How Comas Work


Announcer: Welcome to Stuff You Should Know from HowStuffWorks.com.

Josh Clark: Hello, and welcome to the podcast. I'm Josh.

Chuck Bryant: I'm Chuck. The red light is on.

Josh Clark: Do we have one of those?

Chuck Bryant: No, we need one, though.

Josh Clark: Yeah, we totally do. It's usually just a - we hear our producer Jerry pressing a button. And then we know to go. We just start talking like talking monkeys.

Chuck Bryant: It's like the German train system. It's very efficient.

Josh Clark: Yes, it is, Chuck. Chuck, as you know, it's been an all together rotten day so far. Right?

Chuck Bryant: Yeah, hasn't been our best.

Josh Clark: And what is it like 3:00, 3:30?

Chuck Bryant: In the afternoon?

Josh Clark: Yeah.

Chuck Bryant: Yes.

Josh Clark: So luckily, it'll be over soon enough. And it's Friday. I am even worse than I was before because rather than getting my usual Fresca, I got a Diet Cherry Coke by accident, and all respect to the Coca Cola Company. They've done really well for themselves. But Diet Cherry Coke is atrocious.

Chuck Bryant: I like that you're suffering through it anyway rather than wasting it.

Josh Clark: I opened it. You know. I've got to make do. But -

Chuck Bryant: Honorable.

Josh Clark: As bad as our day has been, I can tell you somebody whose day was even worse?

Chuck Bryant: Who is that?

Josh Clark: How is that for a segue?

Chuck Bryant: That's good.

Josh Clark: I actually just set up the setup for the podcast. What do you think?

Chuck Bryant: You're blowing my mind.

Josh Clark: There's this woman named Patricia Whitebowl, and she was a Cochiti Indian from outside of Albuquerque, New Mexico. And back when she was a lovely, young 28, she was giving birth to her fourth child, son named Mark, and she was giving birth via C-section, and there were complications in the surgery. And Mrs. Whitebowl developed a blood clot in her lung, and it actually cut off oxygen to her brain, and she lapsed into a coma. So comas actually happen - they can happen fairly frequently. They're not uncommon, but Mrs. Whitebowl's type of coma actually is very rare. She was in a coma for 16 years, which is - that's a long time to be in a coma.

Chuc k Bryant: It is.

Josh Clark: So there are other people out there like her. Have you heard of Sunny Von Bulow?

Chuck Bryant: Yeah.

Josh Clark: Reversal of fortune.

Chuck Bryant: Sure.

Josh Clark: So she's been in a coma for 19 years.

Chuck Bryant: Really?

Josh Clark: Uh huh, and a couple years back, she was moved from this very, very expensive care facility to a slightly less expensive one. It was estimated her family is spending a half a million dollars on her care as well as hair stylists and manicurists and stuff like that. They finally had to say, "We gotta move you, ma."

Chuck Bryant: Was she in the coma from the attempted murder?

Josh Clark: Yes.

Chuck Bryant: Really?

Josh Clark: Allegedly by her husband Claus Von Bulow.

Chuck Bryant: Right, who recently passed away. Correct?

Josh Clark: Actually, it was she who passed away. She did. And this is actually kind of common. I'm not sure how she passed away, but people in comas sometimes pass away from pneumonia or something like that. Their body is not functioning very well, so they can succumb to things like that.

Chuck Bryant: Well, apologies for not being up on my Von Bulow history.

Josh Clark: Hey, same here, pal. It's okay. Things move pretty fast in this crazy world of ours.

Chuck Bryant: They do.

Josh Clark: So back to Mrs. Whitebowl. While Mrs. Von Bulow never woke up, Mrs. Whitebowl actually did. After 16 years - this is amazing. This is exceedingly rare. Rarer than a 16 plus year coma is waking up from a 16 plus year coma. Basically, she woke up one day while her - one of her caregivers was adjusting the sheets on her bed. And she lifted her head and shouted, "Don't do that." And scared, I imagine, the daylights out of this woman. And after that, she was writing notes to her family. She called her mother to say, "Merry Christmas." This happened in December of 1999. And within like a month, she was at a mall. She wanted to see how the world had changed.

