Lucid awareness in nonresponsive patients: A “locked-in experience” and its implications

It is generally assumed that nonresponsive people in comatose states are unconscious, especially when it is known that their neuronal circuits are not functioning normally, for example, due to severe anoxia and medically induced comas. Nevertheless, occasional reports suggest that sometimes, patients in such conditions can be fully aware of everything that happens around them. The present publication introduces a well-documented case of this kind. It concerns a patient in Israel who was diagnosed with cerebral edema and suffered severe anoxic brain damage that had already affected his brain stem. He was put in an induced coma to minimize the brain’s oxygen consumption. Still, he was expected to die within hours. However, the patient recovered unexpectedly. It turned out he had been fully conscious throughout the 44 hours he was in this coma. As a result, he was able to describe in detail every occurrence and conversation that had been held at his bedside throughout this time. This locked-in experience had an utterly traumatic impact on the patient. As a result, practices for coma patient care have been adapted and improved in Israel. We argue that it is important to raise awareness regarding the occurrence of such “paradoxical awareness” and hope that this increased recognition will help to improve the practices for coma patient care, also in other countries. Moreover, such individual case studies are vital for advancing the knowledge about the brain conditions under which it is possible to be aware – a largely neglected field of research that may have further important implications, for instance, in the context of organ donation.