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Schiavo tapes: snippets, then not much

A review of four hours of tape on public record shows a few powerful images suggesting Terri Schiavo can respond, but also hours where she has no signs of consciousness.

STEPHEN NOHLGREN
Published November 10, 2003

She seems to smile at her mother's voice. Her eyes follow a shiny balloon. Asked to open her eyes, she arches her eyebrows as far as they will go.

These and other fleeting images posted on the Internet have turned the heart-wrenching case of Terri Schiavo into a constitutional showdown.

But such moments that suggest awareness - culled from four hours of medical examinations that were videotaped in the summer of 2002 - are rare compared to the times when Schiavo lies in bed, slack-jawed and seemingly unresponsive, her limbs stiff, her eyes vacant, her hands curled in tight contractions.

The St. Petersburg Times reviewed all four hours of tapes, which now are public record in the Pinellas County Courthouse. Over and over, Robert and Mary Schindler beg their daughter to demonstrate any sign of consciousness. They have contended for more than a decade that she smiles and laughs in direct response to their conversation. They have told the court that her eyes follow them around the room.

These tests, these videos, offered a chance to show the judge firsthand.

"It's Mommy. Look this way," Mrs. Schindler urges at one point. "Can you say, "No, no, no' like you did before? No, no, no?"

"Terri, Terri, Terri. Can you look over here, sweetheart?"

Here and there, their daughter's glances and moans seem to coincide with what's being asked of her and might lead one to conclude that she responds. But more often than not, the parents' entreaties fall flat.

A judge who viewed all four hours concluded that Terri Schiavo exists in a hopeless vegetative state and ordered that her feeding tube be removed, as her husband requested. Appellate judges, who also saw all four hours, agreed.

Still, there's no denying the haunting power of a few, select moments. They seem to suggest that Schiavo - brain-damaged as she is - retains some shred of awareness and will. They are so disconcerting the Florida Legislature took one look at the snippets, overturned those judicial rulings and empowered the governor to put Schiavo back on the feeding tube.

Yes, the mother's words do seem to prompt what seems like a smile from Terri. Not just once, but twice. Her eyes do follow a balloon on three separate occasions, surprising even a doctor selected by her husband, Michael Schiavo.

But mostly, the Schindlers conduct one-sided conversations with Terri. They speak of family vacations, barbecues and newborn relatives. They profess to spot nuances in their daughter's face that aren't readily apparent to an outsider's eye.

At one point her father gets gruff while trying unsuccessfully to get her to follow a Disney-character balloon. "Come here, Terri, no more fooling around. No more fooling around with your Dad."

He pokes her in the forehead to make sure she's awake. "No more fooling around with your Dad. Listen to me. You see the balloon? You see Mickey?"

Later, he apologizes, telling her others have admonished him for his tone. "I'm not going to lecture you anymore. I was scolded. No more lectures. You do as you please."

Neither the father's gruff admonition nor his soothing apology seem to elicit any reaction from his daughter.

These ministrations are painfully poignant, right down to the music from a portable radio/cassette player.

From the movie Titanic: "Near, far, wherever you are. ... my heart will go on and on."

From James Bond: "Live and let die. Live and let die."

Medical uncertainties

Theresa Maria Schiavo's brain suffered terrible trauma 13 years ago, when her potassium levels dropped so low her heart stopped beating.

For a few years, her family and husband, Michael, worked toward recovery. Then, he changed his mind. It was hopeless, he contended. She would not have wanted to live like this.

Years of litigation culminated with testimony last November by the five doctors who did the videotaped exams - two picked by the Schindlers, two by Michael Schiavo and one by Circuit Judge George Greer, who oversees the case.

The two Schindler doctors said Terri Schiavo, now 39, shows awareness and might be helped by treatment. The other three doctors said she lives in a persistent vegetative state, with no hope of recovery. Greer and an appellate court agreed that her feeding tube should be removed. In October, the tube came out; Terri was expected to die within a few weeks.

Then, the Schindlers posted six segments of the videotaped exams, totaling 4 minutes and 20 seconds, at www.terrisfight.org The clips were seen by thousands of people, including members of Florida's Legislature. With two days of debate, the Legislature passed "Terri's Law" and Gov. Jeb Bush ordered her feeding tube reinserted. She had lived six days without nourishment.

"I said, wait a minute, that's not my definition of somebody in a comatose situation," said Rep. Frank Attkisson, R-Kissimmee, after viewing the Web clips.

Such lay references to "comas" demonstrate the vexing nature of determining vegetative states. Comatose people's eyes are closed, but if their thinking functions remain, those people can be better off than people in true vegetative states.

