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[neutralname]

Did you see this?
Misdiagnosed With Coma, Belgian Man Communicates After 23 Years

Conscious but unable to communicate for 23 years after a car accident that was thought to have put him into a deep coma, a quadriplegic Belgian man has described how medical science finally put an end to his agonizing years of silence.

This is going to make people even more reluctant to sign living wills declining treatment if they are in a coma, and will make families more reluctant to turn off life support machines of brain dead relatives.  I already have students telling plenty of stories of people who woke from comas after many years.  Another cause of increasing health care costs.

I do feel very bad for the man though.  What a nightmare.

[frogfactory]

It is an amazing story, and rather a horrifying thing to think about.

Jam got there first.

[neurogirl]

Actually I disagree. Although this is a horrifying tale, there is some light at its conclusion. Clearly neurologists need to perform more thorough evaluations before delivering a final prognosis - and the technology exists to do just that, albeit somewhat roughly. If functional brain imaging was designated as standard procedure in evaluating coma cases, the results would better inform doctors as well as patients in making a decision to keep or remove live support devices. In fact, it could relieve some of the guilt associated with such a decision.

[svenc]

This is going to make people even more reluctant to sign living wills declining treatment if they are in a coma ...

I'm not so sure that's the case.  First, although I did see this story this morning, I'm not so sure this anecdote will have sufficient legs to have a broad impact.

More to the point, for some people the prospect of being trapped in their bodies for decades may be a strong incentive to decline treatment in a living will.

[neutralname]

My sense is that there is a good deal of distrust of doctors among a substantial proportion of the population, and for many of those people, they are happy to latch onto evidence that people can survive a PVS, and so should stay hooked up to feeding tubes etc whatever the medical evidence.  You saw that come out in the Shiavo case a few years ago.

Then there are people like me who are pretty much ready to have the life support machine turned off if we are going to be significantly disabled.  But we won't be any less likely to do so on account of this news story. 

I don't suppose there's much data on how people react to such new stories, so it's all going to be speculative.  I haven't even seen any data about how people's attitudes towards comas, life support and DNR have changed in the last 20 years.

[kedves]

I hope to hear more about this method in the coming years--what it is, how other ways of measuring brain function failed to detect it, and its increasing use and implications.

The thought of being imprisoned without the ability to communicate with another soul, for years on end, is horrifying.  

I was struck especially by these parts of the story:

Using brain scanning techniques, Dr. Steven Laureys, a neurological researcher at the Liège University Hospital, discovered that Mr. Houben’s cerebral cortex was still active.

On Monday, Dr. Laureys, who recently published a paper on comas, said that as many as 4 out of 10 similar patients may have been misdiagnosed.

He also described the moment he realized, for the first time that Mr. Houben was fully conscious. “It was one of those rare moments where you really see that what you are doing is useful,” he said in a telephone interview.

“It was a very big moment not just for me but for the whole team, one of those few much-needed moments” for medical professionals.

As many as 40%!

And that it was one of those rare moments where you see that what you are doing is useful.  Useful is an understatement.  This is a humanitarian, not only a medical and scientific, effort.  I hope Dr. Laureys has many of these much-needed moments.

I did not notice this story in the news.  Thank you, Neutralname.

I don't study end-of-life issues, but I get the sense generally that people are more aware of the issues now and the need to have a medical directive--although not as aware of the possibilities and their options as they could or should be.  Probably everyone should go back to high school briefly or take a short online course every decade or so in which they stay up-to-date with the things they need to know for the next phase, like sex ed and consumer health for teenagers, but for middle age and beyond.

[neutralname]

Probably everyone should go back to high school briefly or take a short online course every decade or so in which they stay up-to-date with the things they need to know for the next phase, like sex ed and consumer health for teenagers, but for middle age and beyond.

I do teach end-of-life issues, and yet I don't have any end-of-life directive.  I suspect that even most doctors don't have them.  One of the problems is that it is difficult to spell out all the eventualities -- to say what kind of functionality and disability you would be willing to live with, and what sort of probabilities of revival from a coma would be enough to continue treatment.  But if you just say "I don't want to be a vegetable" then that's basically no use in informing actual decision-making in most cases.  It's easier to just appoint a proxy-decision-maker for you.

