The long read: After suffering serious brain traumata, Scott Routley spent 12 years in a vegetative state. But his family were convinced that he was still aware could a pioneering mind-reading technique prove them right?
On 20 December 1999, a young man pulled away in his vehicle from his grandfather’s house in Sarnia, Ontario, with his girlfriend in the passenger seat beside him. Scott Routley, who was 26, had studied physics at the University of Waterloo and had a promising career in robotics ahead of him. But at an intersection just a few blocks from his grandfather’s house, a police car travelling to the scene of a crime crashed into the side of Scott’s car, hitting the driver’s side full on. The police officer and Scott’s girlfriend were taken to the hospital with minor injuries. Scott wasn’t so lucky; his injuries were devastating.
Scott was admitted to hospital, and within hours his rating on the Glasgow coma scale- a neurological scale the above measures a person’s conscious nation- was rapidly dropping. The lowest score possible is three, indicating “does not open eyes”, ” constructs no sounds” and” stimulates no motions “. The highest rating, 15, indicates that you are fully awake, conversing ordinarily and obeying commands. Scott was already a four, merely one step away from complete shutdown. Despite no outward signs of head or facial injury, the impact of the police car with the side of Scott’s car had slammed his brain against the inside of his skull, squeezing it into herniation and bruising it badly.
I heard about Scott 12 years later, soon after arriving in London, Ontario, where I operate a lab that studies acute brain injuries and neurodegenerative illness.” His household are persuaded he is aware, but we have ensure no signs of it, and we’ve been find him for years !” Scott’s doctor told me.
When I took a look at Scott, he certainly seemed vegetative to me. But I needed an expert second opinion, so I called Prof Bryan Young, a senior neurologist in the area. Bryan had been assuring Scott regularly since his accident 12 years earlier, and had an international reputation for meticulous and careful assessment of patients. If he supposed Scott was vegetative, then I knew chances were that he was.
I told Bryan that I was thinking of putting Scott into a functional magnetic resonance imaging scanner( fMRI ), and he agreed that this was a good notion. This remarkable technology, developed for use in humans in the early 1990 s, allows us to detect brain activity associated with thoughts, feelings and intents. More active the sectors of the brain receive more oxygenated blood, and the fMRI scanner can detect this and pinpoint where the activity is happen. This allows us to see when a person is conscious and their brain is working commonly, even when outward appearances suggest they are in a zombie-like state, unaware of the world around them. We have come to refer to such people as inhabiting the “grey zone”, a realm of consciousness that lies somewhere between life and death.
In recent years, thanks to the invention of fMRI, we have induced extraordinary breakthroughs in understanding the mental life of people trapped in the grey zone. We have discovered that 15% to 20% of people in the vegetative nation, who are widely assumed to have no more awareness than a head of broccoli, are in fact fully conscious, even though they never respond to any form of external stimulation. They may open their eyes, grunt and groan, and occasionally utter isolated words. They appear to live entirely in their own world, devoid of thoughts or feelings. Many genuinely are as oblivious and incapable of thought as their doctors believe. But a sizeable number are experiencing something quite different: intact minds adrift deep within damaged bodies and brains. We have even figured out how to communicate directly with such people.
I set off to Parkwood hospital, a long-term care facility in southern Ontario, to assess Scott more thoroughly. In a quiet room off the ward where Scott was staying, a nurse introduced us to his parents, Anne and Jim. Anne, who had worked as a lab technologist, “ve been given” work on the day of Scott’s accident. Her spouse, Jim, was a former banker and trucker. They were clearly devoted to Scott and his life, such as it was, post-injury. Jim and Anne told us that they believed Scott, who loved listening to music from The Phantom of the Opera and Les Miserables, was responding to them, despite his diagnosis:” His face is expressive ,” Anne insisted.” He blinks. He does thumbs up for positives .”
Given Bryan’s multiple evaluations over the years, coupled with our own assessment of Scott’s condition, this was curious indeed. We couldn’t attain Scott do a thumbs-up , no matter how hard we tried. I checked his official medical history. Neither Bryan nor any of the other doctors who had examined Scott over the years had indicated that he could do a thumbs-up since his injury.
Nevertheless, his family were adamant: Scott was responsive, and therefore Scott was aware.
Curious as it was, I had seen this scenario many times over the years. A household is convinced the person they love is aware, despite the absence of any clinical proof to supporting this. One consequence of the brutality and abruptness of most serious brain traumata is that the doctor who assesses the patient- usually a trained neurologist- has generally not met the person in his or her former, healthy life. All the doctors know of the patients is what they see after the accidents. The household has the benefit of years of experience, a much more complete picture of the person within. Households also typically expend a lot more time with the patient after the accident. Neurologists, like all physicians, are busy and have a heap of clinical commitments and patients. That limits how much period they can devote to any one person. By contrast, many family members sit at the bedside for hour after hour, day after day, clutching to the faintest glimmer of hope, watching for the tiniest sign of awareness. It’s natural that if it is there, they will be the first to see it.
But all that time, effort and hoping is also sure to fuel wishful thinking. We are all awfully susceptible to what psychologists bellow verification bias. We tend to search for, interpret, favour and recall information in a way that corroborates our pre-existing beliefs. If the person you love most is lying beside you in a hospital bed, their life hanging by a thread, you desperately want them to pull through. And you urgently want them to know you’re there. You ask them to squeeze your hand if they can hear you- and it happens! You feel a distinct increased number of pressure as their hand gently squeezes yours. Your immediate reaction? They did what you asked, they responded, they’re aware! It’s a perfectly natural, but regrettably not scientific, response. Science demands reproducibility.
Read more: www.theguardian.com