Morbidity and mortality (M&M) conferences are the medical
community's way of sharing the stories of hapless patients who end up
maimed or dead from various illnesses and injuries. It is not, perhaps,
the happiest of topics, but they are held in an effort to learn and
teach so as to protect future patients from suffering the same fate. It
is vanishingly rare for such a patient to be present at their own
M&M conference, but that is exactly the situation I encountered a
few months after my coma. The physicians who had cared for me were
astounded by the high level of my ongoing recovery, and they took
advantage of that apparent miracle to invite me to participate in a
discussion of my unexpected escape from death.
My recovery defied any explanation in medical science. On the morning
that I appeared at the conference, several colleagues shared with me
what a shock it was that I had not only survived (which they had
estimated to be a 2 percent probability by the end of my week in coma),
but that I had seemingly recovered all of my mental function over a few
months — that aspect was truly stunning. No one would have predicted
such a recovery, given the extent of my illness. My neurological
examinations, CT and MRI scans, and laboratory values revealed that my
meningoencephalitis was one of radical — and very lethal — severity. My
initial treatment was confounded by a relatively constant state of
epileptic seizures that proved difficult to stop.
The neurological examination is one of the most important factors in
determining the severity of coma, and can offer some of the best clues
as to the prognosis. By assessing eye movements and pupillary responses
to light, as well as the nature of arm and leg movements in response to
painful stimuli, my doctors determined, as I would have, that my
neocortex, the human part of the brain, was badly damaged even when I
was first brought into the emergency room.
Another crucial factor concerns the quality of verbalization, but I had
none — my only vocalizations were occasional grunts and groans, or
nothing at all. The only exception was when I unexpectedly called out,
"God help me!" while still in the emergency room (I have no memory of
this, but it was reported to me later). Having heard nothing
intelligible from me for hours, close family and friends thought those
words might offer a glimmer of hope — that I might be returning to this
world. But they were the last words uttered before I lapsed into deep
coma.
On day seven of coma, my doctors held a family conference in which they
reiterated that I had been assigned approximately a 10 percent chance of
survival on my initial arrival in the ER, but that that probability had
dwindled to a pathetic 2 percent chance of survival after a week spent
in coma. Much worse than the measly 2 percent probability for survival
was the harsh reality they attached to it, and that was the likelihood
of my actually awakening and having some return of quality to my life.
Their estimate for that possibility was a most disappointing zero
— no chance of recovery to any sort of normal daily routine. A nursing
home was the best-case scenario, albeit a remote possibility.
Of course, my family and friends were devastated by this bleak depiction
of the future. Due to my rapid descent into coma, any physician
realizes the basic impossibility of a complete medical recovery, and yet
that is what happened. I have discovered no cases of any other patients
with my particular diagnosis who then went on to benefit from a
complete recovery.
Toward the end of that morning conference, I was asked if I had any thoughts to share.
"All of this discussion about my case, and the rarity of my recovery,
pales in comparison to what I see as a much deeper question that has
plagued me ever since I opened my eyes in that ICU bed. With such
well-documented decimation of my neocortex, how did I have any
experience at all? Especially such a vibrant and ultrareal odyssey? How
did that possibly happen?"
As I scanned the faces of my colleagues that day, I saw no more than a
dim reflection of my own wonderment. Some might default to the
simplistic assumption that what I had experienced had been nothing more
than a feverish dream or hallucination. But those who had taken care of
me, and those who knew enough neuroscience to understand the
impossibility that such an impaired brain could have even remotely
offered up that extraordinary and detailed complexity of experience,
shared that much deeper sense of mystery. I knew that, ultimately, I
would be responsible for seeking any satisfactory answers. A ready
explanation of my experience wasn't lining up neatly, and I felt
compelled to make better sense of it all.
To read more about Eben's story, and his journey to understand the true nature of consciousness, pick up a copy of Living in a Mindful Universe .
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