January 27, 2009 • 24 mins
Several conditions can cause comas, including brain tumors and overdoses. Tune in as the crew discusses the causes and treatments of comas -- including some miraculous recoveries -- in this HowStuffWorks podcast.
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Speaker 1 (00:00):
Brought to you by the reinvented two thousand twelve Camray.
It's ready. Are you welcome to Stuff you Should Know
from House Stuff Works dot com. This episode is sponsored
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(00:21):
and save ten percent off your entire order. Get your
piece of the Internet at go daddy dot com. Hello
and welcome to the podcast. I'm Josh, I'm Chuck. The
red light is on. We have one of those now
we need one? Now, Yeah, we totally do. It's usually
just a you know, we hear our producer Jerry President
button right, and then we know to go. You just
(00:42):
start talking like talking monkeys. It's like a German the
German train system. It's very efficient. Yes, it is Chuck, Chuck.
As you know, it's been in all together rotten day
so far, right, Yeah, hasn't been our best And what
is it like three in the afternoon? Yeah, yes, okay,
so um, luckily it'll be over soon enough. And it's Friday. Um,
(01:05):
I am even worse than I was before, because rather
than getting my usual fresca, I got a diet cherry
coke by accident. And you know, all respect to the
Coke Cold company, they've done really well for themselves, but
diet cherry coke is atrocious. I like that you're suffering
through it anyway rather than I opened it. You know,
I gotta I've gotta make do. But um, honorable. You know,
(01:26):
as bad as our day has been, right, yeah, I
can tell you somebody whose day was even Worse's how's
that first segue? I actually just set up the setup
for the podcast. So what do you think you're blowing
my mind? Um? There's this woman named Patricia white Bull
and she was a co cheaty Indian from outside of Albuquerque,
New Mexico. And back when she was a lovely young
(01:49):
twenty eight, she was giving birth to her fourth child,
son named Mark, and uh, she was giving birth via
C section, and there are complications in the surgery and uh,
Mrs white Bull uh developed a blood clot in her
lung and it actually cut off oxygen to her brain
and she laughs into a coma. Okay, so comas actually happened.
(02:14):
They can happen fairly frequently. They're not uncommon, but Mrs
white Bull's type of coma actually very rare. She was
in a coma for sixteen years, which is that's really
that's a long time to be in a coma. So, um,
there are other people out there like her. Um, have
(02:35):
you heard of Sunny von Buelow reversal of fortune? Yeah,
so she's been in a coma for nineteen years, uh huh.
And a couple of years back, actually she was moved
from this very very expensive um care facility to a
slightly less expensive when it was estimated that her family
is spending about half a million dollars on her care,
(02:56):
as well as hairstylists and ran chairs and stuff like that,
finally had to say we gotta move you. Mall Um.
Was she in the coma from the attempted murder? Yes? Really,
allegedly by her husband, Claus von Bull, who recently passed away. Correct, Actually, um,
it was she who passed away. Okay, she did, um,
And this is actually kind of common. I'm not sure
(03:17):
how she passed away, but people in comas sometimes passed
away from pneumonia or something like that. It's their their
bodies not functioning very well, so they can succumb to
things like that. Well, apologies for not being up on
my von Buelow history. Hey, same here, Pale. It's okay.
Things move pretty fast in this crazy world of ours.
So back to Mrs white Bowl. Um, while Mrs von
(03:38):
Bulow never woke up, Mrs white Bull actually did after
sixteen years. This is amazing. This is exceedingly rare, rareer
than a sixteen plus your coma is waking up from
a sixteen plus your comma. Basically, Um, she woke up
one day while her one of her caregivers was adjusting
the sheets on her bed, and she lifted her head
(04:00):
and shouted, don't do that, and scared. I imagine the
daylights out of this woman. Yeah. Uh and uh. After that,
she was writing notes to her family. She called her
mother to say, marry Christmas has happened in December. Um,
And within like a month she was at a mall.
She wanted to see, you know, how the world had changed.
(04:22):
So she went to them all. She went to them all.
It's actually a pretty good place to start, right because
I mean back when she fell into a coma, Reagan
had just started his second term right right. Um there,
just I think about how much the world changed between
kidding and she woke up just in time to get
nervous for Y two k Yeah you know good? Yeah? Wow,
that's awesome, isn't that? It's kind of an uplifting story.
(04:44):
We could end it right here and I would be happy.
Probably I would too, actually, but we're not. Yeah, so
you want to talk about combas that I think I
take it from that solicitation. Yes, all right, well chuck,
let me start, because I haven't spoken enough so far.
I agree. I you're just gonna kick it off with
Coma comes from the Greek word coma appropriately enough, with
(05:04):
a with a K. That's the big distinction. And that
word is to sleep in the Greek dialect um. And
that's actually pretty misleading, isn't it. It is because when
you're sleep, you can wake up, and if you're in
a coma, you're not waking up. You don't respond to
stimuli like you know, site or motor function stuff like that. Yeah,
so you can sit there and shot all day at
(05:25):
a comma patient. They're not waking up, right. Um. They
also don't respond respond to pain stimuli. Um. There there's
they're just basically out right, but the brain functions part
of it does, right, Okay, So, um, we should probably
talk about the brain. To understand that coma, you kind
of have to have a minor understanding of the brain, right,
(05:46):
major understanding, major understanding. Exactly. Um. So we've got basically
three parts, yes, that that work to make us these
you know, talking monkeys that we are. Right. Um, You've
got the cerebrum cerebellum in the brains to him, uh,
and they communicate with one another, So you're cerebrum. That's
your higher brain. Yeah, that's controls things like emotion, memory, intelligence, personality, context. Yeah,
(06:12):
it's what most people think of when they think of
the brain. All that good stuff is in there, and
it's the largest part. Two. And then you've got the cerebellum,
which is in charge of balance movements, also very important.
