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'Preservation instinct'

What's also confusing is that many purely reflexive actions might be misinterpreted as conscious behaviors, said Dr. Ira Goodman, chief of neurology for Orlando Regional Healthcare.

"People in a vegetative state can look awake and alert," Goodman said. "They actually move their limbs; they can follow you [with their eyes] when you're moving around the room. They close their eyes at night and go to sleep. But there's absolutely no awareness there."

This is because when blood flow to the brain is interrupted, cells in the areas responsible for higher thinking are most vulnerable and die first. Cells deep within the brain -- in the area called the brain stem -- are more resilient to temporary interruptions in blood flow. The brain stem can emerge intact from such incidents.

Because the stem controls involuntary functions such as breathing and eye movement, a person without higher-thinking abilities can still track people or objects with their eyes, groan, move limbs in response to touch or even smile and grimace. Gebel said it is all part of the "preservation instinct" ingrained in human biology.

"If you need to be able to respond to a tiger jumping out of the bushes, you just want your eyes to pick up the movement," Gebel said. "That's all someone in a vegetative state is doing -- following the light or responding to the sound."

When researchers have removed most of a monkey's brain and left the stem intact, the animals maintain cycles of sleep and wakefulness, respond to light or noise and track objects with their eyes, said Dr. Walter G. Bradley, chairman of the neurology department at the University of Miami School of Medicine.

He has seen snippets of a video made by Schiavo's parents in which the woman appears to focus on her mother's face and smile as her mom touches her cheek.

"The smiling is perhaps the most evocative aspect of the [video], but the reflex smile that I saw was associated with face-touching," Bradley said. "That's the sort of thing that can easily be explained by reflex."

'A black hole'

Last October, five physicians examined Schiavo as part of the legal proceedings.

In summarizing their findings, the 2nd District Court of Appeal said: "Although the physicians are not in complete agreement concerning the extent of Mrs. Schiavo's brain damage, they all agree that the brain scans show extensive permanent damage to her brain. The only debate between the doctors is whether she has a small amount of isolated living tissue in her cerebral cortex or whether she has no living tissue in her cerebral cortex."

The doctor appointed by Circuit Judge George W. Greer was Peter Bambakidis, a board-certified neurologist at the Cleveland Clinic Foundation. According to court records, he said Schiavo's CT scans show "such a profound loss of tissue" that the "normal brain cortex has become lost. It's not there anymore."

One of Michael Schiavo's doctors, Ron Cranford, a neurologist at Hennepin County Medical Center in Minnesota, said her brain scans showed "massive" atrophy of the cerebral hemisphere "compatible with severe irreversible brain damage."

"There is hardly any cerebral cortex left," Cranford said. "It looks like a black hole."

rsuriano@orlandosentinel.com

Our technological ability to sustain human biological functions will soon far outstrip our ability to die a natural death. Indeed, they already do.

But I've also heard that even plants respond to love. But no tubes for me. I don't fear death and there are some things worse then death. I would not wish to live in Terris condition. Some might.

But of this used to be no ones buisness but my doctor, my wifes and mine. Now it's hers mine and the states buisness, it seems.

I live here in Pinellas Co. and have followed this story from the beginning. The story has been hyped all out of shape to the extent that I won't even try to reply to emotional tirades and accusations that fly around on these threads...

"People in a vegetative state can look awake and alert," Goodman said. "They actually move their limbs; they can follow you [with their eyes] when you're moving around the room. They close their eyes at night and go to sleep. But there's absolutely no awareness there."

Apparently Doctor Goodman is not aware of that the National Institute of Neurological Disorders and Stroke doesn't agree with him. The man lacks 'full awareness' as described below.

Coma and Persistent Vegetative State
A coma is a profound or deep state of unconsciousness. The affected individual is alive but is not able to react or respond to life around him/her. Coma may occur as an expected progression or complication of an underlying illness, or as a result of an event such as head trauma.
A persistent vegetative state, which sometimes follows a coma, refers to a condition in which individuals have lost cognitive neurological function and awareness of the environment but retain noncognitive function and a perserved sleep-wake cycle.
It is sometimes described as when a person is technically alive, but his/her brain is dead. However, that description is not completely accurate. In persistent vegetative state the individual loses the higher cerebral powers of the brain, but the functions of the brainstem, such as respiration (breathing) and circulation, remain relatively intact. Spontaneous movements may occur and the eyes may open in response to external stimuli, but the patient does not speak or obey commands. Patients in a vegetative state may appear somewhat normal. They may occasionally grimace, cry, or laugh.
Is there any treatment? Once the patient is out of immediate danger, although still in coma or vegetative state, the medical care team will concentrate on preventing infections and maintaining the patient's physical state as much as possible. Such maintenance includes preventing pneumonia and bed sores and providing balanced nutrition. Physical therapy may also be used to prevent contractures (permanent muscular contractions) and orthopedic deformities that would limit recovery for the patients who emerge from coma.
What is the prognosis? The outcome for coma and vegetative state depends on the cause and on the location, severity, and extent of neurological damage: outcomes range from recovery to death. People may emerge from a coma with a combination of physical, intellectual, and psychological difficulties that need special attention. Recovery usually occurs gradually, with patients acquiring more and more ability to respond. Some patients never progress beyond very basic responses, but many recover full awareness. Patients recovering from coma require close medical supervision. A coma rarely lasts more than 2 to 4 weeks. Some patients may regain a degree of awareness after vegetative state. Others may remain in a vegetative state for years or even decades. The most common cause of death for a person in a vegetative state is infection such as pneumonia.
Information provided by the National Institute of Neurological Disorders and Stroke, National Institutes of Health
Article Created: 1999-03-14 Article Updated: 0000-00-00
© 2003 Medical College of Wisconsin

All references to awareness are speaking of 'awareness of the environment'. The medical definitions of awareness don't speak of self awareness in a patient who is unable to respond to the environment because it can't be communicated. Some coma patients recover 'full awareness' these doctors say. If there is 'absolutely no awareness' as Dr. Goodman states then there would be no possibility of recovering any awareness much less 'full awareness.'

