Chinese man awakens after 5 years of coma. His wife provided total and loving care.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

A Chinese man, Li Zhihua from Xiangyang in Hubei Province, woke up from a 5 year Coma thanks to his wife literally caring for him night and day. 

Tracy You reported on August 22 for the Mailonline:

According to reports, Mr Li was knocked down by a motorbike in August, 2013, while riding a scooter to work.

Describing his condition, Dr Wan Qing'an told reporters: 'When he was taken to the hospital, he was in a vegetative state. He could not respond to anything.'

His wife, 57-year-old Zhang Guihuan, recalled: 'The doctor told me it was possible that he would be in a persistent vegetative state.'

She said she was not willing to accept the diagnosis and wanted to prove the doctors wrong.

According to the article, his loving wife was persistent.

Day in day out, the determined spouse stayed next to Mr Li's bed to chat with him and play his favourite songs, hoping his condition would improve.

'These things were very helpful to stimulate his nervous system,' Dr Wan said.

The strong-willed woman slept only two to three hours a day and looked after Mr Li in every aspect possible. As a result, she lost 10 kilograms (22 pounds) during the course.

Ms Zhang said in order to feed her husband, she had to carefully put food into his month and then gently pressed his tongue to let him know that he could eat.

Mr Li miraculously regained his conscious last year. 

This story shows how love can lead someone to provide care. In this case, her care enabled her husband to recover.

This case also shows how providing stimulation and care may lead to someone recovering from a head injury.
 
In 2004 I attended a conference on Persistent Vegetative State whereby a doctor who ran an "awakening center" spoke about what they did to have such a high success rate in awakening patients in coma.

Ontario man in "vegetative state" woke up.

Alex Schadenberg

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

People who are diagnosed as being in a “vegetative state” (PVS) are often warehoused in institutions. After a period of time a decision is often made to withdraw all treatment including the withdrawal of fluids and food to dehydrate the person to death.

A few years ago I attended a European conference where presentations were made by physicians who operate medical treatment facilities to awaken patients through stimulation, known as awakening centers. The treatment stimulates the body to activate the brain and help it to heal.

The story of Juan Torres, from Oakville Ontario, is significant. Torres awakened from a PVS state and improved beyond expectations. 

Juan Torres with his parents.

An article by Kate Lunau published by MacLean's Magazine (December 31, 2015) tells the story:

“I don’t really know what happened,” Juan Torres, a 21-year-old from the Toronto suburb of Oakville, tells Maclean’s. “But, one day, I just woke up.” 

That Torres is speaking at all is astounding. Early one morning in July 2013, Torres, then 19, was discovered by his mother, face-down and unconscious on his bedroom floor, after choking on vomit in the night. He was left profoundly brain-damaged, and his doctors diagnosed him as vegetative: unable to speak, to eat, to deliberately control his movements, to follow basic commands. Vegetative patients retain their reflexes, and might grind their teeth or grimace; their eyes rove about the room but won’t fix on anything. They don’t demonstrate a glimmer of consciousness and can live that way for years, spending their days in hospitals, long-term-care facilities, or at home, unless families decide to end life support. The doctors who treated Torres didn’t think he’d be any different; they expected his status to be permanent, his mother says.

But Torres life changed:

Today—contrary to expectations—Torres is back home with his family. He gets around in a wheelchair; supported by his parents, he can take halting steps forward. In September, he started the general arts and science program at Oakville’s Sheridan College.

If all this wasn’t unexpected enough, there’s something else about Juan Torres that has left neuroscientists stunned. Not only did he recover, but he claims to remember what happened while he was clinically vegetative—and he has memories to prove it. In those hazy months before anyone knew he was aware, Torres says he remembers a doctor telling him to squeeze his hand, even though he couldn’t. He remembers being asked to “follow a tennis ball” with his eyes. Scientists have tested his memories, asking Torres to identify a set of faces and objects he encountered while technically “vegetative.” And he was able to do it. “I felt sad, because I couldn’t communicate with my family,” Torres says. He felt scared and “emasculated” at his inability to respond to the doctor’s cues and commands. For Torres, it was a nightmare. “I felt trapped in my own body,” he says. “I couldn’t talk. I couldn’t react.” It was like being half-asleep and frozen, he says, unable to respond.

