Grief on the Front Lines by Rachel Jones

Author:Rachel Jones [Jones, Rachel]
Language: eng
Format: epub
ISBN: 9781623176419
Publisher: North Atlantic Books

Seeking Personhood

While healthcare workers can often face significant challenges in establishing effective communication with conscious patients, working with patients with traumatic brain injuries or disorders of consciousness poses uniquely trying circumstances. How does one determine if a patient is conscious? When a patient’s brain shows some activity, might they be awake even if their body is immobile? What therapies are most helpful? Can they recover? Fortunately, there are scientists and clinicians who are actively seeking to answer these questions—often, with profoundly insightful results.

In the late 1990s, neuroscientist Adrian Owen was working on brain imaging techniques in the UK when a colleague asked him to see a patient named Kate, whose acute disseminated encephalomyelitis had left her in a vegetative state. They decided to show Kate images of her friends and families while she lay in a PET scanner and were shocked by what they found: her brain responded in the exact same manner as that of a normal, healthy person. “Everybody thought I was bonkers to bother putting a vegetative patient into a brain scanner,” said Owen, who’d been hoping to get some insight into which areas of the brain were most damaged and why, but was “completely floored” by the results. “It just really got me going, to be honest. It completely changed my career.”

Over the following decades, Owen continued to scan patients with traumatic brain injuries and disorders of consciousness—using PET scans, fMRI technology and more recently, a portable scanner called functional near-infrared spectroscopy (fNIRS). In his book, Into the Gray Zone: A Neuroscientist Explores the Mysteries of the Brain and the Border between Life and Death, Owen outlined his innovative approaches: he’s placed patients in an fMRI scanner and then asked them to imagine specific scenarios such as playing tennis or walking through their house that were easily measured with imaging. When he had them imagine one scenario or the other as “yes” or “no” answers to questions, some were able to do so. Essentially, he had provided them with a way to communicate.

Yet this also created some ethical dilemmas. The scans were time and resource intensive, and only a limited number of questions could be asked. Which ones should they be? Whose interests should they serve—that of the patient, or of science, which was seeking to benefit many more such patients? Sometimes, Owen was able to make these interests overlap—such as when a patient’s family members wanted to know whether the patient was aware of the birth of a niece and other recent family events. Owen shaped it into an exploration of how much memory was intact—and found the patient was able to recall everything, both before and after his injury. Thanks to Owen’s research, and that of others, it’s now widely accepted that one in five vegetative patients is likely conscious, while studies show that vegetative states may be misdiagnosed more than 40 percent of the time. More recently, Owen’s efforts involve scanning patients with acute brain injuries in the ICU in an effort to improve prognosis.

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