Patterico's Pontifications

9/8/2006

Vegetative Woman Not Vegetative — Experts Are Shocked, Stunned, and Amazed . . . Again

Filed under: General,Schiavo — Patterico @ 7:20 pm

The Washington Post today reports on an unprecedented experiment to detect awareness in patients previously classified as vegetative:

According to all the tests, the young woman was deep in a “vegetative state” — completely unresponsive and unaware of her surroundings. But then a team of scientists decided to do an unprecedented experiment, employing sophisticated technology to try to peer behind the veil of her brain injury for any signs of conscious awareness.

Doctors were shocked by what they found:

Without any hint that she might have a sense of what was happening, the researchers put the woman in a scanner that detects brain activity and told her that in a few minutes they would say the word “tennis,” signaling her to imagine she was serving, volleying and chasing down balls. When they did, the neurologists were shocked to see her brain “light up” exactly as an uninjured person’s would. It happened again and again. And the doctors got the same result when they repeatedly cued her to picture herself wandering, room to room, through her own home.

Doctors were also stunned:

I was absolutely stunned,” said Adrian M. Owen, a British neurologist who led the team reporting the case in today’s issue of the journal Science. “We had no idea whether she would understand our instructions. But this showed that she is aware.”

and they were shocked again:

“This is a very important study,” said Nicholas D. Schiff, a neurologist at the Weill Cornell Medical College in New York. “It’s the first time we’ve ever seen something like this. It really is kind of shocking.”

The article cautions that people should not take these findings and leap to the conclusion that they are applicable to the Terri Schiavo situation:

But Owen, Schiff and others stressed that the research does not indicate that many patients in vegetative states are necessarily aware or likely to recover. Schiavo, in particular, had suffered much more massive brain damage for far longer than the patient in Britain, making awareness or recovery impossible, they said.

“I’m quite confident that [Schiavo] would not have responded in this way,” said James L. Bernat, a neurologist at Dartmouth Medical School. But, he said, the findings indicate that current methods of evaluating awareness are unreliable. He added: “Still, if Schiavo had reacted this way, I would be shocked and stunned.”

OK, I made up that last line. But my point is very real: the experts are often wrong. This is a point I have made before (for example, see UPDATE x3 to this post). But it keeps getting made again — all the time.

Recall the case of Terry Wallis, the man who was in a minimally conscious state for 19 years, and whose brain then “spontaneously rewired itself.” The doctors were wrong about him too:

Wallis was frequently classified as being in a permanent vegetative state. Though his family fought for a re-evaluation after seeing many promising signs that he was trying to communicate, their requests were turned down.

When doctors turned out to be wrong about Wallis, they were amazed:

Krish Sathian, a neurologist and specialist in brain rehabilitation at Emory University School of Medicine in Atlanta, US, describes it as an amazing finding. “The bounds on the possible extent of neural plasticity just keep on shifting,” he says. “Classical teaching would not have predicted any of these changes.”

Why, doctors would have bet money it never would have happened this way:

Most neurologists would have been willing to bet money that whatever the cause of it, if it hadn’t changed in 19 years, wasn’t going to change now,” [Dr. James] Bernat said. “So it’s really extraordinary.”

An amusing side note: the research in the Wallis case was led by Dr. Nicholas Schiff — the same guy who was shocked by the revelations in today’s Washington Post article. He termed Wallis’s case “miraculous” — but apparently thought that the era of brain-related miracles ended with Wallis.

So evidently, these doctors can be shocked and stunned by the power of the human brain . . . and then quickly retreat back into their natural state of all-knowing complacency — only to be shocked and stunned again when the next extraordinary case comes along.

Maybe this will help explain why some of us weren’t so quick to write off Terri Schiavo’s life just because some “experts” assured us that she was in a persistent vegetative state with no hope of recovery. I’ll concede that, with the autopsy, the experts were almost certainly right — and they usually are.

Except when they’re not — at which point they become shocked, stunned, and amazed.

19 Responses to “Vegetative Woman Not Vegetative — Experts Are Shocked, Stunned, and Amazed . . . Again”

  1. Not really a joke.

    Caller to 911: “Please help. We were out hunting and my friend just dropped dead.”
    911 operator: “Just calm down, sir. We’re here to help. First, make sure he’s really dead.”
    Silence, then sound of gunshot.
    Caller to 911: “Ok, now what?”

    Pretty much what the death-cultists in the hospices do.

    nk (47858f)

  2. nk –

    If you believe that hospices kill people, then you really are misinformed.
    My mother benefitted greatly by participating in hospice. There were volunteers who came by to spend time with her – this allowed myself and my brothers to continue working for the first couple weeks of her 1 month on hospice. As a nurse, I knew what to expect when she would die, but my brohters and their wives did not. The nurses provided education regarding what to expect. I appreciated this as it allowed me to be a daughter and grieve, rather than educate my siblings.

    Regarding the f-MRI imaging: one article I read indicated that the patient who had these scans showing the amazing results was an anomaly, there were apparently 60 other patients who did not show this kind of result. This shocking pt did improve clinically and become responsive some time after the f-MRI was completed.

