Hoping for the best, expecting the worst.

May 3, 2010 10:40 AM

What are the chances of someone with a 6 on the Glasgow coma scale waking up? Has anyone on here ever experienced a coma, or had a loved one in one?

My wonderful aunt was in a terrible car accident almost ten days ago. Her skull was fractured in several places and the surgeons had to take part of her skull out. Her heart never stopped, but she was on a ventilator for a few days. She is now breathing on her own. She has a tracheotomy, and also a feeding tube. All of her vitals are strong and the doctors say it's just a "wait and see" kind of thing. I know brain injuries vary from person to person, I'm just looking for a little bit of hope. Thanks for reading.

posted by anonymous to Health & Fitness (11 answers total)

Gosh so sorry to read of this.

I can relate some anecdotal and highly personal information: my brother lapsed into a coma and one thing the Nurses told us all to do was never stop talking to him as if he were awake and conscious.

Because on some level he was, and the more we did this, the longer our engagement, the more frequently we'd use his name, carrying out normal conversations and including him, using his name normally, pausing for his-response-that-never-came, the more we saw little signs that he was still there. For example, his eyes would slowly, ever so slowly track across the room if one would sit in an opposite corner, call out his name and just talk to him.

The signs were increasingly positive in Mike's case, before he was taken from us by something unrelated. So if you and your family can mount a vigil, the time is now.

Another thing the Nurses told us was the longer in a coma the less likely the patient will emerge.

I'm obviously not a doctor, and I genuinely wish you, your family and especially your aunt, all the best.
posted by Mutant at 10:54 AM on May 3, 2010 [1 favorite]

My own experience will bring you no hope, I'm afraid. My mother died ten days after suffering a massive heart attack. The lack of oxygen damaged her brain, the doctors knew pretty soon after she didn't wake up from her chemically induced coma that she was not going to recover. They told us it was a "wait and see" situation, but kept our expectations pretty low. Her vitals were fabulous, she was breathing on her own, but after ten days in a coma she caught an infection her organs started shutting down. The doctors offered to treat it aggressively, with the implication that it would only prolong a miserable situation, and I declined. She passed away with me holding her hand, never having woken up after her heart attack.

It was the most intense and horrifying experience of my life, but I felt her close to me even if she wasn't awake. I feel for you, strongly. It is a very, very tough situation to be in. I do not believe my mom could have recovered, even had she not faced a systemic infection. Her passing was devastating, but the thought of her clinging to some crushed existence for years and years would have been even more devastating.

Best of luck to you and your aunt. Nothing is set in stone, but listen closely to the doctors. Most of all, though, go sit with her and tell her everything you are feeling, hold her hand, stroke her hair. She's there, she'll hear it, and so will you.
posted by lydhre at 11:00 AM on May 3, 2010

Biology is always full of surprises, usually ones which disappoint or horrify, but occasionally good things can occur.

I received a phone call that my ex-girlfriend had been diagnosed with the wrong type of diabetes and had been found laying on the floor, where she might have been for approximately two days, with a blood sugar level not dissimilar to that of some fantastic organism which used molasses as its primary circulatory fluid — about 1,200. She had a low Glascow score, I think it was a four. It was gently suggested that I drive down to make my peace with her and that, in the off chance she would survive, she would not have any higher brain function.

Before I made it down, she woke up on Sunday morning after ten days in a coma. Easter, to be exact, which didn't do much for her messiah complex. Sat up and wanted a hamburger. No notable lingering aftereffects. Nurses probably could have put a string in her cath bag to make some really icky rock candy, and here she is, just fine. Biology is weird.
posted by adipocere at 11:19 AM on May 3, 2010 [4 favorites]

One anecdote is not data, and Hollis's experience is not representative by any stretch of the imagination. But you asked for hope and here it is. After a terrible motorbike accident and brain injury in India in February of 2009, and after months and months in hospital in San Francisco and in a long term care facility in Nashville, Burning Man artist and performer Hollis Hawthorne woke up from her coma in February of 2010.

Very best wishes to you and to your aunt.
posted by rdc at 11:25 AM on May 3, 2010

A friend was in a serious car accident and in a coma for about 2.5 months. Came out of it slowly over 2-3 weeks, and then there was a long road to recovery (learning to walk again, speech problems, etc.). 6 years later, he's not 100% where he was pre-accident (voice is still a tad off, balance as well - you might think he was slightly drunk if you didn't know about the accident), but generally speaking he was pretty lucky, and lives an essentially normal life.

Not sure what stage he was in, but hoping the best for your aunt, and sending good thoughts to you and your family.
posted by backwards guitar at 11:32 AM on May 3, 2010

I can't help with your initial question, but I can tell you I scored a 9 when I was a very young kid and wrote up my experiences after college trying to understand the migraines and such: Mild Traumatic Brain Injury and my journey toward understanding it. Mutant's absolutely correct. We've learnt adult brains still develop new neurons, and if you go by some of the research on sleep, when we dream we're actually remapping the connections in our brain to optimize ourselves for whatever we encountered during the day.

Think of Scott Adams' spasmodic dysphonia problem. The mapping for speech went haywire for him and he worked to find a connection back, and found it.

