The woman in the wheelchair wearing burgundy scrubs is lovely, with full eyebrows arching over her closed eyes. Joseph Giacino, director of rehabilitation neuropsychology at Spaulding Rehabilitation Hospital in Boston, squats beside her, looking into her face. “Hi, Kellie, it’s Dr. Giacino. How are you? Can you open your eyes?”
No response.
Two and a half months ago, during what was supposed to be a simple nasal operation for sinusitis, Kellie’s left carotid artery was accidentally sliced open, starving half her brain of blood and oxygen. Since that day, she has not spoken or clearly responded in any way. She opens her eyes, and sometimes she groans or gropes toward people nearby. Most of the time she seems to be asleep.
Is Kellie still in there? Giacino, 52, an expert in disorders of consciousness, will establish her condition more precisely with this exam. First, though, he needs Kellie to be more alert. He rubs her arm and her leg firmly, applying deep-muscle pressure, and her dark eyes pop open. She begins to breathe heavily and to shake. Giacino soothes her. “I’m just waking you up,” he says gently. “You had some bleeding in your brain, and we’re trying to help you get better.” The expression on her face is intense and hard to read. It mixes fear with annoyance, as if she has just woken from a nightmare. “Every kid has a dad and a…” he prompts. She moans, or is she trying to say “mom”? It is difficult to tell whether she is oblivious or struggling to respond. When she makes eye contact and holds it, she seems just as aware as anyone else in the room. By her fierce expression, she looks as if she is about to tell Giacino to buzz off. Yet she does not speak. That is why this exam, calibrated to distinguish between reflexes and real cognition, is so important. When Giacino hands her a toy ball, she grabs it, smoothly and naturally. It is a good sign.
Just a few years ago, a patient like Kellie would have been written off. Anyone who did not regain consciousness within a few weeks after a stroke or head injury was said to have no hope for meaningful improvement. But in the past decade, a series of increasingly spectacular experiments conducted by Giacino and Weill Cornell Medical Center neurologist Nicholas Schiff has proved that this bleak verdict is often wrong. The semiconscious brain is not a useless sack of neural goo, they have shown, and not all damaged brains are the same. Disorders of consciousness come in shades of gray, from severely impaired “vegetative states” to the perplexing “minimally conscious state” in which people slip into and out of awareness. By studying patients who emerge into consciousness after years in limbo, Schiff and Giacino have shown that the brain can sometimes fix itself even decades after damage. They have discovered apparently vegetative people whose minds can still imagine, still recognize, still respond. In turn, these profoundly disabled people have opened the door to one of the last great mysteries of science: the nature of consciousness.
