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Ministry to comatose patients

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Archives / 1991 / May



Ministry to comatose patients

Robert W. Rae
After 44 years of ministry in the Presbyterian Church, Robert Rae writes in retirement from Mesa, Arizona.


May 20, 1977. The morning dawned crisp, beautiful, but a little foggy. With her two children securely belted in the car, she was driving along Interstate 235 in Des Moines, Iowa, Suddenly a huge truck loomed in her path. She swerved her old Chevy to avoid the collision, but the median forced her to rear-end the truck. An other large vehicle emerged from the fog and crushed her car. The impact seriously injured the children and reduced the mother to a helpless quadriplegic. A vigorous, active, young woman, with so much of life ahead of her, was instantly turned into a comatose, vegetating in valid. For 14 years all that could be seen was a body, a vacant stare, and total helplessness.

As a pastor, what was I to do?

The question is both relevant and urgent. Relevancy comes in the very nature of our ministry—to care compassionately for those who desperately need such care, to transmit the love and concern of our Lord to such suffering people. Urgency is found in today's statistics. Highway accidents disable thousands of people each year, leaving many of them brain-damaged, comatose invalids. On any single day, approximately 10,000 Americans slumber in protracted coma. 

Facts about coma

In order to minister effectually to comatose patients, pastors should under stand certain basic facts about coma. "Coma" or "comatose" describes a mental syndrome characterized by complete loss of consciousness, leading to unresponsiveness to external stimuli. This condition may result from any of the following causes:

Simple concussion. Any head injury that produces even a brief period of unconsciousness should be attended to immediately and seriously. A simple concussion may sow the seed for great danger a little later. Often postconcussion complications may include a personality change, persistent headaches, inability to concentrate, emotional outbursts, anxieties, and hallucinations.

Brain damage. Any head injury has the potential to affect the brain. An injury that denies blood and oxygen supply to the brain even for a few minutes can lead to disastrous consequences. With an interruption of blood supply, the brain be gins to atrophy, and its neurons cannot regenerate themselves.

Strokes. Cerebral vascular accidents caused by ruptured or blocked vessels that supply blood to the brain cause strokes, which can degenerate into coma and/or death.

Metabolic abnormalities. Tumors, epilepsy, hypoglycemia, acute alcoholism, diabetic acidosis, and such conditions can cause a deterioration of consciousness, passing through stages of lethargy and stupor to final coma.

Intracranial hemorrhages. Hemorrhage in the cranium can cause blood clots, which if not immediately removed by surgery, may produce cerebral coma.

Until a few years ago, care for coma patients consisted mainly of caring for the body while waiting for either a miracle or death. Patients who remained comatose longer than 24 hours were considered irreversible and were expected to die within two weeks.

By contrast, today's advanced care promises greater hope for the arousal and recovery of comatose patients. One recent study reports the satisfactory recovery of 40 percent of patients who had been comatose for two weeks.2 "Satisfactory recovery" includes the ability to dress and feed one's self, as well as enjoy a measure of independence.

What is the secret?

Dr. John La Puma, M.D., of the University of Chicago Hospitals and Clinics, may have the answer.3 He calls his treatment program "environmental enrichment." Under this program, he provides maximum continuous stimulation calculated to produce patient arousal and recovery. He urges doctors, medical staff, and family members to touch and talk to comatose patients. He uses radio and television to provide continuous stimuli.

Recovered patients have often testified that they did hear and understand what was going on around them during their slumber, even though they could not respond verbally. One recovered patient professed resentment of her physician's 53 days of impersonal treatment.

During that time she wanted to tell him: "Doctor, you never say hello to me. Why do you act as if I'm not here ?" 4 Because comatose patients often hear and comprehend what is said in their presence, care givers are warned against saying anything that such patients should not hear. Careless bedside conversation can leave a patient anxious or troubled.

