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A life-or-death dilemma
Local healthcare providers deal frequently with brain-damaged patients like Terri SchiavoDate published: 3/24/2005
By JIM HALL
Some aspects of the Terri Schiavo case are familiar to those who provide care for severely brain-injured patients. They know the open eyes and vacant stare, the apparent absence of awareness. They've watched as patients, families and physicians make bedside decisions to withdraw life-prolonging support. They've even helped when families could not agree on what to do. What they haven't seen before is the way these issues are playing out on such a public stage. And they wonder what this might mean for the future. "Disagreements among families are not rare, although this degree of polarization, where people just can't be brought to a decision, is rare," said Dr. Rebecca Bigoney. Bigoney is director of ethics services at Mary Washington Hospital. She and other caregivers in the area see patients like Schiavo several times a year. These patients are said to be in a persistent vegetative state. Many, like Schiavo, have suffered cardiac arrest that leads to a loss of oxygen to the brain. As a result, they may lose some or all brain function. Schiavo was 27 when she suffered cardiac arrest. Her brain did not get the oxygen it needed and important portions of it were damaged. Bigoney said she saw copies of Schiavo's MRIs at a conference in Florida in October. The "atrophy" or shrinkage of the brain matter in the cortical hemispheres was obvious, she said. This low oxygen flow led to the loss of speech, thought, memory and emotion. Doctors believe that patients such as her are no longer conscious of themselves or their surroundings. Typically, they do not interact with others or experience pain and have no hope of recovery. The New England Journal of Medicine reported this week that EEG tests of Schiavo's brain have been "flat," indicating no activity in the cortical areas of higher function. What Schiavo retains, Bigoney said, are some of the functions that originate in the brain stem: breathing, blinking, yawning, digestion and some reaction to light and noise. Schiavo also experiences periods of sleep and waking. She is not able to swallow food, so she must be tube fed. She is incontinent. With these patients, appearances can be deceiving, those who care for them say.
Date published: 3/24/2005
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