And then the most ancient part of the brain, um
evolutionarily speaking, is the brain stem. Right, this is like
the basic part of the brain that controls like, um, breathing,
(06:33):
blood pressure, bowel movements. Actually, yeah exactly. So, Um, you
put all these together and you've got us intelligent, reasoning,
pooping humans, wrapping skull around it and some skin and
you've got a human exactly. Um. And all these things
have to kind of communicate with one another, and they
do so through the thalamus um and they send chemical
(06:55):
signals to one another. UM that makes your lungs um
inflate and deflate and makes you think this person is
making fun of me, or they're after me or something. Um.
There there's all this stuff combined, as you said, makes
us this way. If they stopped talking to one another,
you got yourself an altered state of consciousness exactly. And
(07:15):
there's quite a few of those. Yeah, you want to
talk about some of the other altered states. Uh, well, yeah,
there's a vegetative state that a lot of people, um
get confused with comma. It's not exactly the same thing, uh.
And a vegislative state is actually a type of coma um,
but you're generally awake but unresponsive, so your eyes can
be open, but you're still unresponsive. It is generally confused
(07:37):
with with coma because it usually comes after a coma.
Correct um. These people like Mrs white Bowl and Mrs
von Buelow, who are in comas for dozens of years
or tens of years, um, we're uh in a vegetative
state after X amount of time. So if you're in
a coma and you go into a vegetative state, you're
probably in a lot of trouble. You're probably not going
(07:59):
to come out of it. Um. You you some part
of your brain stem responds to stimuli, stimuli like maybe
a sound. So all of a sudden, your eyes um,
which are no longer coordinated, so they're kind of lolling around,
but both in the same direction towards the sound, but
there's no awareness of it. You're not you're not using
any of your higher brain function to figure out what
(08:21):
the sound is. It's just like a basic response. Right.
Your eyes can move, I believe that they could be
like yawning, even you can yawn, that kind of thing, blinking.
And the one real hallmark of a vegetative state is
people in it have sleep cycles. So so you know,
during the day they're diurnal. Still during the day they
will you know, blink or their eyes a lull about
(08:43):
in their head or there, they'll turn their their head
towards something, um. And then at night they're not doing that,
they're sleeping. In a coma, you're just you just appear
to be sleeping the whole time. So that's one. There's
another one that is one of my particular favorite altered
states of conscious stupor that actually scared me. Apparently, if
(09:03):
you are whacked out of your skull on drugs and
you're in a stupor, you're like one or two steps
away from Coma's host. It's all the same process is
going on. It's just I guess to a slightly different degree.
But that's alarming, you know, So watch out, buddy, I'm
watching out. But I distracted. You know, I know which
one you were going to talk about. You just like
(09:24):
to say stupor um. The one I like the most
is locked in syndrome. Yeah. I can't believe I just
said that. The the one I liked the most, the
one you find what's fascinating, Thank you, Chuck. Locked in
syndrome UM is basically where you're, uh, you can move
your higher brain is or you can't move. You're totally
(09:45):
aware though your higher brain is functioning. You are literally
locked into your body um and basically the only thing
you can move are your eyes typically and uh, that's
like Jean Dominique Bobie from the Diamond Bell in the Butterfly,
which is a great movie. We were just talking with Jerry,
our producer beforehand. We've both seen the film. It's really, really,
(10:05):
really great. But you have not because you're too busy
watching Magnet Pion. Yeah I have. I know enough about
the story when it came out, you know, I listen
to NPR and then talked about that like seven Days
in a Row. I think it's really good. But the
guy because he could move his eyes and he had
a computer software system that he could type with it.
(10:28):
But he he and he wrote a book in his
in this locked in state. Yes, right, and um he
typed every single letter of this book by looking at
the by choosing like a keyboard, right or from from
like a computer screen keyboard. I believe that's what happened.
That's nuts. But I mean imagine that. Imagine being locked
in and knowing exactly what was going on, and I'm
(10:50):
very frustrating. Imagine it's very much like the Metallica video one,
except that guy could move right, which was from the
film Johnny got his gun. I think, thank you, Wow,
very nice my fountain of film knowledge today. So those
are a couple of other altered states of consciousness in
case you're interested. If not, you should have fast forward
it to to the last one minute and a half maybe two. Um,
(11:11):
and we're back to coma again. Okay, so somebody falls
into a coma. How how does this happen? What are
some of the ways you can become coma tope? Well,
there's a bunch of ways. Um. One way is from
brain injury, obviously. UM, if you have severe head trauma,
you can get an impact that actually makes your brain
move within your skull. And uh, and now that if
(11:32):
your brain actually hit your skull, that's what a concussion is, correct,
I believe so. But something more severe than that can
cause uh, nerve blood vessels and nerve fibers to swell up,
and that can potentially cut off the flow of blood
and therefore oxygen to the brain. And that's when you're
in trouble. You want your skull to be stationary at
all times, or you want your brain to be stationary
(11:54):
at all times in your skull. Yes, it's just not
good when it slaps around in there. No, it's not. So.
You can also become comatast if you have diabetes, right, diabetes,
certain diseases like meningitis can make it happen. Drug overdose
can make it happen. Yeah, although I believe you told
me that they don't even know exactly how that happens.
