European Stars And Stripes (Newspaper) - December 15, 1987, Darmstadt, Hesse Coma lingering Between life and death it is hell for people to see a loved one in a sleep Wake Cycle moving their eyes and expecting falsely that the individual understands and will by Lawrence k. Altman . New York times miraculous recoveries irom prolonged comas Are the stuff of movies and fairy Lales Bui although medical advances have opened the Way Lor More coma a Licals than Ever to survive most linger in a limbo stale of unconsciousness somewhere Between hic and cd Nash Fevol Icse a Licals even if they can to kept alive indefinitely and oven if they appear to awaken and sleep regularly have any Hope Al Lull recovery by one recent estimate Al least 10,000 americans Are in irreversible comas Al any Given time. Each Case moans an extended period of anguish for loved ones who hang on to a thread of Hope and for Tho doctors and nurses who Musl give daily care to a aliens Wilh hopeless prognoses deciding How to treat comatose a aliens Wilh Limie Chance of recovery poses wrenching and unresolved ethical and economic issues. Doctors have Long recognized the coma As on advanced stale of brain failure in which a person lies in a sleep like state with eyes closed but recent research has shown hat continuous sleep like comas Seldom last More than a month. Those who survive that Long usually proceed Inlo a condition described As a persistent vegetative state. In this Condi Hon the mind is dead bul the brain is nol. Life continues in this state because the brain Stem activates the vegetative or autonomic nervous system to carry on the vital mechanical functions governing breathing heart pumping blood pressure and elimination of wastes Tho patient is unresponsive Ollen appearing awake but giving Little or no evidence of awareness of the environment or ability to express thoughts Many of these a aliens resume Normal cycles of sleeping and waking. Their eyes May open spontaneously and they May reflexively blink when menaced. In is hell Lor people to see a loved one in a sleep Wake Cycle moving their a. And expecting falsely that the individual understands and will recover said or. Fred Plum of the new York Hospital Cornell medical Conler an expert on comas. The longer someone lives in a coma the less Likely he r she will recover. Virtually no one comes Oul of a vegetative slate that has persisted As Long As six months but researchers Hope to team what allows the rare individual to emerge from a coma after being in thai stale for a few weeks. They Hope that such knowledge could be used to help others. The problem of Long term comas looms Over doctors and families every Day in every Hospital although accurate statistics about the numbers of comatose americans Are lacking experts believe the numbers Are increasing largely As a result of the introduction of intensive care units in hospitals and new treatments for once fall conditions some coma patients Are victims of heart attacks and strokes who were saved Only to suffer brain cl.inuifjr.1 Many victims of alzheimer s disease eventually become comatose. And some coma pal inf arc we liar of drug overdoses of automobile accidents in recent years researchers have Hie new technology of pet scanners or Mjor Ilori emotion tomography to measure biochemical actions n the brain such to cols have Collir the Rulh Juty of Itin conventional appraisals doctors Usu to measure Cor Nilion and brain damage Uch is i Lictag lingers in Roll of the eyes and pouring cold Valer m the ears to Lesl Tho direction of Eye movement and Olhoft Rel Okos Tho pet scans have shown that the persistent vegetative stale is comparable to the deeper Sirj rfcs of anaesthesia and thai such patients do not Loci exerting Only reflex responses when pinched or otherwise slim Latch what War. Learner is extremely important because it allows physicians to Deal More humanely Wilh Plum said. With a More Scie Lilic basis Lor diagnosis and prognosis families uncertainty can be reduced. Yet the coma still has its mysteries one is Why some autopsies have Lound such 3 striking disparity below eco the limited extent of structural brain damage and Iho total devastation of the mind another concerns those who Suiter from prolonged comas and the persistent veg Calivo stale what selectively kills the brain cells does the injured brain produce poisons that create even More brain damage would transplants of brain cells help the Bleak Outlook Lor people in the vegetative state underscores the crucial decisions that doctors and families must make about a patient s clinical care in the first hours of a coma in if is period neurological signs May be More important predictors of the patient s future than the actual diagnosis of the underlying illness or injury this could help physicians and families decide whether hero is any Point in Lamg extraordinary Lile saving measures. All Hough the american medical association said last year that it was ethical for doctors to Wil Hotd All Means of life prolonging medical ire Alment including Lood and Waler from people in irreversible comas not everyone agrees. Families rarely get enough counselling in making the crucial decisions about a loved one s care and to dealing with any feelings of guilt that May develop said or. Gerald Steinberg director of the Western Massachusetts Hospital in Westfield. Who ideals Many coma a aliens. Or. Sheldon sorrel a rehabilitation Medicine specialist at san Francisco general Hospital surveyed health care workers and determined that those who were farthest removed irom the coma a aliens besides found it easiest to approve withholding life support. The closer you Are to being the one who has to remove the lube he said Tho More difficulty you have with the decision " state cases extended the principle of the right to die to a aliens Fike Nancy Cruzan who needs no breathing assistance but gets artificial nutrition and liquids introduced directly into her stomach through a tube. Appellate courts in the live slates have held thai there is no difference Between removing a Respirator and removing a nutrition tube and a panel of american medical association experts agrees. But no finding with National implications has Ever been reached in the Federal court system. As a result each stale is loll to make its own Legal decision As Missouri now faces. The decision to end their years of anguish did not come easily the Cru Jans and a daughter Christy while said though thoughts and sometimes even Hopes for an end came Well Belore they made their Lisl Legal move Early this year in an interview in the Cruz ans Home in Carterville near Joplin in southwestern Missouri Cruzan now 53 years old. Remembered a time when his comatose daughter Ell ill and was running a High fever we stood Over her bed he said. And in to prayed or any hmm that night we prayed that she would go we did t want her to Somsri i hoped it would really be Over for her said mrs. Cruzan. "1 know it s All backward because when somebody s sick you want them to get Well " especially difficult the Cruz ans say have been the holidays with Nancy s condition set Olf against memories of laughter and playing a i a Cabin they used to maintain above Tho Clear Walers of nearby sugar deck when their children were Young. Chrisly Nancy s 32-year-old sister has memories thai could have Legal significance because they indicate a preference on Nancy s part Lor avoiding life sustaining measures Christy remembers their talking about the Issue and. She said the memories Are things i draw on to know How Nancy Lei Hal there has to be a Point to life a Quality and nol jus to keep a body on this Earth ii she cd kind come Cruzan said she would say. Guys gel me of of this Early this year Cru Ian Appio Ched the american civil liberties Union Ohice Here seeking Legal help Dick Kiir Tenkach. Its Duc Clor. Obtained True assistance irom William Colby of Shook her Ray & Bacon one of Kansas City s leading la firms tax cleans Nel move was a letter to the director of Iho Missouri rehabilitation Center Al mount Vernon seeking removal of Tho life support tube a request that touched Olf reactions up Lodr. Robert Harmon director of the stale department of health i certainly understand the suffering of that family Harmon said. I am an internist. And i have been through this with families a number of times 1 sympathize with heir with the sympathy however came Little support. The department s general counsel. Robert notch Cut. Used arguments that had been Oll Rod but remix led in earlier cases in other slates asserting thai in the plea should be accepted death would then result irom starvation rather than from natural causes Missouri has a living Vii statute if Al permits comatose or terminally ill patients to procedures Hal prolong the dying process. He Rule it but it set ofic Alty excludes any procedure u provide nutrition 01 hydration Colby sees the cd go differently the i Ira will statute he con Lerote Hijino be in no inc s or Jet or her common a n Chi o do fial she an i with tin body " tuesday december 15, 1987 the stars and stripes Page 17