Adrian Owen (center)

Adrian Owen, who researches communicating with people diagnosed as PVS considers Torres case as “mind-blowing”

“His case is mind-blowing,” says Adrian Owen, a British neuroscientist at Western University who has been investigating one of the most mysterious, least understood phenomena: human consciousness. It’s often said that the brain is the most complex structure in the known universe. Torres’s case shows us how much we’ve yet to understand: the fact that he was creating memories suggests he wasn’t unconscious at all, despite his doctors’ best diagnosis. “It tells us there really was a person there,” Owen says, “and that person was experiencing the world.”

Vegetative patients have not been a high priority for researchers, some of whom doubtless see them as a “lost cause.” It’s hard even to say how many people live this way, or to compare their outcomes. The vegetative state can arise from all sorts of mishaps that lead to brain injury, from a car accident or stroke, to drowning, choking, a sports or military accident. There doesn’t seem to be much consensus on their treatment, either. ...

Owen believes that Torres case is unique, but the question is, how many people are misdiagnosed?

All neuroscientists, including Owen, agree that many—probably most—of the patients diagnosed as “vegetative” truly are so, with no hope of recovery. Certainly, the vast majority will never recover like Torres: there’s no doubt that this young man is an extraordinary case. “I’ve seen hundreds of patients over almost 20 years and he is completely unique,” Owen says. But the issue is, are we misdiagnosing a subset of patients as “vegetative,” and leaving these people to languish? It’s a chilling suggestion.

Torres tells Lunau: “Don’t count me out of the fight just because I’m in bed.” Lunau explains what happened to Torres:

Torres came home around midnight, chatted with his dad and ate some salad—his father didn’t notice anything unusual in his behaviour—before going to bed. Early the next morning, Perez awoke to strange noises coming from his room. At first she thought it was the dogs. She discovered her son lying on the floor in a puddle, in respiratory arrest. How long he’d gone without oxygen is impossible to say. She performed CPR, and her daughter, Laura, called 911. “At the hospital, they said, ‘Hold his hand, because he’s leaving us,’ ” Perez recalls. Her voice falters as she’s overcome by the memory. “They said he was going to die that day.”

The period that followed was devastating, a blur. Both Perez and her husband, Jorge Javier Torres, took several months off work, staying by their son’s hospital bed day and night. ...As the shock wore off, Perez and her husband started researching how to help Torres. “You cannot leave a boy that young,” Perez says. “Not alive, not dead; just lying there. Wouldn’t you try anything?”

They discovered hyperbaric oxygen therapy, in which patients breathe pure oxygen inside a pressurized chamber. HBOT, as it’s informally called, is offered at hospitals and clinics across Canada; it’s approved to treat a range of conditions, such as decompression sickness, air or gas embolism, and carbon monoxide poisoning, but not brain injury. ...

Juan Torres’s parents had no idea whether it would benefit him, but they were desperate to try anything. So they signed him out of the hospital in Oakville on a series of day passes—itself a tricky endeavour, given all the equipment supporting him, including a feeding tube, IV and catheter—and took him by special medical transport to regular HBOT sessions at a private clinic in nearby Mississauga, Ont. ...

Hyperbaric oxygen was just part of their regimen. Torres’s parents assembled a collection of items they’d use to stimulate him daily: flashcards with “colours, words, pictures of the dogs, pictures of family members,” Perez says. She’d rub sandpaper and feathers along his toes. She’d bring in coffee beans to waft under his nose. “I remember that,” Torres says, as his mother tells the story, “the smells, like lemon, mint and hot sauce.” (They used Tabasco.) Once in a while, family members were sure they saw him respond. “The doctors would say, ‘Yes, but it’s just a reflex,’ ” Perez recalls. “It was difficult to keep hope, because there were so many days when you don’t see any signs.”