[grasshopper]

I hope to hear more about this method in the coming years--what it is, how other ways of measuring brain function failed to detect it, and its increasing use and implications.

The thought of being imprisoned without the ability to communicate with another soul, for years on end, is horrifying.  

I was struck especially by these parts of the story:

Using brain scanning techniques, Dr. Steven Laureys, a neurological researcher at the Liège University Hospital, discovered that Mr. Houben’s cerebral cortex was still active.

On Monday, Dr. Laureys, who recently published a paper on comas, said that as many as 4 out of 10 similar patients may have been misdiagnosed.

He also described the moment he realized, for the first time that Mr. Houben was fully conscious. “It was one of those rare moments where you really see that what you are doing is useful,” he said in a telephone interview.

“It was a very big moment not just for me but for the whole team, one of those few much-needed moments” for medical professionals.

As many as 40%!

Can you imagine being fully conscious while people are preparing to pull the plug, and not being able to do a thing to stop it?

Horrifying.

[frogfactory]

40% seems awfully high.  Reminds me of the old factoid that 10% of exhumations reveal evidence of the 'corpse' having tried to claw their way out of the coffin (ripped fabric in the lid, broken fingernails, etc).

I have no idea if that one's true either.  Snopes is silent on the matter.

[sweetcider]

Using brain scanning techniques, Dr. Steven Laureys, a neurological researcher at the Liège University Hospital, discovered that Mr. Houben’s cerebral cortex was still active.

On Monday, Dr. Laureys, who recently published a paper on comas, said that as many as 4 out of 10 similar patients may have been misdiagnosed.

As many as 40%!

40% of what?  The original quote says "similar patients"  I'm not an MD, but I'd guess that "similar patients" does not mean all patients in a vegetative state.

[alleyoxenfree]

The doctor's comment was poignant indeed.  A little like teaching where, every so often, you get to feel you've done something worthwhile.  I can only imagine working in a field where most of the people you see are in vegetative states, neurologically damaged, beyond any hope.  What a contribution he is making.

[navelgazer]

Assisted communication = ouija board. I hope not, but this is pretty suspicious to me.

http://www.wired.com/wiredscience/2009/11/houben-communication/

[neutralname]

Assisted communication = ouija board. I hope not, but this is pretty suspicious to me.

http://www.wired.com/wiredscience/2009/11/houben-communication/

Yes, there's a lot of discussion of this aspect of the case on the bioethics discussion lists.  But some people are still taking it seriously.  Yet to be resolved, I suspect.

[stitch]

I hope to hear more about this method in the coming years--what it is, how other ways of measuring brain function failed to detect it, and its increasing use and implications.

The thought of being imprisoned without the ability to communicate with another soul, for years on end, is horrifying.  

I was struck especially by these parts of the story:

Using brain scanning techniques, Dr. Steven Laureys, a neurological researcher at the Liège University Hospital, discovered that Mr. Houben’s cerebral cortex was still active.

On Monday, Dr. Laureys, who recently published a paper on comas, said that as many as 4 out of 10 similar patients may have been misdiagnosed.

He also described the moment he realized, for the first time that Mr. Houben was fully conscious. “It was one of those rare moments where you really see that what you are doing is useful,” he said in a telephone interview.

“It was a very big moment not just for me but for the whole team, one of those few much-needed moments” for medical professionals.

As many as 40%!

Can you imagine being fully conscious while people are preparing to pull the plug, and not being able to do a thing to stop it?

Horrifying.

More horrifying to me would be not being able to tell them to pull the damn thing all ready.

[rowan1]

Can you imagine being fully conscious while people are preparing to pull the plug, and not being able to do a thing to stop it?

Horrifying.

More horrifying to me would be not being able to tell them to pull the damn thing all ready.

CHIME - living will to me are about havign some control over the quality of my life should I be in an accident such as this man was.  Honestly - I would rather journey on into the undiscovered country of death then lie there screaming and havign no one hear me for 20 + years.