Not quite brain dead
This is an important and sobering article about brain function. Here’s an excerpt:
At TIRR, [Kothari, an assistant professor of rehabilitation at Baylor College of Medicine] estimates nine out of 10 patients who come to him with a vegetative label turn out to be at least minimally conscious, which means they display subtle but inconsistent signs of awareness. Some are fully conscious but too cognitively damaged to express it. A small number are suffering from a condition known as locked-in syndrome, an extreme form of paralysis that prevents fully aware people from doing anything other than blinking.
Families often spend months arguing with doctors and insurance companies to get a loved one into Kothari’s program. Once there, it usually takes his team only a few days to discover a clue ”” a wiggling toe, eyes that tear up when a certain song is played, a subtle head gesture ”” that suggests a patient is aware.
“They said this could never happen.” That’s usually what family members say when they realize their loved one can still think on some basic level. Can still feel. The dramatic scene ”” that moment of rebirth ”” is repeated every few weeks at TIRR, and yet, therapists who have been there for years still choke up every time.
What comes next ”” the arduous work of restoring those patients ”” is far more difficult.
That seems like one of the worst things in the world to happen to anyone.
When my mother had a stroke, she was in a rehab facility for a few months. Towards the end of her stay, the head of her team called me in for a talk with the group. They told me she would always need 24-hour care and would never graduate to walking on her own with a walker or even getting out of a chair by herself.
I was surprised, because she was already learning those things, albeit with some assistance and prompting. But they told me she wasn’t learning to do it (for instance, to get up out of the chair) without prompting and that she would always need prompting. I told them I didn’t see it that way, and I’m not ordinarily an optimist. But I knew my mother. She wasn’t good at following directions, and she had profound left-right confusion. She was smart, but it took her a longer time than most people to learn things like where the buttons and dials were on the stove, and what they did, and which way to turn them. To get up out of the chair and use the walker, she was supposed to press on the arms of the chair, stand, and reach for the walker, never the other way around (reaching for the walker first). And yet she was consistently reaching for that walker, which would have the effect—if she were allowed to complete the action that way—of making the walker roll away from her and probably precipitating a fall.
She’s been doing this for months, they said. She couldn’t learn. Their supposition was that the stroke had made it impossible for her to learn the sequence of events.
“But she’s always been like that,” I tried to tell them. They told me I had to accept reality, had to give up on the idea of her getting better. “We’re the experts,” they said. “We know what we’re looking at, we see patients all the time, and you don’t.”
A few months later she was getting up from the chair correctly and walking with the walker on her own. We were able to cut back on her aides, slowly. She spent many years after that being able to walk, and only stopped a few months before she died.
One of the problems with traumatic brain injury patients, or any kind of rehab, is money:
A single week of treatment at a facility such as TIRR can run in excess of $25,000, and to cover it, insurers demand continuous evidence that a patient is making progress toward regaining functional mobility and self-dependence. It’s a struggle shared by nearly all families fortunate enough to get a brain-injured loved one into a rehab hospital, and one Nick’s family would grapple with soon enough: Health-benefits administrators expect brains to heal like other body parts, with daily improvements, but that’s not how it works in Kothari’s unit.
Here’s an amazing story:
The patient, a man named Scott Routley, had lived in a nursing home for 13 years after his brain was rattled in a car accident. His doctor had seen no evidence since then to suggest he was even minimally conscious, though his parents insisted they saw something different. A flicker in his eye when a loved one entered. A change in expression when his favorite hockey team appeared on TV.
When Owen put Routley in his scanner and told him to think about tennis, a section of the man’s motor cortex lit up on the screen, mimicking the response of someone with normal brain function. A minute later, when Owen asked him to imagine he was walking through his house, a section of gray matter, near the center of Routley’s brain, glowed red on the monitor.
He seemed to be hearing the prompts and reacting to them, if only in his mind. At the very least, it meant he could still hear and process language, two signs of consciousness. Owen wasn’t surprised. By then, he’d conducted that test on dozens of supposedly vegetative patients and found similar results in some.
The article is both encouraging and heartbreaking. These patients usually don’t make full recoveries. Some don’t recover at all.
When I was a medical student at LA County Hospital there was a young woman who had been a victim of carbon monoxide poisoning who was thought comatose. She was often seen on rounds on Neurology with tactless faculty pointing out what a waste of tax payer funds were spent on keeping her alive.
Eventually, after a year or so, there began to be some suspicion that she was alert. First she would tear upon mention of her name. Fianlly she made a full recovery and recounted some of the conversations she had heard at her bedside.
I have also had patients under anesthesia repeat things they heard during operations. I have always warned operating room staff about this. The patients had no pain but heard conversations.
