What Did You Expect?

Last week I read a story about a woman who woke up from a coma (alternate story here) and just haven’t had the time to comment about it. I haven’t had a good rant in a while and I have to get something off of my chest.

I’m happy for this family. What occurred was unarguably a miracle. These same types of miracles happen every so often. Here is a story about how a sleeping pill helped someone wake from a six year coma. Here is a story about a man that woke from a 19 year coma and said “Pepsi” as one of his first words. Here’s a story about a Polish man that also woke up after a 19 year coma. This guy woke up after two years in a coma and remembered everything. Do a web search on “wakes from coma” and you can probably find more.

The media doesn’t report about the 99.9999% of the other cases, though. No one gets joy hearing about comatose patients on ventilators for many years that get contractures, bed sores (even though bed sores should “never” happen), recurrent pneumonias, countless blood draws, Foley catheters, feeding tubes, etc., and then die a slow death. “If it bleeds, it leads” obviously doesn’t refer to decubitus ulcers.

What do we gain from keeping people alive in comas? I did a quick internet and Medline search and it appears that most of the time we don’t gain much. Here is one study stating that after 24 hours in a coma due to cardiac arrest, the chance of making a meaningful neurologic recovery is pretty much nil. After 72 hours, the three patients that woke from their comas “had severe brain damage and required permanent care in an institution” Granted that this is a small study population and it was published in 1982, but I didn’t find many other studies on the topic. This study shows a model to predict poor neurologic outcome after 24 hours in a coma, but did not have a way to strongly predict good neurologic outcome. Also note that these studies do not discuss traumatic brain injury, only comas from cardiac arrest.

There’s the old joke about the lottery being a tax on the mathematically challenged. Yet what do we hear about on TV? The winners whose lives have been changed by winning the lottery. Is the whole Lotto publicity thing a conspiracy? See this post on the Dilbert Blog. What you don’t hear about are all the indigent people who spend what little money they do have trying to hit it big in Jeff Foxworthy’s “redneck retirement plan” and who end up with even less money than they started out with.

I have a pet peeve about the show “ER” for the same reason. Sure, it’s great drama. But things don’t work that way in real life. One minute the paramedics are busting through the doors with an unresponsive patient on the brink of death, after the commercial for BellyBuster Burgers, the patient is sitting up in the hospital bed looking like a TV soap star. Most people in the medical profession realize that the TV show is drama, but the show also fosters unrealistic expectations in a significant subset of people who don’t know how medicine works. I see it every day in the ED and in the patient complaints the ED physicians receive.

The feelgood stories are great, but when you create a public expectation that such things will happen, you’re doing the public a disservice. Anyone who put all their lifesavings into lottery tickets (a move might even make it to the evening news) would be resoundingly criticized if they lost their money. Yet we routinely validate the same longshot odds when we keep comatose patients alive on ventilators year after year after year.

Wonder if the ending would have been the same had Sleeping Beauty been on a vent.