Chuck Bryant: So she went to a mall.

Josh Clark: She went to a mall. That's actually a pretty good place to start. Because back when she fell into a coma, Regan had just started his second term! Just think about how much the world changed between 1984 and 1999. And she woke up just in time to get nervous for Y2K.

Chuck Bryant: Good timing. Wow, that's awesome.

Josh Clark: Isn't that - it's kind of an uplifting story.

Chuck Bryant: Yeah, we could end it right here and I would be happy, probably.

Josh Clark: I would, too, actually.

Chuck Bryant: But we're not.

Josh Clark: So you want to talk about comas then?

Chuck Bryant: I think so. That's where we're headed.

Josh Clark: I take it from that solicitation.

Chuck Bryant: Yes.

Josh Clark: All right, well, Chuck, let me start because I haven't spoken enough so far.

Chuck Bryant: I agree.

Josh Clark: I'm just gonna kick it off with coma comes from the Greek word coma, appropriately enough.

Chuck Bryant: Right, with a K.

Josh Clark: With a K. That's the big distinction. And that word is to sleep in the Greek dialect. And that's actually pretty misleading. Isn't it?

Chuck Bryant: It is because when you're asleep, you can wake up. And if you're in a coma, you're not waking up. You don't respond to stimuli like sight or motor function, stuff like that.

Josh Clark: Yeah, you can sit there and shout all day at a coma patient. They're not waking up. They also don't respond to pain stimuli. They're just basically out.

Chuck Bryant: Right, but the brain functions.

Josh Clark: Part of it does.

Chuck Bryant: Right.

Josh Clark: We should probably talk about the brain. To understand a coma, you kind of have to have a minor understanding of the brain. Right?

Chuck Bryant: Major understanding. Yeah.

Josh Clark: Major understanding. Exactly! So we've got, basically, three parts that work to make us these talking monkeys that we are. You've got the cerebrum, cerebellum, and the brain stem. And they communicate with one another. So your cerebrum, what, that's your higher brain.

Chuck Bryant: Yeah, that controls things like emotion, memory, intelligence, personality.

Josh Clark: Reason. Context!

Chuck Bryant: Learning. Yeah, it's what most people think of when they think of the brain. All that good stuff is in there. And it's the largest part, too.

Josh Clark: And then you've got the cerebellum, which is in charge of balance and movement.

Chuck Bryant: Right, also very important.

Josh Clark: And then the most ancient part of the brain, evolutionarily speaking, is the brain stem.

Chuck Bryant: Right.

Josh Clark: This is like the basic part of the brain that controls breathing, blood pressure, bowel movements, actually.

Chuck Bryant: Yeah, bodily functions.

Josh Clark: Exactly. So you put all these together, and you've got us. Intelligent, reasoning, pooping humans!

Chuck Bryant: Yeah, wrap a skull around it and some skin. And you've got a human.

Josh Clark: Exactly. And all these things have to kind of communicate with one another, and they do so through the thalamus. And they send chemical signals to one another that makes your lungs inflate and deflate and makes you think, "This person is making fun of me," or, "They're after me," or something. There is all this stuff combined, as you said, makes us this way. If they stop talking to one another, you've got yourself an altered state of consciousness.

Chuck Bryant: Exactly and there's quite a few of those.

Josh Clark: Yeah, you want to talk about some of the other altered states?

Chuck Bryant: Well, yeah. There's the vegetative state that a lot of people get confused with coma. It's not exactly the same thing. A vegetative state is actually a type of coma, but you're generally awake but unresponsive. So your eyes can be open, but you're still unresponsive.

Josh Clark: It is generally confused with coma because it usually comes after coma.

Chuck Bryant: Correct.