I don't know how it happens. I couldn't find out
(12:15):
what leads to it. The way I took it was
that there is a m It slows your response, um it.
Maybe it slows the oxygen to your brain, or the
flow of oxygen your brain, or it just relaxes muscles
that need to be working. I don't know. That's literally
off the top of my head, right. I sense a
neurosurgeon email in the near future to climbs up for us, Yeah,
(12:37):
because we want to. But yeah, there are there are
plenty of ways that you can slip into a coma,
And actually you can slip into a coma. You can
go through stages of altered consciousness and then end up
coma toast, which is the granddaddy worst one of all,
although I don't know, lockdan is probably worse. But it
can't happen gradually, that's a good point. Or it can
happen very quickly, like you know, through a major concussion,
(13:00):
through a car accident or something like that if you've
slipped into a diabetic coma, that would happen gradually usually
right exactly, you might get feverish and uh dizzy and lethargic,
and then all of a sudden you're in a coma,
which is frightening. It is do you have diabetes? Me? Neither?
I might one day, though I think my father got
it later in his life. Is a genetic I don't know.
(13:21):
I sense another letter from a personal type clear that
at this point we could just start asking questions we
read do do like a twenty minute reader mail segment.
You just correcting ourselves every time. It's a good idea,
all right, So what do you do if you're in
a coma? I mean, here, let me just say one
thing real quick. After researching comas, you know how when
(13:42):
you have a heart attack, your your heart actually isn't stopped.
It's it's gone out of its rhythmic beat. So when
you are zapped, right when they when they hit you
with the paddles, what they're doing is actually stopping your
heart to give it a chance to restart. With a coma,
it seems like the pattern of of um of discussion
(14:04):
between the different parts of your brain that make you
conscious and aware. Um, they it's been interrupted, but we
don't know how to zap it back into place exactly.
It's a good way to say it, but you know,
I mean you still have to care for these people, exactly.
You can't just say, well, you know, we don't really
know how to do anything to make you better. There
are some ways drug overdose, Uh, if you keep if
(14:27):
you sustain someone's life processes, they can come out after
the drug begins to wear off, or same with alcohol poison. Uh,
diabetic coma that can be treated. Yeah, but once they
like from a major brain injury, you may be in
big trouble or stroke. Sure. I think the first thing
that has to happen is a doctor has to determine
whether or not you're actually in a coma. That's the
(14:48):
first step. Yeah, how do they do that? Well, there's
a couple of um, a couple of scales they use
to determine your level of alertness. And one is from Glasgow.
It's called the Glasgow Coma scale. Is that how it
said it? There's no accent associated with it. I'm not
gonna try my Scottish accent. And then there's the Rancho
los Amigos scale. No, I'm not going to do that either,
all right, We're gonna remain respectful in this one. And
(15:11):
basically the doctors use these two scales and there's varying
test of responsiveness with your eyes, verbal responses, motor responses
to various stimuli and so um they do this to determine.
They use both of these scales actually, uh to to
basically gauge how alert you are and whether or not
you're in fact in a comma. So is it like
they just clap loudly next to your ears and command
(15:33):
you to sit up or something like that, I would
say so. I mean they use um like do your
eyes open when someone speaks to you? Uh, do yours?
Do your eyes open when there's pain involved? So there's
all kinds of little ways that they can check. And yeah,
they I guess they want to determine whether you're in
a coma or whether you're just you know, resting your
eyes or playing possum because of what comes after that, right,
(15:55):
And they while they assign your score an arrange from
three to fifteen, three e being a very deep coma
and fifteen being uh less right now, right, Yeah, I'm
about fourteen. But yeah, alright, so we've established you're in
a coma. It's awful your three right, all right, so
you are just completely dead to the world, but you're
still alive amazingly right. That would be comatose and unresponsive
(16:18):
is the official classification of that's deep of a comma. Okay,
so you're in there. Um, if you're in a car injury,
what they're going to do. They're gonna tree ours, your symptoms,
your problems. So if you're in a car record something
you have injuries from that, they're gonna, you know, control
the bleeding that kind of thing. They want to stabilize
everything else first not first, but you know once you're
once you're stable though, um, and you're still in a coma,
(16:42):
they you can't care for yourself any longer. So they
it's kind of like they're going to poke around and
determine what the causes. Maybe they'll use in e g.
Electro and cephalography right or m r I or f
m r I, which is basically an m r I
for the brain, or CT scan which is computed tomography
right now. They they'll use all these things to basically
(17:04):
either look inside and e g actually is basically, um,
kind of like cooking into your electrical system and checking out,
you know what, how the impulses are doing right, and
they'll diagnose, you know, maybe what caused the coma, that
kind of thing. So once once you once you're stabilized
diagnosed in a coma, you know, you've you've been given
the scale rating, um, and you're in for the long haul. Clearly. Yeah,
(17:27):
they're they're gonna basically use machines to care for you,
like feeding tubes. Um. Oftentimes somebody in a prolonged coma
or vegetative state. Uh, they'll perform a tricky otomy so
they don't have to innovate you um because after a
while the innovation too. But imagine gets real, you know,
uncomfortable that actually so much so that you you would
(17:50):
prefer a hole of the throat. Yeah, and you know,
let me it's a little aside. One of my best friends,
guy named Jen's Baty, in sixth grade, Uh, his mom
started choking h in a restaurant and actually had an
emergency trackeotomy with a stake knife and a pain performed
on her. Yeah, there was a doctor there who did it,
(18:12):
and he just went he was breathing. Again. That's the
worst case scenario right there. And so he used to
have this little scar and still I'm sure still does.