About a month into their new reality, Juan Torres’s parents took him to a little garden outside the hospital to get some fresh air. He was in a portable hospital bed, unable to sit up. “We put him in the nice sun, and started to massage him,” Perez says. “I was talking about how white he was getting.” His fair complexion has always been a running joke with his family members, who call him Snow White. “We are all kind of tan, and he’s the only one with white skin,” Perez says. Torres was “unconscious,” she continues, but he started laughing along at the joke.

They immediately reported this to doctors, who, once again, deemed it a reflex. “I couldn’t believe it. We were talking, it wasn’t random,” says Perez. Even so, vegetative patients do show automatic responses that can confuse and alarm loved ones. It’s not unusual for family members to interpret these as signs of consciousness, when it could just be wishful thinking. “I started to wonder if I was seeing something that wasn’t there,” Perez says.

Researchers, working with Adrian Owen's became involved with Torres.

In late August, Laura Gonzalez-Lara, research coordinator with Adrian Owen’s lab at Western, travelled to Oakville to examine Juan Torres. She’d heard about the young man from a hospital worker involved in his treatment. “He came out completely vegetative,” she says. “There were no signs of awareness, beyond some reflexive behaviour. It was actually pretty low,” she adds, “even for our vegetative-state patients.” A month later, he was brought to London, Ont., for further assessment, including with a functional magnetic resonance imaging (fMRI) machine, which measures and maps brain activity. Although the fMRI tests were inconclusive (Torres moved too much in the scanner), “we assessed him [behaviourally] several times that week,” says Damian Cruse, a former research scientist in Owen’s lab who is now a lecturer in psychology at the University of Birmingham. “Every time, he fulfilled the criteria for vegetative state.”

The family didn't give up.

Not long after, on Thanksgiving, Torres’s family brought him home for a day visit, his first since leaving in an ambulance three months before. As his parents carefully wheeled him into the backyard, the family dogs, Yogi and Cindy, came bounding out to greet him. His father, somehow intuiting on behalf of his son, grabbed a dog whistle and stuck it between Torres’s lips. And Torres did what no one had thought possible: He started to blow.

Not long after, the team at Western phoned Perez. “As we were explaining the results,” Gonzalez-Lara says, telling Perez that tests indicated her son was clinically vegetative, “she told us, well, he just started talking.” Soon after Thanksgiving, Torres had begun mouthing words, then whispering. He gradually regained his voice. That November, he was discharged from hospital and sent to a rehabilitation centre.

Torres went back to London Ontario where they began to test his memory of being PVS.

In May 2014, six months after Torres started speaking, Owen and his team brought him back to the lab. “There was a fair amount of disbelief,” says Cruse. “Everyone agreed it would be a good idea to test his memory, but is he really going to remember the faces of people he met six months ago?”

They showed Torres photos of people he’d met on his initial visit, when he was still clinically vegetative, mixed in with photos of others who looked similar, but whom he’d never encountered. They did the same with objects, including two hand mirrors, one framed in red, the other in white. Torres correctly identified all five faces, and three of the four objects. (Findings will be published in a future scientific paper.) Seeing a photo of Laura Gonzalez-Lara, the research coordinator whom he’d met while vegetative, he said: “That’s Laura.” About another person, he said, “I recognize her nose.” And in still another example, he described the voice of a person he’d met as “deep and monotonous,” a description so bang-on, it made the others laugh.

Recovery among vegetative patients is so rare, But Owen's research does conclude that some people who are diagnosed as “vegetative” are not. The article states:

The more patients he scans, the more he discovers about the wide variety who are labelled “vegetative”—and the possibility that some aren’t vegetative at all. Shortly after being recruited to Western in 2010 (Owen holds the Canada Excellence Research Chair in cognitive neuroscience and imaging), he met Scott Routley, who had been in a car accident 12 years before that left him in a vegetative state. In a brain scanner, Routley could answer “yes” and “no” by activating parts of his brain on command. Owen asked whether he was in pain, and Routley answered no, a first for any vegetative patient.

Juan Torres is another first. Whenever Owen discusses his work, he hears the same question. “Someone will put up his hand and say, ‘Do you have a patient who recovered and can tell you [what it was like]?’ ” Owen’s team has determined that one in five patients who appears to be vegetative retains some level of consciousness, which can’t be detected through standard clinical assessments. The number could go up, he argues, as detection methods improve—but even with a growing body of research, it remains controversial to claim consciousness among these patients. Some worry it could give families false hope, or cause feelings of guilt among those who do decide it’s best to end life support.

