Looking for Hope

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.)
1. None.

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.

10 thoughts on “Looking for Hope”

  1. Dan:

    Good to hear that. Keep the hope and everyone in our family will be fine! A good news, this year is the year of the golden pig, which is my year! I have been very lucky in my life, and I am sure this will help your dad too. Remember everyone here is with you! Tell your dad it's already monday, time for work! Keep us updated!

    God bless

    Gao

  2. Dan –

    I heard what has been going on and to read your accurate detail of it all is very touching.

    I guess my dad was lucky and we caught the heart attack before it happened. He had a 97% blockage in the place where they call it “The Widowmaker”. He had emergency surgery the next day and in the end came ok after a very long rehab period.

    I really hope and pray that you can have the same when he gets out. Just stay positive and keep informing us of his progress.

    joe

  3. Gao,

    Thank you. Your church prayers mean a lot to me. I'm giving my prayers to you and your family, too.

    More improvement during the night: dad kicked his legs off the bed several times (which we haven't seen before), and fought out his oxygen (which he doesn't need, but is better to have than not). We haven't seen this much improvement over the night before, so we are happy for that, too.

  4. Jay,

    Your comment appeared after I posted mine. Thank you as well.

    Our neurologist, who is currently attending an out-of-state conference, said this was good news as well. A tracheotomy has been reschedued until Monday, and I wonder if part of it is seeing what happens over the weekend.

  5. Dan:

    U know ur father is just a little tired of work and having a couple of days sleep… he'll be fine.. Stay positive, feifei and I are with you. I will pray for u too when I go to church! I know both you and ur father are tough man! Don't give up! We will get through this.

    Gao

  6. Biz,

    You're right. This is the guy who decided to vacation in Jamaica's cockpit, lived on the beach, and fought a dog for bread. I'm not going to underestimate him.

    Mike,

    Thanks. After I wrote this there was some further improvement — he held one hand in another, which is more complicated than anything else he had done with his arms. (Indeed, the dexterity of the legs relative to the arms had worried the neurologist). Another small step, another improvement. Another cause for hope.

  7. Joe H,

    Thank you. We've heard so many stories first hand — an uncle who had a stroke, a client who was in a coma for three months — and they give us hope.

    Can I ask how long your father's rehab was?

    Gao,

    The other day I told him, “Dad, you always told me the First Rule of Accounting, which is true from the smallest farmer to the biggest company: PROFIT is THEORY, CASH is FACT.” Then he smiled big.

  8. Dan-

    It took a few months for him to get back to doing normal things. it was a very long process and it took a strong body as well as mind. Now he runs around doing things he always did, just has a scar now and has to watch his diet closely.

  9. Dan,

    Thank you for the info regarding your father's coma and the level (moderate).

    Hang in there, keep talking to him and letting him know that you love and miss him.

    I will keep you and your family in my daily prayers.

    I miss you!

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