What is it like to be in a coma?

What does it feel and experience to be in a coma, if consciousness is still functioning?

The state of coma is one of the most horrible concepts a human being can imagine, perhaps second only to death itself. The idea that a human being cannot move even if he wants to, that he is not able to communicate even if he tries with all his might and that, in short, the body becomes a prison, is one of the most traumatic and unpleasant events that a conscious person can imagine.

But does a comatose person really feel this way? To give a correct answer, we must turn to science and research. The annual incidence of coma in certain regions is 8.5 patients per 100,000 inhabitants per year, and the average age of presentation is typically 8.5 per 100,000.and the average age of presentation is usually 41 years of age. Interestingly, up to 60% of coma cases are due to traffic accidents, while a severe fall is responsible for up to 30% of coma events.

Unfortunately, the prognosis is worse the longer the patient remains in coma, and in some sample groups more than half of the cases end in death. In any case, beyond data and statistics, we have recovered a very interesting idea that is not usually explored in the media: what is it like to be in a coma? Here we try to give you the answer, in the most objective and informal way possible.

What is coma?

The coma is defined as a prolonged state of unconsciousness, during which the patient is unable to wake up, fails to respond to basic stimuli, and is not able to wake up.s (light, pain, sound), does not have a normal sleep-wake cycle and is unable to initiate or carry out voluntary actions. The comatose process may be initiated by a central nervous system failure or, alternatively, reflect a metabolic process at the systems level. In any case, all etiological agents lead to a common point: brain failure.

This damage can be caused by neuronal dysfunctionality, either by a structural process or by a non-structural one that affects the central nervous system (CNS) in some way. In addition, various etiological agents of an infectious or metabolic nature can also affect the brain and lead to a comatose state. These include hypoglycemia, hyperglycemia, excessive alcohol intake, uncontrolled consumption of drugs and use of illegal drugs.

The accepted pathophysiology of coma is that in coma, the brain receives a limited supply of glucose and/or oxygen.. For example, as little as 15 seconds of circulatory collapse leads to fainting and loss of consciousness. If the lack of nutrients and oxygen continues, neuronal damage occurs and the patient's altered mental state is prolonged over time. In addition, it is also possible for neuronal destruction to occur directly in the encephalic tissue, for example, due to internal hemorrhage or contusion that damages its cellular structure.

It is also essential to note that another source of brain dysfunction may be increased intracranial pressure.. This event makes correct perfusion between the brain and the rest of the body impossible and, therefore, prevents the correct exchange of substances and neuronal functioning. At the end of the day, it is all about a failure at the brain level that prevents thinking and performing tasks in a normal way.

How a person in a coma feels: what science says

For science to understand how a comatose patient feels, it is necessary to monitor a number of essential parameters. For example, gray mass metabolism in patients with a coma of hypoxic origin is 50-70% of normal: it is not zero, but it is significantly decreased..

If the overall brain metabolism when awake is 100%, in a state of deep sleep it decreases to 60% and in a coma to 50%, a value slightly higher than that of a patient under general anesthesia (40%). In any case, many studies have shown that the level of consciousness correlates poorly with brain metabolism, so it seems that this parameter is not going to give us the answer.

A comatose patient can have his brain responses quantified using a variety of sophisticated techniqueseven though he or she is unable to speak. For example, the scientific article Semantic processing in a coma patient (2005) attempts to explore the electrical responses of the brain in a comatose patient on day 6 and 22 of his state. Interestingly, there was a significant difference in brain reaction between the patient's utterance of unfamiliar and familiar words. This could be evidence that comatose people have some semantic knowledge.

On the other hand, the article published in 2019 Hidden brain activity revealed in people with coma manages to decipher, by means of electroencephalography techniques, the electrical activity of the brain of 104 patients in a comatose or similar state when processing an instruction. When the individuals were asked to move a hand, 15% of them showed neurological patterns similar to those of healthy people to the same command. The prognosis of those who did not show this brain activity was worse in the long term.

After all these data, we can only think that "something is there" in a person in coma. The brain is under minimal activity, but depending on the severity of the injury and the general physiological state of the patient, it seems that some may respond better than others to certain extrinsic stimuli. In any case, it is clear that the level of response in this clinical picture is minimal, since it is impossible to awaken a person in coma with words or simple stimuli..

What patients say

Despite the poor prognosis in many cases, there are thousands of examples of people who have been able to come out of the coma with the ability to communicate. So there is no need to remain only in the realm of conjecture: unlike death, there are people who have come back to tell us how they feel.

The newspaper The morning bulletin reports, for example, the testimony of a woman who was involved in a car accident in 2011 and was voluntarily put into a coma by medical professionals in an attempt to save her life.

This person describes the coma as a blurry and fuzzy event, where the mind does not form concrete thoughts and dreams, but she was able to perceive the brain as a blurry and fuzzy event.But she was able to perceive Pain and form a kind of memories that her brain invented to try to make sense of everything that was happening around her. For example, this patient was able to recognize her husband's voice in the room, although she did not understand what he was saying.

She also describes that she believed she was being raped in her transient state, as she was able to feel pain in the anal and vaginal area, when in fact this fuzzy memory corresponded to the surgical processes that were taking place in her body to save her life. She was able to notice temperature changes in a cursory manner when she was moved from room to room and, on occasion, had nightmares.. Everything was intermingled in a sense of reality-wakefulness-dreaming and blurred moments.

Summary

Undoubtedly, the testimonies of some people who have survived a coma are, to say the least, overwhelming. Even those of us who are accustomed to reporting on the more unpleasant side of human physiology are shocked by this type of situation, because for a human being to be able to perceive himself in one way or another in a comatose state is a shock on an empathic level. Anyway, rationality must make its way over anecdote: this is a concrete and induced case, so it cannot be generalized.

Some people are able to place some memory or fuzzy perception during a coma, while others are not. Therefore, to the question of what it is like to be in a coma, we can only give one answer: it depends on each case. From nightmare to total absence of recognition there is a large spectrum, which can only be described and perceived by the patient himself if he manages to come out of his transient state of unconsciousness.

Bibliographical references:

• How does coma feel like, Harbor Light Hospice. Recogido a 18 de marzo en https://www.harborlighthospice.com/blog/what-does-a-coma-feel-like/#:~:text=A%20coma%20is%20similar%20to,or%20communicate%20in%20any%20way.
• Huff, J. S., & Tadi, P. (2017). Coma.
• Kotchoubey, B., Daltrozzo, J., Wioland, N., Mutschler, V., Lutun, P., Birbaumer, N., & Jaeger, A. (2005). Semantic processing in a coma patient. Grand Rounds, 5: pp. 37 - 41.
• Tong, F., & Pratte, M. S. (2012). Decoding patterns of human brain activity. Annual review of psychology, 63: pp. 483 - 509.
• What it feels like to be in coma, the bulletin. Recogido a 18 de marzo en https://www.themorningbulletin.com.au/news/what-its-really-like-to-spend-weeks-in-a-coma/3323711/#:~:text=Usually%2C%20comas%20are%20more%20like,of%20what's%20happening%20to%20you.