For Christ’s Sake! You Can’t Come Back From Being Brain Dead!
There’s a difference between brain death, a coma, and a vegetative state.
Around this time last year, a (former) friend of mine called me concerned about a mutual friend. He told me the doctors did everything they can do and he’s never getting back up. “Is he brain dead?” I asked, because y’know. Brain science is kind of my thing. So I was curious about what exactly was going on with our friend — whose condition he didn’t seem too clear on anyway. I was really curious about why he thought his friend was never getting up.
Yes!” he snapped, “He’s not getting back up!” he replied, clearly frustrated with my question, but also clearly challenging my training and education. Which naturally, annoyed me. “His parents won’t pull the plug because the doctors said that he might have some cognitive function later.”
“So, he isn’t brain dead,” I was relieved and frustrated at this guy’s confusion, “There’s hope if he’s not.”
A brain-dead Brazilian woman, pregnant with twins, was kept alive for 123 days - the longest time ever - so she could…nypost.com
“The doctors said they’ve done all they can do!” He snapped back.
Months went by and people talked about his condition in different ways. Some said he was in a coma, some said he was brain dead. Most of them used it interchangeably, even though they aren’t the same thing.
A few months later, our friend woke up. He will never be back to 100%, but he’s very much alive and functioning, and absolutely shocked that Trump won the election. It turns out, he was in a vegetative state, though I never got the reason he was in that position. I was happy to hear he was fine, especially because my non-medical friend basically killed him with his understanding of what was going on with him. It’s good to know that he’s back and the rumors weren’t true. He wasn’t brain dead after all.
Back in my hometown of Oakland, California in 2013, a young girl named Jahi McMath had a horrible accident while getting her tonsils removed, that left her brain dead. While the hospital wanted to take the girl off life support, her family absolutely refused and has filed a handful of lawsuits since, arguing that the child is still alive because her heart is beating. I watched as news professionals debated and scratched their heads over the very clear issue of whether she was dead or alive. McMath is still on life support today, under the care of neurologist Dr. Alan Shewmon, who does not believe in the concept of brain death, and says she is still “technically alive.”
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Around the same time this bizarre story arose, there was a woman in Texas named Marlise Munoz in December of 2013, whose husband found her unconscious on the floor for what could have been an hour. He rushed her to the hospital, where she was pronounced brain dead. His husband then asked that the plug be pulled so he could bury his wife. However, the hospital refused to do this because the woman was only a few weeks pregnant. The fetus was said to have severe deformities and a possible heart problem, due to the lack of oxygen during the early stages of its development. Fortunately, the family’s wishes won out, and the plug was pulled on Munoz three months later, in January of 2014.
These stories are both different, with the families wanting their grief to end in two different ways, but the science is clear: when you are brain dead, you are not coming back. There are rare cases where brain death is misdiagnosed but again, those are rare. And in those cases, you may hear that patients regain consciousness, but those patients were usually either in a coma or a vegetative state — and those are not interchangeable terms.
Brain death is the irreversible loss of brain function. This diagnosis is rare, and most people will not enter the hospital with a brain dead diagnosis. A patient will be determined to be brain dead after a catastrophic brain injury that leads to complete termination of brain function in the upper and lower (brain stem) of the brain. There are varying legal definitions of brain death from state to state or even country to country. However, no matter how it is defined, it is still irreversible and without the use of life support, the patient will cease to breathe or continue to have a heartbeat.
Causes of brain death vary case-by case. A patient can go brain dead due to a head injury in a motor vehicle crash, or a severe blow to the head. They can have an aneurysm or stroke. Some patients have lost oxygen to the brain for some period of time by drowning or a heart attack. A rare few have had brain tumors. Physicians that determine brain death are never a part of the team of doctors who are fighting to save a patient’s life because they are usually part of a transplant team, who will talk to a patient’s family about organ and tissue donation. Misdiagnosis of brain death is overwhelmingly rare due to the amount of tests there are to determine brain death.
Conversely, a coma happens when a patient has suffered a brain injury that has caused them to have a partial loss of consciousness. To many, a coma may resemble sleep. It is very rare for a coma to last more than a few weeks. Patients in a coma do not react to stimuli such as sound or touch. Their brain reacted to whatever trauma they experienced by shutting itself down. Sometimes, physicians induce a coma in patients in order to allow a patient to heal. In the best case scenario, a patient will wake up to a coma with little damage or long-term effects. In the worst-case scenario, they will wake up in a vegetative state.
Vegetative patients are still unconscious. Also called “unresponsive wakefulness,” the main difference between this state and a coma is that the patient’s eyes are open and they will appear to be awake. Vegetative patients move involuntarily, react reflexively to outside stimuli such as noise or pain, and may even say some words. Patients in this state after four weeks are said to be in a “prolonged” vegetative state.
There are ethical questions regarding brain death, of course. Most of them, in my opinion, have to do with semantics. For one, brain death is often called “legally dead,” as many people do not consider someone they see breathing on a respirator dead. However, brain dead patients cannot breath without the respirator long-term, and will eventually stop without the help of a machine.
Calling these methods “life support” does not help much either, seeing as there isn’t much life to support in a lifeless body. Brain death and its definition were made especially for cases where physicians could most successfully procure organs, and I believe it should continue to be used as a determinant for such a donation. However, the public needs to be better advised that their loved one isn’t coming back. There is nothing else that medicine can do for them — and “life support” is a misnomer.
In countries like Japan, brain death donations are very low because of cultural concerns. To many Japanese people, death does not occur until the heart stops beating. While donations can happen as a result of cardiac death, they are best done while patients still have oxygen and blood circulating to the organs. Definitions of cardiac death being actual death are archaic and trite and the value of saving one or several lives should be valued more than salvaging the body of someone who cannot be saved.
Bereavement is one of the most difficult parts of the medical profession. It’s one of the hardest parts of being human to accept that someone is dead and not coming back. However, education is the main way to make people understand that their loved ones aren’t coming back and that further treatment after the determination of brain death isn’t beneficial for the patient and is costly to the hospital and the family.
Now let’s argue. You can contact me at firstname.lastname@example.org