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Unfortunately, I have participated in chronic pain groups where I have witnessed unprofessional behavior from physicians. Most RNs have also witnessed similar behavior. There are diagnoses in medicine that are known as *wastebasket diagnoses*. These are what are pulled out and presented when the physicians really just don't know, but the patient and the family demand something concrete. I am beginning to think that various descriptions of cognitive states may be this sort of diagnoses.

If a patient can produce any response demonstrating cognition in response to any stiumulus, with a frequency above chance, the patient is not PVS. In some cases on non-PVS patients, identifying a stimulus and response may take a very long time and yet be unmistakable once found.

As a hypothetical examine, imagine a patient with almost no sensory abilities except the left pinkie and no motor abilities except breathing. Such a patient might easily be diagnosed PVS, but suppose a doctor tapped his pinkie and the person took an unusually quick breath, then paused, and then resumed normal breathing. Possibly reflex. Suppose the doctor taps the pinkie three times and the patient responds shortly thereafter by taking three quick breaths, pausing, and resuming normal breathing. Suppose this is tried with two taps, and five taps, and four taps, yielding similar results. Such a finding would prove the patient not to be PVS.

What a diagnosis of PVS really means, quite simply, is that the person making the evaluation has given up on finding any stimulus/response combination that would demonstrate cognition and disprove the diagnosis. Based on the amount of time spent examining Terri, it's clear Michael's doctors didn't try very hard.