Reminds me of that guy South African who was comatose all those years (his mother even recommended euthanasia?) and then made a full recovery one day.
https://www.mirror.co.uk/news/world-news/man-trapped-coma-awake-12-4976769
This one hits close to home.
I had a good friend who was similarly “locked in” after a severe stroke, with only her husband and myself, and sometimes a few staff, convinced that she was sentient but paralyzed. He had to fight the insurance companies and the doctors (nurses were much more sympathetic to his claims) every inch of the way to keep her in treatment.
She was making good progress when, after nearly the end of the third year, she died from a sudden heart attack.
Mike – I’ve seen similar reports from news stories and science reports. For me, even if the “brain” isn’t hearing what is said or done, the “spirit” is — so be careful around the comatose, or even the really dead!
PS – one of the functions of the traditional wake, and indeed of the delay between death and burial (or embalming), is to give the alleged corpse time to recover. “Buried alive” is of course a staple of the hooror story.
Robert Graves was severely injured in the trenches in WWI, and was laid against the wall to await transport; his removal was delayed sufficiently that he was awake again before the hearse got to him.
I’ve got a description of a “near death experience” in my second book, Kindle version only.
For me, being locked in that way would be a terrible fate- certainly worse than death unless there were a high-probability of escaping it alive (which doesn’t appear to actually be the case).
I’ve got to admit these stories are the reason I don’t check the “Organ Donor” box on my driver’s license.
Odds are I’m being silly. Still….
Liberals hate those brain-damaged people. Remember how Andrew Sullivan raged about the need to pull plug–now!–on Terry Schiavo? Probably no accident that this facility is in Texas.
The TV show “House” was often medically accurate, and there was a med school student/intern who created a web site (now defunct) to look at the more interesting episodes.
Episode “Locked-In,” Season 5 – Ep.19; and “Meaning,” Season 3 – Ep.1 are on target. It don’t recall the first, but “Meaning” was quite memorable, and I like Kathleen Quinlan.
No comment: for once.
I read this while helping care for my friend.
The Brain That Changes Itself: “Stories of Personal Triumph from the Frontiers of Brain Science” by Norman Doidge.
Not seeking to offend, and I will make it clear that my comments refer to my own opinions about myself, not desires to inflict on others. That said, Terri Schiavo represents the ultimate nightmare to me. At autopsy, it was shown that she had massive and irretrievable brain damage. Much of her brain was simply gone. There was no possible recovery, no hope – just delusional, wishful family at war with a husband who had long since come to grips with the fact that his wife was dead. Therapy had been tried in the early years, with no positive outcome. Terri was gone, never coming back – a horrifyingly long time before her family was forced to let the shell of her go.
I have made it clear to my family and husband that I forbid this sort of thing to be done to me. We have the technological ability to keep some bodies alive indefinitely, though the person that had been inside is irretrievably lost. That doesn’t mean that we should. If I am gone, let go of me. I can’t imagine my parents clinging to an artificially supported body, which I have long since vacated; I can’t imagine them lashing out at my husband for wanting to pick up the pieces and live the rest of his life. However, it reminds that I probably ought to get it down on paper officially.
A single week of treatment at a facility such as TIRR can run in excess of $25,000.
It’s in their best interest to ensure that every patient referred to them shows some signs of cognitive function. And they do! Well, fancy that!
I’d be much more inclined to trust them if they were saying “sorry, but the doctors are right this time” a lot more.
Otherwise it looks to me like they are taking money off vulnerable people.
There’s some eliding going on in that article too. Being told that someone is “highly unlikely” to make a recovery means the doctor thinks there is some chance. Some of those people will make it out. That isn’t a miracle, nor does it make the people who do the recover miracle workers.
Others are considered by multiple doctors as having no chance of recovery. That is a very different thing. What number of those ever make it out?
One study pegs their number at as many as 280,000.
Is the US actually going to keep a quarter of a million people alive on life support? At a million dollars a year each?
For every person kept alive at enormous expense with nearly zero chance of recovery, another person is not treated with the money spent. Some of those people will die as a result. You don’t get to know the names of those people, but they die all the same.
It’s not like those being kept alive, literally trapped, are enjoying the experience.
The opportunity cost of keeping people on life support is that other people die. That’s a shitty fact we have to deal with, but we can’t just wish it away.
Oh. From the title, I thought the article was going to be about the Democrat National Committee.
CapnRusty:
+1000
Chester Draws sez, : “For every person kept alive at enormous expense with nearly zero chance of recovery, another person is not treated with the money spent.”
That is, happily, fiction, unless all care is provided thru a single-payer system, in which the patients with poor recovery potential are sacrificed the the God of Progressivism. See the UK NHS.
Per the NHS, only 1 of 3 kidney failure patients is deemed transplant-eligible.
