Published May 06, 2005
Buffalo, N.Y. –
Firefighter Donald Herbert is all over the news, having uttered his first words in a decade after suffering a severe brain injury while fighting a fire in 1995.
Herbert's doctor, Jamil Ahmed, MD of the University at Buffalo, tells WebMD that Herbert is medically stable and "much better than before. He is definitely out of the coma. He's responsive, answering in 'no' or 'yes' with me, and moving all the extremities and shaking the hand."
Ahmed says Herbert's family says Herbert has been more communicative with them, asking his wife, "How are you doing?" and asking about his condition.
The change came about three months after Ahmed prescribed medications targeting chemicals in the brain, including norepinephrine, dopamine, and serotonin. The names of the medications were not disclosed, in keeping with the wishes of the Herbert family. Ahmed says the drugs are "mostly given to people who have attention problems, cognitive problems, Parkinson's disease, and mood disorders."
Ahmed also told WebMD that Herbert's condition may fluctuate. "He is not continuously answering questions and talking. It's never happened before -- a big change for him. We are hoping he should progress more."
On Saturday Herbert spoke his first words in a decade. According to media reports, he asked for his wife and was able to have conversations with his family.
In December 1995, Herbert reportedly went without oxygen for several minutes after being trapped under a collapsed roof while fighting a house fire. The father of four is now in his 40s.
Speaking after such a long silence imposed by brain injury is "rare," says neurologist Nancy Childs, MD, of Texas NeuroRehab Center in Austin. But "recovery" might not be the right word for it, she says.
"What we're really talking about with this patient and a couple of the others that have been in the news is recovery of speech for a period of time," Childs tells WebMD, emphasizing that she does not know the particulars of Herbert's case.
"As far as disability status and what they can do -- moving and walking and transferring from a bed to a wheelchair or standing -- as far was we know those sorts of functions have not changed in these people," says Childs.
"They remain in the severe disability category. That doesn't detract from the fact that something really unusual has happened when they start talking," she says.
States of Consciousness
Ahmed says that before Herbert started talking, he was diagnosed as being in a persistent vegetative state. Ahmed says he'd heard that Herbert may have moved, understood more, and may have been more responsive -- which could indicate that he was actually in a minimally conscious state, not a coma -- but Ahmed says he himself never saw that happen.
In a minimally conscious state, "there's inconsistent but definite behavioral evidence that the patient has an awareness [that] may be better or worse at some times," says Childs, who has worked for 18 years with patients with catastrophic brain injuries and disorders of consciousness.
In a vegetative state, "there is no awareness of yourself or the environment," she explains.
Childs says Terri Schiavo, who was recently at the center of a high-profile case regarding removal of her feeding tube, was in a persistent vegetative state.
Little Known About Such Cases
Asked what scientists know about what's going on in the brain in cases like Herbert's, Child says, "practically nothing."
"Some of the basic science and basic questions about what happens with the neurophysiology of the brain as patients move through levels of consciousness are just beginning to be explored," she says. "We have very little science about the huge majority of patients, let alone what happens with this handful of patients who do the unusual."
"I think it's true that the rare cases that have been reported have been younger. We do know [of] studies of traumatic brain injuries that as a whole, younger [patients] do better."
Patients who reach minimal consciousness within the first few months do better than those who are vegetative," says Childs. But "nobody knows" what predictors or factors might explain cases like Herbert's, she says.
"Brain injury recovery is a very slow process," says Paulette Demato, program director of the Coma Recovery Association.
"People may proceed to a certain level and then reach a plateau, and nothing else may happen for years after that," she tells WebMD.
Herbert's case "kind of gives hope to all the families out there who are waiting for that miracle. These things do happen," says Demato.
"Several months ago, there was a woman in Kansas who began to speak after 20 years. It doesn't mean that they're 'waking up' after that period of time. It means certain things are beginning."
The woman in Kansas that Demato referred to is Sarah Scantlin. Her brother, Jim Scantlin, shared her story with WebMD.
