Awakening the Unresponsive Patient

This article was published by HALO on June 7, 2023

By Julie Grimstad

Julie Grimstad

On the night of January 14, 2023, my 19-year-old grandson Joshua was in a terrible car accident. Fortunate to be alive, he was care-flighted to a trauma center in Fort Worth, Texas. For several weeks, Joshua was unresponsive. After a while, he would open his eyes but there was no sign that he was aware of his surroundings. A neurosurgeon told Josh's father and me that he did not expect Josh to make any further progress!

It was then that Nancy Valko, RN, reminded me of a little book—A Gentle Approach—written by a friend nearly 30 years ago. The author, Jane D. Hoyt, has gone to her eternal reward, but I could hear her voice of experience encouraging me, “Don’t ever give up.” I doubt that this remarkable booklet is still in print. Therefore, I will share with you several of the 38 instructions it contains. (To obtain the entire invaluable list, email feedback@halovoice.org with your request.) These tips for communicating with an unresponsive patient resulted from Jane Hoyt’s years of experience helping semiconscious and presumed comatose people recover consciousness and mobility.

Above all, talk to the person! Keep encouraging the person to respond, no matter what the apparent extent of her or his disability. Some people who appear unconscious are “locked in” – a physical paralysis – but actually aware of their surroundings.

If you suspect that the person may be in a “locked-in” state, ask the person to move his or her eyes upward. (One of the capacities that can survive damage causing the “locked-in” syndrome is the ability to move one’s eyes upward.)

If the person moves in any way, try to document what was happening prior to the activity. For example: “John startled and turned to the left when the door to the left slammed shut at 6:16 p.m., 7/12/94.” Speculate about what stimulus leads to what response. If possible, repeat a stimulus that appears to produce a response.

Gently and repeatedly remind the person of his or her value to you no matter what the anticipated extent of recovery.

If the person seems just to stare, position your face—or whatever should be the center of attention—exactly where the person’s eyes seem to be looking.

In the patient’s room, display photographs of him or her prior to hospitalization, but take special care to avoid depressing comparisons. Bring pictures of family and close friends to show the person whenever her or his eyes are open. Hold the picture about one foot from the person’s face and slowly move the picture a few inches to each side in case his visual field is impaired.

When leaving, no matter for how long, never say “Good-bye” since that has a ring of finality to it. Instead say, “I’ll see you __________” (giving your best guess as to when you’ll be back), or “I’m not sure when I can return, but do remember I’ll be with you in thought all the time,” or “I’ll be back at six. That’s in three hours. Then you and I can watch the news together.”

Hopefully, you will never need these instructions but if you do, remember, “Don’t ever give up!”

Joshua is now fully aware, learning to speak again, and slowly gaining command of his limbs. Thanks be to God, to all the therapists who have helped Josh, to his family and friends who never gave up, and to everyone who prayed and is still praying for Josh’s full recovery.