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What is it like to be in a coma?

What is it like to be in a coma?

Can coma patients hear, see or dream? Some are surprisingly alert while unconscious, and they're teaching scientists valuable lessons about the human brain

When T Renee Garner was 32 weeks pregnant with her son, she was rushed to the hospital with extremely high blood pressure, her foetus in distress. Intravenous medication lowered her blood pressure, and her baby was delivered safely before being taken to the neonatal intensive care unit.

But when Garner went to visit him there the next day, she still wasn’t well, and she began experiencing leg cramping so severe it left her weeping in the hospital. Then everything went black—for three days.

"Garner says that while she was in the coma, she heard the words 'it died', which she took to mean that she had died"

Doctors determined that Garner’s coma was the result of a severe electro­lyte imbalance—her sodium had dropped precipitously—caused by the IV medication she’d received.

Garner says that while she was in the coma, she heard a siren and then the words it died, which she took to mean that she had died (it was actually a battery on a monitor that had died). She also recounts having horrible dreams.

“I can’t remember them, but I know they tormented me,” she says. “Every dream I had during my coma was a nightmare.”

Every coma victims' experience is unique

Illustration of coma patient having out of body experience above hospital bedCopyright: James Steinberg. Some coma patients are more aware of their surroundings than others

Zaida Khaze was 19 when she was riding in a car that was hit by a drunk driver. Her head injury was so severe that she lost the ability to walk, speak and swallow, and she lapsed into a coma that lasted ten days.

When she started to fully awaken in the rehab hospital to which she had been transferred, she remembered none of it: not the accident nor the aftermath. The only thing she did remember was having her entire family gathered around her. But, in fact, they were never all there at the same time.

What an individual patient will experience during a coma remains a mystery to doctors. Even the medical definition is vague. The Mayo Clinic in the US calls it “a state of prolonged unconsciousness that can be caused by a variety of problems.”

"Some people hallucinate that people came to visit them who never actually did"

Technically, someone in a coma is unresponsive to light, sound, touch and verbal communication, but that doesn’t necessarily mean the patient isn’t aware, says Dr J Javier Provencio, professor in neurology and director of the Nerancy Neuroscience Intensive Care Unit at the University of Virginia.

Dr Provencio has had patients tell him they remember when doctors and nurses came into the room and pinched their big toe so hard it hurt, though they didn’t respond at the time and were completely unconscious (the pinch is a way for doctors to see whether people in a coma will respond to the pain or even wake up from it).

“Some remember nothing; some remember a great deal of feelings, but nothing specific. Some people hallucinate that people came to visit them who never actually did,” he says.

Can people hear in a coma? It turns out, yes

On the other hand, there are people like Jennifer Beaver. On a Saturday night in June 2017, she was riding in a golf cart with her husband and two friends. When she turned to talk to one of them, she slipped and fell off the moving cart, landing on her head.

She suffered a massive brain bleed and was immediately rushed to the nearest trauma hospital, whisked into emergency surgery, and then put into a medically induced coma for a week to allow her brain to heal.

The doctors told Beaver’s husband that she was unlikely to survive the injury and that if she did, she might be severely disabled.

And yet, when doctors gradually brought her out of the coma, Beaver was not only relatively healthy but could also recall pieces of discussions she’d overheard.

“I remember friends and family in the room, and one friend who flew in from Los Angeles to see me,” she says. “Later on, I texted the friend and asked her if she had been in the room because I was certain I’d heard her voice, although I couldn’t recall seeing her.” The friend had, in fact, been there.

What coma patients can teach us

A doctor holds a coma patient's hand while they lie in a hospital bedHow each patient experiences their coma is helping to inform research into the condition

Even with brain imaging and other tests, doctors can never be certain whether a specific patient will emerge from a coma or how they will recover.

But hearing the stories of patients who have come out of their comas and recovered can help doctors learn more about this strange phenomenon. One of the most important lessons: the human brain is a lot more resilient than they once thought.

“For a long time we were vastly under­estimating the brain’s potential for recovery,” says Dr Stephan A Mayer, a specialist in neurocritical care and emergency neurology at Westchester Medical Centre Health Network in Valhalla, New York.

Many patients whom doctors thought had no hope of waking up have come out of their comas. “After about ten years of doing this, I realised I knew less about prognosis than ever,” Dr Mayer admits.

"The human brain is a lot more resilient than doctors once thought"

Becoming clearer about which are the best treatments for coma patients—and about how to better predict recovery prospects—are thriving areas of study.

Dr Provencio is one of the founders of the Curing Coma Campaign, a group of neurocritical care specialists from all over the world who are developing improved coma treatment strategies.

The Curing Coma campaign website provides valuable information for patients, families and healthcare providers.

“We’re really looking for people who have been affected by coma
to help us learn about their experiences before, during and after,” says Dr Provencio.

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