6 Awful Realities Of Falling Into (And Out Of) A Coma
A coma is something that exists in movies and TV mainly as a plot device -- a way to write a character out of a story without killing them off. Then, after a week or a month or a year, they wake up full of revelations and plot twists. To them, it's like time skipped forward, aside from being a bit groggy.
In real life? Yeah, it's a bit more messy. We talked to Tim, who woke up from a coma and told us that, among other things, it's not as simple as "waking up."
Falls That Barely Hurt Your Body Can Mangle Your Brain
A single leaf fell off a tree and almost killed me.
It was ten years ago. I was a construction worker, and a coworker and I were waterproofing a house. I remember the morning very clearly, mixing up buckets of gray waterproofing material and pouring it over the plywood on a lightly-sloped roof. I noticed a leaf had fallen into the still-wet waterproofing near one of the roof's corners. No problem, I figured, I can yank that off without walking through the wet stuff. The rest of this part of the story was relayed to me secondhand, because that would be my final clear memory of the next two months.
When I bent to remove the leaf, my foot squished into the wet material. I struggled for a bit to catch my balance, but I stumbled and sailed right off that roof. I didn't fall far -- only about 11 feet, like jumping off a standard basketball hoop. I even landed feet-first. My head hit the ground, but I didn't fracture my skull or anything else. If you were an adventurous kid, you've probably jumped from that height dozens of times.
But the brain is fragile -- that's why you evolved that fancy skull you're wearing around it. So when the left side of my head met the ground, my brain hit the interior of the other side of my skull in exactly the wrong way. That gave me a subdural hematoma and subarachnoid hemorrhage, thanks to something called a contra coup head injury. That name makes it sound like Nicaraguan rebels took over my brain, and that's actually pretty much what happened.
While they loaded me out of the ambulance at the hospital, the paramedics supposedly said to my friends, "We've gotta be honest with you guys ... he's gonna die. Might already be dead. They're probably getting ready to harvest his organs." But maybe they say that to everybody, so they won't be disappointed.
You Don't Simply "Wake Up" From A Coma
Television portrays a coma as a binary thing. You're either completely unconscious and show no response to any stimulus or you're awake and aware. This works nicely for the plot, so a character can be hopelessly unconscious until the right moment, when they wake up and stop the wedding. With a real coma, forget the asleep/awake dichotomy. There are all sorts of layers of consciousness a patient will swim through on the way to recovery. Doctors use the Glasgow Coma Scale to measure it, from a score of three (deep unconsciousness) to 15, grading you based on eye, verbal, and motor responses. You can interact with people, even walk around -- then go right back into further unconsciousness.
So in my case, at the start, I did look like I was sleeping. But as the weeks went by, there were times when I opened my eyes wide and looked at everything around me (high marks in eye response!), including into a camera lens. But I was still in a "coma."
During these times, family would show me pictures and ask me to point to specific people in them. To their delight, I was able to correctly do so while unconscious and not otherwise registering what was going on. Later, they'd even get me out of bed and take me up and down hospital hallways -- again, while I was very much still comatose. I'd just get back in bed and return to deeper unconsciousness.
One friend came to visit, but instead of finding me in bed like usual, I was standing in the hospital hallway, 6'2" and anorexia-thin. I was in a hospital gown with big, red, size 13 shoes, and stumbling along zombie-like with a nurse's assistance. Then I saw a wheelchair against the wall in the corridor and sat in it, passively refusing to walk any further.
That sounds like something I'd do, but I have no memory of any of this. Not that walk, or any of the others.
They Saw Open Your Skull And Throw You In A Cage
In the week following the accident, my head was taken apart by the ol' bone saw to relieve pressure on my brain and permit surgery. They removed nearly the entire right side of my skull, and my sister once touched my brain through nothing more than a thin covering layer of skin. They later put the skull back together and heavily bandaged my head, and they stuck special preventative net gloves on my hands. This was to keep me from, say, pulling the bandages off and perhaps disturbing the skull reassembly because I decided my brain was itchy.
You see, that's another thing about being in a coma -- you tend to pull stuff out or off. I yanked my tracheostomy out, leaving me with a larger, deeper scar right at the bottom of my throat (it's cool-lookin' if you ask me -- I dig V-necks). IVs, PIC lines, catheters, feeding tubes, and more are all prime for the pulling out by a patient who doesn't even know they're in a coma. At times, I was physically tied into bed with special medical restraints. One nurse said that while restrained, I tried to "slither out of bed like a snake."
When I first fully regained consciousness, I didn't know I'd lost two months. And I found myself in the most undignified of lodging arrangements: I woke up in a cage. Okay, it wasn't like they had steel bars around me -- it was a hospital bed with walls of netting on all sides. The material was not dissimilar to fishnet stockings, now that I think of it, so that's one fetish that does nothing for me now. Still, the cage zipped shut from the outside, so when closed, there was no escape. It would be a glorious day when I graduated to a normal bed a week or two later, fitted with an ankle bracelet to keep me from wandering away.
I now get that the cage was for my own safety, and I was sleeping most of the time anyway. But my greatest encaged distress came when I needed to go to the bathroom. I tried to call a nurse, but I was left on my own for long stretches in that cage. Well, I confess ... I took a leak through an opening in the netting onto the floor below at least twice. I may have been brain damaged, but I was not going to wet the bed.
