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The Sydney Morning Herald

http://www.smh.com.au/world/doctors-thought-he-was-in-a-coma-but-he-was-in-fact-conscious-20091124-j8gs.html

Doctors thought he was in a coma, but he was in fact conscious November 24, 2009 - 12:05PM



Rom Houben can now communicate thanks to a special computer. Right, Houben is pictured before his accident. Photo: Sky News

For 23 torturous years, Rom Houben says he lay trapped in his paralysed body, aware of what was going on around him but unable to tell anyone or even cry out.

The car crash victim had been diagnosed as being in a vegetative state but appears to have been conscious the whole time. An expert using a specialised type of brain scan that was not available in the 1980s finally realised it, and unlocked Mr Houben's mind again.

Mr Houben, 46, is now communicating with one finger and a special touchscreen on his wheelchair.

"Powerlessness. Utter powerlessness. At first I was angry, then I learnt to live with it," he said, punching the message into the screen during an interview with the Belgian RTBF network, aired on Monday. He has called his rescue his "renaissance".

"I would scream, but no sound would come out,'' he said. "I will never forget the day they finally discovered what was wrong - it was my second birth.''

He could hear what was being said around him throughout but was unable to respond.
"I became the witness to my own suffering as doctors and nurses tried to speak to me and eventually gave up," he said.

Cut off from the world, he passed his time in thought.
"I dreamed of a better life all the time. Frustration is too small a word to describe what I went through," he said.

"I want to read, to talk to my friends with the computer and to live life now people know I'm not dead."

Over the years, Mr Houben's family refused to accept the word of his doctors, firmly believing their son knew what was happening around him and gave no thought to letting him die, his mother, Fina, said.

She was vindicated when the breakthrough came.
"At that moment, you think, 'Oh, my God. See, now you know.' I was always convinced," she said.

The discovery took place three years ago but only recently came to light, after publication of a study on the misdiagnosis of people with consciousness disorders.
While a 23-year error is highly unusual, the wrong diagnosis of patients with consciousness disorders is far too common, said the study, led by Steven Laureys of Belgium's Coma Science Group.

"Despite the importance of diagnostic accuracy, the rate of misdiagnosis of vegetative state has not substantially changed in the past 15 years," the study said.

Back then, studies found that "up to 43 per cent of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state".
The issue is fraught with difficult medical and ethical questions. Patients diagnosed as being in a vegetative state with no hope of recovery are sometimes allowed to die, as was done in 2005 with Terri Schiavo, the severely brain-damaged Florida woman at the centre of the biggest right-to-die case in US history. Her feeding tube was removed.

"It makes you think. There is still a lot of work to be done [to better diagnose such disorders]," Caroline Schnakers of the Coma Science Group said.
Mr Houben was injured in an car accident in 1983 when he was 20. Doctors said he fell into a coma at first, then went into a vegetative state.

A coma is a state of unconsciousness in which the eyes are closed and the patient cannot be roused. A vegetative state is a condition in which the eyes are open and can move, and the patient has periods of sleep and periods of wakefulness, but remains unconscious and cannot reason or respond.

During Mr Houben's two lost decades, his eyesight was poor, but the experts say he could hear doctors, nurses and visitors to his bedside, and feel the touch of a relative. He says that during that time, he heard his father had died, but he was unable to show any emotion.

Over the years, his sceptical mother took him to the United States five times for tests. More searching got her in touch with Mr Laureys, who put Mr Houben through a PET scan.

"We saw his brain was almost normal," said neuropsychologist Audrey Vanhaudenhuyse, who has worked with Mr Houben for three years.

The family and doctors then began trying to establish communication. A breakthrough came when he was able to indicate yes or no by slightly moving his foot to push a computer device placed there by Mr Laureys's team. Then came the spelling of words using the touchscreen.

Mr Houben's condition has since been diagnosed as a form of "locked-in syndrome", in which people are unable to speak or move but can think and reason.

"You have to imagine yourself lying in bed wanting to speak and move but unable to do so while in your head you are OK," Ms Vanhaudenhuyse said. "It was extremely difficult for him and he showed a lot of anger, which is normal since he was very frustrated."

With so much to say after suffering for so long in silence, Mr Houben has started writing a book.

"He lives from day to day," his 73-year-old mother said. "He can be funny and happy, but is also given to black humour.''

Recently he went to his father's grave for the planting of a tree.
"A letter he wrote was lowered into the grave through a tube," his mother said. "He closed his eyes for half an hour, because he cannot cry."

There is little hope that Mr Houben's physical condition will get better, but his mother said she refuses to give up. "We continue to search and search. For 26 years already."

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"The family and doctors then began trying to establish communication. A breakthrough came when he was able to indicate yes or no by slightly moving his foot to push a computer device placed there by Mr Laureys's team. Then came the spelling of words using the touchscreen."

As a retired nurse, I was particularly interested and fascinated by this news story - I had heard it briefly on FoxNews, but the article you posted gave a lot more detail - I have always assumed that any comatonse patiet I ever cared for as a nurse could hear everything that was said and was very careful to mince my words accordingly - :shock:

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This was a very interesting article.  My step mother was in that stage for over 8 years.   She had a major stroke among other things that were diagnosed, but I would go to the nursing home at least weekly and sit and talk to her.  She appeared to have no idea who I was or what I was saying, but in my heart I knew she did.  The last time I saw her, I sat and told everything that was happening in my life.  My Dad and brother and my youngest son were there.  I asked for time alone with her.  I told her it was time, she had been through enough and it was okay to go.  I also told my family that this time was the end and at the time I lived in San Jose and was not going back to California until she passed.  Four days later, she finally past.  She was 53 yrs. old.  I think the story of the young man was a miracle.  You just don't know if they can understand, but you keep talking knowing in your heart that they do hear you.
More research is being done all of the time and someday, I believe, they will have more answers.

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I know that this may cound gross, but, as a nurse for many years (now retired), I always wondered if all those supposedly "brain dead" people who had their organs removed for donation were really dead - it's certainly something to think about - maybe there should be a more definitive test developed before removing organs when the donor could possibly still be alive - this is disturbing to me - :shock:

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This was a very interesting story. I do believe that people in a coma can hear others talking to them, and I believe it is very important for their loved ones to talk to them. Sometimes it helps them to recover and sometimes it doesn't, but they still need to hear us. Nightowl, I guess I never thought about that with the organ donors, but I would certainly hope that the doctors would make sure before removing organs.

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Spiderweb - The problem that confronts the medical community is that if they wait too long to extract an organ for transplant, it may start to deteriorate (even if the "dead patient" is on a respirator to keep the tissues filled with oxygen - at least that is my understanding - I often thought about putting a "dead patient" on intense pain medication prior to extracting the organ just in case total brain death has not occurred and pain could be felt - also, there is definitely a need to use a more sophisitacated piece of equipment needed to determine that the "patient" is really "totally brain dead" before starting the process - :shock:

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This article really disturbed me. I can't imagine what this guy must have gone through! It would be like solitary confinement but worse! I can't imagine spending one day like that, much less 23 years. To have people come around and make a comment or whatever and not be able to respond and to know that most of the people probably consider you "dead" to some degree. And to find out about his fathers passing, it's just unimaginable what he must have gone through. Thank God he got another chance at life! His book he's writing should be pretty interesting to read.

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