The article suggests that Torres's recovery is impossible to explain, except for the fact that the body stimulation that is done at awakening centers in Europe have a fairly successful recovery rate. I am not a scientist or a doctor, but it appears clear that the stimulation that the family did was likely what led to Torres's recovery. The article states:

Juan Torres’s recovery is impossible to explain, although his youth and physical strength must have helped. Medical reports on Torres’ rehabilitation, which Perez provided to Maclean’s, suggest that healthy parts of his brain may have been recruited to work on behalf of areas that were permanently damaged. Owen admits this is possible, but “his recovery was fairly swift for that to have been the case,” he says. “There’s not any clear neuroscientific explanation I can give.”

Torres says he feels pride at his recovery. “I learned a lot, actually,” he says. “I used to get mad. Now I’m more patient.” But a sense of loss hangs over him. A focused and determined young man—his recovery is no less a testament to his own resolve, and his family’s—his frustration can at times be palpable. His life has swerved down a path he never could have predicted. But he’s back in school. He’s playing sports, including wheelchair rugby. (He enjoys “the competition,” he smirks. “The violence.”) Torres spends spare hours making electronic music on a laptop at home. He dreams of becoming a platinum-selling record producer.

Every day, even now, Perez tells her son how grateful she is. The fact that Juan Torres was building memories as he lay in bed, by all accounts unconscious, is still a cause for marvel. “In a way, he was there,” Perez says, “even though he wasn’t. It’s like dying and coming back again.”

In 2004, after attending the European conference I stated that awakening centers need to be established in Canada. For those who are reading this article and have a family member who is PVS, try to stimulate the brain, as the family did for Torres. There is nothing to lose.

People in a vegetative state may be aware

By Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

The UK Independent published an article on a study by scientists at Cambridge University concerning tests on people considered to be in a vegetative state or a minimally conscious state.

The Independent is reporting that:

Severely brain-damaged patients in a persistent vegetative state may be capable of being consciously aware of the outside world, scientists said.

Scientists at Cambridge University have developed a test to determine whether people in a vegetative state can respond to their surroundings. Dr Srivas Chennu reported that:

“Our research could improve clinical assessment and help identify patients who might be covertly aware despite being uncommunicative,”
“... for patients diagnosed as vegetative and minimally conscious and their families, this is far more than just an academic question; it takes on a very real significance,”

The article in the Independent explained the research data:

The researchers analysed the brainwaves of 32 patients using 128 electrical sensors fixed to the scalp to measure electroencephalograph (EEG) activity. 13 members of the group were classed as being in a persistent vegetative state, with the rest being minimally conscious. 

The study, published in the online journal Plos Computational Biology, found that four of the 13 patients with persistent vegetative state had a “robust” network of brain activity that would allow conscious thoughts, which was confirmed when they were asked to imagine playing tennis when their brains were scanned using a magnetic resonance imagining (MRI) machine.

Patients in Vegetative States should not be presumed unaware

The following article was the editorial in the Calgary Herald on August 19, 2013.

Editorial: Calgary Herald - August 19, 2013

Canadians might recall the end-of-life case of Terri Schiavo, in which Schiavo's husband wanted to remove her from life support given her presumed constant vegetative state. It was a famous battle in Florida between her husband and her parents - a legal struggle that ended with her death by starvation.

Researchers at Western University in London, Ont., Ontario have discovered that at least some ostensibly unaware patients are, in fact, conscious of the world around them. This discovery will rightly raise new objections to allowing family or governments to "pull the plug" or remove the feeding tubes of patients who seem unresponsive but who can understand and respond.

Adrian Owen

The Ontario researchers, led by Adrian Owen at the Brain and Research Institute at the university, were able to elicit "yes" or "no" responses using magnetic resonance imaging. Researchers asked three vegetative patients questions about whether they were in a hospital, and if they recognized their names - questions that could provoke a simple yes or no, and which spurred brain activity the scientists could map.