I'm *not* saying your aunt can or will wake up. What I am saying is now's the time to be creative, note everything, and try to help her back. Talk to her, use her name, touch fingers and tell her which you're hitting as you do it, hug her and tell her you are. Talk about her favorite topics and what is happening with them. I'd even go on a safari for pine cones, leaves, oranges, etc. to put in her hand and tell her what they are. Purposely get some things wrong (very occasionally, don't overdue it) so she'll want to correct you. Anything to reconnect her with the waking, active, world.
posted by jwells at 11:35 AM on May 3, 2010 [4 favorites]

Unfortunately a single GCS number is not much help in determining prognosis. It's meaning differs acording to the reason for the brain injury, so the same score carries different meaning in someone who has had a stroke, versus an overdose, versus trauma. What the value of the various components of the score can also be important. When was the score of 6 determined and has it changed? Who made the assesment and how experienced were they? Some studies show a good bit of variability between evaluators, so one person's GCS of 6 might be another's 4 or 8. There is a lot of other information as well; how experienced are the staff at caring for these patients (I assume she is at a trauma center which means they should be pretty experienced)? What other injuries does she have? What other medical conditions does she have? What does the physical exam beyond the GCS show (the GCS is a rapid evaluation designed to be done by any medical person and is not a substitute for a complete neurological exam)? What do CT or MRI scans show? I hate to answer your question with more questions, but the people caring for her have the answer to all or most of them and they don't have a clear cut answer to your question. The fact that they are taking a wait and see approach is actually encouraging; many physicians in these situations tend to emphasize the worst case scenario in order to avoid giving the family false hope. So she definitely has a chance at some recovery, but how much is impossible to say from the information we have and even with more information difficult to say with any certainty.

Sorry to hear about your aunt and I hope she does well.
posted by TedW at 12:10 PM on May 3, 2010 [1 favorite]

About 15 years ago, a car accident put a friend in a coma for a month. Pieces of skull, face, pelvis, had to be rearranged and he needed a tracheotomy. Docs initially expected him to die within 24 hrs (doc to his parents: "Don't bother coming." They came anyway, of course). He came out of it. Rehab was difficult but that's par for the course. Now, he walks with a limp and has memory problems, but the memory lapses are not obvious to anyone who doesn't know him very, very well.

Good luck.
posted by cybercoitus interruptus at 12:12 PM on May 3, 2010

In addition to talking to him, bring in some music that he likes. Music acts on different parts of the brain, and may reach him, and provide comfort.
posted by theora55 at 2:32 PM on May 3, 2010 [1 favorite]

I had a bunch of heart attacks July 6 2004, died in a friends truck on the way to the hospital, and was dead without oxygen for a long time, and that after being compromised for oxygen maybe 12 hours -- the heart attack had started the night before. (I know that the heart attack started the night because of a conversation I'd had with a friend the night before; I didn't/don't remember it but she does, and she told me about it. I just couldn't catch my breath -- I thought it was the fumes from oil paint, which I'd not painted with very much.) I died twice more that day, once in ER and once in ICU, but I was on a vent so it wasn't *as big* a deal as the first one; at least my brain had oxygen, unlike the first one.

I've timed that drive a number of times, from where I died to the hospital, during rush hour, which is the time I died -- the shortest I've been able to drive that route is 8 minutes. That's a long, long time without oxygen. (I'm my cardiologists favorite 'save', he's only had one person be 'further out' than I was and make it back, but that guy doesn't really have any quality of life at all, and I do. I see my cardiologist once yearly now, we have quite a time; he's younger than I am, I always call him a kid, we bust each others chops -- he's a cool guy.)

I was completely comatose for three or four days, the doctors told my family and friends to bag it, that they were pretty much coming to town just to put me in the ground; the doctors didn't want to build up false hopes at all.

But my siblings didn't give up, they spoke to me, and spent time in my hospital room, massaging my hands/feet, etc and etc. They tell me the first sign I gave that I was 'in there' was when my younger brother walked into the room and I heard his voice; they tell me that I raised an eyebrow. Ever so slowly I came around, came to consciousness, but quite impaired at the first, like the guy in that flick "Momento" who has only short-term memory -- that was me, for a few days.

I walked out of the hospital after a week, maybe nine days, but I was very weak, needed considerable time to find my way to any strength -- they wanted me to walk but I'm not a walker, spent the time in the pool instead, slow, easy laps using kickboard, up and down that pool here at my condo. I also had physical therapy but didn't really need too much of it, mostly it was a gradual rebuilding of my strength. I had speech therapy but didn't really need it -- amazingly, I'd kept pretty much most of my brain function. (Speech therapy is *way* more than just about speech; it's about logic and language skills of any sort, reading, comprehension, on and on.)

I lost my sense of smell, which would have been what I'd have chosen, for sure -- I could just as easily been blinded, or deaf. Or dead, for that matter. Or in a vegetative state, in some dead-end assisted living place. Or anywhere in between. My balance is not the best but that could just be my age -- I'm 55 now, 49 when I died. And I didn't really notice my balance being 'off' until I started practicing yoga, 2.5 years ago. My memory isn't the best either but it could be age coming on also; I suspect it's a bit of both of those.

I'm extraordinarily lucky, it's just a huge gift to be here. Most days I know that.

The upshot? It really is chance, it seems to me. Grace, if that blows your skirt up, if that makes any sense to you. Your aunt might walk out of there next week. I don't know of any way to tell, and neither did the staff at the hospital I was in when it came down for me; each time I showed any improvement they cautioned my people not to expect more, they were as surprised as anyone as I came around. Pray if you believe in it -- I do, and there were people all over the place praying for me, for healing, but this is you, and your aunt, it's your show.

I wish her good luck and I wish you peace.
posted by dancestoblue at 3:13 PM on May 3, 2010 [5 favorites]

I've got no direct experience with comas, but wanted to let you know about Dr. Arnold Mindell's Coma work, described here. He and his partner Dr. Amy Mindell have written a book - Coma - also available as a free e-book. I'm not sure where you are located, but there's an organisation of comawork practitioners in South Africa, and one in Canada. I've found contact details (USA) for individual comawork practitioners.
The best of luck to you and your aunt.
posted by metaphorical at 9:28 PM on May 3, 2010