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Science and Vatican agree:
Cognitively disabled can recover
By Susan Brinkman
Catholic Standard &Times Correspondent
On Sept. 11, 2001, while the world was riveted to the sight of two planes crashing into the World Trade Center towers, a 60-year-old Missouri man was fighting for his life in a St. Louis hospital. Hit by a truck, he had suffered massive head injuries and was flown to a state-of-the-art intensive care unit where doctors tried valiently to save his life.
Three days later, he was still alive, but in a coma and breathing only with the aid of a ventilator. Doctors saw little hope that he would recover and recommended that the family withdraw treatment and let him die.
"When the family wouldn't withdraw treatment, the hospital told them they had to put him somewhere else because he was never going to recover," said ex-trauma nurse and Spokesperson for the National Association of Pro-Life Nurses Nancy Valko. "They told the family he was going to die. He would never get off the ventilator. There was absolutely no chance of recovery."
The man was transferred to a nursing home, where patients are likely to receive little or no rehabilitative help. Thankfully, Valko visited him weekly and, together with the family, employed nothing more than a few simple sensory stimulation techniques she'd learned on the job. Ever so gradually, they began to see signs of awakening. "By Thanksgiving, the man was awake and talking and able to start eating by mouth," Valko said. "He's made a full recovery."
Valko is one of many in the medical profession who greeted the Pope's recent statement about the ethical care of persons in a persistent vegetative state (PVS) with tears of joy.
"In America, it's basically two months [in a hospital] and you're out," she said. "They give you a choice between warehousing your loved one in a nursing home, taking them home, or pulling the plug. People need another choice."
She believes one of those choices ought to be what the Pope referred to in his address to participants in the "International Congress on Life-Sustaining Treatments and Vegetative State" as "awakening centers," specialized institutions that provide intensive rehabilitation to patients who need more time and more intensive rehabilitation in order to recover. Wherever these programs exist, patients are benefitting.
"This is probably the most important part of his statement, and it's the most ignored," Valko said. "I don't want to give people false hope, but almost everybody that I've worked with has improved to some degree. And some have even made total recoveries."
There is plenty of skepticism in the ranks of doctors and medical ethicists who claim cases such as the Missouri man are two out of 100. Valko and many other professionals who are highly skilled in this very specialized area of medicine, wholeheartedly disagree.
"How about 58 percent and 43 percent," Valko said. "These are the studies that are out there. "
One such study published in the Archives of Neurology in 1991 followed 84 patients with a firm diagnosis of PVS. Of these patients, more than half recovered consciousness within three years.
Another study conducted in Great Britain in 1996 revealed that 40 percent of patients diagnosed as PVS were actually conscious of what was going on around them. Even more disturbing are studies revealing that researchers are unable to identify "predictors of recovery" enabling doctors to determine who might -- and who might not -- wake up.
All this amounts to too little science to justify the prevailing rush to pull the plug on patients who might otherwise have a shot at recovery. Although one medical ethicist went so far as to say the Pope was "medically ignorant" for making these suggestions, professionals like Valko believe that science supports the Pope's position much more than it does the plug-pullers.
Very little is known about the brain function of persons in deep states of coma, which is why there is such a high degree of diagnostic error in determining the possibility for recovery in these patients. But research in this field is promising.
Japanese researchers have been able to bring back patients who have been in a coma for up to three years through the use of aggressive electrical stimulation to the brain stem. Dr. Tetsuo Kanno, chairman of neurosurgery at Fujita Health University in Toyaoke Achi, Japan, teamed up with Dr. Edwin Cooper, an orthopedic rehabilitation consultant in Kingston, N.C. to introduce the treatment to 30 coma patients at Legacy Emanuel Hospital and Health Center in Portland, Oregon.
Kelly Masterson was in a coma for 10 months after her Jeep Cherokee hit a tree on Christmas Day, 1999. She was declared hopeless and moved to the Legacy Center, where she received the experimental treatment for four hours a day. She is now walking and receiving speech therapy.
Dr. Mihai Dimancescu, a neurosurgeon at South Nassau Community Hospital on Long Island has had tremendous success with a sensory stimulation program involving sound, smell and touch to stimulate the senses. He has treated more than 1,000 patients and, as reported in Newsday in 1993, was producing a "91 percent arousal rate for prolonged coma patients compared to traditional medicine's 10 percent rate of arousal."
Perhaps the most startling advances are the most recent. In a Sept. 28, 2003 article by the New York Times' Carl Zimmer entitled "What If There's Something Going on In There?," researchers from Sloan-Kettering, Columbia and Cornell did an MRI on the brain of a man who had been in a PVS for four years. While playing a recording of his sister's voice, researchers were stunned to see distinct clusters of neurons in his brain firing in a manner that was virtually identical to that of a healthy subject.
Dr. Joseph T. Giacino, a neuropsychologist who collaborated on the study, believes that "a vast number of people who might once have been considered vegetative actually have hidden reserves of mental activity," Zimmer wrote. The result of this work was the introduction of a new category of consciousness - the minimally conscious.
"The implications of this research, both for medical ethics and practical policy, are potentially huge," Zimmer wrote. "Traumatic brain injuries are a significant health problem in the United States, but the study and treatment of them are clouded with a sense of hopelessness. "
This sense of hopelessness has a name. It's the "right-to-die movement" and Valko encounters it much too often. She recently attended a "Pediatric right to die" conference where the whole theme was how to convince families they're being cruel to keep their loved ones in a vegetative state alive. "That's actually how bad it has gotten. People don't realize what's happening out there."
Why are some professionals so determined to kill rather than search for ways to heal? Some claim it's all about money, but end-of-life care amounts to a mere 12 percent of overall health care costs. Valko believes it's an attitude problem.
"I think what's really motivating people is this tremendous fear of disability and dependency," she said. "Attitudes have consequences. People used to ask me how I can take care of someone who doesn't recognize me. This is the problem in our society. It's not whether they recognize me, it's whether I recognize them. And I do."
Thankfully, so does the Pope.
Contact Susan Brinkmann by email or (215) 965-4615
Reprint from The Catholic Standard & Times, official newspaper of the Archdiocese of Philadelphia with permission from Susan Brinkman.
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