Josh Clark: These people like Mrs. Whitebowl and Mrs. Von Bulow who are in comas for dozens of years - or tens of years were in a vegetative state after X amount of time. So if you're in a coma and you go into a vegetative state, you're probably in a lot of trouble. You're probably not going to come out of it. You - some part of your brain stem responds to stimuli. So maybe a sound! So all of a sudden, your eyes, which are no longer coordinated, so they're kind of lolling around, but both in the same direction toward the sound, but there's no awareness of it. You're not using any of your higher brain function to figure out what the sound is. It's just like a basic response.

Chuck Bryant: Right. Your eyes can move. There can be like yawning, even. You can yawn if you're in a vegetative state.

Josh Clark: Yeah, you can blink. That kind of thing! The one real hallmark of a vegetative state is people in it have sleep cycles. So you know, during the day, they're diurnal still. During the day, they will blink, or their eyes will loll about in their head, or they'll turn their head toward something. And then at night, they're not doing that. They're sleeping. In a coma, you just appear to be sleeping the whole time. So that's one. There's another one that is one of my particular favorite altered states of consciousness.

Chuck Bryant: Stupor?

Josh Clark: That actually scared me. Apparently, if you are wacked out of your skull on drugs and you are in a stupor, you're one or two steps away from comatose. It's all the same processes going on. It's just, I guess, to a slightly different degree. That's alarming.

Chuck Bryant: Yeah, it is. So watch out, buddy.

Josh Clark: I'm watching out.

Chuck Bryant: But I distracted you, and I knew which one you were going to talk about.

Josh Clark: You just like to say stupor.

Chuck Bryant: I do.

Josh Clark: The one I like the most is locked in syndrome. I can't believe I just said that. The one I like the most.

Chuck Bryant: The one you find most fascinating.

Josh Clark: Thank you, Chuck. Locked in syndrome is basically where you're - you can move. Your higher brain is - or you can't move. You're totally aware, though. Your higher brain is functioning. You are literally locked into your body. And basically, the only thing you can move are your eyes, typically. And that's like Jean Dominic Bauby from The Diving Bell and the Butterfly.

Chuck Bryant: Right, which is a great movie? We were just talking with Jerry, our producer, beforehand. We've both seen the film. It's really, really great. But you have not because you're too busy watching Magnum, PI.

Josh Clark: Quiet, you. I have - I know enough about the story when it came out. You know, I listen to NPR, and they talked about that like seven days in a row, I think.

Chuck Bryant: Yeah, it's really good.

Josh Clark: But the guy - because he could move his eyes, he had a computer software system that he could type with it, but he - and he wrote a book in this locked in state. And he typed every single letter of this book.

Chuck Bryant: By looking at the -

Josh Clark: By choosing like a keyboard. Right? Or from a computer screen keyboard!

Chuck Bryant: I believe that's what happened.

Josh Clark: That's nuts. But I mean imagine that. Imagine being locked in and knowing exactly what was going on.

Chuck Bryant: I know, very frustrating, I imagine.

Josh Clark: It's very much like the Metallica video, One. Except that guy could move!

Chuck Bryant: Right, which was from the film Johnny Got His Gun, I think.

Josh Clark: Thank you. Very nice!

Chuck Bryant: I'm a fountain of film knowledge today.

Josh Clark: So those are a couple of other altered states of consciousness, in case you're interested. If not, you should have fast forwarded through the last, what, minute and a half, maybe two. And we're back to coma again. So somebody falls into a coma. How does this happen? What are some of the ways you can become comatose?

Chuck Bryant: There's a bunch of ways. One way is from brain injury, obviously. If you have severe head trauma, you can get an impact that actually makes your brain move within your skull. I know that if your brain actually hits your skull, that's what a concussion is. Correct?

Josh Clark: I believe so.

Chuck Bryant: But something more severe than that can cause blood vessels and nerve fibers to swell up, and that can potentially cut off the flow of blood, and therefore, oxygen, to the brain. And that's when you're in trouble.

Josh Clark: You want your skull to be stationary at all times. Or you want your brain to be stationary at all times in your skull. It's just not good when it slaps around in there.

Chuck Bryant: No, it's not.

Josh Clark: So you can also become comatose if you have diabetes.

