Sunday, 12 August 2012

Locked in

How shocking that someone can wake up in a hospital bed, hear the people around him planning to switch off his life support, and have no way of telling them he is 100% mentally aware.

Which is what happened to Richard Marsh from California three years ago after a stroke. At the time he could do nothing but blink, and the medical staff were convinced he was in a persistent vegetative state. But his wife Lili didn't agree, and refused to let them end his life.

What a sound decision that was. Four months later he went home, and he has now recovered 95% of his physical functioning. Just suppose his wife had gone along with the doctors and given up on him?

The first sign that he wasn't actually a goner was his twitching fingers. Then the doctors discovered he could communicate by blinking. Only then did they realise their colossal misjudgment.

But this made me think, surely there should be some routine "blink test" to check if a patient in that condition (what they call locked-in syndrome) can communicate by blinking? Then such an awful misunderstanding would never have occurred.

And surely there must be some sort of test of mental functioning that could at least indicate that there is activity beyond a mere vegetative state, even if it can't say exactly what that activity is?

It seems extraordinary that someone's life can be written off so casually when the reality entirely contradicts the doctors' assumptions. Is modern medicine really as advanced and sophisticated as we think it is?

Pic: Someone completely different. I couldn't find a picture of Richard Walsh on the net. 

24 comments:

John Gray said...

just to let you know
life support is NEVER switched off in any case....
settings on a ventilator say are switched to as near "atmospheric" levels as possible
it just bugs me when emotive phrases such as "switch off" are used

Nick said...

John - Well, as a nurse you obviously know about all this. But I'm always reading about someone's life support being switched off. So how do you mean it's never switched off?

John Gray said...

if someone is on a ventilator then the vent settings are reduced to near enough to normal "air" levels
it is falsehood to think things are just ended at the flick of a switch

Nick said...

John - Are you saying the ventilator is always switched off gradually rather than instantly?

Wisewebwoman said...

Did you see "The Diving Bell and the Butterfly", Nick?

Exactly what you're talking about.

You would like it.

XO
WWW

Nick said...

www - I didn't, but I know of the film, which was referred to in the Guardian piece.

Scarlet Blue said...

My worst nightmare. This and being buried alive.
I have experienced lucid dreaming - where your brain is awake, but you can't move your body - it's very strange... and also interesting.
Sx

Nick said...

Scarlet: I think my worst nightmare would be burning to death or being tortured to death. I've never experienced lucid dreaming. It sounds a bit like those dreams where you're trying to run away from someone but your legs won't move.

Rummuser said...

That must have been a traumatic experience for the patient, listening to talk being unable to communicate his being alive. I sure wouldn't like to be in that situation!

Medicine as practiced now is certainly dependent on a lot of unnecessary tests and procedures but why a test to ensure that someone is beyond bringing back cannot be devised is beyond me!

Nick said...

Ramana: I would have thought a simple test of that sort would have been devised many years ago, to avoid just such a huge miscalculation.

Liz said...

That must have been a nightmare. It's amazing that with all our incredible technology we can't work out whether the brain is alive or not. Thank goodness his wife persisted.

Nick said...

Liz - I'd love to know exactly why his wife was so resistant, but the article doesn't explain. She must have just sensed something.

Jenny Woolf said...

I thought there was a "test" - they do various reflex tests I know before deciding whether someone is past help.

Nick said...

Jenny: I suppose reflex tests are not quite the same as tests of mental functioning or ability to communicate.

John Gray said...

no nick the ventilator just delivers air oxygen and the "support" it gives the patient will be minimal (basically it gives near enough atmospheric pressure)
there are clear guidelines a set of medics have to perform to ascertain if the patient is brain dead...cases like the one you describe are very rare indeed,
and usually physiological reactions to painful stimuli do still occur

Nick said...

Ah, I'm a bit clearer now, John, thanks. I'm glad to hear cases like this one are very rare. And I'm glad to hear there are usually physiological reactions.

speccy said...

My mother (who was terminally ill, but reasonably switched on) would have failed a blink test; one of her symptoms was that she couldn't open her eyes properly. There's always another variable I suppose...

Nick said...

Speccy: That's unfortunate, if you rely on a blink test. Which is why a number of different tests should be used, I guess.

John Gray said...

so nick just to add one thing.... often with seriously ill people that are deteriorating, medications are often used to keep vital systems going. these can be given in huge quantities and strengths and when "enough is enough" so to speak, the pumps that are administering these medications may be switched off. often this then results in the body systems crashing ...some times immediately
I hope thing perhaps are a little clearer!
x

Nick said...

John: I see. So in those cases it's not so much a question of "switching off life support" but of withdrawing the drugs?

John Gray said...

yes.... it's commonly called "withdrawing" on a patient...ie let nature take it's course

Nick said...

John: I feel a bit better informed on the subject than I was a few days ago!

blackwatertown said...

I had the good fortune to be chatting to Richard Marsh recently - does seem almost miraculous. Though there is sometimes temporary locked-in syndrome after a stroke. That may be what he had. Interesting friendly guy.

Nick said...

Paul: Temporary locked-in syndrome? I hadn't heard of that. It was certainly an extraordinary recovery from near total paralysis.