Inside Terri's brain
She's probably not in pain. Still, doctors can't read her mind
When Terri Schiavo finally opened her eyes one month after her husband found her unconscious and gasping for air, it undoubtedly looked as if she was getting better. She had suffered cardiac arrest in the early morning hours of Feb. 25, 1990, and defibrillation was performed seven times in the emergency effort to resuscitate her. Her potassium level was a dangerously low 2.0, likely the result of a history of eating disorders and the cause of her sudden collapse. As a teenager and young adult of 5 feet, 3 inches, her weight had gone from over 200 pounds to 110 pounds.
After a month in a coma, "the eyes open, and the family interprets it as a sign of improvement," says Ronald Cranford, neurologist with the Hennepin County Medical Center in Minnesota and one of several doctors who examined Schiavo. Yet the open eyes and the normal sleep-wake cycle are cruel symptoms of a neurological condition called persistent vegetative state, or PVS. Other deceptive signs are eyes that can tear and a mouth that can curl into a grimace that family members would love to interpret as a smile.
Videotape. Families can read a lot more into facial movements: knowing, feeling, understanding, recognition. But, say neurologists, these are automatic reflexes of the brain stem, the part of the brain that mindlessly keeps the heart beating and the lungs breathing. Some of Schiavo's reflexive moments have been captured on videotape, run in newspapers, and shown on television screens.
Ten years of court decisions have upheld the PVS findings of neurologists who examined her and dismissed the claims that she was not in a PVS and could be successfully treated.
Coma and PVS are two distinct neurological disorders. A coma is unconsciousness with eyes closed. People can come out of comas and do well, they can come out of comas with brain damage, they can slip into persistent vegetative state and open their eyes while not regaining consciousness, or they can die. Another neurological state is called minimally conscious, in which the patient can have dementia but be capable of responding to simple commands or following objects with the eyes. Together, they lead to public confusion about who can get better, and who almost never will.
No one can truly know another's awareness, and technology has not advanced to the point where a test of any kind can definitively pinpoint PVS. Instead, doctors make a diagnosis of persistent vegetative state, just as they do with Alzheimer's or Parkinson's disease, with what they call clinical certainty. They perform a very detailed physical examination looking for any signs of awareness that can then be repeated. "The examination is tedious. It's time consuming," says James Bernat, professor of neurology at Dartmouth Medical School. "For example, if you say, 'Open your eyes,' and they happen to open their eyes, you have to do it again and again." The hands-on diagnosis is buttressed with laboratory tests including electroencephalograms, a measure of the brain's electrical activity, and CT scans. Schiavo's CT scans showed severe atrophy of the brain. Her EEG s, says Cranford, have been flat.
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