Melida

A teenage driver, preoccupied with the test she's about to take, suddenly slams on the brakes; a squirrel has just crossed her path. Across town, a young man, training for an upcoming triathlon, sees a car streak toward him in his peripheral vision. A babysitter, turning for the few moments it takes to scroll through the messages on her cell phone, too late sees the van swing into the driveway where her preschool charge has chased after a ball. Three accidents ensue. Three people are raced to nearby hospitals. Three patients lapse into comas. And three lives are profoundly changed.

A severe blow to the head, caused by an accident, fall, or other injury, may result in a coma. Other extreme insults to the brain, such as drug or alcohol overdose, infection of the brain, strokes, seizures, and lack of oxygen can also give rise to comas.

The comatose patient is in a state of unconsciousness brought on by trauma to the brain. He is not responsive to the people and activities around him. He cannot be aroused, even by pain, though he appears to be in a deep sleep.

In general, most people who lapse into comas come out of them within a few weeks. Others, however, never fully emerge. Some patients have remained comatose for years, surviving only with the help of others for their most basic of needs. This condition is referred to as a persistent vegetative state. A patient in this state is able to breathe on his own, experience normal sleep patterns, move his limbs and sometimes even smile or cry. However, due to damage to the cognitive centers of his brain, he cannot think or reason.

Television and movies generally portray a victim emerging from a coma alert and able to communicate coherently with family and friends. The reality of coma recovery, however, is far different. Most people emerge from a coma in stages that range from total unresponsiveness to confusion to full awareness and functionality.

Two standardized methods are used to assess the stages coma patients pass through. One of these is the Glasgow Coma Scale, used to evaluate eye-opening, verbal responses, and movement. A score from three (signifying a severe brain injury) to fifteen (signifying a mild brain injury) is assigned to each of these areas.

The Rancho Los Amigos Scale is a more detailed guide with eight levels to measure a patients progress. With this tool, physicians are able to track a patients recovery from a coma beginning with no response at all to stimulation. After this come three states of confused responses to the patients environment. In the last stage, a patient is able to respond purposefully and appropriately to people and happenings around him. At this level, a patient is both alert and able to manage everyday life, though he may still struggle with social, intellectual, and emotional deficiencies. His response to stress may also cause continuing problems.

Many coma patients require therapy to relearn basic tasks of life and to overcome physical, behavioral and cognitive difficulties.

Lisa Clark is a freelance writer. Her fictional short stories include one featuring a locked-in patient as the main character. She has also the author of various factual articles. She is currently working on a novel.