Hubris (Repost from AMNAP 1.0)

I'm sure we all remember the spectacle last year of Terri Schaivo's last days. Court decisions came down, then were appealed appealed to higher courts. In the end, Schaivo - who we were told emphatically was "already gone" years ago - was pulled off her feeding tube and dehydrated to death and was laid to rest.

Practically the entire "scientific" medical community assured all of us that Schaivo's condition was permanent, that the real Terri Schaivo was hopelessly gone. But what if the medical consensus was based on a flawed understanding of how human consciousness works? What if our memories and personalities are not really "stored" in our brains after all, but simply accessed through them. In that case recovery from extremely severe brain damage seems much more reasonable.

This week, the Guardian published a fascinating article about a new treatment for "hopeless" PVS cases that is bringing many of them back to life:

We have always been told there is no recovery from persistent vegetative state - doctors can only make a sufferer's last days as painless as possible. But is that really the truth? Across three continents, severely brain-damaged patients are awake and talking after taking ... a sleeping pill. And no one is more baffled than the GP who made the breakthrough. Steve Boggan witnesses these 'strange and wonderful' rebirths.

For three years, Riaan Bolton has lain motionless, his eyes open but unseeing. After a devastating car crash doctors said he would never again see or speak or hear. Now his mother, Johanna, dissolves a pill in a little water on a teaspoon and forces it gently into his mouth. Within half an hour, as if a switch has been flicked in his brain, Riaan looks around his home in the South African town of Kimberley and says, "Hello." Shortly after his accident, Johanna had turned down the option of letting him die.

Three hundred miles away, Louis Viljoen, a young man who had once been cruelly described by a doctor as "a cabbage", greets me with a mischievous smile and a streetwise four-move handshake. Until he took the pill, he too was supposed to be in what doctors call a persistent vegetative state.
Across the Atlantic in the United States, George Melendez, who is also brain-damaged, has lain twitching and moaning as if in agony for years, causing his parents unbearable grief. He, too, is given this little tablet and again, it's as if a light comes on. His father asks him if he is, indeed, in pain. "No," George smiles, and his family burst into tears.

It all sounds miraculous, you might think. And in a way, it is. But this is not a miracle medication, the result of groundbreaking neurological research. Instead, these awakenings have come as the result of an accidental discovery by a dedicated - and bewildered - GP. They have all woken up, paradoxically, after being given a commonly used sleeping pill.

Across three continents, brain-damaged patients are reporting remarkable improvements after taking a pill that should make them fall asleep but that, instead, appears to be waking up cells in their brains that were thought to have been dead. In the next two months, trials on patients are expected to begin in South Africa aimed at finding out exactly what is going on inside their heads. Because, at the moment, the results are baffling doctors.

The remarkable story of this pill and its active ingredient, zolpidem, begins in 1994 when Louis Viljoen, a sporty 24-year-old switchboard operator, was hit by a truck while riding his bike in Springs, a small town 30 minutes' drive east of Johannesburg. He suffered severe brain injuries that left him in a deep coma. He was treated in various hospitals before being settled in the Ikaya Tinivorster rehabilitation centre nearby. Doctors expected him to die and told his mother, Sienie Engelbrecht, that he would never regain consciousness. "His eyes were open but there was nothing there," says Sienie, a sales rep. "I visited him every day for five years and we would speak to him but there was no recognition, no communication, nothing."

The hospital ward sister, Lucy Hughes, was periodically concerned that involuntary spasms in Louis's left arm, that resulted in him tearing at his mattress, might be a sign that deep inside he might be uncomfortable. In 1999, five years after Louis's accident, she suggested to Sienie that the family's GP, Dr Wally Nel, be asked to prescribe a sedative. Nel prescribed Stilnox, the brand name in South Africa for zolpidem. "I crushed it up and gave it to him in a bottle with a soft drink," Sienie recalls. "He couldn't swallow properly then, but I helped him and sat at his bedside. After about 25 minutes, I heard him making a sound like 'mmm'. He hadn't made a sound for five years.

"Then he turned his head in my direction. I said, 'Louis, can you hear me?' And he said, 'Yes.' I said, 'Say hello, Louis', and he said, 'Hello, mummy.' I couldn't believe it. I just cried and cried."

Hughes was called over and other staff members gathered in disbelief. "Sienie told me he was talking and I said he couldn't be - it wasn't possible," she recalls. "Then I heard him. His mother was speechless and so were we. It was a very emotional moment."

Louis has now been given Stilnox every day for seven years. Although the effects of the drug are supposed to wear off after about two and a quarter hours, and zolpidem's power as a sedative means it cannot simply be taken every time a patient slips out of consciousness, his improvement continues as if long-dormant pathways in his brain are coming back to life.