But it was crazy. Guys. The only person I ever
knew who had an emergency trade. I thought that was
something just you know, you get on the er. Yeah,
it happens, It happens. Uh. So back to comas, another
thing that that is often done is a physical therapy
(18:33):
just to keep the muscles moving. Um, they'll they'll, you know,
the nurses will move the patient to prevent bed swords
and then move the muscles, flex the legs to keep
you know, atrophy from setting in. Or if you're uma therman,
you can do a really focused you know, um regime
right within an eight hour period and you'll be walking again. Right. Yeah. So, um,
(18:55):
how we need to bring this down a little bit,
don't we? I think so? Yeah, because searching it, it's
when you really get a grasp on comas, in the
peculiar nature of them and just the fact that we
have no way to bring somebody out of a coma.
It's kind of heartbreaking to think that their families out
there who would go to the hospital every day or
(19:16):
every week and yeah, and you hope because there's people
like Patricia White Bull who sit up all of a
sudden and there you have it. You know, somebody can
come out of a long comma. It's that's rough true.
I've got a study for you that might encourage you
a bit. I'd love to hear it, just from two
thousand six. It's from Dr Adrian Owen of Cambridge University
and neuroscientists, and he's trying to determine a consciousness meter
(19:40):
for people in comas and vegetative states. So what he
does is he hooks a normal, healthy person up to
uh an f m R I machine, which I know
you understand how that works right, Well, it basically it's
it it uses magnet magnetic imaging to see through the
skull um and basically it's watching the brain. It is
watching the electrical activit being in the brain. So if
(20:01):
you know the the prefrontal cortex lights up when you
tell somebody to you know, um, and when somebody sees
a bunny, you'll know that the prefrontal cortex is involved
in and taking cuteness into context or something. Well, that's
I'm impressed. So he'll hook up a healthy person and
then someone in a come our vegetative state and asked
him to do something like, imagine playing a game of tennis.
(20:23):
I believes what he is on this one woman, and
he found that, um, the brain activity was really similar
for both of these people, which led him to believe that, uh,
there may be a lot more brain activity going on
and some of these different states of mind. Yeah, that
that pretty much flatly contradicts our understanding of vegetative states. True,
but it also this was one one person. I believe
(20:45):
that it was successful in and I'm sure there's been
subsequent studies since. But he himself said that, you know,
we need to keep studying this kind of thing before
we make any determinations. Yeah, yeah, we need to basically
figure out how to bring people out of comas. Right,
but it does happen. You can come out of a coma. No,
you totally can't. You can't bring someone out of a coma.
But I think they said that who score a three
(21:08):
or four on the on the scale within the first
twenty four hours are likely to either die or remain
in the vegetative state, So that's no good. And but
on the other side, who score between eleven and fifteen
are likely to make a good recovery. So well it
makes sense. I mean, if you can, you know, shake
somebody's hand when they tell you to, right, you're probably
(21:28):
gonna make it. But apparently it's his first twenty four
hours are really telling. Yeah, I would imagine. So, so
that's that's comas. Huh. That's my understanding of Comma, the
great medical mystery that still remains one day maybe I hope.
So all right, chilling, uh, Chuck, do you want to
do listener mail? Yeah, let's do listener mail. And I'm
(21:49):
starting to separate listener mail into different categories good cream
from the rest of the crop, as exactly the men
from the boys, well, just more like a good way
to woman from the girls. Shut it. Um. So, first
of all, we've decided to change this one part to
stuff we should know. This is instead of corrections a
lot of times are not in actual correction, but something
(22:09):
a listener has added that we did not realize. And
there's stuff we should have known, stuff we should have known.
We can call it that, but that that actually came
from Brian Smith of California suggested we call it that. Yeah,
we're actively following our listeners commands at this point. So, Brian,
we appreciate the title there, and we're gonna use that now.
So something we did miss in the body armor episode.
(22:30):
We talked about a lot of kinds of body armor,
which was good, but we failed to mention one new,
very awesome one called dragon skin armor. And apparently these
are a little small, overlapping ceramic disks, sort of like
the medieval scale mail. And um, it's just a modern
version essentially, and it's more effective from repeated hits from
(22:50):
a bullet. So a lot quite a few people sent
this in. Michael Schivitz, retired naval officer or I don't
know about officer, retired U S. Navy, Reno Marino or
Renee Marino from Brooklyn, and Devin Montess in California. And
I'm sure we missed a few others, but yeah, we
actually got a lot of mail about the dragon skills.
(23:14):
And I say, I find it comforting to know that
we're advancing light years now, right, And I have one
more quick one, and this is uh apropos to our
topic today of commas, John mull Queen. It's a doctor
in Massachusetts. And John wrote in and said I thought
it would never happen. But I heard a mistake on
stuff you should know, uh exorcism. Apparently you said this
(23:37):
is not me. You said that someone with epilepsy. You
could throw somebody in an MRI machine and look at
the parts of the brain and see that someone is epileptic.
And John says that, actually you would not see epilepsy
in an MRI. I caesars are diagnosed with an E
E G machine, which is what we just spoke about,
So we appreciate that correction. Yeah, thank you. Is he from?
(23:58):
Is he from Farmington Framing hand? You know it's from
Gardner mass Well x x o O to all of
our listeners who sent mail, and you two can send mail.
You can send it to uh stuff podcast at how
stuff works dot com. I gotta tell you there's plenty
more information on comas in the great article on the
(24:18):
site called how comas work. Just type those three little
words into our handy search bar and of course how
stuff works dot com for more on this and thousands
of other topics. Is it how stuff works dot com,
brought to you by the reinvented two thousand twelve Camray.