    Jan (dad581)

  3. I’m sorry if I’ve painted with too broad a brush Jan. I was mocking self-fulfilling prophecies more than anything else. Experts tell me that my father should have died 18 years ago. He is 100% compos mentis, tells the doctors how to take pleasure with themselves, and has three sons who want him alive to back him up when he says it.

    nk (2e1372)

  4. I work in a large state facility in California. We have many clients who, for various reasons are as you described. Alert, oriented but unable to move or communicate. It is not difficult for a professional to tell the difference between a person like this and one who is in a vegetative state. Also, people who are in vegetative states sometimes wake up.

    We do the best we can for all the residents of my facility regardless of their status. They recieve nutrition and hydration, often through tubes. They attend activities and social functions. They engage in physical activity to the fullest extent possible. They are escorted on frequent field trips. Family visits are encouraged. They receive extensive routine and heroic medical measures. I have encountered clients who have spent as much as 70-80 years in the system. The families have decided that they want their family members to live as long a possible and that is what happens. If there are no responsible family members a state appointed conservator oversees the care of the individual and they are generally very strict.

    I must tell you that even with all we do, the lives of those trapped in nonfunctional bodies is not a good one. After lengthly observation, it is not a life I would choose to live. As immune and organ systems weaken through atrophy, often their bodies begin to decay. This is a process that can take decades. The responsible family members sometimes make the decision to discontinue heroic measures. If they want to discontinue life support, they have to regain custody and remove the client from state supervision and care.

    The Terri Schiavo case seemed to be all about contention between family members and have nothing to do with concern about Terri herself. This was a perversion of the caring concern for the suffering loved one that should hve been taking place. Everyone on both sides of this issue should be ashamed of themselves. I am shocked, stunned and amazed at the selfishness and insincerity I saw displayed.

    Dave Wickert (e2d901)

  5. Gee, so maybe there is intelligent life in the comatose USA after all!

    Max Gross (2f07be)

  6. Not to be cynical or anything but scientists have a regrettable tendency to describe their own discoveries as more shocking and/or surprising than they actually are. And of course newspaper reporters also have a tendency to overuse the words shocking and surprising. So I would be a little cautious about stories like this.

    However it is also true that experts often exaggerate about how reliable their knowledge is.

    James B. Shearer (fc887e)

  7. omg, we murdered terri schiavo after all!
    well, actually, the florida courts decided she was pining for the fjords. then, in a watershed affirmation of state’s rights (/snark) the nominally conservative party which controls congress enacted federal jurisdiction (and came back early from its vacation to do so), and then the federal courts declined to interfere with the florida courts’ determination that she was pining for the fjords.
    many of us snickered throughout this entire episode at the damage the repubs did to themselves as the “feeding tube party.” let me tell you about the feeding tube that really counts to us americans. it’s the economic feeding tube that china maintains in us, continuing to buy our dollar-denominated debt the way it does. if china ever withdraws this feeding tube, our economy would go code blue. i’m ready for this, are you?

    assistant devil's advocate (781257)

  8. I am sad that Terri Schiavo was starved and dehydrated to death… it was abhorent and on court’s orders no less.

    I’m glad that congress and President Bush attempted to intervene.

    Life is precious and I do not believe she wished to die. I guess God knows for sure. You don’t and I don’t.

    Chris from Victoria, BC (9824e6)

  9. If I start on this topic (Terri), you will never get my rants off this site again. I will therefore post one comment, then rage off-line.

    I cannot remember anything that so offended even minimal human decency than to starve a completely immobilized woman to death over the course of weeks on international television, all the while proclaiming that international execution show some freaking exercise of virtue. No one chooses to die that way. No one. It was torture/killing for profit that took place only after Michael banked the MedMal damages and needed Terri dead to avoid splitting his litigation jackpot.

    Further, how the hell does Michael Schiavo get away with his obvious lies? If Terri had actually expressed the desire to not live dependent on life-support, that information does NOT take over seven years to come out, and Michael Schiavo would NOT have testified during years of MedMal litigation that he needed several millions of dollars to care for Terri and rehabilitate her. He obviously lied somewhere along the way, yet people were so keen to kill that woman off that they not only accepted his obvious lies, but they then demanded that she be murdered in a specifically vicious and public fashion.

    A final note: I will never forget one television interview I witnessed with Peter Beinart and Catherine Crier (sp?). Both of them, inexplicably, so desperately needed Terri to die horribly that their faces were literally twisted with rage as they issued their death demands. I will never understand why they would so need to see that woman executed in such vicious fashion. What does that say about them, both intellectually and morally? And that vicious clown Crier actually sat on a bench somewhere at one time?

    End of rant. I will never get over the murder of Terri Schiavo. Not ever.

    Federal Dog (9afd6c)

  10. I’m a proud member of the “Feeding Tube Party.” Better a part of the “Feeding Tube Party” than a part of the “Hell, Let’s Kill ‘Em Off Cuz I Want the Money” Party.

    sharon (dfeb10)

  11. The entire debacle of the Terri Schiavo case was based on a false premise. Either Mrs Schiavo was in a permanently unaware state or she wasn’t; we didn’t really know. But the people who wanted her to die wanted to end her suffering were projecting what they believed they would suffer, were they in her condition.