In the US, it is quite different. From a recent transplant journal paper, “From 5000 to 10 000 kidney patients die prematurely in the United States each year, and about 100 000 more suffer the debilitating effects of dialysis, because of a shortage of transplant kidneys.”
The push is to increase US transplants, in contrast to the NHS negativity.
Only ~2000 kidney transplants are done in the UK yearly, versus ~ 18,000 in the US, a ratio of 1:9, versus a population ratio of 1:5. So a higher fraction of US renal failure patients get transplants.
Another way to look at the numbers is the annual rate of renal transplantation in the UK is 0.00003 versus the US 0.000055. Twice the rate here as there.
For to me to live is Christ, and to die is gain.
Hanging in between? Let me go.
Chester:
Don’t worry your socialist planners have the answer, forbid treatment to all, because they all are going to die anyway. And of course in Great Britain, the NHS and the courts can and will prevent parents from taking a child out of country for other treatment options. How’s that for “shitty?”
Just ask “Dr.” Rahm Emmanuel: in his world view once you got beyond a certain age; you are SOL as far as medical care. So save me your “concern” for those who are not dead yet but unresponsive; less expensive to kill them (euthanasia or denial of care) and move along with “helping” the more deserving.
I knew a young man who had an off-road motorcycle accident resulting in a brain injury which left him in a vegetative state for twenty years. Finally he died.
His mother wouldn’t allow the plug to be pulled. His brother estimated that the state of Tennessee paid out around a million dollars to keep the young man alive.
That money came from the state budget. I must believe some people got less money or no money for their medical treatments as a consequence.
We digressed a bit away from Neo’s closing observation: “These patients usually don’t make full recoveries.”
In point of fact, no one makes a “full” recovery from massive brain injury. Which is not a cost-benefit excuse to kill (“euthanize”) them to “end their suffering”.
Morality is at stake here. Welcome to another slippery slope of moral relativism.
As to huxley’s anecdote, cost of taxpayer-funded care of an individual person is irrelevant. Think of it as fiscally equivalent to health insurance.
Some persons have many $ expended on their cancer treatment or their MS, yet in the end they die. Wrong to do? That was Hillary’s reasoning on health care: if it didn’t work, it should not have been done, those monies should not have been spent.
In the case of taxpayer expenditures, there are lots more wasteful expenditures than keeping someone alive. And taxes are not static. Have you noticed they go up, never down?
You’re not getting out of this life alive, hux.
Chester Draws Says:
April 22nd, 2018 at 11:39 am…
Others are considered by multiple doctors as having no chance of recovery. That is a very different thing. What number of those ever make it out?
* * *
I’m zeroing in on this one because of my friend’s experience .
About the second or third day in the ICU after a massive stroke, the doctors wanted to pull the plug, but her husband was unwilling to let her go without a fight.
In my late night talk with the attending nurse, we discussed the number of people in that condition who had recovered, which she said was zero.
Because they had always pulled the plug instead of trying any recovery treatment.
Tautology much?
Frog: Call me huxley, not hux. And spare me the snarky rhetorical questions.
Invoking “insurance” doesn’t make cost issues go away. The young man I mentioned was in Tennessee and was cared for under TennCare:
_______________________________________________
The total annual budget for TennCare increased from $2.64 billion in 1994 to more than $8.5 billion in fiscal year 2005, with essentially no change in the number of participants enrolled. After becoming Governor in 2003, Phil Bredesen hired the consulting firm McKinsey & Company to evaluate the financial sustainability of TennCare and make recommendations for future actions. The McKinsey report, issued in late 2003, concluded that TennCare was not financially viable. A follow-up report in January 2004 identified options that ranged from returning to the original Medicaid program to setting limits on enrollment and benefits. In response to these reports and to stem the growth in costs, in 2005 the state implemented several program changes, including removing about 190,000 participants, imposing limits on the number of prescription medications each participant could receive, and reducing some other benefits.
https://en.wikipedia.org/wiki/TennCare
In my work as a military corpsman I was told to be very careful of what I said around patients who were apparently comatose and unresponsive because, I was told, they are often quite well aware of what is going on around them, and remember what was said in their presence when they awake.
As always, the liberals have a solution: Let’s starve them to death, even though it certainly results, in at least some cases, of grueling torture that could last for weeks. In these instances, I am always reminded of Terry Schiavo, and of her fate. Of course, the worst villain in that situation was her husband, but nevertheless, we will continue to see this result, especially as we progress towards socialized medicine.
The Catholic Church places the highest value on human life. The moral requirement, according to Catholic teaching, is that we can never deprive someone of ordinary care, not extraordinary, but ordinary care. In other words, it is seen as morally acceptable to “pull the plug” in terms of removing things like artificial respiration, when all other options have been exhausted.