(24:39):
It's ready, are you
Brought to you by the reinvented two thousand twelve Camray.
It's ready. Are you welcome to Stuff you Should Know
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piece of the Internet at go daddy dot com. Hello
and welcome to the podcast. I'm Josh, I'm Chuck. The
red light is on. We have one of those now
we need one? Now, Yeah, we totally do. It's usually
just a you know, we hear our producer Jerry President
button right, and then we know to go. You just
(00:42):
start talking like talking monkeys. It's like a German the
German train system. It's very efficient. Yes, it is Chuck, Chuck.
As you know, it's been in all together rotten day
so far, right, Yeah, hasn't been our best And what
is it like three in the afternoon? Yeah, yes, okay,
so um, luckily it'll be over soon enough. And it's Friday. Um,
(01:05):
I am even worse than I was before, because rather
than getting my usual fresca, I got a diet cherry
coke by accident. And you know, all respect to the
Coke Cold company, they've done really well for themselves, but
diet cherry coke is atrocious. I like that you're suffering
through it anyway rather than I opened it. You know,
I gotta I've gotta make do. But um, honorable. You know,
(01:26):
as bad as our day has been, right, yeah, I
can tell you somebody whose day was even Worse's how's
that first segue? I actually just set up the setup
for the podcast. So what do you think you're blowing
my mind? Um? There's this woman named Patricia white Bull
and she was a co cheaty Indian from outside of Albuquerque,
New Mexico. And back when she was a lovely young
(01:49):
twenty eight, she was giving birth to her fourth child,
son named Mark, and uh, she was giving birth via
C section, and there are complications in the surgery and uh,
Mrs white Bull uh developed a blood clot in her
lung and it actually cut off oxygen to her brain
and she laughs into a coma. Okay, so comas actually happened.
(02:14):
They can happen fairly frequently. They're not uncommon, but Mrs
white Bull's type of coma actually very rare. She was
in a coma for sixteen years, which is that's really
that's a long time to be in a coma. So, um,
there are other people out there like her. Um, have
(02:35):
you heard of Sunny von Buelow reversal of fortune? Yeah,
so she's been in a coma for nineteen years, uh huh.
And a couple of years back, actually she was moved
from this very very expensive um care facility to a
slightly less expensive when it was estimated that her family
is spending about half a million dollars on her care,
(02:56):
as well as hairstylists and ran chairs and stuff like that,
finally had to say we gotta move you. Mall Um.
Was she in the coma from the attempted murder? Yes? Really,
allegedly by her husband, Claus von Bull, who recently passed away. Correct, Actually, um,
it was she who passed away. Okay, she did, um,
And this is actually kind of common. I'm not sure
(03:17):
how she passed away, but people in comas sometimes passed
away from pneumonia or something like that. It's their their
bodies not functioning very well, so they can succumb to
things like that. Well, apologies for not being up on
my von Buelow history. Hey, same here, Pale. It's okay.
Things move pretty fast in this crazy world of ours.
So back to Mrs white Bowl. Um, while Mrs von
(03:38):
Bulow never woke up, Mrs white Bull actually did after
sixteen years. This is amazing. This is exceedingly rare, rareer
than a sixteen plus your coma is waking up from
a sixteen plus your comma. Basically, Um, she woke up
one day while her one of her caregivers was adjusting
the sheets on her bed, and she lifted her head
(04:00):
and shouted, don't do that, and scared. I imagine the
daylights out of this woman. Yeah. Uh and uh. After that,
she was writing notes to her family. She called her
mother to say, marry Christmas has happened in December. Um,
And within like a month she was at a mall.
She wanted to see, you know, how the world had changed.
(04:22):
So she went to them all. She went to them all.
It's actually a pretty good place to start, right because
I mean back when she fell into a coma, Reagan
had just started his second term right right. Um there,
just I think about how much the world changed between
kidding and she woke up just in time to get
nervous for Y two k Yeah you know good? Yeah? Wow,
that's awesome, isn't that? It's kind of an uplifting story.
(04:44):
We could end it right here and I would be happy.
Probably I would too, actually, but we're not. Yeah, so
you want to talk about combas that I think I
take it from that solicitation. Yes, all right, well chuck,
let me start, because I haven't spoken enough so far.
I agree. I you're just gonna kick it off with
Coma comes from the Greek word coma appropriately enough, with
(05:04):
a with a K. That's the big distinction. And that
word is to sleep in the Greek dialect um. And
that's actually pretty misleading, isn't it. It is because when
you're sleep, you can wake up, and if you're in
a coma, you're not waking up. You don't respond to
stimuli like you know, site or motor function stuff like that. Yeah,
so you can sit there and shot all day at
(05:25):
a comma patient. They're not waking up, right. Um. They
also don't respond respond to pain stimuli. Um. There there's
they're just basically out right, but the brain functions part
of it does, right, Okay, So, um, we should probably
talk about the brain. To understand that coma, you kind
of have to have a minor understanding of the brain, right,
(05:46):
major understanding, major understanding. Exactly. Um. So we've got basically
three parts, yes, that that work to make us these
you know, talking monkeys that we are. Right. Um, You've
got the cerebrum cerebellum in the brains to him, uh,
and they communicate with one another, So you're cerebrum. That's
your higher brain. Yeah, that's controls things like emotion, memory, intelligence, personality, context. Yeah,
(06:12):
it's what most people think of when they think of
the brain. All that good stuff is in there, and
it's the largest part. Two. And then you've got the cerebellum,
which is in charge of balance movements, also very important.
