Bodies grow normally in a coma

Mystery vegetative state - What does a person experience in a vegetative state?

She is five minutes away from her old life. From the new four months. A car accident divides Melanie Zimmermann's biography into a before and an after.

On September 9, 2017, she said goodbye to her son after the school service. This is her last memory before the accident.

Five minutes later, a young man at the exit of the town turns the steering wheel of his car to the left, starts an overtaking maneuver in a difficult spot and crashes head-on into the oncoming car.

I'm missing four months. The period from September to December is completely gone. No memory.
Author: Melanie Zimmermann, former coma patient

Into the spiritual nowhere

Melanie Zimmermann suffers massive injuries: countless complicated fractures, paralyzed legs and arms, a severe traumatic brain injury.

It falls into a temporal nothingness. «I'm missing four months. The time from September to December is completely gone. No memory, ”says Zimmermann.

During this time, Melanie Zimmermann goes through all phases of spiritual awakening: first from coma to vegetative state, then from minimal state of consciousness to full consciousness.

We still understand little about the states of consciousness after brain injuries.
Author: Margret Hund-Georgiadis, Head Physician Rehab Basel

No memories

For many weeks, the 37-year-old remains mentally stuck in a shadowy realm. The coma-awake period, that transition from coma to minimal consciousness, seems to Zimmermann to be the most puzzling.

This state of waking and sleeping phases, in which those affected remain with their eyes open but without any recognizable consciousness, is still largely not understood by science.

Melanie Zimmermann cannot remember her vegetative state. Even the weeks in which she was able to speak again are gone.

The vegetative state is elusive

Margret Hund-Georgiadis, the head physician at Rehab Basel, puzzles like all coma researchers: “What is the brain doing behind the vegetative state? We still understand so little about the states of consciousness after brain injuries. We are really only at the door. "

While coma patients remain immeasurably unconscious, coma patients have sleep and wake phases. You breathe independently. Some can eat. But they don't show meaningful responses to questions or touch. By definition, they are denied pain and feelings.

But the reality is not that clear. Margret Hund-Georgiadis has doubts. Awareness may already be there in the vegetative state and the previous definition needs to be reconsidered.

What arrives in the brain

At the Rehab Basel, which houses the only vegetative coma station in Switzerland, all patients are tested using an EEG. Electroencephalography measures brain waves.

First of all, the question is whether sensory stimuli even reach the patient's brain. Can he see, can he hear, can he feel pain?

Then the neuroscientists see whether the stimuli are processed further. For example, they make patients hear grammatically incorrect sentences. Patients who recognize the "interfering signal" show a different brain wave pattern than patients who do not process the auditory stimulus any further.

Misdiagnosis with tragic consequences

Knowing this is not only interesting, but existentially important. Recent studies show that more than half of the vegetative coma patients have at least some “hidden internal behavior”. That is good and tragic at the same time. What is there can be promoted. What is overlooked leads to misdiagnosis.

Around every third vegetative coma patient - according to research estimates - is actually not at all. And stunted in the nursing home.

A minimal awareness

Margret Hund-Georgiadis is also sure that there are patients in nursing homes who have been given up too early. People who are at least minimally conscious, feel pain, have feelings. But not being able to make all this noticeable to the outside world.

They are drifting in the depths of a damaged body and brain and are not receiving the therapeutic help they need to latch onto the world around them.

Lure the ghost out of reserve

Therapists and nurses throw out lifebuoys every day and try to bring patients back from this amorphous state of consciousness into the here and now.

Every therapy session, every nursing activity is adapted to the patient's state of consciousness at an adequate pace and in simple words.

On the vegetative coma ward

It's 11 a.m. on a sunny July day. Christof Meiser, head of the vegetative coma station at Rehab Basel, wakes Sandra up.

Sandra is in her mid-twenties. She fell from her horse four months ago and ended up in a coma with a severe traumatic brain injury. Meanwhile her mind is about to leave the vegetative state.

Sandra is somewhere in the land of minimal consciousness. She cannot move by herself, cannot speak, cannot coordinate her eyes.

Understand what is happening

Christof Meiser wakes the patient with a gentle touch and a soft hello. He's looking for her gaze.

Sandra needs time to wake up. She should have the opportunity to understand what is happening to her.

She should at least partially understand that this man in white now wants to turn her on her back from the side position and put her in the wheelchair.

The vegetative coma nurse explains each of his steps. Only in this way does your injured brain have the chance to establish connections between internal and external processes and thus gradually develop an awareness of itself again.

Where does the I begin?

