In her 30 years of nursing, Nancy Valko brought so many patients out of comas that other nurses started asking if she was a witch.
But Valko, president of Missouri Nurses for Life and spokeswoman for the National Association of Pro-Life Nurses, said that her methods were simple: talking to the patients, playing their favorite music, making simple requests.
Valko recounted, "I used to get teased for talking to comatose patients. I was even asked if I talked to my refrigerator."
But her talk got results: One day, a 17-year-old boy came to the hospital in a deep coma. The neurosurgeon on duty said, "He won't live until morning and it's a good thing, because he'd be a vegetable."
The boy lived, and soon he could even move at the nurses' request -- but he would never respond when the neurosurgeon was present.
Eventually he was released, and Valko never expected to see him again. But one day a handsome young man walked into the ward and said, "Do you remember me?"
The 17-year-old had come back to thank them for saving his life. When Valko mentioned the neurosurgeon, she recalled, "He got very serious." The boy said, "I remember him calling me a vegetable. I wouldn't move for him."
Valko‚s experience is not unique. Dr. Mihai Dimancescu, a Long Island neurosurgeon who has worked with many patients in comas, noted a growing "recognition that people who have some kind of a brain injury, even if they're in a coma for several weeks, do have the potential for recovery. A lot of hospitals are more aggressive in the early days of treatment, particularly the university hospitals and some of the larger community hospitals."
Although Dimancescu stressed that no technique was at all certain, he explained that new knowledge of the brain has shown that "new connections can be made between brain cells where connections have been lost. Parts of the brain can take over the function of other parts that have been lost."
And the techniques are improving constantly. Paulette Demato, program coordinator for the New York-based Coma Recovery Association, said that a flu medication called amantadine has had a few successes. One woman in New Mexico was given amantadine as a routine flu treatment and awoke from a 16-year-long coma, Demato said (see sidebar).
These treatments are rare and uncertain. But bigger hospitals are starting to change the basic way they treat comatose patients.
In the smaller hospitals, though, many doctors and patient advocates say that the financial pressures of managed care lead doctors to push for withdrawal of costly treatments.
And even doctors can be misinformed about coma recovery.
Demato said, "Particularly with older patients, the medical community will say, 'They're not going to wake up, and they've already lived their lives', so how about we disconnect them from all the machinery?"
She added that families are often "not given the opportunity to wait and see what happens. Very often the medical community will try to force a family's hand and convince the family to cut off care."
Dimancescu warned that patients in comas may not get proper nutrition or treatment for infections because they have been, in essence, written off by the medical staff.
Pope John Paul II stressed that withdrawal of nutrition and routine medical care is morally unacceptable during his Oct. 2, 1998, ad limina meeting with bishops from California, Nevada and Hawaii. "As ecumenical witness in defense of life develops, a great teaching effort is needed to clarify the substantive moral difference between discontinuing medical procedures that may be burdensome, dangerous or disproportionate to the expected outcome, and taking away the ordinary means of preserving life such as feeding, hydration and normal medical care," the Pope said.
Valko said that she had seen an 84-year-old woman recover after her doctor and family almost decided to withdraw feeding. "We brought her all the way back," Valko said. "She was feeding herself Jell-O with a spoon. We taught her how to flirt."
Valko noted, "That was a woman who was supposedly totally gone; in fact, she was marked for no feeding."
Valko said that some patients are unresponsive because they are "a little like turtles. They withdraw, out of fright."
But Joanne Lynn, president of Americans for Better Care for the Dying, said that anyone "in coma long enough to have been treated with some vigor" was so unlikely to recover that an awakening would be in "the range of the miraculous."
"On the average, the error is to hang on too long and put families through too much," Lynn said. She said that someone who had been in a coma for "a few weeks or a month or two" was extremely unlikely to recover, and that families should act accordingly. She compared dramatic coma-recovery stories to "tales of people who awake from the dead. We do not wait three days before we bury people."
But neurosurgeon Dimancescu argued that "misconception number one" about patients in comas was the belief that "once somebody's been in a coma for a week or more the situation is irreversible."
He added, "A lot of people are diagnosed in a coma when they're not. They do understand some things." He urged doctors to "look for a response in an unusual way: eye-blinks, one for yes, two for no; or they might be able to respond by moving a finger."
He stressed that people in comas may be able to hear: "The last thing to go is the hearing, and the first thing to come back is the hearing. What one has to do is try to be imaginative. Put yourself in the position of somebody who's had a severe insult to the brain, in a hospital bed, probably very frightened."
Dimancescu said that some people are skeptical of coma stimulation because they "believe that stimulation and therapy is recommended ad infinitum, no matter what the person's progress is. That would be a waste of resources and create false hopes in the family." In practice, he said, intense care was "usually recommended for about three months."
He added that doctors‚ predictions were often wrong -- patients who did not seem badly injured might never recover, but patients with greater injuries could awaken.
Valko summed it up: "We don't know as much as we think we do, doctors and nurses."