In September 1984, Sarah Scantlin was a pedestrian crossing a street when a drunk driver hit her. She lingered in a coma for five or six weeks, then entered a minimally conscious state, says Jim Scantlin of Fayetteville, Ark. Unlike Herbert, Sarah Scantlin did not suffer from oxygen deprivation to her brain.
"We never knew if she knew it was us [in the room with her] or not," says Jim Scantlin.
In January of this year, Sarah Scantlin started talking, he says. For a few weeks, she declined to talk to her parents, probably because she wanted to practice talking first, says Jim Scantlin.
Then, on Feb. 4, she talked by phone to her mother and father. The staff at Golden Plains Health Care Center -- a nursing home in Hutchinson, Kan. -- put her on speaker phone. "She can't hold a phone," says Jim Scantlin.
'Someone Wants to Talk to You'
Later that day, Jim Scantlin was surprised to see his wife show up at his office. He hadn't yet heard about Sarah Scantlin phoning home. "There was a conference call going on, and my wife said, 'Someone wants to talk to you.' I couldn't make out what was going on. Beth grabbed my arm and said, 'It's Sarah.' I said, 'Sarah?' and she said hello."
"Pretty much everything after that was a blur. She counted and said she's doing fine and that she missed me and loved me. I didn't know whether to laugh or cry or what. My whole body went numb," says Jim Scantlin.
Since then, Sarah Scantlin has told people she knew about the Sept. 11 terrorist attacks and the Oklahoma City bombing, says Scantlin. Those events happened while she was in the minimally conscious state.
Sarah's Current Condition
Today, Sarah Scantlin is at the University of Kansas Medical Center and is doing "remarkably well," says Jim Scantlin. Sarah Scantlin has had three surgeries in five weeks. "Her feet, hands, and arms all atrophied, so they're getting her in a position where she can use them again," says Jim Scantlin.
He says she's been "real quiet" the last couple of times they've talked. "I think it hurts more than she says it hurts," he says, referring to Sarah Scantlin's recovery from her recent surgeries.
"She's certainly not the Sarah she was. That person's gone in 20 years," says Jim Scantlin, saying Sarah Scantlin can now eat regular food again and can stand up when supported by a device. "She can only stand for 15-20 minutes. It's a lot of work for her," he says, saying she has to relearn skills that many healthy adults take for granted.
Sarah Scantlin's progress took Jim Scantlin by surprise.
"I probably gave up hope a long time ago," he says. "Your defense mechanism is, 'She is the person she is and that's just what there is. Me wishing she was better all the time is just going to drive everyone crazy.'"
He says when Sarah Scantlin first left the hospital to go to a nursing home in 1984, doctors said she might last 10-12 years. But he says the nursing home took "great care of her" and that she'd always been "relatively healthy the whole time."
'It's Hard Stuff'
He calls Sarah Scantlin's speaking a miracle. "It took me probably three weeks to be able to say that. ... I looked up 'miracle' and it said something about an event unexplainable by the laws of nature usually attributed [to] God. Well, I can accept that," he says.
That doesn't make it easy. "It's hard stuff," he says. "I was thinking that there are plenty of people in accidents who wake up where Sarah's at right now and everybody's really upset and distraught that their whole life is gone. On the flip side, Sarah is in the same state and how joyful we are."
'Be Joyful About Today'
"My parents brought us up in an environment where today is today and tomorrow takes care of itself," says Jim Scantlin. "We don't know what's going to happen."
"I don't know that I have any great words of wisdom," says Jim Scantlin. "Everyone has to make their own family choices. ... You don't know until you're there."
By Miranda Hitti, reviewed by Michael W. Smith, MD
SOURCES: Jamil Ahmed, MD, University of Buffalo, New York. Nancy Childs, MD, neurologist, Texas NeuroRehab Center. Paulette Demato, program director, Coma Recovery Association. Jim Scantlin, brother of Sarah Scantlin.