Mystery Drugs Turn Man Into Chatterbox After 10-Year Stupor

Soon after Dr. Jamil Ahmed stood before TV cameras a few weeks ago and told how his brain-injured patient had snapped out of a stupor lasting almost 10 years, the telephone calls and e-mails began.

Everybody wants a word with Ahmed, 43, who’s just three years removed from his residency training in Boston after earning a medical degree in Pakistan.

Doctors are calling about patients. Family members of brain-injured people are asking if Ahmed can talk to their doctors. And just what drugs was the brain-injured former firefighter, Donald Herbert, taking when he turned from being barely aware and almost mute into a virtual chatterbox for 14 hours with his astounded family and friends?

Ahmed, asked by Herbert’s family not to identify the drugs, has returned a few phone calls, explaining his medication strategy in general terms and warning, “There is no guarantee.”

That’s for sure. Ahmed was treading in largely untested waters when he put Herbert on a combination of drugs usually used to treat Parkinson’s disease, depression and attention deficit hyperactivity disorder.

But, he said, he’d seen such drugs help other brain-injury patients at the Erie County Medical Center regain focus, memory and powers of concentration, and become less agitated or irritable. He’d even seen such drugs bring people out of comas and other kinds of impaired consciousness, although not after nearly 10 years like Herbert.

So when he heard that Herbert, 44, had improved, “I was not surprised,” said Ahmed, a genial rehabilitation specialist. “I was expecting from the beginning he should make a change.”

In a wide-ranging discussion, Ahmed waved off a question about Terri Schiavo, the brain-damaged Florida woman who died in March after her feeding tube was removed. He had not examined her and could say nothing, he said. But he stressed that family and doctors should not give up on trying to help brain-damaged patients.

“I’m confident that if we try the same way on other people who are in a coma, there could be a difference,” he said. “There could be a lot of people who could wake up.”

And that prescription is not just about pharmacology. “God will not help you unless you try something,” said Ahmed, a Muslim. “If you try something and if you believe, God may help you.”

Ahmed grew up in Karachi, the sixth of nine children. When he was 15 or so, he listened to his father, an attorney, and older brothers discussing what his career should be: engineer, lawyer or doctor. Nobody asked him, but he piped up that he wanted to be a doctor, simply because he wanted to help sick people.

After attending college and medical school in Karachi, he left for the United States. “I wanted to do something; I wanted to be something,” Ahmed said.

When he arrived, some people tried to discourage him, saying he could never find time to support himself while studying for U.S. medical exams. But he did, giving physicals and drawing blood for insurance companies to support himself, and studying his texts on subways and buses between appointments.

After receiving some training in New York, he did his residency at Boston University Medical Center, where he was drawn to the idea of caring for brain injuries. Those patients present a variety of problems, with not only mental deficits but fluctuations in mood and behavior that can make a usually placid person fly into a rage, and put a severe strain on the family, Ahmed said.

“They don’t understand, why is he acting like this?” said Ahmed, who follows up after his patients leave the hospital.

He joined the rehabilitation medicine department at the Buffalo hospital after his residency, and colleagues started sending him brain-injury patients.

In December 2002, just a few months after he started work, Herbert’s wife, Linda, showed up to talk about her husband, who had suffered brain injuries when a roof collapsed on him while fighting a fire seven years before. Everybody said nothing could be done to help him, Ahmed recalled her saying. Could he help?

“We could try. I think there is a hope,” Ahmed replied.

He had already seen promising results from medications like the ones he’d end up prescribing for Herbert. He’d started trying them in Buffalo. The idea was that such drugs might jog the brain’s supply of substances that brain cells use to communicate and bring about other changes in the brain, maybe even helping to fix anatomical damage.

Others had tried the medication approach too, but “the evidence is not great,” said Dr. Steven Flanagan, medical director of brain injury rehabilitation at Mount Sinai Hospital in New York. He and his colleagues used such drugs anyway, sometimes with success.

“People who do a lot of this work wouldn’t be surprised that someone woke up using one of these medications,” Flanagan said. But in the case of Herbert, he said, it is “still highly unusual and rare that someone would wake up 10 years out just because of a medication.”

Ahmed went to work with Herbert, testing one medication after another. “We always had hope,” he said.

It was Saturday, April 30, that Herbert went on his talking jag. An excited family member reached Ahmed at home. The doctor said it was good news and advised the family to relax and not push Herbert. The next night, Ahmed heard a news report about a firefighter who’d emerged from severe brain impairment. He realized they were talking about his patient. But he didn’t think any more about it until Monday morning, when he listened to the radio while driving to work. This time, the news report included an interview with a neurologist.

“Then I thought, this is news now,” Ahmed said.

But just how big the news was didn’t become clear to him until two days later, when a news conference was arranged. “That’s the time I started realizing this is something important,” he said.

At the news conference, Herbert’s family said he had fallen back from his 14-hour burst and was having only infrequent moments of mental clarity.

In the days that followed, Ahmed said, Herbert started talking more and smiling. When Ahmed visited, Herbert was tossing a soccer ball to his family. More recently, he began physical therapy and has been walking with assistance, Ahmed said.

It’s not clear what will happen from here. But the results so far are encouraging for a man who’d been limp in a wheelchair and drooling. And they seem to back up Ahmed’s philosophy of medicine. “I never give up,” he said. “Don’t give up. There should be always hope. And God is going to help you.”