    Trouble is, if Mrs Schiavo was in the state they claimed, she was incapable of suffering; for her to have been suffering, she would have had to have been at least somewhat self-aware and conscious, which was what her parents claimed, and, if she was in that state, it was wrong to put her to death.

    The murder of Mrs Schiavo was due not to her suffering, but to the “suffering” of those who were still completely conscious: her “husband” and her family. Mrs Schiavo’s parents were not suffering so greatly by their daughter’s state that they wished her dead; it was only her “husband’s” suffering that seemed to count, since he had the legal hammer.

    This case was important to the pro-death community for one reason: they had to continue to establish that the lives of helpless people depend upon the consent of others.

    Dana (3e4784)

  12. These functional MRI and PET scan findings should lead to advances in the care of people in persistent vegetative states. As pointed out in the comments here, and as we well remember from accounts at the time, one of the issues was whether Terri Schiavo had completely and permanently lost all higher mental functioning.

    Suppose Schiavo had been evaluated, repeatedly, in this manner. Would it have altered either side’s position in the debate?

    If “normal” brain activity had been detected upon “playing tennis” or “walking though your house” instructions, would that have put the nail in the coffin [/morbid pun] of the “end feeding and hydration” camp?

    Suppose no activity was detected. Would that have taken the wind out of the sails of the “keep Terri alive” advocates?

    In Schiavo’s case, the latter finding would have been overwhelmingly likely, given the extensive brain atrophy that was observed on autopsy.

    Some people take a position on Schiavo on purely philosophical grounds. If one believes that Schiavo was living a human life worth sustaining because she was breathing and could accept food and water, then I suppose even definitive demonstrations of the absence of brain activity would not have meant much.

    AMac (12bb07)

  13. What 90% (maybe more) of the people who are still exercised over Terry Schiavo’s case miss is that her actual state is almost entirely irrelevant to the issue that makes the whole mess frightening.

    Just a short time ago the standard for removing life support was along the lines of “If there is iron clad documentation of the person’s wish to die in these circumstances, we will consider it. But you had better cross all the “t’s” and dot all the “i’s””

    In the Schiavo case the decision was based on hearsay evidence coming from a person who had a financial interest in the case. If this doesn’t scare the hell out of everybody who might become deathly ill, they aren’t thinking about it.

    Yes, the autopsy demonstrated pretty conclusively that nobody was OR COULD BE home. Doesn’t matter. The principles by which the decision was made were horrible, and matters are far more likely to get worse than better unless the people who defended Terry and her Parents keep fighting.

    C. S. P. Schofield (c1cf21)

  14. Good points about the slippery slope, CSP Schofield.

    From what I could see about husband Michael, he was/is a pretty loathsome character. Nonetheless, if I were in Terry’s shoes, I would have chosen death/assisted suicide. IANAL, but as I recall, it seemed like an agonizing case to decide, on many grounds.

    That case was the catalyst for my spouse and I to find a lawyer and settle our affairs, including advance directives and powers of attorney. Whatever one’s views on right-to-life, that is a step that most people of my acquaintance continue to put off. Whatever specifics the documents contain, such instructions are gifts to one’s family that I strongly recommend.

    AMac (12bb07)

  15. My mother’s doctor told her this week that because of Terri Schiavo’s case, patients who have any medical problems other than not being able to swallow (as my mother barely can), will not be given a feeding tube.
    .
    .
    .

    / GITMO detainees and death row criminals excepted(?)

    b (5758da)

  16. This exercise in “but still, it was wrong” hindsight on the part of people here is a strong example of just not wanting to admit YOU were wrong. There would have been no Schiavo circus if people minded their own business. These types of situations occur every day, and families make these painful decisions every day. But Schiavo offered photo-ops, right-to-life rants and a President making a special trip to sign an unconstitutional bill (he even cut his vacation short – miracle!).
    Yes, we have much to learn about the human brain, and maybe the definition of life and being alive will evolve, as it has before. But as the facts now CONCLUSIVELY show, they got it right on Schiavo, and new research does not re-write history. That history shows a group of busy-bodies meddling in something they had no busing poking their noses in, and mostly for cynical, political gain.

    mmm...lemonheads (22f970)

  17. […] The other day I told you about those doctors who are shocked, stunned, and amazed every time a “vegetative” patient turns out not to be — and are similarly gobsmacked whenever the physiology of the brain reveals a new and previously unknown wonder. […]

    Patterico’s Pontifications » More on Trusting the “Experts” (421107)

  18. Let’s move on folks, nothing to see here. yeeesh.

    paul from fl (464e99)

  19. […] Doctors are never wrong. Except when they are . . . and then they’re shocked, stunned, and amazed. […]

    Patterico's Pontifications » Still More Doctors Amazed to Learn Patient in Persistent Vegetative State . . . Wasn’t (e4ab32)


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