Chuck Bryant: Right, diabetes. Certain diseases like meningitis can make it happen. Drug overdose can make it happen; although I believe you told me that they don't even know exactly how that happens. Is that right?

Josh Clark: I don't know how it happens. I couldn't find out what leads to it. But the way I took it was that there is a - it slows your response. It may be it slows the oxygen to your brain or the flow of oxygen to your brain, or it just relaxes muscles that need to be working. I don't know. This is literally off the top of my head right now.

Chuck Bryant: I sense a neuro surgeon e-mail in the near future to clear this up for us.

Josh Clark: I hope so because I want to know. But yeah, there are plenty of ways that you can slip into a coma. And actually, you can slip into a coma. You can go through stages of altered consciousness, and then end up comatose, which is the granddaddy worst one of all.

Chuck Bryant: Exactly.

Josh Clark: Although I don't know. Locked in is probably worse.

Chuck Bryant: Right, but it can happen gradually. That's a good point, which is where the term comes from.

Josh Clark: Or it can happen very quickly, like you know, through a major concussion, through a car accident or something like that. If you've slipped into a diabetic coma, that would happen gradually, usually.

Chuck Bryant: Right, exactly. You might get feverish and dizzy and lethargic, and then all of a sudden, you're in a coma, which is frightening.

Josh Clark: It is. Do you have diabetes?

Chuck Bryant: No.

Josh Clark: Me neither.

Chuck Bryant: I might one day, though. I think my father got it later in his life.

Josh Clark: Is it genetic?

Chuck Bryant: I don't know. I sense another letter from a person with diabetes to clear that up.

Josh Clark: At this point, we should just start asking questions and redo like a 20 minute reader mail segment just correcting ourselves every time.

Chuck Bryant: That's a good idea.

Josh Clark: All right, so what do you if you're in a coma? I mean - let me just say one thing real quick. After researching comas, you know how when you have a heart attack, your heart actually isn't stopped. It's gone out of its rhythmic beat. So when you are zapped, right, when they hit you with the paddles, what they're actually doing is actually stopping your heart to give it a chance to restart. With a coma, it seems like the pattern of discussion between the different parts of your brain that make you conscious and aware, it's been interrupted, but we don't know how to zap it back into place.

Chuck Bryant: Exactly. That's a good way to say it.

Josh Clark: But, I mean, you still have to care for these people. You can't just say, "Well, you know, we don't really know how to do anything to make you better." There are some ways. Drug overdose! If you sustain someone's life processes, they can come out after the drug begins to ware off, or same with alcohol poisoning. Diabetic coma! They can be treated. But once say like from a major brain injury, you may be in big trouble. Or a stroke!

Chuck Bryant: Sure. I think the first thing that has to happen is a doctor has to determine whether or not you're actually in a coma. That's the first step.

Josh Clark: Yeah, how do they do that?

Chuck Bryant: Well, there's a couple of scales they use to determine your level of alertness. And one is from Glasgow. It's called the Glasgow coma scale.

Josh Clark: Oh, is that how it's said? There's no accent associated with it?

Chuck Bryant: I'm not gonna try my Scottish accent today. And then, there's the Rancho Los Amigos scale. I'm not going to do that either. We're going to remain respectful in this one. And basically, the doctors use these two scales, and there's varying tests of responsiveness with your eyes, verbal responses, motor responses to various stimuli. So they do this to determine. They use both of these scales, actually, to basically gauge how alert you are, and whether or not you are, in fact, in a coma.

Josh Clark: So is it like they just clap loudly next to your ears and command you to sit up or something like that?

Chuck Bryant: I would say so. I mean they use like - do your eyes open when someone speaks to you, do your eyes open when there is pain involved? So there's all kinds of little ways they can check.

Josh Clark: Yeah, I guess they want to determine whether you're in a coma or whether you're just resting your eyes or playing possum because of what comes after that.

Chuck Bryant: Right. They assign you a score on a range from 3 to 15, 3 being a very deep coma and 15 being -

Josh Clark: That's right now. Right?

Chuck Bryant: Yeah, I'm at about 14. But yeah!

