What is coma?
Today coma is understood medically as a state much like sleep, in which individuals are completely unarousable and are unresponsive to external stimulation and to their own inner needs.
However, in ComaCARE we believe that people in coma are working to be more aware of potentially meaningful experiences and can often be reached through special communication methods. Go to ComaCARE How we work

Is the person unconscious or asleep?
In a coma people experience a sleep wake cycle and are in an altered state of consciousness also known as minimal consciousness. Coma clients may be
more or less awar at any one time of what is happening around their beds.

Can the person hear me?
Always assume the person in coma can hear you. Hearing seems to be the last faculty to deteriorate. Speak to the person and where possible “listen” for tiny signals which could set up a binary ( yes/no) communication system.
Go to training for carers.

Is it important to be quiet and peaceful in the room?
Not necessarily. It is usually best to speak in your normal voice, while at the same time following the mood or atmosphere of the client in coma.
Some exercises require more than one person and may involve a lot of affirmation, encouragement and even cheer leading at times.

What do I do if the person looks in pain or sad?
Often the person’s physical ability to respond is constrained in some way, so what may appear as a grimace from the outside could be a totally different experience from the inside. Please don’t make assumptions but rather support the person by feeding them sensory grounded information. For instance rather than say, "You are crying; you must be sad." Say."There is water coming from your eyes." This "fill in the blanks" type statement will help the patient with their awareness and at the same time allow them to fill in their own emotional content. If possible, try to ask what the person is actually feeling through a binary form of communication. Go to training for carers.

Won’t I disrupt the person is coma with coma work interventions; why not just let them be, especially if they are peaceful?
You won’t disrupt them if you learn to recognise negative feedback and do not persist beyond three tries at a communication attempt. Negative feedback is no change in their communication pattern following your interventions.
When comatose clients are peaceful they may be doing deep meditation or inner work. Some outside prompting can be very beneficial to move their awareness process along, so they can change and grow and come further out of coma. You will get subtle positive feedback if you are on the right path.

Can I touch the person in coma?
If you introduce yourself and ask permission! All human rights apply to a person in coma. We must be sensitive to client feedback and our own inner feelings.
If it does not appear or feel right then follow that feedback.

How long does a coma last?
Generally, the deepest level of coma lasts from two to four weeks. If the person does not waken from the coma, she enters into various stages of semi comatose states, so called vegetative states that include sleep wake cycles. These varying stages of altered states occur in people suffering from traumatic brain injury and in people undergoing metabolic comas from changes in blood chemistry near death.

In general, a comatose person suffering from brain injury fares best when coma work treatment is received as quickly as possible. Brain injury affects every person differently. Prognosis is difficult.

Is it useful for the coma worker to “know” the person before the coma?
It is useful to gather as much information concerning the person’s physical, mental and emotional well being before they entered coma. It is important to know all these factors because if the person begins to return to everyday life, they may be confronted with these deep and everyday issues once again. However do not stress this in communication attempts if you get no positive feedback, because the person may not be relating to this information in their altered state.

What medical tests are used and why?
When someone is in a coma, various tests are used to identify the kind of brain disturbance that has occurred.

• Electrical activity can be tested with an electroencephalogram (EEG)
  which determines if the person is alert, awake or asleep.
• A computerized tomography (CT) or computerized axial tomography (CAT) scan and magnetic resource imaging (MRI) reveal physical abnormalities through high quality, cross sectional views of body tissues.
• The Glasgow and Rancho Los Amigos scales are behavioural tests which attempt to the determine the depth of the coma state.
• There is also a scale for children in coma.

What are all the machines and tubes in and around the patient?
The machines around the bed are to monitor the patient’s progress and to keep them stable. Please don’t be afraid to ask the medical staff what they are and what they do.
Some of the more common are:

Arterial line:	A very thin tube which is attached to a monitor is inserted into an artery usually in the arm. This allows measurement of the blood pressure and the concentration of oxygen and carbon dioxide in the blood.
Catheter:	This is a flexible tube for withdrawing fluids from or introducing fluids into the body and is frequently used to drain the urinary bladder.
Electrocardiogram:	This monitors the patient’s heart rate and rhythm. Round electrode pads are located on the chest and are linked to a monitor.
Intracranial Pressure (ICP) Monitor:	This measures the pressure within the brain and is attached to the patient’s skull.
Intravenous (IV) :	Tubing inserted into a vein through which fluids and medications can be given.
Nasogastric tube:	A tube that passes through the patient’s nose and throat and ends in the patient’s stomach. This tube allows for direct “tube feeding” and to remove stomach acids.
Respirator,ventilator:	A machine that does the breathing work for the patient. It delivers humidified air in the appropriate percentage of oxygen at the appropriate rate through an endotracheal tube.
Tracheostomy tube:	A tube inserted into a surgical opening at the front of the throat providing access to the trachea and windpipe to assist in breathing.

How can I help the family?
As a caregiver or friend please take time to listen to the feelings of the family and friends without judgment. They may be feeling angry, incompetent, powerless etc. and may express their feelings in what seem irrational ways. Listen to them in a private place and not “above” the patient.
Refer them to this website and reading materials.
If they want to learn, teach them coma work techniques.

What is a living will?
A living will, also known as an advance directive, often contains a declaration that one does not wish to have one’s life prolonged by artificial means. However, once in a coma or altered state we may have a different opinion about our decision; many people have life changing experiences in coma while others need time to work through family and relationship concerns. Some people come out of coma and live fully for minutes, months or years more.

In ComaCARE work we apply the principle of the TWO STATE ETHIC – in that we regard seriously a pre-arranged document, but also appreciate that people may require information about living and dying from other states of consciousness.
People change their minds and anyone in a coma also has the right to do so.
Go to living wills

Are there resources I can read about coma?
Refer to resources page for a reading list.
Please contact ComaCARE for further information or visit other places on this website.