An early lesson learned: Never give up hope

For “Brad” and “Amy,” prom night was a wonderful cap to an exciting senior year together. After an evening of celebration, the young couple got in their car and set off for home. They never made it. Amy arrived at the hospital with multiple bruises and a broken arm. Brad was brought in by the paramedics, unconscious from a critical head injury.

I started my internship a month after Brad was admitted to the neurosurgical unit in a coma. My first few months left me little time beyond working, studying and catching up on sleep to wander beyond the pediatric wards to other units. Winter frost decorated the hospital windows the night I walked through the neurosurgical hallway on my way back to the call room and noticed the unusually young man lying alone in his spare room.

Most neurosurgical patients were far older than his 18 years. I gazed at the handsome young adult lying on his bed. His legs were stretched out straight, his elbows were flexed, his arms pressing on his chest, his hands pointing down in tightly clenched fists. I recognized the signs of severe damage to the corticospinal tract (the pathway between the brain and spinal cord).

In those days before strict privacy laws, his nurse quickly apprised me of his medical history. His neurosurgeons felt his prognosis was poor, she added, as he had been comatose and unresponsive for months after his accident. It was likely that he would be moved to a long-term-care facility soon, now that he was off a respirator and able to be fed with a feeding tube.

His parents still came by to see him at least once a week, his nurse told me, but his girlfriend, who had made a full recovery, had gone off to college.

Brad’s days passed with his unseeing eyes staring at the ceiling as his nurses fed him, changed him and gently moved his stiff arms and legs to help him avoid ulcers from friction with the bedsheets.

A bookmarked paperback rested on the end table next to Brad’s bed, left behind by one of his few visitors. With an hour to go until my next task in the neonatal unit, I sat down in the vinyl recliner, opened the book and, glancing occasionally at Brad, began to read the story out loud.

During the next few weeks, I tried to visit Brad at least every other day. I would read to him from the book or talk to him about the world beyond the barren walls of his “prison,” my words a monologue with no response. Brad’s nurses greeted me warmly, a few sharing my hope that, despite the passage of time, Brad’s future would bring recovery, not abandonment.

The word came with the arrival of spring: Having shown no progress, Brad was to be transferred to a long-term-care center within the week, where his sustenance needs could be taken care of. My heart was heavy as I entered his room, knowing his bed would soon be empty. I noted a new book on his end table and picked it up. It was Brad’s high school yearbook, brought by his parents earlier in the day.

I leafed through it and soon found Brad’s smiling photo greeting me. A few more pages, and there was Amy -- a beautiful girl, lucky to have survived the accident. I turned the book back to Brad’s picture and placed it in front of his eyes, and then moved to Amy’s picture as I read her name.

I almost dropped the book -- a tear, was that a tear rolling down Brad’s cheek? Stunned, I called to Brad’s nurse to witness the tears from his once-lifeless eyes. The call immediately went out to Brad’s neurosurgeon. The plans for his transfer were quickly canceled.

After so many discouraging months of unresponsiveness, Brad rapidly began “waking up.” To facilitate his recovery, he was moved to a rehabilitation unit for intensive physical and occupational therapy, where I was able to visit him several weeks later.

He was sitting up in bed, eating soft food from a tray. His eyes lighted with recognition and he reached out an unsteady hand to greet me.

“I know you,” he said with a labored effort to form each syllable. “You used to come read to me.”

He had been aware of his environment for a long time, he explained, but was unable to communicate with his visitors. He had no memory of the night of his accident or the weeks after, but could recall much of his senior year, and deeply missed his friends.

He seemed enthusiastic about the future, despite the many challenges he faced, and thanked me for taking the time to sit with him when he was alone.

Over the years, I’ve had many patients who have suffered serious injury or illness. In most cases, I’ve been able to help them on the road to recovery. In a few sad circumstances, my efforts and those of my colleagues have been futile and our patients have passed on.

I acknowledge the right of patients to sign living wills in which they make the choice about the extent of their care. But Brad’s story only hardened my resolve as a doctor to “never give up” in the absence of such a document.

When it came to saving and improving the quality of a life, to paraphrase the Roman motto Dum spiro, spero: “While the patient breathes, there is hope.”

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Dr. Linda Reid Chassiakos is director of the Klotz Student Health Center at Cal State Northridge and a clinical assistant professor of

pediatrics at UCLA.