BACK FROM THE ‘DEAD’
Nearly 7,000 people in vegetative states may actually be conscious — and even able to communicate. A doctor reveals how he brings patients out of ‘the gray zone’
THEYcalled him a dead man.
Last month New York-Presbyterian Hospital issued a death certificate for 68-year-old Yechezkel Nakar after he suffered a stroke that rendered him unconscious and unresponsive.
Trouble is Nakar wasn’t dead. His heart was still beating, and he remained on life support at Maimonides Medical Center while his family filed a lawsuit asking the court to withdraw his death certificate so they could be reimbursed for his continuing care. He survived for another 21 days after doctors had officially declared him deceased.
Nakar’s story not only raises the role of morality in medical care (his family objected to removing him from life support on religious grounds), but also highlights medicine’s limited understanding about this borderland between the dead and the living — an area the British-born neuroscientist Adrian Owen calls “the gray zone.”
Dr. Owen has spent the last 20 years using brain scans to try to communicate with people written off as brain-dead — as unreachable as heads of broccoli. And to the shock of the neurological community he has been successful. His studies estimate that upwards of 15 to 20 percent of patients in persistent vegetative states or “unresponsive wakefulness” may actually be conscious but locked in their bodies and unable to communicate. Some, he’s found, have “intact minds adrift deep within damaged bodies and brains.”
This has serious implications for the estimated 15,000 to 40,000 people on life support in the United States — a number that has nearly doubled in the last decade as medical advancements keep people alive longer. Some are warehoused in sub-acute units, derisively called “vent farms,” where hosts of people live out their last days, months or even years. If Owen’s data is correct, more than 7,000 of these people could be conscious — a realization that sounds more like a “Twin Peaks” plotline than real life.
In his book “Into the Gray Zone: A Neuroscientist Explores the Boundary between Life and Death” (S&S), out now, the Canada-based Dr. Owen introduces readers to patients who helped bring him closer to breaking through this gray zone. Here are four astounding cases that led to some of his most exciting breakthroughs.
KATE
Before Dr. Owen began his investigation, doctors believed that once you were vegetative for several months, there was zero chance of recovery. This led to some weird-buttrue moments like the Venezuelan man Carlos Camejo, who lost consciousness 10 years earlier in a car accident but awoke during his own autopsy.
In 1997, Dr. Owen met a patient named Kate Bainbridge, who had developed encephalomyelitis, a brain and spinal-cord tissue inflammation. With this diseases, some recover, others die — and another group, including Kate, enter into a persistent vegetative state. Dr. Owen wanted to know: Are people like Kate completely lost?
He decided to track her visual processing system to see if her brain respondedtoimages. Dr. Owencollected pictures of Kate’s favorite people and showedher the images while scanning her brain using Positron Emission Tomography (PET), which works by monitoring blood flow marked with radioactive tracers. Whenhealthypeo- ple see familiar faces, blood flow tends to increase in a part of the brain called the fusiform face area. Wouldthis happen with Kate?
To his surprise, whenever Kate was shown family photos, her visual cortex lit up but then “returned to relative inactivity when a cloth covered her face . . . Her brain responded just as if she was awake and aware, just as if she was a perfectly healthy person,” Dr. Owen writes.
Luckily, after six months in a vegetative state, Kate recovered well enough to share her side of the story. Though she didn’t recall seeing the faces she was shown, she did remember being conscious and being desperately thirsty and trying to call out. She said she was in so much psychic pain that she even tried to kill herself by holding her breath — a common occurrence among those locked in their bodies, Dr. Owen writes.
“Part of Kate was still there,” he writes, “and perhaps that’s what was reflected in our early scans.”
After Dr. Owen published Kate’s story in the medical journal The Lancet, responses ranged from excitement to incredulity. Some questioned his research methods and others suggested that Dr. Owenwas fooled by an automatic response. Nevertheless, the idea of “the gray zone” was born.
KEVIN
Nowthat Dr. Owen knew the visual cortex could be activated by familiar images in some people in vegetative states, he wanted to know: Would speech cause a similar change?
In 2003, he tested Kevin, a 53-yearold bus driver whowas unresponsive four months after suffering a massive stroke that devastated his brain stem and thalamus. Dr. Owen scanned Kevin while playing sentences — some clear and some layered in static noise. If Kevin understood the sentences, Dr. Owen expected to see a greater increase of activity in the temporal lobe.
Again, like the healthy controls, Kevin’s brain lit up in the exactly same way. “Surely this was key evidence that Kevin’s brain wasn’t just hearing speech — his brain understood it!” writes Dr. Owen. “There could be little doubt that Kevin’s brain was processing meaning.”
Dr. Owen and colleagues scanned Kevin again using an fMRI scanner that measures activity through oxygen in the blood (the more brain activity in one area, the more blood rushes to it with its stock of oxygen).
This time, Dr. Owen read Kevin ambiguous sentences containing words with multiple meanings like, “the shell was fired toward the tank”
[Patient] Kevin’s brain wasn’t just hearing speech — his brain understood it! — author Dr. Adrian Owen (left)