And then the most ancient part of the brain, um
evolutionarily speaking, is the brain stem. Right, this is like
the basic part of the brain that controls like, um, breathing,
(06:33):
blood pressure, bowel movements. Actually, yeah exactly. So, Um, you
put all these together and you've got us intelligent, reasoning,
pooping humans, wrapping skull around it and some skin and
you've got a human exactly. Um. And all these things
have to kind of communicate with one another, and they
do so through the thalamus um and they send chemical
(06:55):
signals to one another. UM that makes your lungs um
inflate and deflate and makes you think this person is
making fun of me, or they're after me or something. Um.
There there's all this stuff combined, as you said, makes
us this way. If they stopped talking to one another,
you got yourself an altered state of consciousness exactly. And
(07:15):
there's quite a few of those. Yeah, you want to
talk about some of the other altered states. Uh, well, yeah,
there's a vegetative state that a lot of people, um
get confused with comma. It's not exactly the same thing, uh.
And a vegislative state is actually a type of coma um,
but you're generally awake but unresponsive, so your eyes can
be open, but you're still unresponsive. It is generally confused
(07:37):
with with coma because it usually comes after a coma.
Correct um. These people like Mrs white Bowl and Mrs
von Buelow, who are in comas for dozens of years
or tens of years, um, we're uh in a vegetative
state after X amount of time. So if you're in
a coma and you go into a vegetative state, you're
probably in a lot of trouble. You're probably not going
(07:59):
to come out of it. Um. You you some part
of your brain stem responds to stimuli, stimuli like maybe
a sound. So all of a sudden, your eyes um,
which are no longer coordinated, so they're kind of lolling around,
but both in the same direction towards the sound, but
there's no awareness of it. You're not you're not using
any of your higher brain function to figure out what
(08:21):
the sound is. It's just like a basic response. Right.
Your eyes can move, I believe that they could be
like yawning, even you can yawn, that kind of thing, blinking.
And the one real hallmark of a vegetative state is
people in it have sleep cycles. So so you know,
during the day they're diurnal. Still during the day they
will you know, blink or their eyes a lull about
(08:43):
in their head or there, they'll turn their their head
towards something, um. And then at night they're not doing that,
they're sleeping. In a coma, you're just you just appear
to be sleeping the whole time. So that's one. There's
another one that is one of my particular favorite altered
states of conscious stupor that actually scared me. Apparently, if
(09:03):
you are whacked out of your skull on drugs and
you're in a stupor, you're like one or two steps
away from Coma's host. It's all the same process is
going on. It's just I guess to a slightly different degree.
But that's alarming, you know, So watch out, buddy, I'm
watching out. But I distracted. You know, I know which
one you were going to talk about. You just like
(09:24):
to say stupor um. The one I like the most
is locked in syndrome. Yeah. I can't believe I just
said that. The the one I liked the most, the
one you find what's fascinating, Thank you, Chuck. Locked in
syndrome UM is basically where you're, uh, you can move
your higher brain is or you can't move. You're totally
(09:45):
aware though your higher brain is functioning. You are literally
locked into your body um and basically the only thing
you can move are your eyes typically and uh, that's
like Jean Dominique Bobie from the Diamond Bell in the Butterfly,
which is a great movie. We were just talking with Jerry,
our producer beforehand. We've both seen the film. It's really, really,
(10:05):
really great. But you have not because you're too busy
watching Magnet Pion. Yeah I have. I know enough about
the story when it came out, you know, I listen
to NPR and then talked about that like seven Days
in a Row. I think it's really good. But the
guy because he could move his eyes and he had
a computer software system that he could type with it.
(10:28):
But he he and he wrote a book in his
in this locked in state. Yes, right, and um he
typed every single letter of this book by looking at
the by choosing like a keyboard, right or from from
like a computer screen keyboard. I believe that's what happened.
That's nuts. But I mean imagine that. Imagine being locked
in and knowing exactly what was going on, and I'm
(10:50):
very frustrating. Imagine it's very much like the Metallica video one,
except that guy could move right, which was from the
film Johnny got his gun. I think, thank you, Wow,
very nice my fountain of film knowledge today. So those
are a couple of other altered states of consciousness in
case you're interested. If not, you should have fast forward
it to to the last one minute and a half maybe two. Um,
(11:11):
and we're back to coma again. Okay, so somebody falls
into a coma. How how does this happen? What are
some of the ways you can become coma tope? Well,
there's a bunch of ways. Um. One way is from
brain injury, obviously. UM, if you have severe head trauma,
you can get an impact that actually makes your brain
move within your skull. And uh, and now that if
(11:32):
your brain actually hit your skull, that's what a concussion is, correct,
I believe so. But something more severe than that can
cause uh, nerve blood vessels and nerve fibers to swell up,
and that can potentially cut off the flow of blood
and therefore oxygen to the brain. And that's when you're
in trouble. You want your skull to be stationary at
all times, or you want your brain to be stationary
(11:54):
at all times in your skull. Yes, it's just not
good when it slaps around in there. No, it's not. So.
You can also become comatast if you have diabetes, right, diabetes,
certain diseases like meningitis can make it happen. Drug overdose
can make it happen. Yeah, although I believe you told
me that they don't even know exactly how that happens.
I don't know how it happens. I couldn't find out
(12:15):
what leads to it. The way I took it was
that there is a m It slows your response, um it.
