Human Exceptionalism

Dehydrated Patients May be Aware!

Imagine you are in a hospital or nursing home with a brain injury. Doctors say you are “not there,” but you are. And you hear doctors tell your family to stop giving you food and water! Imagine what that would feel like.

And imagine the suffering that would cause! Kate Adamson, wrongly diagnosed as PVS after a brain stem stroke, was actually awake and underwent surgery with inadequate anesthesia. That wasn’t as bad as not being given food and water after her surgery to correct an intestinal blockage. She survived and regained consciousness, telling Bill O’Reilly about the agony of dehydration, as recounted in my 2003 Weekly Standard piece, “A Painless Death?”

When the feeding tube was turned off for eight days, I thought I was going insane. I was screaming out in my mind, “Don’t you know I need to eat?” And even up until that point, I had been having a bagful of Ensure as my nourishment that was going through the feeding tube. At that point, it sounded pretty good. I just wanted something. The fact that I had nothing, the hunger pains overrode every thought I had…It was sheer torture, Bill.

That horror may be happening more than we know. A new study shows that some “unconscious” patients are aware. From the JAMA Neurology report:

We show for the first time that a patient who had been in a vegetative state for 12 years was able to selectively pay attention to some external events in his environment while ignoring others, according to command. Despite his diagnosis, the fMRI approach allowed the patient to establish interactive communication with the research team in 4 different sessions. The patient’s brain responses within specific regions were remarkably consistent and reliable across 2 different scanning visits, 5 months apart, during which the patient maintained the long-standing vegetative state diagnosis. For all 4 questions, the patient produced a robust neural response and was able to provide the correct answer with 100% accuracy…

To our knowledge, in this study we establish for the first time that some entirely behaviorally nonresponsive patients can use selective attention to communicate. 

Of course it has nothing to do with Terri Schiavo!

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