However, it is never acceptable to withdraw basic food and water, which is what happened to Terry Schiavo. No human can survive without food and water, therefore it is considered “ordinary care”, and no one can be licitly deprived of ordinary care. The Catholic view on this is consistent with the Hippocratic Oath (is that still a thing?)… first, do no harm.
I think Catholic teaching shows us best how to approach these tough situations which have only become recently relevant due to technology or increased scientific understanding. Nothing can provide easy answers to tough situations, but if you are approaching the situation from a sound and solid moral basis, you’re going to be able to come up consistent and logical options.
In situations where the life of the mother and baby are both threatened, Catholic doctors run on the doctrine that doing anything in this situation, such as trying to save the mother or the baby, is beyond basic care. Thus the doctor should let nature run its course and let both the mother and baby die.
Vatican teachings, apart from the Jesuits and Dominican factions, are better than secular eugenics, but it is not the best approach.
In point of fact, no one makes a “full” recovery from massive brain injury. Which is not a cost-benefit excuse to kill (“euthanize”) them to “end their suffering”.
Frog is stepping outside of his field here and thus inaccuracies pop up.
http://www.ldsliving.com/LDS-Scouting-and-Young-Men-Leader-Survives-Rafting-Accident/s/82921/
10 minutes without oxygen means the brain is suffering significant damage. This ain’t even comatose, this is no oxygen.
The obsolete and classical interpretation of brain wave is that the consciousness originates from the biological gray matter of the brain. Thus when the biology is damaged, it is like smashing a computer apart. It doesn’t start up again.
Quantum neuroscience has a somewhat different take on the nature of consciousness and what the brain is for.
An easy way to look at it is to check the internet connection on your computer. When it is working, turn off your wi fi router. Immediately your browser stops working and getting data. This might be due to a hardware problem on your computer, but for now it is because you turned off the source of your data bandwidth signals.
A person that suffers brain damage has suffered a break in his wifi connection as well as hardware damage to his setup. The body has a limited amount of recovery abilities, but this is limited by the DNA or data bandwidth it has. The cells are not “intelligent” thus it doesn’t know how to utilize its resources the best. A computer can be rebooted via a signal from the wireless router. People call it remote administration or hijacking the root core.
Even if the data on a hard drive is hopelessly corrupted, the wireless source can reboot the computer and send enough data to reconstruct the boot up process and fix certain issues. If the hard drive is corrupt, reformatting can bypass the damaged sectors.
https://www.online-tech-tips.com/computer-tips/remote-shutdown-command/
The brain and consciousness works in a similar fashion based upon Quantum neuroscience findings and research. The brain is the receiver of the data, but the consciousness is somewhere else sending the data via an invisible conduit: wi fi.
Thus when a computer gets to the point where you can’t restart it, so long as it still has a connection to the wifi, the Source of the consciousness can send enough data to the computer so that the hard drive regenerates itself. Thus making a full or partial “recovery” as doctors might call it.
In other words, patients under permanent comatose are computers that are frozen and need a restart to fix itself. Doctors have tried electricity shocks and other methods to restart the consciousness: didn’t work. The data sequence must be sent from the Source and it is very highly encrypted (much like DNA), with the right sequence of data and commands necessary to reboot and fix the body.
Leave it to a non-Catholic to inform us all about Catholic theology. Shesh.
When living in Salt Lake City I was told that the LDS really had a hatred for the Catholic church. Maybe not all LDS but one seems to have a hate going.
And now we learn all about neuroscience and how electronics engineering and software is the same as biology. Who knew? Does he? Nope.
It is not the same. That is due to misinterpretation of the analogy. Much as Jesus used parables to speak to the ignorant or illiterate, scholars are forced to rotate down their concepts so that most people can comprehend it without lengthy technical discussions.
Also, I never did LSD in Utah or Salt Lake. I was never there. That’s a pretty weird accusation though.
The problem with people who don’t understand the science attacking the messenger is that no matter whether the messenger is right or wrong, you still won’t get the science.
There is that old joke about LSD and LDS and you can look. I don’t care what you have taken or take, nor do I care where you live or have lived. You do seem to have a “thing” about Catholics. Spin that one.
the formal medical ‘tests’ for vegetative state are very primitive and written in the 70s…
It is another ideological thing imo. Certain usual suspects with their love of experts… and wanting authority over life and death given to them and gov… over others…
It’s good that you don’t care. Perhaps you can stop trolling now.
As for brain damage or comas or permanent veggie states, I am not responsible for those standards. The current thing was produced by Doctor Classes given power by the Western authorities. I am neither in a Doctor Class nor part of the Western authorities. I wash my hands of the consequences, as a result.
If humans want to progress further in medical science, they’re going to have to go outside the box even if it means the Doctor Classes belittle them and ridicule them. It’s your health on the line, not mine.
English comprehension is not your strong suit. Heal yourself.