Pastoring comatose patients

While medical science has done much to understand the physical and mental trauma that is associated with comatose patients, pastors can also play a significant role in dealing with such patients and their families. Pain is a personal hurt; it has its spiritual dimension, and it cries out for a word of comfort, a message of hope, an assurance of peace. Here's where the pastor's role becomes significant without becoming intrusive. I suggest five pastoral steps that may contribute in dealing with comatose patients.

1. Begin by offering "reality orientation." Comatose patients may hear and comprehend much of what is said to them, even though they may not be able to respond. Therefore, as a pastor, speak to the patients clearly, identifying names and interests. Talk about patients' interests, with the assumption that they understand you. Guard against saying any thing negative to the patients.

2. Remember comatose patients respond to arousal techniques. Human touch has never lost its magic. Your touch of encouragement and concern, a warm hand shake, a hug to show that you care, a laugh all these have their, value in your pastoral visit to a comatose patient.

3. Nurture the faith of your patients. A pastoral visit, at any time, should be a faith-nurturing occasion. The bedside of a comatose patient is no exception. Words of confidence in God's ultimate purposes, reading appropriate scripture passages (eg., Ps. 23; Isa. 43:2; Matt. 6:9-13; Rom. 12:12; 8:28; 2 Cor. 12:8), and offering prayers of faith do mediate pastoral concern. A prayer such as the following would bring strength to the suffering:

Our Heavenly Father: You know the needs that burden our hearts just now. You can give us strength equal to our stress. We need Your help and Your hope. We are grateful for Your love that will not let us go, and for those whose labors of love lift our spirits and lighten our loads. We ask You to work all things together for our good and Your glory, Father God. Have Your own way with our lives and our loved ones, O God. We trust our future into Your loving hands, through Christ our Lord and Saviour. Amen.

4. Counsel and comfort the patient's family. Families of comatose patients go through a lot of agony and tension. In addition, they have to deal with many details, such as life-support efforts, payment of long-term care, institutional care, home nursing, etc. Pastors need to be competent in counseling in these areas. Also, there may come a time when the pastor must counsel a family to accept the impossible. Isn't preparing a family to face suffering and death an important pastoral responsibility?

5. Value opportunities for ministry to the Lord's disabled disciples. With evidence that comatose patients do respond to external stimuli, and with a faith that undergirds all Christian hope and action that nothing is impossible with God, what a marvelous privilege a pastor has to transmit that hope to a suffering patient.

Witness how God used a friendly salutation to arouse Jackie Cole from her 47- day coma.

As Jackie's coma dragged on, her husband came to believe that his wife's respirator was thwarting God's will for her departure. After considerable anguish, Harry Cole and his children petitioned the Baltimore City Circuit Court for per mission to shut off Jackie's respirator so she could die with dignity. Judge Carrol Byrnes denied their petition, contending that Jackie was not yet "brain dead."

Six days after Judge Byrnes' decision, a friend of the family stopped by Jackie's hospital room. In his usual manner, he took her limp hand in his and cheerfully said, "Hello, Jackie!"

Jackie opened her eyes and smiled warmly at everyone in the room. Through that simple salutation, God called her out of her long slumber and set her feet on the road toward recovery.

Jackie later described her comatose slumber in these words: "I'd wake up and kind of swim to the surface, see some body, and then I'd fall back again like I was sinking under water. . . . [Now] I feel like a whole new person. I've become a much better person than I was. I'm easier to live with and I'm not unhappy about anything. I'm glad I fought so hard to live. I give thanks to God for being alive."

Jackie Cole's miraculous recovery should encourage pastors and other care givers to continue their ministry with courage and confidence. God faithfully undergirds the labors of love by His care givers. With Him "all things are possible" (Matt. 19:26).

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1 Richard Ostling, "Is It Wrong to Cut Off
Feeding?" Time, Feb. 23, 1987.

2 Leah Wallach, "Coma Comeback." Omni,
June 1986.

3 "Talking to People in Coma," Vogue, April

4 Ibid.

5 Joan Tattner Heilman, "The Miraculous
Story of a Coma Survivor," Redbook, July 1987.

6 Ibid.

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