Into the Abyss by Anthony David

Author:Anthony David
Language: eng
Format: epub
Publisher: Oneworld Publications

6

Silent Music

It was an eerie place. A small, self-contained ward with half a dozen beds, bleached by artificial light. Green LED screens displayed oscillating waveforms, emitting rhythmical beeps. Staff in starched uniforms with clipboards, making notes, speaking softly. Cuddly toys, enlarged colour photographs stuck on the walls: young people gurning for selfies; bungee jumps; celebration cakes with twenty-one candles.

This was a unit for people in a persistent vegetative state (PVS) or minimally conscious state (MCS). All had suffered ‘catastrophic brain damage’. (For once, the technical term is not a euphemism but tells it like it is.) For the younger people the catastrophe is mostly a traumatic one, a road-traffic accident, sometimes described in medical-note shorthand as ‘lorry vs man’ or ‘car vs bike’. Occasionally it’s encephalitis, a viral infection of the brain. Across the age range, brain haemorrhage or tumours – and overzealous neurosurgery – can do it. Another major cause is anoxia (lack of oxygen) to the brain following cardiac arrest, strangulation (perhaps following a suicide attempt by hanging), drowning or a major metabolic upset such as prolonged hypoglycaemia (low blood sugar due to a diabetic person getting way too much insulin). There are also many individually rare causes, such as inherited disorders affecting the fundamental biochemical processes or those leading to degeneration of the brain tissue, which add up in aggregate.

***

I was advising on a forty-two-year-old patient, Malik, with schizophrenia. He had recently fallen or jumped from a three-storey building and sustained a severe head injury. He was emerging slowly from a coma and was now shouting out occasionally and pulling at his feeding tube, seemingly distressed. He had been on maintenance antipsychotic medication, but the team looking after him wasn’t sure if he should go back on it. It was the sort of fair question often asked of the neuropsychiatrist but for which there is almost no reliable guidance available from clinical trials. Was he really ‘distressed’ or was his body merely reacting in a reflexive way to the intrusive life support? Were his schizophrenia – or his suicidal impulses, if he had them – beginning to reassert themselves now that he was recovering consciousness? It was impossible to tell. The patient’s elderly mother was hovering by the door and caught my eye.

“Is he going to all right, doctor?”

She was well spoken with just a hint of a South Asian accent. She came across as educated; polite but direct. I explained that I wasn’t part of his clinical team so wasn’t the best person to speak to, realising that this sounded evasive.

“You’re the neuropsychiatrist, aren’t you?”

“Yes, but—”

“You know Malik has had mental health problems for years, since he was a young man… He’s been on tablets and injections for ages.”

“Yes, right, and I think he probably should go back on them…although it’s hard to say if they will help, and they might even interfere with him coming round. You see, we really don’t know what the best thing to do is for people in your son’s situation—”

“I

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