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TO BE HALF-DEAD
August 12, 2009I loved a boy in my past.
He was 14 when he was hit by a car while trying to follow me home. We were walking as we always do across the park towards the end of the river. It was 6 o’ clock when I saw him trashed to the street as the vehicle screeched for a break.
It was not his fault. He was always careful. He was always mindful. It was just that afternoon that he did not think too seriously. It was just one afternoon that a group of college brats suddenly appeared from nowhere. They were car racing and that boy’s life stopped.
He has been dead for years. I have lost his smile, his laughter, his silly look. It’s been four long years since I heard him whisper secrets to me, since I heard him scream my name from the rooftop of our high school building. I’ve lost a beautiful part of me when I saw him filled with blood as he was pulled from the street and rushed to the hospital. I was there when he was hooked to a ventilator, when the doctors pushed some volts on his chest to revive him. Later did I realize it was called defibrillation.
It’s been years and I still love that boy.
He’s not dead dead though. His in comatose. Almost gone. I can still feel him, his warm face, his beating heart, his breath. I still talk to him; tell him stories about my escapades and my suitors; share him my dreams. I still wait for his advice on what to do with my life, on how to trust another guy. I still await to hear his voice whisper my name or just for him to look at me once again… or one more time.
The doctors could not assure if he will wake up. They could only say it is possible. They explained that recovery is likely if the cause is overdose of sedative; complete recovery is possible if the cause is low blood sugar that lasted for an hour. If it is head injury, substantial recovery may occur even if the coma lasts several weeks but not if it lasts more than three months. However, if the cause is cardiac arrest or oxygen deprivation, full recovery rarely occurs if after 1 week, the person is still unable to move his limbs.
They said that COMA is a state of unresponsiveness that a person cannot be aroused, even with vigorous repeated attempts. Under normal conditions, the brain can quickly adjust its own levels of activity and consciousness because deep within the brainstem are nerve cells and fibers controlling consciousness and arousal levels (the reticular activating system). The brain makes adjustments based on inputs from eyes, ears, skin and other sensory organs.
Impairment results when the nerve fibers connecting the brain and the sensory organ malfunction, when blood flow to the brain decreases or when toxic substances damage the brain. Levels of impaired consciousness can range from reduced alertness (obtundation) to stupor (hypersomia) and to coma (complete unresponsiveness). People in the deepest stages of coma need a ventilator because the brain cannot perform essential body functions, including maintenance of breathing.
Head injury directly damaged the area of his brainstem that controls consciousness levels. Antiarrythmic drugs (Adenosin or Nutaphake, Amiodarone HCL or Cordarone, Lidocaine and Phenytoin) are given to keep his heart beating normally. Although, the doctors explained that sometimes, bleeding in and around the brain (hemorrhage), hematoma (accumulation of blood), tumor or pus, can directly damage the area of the brainstem as they place pressure at the site.
My own research led me to understand that apart from vehicular accidents, neurologic (cardiac arrest, aneurysm, infection, severe lung disorder, seizures), toxicologic ( alcohol intoxication, drug overdose), and metabolic causes (hypothryroidism, liver encepalopathy, kidney failure, extremes in temperature, hypernatremia, hyponatremia, hyperglycemia and hypoglycemia) can also lead to stupor or coma.
Doctors look for signs of brain damage such as Cheyne-Stokes respiration (periodic breathing from rapid to slow to none for seconds); unusual postures such as DECEREBRATE rigidity (head titled back, arms and leg extended, hands flexed, arms pronated, extended and adducted, feet plantar flexed) and DECORTICATE rigidity (plantar flexion, lower extremity internal rotation, adduction and flexion of upper extremities. arms flexion). When there is widespread loss of activity in all parts of the CNS, however, there is usually a GENERAL LIMPNESS.
Through the years, I have tried to understand what he is into. A year from now, I will be in medical school because I have a lot of questions that need answers. I need to know the possibilities.
Yesterday, I talked to my uncle who is a physician and he explained to me something about Persistent vegetative state, wherein a person is awake but devoid of conscious content. It results after severe brain damage when the cerebrum (containing thought and behavior) is destroyed, but the thalamus and brainstem (controlling sleep cycles, body temperature, breathing and heart rate) are spared.
In this state, a person can still open his eyes, relatively have normal sleep and wake patterns, breathe and swallow spontaneously, and may even show a startled reaction to loud noises. However, he lacks all capacity for conscious thought and behavior and he would only manifest reflex responses like jerking and stiffening. If it persists for months, recovery is unlikely.
Some people, though, are in the locked-in state, a condition wherein they think, but are so severely paralyzed that can only respond by opening and closing their eyes. They are conscious and the brainstem is affected but not the cerebrum.
According to him, Brain death is the most severe form of unconsciousness because the brain has permanently lost the ability to perform all vital functions. The person is legally dead, while the heart continues to beat. A person is said to be brain dead if he is unresponsive to painful sensation, not reactive to light, unable to breathe without assistance. Pronouncement of brain death should be made only after medical problems are corrected and EEG is done to confirm absence of brain waves and Doppler ultrasonography to determine absence of blood flow to the brain.
I guess, there is a part of my life that will never be bridged.
Sometimes, I already want to give up. My life has been half-dead, too, the day he met an accident. I have no memories of him since the day they brought him to the hospital, except that he’s lying in deep sleep. He will always be a boy in my past because, in my mind, he never grew up to be a man. I have been trying to understand how a “dead” boy can be revived, how I can pull him from that sleep and show him a world outside his bed.
I will pursue neurosurgery after I finish medical school because I need answers that will help me cope, hope or finally let go. I have my life, too, you see. I was not hit by a car 5 years ago, but that same day I became half-dead as he is right now because I loved him. Something in me also died that day. And just as I have been trying to wake him up, I must also revive myself.
But he hasn’t waken up. And I couldn’t reach to where he is. We have grown up and through the years, I’ve kept myself near him. This boy in my past doesn’t know me anymore.
And he does not love me, of course.
How could he?
HE NOW EXISTS SOMEWHERE I COULD NEVER BE.