Josh Clark: All right, so we've established you're in a coma. It's awful. You're a 3. So you are just completely dead to the world, but you're still alive, amazingly.

Chuck Bryant: Right that would be comatose and unresponsive is the official classification of that deep of a coma.

Josh Clark: Okay, so you're in there. If you were in a car injury, what they're going to do - they're going to triage your symptoms, problems. So if you were in a car wreck or something, you have injuries from that, they're going to control the bleeding, that kind of thing.

Chuck Bryant: Yeah, they want to stabilize everything else first. Or not first, but you know.

Josh Clark: Once you're stable, though, and you're still in a coma, you can't care for yourself any longer, so it's kind of like they're going to poke around to determine what the cause is, maybe. They'll use an EEG, electroencephalography.

Chuck Bryant: Right, or MRI or FMRI, which is basically an MRI for the brain, or a CT scan, which is a computed tomography.

Josh Clark: Right. They'll use all these things to basically either look inside - an EEG actually is basically kind of like hooking into your electrical system and checking out how the impulses are doing. They'll diagnose maybe what caused the coma, that kind of thing. So once you're stabilized, diagnosed in a coma, you've been given the scale rating, and you're in for the long-haul, clearly -

Chuck Bryant: Right, you're stable.

Josh Clark: Yeah, they're going to basically use machines to care for you. Like feeding tubes! Often times, somebody in a prolonged coma or vegetative state, they'll perform a tracheotomy so they don't have to intubate you because after a while, the intubation tube, I imagine, gets real uncomfortable. Actually so much so that you would prefer a hole to the throat! Did you know - as a little aside, one of my best friends, a guy named Jens Beatty, in sixth grade, his mom started choking in a restaurant, and actually had an emergency tracheotomy with a steak knife and a pen performed on her. There was a doctor there who did it. He just went - and she was breathing again.

Chuck Bryant: Holy cow. That's worse case scenario right there.

Josh Clark: She used to have this little scar - I'm sure she still does. But it was crazy. Only person I ever knew who had an emergency tracheotomy.

Chuck Bryant: Seriously, I thought that was something just - you get on the ER or House or something.

Josh Clark: Exactly, yeah. It happens.

Chuck Bryant: So back to comas. Another thing that is often done is physical therapy just to keep the muscles moving. They'll - the nurses will move the patient to prevent bedsores, and then move the muscles, flex the legs to keep atrophy from setting in.

Josh Clark: Or if you're Uma Thurman, you can do a really focused regime within an eight hour period, and you'll be walking again. Right?

Chuck Bryant: True.

Josh Clark: Wow, we need to bring this down a bit. Don't we?

Chuck Bryant: I think so.

Josh Clark: Yeah. Because researching it, when you really get a grasp on comas and the peculiar nature of them and the fact that we have no way to bring somebody out of a coma, it's kind of heartbreaking to think that there are families out there who go to the hospital every day or every week.

Chuck Bryant: Hoping.

Josh Clark: Yeah, and you hope because there's people like Patricia Whitebowl who sit up all of a sudden and there you have it. Somebody can come out of a long coma. It's rough.

Chuck Bryant: True. I've got a study for you that might encourage you a bit.

Josh Clark: I'd love to hear it.

Chuck Bryant: It's from 2006. It's from Dr. Adrian Owen of Cambridge University, a neuro scientist, and he's trying to determine a consciousness meter for people in comas and vegetative states. So what he does is he hooks a normal, healthy person up to an FMRI machine, which I know you understand how that works. Right?

Josh Clark: Well, it basically uses magnetic imaging to see through the skull. And basically, it's watching the brain and watching the electrical activity in the brain. So if the pre-frontal cortex lights up when you tell somebody to - when somebody sees a bunny, you'll know that the pre-frontal cortex is involved in taking cuteness into context or something.

Chuck Bryant: I'm impressed.

Josh Clark: Thanks.

