What's going on in Schiavo's head?
OAKLAND ROSS
FEATURE WRITER
PINELLAS PARK, FLA.—For 15 years, Terri Schiavo has lived in a private purgatory that is neither life nor death, but something in between — eerier and more troubling.
Yesterday, the brain-damaged 41-year-old Florida woman entered her 11th day without food or water, the result of a court decision handed down on March 18.
Doctors began administering morphine, not for the relief of pain but to ease her breathing — a sign that her death is likely no more than a day or two away.
Or did Terri Schiavo actually die upwards of a decade and a half ago?
Did her life effectively cease soon after that grim day in February 1990 when her heart briefly stopped beating, depriving her brain of oxygen so that she lapsed into a coma, from which she has never recovered?
Leon Prockop, a professor of neurology at the University of Southern Florida in Tampa, believes that this is exactly what happened, and he is not alone.
Prockop said he would "use the term `coma vigil,'" describing a condition that other neurologists have labelled a "persistent vegetative state."
"It's the state of being in a coma, but the person appears to be awake."
Prockop has looked at Schiavo's CAT scans, and he harbours no doubt whatsoever. "Her death occurred some time ago," he said in an interview yesterday. "That's my opinion."
It sure isn't everybody's.
According to Prockop and others, Schiavo's parents — the Schindlers — and family are seeing what they deeply want to see: a daughter and sister whom they love and who loves them back.
But they also say that the family are the victims of cruel illusion — the physical presence of a woman who is awake but not aware.
In this South Florida town, the debate about Terri Schiavo rages while the world watches, but really there is no debate at all.
Schiavo's sad plight has raised a welter of confounding moral and medical questions. But perhaps none of them is more troubling than the debate over what precisely is going on in that poor woman's head.
There are at least two sides to the story, and they are worlds apart.
Prockop may state his position more forcefully than others , but his view nonetheless coincides with the vast preponderance of expert medical opinion on the subject of Terri Schiavo.
She once was a woman with hopes and dreams, likes and dislikes, foibles and regrets, but she is not that way now, she hasn't been for years, and she never will be again.
"She has lost all frontal lobe functions," Prockop said. "In her case, there is a severe absence of brain tissue. This is not guesswork."
Understandably, there are those who wish fervently that it were not so.
Day after day, the woman's father, Bob Schindler, has appeared on camera, speaking about his daughter as if she were a thinking, communicating human being with feelings and opinions and a determination to live, even as she slowly sinks toward what yesterday seemed to be an inevitable, court-ordered death.
`She has amazing endurance. Don't give up on her. We haven't given up on her.'
Bob Schindler
"She's responsive, and she's responding to me," Schindler said early yesterday after visiting the woman at the Woodside Hospice in this Tampa-area suburb.
Again, he pleaded for someone to intervene and stop his daughter's death. "She has amazing endurance. ... Don't give up on her. We haven't given up on her, and she hasn't given up on us."
Lawyers and advisors associated with the Schindler family have used similar language in speaking of a woman whom they insist is conscious and aware of her surroundings. They say she communicates with gestures. They say she tries to speak.
Last week, a Florida neurologist named William Cheshire endorsed this view in an affidavit he swore out on behalf of the state's Department of Children and Family Services.
Cheshire, who is on staff at the Mayo Clinic in Jacksonville, drew his conclusions after observing Terri Schiavo in person and reviewing her medical history. He said she was alert and possibly capable of recovery, although he did not conduct an examination of his own.
But the courts have concluded the very opposite and, on March 18, Judge George Greer of the Pinellas Circuit court declared that the woman's feeding tube could be removed, in accordance with what Michael Schiavo, her husband, maintains were her wishes, expressed before she lapsed into unconsciousness 15 years ago.Cheshire is not willing to talk to the media about the case, and the Mayo Clinic where he works has distanced itself from his opinion on the matter, declaring on its website that "the standard procedure for the evaluation of a comatose patient includes ... the performance of a comprehensive neurological examination."
Cheshire conducted no such examination before reaching his opinion.
"The problem is that this case is political," said Walter Bradley, chairman of the neurology department at the University of Miami, who flatly disagrees with Cheshire's conclusions, as apparently do most neurologists familiar with the case.
Still, the disparity between these two views has persisted, day after day, so it often seems the two sides are talking about two different women. Yet they are both talking about the same Terri Schiavo. Whether she should be allowed to live or to die — that is one question. Just who, or what, is doing the living or the dying — that is another question. "Families and friends want desperately to see something that is volitional," said Prockop.
And in Terri Schiavo, they genuinely believe that they do: Her eyes rove the room when they are present, and sometimes her gaze seems to fix itself on them. She starts at sounds. She responds to light. She moans, as if trying to speak. When they hold her hand, she tightens her grip. At night, she closes her eyes and falls asleep. With the morning light, she awakens again.
But, said Prockop, all these activities are merely mirages of sentience rather than the real thing. They are automatic reflexes to stimuli and are controlled by primitive portions of the brain.
For people in the Schindler's position, the result is agonizingly seductive, not only because they keenly want to see sense and feeling where, sadly, there is none — but because this is so very easy to do.
"This is exactly the difficulty," said Bradley. "Even trained medical people have real difficulty."
Prockop agreed: "The first time I saw a coma vigil, I, too, thought the patient was responding."
Prockop and Bradley have examined Schiavo's CAT scans — electronic readings that detail the physical condition of her brain — and they agree on what is there and on what is not.
"She has approximately 20 per cent of her (total) brain tissue left inside her skull, and the remaining tissue is damaged," said Prockop. "The tissue that controls the higher brain functions is gone. It's disappeared."
This, he said, is what typically happens in such cases.
After Schiavo suffered her heart attack 15 years ago, and her brain was starved of oxygen, much of her brain tissue became scarred and then necrotic — in other words, it died.
What remained was interpreted by her system as foreign matter, and it was slowly flushed away, to be replaced over time by cerebro-spinal fluid, which has the appearance of water.
According to Prockop, this is the same miserable fate suffered by elderly people in the advanced stages of Alzheimer's disease. In Schiavo's case, he said, the damage is severe and, as in all such cases, irreversible.
"Her CAT scan shows a greater degree of brain damage than I have ever seen in a living person," he said. "That brain tissue cannot come back. It never has, and it never will."
But neurologists do not rely only on high-technology tests to make their diagnoses. They also examine a brain-damaged patient, testing for a wide range of reflexes. The neurologists who have had the opportunity to examine Schiavo have concluded that she can neither think, nor remember, nor feel — and that, sadly, she never will.
Reply With Quote
- Ty