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Thousands of Families Facing Similar Decisions

March 19, 2005|Thomas H. Maugh II | Times Staff Writer

At any one time, as many as 35,000 Americans -- up to 10,000 of them children -- are in a persistent vegetative state similar to that of Terri Schiavo, medical experts said Friday.

Every week, tens or hundreds of families across the country must make the same wrenching decision that Schiavo's husband and parents have been fighting over for more than 10 years, but the decisions are typically made in a much less public forum.

There is often a great deal of confusion about what it means to be in a vegetative state, according to physicians. First of all, such a patient is not brain dead.

"Brain dead is a state that is very well defined," said Dr. Michael Keane, a critical care specialist at UCLA Medical Center. "There are tests that can be done to show that there is no brain stem function. If you are brain dead, you truly are dead."

The term coma covers a broad range of states. A person who drank too much, passed out and cannot be roused is in a coma, Keane said. At the other extreme, a coma can be so deep that the patient requires blood-pressure support and help breathing. In all cases, the patient's eyes are shut and he or she is unresponsive.

A coma is usually considered to be a short-term situation. After a few weeks or months, the situation is usually resolved with the coma being reversed or the patient dying.

A persistent vegetative state is something different, "sort of like being in an awake coma," said Dr. David A. Goldstein of the Keck School of Medicine at USC. Patients' eyes are open, they have sleep-wake cycles, and it often appears that they are interacting with visitors, which makes it hard on families.

The brains of such patients are functioning only at a very rudimentary level, said Dr. Kenneth V. Iserson of the University of Arizona Health Sciences Center in Tucson. They cannot feel pain, express themselves or receive communication. They may have grimaces or smiles or other facial movements that look like they are reflecting emotions, but "there really isn't a significant relationship with the outside world," Goldstein said.

And the longer the state persists, "the less likely they are to come out of it," Keane added. Schiavo has been in this condition for 15 years "and it is very, very unlikely she would wake up," he said.

Now that Schiavo's feeding tube has been removed, changes in her condition will be slow to occur and barely perceptible at first. In the first couple of days, she may -- or may not -- feel pangs of hunger or thirst.

"Most patients don't seem to give any outward evidence that they are in pain," Goldstein said.

After a couple of days, her kidneys will begin to fail, releasing toxins into her bloodstream that will anesthetize her body. Soon after, she will lapse into a coma. Eventually, she will stop breathing. The whole process could take one to two weeks.

"This is not a cruel procedure," Goldstein said. "It is unlikely that [she] will feel pain in any way that we as sapient people will identify. Many family members think it is a very comforting procedure

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(BEGIN TEXT OF INFOBOX)

Body in decline

Without the feeding tube, Terri Schiavo's body will begin to deteriorate. Death in such cases usually occurs within two weeks.

Death process from withdrawal of feeding tube

Day 1: Tube, which is placed through the skin and into the stomach, is removed in a simple surgical procedure.

Days 3-4: Urine output decreases and patients begin to lose normal body secretions; mouth begins to look dry and the eyes appear sunken.

Days 5-9: People who are alert have a marked decrease in their alertness. Respiration becomes irregular.

Days 10 and beyond: Patients do not appear to respond to their environment at all and may lapse into a coma.

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Sources: LifePath Hospice; Ohio State University Medical Center

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