Maybe it slows the oxygen to your brain, or the
flow of oxygen your brain, or it just relaxes muscles
that need to be working. I don't know. That's literally
off the top of my head, right. I sense a
neurosurgeon email in the near future to climbs up for us, Yeah,
(12:37):
because we want to. But yeah, there are there are
plenty of ways that you can slip into a coma,
And actually you can slip into a coma. You can
go through stages of altered consciousness and then end up
coma toast, which is the granddaddy worst one of all,
although I don't know, lockdan is probably worse. But it
can't happen gradually, that's a good point. Or it can
happen very quickly, like you know, through a major concussion,
(13:00):
through a car accident or something like that if you've
slipped into a diabetic coma, that would happen gradually usually
right exactly, you might get feverish and uh dizzy and lethargic,
and then all of a sudden you're in a coma,
which is frightening. It is do you have diabetes? Me? Neither?
I might one day, though I think my father got
it later in his life. Is a genetic I don't know.
(13:21):
I sense another letter from a personal type clear that
at this point we could just start asking questions we
read do do like a twenty minute reader mail segment.
You just correcting ourselves every time. It's a good idea,
all right, So what do you do if you're in
a coma? I mean, here, let me just say one
thing real quick. After researching comas, you know how when
(13:42):
you have a heart attack, your your heart actually isn't stopped.
It's it's gone out of its rhythmic beat. So when
you are zapped, right when they when they hit you
with the paddles, what they're doing is actually stopping your
heart to give it a chance to restart. With a coma,
it seems like the pattern of of um of discussion
(14:04):
between the different parts of your brain that make you
conscious and aware. Um, they it's been interrupted, but we
don't know how to zap it back into place exactly.
It's a good way to say it, but you know,
I mean you still have to care for these people, exactly.
You can't just say, well, you know, we don't really
know how to do anything to make you better. There
are some ways drug overdose, Uh, if you keep if
(14:27):
you sustain someone's life processes, they can come out after
the drug begins to wear off, or same with alcohol poison. Uh,
diabetic coma that can be treated. Yeah, but once they
like from a major brain injury, you may be in
big trouble or stroke. Sure. I think the first thing
that has to happen is a doctor has to determine
whether or not you're actually in a coma. That's the
(14:48):
first step. Yeah, how do they do that? Well, there's
a couple of um, a couple of scales they use
to determine your level of alertness. And one is from Glasgow.
It's called the Glasgow Coma scale. Is that how it
said it? There's no accent associated with it. I'm not
gonna try my Scottish accent. And then there's the Rancho
los Amigos scale. No, I'm not going to do that either,
all right, We're gonna remain respectful in this one. And
(15:11):
basically the doctors use these two scales and there's varying
test of responsiveness with your eyes, verbal responses, motor responses
to various stimuli and so um they do this to determine.
They use both of these scales actually, uh to to
basically gauge how alert you are and whether or not
you're in fact in a comma. So is it like
they just clap loudly next to your ears and command
(15:33):
you to sit up or something like that, I would
say so. I mean they use um like do your
eyes open when someone speaks to you? Uh, do yours?
Do your eyes open when there's pain involved? So there's
all kinds of little ways that they can check. And yeah,
they I guess they want to determine whether you're in
a coma or whether you're just you know, resting your
eyes or playing possum because of what comes after that, right,
(15:55):
And they while they assign your score an arrange from
three to fifteen, three e being a very deep coma
and fifteen being uh less right now, right, Yeah, I'm
about fourteen. But yeah, alright, so we've established you're in
a coma. It's awful your three right, all right, so
you are just completely dead to the world, but you're
still alive amazingly right. That would be comatose and unresponsive
(16:18):
is the official classification of that's deep of a comma. Okay,
so you're in there. Um, if you're in a car injury,
what they're going to do. They're gonna tree ours, your symptoms,
your problems. So if you're in a car record something
you have injuries from that, they're gonna, you know, control
the bleeding that kind of thing. They want to stabilize
everything else first not first, but you know once you're
once you're stable though, um, and you're still in a coma,
(16:42):
they you can't care for yourself any longer. So they
it's kind of like they're going to poke around and
determine what the causes. Maybe they'll use in e g.
Electro and cephalography right or m r I or f
m r I, which is basically an m r I
for the brain, or CT scan which is computed tomography
right now. They they'll use all these things to basically
(17:04):
either look inside and e g actually is basically, um,
kind of like cooking into your electrical system and checking out,
you know what, how the impulses are doing right, and
they'll diagnose, you know, maybe what caused the coma, that
kind of thing. So once once you once you're stabilized
diagnosed in a coma, you know, you've you've been given
the scale rating, um, and you're in for the long haul. Clearly. Yeah,
(17:27):
they're they're gonna basically use machines to care for you,
like feeding tubes. Um. Oftentimes somebody in a prolonged coma
or vegetative state. Uh, they'll perform a tricky otomy so
they don't have to innovate you um because after a
while the innovation too. But imagine gets real, you know,
uncomfortable that actually so much so that you you would
(17:50):
prefer a hole of the throat. Yeah, and you know,
let me it's a little aside. One of my best friends,
guy named Jen's Baty, in sixth grade, Uh, his mom
started choking h in a restaurant and actually had an
emergency trackeotomy with a stake knife and a pain performed
on her. Yeah, there was a doctor there who did it,
(18:12):
and he just went he was breathing. Again. That's the
worst case scenario right there. And so he used to
have this little scar and still I'm sure still does.
