Looking for Hopeon February 16, 2007 at 12:00 am
I think my father is in a moderate coma. Considering what we know, that would be a good thing.
Over the last few days I have been trying to find what information I can. I came across the Glasgow Coma Scale, which divides measures eye response, verbal response, and motor response. Here’s the scale, with where dad seems to be bolded:
Best eye response (E):
4. Eyes opening spontaneously.
3. Eye opening to speech.
2. Eye opening in response to pain. (Patient responds to pressure on the patient’s fingernail bed; if this does not elicit a response, supraorbital and sternal pressure or rub may be used.)
1. No eye opening.
Best verbal response (V):
5. Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)
4. Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
3. Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange).
2. Incomprehensible sounds. (Moaning but no words.)
Best motor response (M):
6. Obeys commands. (The patient does simple things as asked.)
5. Localizes to pain. (Purposeful movements towards changing painful stimuli; e.g. hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)
4. Withdraws from pain (pulls part of body away when pinched; normal flexion).
3. Flexion in response to pain (decorticate response).
2. Extension to pain (decerebrate response: adduction, internal rotation of shoulder, pronation of forearm).
1. No motor response.
This adds to a score of nine:
Generally, comas are classified as:
* Severe, with GCS ≤ 8
* Moderate, GCS 9 – 12
* Minor, GCS ≥ 13.
The motor responses came to their current level in the first few days. First they were happy with his reaction to pain, then he would posture, and finally (in the last truly hopeful report we had from a neurologist) it appeared he localized to pain. Then for 36 or 48 hours no improvement. This brought me down, as what we need to see is steady improvement.
People do not just wake up from comas, we are told over and over again. That is Hollywood. In the real world people slowly recover.
So we look for signs of slow recovery.
Last evening I spent a half hour with my dad, then a half hour working, then another hour hour working. I would talk about this and that, the normal happenings in our lives, but I kept repeating “That’s very good. Now more your arm farther, across your body” whenever I would see his arm move. “I know it’s hard, but you need to move your arm farther.”
Around five thirty I stopped talking for a bit. I held his hand and laid my head down on the side of his bead. When I looked up again I saw his hand resting on his chest. This was the greatest self-initiated movement I had seen from him.
Today was even better. Twice when I was talking to him he opened his eyes and kept them open (if only half-way). (Once my words to him immediately previous to that were “open your eyes,” but that may be a coincidence.) Each time I positioned my head so I was looking right at him and I talked loudly, clearly, and slowly to him. I was holding one of his hands and he started moving the other, so I held that one too. He relaxed as I put my hand over his body. He smiled as I said, again and again, the names of the people who were there with them. After he closed his eyes I wiped away a tear.
I do not know for sure what is really going on with my father. What I know makes me think we are beginning to see mental reflexes, better than mere physiological response but still in deep sleep. But whatever we are seeing, it is greater than anything since Saturday. My dad is better this morning than he was last evening, and he is better last evening than he was yesterday morning.
I love my dad. I want him back.