Carrots don't wince in pain: The brain-damaged are people, too

Date published: 3/8/2006

LITTLE ROCK, Ark.--The most revealing obituary in the paper the other day was that of a 44-year-old man many must have thought as good as dead for almost a decade--since December of 1995.

That's when a burning roof collapsed over the head of the Buffalo, N.Y., firefighter, leaving him blind, brain-damaged, largely mute and completely unaware of his surroundings. Or so it must have seemed from the outside looking in. Doctors held out little hope of his ever regaining consciousness, for Donald Herbert of Rescue Company 1, 2nd Platoon, had been deprived of oxygen for several crucial minutes.

This father of four had fallen into a years-long stupor. Some--not all--might have called it a case of PVS, or persistent vegetative state, which is always an inexact diagnosis. Indeed, it's less a medical syndrome than a misleading label.

Because, on April 30 of last year, the vegetable spoke. Indeed, he rattled on for 14 hours, much to the astonishment and delight of doctors, nurses, family, fellow firefighters and surely everybody else who'd heard about his case.

Many of us have heard of PVS before, notably in Terri Schiavo's media-saturated, legally complicated, medically contested, personally agonizing, politically polarizing, just-plain-awful case and scandal.

Vocabulary is always the crucial ground on which these life-and-death issues are fought, and, as a label, "persistent vegetative state" is a good example of how the terms in which a debate is conducted shape its outcome. This one tends to dehumanize the patient, even de-animalize him.

Paul McHugh, university distinguished-service professor of psychiatry at Johns Hopkins, has explained, in Commentary magazine, the origin--and effect--of the term persistent vegetative state in judicious language, as befits a physician and professor:

"It is perhaps because such patients display so lowered a state of vigilance that, in striving to define their condition, neurologists lighted upon a metaphor contrasting vegetation with animation. I remember teasing the admirable clinician who first coined this term that I had seen many patients but few carrots sleeping, waking, grunting, or flinching from pain. Although the term 'vegetative' does distinguish what is lost from what remains in such a patient's capacities, it can also have the unfortunate effect of suggesting that there is something less worthy about those in this condition."

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Date published: 3/8/2006