyes. They just came alive."
He started speaking six months later -- his first word was "Mom." "It was pure joy," Mrs. Cressler said.
Although Brian's body will never be the same since his accident -- he only has partial use of one limb and has memory problems and seizures -- he is able to do many things with the help of his parents, his wheelchair, and a specially trained dog named Sara.
The doctors who treated him right after his accident are astonished by his progress. "When I think about Brian, I think about when I first saw him in the intensive care unit and so close to death," neurosurgeon Robert J. Bernardi told the Post-Dispatch. "Now, when his parents come in with pictures of him hitting tennis balls in his wheelchair and swimming laps in a pool, it's hard to imagine."
Brian Cressler's story is remarkable, but not unique. Patients who emerge from coma have often received therapy consistently, to stimulate their brains and keep their bodies moving.
There is a growing "recognition that people who have some kind of a brain injury, even if they're in a coma for several weeks, do have the potential for recovery," Dr. Dimancescu told the National Catholic Register. "New connections can be made between brain cells where connections have been lost. Parts of the brain take over the function of other parts that have been lost."
The challenge is to convince doctors and hospitals to give the patients time to wake from a coma.
"Particularly with older patients, the medical community will say, 'They're not going to wake up, and they've already lived their lives, so how about we disconnect them from all the machinery?'" Paulette Demato, program coordinator for the Coma Recovery Association, told the Register.
Families are often "not given the opportunity to wait and see what happens," Demato added. "Very often the medical community will try to force a family's hand" and convince the family to stop treatment, even to cause death by starvation and dehydration by removing the feeding tube.
Even patients who spend years in a coma-like state have come fully back to consciousness. Patricia White Bull of Albuquerque, New Mexico, was unresponsive for 16 years after suffering a lack of oxygen while giving birth to her son Mark, the Associated Press (AP) reported.
On Christmas Eve 1999, while nurses were fixing her bed, she suddenly said, "Don't do that," according to the AP. By early January she was able to speak clearly and visit with her four children. "I just went up to her and gave her a hug, and she gave me a hug back," her oldest child Cindi told the Albuquerque Journal. "It was the first time she had ever hugged back. It was scary at first. It was overwhelming emotionally."
Her doctors, who told her family that White Bull would remain in a "vegetative state" her whole life, could not explain why she regained consciousness, the AP reported. Her mother called it a "Christmas miracle from God."
Real-life stories about people recovering from coma demonstrate that doctors must take greater care before they declare that a patient will "never wake up." Dr. Dimancescu told the Register that "misconception number one" about coma patients is the idea that "once somebody's been in a coma for a week or more the situation is irreversible."
He added that "doctors' predictions are often wrong."
(Liz Townsend is a writer with National Right to Life)
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