Terri doesn't just follow people and objects with her eyes she turns her head as well. She doesn't simply grunt she attempts to verbalize and in the past, before therapy and visitations were prohibited, she clearly spoke words to family and nurses. There are multiple affadavits that attest to that. There are audio visual tapes that have recorded it. Words are not a product of reflex motor activity they are products of complicated cognitive funtions that result from sophisticated coordination of thought and motor skills. But don't take my word for it let's look at what Sara Green Mele, MS, CCC-SLP says about it. For brevity I will edit it. Go to the link for the full affadavit.

Posted: August 2, 2003 1:00 a.m. Eastern
© 2003 WorldNetDaily.com
AFFIDAVIT
STATE OF ILLINOIS
COUNTY OF COOK
BEFORE ME the undersigned authority personally appeared Sara Green Mele, MS, CCC-SLP, who being first duly sworn, deposes and says:
1. My name is Sara Green Mele, and I have been engaged in the continuous private practice of speech-language pathology since 1996, and have served on the staff of the Rehabilitation Institute of Chicago from 1996 to 1999 and from 2001 to the present. Prior to that I practiced cognitive therapy at Baylor Institute for Rehabilitation in Dallas Texas. In both settings I worked with the broad range of brain injured populations. The Rehabilitation Institute of Chicago is affiliated with Northwestern University Feinberg School of Medicine, and is recognized in the United States rehabilitation community as the top facility in the United States. The Baylor Institute for Rehabilitation is affiliated with Baylor University Medical Center, and is recognized in the United States rehabilitation community as one of the top ten facilities in the United States. I am a clinical lecturer at Northwestern University Feinberg School of Medicine, and lecture for continuing medical education credits (CME) through the Rehabilitation Institute's continuing education program as well as at national conferences. In April of this year I participated in the presention of a two-day head injury course entitled Interdisciplinary Rehabilitation Management in Traumatic Brain Injury to over two hundred health professionals in Tampa, Florida. My full curriculum vitae is attached.
2. In my practice, I treat many patients who have had diffuse brain injury, both anoxic and hypoxic, and I am familiar with states of impairment known as coma, coma-like, minimally conscious and persistent vegetative state. I regularly participate in the evaluation and cognitive/linguistic diagnosis of patients whose differential diagnosis include such conditions. In connection with my practice of speech-language pathology, I also evaluate patients, and train others in the evaluation of patients for swallowing function. During my career as a speech-language pathologist, I have personally treated approximately thirty patients similar to Terri Schiavo.
3. In evaluating patients for rehabilitation, the Rehabilitation Institute of Chicago does not track the diagnosis of patients by their referring caregivers, but rather evaluates them for itself because the misdiagnosis rate is so high.
4. While I have not physically examined Terri Schiavo, I have looked at her medical records at MediPlex covering the period from January to July of 1991, including physical therapy, speech and language therapy, and occupational therapy. Also, I have studied the video clips presented at the October 2002 Medical Evidentiary Hearing, along with audio recordings of Terri Schiavo interacting with her father in November of 2002. The observations that follow are all within the parameters of speech-language pathology, and are similar to the observations that I am called upon to make regularly in the course of treating patients as a speech-language pathologist. All conclusions are based on standards used in the speech-pathology profession in the treatment of patients such as Theresa Schiavo.
5. Based on my experience and my observations, Mrs. Schiavo is clearly aware of her environment and interacts with it, albeit inconsistently. She is able to comprehend spoken language, and can, at least inconsistently, follow simple one-step commands. This is documented both in the MediPlex records and in the following behaviors noted in the following video segments:
[edited a lot out here]
10. It is not my opinion that Mrs. Schiavo is in a coma or in a persistent vegetative state. In my opinion, she exhibits purposeful though inconsistent reactions to her environment, particularly her family. Her eye movements, easily observed on the videotape, are particularly suggestive that she recognized family members and responded. She also appeared to have sufficient sustained attention to track a balloon. It is not my opinion that these behaviors are merely reflexive. The entire range of behaviors listed above, and each and every one of them, are inconsistent with a diagnosis of persistent vegetative state.
11. Even without the benefit of any medical treatment which successfully improves this patient's organic medical condition or cognitive abilities, in my opinion Terri would benefit from speech-language therapy, physical therapy and occupational/recreational therapy. Her ability to interact with her environment and her ability to communicate can be enhanced. Her quality of life can be significantly enhanced.
[more edited out]
14. It is my judgement based on my training and clinical experience working with patients similar to Terri that she would, within a reasonable degree of clinical probability, be able to improve her ability to interact with her environment, communicate with others, and control her environment if she were given appropriate therapy and training as outlined above. These recommendations, in my opinion, would greatly improve Terri's quality of life.
FURTHER AFFIANT SAYETH NAUGHT.
Sara Green Mele, MS, CCC-SLP