At any one time, up to 35,000 Americans - up to 10,000 of them children - are in a persistent vegetative state similar to that of Terri Schiavo, medical experts said yesterday.
Every week, scores of families across the country must make the wrenching decision that Schiavo's husband and parents have been fighting over for more than 10 years, but the decisions are typically made in a much less public forum.
There is often a great deal of confusion about what it means to be in a vegetative state, doctors say. First, such a patient is not brain dead.
"Brain dead is a state that is very well defined," said Dr. Michael Keane, a critical care specialist at the University of California, Los Angeles Medical Center. "There are tests that can be done to show that there is no brain stem function. If you are brain dead, you truly are dead."
The term coma covers a broad range of states. A person who drank too much and passes out, who cannot be roused, is in a coma, Keane said. At the other extreme, a coma can be so deep that the patient requires blood pressure support and help breathing. In all cases, the patient's eyes are shut and he or she is unresponsive.
Comas are usually considered a short-term situation. After a few weeks or months, the situation is usually resolved with the coma being reversed or the patient dying.
A persistent vegetative state is something different, "sort of like being in an awake coma," said Dr. David A. Goldstein of the Keck School of Medicine at the University of Southern California. The patients' eyes are open, they have sleep-wake cycles, and it often appears that they are interacting with visitors, which makes it very hard on families.
The brain of such patients is functioning only at a very rudimentary level, said Dr. Kenneth V. Iserson of the University of Arizona Health Sciences Center in Tucson. They cannot feel pain, express themselves or receive communication.
The longer the state persists, "the less likely they are to come out of it," Keane said. Schiavo has been that way for 15 years, "and it is very, very unlikely she would wake up," he added.
Now that Schiavo's feeding tube has been removed, changes in her condition will be barely perceptible at first. She may -or may not - feel pangs of hunger or thirst. "Most patients don't seem to give any outward evidence that they are in pain," Goldstein said.
After a few days, her kidneys will begin to fail, releasing toxins into her bloodstream that will anesthetize her body. Soon after, she will lapse into a coma. Eventually, she will stop breathing. The process could take one to two weeks.
The Los Angeles Times is a Tribune Publishing newspaper.
Every week, scores of families across the country must make the wrenching decision that Schiavo's husband and parents have been fighting over for more than 10 years, but the decisions are typically made in a much less public forum.
There is often a great deal of confusion about what it means to be in a vegetative state, doctors say. First, such a patient is not brain dead.
"Brain dead is a state that is very well defined," said Dr. Michael Keane, a critical care specialist at the University of California, Los Angeles Medical Center. "There are tests that can be done to show that there is no brain stem function. If you are brain dead, you truly are dead."
The term coma covers a broad range of states. A person who drank too much and passes out, who cannot be roused, is in a coma, Keane said. At the other extreme, a coma can be so deep that the patient requires blood pressure support and help breathing. In all cases, the patient's eyes are shut and he or she is unresponsive.
Comas are usually considered a short-term situation. After a few weeks or months, the situation is usually resolved with the coma being reversed or the patient dying.
A persistent vegetative state is something different, "sort of like being in an awake coma," said Dr. David A. Goldstein of the Keck School of Medicine at the University of Southern California. The patients' eyes are open, they have sleep-wake cycles, and it often appears that they are interacting with visitors, which makes it very hard on families.
The brain of such patients is functioning only at a very rudimentary level, said Dr. Kenneth V. Iserson of the University of Arizona Health Sciences Center in Tucson. They cannot feel pain, express themselves or receive communication.
The longer the state persists, "the less likely they are to come out of it," Keane said. Schiavo has been that way for 15 years, "and it is very, very unlikely she would wake up," he added.
Now that Schiavo's feeding tube has been removed, changes in her condition will be barely perceptible at first. She may -or may not - feel pangs of hunger or thirst. "Most patients don't seem to give any outward evidence that they are in pain," Goldstein said.
After a few days, her kidneys will begin to fail, releasing toxins into her bloodstream that will anesthetize her body. Soon after, she will lapse into a coma. Eventually, she will stop breathing. The process could take one to two weeks.
The Los Angeles Times is a Tribune Publishing newspaper.
