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Coma Recovery Association, Inc.
The traditional management of the majority of individuals with a severely impaired level of consciousness or responsiveness, otherwise known as prolonged coma, persistent vegetative state or akinetic mutism, following stabilization in a hospital setting, takes place in a nursing home. Most nursing homes are designed to provide "custodial" care consisting of keeping an individual fed and clean. In actuality, the long term care poorly responsive patient will be in a drab undecorated room, confined to a bed, being turned every 3 or 4 hours, occasionally being put in a chair, sometimes for as long as six hours in a stretch, where he or she will slump over and remain that way until returned to bed. Feedings generally consist of tube feedings given systematically, whether the individual is hungry or not, always in the same quantities. A physician visits about once a week and will see the patient only if the nurses report a problem; a patient may run a fever of 102 degrees or 103 degrees for 3-4 days before being examined. The patient is often unattended for long periods of time, two, three or four hours at a stretch, immobile, occasionally lying in soiled or wet sheets until the next routine nursing visit. Physical therapy, or any physical activity, is non-existent. Finally, the patient’s existence is void of any visual, auditory or tactile stimulation. Any one of us in such a situation would be considered deprived and the effects of deprivation can be devastating. Loss of weight, muscle atrophy, contractures (muscle and tendon shortening), decalcification of bones, fractures, dislocations, deformities, infections, bed sores, compounded by wet and/or soiled sheets, susceptibility to illness, depression, mental regression, hormonal deficiencies with loss of secondary sexual characteristics (body shape and fat distribution, muscle configuration, distribution of hair) all eventually leading to death, not because of the initial insult to the brain, but because of the subsequent deprivation. Most of us have read the unfortunate stories of children locked in attics by sadistic parents, discovered 6, 8 or 10 years later, unable to speak, displaying infantile behavior, with puny statures, having failed to thrive! They have suffered the effects of deprivation. For anyone who fails to understand what deprivation can do, I suggest that you strip your room, have someone put a feeding tube into your stomach, put on diapers and a hospital gown and go to bed for one week. Do not move, do not talk. You will be turned 2-3 times a day, your diaper will be changed 3-4 times a day, you will be fed through the tube 4-5 times a day, always the same amount, whether you are hungry or not, whether you are thirsty or not. At the end of the week, let me know if you would tolerate the same regimen for 6 months or a year, and what you would be like at the end of that time! Mihai D. Dimancescu, M.D. Copyright © 1985-2000, * Coma Recovery Association, Inc.
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