I wonder how it is all these years I could have my eyes open and know what is going on around me, yet be considered "vegetative." I got to thinking about the levels of consciousness (LOC). (For ease I will use Wikipedia http://en.wikipedia.org/wiki/Altered_level_of_consciousness)
Definition
Scales and terms to classify the levels of consciousness differ, but in general, reduction in response to stimuli indicates an altered level of consciousness:Level | Summary (Kruse)[2] | Description |
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Conscious | Normal | Assessment of LOC involves checking orientation: people who are able promptly and spontaneously to state their name, location, and the date or time are said to be oriented to self, place, and time, or "oriented X3".[7] A normal sleep stage from which a person is easily awakened is also considered a normal level of consciousness.[8] "Clouding of consciousness" is a term for a mild alteration of consciousness with alterations in attention and wakefulness.[8] |
Confused | Disoriented; impaired thinking and responses | People who do not respond quickly with information about their name, location, and the time are considered "obtuse" or "confused".[7] A confused person may be bewildered, disoriented, and have difficulty following instructions.[8] The person may have slow thinking and possible memory time loss. This could be caused by sleep deprivation, malnutrition, allergies, environmental pollution, drugs (prescription and nonprescription), and infection. |
Delirious | Disoriented; restlessness, hallucinations, sometimes delusions | Some scales have "delirious" below this level, in which a person may be restless or agitated and exhibit a marked deficit in attention.[2] |
Somnolent | Sleepy | A somnolent person shows excessive drowsiness and responds to stimuli only with incoherent mumbles or disorganized movements.[7] |
Obtunded | Decreased alertness; slowed psychomotor responses | In obtundation, a person has a decreased interest in their surroundings, slowed responses, and sleepiness.[8] |
Stuporous | Sleep-like state (not unconscious); little/no spontaneous activity | People with an even lower level of consciousness, stupor, only respond by grimacing or drawing away from painful stimuli.[7] |
Comatose | Cannot be aroused; no response to stimuli | Comatose people do not even make this response to stimuli, have no corneal or gag reflex, and they may have no pupillary response to light. |
The beginning of consciousness.
Looking at this, I was awake, but "confused" in the beginning. I wouldn't have used that term, but rather have used "impaired thinking". I wonder now...the definition of this state says "People who do not respond quickly...." I did not respond quickly. I still don't. If you have heard my voice it is rather slow. At the time of hospitalization, it was even slower, or not even there at all.
Was it really a consciousness problem, or a communication problem?
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It clearly becomes discrimination of my speech. Ask me to write it out and I can. Sure it might take me awhile because I only type with one hand. If I have to verbally say it, forget it. You may or may not even understand me. Again, at issue is speed. In order to be conscious I must be fast and and my speech understood. If that is the criteria, I fail. | ||
Writing became my main method of communication. In the hospital, I was having a problem getting people to read what I wrote. This was a long process for me. I needed another person because my arms didn't work. This meant waiting (sometimes days) for my mother to visit so I could have someone write it out. Staff weren't reading the messages I had her write, so I came up with a different idea... (This is El Camino Hospital, around St Patrick's Day, as you can see by the shamrocks on the door.) Look at my shirt. It's covered part-way, but reads "IF I GAVE A SHIT, YOU'D BE THE FIRST PERSON I'D GIVE IT TO." Staff read that! I got more. I guess consciousness was in a sarcastic t-shirt quote...with a curse word. | ||
Conscious but Different. I am different. The word "vegetative" has been used to describe what I am, although this is a misuse of the term. I am not vegetative. I'm just very slow. The slowness appears when I talk, not when you read. If I try to speak faster, you can't understand me. | ||
If the data doesn't fit, you don't throw out the data. You throw out the idea. So I don't fit. You don't put me in a category just to get rid of me. Throw out your idea and start over; no assumptions. | ||
Keep on writing Angela and we'll keep reading. Maybe one of these days the right person will see your thoughts in text and "start over".
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