OFFICER'S BRIEF REVIVAL SPURS COMA DEBATE.
The news that the Tennessee police officer who awoke from a coma state after seven years is talking once again is a dramatic twist in a story that has fascinated the medical world.
Because Gary Dockery's emergence from this neurological netherworld is considered a near-miracle, doctors say it shouldn't raise false hopes for relatives of similar patients.
But at the same time, a thread of hope can sometimes sustain families faced with the devastation of seeing someone they love in that condition.
"Miracles like that can happen," said Jeannette Jones, 52, a South Side electrician whose son has been in a vegetative state since 1985. "But only if there's someone there holding on to that person. If he never stops being loved, if there's always someone there to project a feeling of caring, it makes him want to come back."
Though doctors hope to gain a glimmer of understanding from Dockery's case, in some ways his story only heightens the deep mystery surrounding those who lapse into unconsciousness for months or even years. Doctors can't even agree on labels for various degrees of impairment, let alone figure out why a few patients recover.
The case of Dockery, who was shot in the head in 1988, also renews attention on the difficult ethical issues surrounding the care of such patients, from the costs of keeping them alive to the rights of families to retain control over the patient's destiny.
"Do patients wake up from long comas? Yes," said Dr. William Chamberlin, medical director of the University of Illinois Hospital in Chicago. "The problem is, it's hard to tell the difference between the 1 percent that will and the 99 percent that won't.
"Things like this make it very hard on the patients' families. Even if he recovers, he's still extraordinarily impaired. (Recovery) will take an enormous amount of time."
Jones knows her son, John Boyd, 32, is in the terminal stages of multiple sclerosis. But she never gives up. "I hope every day that he's going to wake up and say 'mama,' " she said. "How wonderful that would feel."
But even if he never does, she knows it's her love that has kept him alive this long.
"They told me he wouldn't live past 1986," she said, "but we've had nine birthday parties since then."
When Dockery, 42, was hospitalized this month for pneumonia, he suddenly woke up and talked for 18 hours. After undergoing surgery, he once again lost his speech but regained limited verbal ability Wednesday.
Dr. Bruce Kaplan, a neurologist at Parkridge Medical Center in Chattanooga, Tenn., where Dockery was moved out of intensive care Thursday, told a news conference last week: "We very much want this case to be an isolated wonder that doesn't set back the gains we've made in being able to help families cope with what is a devastating medical problem."
No one knows what triggered Dockery's improvement, but Dr. Anthony Reder, associate professor of neurology at the University of Chicago, speculated that the pneumonia that threatened the officer's life might somehow have jarred him into consciousness - and that the surgery doctors performed the week before last to drain fluid from his lungs could have temporarily affected his speech.
According to the 1994 report of the Multi-Society Task Force on the "Persistent Vegetative State," the cost of hospital care for the first three months for such a patient is estimated to be about $150,000. The cost of long-term nursing care ranges from about $125,000 to about $180,000 a year. The total annual cost in the United States is estimated at $1 billion to $7 billion.
Some 10,000 to 25,000 adults and 6,000 to 10,000 children in the United States are diagnosed each year as being in persistent vegetative states. But nearly two-thirds can be expected to recover consciousness or die within six months.
"Most people would have been written off," Reder said. "Is this a useful way to use our health resources? Usually not." If one patient wakes up every few years and hundreds don't, is it worth a full-court press?
The family of Matt Graff, 39, never gave up while he was in a vegetative state for the better part of a year after surgery for hydrocephalus.
"My eyes would be open," said the Burbank resident, "but there was no one home." Like Dockery, Graff was sometimes able to respond to questions by blinking.
Graff was admitted to the Rehabilitation Institute of Chicago in April 1979. "By then, my body was all curled in," he said. But after intensive physical therapy and speech therapy, he recovered.
Graff has no memory of the period between August 1978, when he was hospitalized for the first of 17 operations, and October 1979. "I missed Three Mile Island, John Wayne Gacy, the Jonestown Massacre and two popes," he said.
Graff, who is director of audiovisual services at the Marriott Oak Brook Hotel, said he is "100 percent recovered," although he has a brain shunt and a seizure condition that is controlled by medication.
But the vast majority of patients such as Graff never recover, and their loved ones sometimes accept that reality before their doctors do.
Chamberlin noted that until fairly recently there was "a presumption that we should do everything possible to keep each patient alive. Families finally had to resort to the courts to force doctors to let their loved ones die."
In 1989, the American Academy of Neurology defined the persistent vegetative state, classified artificial feeding and hydration as forms of medical treatment, and stated that patients or their surrogates could decide to terminate treatment.
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|Publication:||Daily News (Los Angeles, CA)|
|Date:||Feb 25, 1996|
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