I recently met a nurse anesthetist who was anxious to share with me a good-news experience of a woman who had suffered Anoxic Brain Injury.
This happens when the brain is completely deprived of oxygen because the heart has stopped pumping blood. After about four-to-six minutes, brain cells begin to die, and the person can then be declared to be “minimally conscious” or in a “persistent vegetative state” (PVS). Many can survive decades in this condition without regaining consciousness.
The woman patient mentioned by the nurse was in her thirties and relatively healthy. She had undergone an endoscopy. And while being prepped for the procedure by the anesthetist, she was given Propofol, a drug commonly used to induce and maintain anesthesia during surgery. (Those who have had colonoscopies are likely familiar with Propofol, which is administered intravenously.)
The nurse related what happened next, and the attending physician corroborated her account.
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Sedation using Propofol usually wears off after five to ten minutes, but in this case the patient didn’t wake up. Her heart rate dropped and entered into asystole, or cardiopulmonary arrest, where the heart’s electrical and mechanical activity completely stops (commonly referred to as “flatlining”).
Immediately, those attending her began to administer cardio-pulmonary resuscitation (CPR), consisting of chest compressions combined with artificial respiration. A manual resuscitator, called a bag valve mask, was used.
A CT scan and MRI of the brain showed there had been no stroke. But an electroencephalogram (EEG) indicated slow brain waves, which are indicative of brain damage due to lack of oxygen to the brain.
The patient was placed on a ventilator to move breathable air into and out of the lungs automatically. But she remained completely unresponsive.
Her husband offered a suggestion. “If she can hear our one-year-old daughter talk,” he said,” she will come out of this.”
Online contact was made with the little girl, using the FaceTime app. Upon hearing her child, the woman woke up. She was in perfect condition, and was “discharged without deficit” — that is, requiring little or no further care.
Shortly after this incident, a front-page article in The New York Times (September 15, 2024) reported on a large study of patients declared to be in a “persistent vegetative state.” It found that 25 percent of these individuals, though unable to communicate, showed signs that they might still have some level of awareness.
Neurologists used a technique called functional magnetic resolution imaging, which tracks the flow of blood through the brain. Speaking to the PVS patients, the doctors asked them to imagine themselves doing complex cognitive tasks, such as playing tennis. Some responded with brain activity typical of healthy people, suggesting that “they were able to think and be aware.”
This study and the case related to me by that nurse necessarily lead us to some important considerations in caring for minimally conscious patients:
- Unless there is a specifically instructed DNR (Do Not Resuscitate) order, every effort should be made by a medical team to resuscitate a person who has sustained cardiopulmonary arrest (referred to as having “coded”).
- Use of a respirator for a period of time may be necessary to stabilize a patient. It should not be removed too soon. Rather, it should be continued until the patient can breathe freely on their own, or until further use of it is deemed completely futile.
- A feeding tube, either through the nose or inserted directly into the stomach, is essential to the care of anyone in PVS (rather than “disproportional,” as it has often been described). Not to provide nourishment would lead to painful starvation, which — if awareness is indeed present — could prompt profound despair, impeding possible recovery. Until it’s clear that the body can no longer absorb nutrients and tube use is futile, feeding should be considered indispensable.
- Hospice care should not be considered prematurely. Hospice provides palliative care, which involves only comfort measures, and might actually hasten death. Long-term nursing care may be more appropriate.
- The pressing need for organ donations should not drive medical decisions. The Wall Street Journal recently reported (September 11, 2024) that at a hearing before a House subcommittee it was stated that organ procurement groups often push surgeons and medical staff to obtain organs while patients are still alive. Someone must be legally dead — that is, the lower brain, which controls breathing, is no longer functioning — before organs can be removed.
- All of these decisions should be made by a Health Care Proxy designated in advance by the patient (hence the necessity of having a proxy pre-arranged).
- Allowing for the possibility of awareness, conversations regarding the patient should be held out of their hearing range. Imagine the terror they could experience when listening to various scenarios being discussed.
- Light conversation — news of family and friends, reassurances of love — can be most helpful in keeping the patient’s agitation down and maintaining the sense of connection to others.
- If the patient is religious, gathering around the bed offering prayers hand-in-hand, may be most efficacious.
- Finally, more must be done to find ways for minimally conscious patients to communicate with the outside world. Perhaps research into devices such as Elon Musk’s neurochip, used to help paraplegics, might reveal ways to end their isolation, and aid in better decision making about PVS care.
The bottom line is that we must not assume a person in a persistent vegetative state cannot recover. The lady who heard her little girl’s voice and numerous similar cases show that life is possible and should be sought after until it is indisputably gone.
LifeNews Note: Rev. Michael P. Orsi is senior advisor to Action for Life Florida and host of “A Conversation with Father Orsi,” a weekly television series that delves into current events with a focus on sanctity of life issues. His writings appear in numerous publications and online journals. His TV show episodes can be viewed online at: https://www.youtube.com/channel/UCyFbaLqUwPi08aHtlIR9R0g
