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Stephen arrived home around
midnight after spending the
evening with friends. Hours later, his
mother, Helen, heard strange sounds
coming from the 19-year-old’s bedroom.
She found him lying face down on his
bed. He had choked on his own vomit,
most likely as a result of alcohol intoxi-
cation. He wasn’t breathing.
Stephen sustained severe brain
damage due to lack of oxygen for 10 to
15 minutes. Two months later he was
declared to be in a persistent vegetative
state. People in this condition can some-
times grunt and groan, but otherwise are
completely unresponsive to the world.
Vegetative patients can live for several
years, sometimes decades, and usually
die from infections, organ failure or
complications related to their original
injury. Extremely few recover some
ability to communicate and comprehend
their environment.
In recent years, neuroscientists
have found that perhaps as many as
20 percent of patients who appear
to be vegetative actually have some
consciousness. Doctors determine
this through tracking brain activity in
response to questions.
Tests on Stephen showed no such
consciousness. And yet he eventually
recovered and resumed his life, some-
thing that almost never happens. How
did Stephen beat such long odds?BEYOND HOPE?
On that summer morning when Helen
discovered her son dying, Stephen was
rushed to the local hospital. A CT scanshowed extensive damage to the white
matter in his brain, including the
frontal and parietal lobes, regions
critical for working memory, attention
and other high-level cognitive func-
tions. On admission, his score on the
Glasgow Coma Scale was 3 out of 15.
You can’t score lower than a 3 — even
the dead can hit that number. Stephen
spent several months in the hospital
without improvement.
A vegetative state can be caused by a
traumatic brain injury, such as a sharp
blow to the head, or a non-traumatic
brain injury like oxygen deprivation,
a viral infection or stroke. People with
traumatic brain injuries may show some
improvement within the first year. But
for non-trauma patients like Stephen,
if they don’t make progress in the first
few months, they’re usually considered
beyond hope of recovery.
Though people in vegetative states
are cognitively non-responsive, the
brain stem and the brain region called
the diencephalon are usually preserved.The diencephalon regulates sleep-wake
cycles and motor reflexes, while the
brain stem controls automatic functions
like breathing, blood pressure, heart
rate, swallowing and pupil dilation. In
sharp contrast, people who are in comas
often need a ventilator to breathe, can’t
open their eyes and do not have sleep-
wake cycles.
Because so many basic biological
functions remain intact for vegetative
patients, they are often cared for at
home. Sure, it’s not easy; they’re fed
and hydrated through tubes and have
hygiene needs. But it is doable for a
dedicated family. After several months
in the hospital, Stephen had regained
the ability to breathe on his own and
went home. Soon after, the family
brought him to the Brain and Mind
Institute at Western University in
Ontario, Canada, where my team and I
evaluated him.FAMILY MEDICINE
For four days, we tested Stephen using
every tool at our disposal, looking
for some sign of inner life. Stephen’s
eyes rolled in his head and did not
appear to focus on anything, and his
reflexes occasionally jerked his body. A
functional MRI (fMRI) scan and an
electroencephalogram (EEG), both of
which measure brain activity, yielded no
positive results.
Many families of these patients
resort to alternative therapies, because
no conventional treatments are effec-
tive. Stephen’s family tried hyperbaric
oxygen therapy, a well-establishedBorder
Line
A young man with a massive
brain injury straddles the world
between life and death.
BY ADRIAN OWENIn recent years,
neuroscientists have
found that perhaps
as many as 20 percent
of patients who appear
to be vegetative
actually have some
consciousness.
Vital
Signs