But once I was free of my fishnet cage, I got the nastiest surprise of all ...
Your Body Withers Away
A coma patient in a movie is a sleeping beauty who emerges from the coma as if they just had a nap. But if you've followed any right-to-die case on the news, you know coma patients are hooked to this world by a feeding tube, a system that leaves them emaciated. Not only is this a less-than-ideal way of eating, but it also caused me some significant digestive system problems, which left me in need of additional surgery and made an already skinny guy the kind of thin you normally only see in war refugees.
Once I was up and started eating, I turned into a fiend in that hospital cafeteria. I was begging the elderly for the scraps they were planning to throw away, pleading with the staff for seconds. I didn't realize it, but I became a spectacle for the others in that cafeteria, mostly elderly patients delighted to see a recovering young man so enjoying the stuff they were going to throw away. Even though it's been 11 years and I know hospital cuisine isn't exactly held in high esteem, I still remember what they served in that cafeteria as the best stuff I've ever eaten.
And lying basically motionless in bed for months sucks away your muscles even worse than it does fat. That's why nurses would take me on short walks at later stages of the coma, but that exercise wasn't enough. Severe muscle damage made me quite literally skin and bones. I didn't even have the strength to comfortably breathe on my own. My first walk, fully conscious and unassisted, felt bizarrely hard. Remember: I didn't understand I'd been in a coma, let alone grasp the intricacies of my muscular atrophy. Standing, I felt something was wrong. My balance was off, and I swayed. Keeping myself from falling over required serious effort and concentration, like I'd drunk five shots.
Since my release, I've been back to intensive rehab repeatedly to remember old times, and it's amazing how small it seems. The hallways are short and relatively narrow, not the endless, arduous obstacles they looked when I was relearning to walk. The stairs are only stairs, but I thought them steep and long, like they were designed specifically to pump the quads of an Olympian. Going back made me immediately think of returning to my elementary school as an adult -- it all seems so small, not at all how you remember it.
... And The Brain Doesn't Fare So Well, Either
On TV, the coma patient always wakes up. If the writer wanted the character to die, they'd just kill them and not even bother with the coma at all. In real life, half of all real coma patients die within a month.
And when a TV character does wake up, they're bewildered but otherwise mentally good as new, ready to run into court and finger the culprit. In real life, out of the fraction who survive major comas and recover physically, a quarter are permanently mentally disabled. And even those without a permanent disability usually start with impaired cognitive function, considering that their brain previously couldn't even stay awake.
So at first, my short-term memory was devastated. Therapists spent much of our time together reading me lists of words or numbers and having me recall as many as possible. I hated that exercise. Then I found myself failing and taking far too long to perform simple tasks, such as reading and arithmetic. Do you remember being a child and struggling with basic concepts of mathematics or language that now seem so simple? Well, that's how I remember myself at 22.
I resisted the therapy for it -- I would kind of play along, but felt insulted that I was being given elementary school work. I needed it, but that's another common symptom of traumatic brain injury: believing that you're much better off than you really are. The brain-injured have pride, too. But while plenty of people have no ability to totally recover, through no fault of their own, those who can should push themselves to do so. I couldn't live being condescended to like a child. So I started college about eight months from the date of the accident to prove to everyone, including myself, that I could do it.
I graduated from UC Davis with a 3.99 GPA -- damn that one A- in sociolinguistics. And that's after having been a mediocre high school student with no plans of any other education at all.
And now here comes the weird part ...
I Still Can't Distinguish Between Dreams And Memories
Have you ever had a dream so real that it took a moment after waking up to realize you were in bed and had only been dreaming? When dreams are your only experience for weeks or months, it takes a correspondingly long time to figure out it was just a dream.
For example, two of my big interests are true crime and cooking, and during my coma, those two birthed a long extended dream about working with a crime family and becoming personal chef to none other than John Gotti. Later, during rehab, I was totally sure this had been real. I even told people about my fascinating employment, and they'd go on to tease me about this for years. I would have passed any lie detector test -- I remembered cooking on the Telfon Don's Teflon as clearly as you remember yesterday.
I was fortunate to receive frequent visits while in the hospital, and though I remember almost none of it, I do remember one specific time that my mom and brother came to see me. I was in bed, they were standing near me, but we weren't in a hospital at all. No, I was lying in the bedroom of a house. They were really there visiting me in the hospital, and I could see them, but my mind put us in a totally different location. The memory even included the real hospital window, but my mind added snow, even though I was in Northern California in June.
At other times, my dreams tried to explain what had landed me in the hospital. The real hospital stuff I saw, along with the subconscious awareness of my significant hearing loss (I'd hit the ground hard enough to knock my left ear's drum and ossicles completely out), told me something terrible had happened. I had played a lot of action/military video games like Metal Gear Solid and Splinter Cell, and my dreams found me in that sort of world. I saw gunfire, explosions, jungles, and camouflage. I decided I had been in some vague war, and an explosion had got me.
So while I'm reasonably sure that this, right now, is reality, I can't be completely certain I'm not still in a coma, believing I'm writing about being in a deeper coma. Or maybe I'm dead, and this is what the afterlife is: writing about how I think I survived a terrible accident. And maybe you -- yes, you -- are in a coma or dead too, and this article is how we together let go and move on.
For more insider perspectives, check out 5 Nightmares You Don't Know Until You're Diabetic and 5 Horrifying Things That Happen When You Go Missing.
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