In 1997, Adrian M. Owen came across a young teacher from England named Kate. Kate’s doctors declared that she had fallen into a vegetative state after being a coma. One who is in a vegetative state means that they “lacked conscious awareness,” meaning she showed no response to any stimulus by her doctors or family.
After meeting Kate, Owen and other professionals ran multiple tests to detect hidden awareness in vegetative patients. By using functional magnetic resonance imaging (fMRI), they later figured out that by having the patient do simple activities, such as play tennis or walk around the rooms of their home, they were able to see the brain activity in the premotor cortex and the parahippocampal gyrus.
Adrian Owen has made outstanding findings about patients who are in the vegetative state, that will be used to help make important medical decisions about the patient. The hospital will do its best to meet the needs of each patient and will help with what decisions need to be made next.
Patients who have fallen into a vegetative state will have to undergo multiple tests to see if the patient is able to make their own medical decisions or he/she is still consciously aware. The patients that will be tested will be patients that have been officially diagnosed in this vegetative state the longest, which means this individual displays all symptoms to one who is in the vegetative state and has been this way for a numerous amount of days/months/years.
After the choice has been made, the patient will continue through and will be provided with tests that will allow the doctors and family members to see if the individual is still consciously alive. They will start by taking the patient through the process of a fMRI.
If the patient reacts positively to the test — meaning the doctors can detect conscious awareness by brain activity in the patient, then the family members will be informed and the hospital will sit down and discuss further in depth what steps to take next.
In the result of the patient being conscious, it will then be the patient's call on all medical decisions that they need to undergo. If the results of the fMRI are negative and there isn’t any brain activity, then the family members will be informed and they will be able to discuss possible arrangements for their loved one. In the result of the tests being negative, there is another option the patient may be able to undergo.
This procedure is called Vagal Nerve Stimulation (VNS), which is having a device that sends electrical signals along the nerve to the brain stem which then sends impulses to other areas of the brain. This method allowed a man that had been pronounced in the vegetative state for 15 years after a bad car accident in his early ages to be able to regain consciousness and become aware once again.
Every patient in the vegetative state is unique and case sensitive, but if the circumstances are right, then the patient will undergo these tests to see if the patient is still conscious.
Depending on the case of the patient, this will decide which patients will not be able to undergo the fMRI or even the VNS. With the fMRI, the patients that have had previous surgery that involved metal being implanted in their bodies, will not be able to endure the fMRI due to the machine reacting with metal.
Another reason why a patient would not be able to have the opportunity to have either, fMRI or VNS, would be the cost of each test. Depending on the insurance that the patient has would decide whether the individual would be able to receive treatment for one who is in the vegetative state. In addition, a patient that cannot remain still for a long period of time, would not be able to obtain either test due to results being obscured through movement. The patients that are unable to experience either test, will be transferred to a long-term care facility where they will be taken care of until further tests surface or until family members make other choices/arrangements.
Every year about 50,000 people are diagnosed with being in a vegetative state in America, which means that a numerous amount of hospitals need to have available beds for these people. The severity and the amount of time one has been in the vegetative state would determine who gets the next available bed. For example, a patient that has been in a vegetative state for a long period of time will be allowed to keep their stance in the hospital.
Yet for the patients who have just fallen into that state will be either given a bed, if there is room, or they will be referred to another hospital that can meet the need of this individual. Based on the case of the patient, they will then see if they are eligible for fMRI or even the VNS, then they will be transported to a bigger hospital that carries the right equipment for those procedures.
Each case of individuals in the vegetative state is distinct in its own way, yet choosing which and how each patient gets treated is the hardest decision. Adrian Owen and other researchers have spent years developing a way to communicate and detect a conscious awareness of patients who are in a vegetative state. Using the different methods (fMRI and VNS) each patient could potentially have an opportunity to be able to communicate once again to family members and doctors. The hospital will do it’s best to meet the needs of each individual and their family members on every decision that needs to be made.
