Modern science has changed so many things in so many ways. Who knows which one of us would long since have died of the plague or small pox or a hundred other devastating killers had it not been for the knowledge that permitted us to prevent these horrifying conditions that wiped out thousands of human beings in days of old.
The advanced technology of the last thirty years has greatly improved our ability to save a baby at risk. Thousands of profoundly brain-injured babies who would never have made it even fifteen years ago now survive.
Surely this is man at his best, heroically striving to protect and save our littlest, weakest, most vulnerable members until help arrives. For many, The Institutes has been the place where that help is sought and found.
No child has ever been judged too hurt or too impossible to be accepted here. Indeed, if we could only take one child, we would choose the most hurt child because his need is the greatest.
By and large, those most profoundly hurt kids whom the world calls "comatose" have found their way here from virtually every continent and from more than thirty-five nations.
Parents of children in coma call us and write to us daily. Often these children were well children who, because of severe trauma, are in a coma.
It is well known that when trauma occurs the brain responds by swelling, as do other parts of the body when injured.
However, since the brain is confined in a hard, bony case, it does not have the space to swell, as an arm or a leg might. This swelling, or edema, suppresses the brain. Sometimes this suppression is severe enough that the result is what we call coma. When this edema subsides, the suppression of the brain that may be a result of the swelling ceases, and the individual often becomes conscious. Only after the edema has been permitted to decrease or disappear can the individual be properly evaluated to determine the extent of the injury that has been sustained.
The initial period of edema may last for days. At anytime during this period, the comatose patient may "wake up" and literally walk away, amazing all those who had thought that coma was a one-way ticket to the grave.
During this critical period, the comatose patient is given around-the-clock intensive care. In very modern hospitals where staff have had the benefit of modern training in coma arousal, the staff begins such arousal techniques immediately after emergency treatment has been provided. In such hospitals, the coma patient gets not only the benefit of superb lifesaving technology, but he also gets stimulation that actually helps the healing process and brings about a restoration of function more quickly and more completely.
There is nothing new in all of this.
We have trained such coma arousal teams for three decades. We have seen such teams arouse patients in Rio de Janeiro, in Osaka, in Paris, in Melbourne, etc.
But technology marches on. Now we have the technology to transplant organs. We hear much of organ banks and organ donors. Every individual has the option to leave his organs to the use of others once he is gone.
So far, however, there do not seem to be enough fresh organs to go around.
This need to locate and "harvest" fresh organs may totally change the status of the comatose individual.
In some circumstances, families of comatose people are approached within hours of the injury that caused the coma and asked to donate the organs of their loved ones.
Ten years ago, all of medical science would have been poured into the intensive care of this patient to bring about his recovery.
In modern hospitals where coma arousal programs are known and practiced, this same process continues.
However, in less modern hospitals the comatose patient has never been understood or treated. He has always been viewed as hopeless. In the past, he has been provided with emergency care to save his life but no treatment for his injury.
Now he is seen as providing organs to those who are not as "hopeless" as he is thought to be.
Time is the critical factor here.
In the bad old days, to some degree, time was the friend of the coma patient–at least in the first few days or weeks. During that period, he was given the time for the edema to subside. If edema was the cause of the coma, he might wake up and walk away. If there was a substantial injury, then the coma might well persist even after the edema had subsided. A patient, in this instance, would then have the opportunity to receive treatment for the injury.
The coma patient needs time.
No one comes out of a deep coma in minutes or even hours.
But those who believe that coma patients are hopeless see no reason to wait. Why not be certain of fresh organs now rather than wait days or weeks and perhaps have organs fail or be less useful?
Let us add to this equation the fact that the parents or the family of the coma patient are just handling the horror of the injury and the near-death of their loved one. They are in shock themselves. They are not child brain developmentalists. They are not neurosurgeons. They do not know that people regularly recover from severe brain injuries. When they are approached to give away parts of their still-living relative, this constitutes a second shock–perhaps a more profound one than the first.
It seems like a clear case of saving heart patients, liver patients, and kidney patients who would otherwise die.
But is it that simple?
Perhaps all of this is just a new wrinkle on the old medieval prejudice that assumes that people injured in the brain are less valuable than those injured in the heart, liver, or kidneys.
Some might well argue that in some instances it is necessary to choose who will live and who will die.
When two patients lay dying and there are only resources to save one of them, of course such a choice must be made.
But the comatose patient is not dying. Indeed, he has survived his injury and he is in a process of recovering.
Do we have the right to interrupt that recovery and take his organs?
If so, why not approach relatives of patients who are clearly terminal and ask for their organs?
After all, these people are dying. Why can't we at least employ the same logic that allows us to seek organs from the comatose?
The answer may be a wickedly simple one.
Imagine approaching a totally conscious, terminally ill patient and explaining to him that you need his heart, liver, or kidneys in a matter of hours. It is not hard to imagine that he might object. Surely his family would violently object.
But who will object for the man in a coma?
In two days, our terminally ill man may be dead and gone, and our man in the coma may be awake and laughing with his wife and children–that is if he still has his heart, liver, and kidneys.
There is much talk nowadays of flat EEG's. Television soap operas have educated us to the idea of "brain death." The machines that go beep in the night are supposed to tell us when brains die, and we, the children of technology, are supposed to believe them when they do.
But we don't.
Doctors are still old-fashioned in many ways. They have an innate distrust of those machines that say the brain is dead, dead, dead, and going to stay dead. As one neurosurgeon said to me recently, you only have to see one patient who had a flat EEG wake up and walk away to know that the machines are not always right.
An article in a prestigious medical journal warns doctors to be careful what they say around comatose patients. (They might take a dim view of hearing that the staff is looking for a fresh liver–and they don't mean for dinner!)
It is a supreme irony that The Institutes, which has for so long championed the right of the individual to be aroused from a coma, should now find that before that right can be addressed we must first insure the right of the individual to be in a coma.
For if this present trend continues to its illogical extreme, coma will be a thing of the past. Indeed, since the proper use of words is also becoming a thing of the past, we will no doubt be able to say we have found a new cure for coma–and it is death –swift, sure, and with the value of that liver thrown in, so very cost- effective.
