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False hopes are a symptom of Schiavo's state

By LISA GREENE
Published March 22, 2005

It is something that doctors who treat brain injuries have to explain to hopeful families again and again: This smile, that hand that squeezed another's, all those little signs that seem so hopeful - they do not mean recovery.

And they do not mean that for Terri Schiavo, despite politicians who claim that she can laugh, cry and respond to her surroundings, says a neurologist who has examined Schiavo.

"All the things that imply cognitive function do not exist," Dr. Melvin Greer, a University of Florida neurologist, said Monday.

Greer examined Schiavo and testified about her condition three years ago. "Is the diagnosis of persistent vegetative state in doubt? In my opinion, no."

Other neurologists said that patients in a vegetative state are among the hardest, most heart-breaking cases for families to understand.

Families want to believe reflexes mean something more, said Dr. Anish Bhardwaj, co-director of the neuro-critical care division at Johns Hopkins University School of Medicine in Baltimore.

"You can't blame them for doing that," he said. "It's not unusual for families to come tell us, "She smiled at this,' or, "He smiled at this,' or, "She squeezed my hands today."'

Think of putting your finger inside a baby's hand, Bhardwaj said, and how the baby grasps your finger. It's not a conscious thought, but a reflex, an automatic response from deep in the brain.

Those are the same kind of responses people see in Schiavo, said Greer, who is not related to the judge who has heard much of the case.

Some members of Congress proclaimed that Schiavo is not in a vegetative state after seeing a few minutes of videotape. They watched her smile, saw her eyes follow a balloon, heard her moan.

"They are the claims made all along by her parents, and by people who are well-meaning," Greer said. "They want to identify her with greater abilities" than she has.

It is impossible to diagnose Schiavo from a few minutes of video, said Dr. Michael Pulley, assistant professor of neurology at the University of Florida College of Medicine.

"It's extremely difficult to form an opinion about someone's brain function unless you've examined them," he said. "There are a lot of things that can be misleading based on videotaping."

Greer was one of five doctors who examined Schiavo and testified in court. Two doctors chosen by Schiavo's parents, a neurologist and a radiologist, said she showed some awareness. The two neurologists Michael Schiavo chose, as well as the one the court picked, said she is in a vegetative state.

Questions about Schiavo's condition have become confused by the issue of whether her feeding tube should be removed, Greer and Pulley said. Some people might want a feeding tube even in a vegetative state; others might not, even with a less severe brain injury.

A person falls into a vegetative state because of damage to the cerebral cortex, the part of the brain that makes us think, respond to questions and remember the faces around us. The cells in the cortex work hard to do that, using oxygen at a rapid rate.

That makes them especially fragile. When the heart stops beating, and blood stops flowing, the cells in the cortex begin to die. They either die within a short time, or begin a downward spiral that scientists don't completely understand and don't know how to repair, said Dr. Walter Bradley, neurology chairman at the University of Miami's Leonard M. Miller School of Medicine.

The speed of cell death varies, but in most cases the cortex sustains widespread damage in three to five minutes, Bradley said.

Terri Schiavo's heart stopped for five minutes.

Deeper inside the brain is the brain stem, which governs breathing, heartbeat and reflex movements. Its network of blood vessels helps protect it if the heart stops beating, Bhardwaj said, and it can survive a few minutes longer.

When it lives, but the cortex dies, the result is a vegetative state: a person who can breathe but not talk, open his or her eyes but not recognize anyone. The person has no conscious awareness of surroundings.

"These reactions look as if they're real," Bradley said. "But the thinking brain is destroyed."

[Last modified March 22, 2005, 06:31:24]