No Miracles in Coma Cases, Doctors Say

For patients in a coma there may be recoveries--even full recoveries--but there are no miracles.

Instead there are signs and hints, indications that trained observers take note of to determine what kind of recovery a patient will have.

Minute reactions to various stimuli--voices, light and touches--are signs that awareness may be returning and are the chief indicators of a successful recovery.

Such a recovery appears to be in store for Amanda Arthur, a 17-year-old Newport Beach cheerleader who had lain in a coma since a May 23 car accident. Amanda recently regained consciousness and has begun speaking sentences.

“Right now she’s making significant, great improvement,” said her neurologist, Dr. David Lombardi of Western Medical Center-Santa Ana. “I think the door’s wide open for more improvement.” When Amanda was admitted to the hospital shortly after the crash, she was in a “fairly deep” coma, Lombardi said.

“She wasn’t making any response to the environment,” he said. “She wasn’t making purposeful movements.”

According to neurological experts, patients in deep comas experience a complete absence of consciousness, existing in a darkened world where all basic functions and reflexes, including the ability to swallow and to sleep, have disappeared.

Recovery from a coma can be defined as the regaining of control, experts said.

“In two to three weeks, if a patient can control some part of their body--their eyes, head, neck, hands--something, then there is a greater chance of recovery,” said Dr. Dan Handly, a neurologist at Johns Hopkins Medical Center in Baltimore. “If in two or three weeks they haven’t changed at all, that’s when I tell a family it’s unlikely their loved one will recover.”

How quickly someone recovers depends on several factors, including the patient’s age and the severity of the injuries that caused the coma. Patients younger than 20 have the best chance of making a full recovery, doctors said.

Recovery is a process of steps and stages. Patients do not snap out of a coma, doctors said.

The first stage is moving into a vegetative state where patients regain the ability to sleep, according to Dr. Stephen Ashwal, professor of child neurology at Loma Linda University School of Medicine and a leading expert on coma recovery.

Patients can then progress to a minimally conscious state. If fortunate, they continue to improve until they begin to talk and move toward normality, doctors said. Arthur’s recovery is not unusual given her age, Ashwal said.

“In this particular situation, a three-month period of time would not be under the ‘miracle’ branch of medicine--it’s been well known to occur,” Ashwal said.

Even with a good prognosis, a patient’s recovery probably will take many months.

Such has been the case of James Black, a 27-year-old Huntington Beach man who went into a coma after he was hit by a drunk driver in November.

Black was treated at St. Jude Medical Center in Fullerton, where at first he lay in a moderately deep coma. Then one day the sound of his mother’s voice brought a sleepy smile to his lips. By the time his parents took him to their home in Oregon, he could walk with a little help.

“I remember how thrilling that was when he could first say ‘Hi’ to us,” Judy Black said, starting to cry at the memory.

It has been a hard road for the Black family, and they have learned to celebrate when their formerly athletic son relearns a skill.

“I can only express my best wishes to this young girl’s parents and a hope that their strength stays with them,” Judy Black said. “It will be the love part that carries them through.”

There is still much that doctors do not know about how the brain recovers from coma, but if there is any aspect of recovery they might concede is “miraculous,” it is the role played by the love of friends and family.

“Their voices, their faces, their presence mean so much to the unfortunate victim,” said Dr. Fred Nowroozi, medical director of the Regional Brain Injury Program at St. Jude.

“I think that the patients who have great family support are the ones who are going to have a better recovery,” Nowroozi said. “It’s unbelievable how it happens, but it’s their love that works.”