#flashtv

me: 

Ahhhh, yes. Comas. Also known as the classic go-to in soap opera’s, the whump-trope that defines the very stories of Days of Our Lives and General Hospital, the misunderstood head injury across the board.

Let’s break it down, shall we?

To understand a coma, it’s best to understand consciousnessfirst.

Consciousness is the having of perceptions, thoughts, and feelings; awareness. When we’re awake, we’re conscious. We’re able to collect, contain and store all of the thoughts, memories, feelings, and wishes of which we are aware of at any given moment. This is a aspect of our mental processing that we can think and talk about rationally. A part of this includes our memory, which is not always part of consciousness but can be retrieved easily at any time and brought into our awareness.

Unconsciousness is the opposite of this. For whatever reason, you’re not aware and you’re not awake. This could be due to drugs/medicine, head/brain injury, or simply our natural resting state (ie: sleep)

We won’t get too deep into the topic of natural unconsciousness. Rather, let’s focus on head trauma.

This is your brain experiencing a concussion – for the most part.

You see, humans have a gel/goop layer (cerebrospinal fluid) that helps cushion the brain from mild whiplash. But since we are human and have made things that make the human body travel faster than what we do naturally (cars, trains, planes, oh my!) our brain goop can’t handle that kind of force (ie falling of a bicycle, hitting you head on the ground, running into a wall etc). The brain shifts and the goop can absorb most of the impact, but the fact that the brain is so soft means that it will accordion up in the skull from the momentum of the force received and bounce back.

That’s not good for the brain.

Okay, so we know that consciousness is when we’re awake and aware. Unconsciousness is when we’re…well, not. Head trauma is something like when the brain gets rattled within our own skull, ie a concussion.

So where does a coma come into play? What is a coma?

Let’s start with the TV Myth: Character gets BOINKED on the head, cut to scene in hospital where doctor tearfully tells the family/loved ones that Character is in a…dun.DUNUNNNNN. A coma. Cue to loved one holding the hand of the Character, crying and begging them to wake up. End with Character finally blinking their eyes open, smiling and hugging the loved one who never left their bedside.

That’s the myth. So what’s the reality?

For starters, it’s a whole lot less dramatic.

Coma is essentially a state of unconsciousness and unresponsiveness. Imagine being asleep, but the rest of your body also cannot work properly, and you can’t wake up until whatever is causing the coma is reversed. In trauma medicine, the Glasgow Coma Scale (GCS) score is used to determine the coma status, which is essentially a surrogate for brain and brainstem damage. Trauma can cause coma, as well as medical problems, drugs, and lots of other things.

Comas are short-term transient states in which the eyes almost always remain closed, normal sleep and wake cycles cease and the patient cannot be roused. When a reaction to traumatic brain injury, comas only last for approximately 10 to 14 days. Once the brain starts to recover, patients may move on to a vegetative or minimally conscious state.(please note here: they do not just wake up and go back to a normal routine. This is the start of their healing journey.)

Speeaakkkingg of the GCS, let’s discuss that briefly. The Glasgow Coma Scale (GCS) is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury. Basically, it is used to help gauge the severity of an acute brain injury. The test is super simple and reliable — it measures Eye Opening, Verbal Response and Motor Response. This is a series of assessments for a patient regarding their ability to open their eyes (spontaneously, to voice, to pain, or not at all), give a verbal response (oriented or disoriented, inappropriate words, incomprehensible sounds, or none at all) and provide a motor response(follow simple commands, only responds to pain, withdraws, flexion, extension, or flaccid.)

Each of these categories are graded in numbers, and the lower your grade, the worse you’re off. 8 or less is severe, while 13-15 is mild.

There’s more than just the “hit on the head” coma, of course. Doctors put people into induced comas usually via medications. Anesthesia drugs such as barbiturates are given to patients to induce a coma so that surgery can be performed without the patient feeling it or moving, even surgery on the brain, or to protect the brain from further damage after an injury, etc. Think of someone who is “out” during surgery as medically induced coma. During a traumatic coma for example, they’d be in a similar state when assessed clinically.

The reason the body goes into a coma in the first place is in response to lattice functioning certain areas of the brain, and to restore these certain functions or preserve the body, it shuts down all but the essential processes of the body. This is somewhat comparable to hibernation. It’s a preservation repair process and why sometimes comas are medically induced; it allows higher brain function to be preserved while the body repairs itself and reduces swelling in areas of the brain.

So what causes coma?

Anything that reduces brain function. This includes drugs, alcohol, poisoning, head trauma, strokes, heart attacks, altitude sickness, diabetic shock, hypothermia, ect ect ect.

And of course, random strikes of lightning ;)

“So that’s it, right? A coma is just the brain hiding away for a while so it can recover? Once you wake up, all is well?”

This situation is so, so rare. It depends highly on many circumstances, ie: how long the patient was in the coma, what caused it, the severity of it (think back to the GCS scale) and so on and so forth. Typically, regaining consciousnesses comes very gradually, over the course of days, weeks or months. Sometimes the patient needs to re-learn basic motor skills, like talking, eating and walking. It’s far from the happy ending the media tends to display.

But of course, who wants to watch a character struggle with a spoon full of mashed potatoes? That, I’m afraid, is the truth to comas. If there is a severe injury, whether from trauma (blow to the head), or anoxic brain injury (stroke), it can be hard to determine exactly how/when people will come out of it.  A lot can depend on the area damaged. Generally speaking, if it’s in the center of the brain or in the brainstem, it’s bad news. Scans can tell physicians the damage done but can’t determine level of functionality left. That part is a waiting game. It’s amazing how sometimes people come back from the brink too.