The Patient Was…

The patient was a 37-year-old male admitted to the hospital in a deep coma. He was my exact age at the time.

He had been in a rare type of accident and had been deprived of oxygen for a prolonged but uncertain length of time. When rescuers reached him, he was in shock and completely unresponsive, and they felt his chances of survival were essentially zero. They were arranging helicopter transport to the nearest hospital, but family members who were my patients prevailed upon them to transport him to my hospital. The first responders agreed only because they were convinced that any attempts at treatment would be futile, anyway.

On admission to the hospital, he was completely unresponsive as had been described by the rescue team. He was on a ventilator with oxygen because he could not breathe on his own. He heartbeat was steady but too slow for effective circulation, so a pacemaker was inserted to provide an adequate pulse rate. He required powerful medications given intravenously to maintain even minimally effective blood pressure.

For all intents and purposes, he was brain dead, and basic bodily functions were being maintained by machines and drugs. He was continually monitored for signs of return of some intrinsic body activity, but there were none.

After a few days, the inevitable question of how long to maintain the patient on “machine existence” was raised. My own judgement was colored by the fact that he was my age, and I couldn’t bring myself to recommend discontinuation of his treatment, at least for a few more days.

His family was conflicted. They realized the apparent futility of keeping him alive on machines, but they couldn’t quite face the decision of ending his life at such a young age. Despite my own difficulty with the decision, they looked to me for advice.

I asked the family if they could accept seeing him in his present state for a few more days. I was frank, and said if I were the patient, at his age, I would want to be given a little longer chance to recover, however unlikely that might be. They agreed to wait a few more days before deciding to “pull the plug.”

There were lots of scientific articles dealing with patients in coma. I was familiar with a lot of that literature, but clearly was not a specialist in that area. Despite the fact that the patient showed no signs of neurologic function, I thought it prudent and necessary to obtain an expert opinion before we decided to discontinue the artificial life support systems that were sustaining him. The family agreed.

A consultant with vast experience with patients in comatose states agreed to see him. After his evaluation, he and spoke privately, away from the family. His opinion was clear: He had never seen recovery in someone like the patient. His advice was to discontinue any life-sustaining technology.

I explained the consultant’s view to the family members. They accepted it with equanimity but wanted to know my personal opinion. They were aware that I was influenced by being the same age as the patient.

I explained that while I respected the consultant’s opinion and had no reason to question it, I would not yet discontinue the patient’s life support. I admitted that I had no medical reason to hope that he might recover some neurologic function. I could only say that if it were me, I would want to continue a little while longer.

We agreed to maintain things as they were for another week.

A couple of days after that, for some inexplicable reason, the patient’s heart function improved enough to discontinue the artificial pacemaker that had maintained a normal heart rate. Then, a trial of breathing without a ventilator was successful, so the breathing tube in his throat was removed.

Two days after that, he opened his eyes. I happened to be in his hospital room at the time, making one of my usual twice-daily visits to my hospitalized patients. The moment was memorable. His parents, who were there, cried openly, and I teared up myself at seeing their reaction.

Within a day, he began to move his limbs. He was able to swallow, so he was fed orally instead of intravenously. Physical therapy began to work with him aggressively. And defying all the laws of probability, he began to speak coherently.

Ultimately, he regained almost completely normal physical and neurological function. He was able to return to work, although at a level with slightly less responsibility than before his accident.

I was eager to give the extraordinary follow-up information to the neurology consultant who had seen him and declared his case hopeless. I thought he would be excited and fascinated.

I was wrong.

He heard me out, sitting impassively. When I was done with all the medical details, he looked directly at me, steepled his fingers, and leaned forward.

“I’m not interested,” he said. “I have built a reputation as a coma expert. I have written papers and books describing my experience with hundreds of coma patients. My opinions are considered incontestable. Not a single patient like yours has ever recovered before. Do you think I am going to change my views because of one case? Do you think I am going to have people question my judgement based on one isolated instance? No. I’m not going to acknowledge it, speak about it, or write about it. My word stands. As far as this is concerned, it never happened.”

I never spoke with him again, and never asked him to consult on another patient.