162 Chapter 8
The chart shows that Patient Four Star has suffered a massive closed head injury. He is listed as
being in an “eye- open vegetative state” and “decerebrate.” An eye- open vegetative state is a condi-
tion of complete absence of awareness of the self; the patient is oblivious to the environment but
has wake- sleep cycles. According to the medical reports, Patient Four Star awakens in the morning
and opens his eyes; at night, he goes through the usual stages of sleep seen in normal persons. If
you watch him sleep, you can see the rapid eye movements under his eyelids and the deep breath-
ing as he apparently dreams. A decerebrate patient lacks higher- level brain functions due to wide-
spread cortical brain damage. Patient Four Star, like many decerebrate patients, occasionally has
rigid extension of his limbs and lies in bed in this forced posture. On this rainy day in October, he
is apparently captivated by the college football game.
You won der where to begin as you pull up a chair and sit by Patient Four Star’s bed. He is still
focused on the football game halted by a timeout. You review the neurological report that was
done several weeks ago. Perhaps some spontaneous recovery has occurred and the patient has
improved. Just as the nurse observed, he seems to be an enthusiastic sports fan. Patient Four Star
just might have a normal mind trapped in a spastic body. You have heard stories of such persons.
You have seen movies of patients snapping out of comas after years of existing in an unconscious
netherworld.
The neurological report shows that the patient does not startle to loud sounds or visually track.
He does not anticipate a needle prick. According to the medical reports, Patient Four Star does not
respond to any visual or verbal commands or internal needs. The coma scale places him almost at
the lowest level compatible with survival. But he watches the televised football game with the same
concentration as millions of sports fans. You won der if he is irritated by your presence. When you
shuff le the chart’s paper, you expect him to turn up the sound and “shush” you. You suspect that
the nurse was right; Patient Four Star is ready to tell his story.
The storm intensifies, and icy raindrops sound like sand hitting the win dow. The game has
resumed. Then suddenly, the hospital lights f licker and the tele vi sion’s cable connection is broken.
The picture dissolves, the announcer’s voice becomes static noise, and the tele vi sion screen turns
to snow. You look at Patient Four Star and see that he is watching the snowy screen and listen-
ing to the noise with the same interest as he did the football game and realize the futility of your
assignment.
Case Study 8-8: Closed Head Injury Resulting From an
Airplane Accident
After graduating from an Ivy League university with a degree in recreational management,
Mary Lynn landed a job with the Department of the Interior. There she approved and monitored
concession contracts for the Grand Canyon and Yellowstone National Parks. Selling hot dogs,
bread, ice cream, and trinkets of wolves and geysers are big businesses in national parks, and Mary