BETWEEN LIFE AND DEATH

The BBC recently had an article about the scientific research conducted with severely vegetative patients. The most revealing aspect of the article (and study) was that a patient in a deep coma awoke to tell the medical community what she experienced in her vegetative state. It was totally different than what medical science perceived was happening inside the brain of an unconscious patient.

The problem is that the scientific definition of “death” remains as unresolved as the definition of “consciousness”. Being alive is no longer linked to having a beating heart, explains Owen. If I have an artificial heart, am I dead? If you are on a life-support machine, are you dead? Is a failure to sustain independent life a reasonable definition of death? No, otherwise we would all be “dead” in the nine months before birth.

The issue becomes murkier when we consider those trapped in the twilight worlds between normal life and death – from those who slip in and out of awareness, who are trapped in a ‘minimally conscious state’, to those who are severely impaired in a vegetative state or a coma. These patients first appeared in the wake of the development of the artificial respirator during the 1950s in Denmark, an invention that redefined the end of life in terms of the idea of brain death and created the specialty of intensive care, in which unresponsive and comatose patients who seemed unable to wake up again were written off as “vegetables” or “jellyfish”. As is always the case when treating patients, definitions are critical: understanding the chances of recovery, the benefits of treatments and so on all depend on a precise diagnosis.

In the 1960s, neurologist Fred Plum in New York and neurosurgeon Bryan Jennett in Glasgow carried out pioneering work to understand and categorise disorders of consciousness. Plum coined the term “locked-in syndrome”, in which a patient is aware and awake but cannot move or talk. With Plum, Jennett devised the Glasgow Coma Scale to rate the depth of coma, and Jennett followed up with the Glasgow Outcome Scale to weigh up the extent of recovery, from death to mild disability. Together they adopted the term “persistent vegetative state” for patients who, they wrote, “have periods of wakefulness when their eyes are open and move; their responsiveness is limited to primitive postural and reflex movements of the limbs, and they never speak.”

In 2002, Jennett was among a group of neurologists who chose the phrase “minimally conscious” to describe those who are sometimes awake and partly aware, who show erratic signs of consciousness so that at one time they might be able to follow a simple instruction and another they might not. Even today, however, we’re still arguing over who is conscious and who isn’t. 

Kate Bainbridge, a 26-year-old schoolteacher, lapsed into a coma three days after she came down with a flu-like illness. Her brain became inflamed, along with the primitive region atop the spinal cord, the brain stem, which rules the sleep cycle. A few weeks after her infection had cleared, Kate awoke from the coma but was diagnosed as being in a vegetative state. Luckily, the intensive care doctor responsible for her, David Menon, was also a Principal Investigator at the newly opened Wolfson Brain Imaging Centre in Cambridge, where one Adrian Owen then worked.

In 1997, four months after she had been diagnosed as vegetative, Kate became the first patient in a vegetative state to be studied by the Cambridge group. The results, published in 1998, were unexpected and extraordinary. Not only did Kate react to faces: but her brain responses were indistinguishable from those of healthy volunteers. Her scans revealed a splash of red, marking brain activity at the back of her brain, in a part called the fusiform gyrus, which helps recognize faces. Kate became the first such patient in whom sophisticated brain imaging (in this case PET) revealed “covert cognition”. Of course, whether that response was a reflex or a signal of consciousness was, at the time, a matter of debate.

The results were of huge significance for science but also for Kate and her parents. “The existence of preserved cognitive processing removed the nihilism that pervaded the management of such patients in general, and supported a decision to continue to treat Kate aggressively,” recalls Menon.

Kate eventually surfaced from her ordeal, six months after the initial diagnosis. “They said I could not feel pain,” she says. “They were so wrong.” Sometimes she’d cry out, but the nurses thought it was just a reflex. She felt abandoned and helpless. Hospital staff had no idea how much she suffered in their care. Kate found physiotherapy scary: nurses never explained what they were doing to her. She was terrified when they removed mucus from her lungs. “I can’t tell you how frightening it was, especially suction through the mouth,” she has written. At one point, her pain and despair became so much that she tried to snuff out her life by holding her breath. “I could not stop my nose from breathing, so it did not work. My body did not seem to want to die.”

Kate says her recovery was not so much like turning a light on but a gradual awakening. It took her five months before she could smile. By then she had lost her job, her sense of smell and taste, and much of what might have been a normal future. Now back with her parents, Kate is still very disabled and needs a wheelchair. Twelve years after her illness, she started to talk again and, though still angry about the way she was treated when she was at her most vulnerable, she remains grateful to those who helped her mind to escape.

In applying this real life coma story to LOST, there is a theme of "gradual awakening" of the dead in the sideways world to the events of their recent past (i.e. the plane crash). A person in a coma, or in a state between life and death, still can perceive the world around them - - - and still have strong emotions like pain and anxiety. For those who think most people pass quietly in their sleep may have to rethink that position. With her mind still active, the coma victim is trapped inside her own head. And what was she thinking about? Escape. What was the most driving force for everyone on the island, including the smoke monster? Escape. It was the inability of the coma patient to communicate with the outside world that led to frustration and more pain. Likewise, fans continually barked at the television screens when LOST survivors continually failed to communicate with each other, or ask the simple, common sense questions to get answers. 

Many of the same elements of the coma patient study were embedded into the LOST story. It gives those fan theories about mental or coma patients more real scientific evidence to support their viewpoint of the series.