The unthinkable has happened. Someone you love has suffered a severe brain injury and is now unable to communicate.
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You meet with the doctor, who tells you one of two things:
- Your loved one is in a coma.
- Your loved one is brain dead.
Both sound ominous, but what do they mean in terms of your loved one’s recovery?
The first step is to understand the full meaning of terms doctors may use. Here’s a guide to what they really mean.
People who are in a coma are very much alive, but they are unable to interact with the outside world. “Being in a coma is the first step of severe brain injury,” says neurologist J. Javier Provencio, MD. “Given enough time, a person who is in a coma will either get better, die or go into a persistent vegetative state.”
2. Persistent vegetative state
A persistent vegetative state is the term used to refer to someone who has been in a coma for at least three months.
Those who are in a persistent vegetative state lose their higher brain functions. However, other functions, such as breathing and circulation, remain intact. Although people in a persistent vegetative state may appear somewhat normal, they can’t speak and are unable to respond to commands.
“People can sometimes live in a persistent vegetative state for years, although they usually succumb to other medical problems like pneumonia,” says Dr. Provencio.
In rare instances, people have made miraculous recoveries. “Based on the collective experiences of doctors worldwide, it’s not reasonable to expect people will wake up once they reach this point,” Dr. Provencio says.
3. Brain death
There’s no easy way to say it, but if the brain is dead, the person is dead. And no amount of waiting or heroic measures will change that fact.
“Families have a difficult time with this concept because their loved ones are still warm and appear to be breathing,” says Dr. Provencio. “But the truth is that breathing machines and other technology allow them to look alive, even though they’re not.”
When a person is declared brain dead (the technical term is “death by neurologic criteria”), families often worry that the doctor may be wrong and the person might still be alive.
However, there’s a rigorous neurological evaluation that is used to make the determination, which is how doctors can be absolutely certain that the person is dead.
Making decisions about life support
Families face the difficult task of deciding how aggressively their loved one should be treated and whether or not to withdraw life support once it’s been started.
“When families are struggling to decide what to do, I ask them to think about how their loved one has lived,” Dr. Provencio says. “Whether or not a person wakes up isn’t the only thing to consider.
You also need to think about whether or not they will be able to do the things they once enjoyed. When making these types of decisions, it’s important to try to get past what you want and redirect your thoughts to what your loved one would want.”
RELATED: End-of-Life Care: Who Will Speak for You?
Hoping for a miracle
It’s natural to hope for a miracle. But according to Dr. Provencio, the majority of families he’s met who held out for a miracle ended up wishing they hadn’t. “Unfortunately, none of the choices are easy and there are no absolutes,” he says.
Your guide to brain health