Mattheus had barely taken a seat in his waiting room when Dr. Padden came out to greet him.
“Glad to see you,” said Dr. Padden, walking right over to him. To Mattheus’s surprise Dr. Padden was a good looking, well dressed, American man in his early fifties. His strong, professional manner put Mattheus at ease.
“Thank you so much for meeting me on such short notice,” said Mattheus.
“It’s my pleasure,” said Dr. Padden, “please come in.”
Mattheus followed him into his large, modern, well-appointed office that looked out over a sloping cliff and had beautiful photos of his family prominently displayed on his desk.
“Quite a place you’ve got here,” Mattheus looked around impressed.
“I’m fortunate to be part of a facility like this,” Dr. Padden nodded. “Tell me how I can be of help?”
Mattheus admired the way Dr. Padden cut straight to the chase. “I need to learn about Tara’s condition from a medical point of view,” Mattheus replied. “I’m interested in learning more about comas.”
“Fair enough, that makes sense,” said Dr. Padden, sitting down on a small couch and motioning for Mattheus to take a chair facing him. “There’s so much misinformation floating around. You really need a clear understanding of what we were up against.”
“Great,” said Mattheus excited to get going.
“As you know, Tara was in a coma for about two months,” Dr. Padden started.
“Is that unusual?” Mattheus burst in.
“It’s a relatively long time,” Dr. Padden answered calmly. “But, let me explain. A coma means deep sleep, a state of unconsciousness lasting more than six hours. During this time a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound. They do not initiate voluntary actions. It can last for any length of time, from several days to several weeks. In severe cases a coma may last for over five weeks. Some have lasted as long as several years.”
“For several years?” Mattheus was horrified.
“Unusual, but it does happen,” Dr. Padden replied.
“Are patients able to feel, speak or hear anything at all?” Mattheus asked quickly, needing to corroborate or disprove the rumors Cindy had heard.
“So far as we know, a comatose person is unable to consciously feel, speak, hear, or move,” Dr. Padden replied.
“What was Tara’s prognosis and treatment?” Mattheus was hungry for more. “Did she have a chance? Was her death inevitable, just a matter of time?”
“That’s hard to answer,” said Dr. Padden. He was oobviously rooted in facts, and Mattheus greatly appreciated that. “There are different kinds of comas,” Dr. Padden went on. “A coma may develop as a response to injury to allow the body to pause and use its energy to heal before the patient wakes up. This kind of coma can be seen as a path to healing. Some comas are even medically induced during neurosurgery or traumatic brain injury to protect other functions of the brain.”
“Did you see Tara’s coma that way?” asked Mattheus, fascinated. “Was she on the road to healing?”
“Tara’s coma was caused by a severe brain injury,” Dr. Padden continued, looking down at the floor. “ The severity and mode of the onset of the coma has something to do with how it goes.”
Mattheus began to feel uneasy. There was so much he didn’t know and hadn’t heard anyone speak of before. Was there any way to actually prove that Tara would have woken up and been well if she was given more time?
“What kind of treatment did Tara have?” Mattheus continued.
“The comatose patient is usually placed in an Intensive Care Unit immediately,” Dr. Padden promptly replied. “We monitor breathing and brain activity through CT scans. We watch the patient's respiration and circulation and if necessary use intubation to help them breathe. We administer intravenous fluids, blood and other supportive care. Once a patient is stable and no longer in immediate danger, the medical staff usually concentrates on maintaining the health of the patient’s body.”
The idea that a patient could be healthy and in a coma was startling to Mattheus.
“Was Tara healthy?” Mattheus asked suddenly.
“Yes, Tara was basically healthy,” said Dr. Padden, “and it was our job to keep her that way. We watched for infections such as pneumonia and bedsores, and made sure she had balanced nutrition daily. The nursing staff moved her every two to three hours from side to side. Some comatose patients are even put in a chair. The goal is to move the patient as much as possible.”
Mattheus was amazed by the intricacy of all that had to be done. He could only imagine how confusing and frustrating the situation could be.
“We also have to keep the patient from hurting themselves,” Dr. Padden continued. “They can become restless, thrash around and even pull on tubes or dressings. Wrist restraints may be put on or medicine given to calm them down. Sometimes side rails on the bed have to be up to prevent the patient from falling.”
“Did that happen to Tara?” asked Mattheus horrified, “was she restless, did she toss around, pull on her tubes?”
“Once or twice she did, as I recall,” said Dr. Padden.
“Was she trying to tell you something by behaving that way?” Mattheus couldn’t help ask.
Dr. Padden shook his head strongly. “Absolutely not,” he insisted. “A tremendous danger in working with comatose patients is assuming their behavior means something. It doesn’t. These are reflex behaviors made in response to bodily discomfort. The unconscious part of the brain does what it does, but it’s beyond the patient’s control.”
“I see,” said Mattheus.
“I’m glad you do,” replied Dr. Padden. “So many interpret every little move or grimace the patient makes. It’s common for the family to claim that the patient is trying to communicate with them, or that they’re about to wake up. It’s very difficult to disabuse them of that idea, too.”
“I’m sure it is,” said Mattheus, “I can see how hard it must be sitting there, waiting.”
“Excruciating,” Dr. Padden agreed, “and often the patient looks as though they’re about to return. And, of course, some do. When that happens they come back little by little.”
“What were Tara’s chances of returning?” Mattheus asked bluntly then.
“It’s hard to say what her chances were,” Dr. Padden began tapping his fingers on his legs.” Some come out, some progress to a vegetative state and others die. Some recover a life, others do not. Some go on to regain a degree of awareness, others remain in a vegetative state for years or even decades. The longest case recorded or remaining in a vegetative state was forty two years.”
“Oh God,” said Mattheus, “forty two years of living in a fog.”
“Some people in deep coma recover well while others in a so-called milder coma sometimes fail to improve. Some people come out fine, others with with significant impairments. Only time shows us what will happen,” said Dr. Padden.
“This is a tough situation,” said Mattheus, “a hard call what to do.”
“Nothing to do but wait,” Dr. Padden commented. “Patience is the best medicine here.”
Mattheus was startled to realize that it was in the realm of possibility that Tara could have lived. “You were all hoping that Tara would regain full awareness weren’t you?” he asked.
“Of course we were,” said Dr. Padden. “Everyone always hopes that. And it can be subtle. In the first days, patients may awake only for a few minutes, then the length of time awake gradually increases. A person with a low predicted chance of recovery may still awaken and do well. I tell that to the families, but they don’t listen.”
“I can understand why not,” said Mattheus.
“So can I,” said Dr. Padden.
Mattheus felt momentarily shaken. Who could bear living with the unknown? He understood why people wanted probabilities, something to hold onto.
“According to statistics, what were Tara’s chances?” Mattheus asked.
“Tara was in a coma for two months. The chance of full recovery was very low, but still possible,” Dr. Padden replied.