Christof Meiser shakes Sandra lightly over and over again. She should feel that she has a body, where it begins, where it ends, in which position it is currently in space.

The patient is embedded in many small pillows that are moved with every change in position. As much body surface as possible should be in tangible contact with the environment.

A show of strength for everyone

After a long, slow turn on the mattress, Sandra lies across the bed. Meiser raises the bed a bit and lets Sandra slide gently onto the wheelchair. Christof Meiser is now sweating from his forehead. Sandra can hardly hold her head upright anymore.

45 minutes have passed. 45 minutes of hard work for both of them: for Sandra an exhausting brain power, for Christof Meiser a physical show of strength - and sometimes an emotional one too.

Consciousness research is awakening

Philosophers have been concerned about consciousness for centuries. Brain research only recently.

Up until 20 years ago, coma and consciousness research itself was to a certain extent in a comatose state. "And that is expressed very gallantly," says Margret Hund-Georgiadis.

She believes that science did not dare to tackle the subject for so long because philosophy had set the hurdles so high in the course of history.

The physicians and scientists found this consciousness too complex and unfathomable.

More awake than expected

At the end of the last millennium, pioneers such as the Belgian coma researcher Steven Laureys breathed life back into consciousness research.

They suspected that the brain of patients in a vegetative state was more alert than previously thought. Imaging methods should prove the new generation of coma researchers right.

What is a vegetative state?

In 2009, Laureys and his British colleague Adrian Owen pushed people classified as vegetative coma patients into the brain scanner.

They asked the listless patients to imagine they were playing tennis or walking around a house. 5 of the 54 subjects actually showed increased blood flow in typical brain areas.

So they were minimally conscious - and misdiagnosed. Or proof that the vegetative state concept should be rethought.

Where is the consciousness located?

But measuring is one thing. Knowing what one has measured is the other. Critics say: There are processes in the head that run automatically. Completely unconscious. That could apply to playing tennis in your head.

The reaction to incorrect grammar could also be an automatism of a brain that has been familiar with language since early childhood.

Images from the scanner are not photos of consciousness. But they are an approximation of what researchers like Steven Laureys and Margret Hund-Georgiadis suspect behind it: The “I” in the head is created through the concert of nerve cells.

100 billion neurons

Nerve cells need company. They do little on their own. But a lot as a group. Every nerve cell in the brain is in contact with thousands of others and exchanges information with this information.

Perhaps awareness is not as much as we think it is. Maybe it's just a wakefulness and nothing more.
Author: Margret Hund-Georgiadis, Head Physician Rehab Basel

The interconnection of around 100 billion neurons in our brain creates what we call consciousness. If the networks are destroyed by an accident or a stroke, consciousness also falls silent.

What is consciousness

One theory is that there are two networks that mesh and form human consciousness. The external network enables the body and its surroundings to be perceived.

It brings sensory impressions into consciousness. It evokes an implicit self in the here and now. An elementary, existential self-awareness.

The other, the inner network, is evolutionarily younger. It is about itself, about the introspection: Who am I, what do I want?

The inner network maintains our own history, our biography.

The measurement of consciousness

The exact measurement of consciousness is the goal of research. But what does this mean for those patients who are denied consciousness? Who are no longer certified as having treatment potential? These are ethical questions of the future - to which modesty could be an answer today.

Brain researcher Margret Hund-Georgiadis ponders the relativization of what is measured: “We have very philosophical ideas about consciousness. We learned that. ‹I think therefore I am›, for example. But maybe we have to make ourselves very small first. Perhaps awareness is not as much as we think it is. Maybe it's just a wakefulness and nothing more. " But no less either.

As a rule, even those people who find their way back to consciousness are left with impairments. This is also the case with Melanie Zimmermann.

Back to another life

Ten months after the accident, her brain is still tired and quickly exhausted. The energy from before may not come back.

If I have breakfast with the children and prepare the lunch for them, I'll be exhausted and have to lie down.
Author: Melanie Zimmermann, former coma patient

Melanie Zimmermann will be prepared for this when she leaves rehab in a few days and returns home to her husband Patrick, their six-year-old daughter Lea and their nine-year-old son Tim.

Hardly any energy for everyday life

She, who managed so many things before the accident - raising children, the job as an employment agency, her relationship, her friendships, the household - she is preparing for a new life: “At first I thought I would go back to work immediately can go. Now I know: If I have breakfast with the children and prepare the lunch for them, I'll be finished and have to lie down. "

It will be smaller, the new life of Melanie Zimmermann. At least at the beginning. Maybe it will grow back into its former shape.

But it will likely take a new shape. One that is the same as the old one and yet unique.