Chuck Bryant: So he'll hook up a healthy person, and then someone in a coma or vegetative state, and ask them to do something like imagine playing a game of tennis, I believe, is what he used on this one woman. And he found that the brain activity was really similar for both of these people, which led him to believe that there may be a lot more brain activity going on in some of these different states of minds.

Josh Clark: Yeah, that pretty much flatly contradicts our understanding of vegetative states.

Chuck Bryant: True, but it also - t his was one person, I believe, that was successful. And I'm sure there's been subsequent studies since. But he himself said that we need to keep studying this kind of thing before we make any determinations.

Josh Clark: Yeah, we need to basically figure out how to bring people out of comas.

Chuck Bryant: Right, but it does happen. You can come out of a coma.

Josh Clark: Yeah, no, you totally can.

Chuck Bryant: You can't bring someone out of a coma, but I think they said that 87 percent who score a 3 or 4 on the scale within the first 24 hours are likely to either die or remain in the vegetative state. So that's no good. And but on the other side, 87 percent who score between 11 to 15 are likely to make a good recovery.

Josh Clark: Well, that makes sense. I mean if you can shake somebody's hand when they tell you to, you're probably going to make it.

Chuck Bryant: But apparently, it's those first 24 hours are really telling.

Josh Clark: Yeah, I would imagine so. So that's comas. Huh.

Chuck Bryant: That's my understanding of comas.

Josh Clark: The great medical mystery that still remains. Solved one day maybe.

Chuck Bryant: Hope so.

Josh Clark: All right, chilling. Chuck, you want to do listener mail?

Chuck Bryant: Yeah, let's do listener mail, and I'm starting to separate listener mail into different categories now.

Josh Clark: The cream from the rest of the crop, as it were.

Chuck Bryant: Exactly.

Josh Clark: The men from the boys.

Chuck Bryant: Well, just more like a good way to -

Josh Clark: The women from the girls.

Chuck Bryant: Shut it. So first of all, we've decided to change this one part to Stuff We Should Know. This is instead of corrections. A lot of times, they're not an actual correction, but something a listener h as added that we did not realize. And -

Josh Clark: Or Stuff We Should Have Known.

Chuck Bryant: Stuff We Should Have Known. We can call it that. But that actually came from Brian Smith of California suggested we call it that.

Josh Clark: Yeah, we are actively following our listeners' commands at this point.

Chuck Bryant: So Brian, we appreciate the title there, and we're gonna use that now. So something we did miss in the body armor episode. We talked about a lot of the kinds of body armor, which was good. But we failed to mention one new very awesome one called dragon skin armor. And apparently, these are small little overlapping ceramic discs sort of like the medieval scale mail. And it's just a modern version, essentially, and it's more effective from repeated hits from a bullet. So a lot - quite a few people sent this in! Michael Shivets, retired naval officer. Or I don't know about officer, but retired US navy. Reno Moreno or Rene Moreno from Brooklyn, and Devin Montess in California, and I'm sure we missed a few others.

Josh Clark: Yeah, we actually got a lot of mail about the dragon scales. I have to say I find it comforting to know we're advancing light years now.

Chuck Bryant: Right and I have one more quick one. This is apropos to our topic today of comas. John Amolquine, it's a doctor in Massachusetts, and John wrote in and said, "I thought it would never happen, but I heard a mistake on Stuff You Should Know." Exorcism apparently, you said - this is not me. You said that someone with epilepsy, you could throw somebody in an MRI machine and look at their parts of the brain and see that someone is epileptic. And John says that, actually, you would not see epilepsy in an MRI. Seizures are diagnosed with an EEG machine, which is what we just spoke about.

Josh Clark: Gotcha.

Chuck Bryant: We appreciate that correction.

Josh Clark: Yeah, thank you. Is he from Farmington?

Chuck Bryant: Framingham. No. He's from Gardener, Mass.

Josh Clark: Well, XXOO to all of our listeners who sent mail. And you, too, can send mail. You can send it to StuffPodcast@HowStuffWorks.com. And I gotta tell you, there's plenty more information on comas in the great article on the site called How Comas Work. Just type those three little words into our handy search bar at, of course, HowStuffWorks.com.

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