THE NEW YORK TIMES – The fourth floor of the long-term-care hospital where I sometimes work houses patients with severe brain injuries.
When I am called there to consult, I always hesitate before entering the room. Of all the ways that our bodies can fail, brain injuries are some of the most devastating to witness.
Some patients moan involuntarily. Others lie still, their eyes open but unresponsive.
As I place my stethoscope on the patient’s chest, often without a word, I reassure myself that at least the patient is unaware. Her personhood is gone. She is “not in there” any longer.
But an increasing body of research indicates that patients who have suffered catastrophic brain injuries experience a far more complicated reality.
“Patients with brain injury who are unresponsive to commands may perform cognitive tasks that are detected on functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). This phenomenon [is] known as cognitive motor dissociation … ” – NEW ENGLAND JOURNAL OF MEDICINE, August 14, 2024
A provocative large study published last year in The New England Journal of Medicine suggests that at least one in four people who appear unresponsive actually are conscious enough to understand language. As a doctor who sometimes sees patients like this, these findings are, in a word, terrifying.
Studies like this raise the possibility that there are tens of thousands of men and women locked inside their own minds, isolated to a degree I cannot even imagine.
They are voiceless and largely invisible, with some of them being cared for in nursing facilities.
There are a handful of researchers in a few institutions working to identify these patients and develop tools they can use to communicate. A lack of resources is one major barrier. A larger one is philosophical. The way many doctors think about these patients reflects the medical system’s inability to deal with uncertainty, and even what kind of life we believe to be worth living.
I’ve often struggled with how to recommend care for patients with uncertain recoveries after brain injuries …