As one Toronto newspaper reported, one patient, 38-year-old Scott Routley, was even able to let researchers know he was not in pain by responding to yes or no questions, with resulting brain activity captured by the MRI machine. This happened 12 years after the automobile accident that left him in a vegetative state.

This discovery casts into doubt the wisdom of past decisions by some family members and the courts who agreed with them, to end people's lives.

Terri Schiavo

In Schiavo's case, the argument over whether she was in a persistent vegetative state lasted 15 years. It started with her collapse due to cardiac arrest in 1990, and her husband's initial court attempt to have her feeding tubes removed in 1998. That was followed by court battles between the husband and Schiavo's parents, who opposed removing the feeding tube.

Her feeding tube was removed several times and then reinserted after more court orders. It was removed for the last time in March 2005 after one last successful court petition by the husband. Schiavo was literally starved and dehydrated to death and died 13 days later.

Routley is in a similar state as Schiavo was, but fortunately for him, the new research backs up what many families have always claimed: their loved ones are not necessarily unaware and in some twilight zone. Until now, they have simply been unable to communicate with those around them.

Plenty of people, including Schiavo's husband, insisted she was not self-aware. The new research shows that such forced starvation was a mistake, and wrong.

Such patients have every right to live and to die peacefully and naturally later, rather than have their lives prematurely ended by removing a feeding tube.

At least in some cases, they may be fully aware of others' decisions to end their lives, and subjected to a death by starvation inflicted on them - something that can hardly be defended as either necessary or compassionate.

Rediscovering consciousness in PVS patients

The recent edition of Discover Magazine is reporting on new research that is showing that the human brain can regenerate after traumatic injury and it is proving that certain types of stimuli has had some success at restoring consciousness for people who are thought to be in a Permanent Vegetative State (PVS).

Before explaining some of the findings in the article I question why this news is being reported as new or revolutionary. In 2004, I attended a conference in Europe on Persistent Vegetative State. At that conference there were two presentations on the success of "Awakening Centers" in Europe.

Awakening Centers didn't use electrical impulses, such as those being used by the team at Cornell Medical Center, but rather they focused on physical stimuli. The Awakening Centers would physically stimulate all the parts of the human body by simulating crawling or simulating walking as well as they would have physiotherapists stimulate all the main muscles of the body. These Awakening Centers had significant success with people who were abandoned as PVS patients.

I also question why there are no Awakening Centers in North America and there has been no information reported about the success of the Awakening Centers in Europe.

The article in Discover Magazine explains the success that Dr Giacino is having by using electrical stimulation on people who are diagnosed as PVS. The success of this work is turning our understanding of PVS up-side-down.

The article states:

The old verdict was harsh but clear-cut: Mourn your loved one, because he or she is gone.

“These are human beings who seem to have lost their humanity,” Giacino says. “The question is, is that really the case?”

The article describes the case of a man who was beat up and had been beat-up and was believed to be in a PVS state. After stimulation was applied to the brain the article stated:

As soon as the researchers switched the stimulator on, the man’s eyes opened. The doctors were not yet sure that it worked; they waited two months for the patient to completely heal from surgery before beginning their cognitive tests. The real moment of drama came during one of those first sessions, when the patient had the electrodes fully switched on for several hours. Schiff and Giacino showed him a picture of a red Radio Flyer, and before Schiff even remembered what the toy was called, the patient said, “Wagon.”

As months passed his repertoire increased; with the stimulator switched on, he could swallow, hold a cup, name objects, speak short sentences, and smile. The real impact of the stimulation is best described by his mother, who had been told the night of his beating that he would never be more than a vegetable. “My son can now eat, speak, and watch a movie without falling asleep,” she said through tears at a press conference announcing the results of the study. “He can express pain. He can cry and he can laugh. The most important part is, he can say ‘Mommy’ and ‘Pa.’ He can say, ‘I love you, Mommy.’ ”

Research concerning the rediscovering of consciousness is important because today we warehouse people in care homes who are determined to be in PVS or we abandon them to death by dehydration. They are treated as non-humans or the living dead.