Vegetative people may seem alert if their involuntary functions remain intact. They may blink, sleep, wake up, make sounds and flinch. They even may laugh, shed tears and utter random words. But the brain sections that control thought are gone. Most doctors agree that such patients have little or no awareness of self and surroundings, and will never improve.

Patricia Anderson, lawyer for the Schindlers, noted in court that doctors sometimes err. Some people tagged with the vegetative label later come out of it, including one patient who emerged after 22 months. His doctor? Minnesota neurologist Ronald Cranford, who testified that Terri Schiavo is a hopeless case.

Cranford acknowledged that misdiagnosis, saying he lacked the benefit of a brain CAT scan. Schiavo has undergone multiple scans, he said, and they show a decimated cerebral cortex, the thin brain coating that controls higher functions.

Radiologist William Maxfield, chosen by the Schindlers, testified that Schiavo's cerebral scans show improvement, but none of the other doctors supported him.

The Schindlers couldn't make their case with scans, or blood tests, or X-rays. They needed their daughter to perform. Her life depended on the doctors' exams and what four hours of video - taken as a whole - really show.

What about that balloon?

"Hi. It's Mommy. Hi baby, how are you?"

Mary Schindler enters the hospice room and breaks the silence that surrounds her daughter. She kisses Terri, strokes her face and fluffs her pillow. Terri's face seems to brighten. Her blinking slows. She seems to stare at her mother. Her mouth opens, as if smiling.

Is this the "pure love" of a disabled soul, as Anderson contends? Has that familiar voice and tender breath on cheek pierced through Schiavo's shroud?

Probably so, the two Schindler doctors testified.

No way, said the two doctors picked by Michael Schiavo and the doctor picked by the judge.

"This is a reflex response," testified University of Florida neurologist Melvin Greer, not related to the judge. "The muscles of the facial area will react to sensory and auditory stimulation."

In court, the doubters contended that Dr. Cranford elicited a similar reaction when he touched and talked to Schiavo much like her mother had.

The videotape seems less conclusive. Schiavo makes a smile-like expression with Cranford, but it is less pronounced than the two incidents with her mother.

In another scene, not posted on the Web, Robert Schindler reminds his daughter of her "lazy eye" syndrome and how, when she was a girl, she would annoy her mother by purposely lolling her eye around.

Schiavo makes a sound a lay person might interpret as a laugh. Her noises get louder and louder until they exceed any other sound she makes during all four hours.

"You sound like an air raid siren," her father says. "Are you trying to tell me something?"

She also seems to laugh, after a 45-second delay, when her mother plays loud piano music next to her ear. On another occasion, she seems to laugh at no apparent stimulus.

"What you see," said lawyer Anderson, "is a human spirit very nearly crushed by the most unimaginable circumstances saying, "Here I am. Here I am. I like that balloon. I love my mother. I like piano music.' "

George Felos, Michael Schiavo's attorney, scoffed at the notion that a father's reminiscing prompted conscious laughter.

"If Terri has the ability to comprehend language and supposedly laugh and respond to the context of what she heard, then why doesn't Terri laugh when you say, "Terri, please laugh.' If she has the ability to comprehend language, why can't she follow a simple command" like blinking her eyes.

What about that balloon? The tapes indicate that her eyes followed it three times and failed to follow it twice. Cleveland neurologist Peter Bambakidis, appointed by the court to examine Terri, said the retina connects with regions of the brain that control involuntary reflexes. Her eyes follow things, he said, but she has no awareness of what she is seeing.

The single most dramatic moment occurred when William Hammesfahr, a Clearwater neurologist picked by the Schindlers, asked Schiavo to open her eyes.

At first, her eyelids barely flutter. She slowly turns her head toward Hammesfahr, gradually opening her eyes. Then her eyebrows lift into an exaggerated arch - the kind of face a cartoonist might draw to show astonishment.

A lay person could easily conclude that she somehow tapped into a latent reservoir of cognition, even if just for a second. Hammesfahr and her parents bubble with excitement.

"Good job!" the doctor exults. "Good job, young lady!"

But she never pulls it off again, or anything remotely like it. For nearly an hour, her parents and the doctor tell her to open her eyes, close her eyes, look this way, look that way - with little apparent response.

Judge Greer counted.

"By the court's count, (Hammesfahr) gave 105 commands to Terri Schiavo and, at his direction, Mrs. Schindler gave an additional six commands," Greer wrote. "He asked her 61 questions and Mrs. Schindler ... asked her an additional 11 questions. The court saw few actions that could be considered responsive to either those commands or those questions."

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