In the media and in everyday speech the word ‘coma’ is sometimes used in a general way to cover a wide range of conditions in which the individual has suffered brain injury, leaving them with no consciousness at all or with very limited consciousness. We read about celebrities, sports personalities or politicians said to be in a ‘coma’ after months or years but they are probably in a vegetative or minimally conscious state. It’s very unusual for a coma to last more than a few weeks at most. People in a coma are completely unresponsive. They do not move, do not react to light or sound and cannot feel pain. Their eyes are closed. The brain responds to extreme trauma by effectively ‘shutting down’.
Some scientists compare it to being under a general anaesthetic. Sometimes patients with very severe brain injuries who do not enter a coma naturally are placed in a medically-induced coma (using a drug like propofol which is used in anaesthesia) to try to allow the brain time to heal. After a few days or weeks in a coma a person who does not die usually ‘wakes up’ in the sense that their eyes open. If they have only been in a coma for a few days they may ‘wake up’ to full consciousness with relatively little damage. If the person has very severe brain injuries though, they may move from coma into a vegetative or minimally conscious state.
In a vegetative state the person is still unconscious. They have no awareness of themselves or their environment. The main difference between ‘coma’ and the ‘vegetative state’ is that at some point the person’s eyes will be open and there will be times when they seem to be ‘awake’. They may move parts of their body, but this movement is not voluntary. Movements can include grinding their teeth, thrashing, and facial movements such as grimacing, yawning or smiling. They might jerk as a reflex response to loud noises or move a hand away from a source of pain. They may produce sounds (grunting or moaning) or even occasional words. After four weeks the person is said to be in a ‘prolonged’ vegetative state.
If a person remains in a vegetative state for several months after brain damage involving oxygen-deprivation (caused, for example, by a cardiac arrest), or for one year after a traumatic brain injury (such as a car accident, a fall, or an assault), the chances of recovering consciousness are very low and they are said to be in a ‘permanent’ vegetative state.
Many people dislike hearing the word ‘vegetative’ applied to someone they love. There are other names for the condition (‘apallic syndrome’ or ‘unresponsive wakefulness syndrome’) – but the ‘vegetative state’ is still the most widely used term in the UK.
Imogen talks about that horrible expression – the permanently vegetative state which was her husband’s diagnosis.
Professor Derick Wade of the Oxford Centre for Enablement talks about the meaning of the words coma and the vegetative state.
Questions are often raised about whether you can be sure that someone definitely has no awareness of themselves or their environment. Here Derick Wade addresses this question.
How can you be sure that someone is not conscious? Derick Wade describes how he assesses whether or not a patient is conscious.
Another key concern is whether a vegetative patient can feel pain. Some people report that the patient shows no signs of pain. Morag, for example, said of her father that while he was in a vegetative state, ‘he was in what we could call a deep coma, where you know, if you’d have put pins in him he wouldn’t have reacted at all.’ Sometimes however patients seem to show facial expressions or reactions to painful stimulus that make families worry that they are experiencing pain.
Can a vegetative patient feel pain?
Fern does not think her partner feels pain
Fern describes how her partner did appear to be suffering before he was given ongoing long-term pain relief. Since he has been administered pain relief she has noticed that he appears more relaxed and not in pain.
Here some different families talk about their experience of their relative.
David and Olivia describe how they experienced being with David’s mother when she was in a permanent vegetative state.
Mark’s brother has still not received a formal diagnosis, three years after he was hit by a car while cycling. They are not sure whether he is vegetative or minimally conscious’ and, watching him, they wonder if he experiences emotions.
For more on family observations of being with the patient, see ‘Impact of visiting‘