The case of Terri Schiavo was even refered to in the article which stated:

In 2005, just as the deep brain stimulation patient was making his first forays into awareness, the fate of Terri Schiavo, a Florida woman who had been in a vegetative state since 1990, sparked an ideological war. Her husband wanted her feeding tube removed, ... her parents disagreed. Eventually, everyone from the governor of Florida to the U.S. Congress took sides. The arguments hinged on different impressions of how much awareness Schiavo still retained. A clip of Schiavo smiling was shown over and over again on TV. Senate majority leader Bill Frist (a heart surgeon) insisted that the video meant she was still conscious. ... Eventually her feeding tube was removed and she died

The future holds much hope for people who are declared to be PVS. The article refers to one successful case that appeared from the outset to be impossible. The article stated:

One of the Schiff group’s recent subjects was 23 years old when he sustained a severe head injury in a car crash. CT scans showed that his brain was ravaged, with a huge shadow of fluid where neural flesh should be. He spent three months in a vegetative state. A year after the accident, a physical therapist realized the patient could voluntarily move his head. The therapist trained him to use a letter board, in which a helper points to letters until the patient reacts, spelling out a message one letter at a time. His IQ turned out to be normal, and apparently his personality survived too; after several hours of being queried and quizzed by Schiff’s team, he used the board to spell G-E-T O-U-T.

Schiff’s team helped him acquire a head mouse, which allows him to use a computer by moving his head to control the cursor. He slowly continued to improve. Last winter, this man—who not long ago might have been abandoned as hopeless—sent Schiff’s group an e-mail. "Hi," it said; "I’m doing well." It was a telegram from a future world.

There is hope that many more people will soon be able to be brought out of coma to once again be treated as a human being and not as the living dead.

Cases like Eluana Englaro can have happy endings. Missionary Rejects Award in Protest of Italy's Euthanasia death - Eluana Englaro

Aldo Trento, an Italian missionary priest in Paraguay, is returning the honour he received from the Italian president, Giorgio Napolitano because he refused to protect the life of Eluana Englaro, the woman who was recently dehydrated to death in Italy.

Zenit is reporting that Trento told the Italian newspaper I1 Foglio:

"I have more than one case like Eluana Englaro."

He continued: "I think of little Victor, a child in a coma, who clenches his fists. All we do is feed him through a tube. Faced with these situations, how can I react to the case of Eluana?"

"Yesterday they brought me a girl who was naked, a prostitute, in a coma, who had been dumped in front of a hospital. Her name is Patricia and she is 19. We washed her. Yesterday she started to move her eyes."

"Celeste is 11; she suffers from a very grave form of leukemia; she was never taken care of and they brought her to me just to bury. Today she is walking. And she laughs."

"Cristina is a little girl who was left in a garbage dump, she is blind, deaf, she trembles when I kiss her, she lives with a feeding tube like Eluana. She does not respond except for the trembling but little by little she will regain her faculties."

"I am the godfather for many of these sick people. I'm not bothered by their decaying bodies. If you could see with what humility my doctors care for them."

Trento says that he feels "immense sorrow" for Englaro: "It is as if you were to say to me: 'We're going to take away your sick children now.'"

For the missionary, "man cannot be reduced to chemicals."

Link to the text of the Zenit article:
http://www.zenit.org:80/article-25110?l=english
In 2004 I attended the International Congress in Rome on Persistent Vegetative State. One of the interventions was by a physician in Italy who worked at an "Awakening Center".

There were two aspects to the awakening centers.
1. The people were treated in a dignified manner, like human beings,
2. The people in Vegetative State were given physio-therapy in a machine that stood them upright - on their feet - and exercised all parts of their body. They were having significant success in bringing people out of vegetative state.

I do not know whether these Awakening Centers have continued to improve the methods or not but I do know that the attitude was that certain types of brain injuries can be healed, or at least partially healed.

Finally, those who read the report that indicated the level of care Eluana was receiving, you could only conclude, why did her father want her dead? She was lovingly and incredibly cared for in a dignified and compassionate manner.

When reading the report my reaction was: Who could think that her life had no value?