But it was crazy. Guys. The only person I ever
knew who had an emergency trade. I thought that was
something just you know, you get on the er. Yeah,
it happens, It happens. Uh. So back to comas, another
thing that that is often done is a physical therapy
(18:33):
just to keep the muscles moving. Um, they'll they'll, you know,
the nurses will move the patient to prevent bed swords
and then move the muscles, flex the legs to keep
you know, atrophy from setting in. Or if you're uma therman,
you can do a really focused you know, um regime
right within an eight hour period and you'll be walking again. Right. Yeah. So, um,
(18:55):
how we need to bring this down a little bit,
don't we? I think so? Yeah, because searching it, it's
when you really get a grasp on comas, in the
peculiar nature of them and just the fact that we
have no way to bring somebody out of a coma.
It's kind of heartbreaking to think that their families out
there who would go to the hospital every day or
(19:16):
every week and yeah, and you hope because there's people
like Patricia White Bull who sit up all of a
sudden and there you have it. You know, somebody can
come out of a long comma. It's that's rough true.
I've got a study for you that might encourage you
a bit. I'd love to hear it, just from two
thousand six. It's from Dr Adrian Owen of Cambridge University
and neuroscientists, and he's trying to determine a consciousness meter
(19:40):
for people in comas and vegetative states. So what he
does is he hooks a normal, healthy person up to
uh an f m R I machine, which I know
you understand how that works right, Well, it basically it's
it it uses magnet magnetic imaging to see through the
skull um and basically it's watching the brain. It is
watching the electrical activit being in the brain. So if
(20:01):
you know the the prefrontal cortex lights up when you
tell somebody to you know, um, and when somebody sees
a bunny, you'll know that the prefrontal cortex is involved
in and taking cuteness into context or something. Well, that's
I'm impressed. So he'll hook up a healthy person and
then someone in a come our vegetative state and asked
him to do something like, imagine playing a game of tennis.
(20:23):
I believes what he is on this one woman, and
he found that, um, the brain activity was really similar
for both of these people, which led him to believe that, uh,
there may be a lot more brain activity going on
and some of these different states of mind. Yeah, that
that pretty much flatly contradicts our understanding of vegetative states. True,
but it also this was one one person. I believe
(20:45):
that it was successful in and I'm sure there's been
subsequent studies since. But he himself said that, you know,
we need to keep studying this kind of thing before
we make any determinations. Yeah, yeah, we need to basically
figure out how to bring people out of comas. Right,
but it does happen. You can come out of a coma. No,
you totally can't. You can't bring someone out of a coma.
But I think they said that who score a three
(21:08):
or four on the on the scale within the first
twenty four hours are likely to either die or remain
in the vegetative state, So that's no good. And but
on the other side, who score between eleven and fifteen
are likely to make a good recovery. So well it
makes sense. I mean, if you can, you know, shake
somebody's hand when they tell you to, right, you're probably
(21:28):
gonna make it. But apparently it's his first twenty four
hours are really telling. Yeah, I would imagine. So, so
that's that's comas. Huh. That's my understanding of Comma, the
great medical mystery that still remains one day maybe I hope.
So all right, chilling, uh, Chuck, do you want to
do listener mail? Yeah, let's do listener mail. And I'm
(21:49):
starting to separate listener mail into different categories good cream
from the rest of the crop, as exactly the men
from the boys, well, just more like a good way
to woman from the girls. Shut it. Um. So, first
of all, we've decided to change this one part to
stuff we should know. This is instead of corrections a
lot of times are not in actual correction, but something
(22:09):
a listener has added that we did not realize. And
there's stuff we should have known, stuff we should have known.
We can call it that, but that that actually came
from Brian Smith of California suggested we call it that. Yeah,
we're actively following our listeners commands at this point. So, Brian,
we appreciate the title there, and we're gonna use that now.
So something we did miss in the body armor episode.
(22:30):
We talked about a lot of kinds of body armor,
which was good, but we failed to mention one new,
very awesome one called dragon skin armor. And apparently these
are a little small, overlapping ceramic disks, sort of like
the medieval scale mail. And um, it's just a modern
version essentially, and it's more effective from repeated hits from
(22:50):
a bullet. So a lot quite a few people sent
this in. Michael Schivitz, retired naval officer or I don't
know about officer, retired U S. Navy, Reno Marino or
Renee Marino from Brooklyn, and Devin Montess in California. And
I'm sure we missed a few others, but yeah, we
actually got a lot of mail about the dragon skills.
(23:14):
And I say, I find it comforting to know that
we're advancing light years now, right, And I have one
more quick one, and this is uh apropos to our
topic today of commas, John mull Queen. It's a doctor
in Massachusetts. And John wrote in and said I thought
it would never happen. But I heard a mistake on
stuff you should know, uh exorcism. Apparently you said this
(23:37):
is not me. You said that someone with epilepsy. You
could throw somebody in an MRI machine and look at
the parts of the brain and see that someone is epileptic.
And John says that, actually you would not see epilepsy
in an MRI. I caesars are diagnosed with an E
E G machine, which is what we just spoke about,
So we appreciate that correction. Yeah, thank you. Is he from?
(23:58):
Is he from Farmington Framing hand? You know it's from
Gardner mass Well x x o O to all of
our listeners who sent mail, and you two can send mail.
You can send it to uh stuff podcast at how
stuff works dot com. I gotta tell you there's plenty
more information on comas in the great article on the
(24:18):
site called how comas work. Just type those three little
words into our handy search bar and of course how
stuff works dot com for more on this and thousands
of other topics. Is it how stuff works dot com,
brought to you by the reinvented two thousand twelve Camray.
(24:39):
It's ready, are you
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