Coma

Upon emerging from a coma, some people describe the coma as feeling like being in a dream, and that parts of their hospital care appeared in, or took on a distorted form within the dream, such as hearing beeps of machinery or feeling their bed being moved around.

Some people report having heard the voices of their loved ones or hospital staff. Others report having no recollection of their time in the coma at all.

Experiences are varied, and ultimately it is impossible to tell how your loved one is feeling in a coma. In any case, it might be helpful for you to talk to them gently and reassuringly as if they were awake, just in case this does help.

Unfortunately, it is impossible to tell if and when someone will emerge from a coma. In many cases, comas last for a few weeks, but this can be much shorter or longer, and will largely depend on the extent, type and location of injury in the brain. For instance, there is a part of the brain called the brainstem which, if severely damaged, can result in the person remaining in a coma.

Unfortunately, there is no proven way that you can help your loved one to wake up from their coma. However, there may be ways in which you can offer comfort to your loved one and feel involved in their care. Some people say that the voices of their loved ones provided comfort to them while they were in a coma, so talking to your loved one gently and calmly might be helpful. Talk to them in a normal voice, and do not say anything that you would not want them to hear.

While it is natural to want to hope that movement might be in response to your touch (or voice, familiar music, familiar scents, etc), it is more likely that this is reflexive rather than done with any purpose or intent.

Ask clinicians involved in your loved one’s care about signs to look out for that might suggest that your loved one is beginning to emerge from their coma.

You can also discuss the option of video recording your interactions so that you can share any recorded movements with clinicians to discuss these together. Clinicians may also be able to teach you to use simple clinical measures to document your observations.

You may be spending more time at your loved one’s bedside than them. You may therefore be more likely to pick up on signs if your loved one is beginning to emerge from the coma.

It is impossible to say if and when a person will emerge from a coma, and what their condition will be when they emerge, as all cases are different. In the early stages, clinicians may tell loved ones to ‘prepare for the worst’, or that their loved one may never walk or talk again. This can be very difficult to hear, but it is important to prepare for all eventualities.

It may be that your loved one has difficulties with walking or talking after emerging from a coma, but many people go on to making good long-term recoveries after brain injury. Rehabilitation can be offered to help with redeveloping these skills, and adaptive equipment can be used where needed to adjust.

People may also develop a range of physical, emotional, cognitive or behavioural effects after brain injury, such as having problems with their speech or thinking skills, for which varying forms of rehabilitation and adaptive techniques can also be offered.

Many people go on to making good recoveries and living fulfilling lives after brain injury, even after having been through a coma. The journey to recovery can be long and take a significant amount of adjustment, but at Headway we know that there can be life after brain injury.

Our brains are responsible for everything that we think, feel, say and do. It is also responsible for our most basic functions such as breathing, being alert and regulating our sleep-wake cycles.

While the brain is naturally well protected, accidents or illnesses can cause damage, for instance through injuring specific brain structures or causing blood to leak into the brain. This can interfere with the brain’s functioning, and in cases of very severe injury, can lead to a coma.

If a person does emerge from a coma, they will not suddenly sit up or start asking questions, like we sometimes see in films. In most cases, they will gradually begin to regain consciousness, although they will be very confused at first about where they are and what has happened.

In some cases, a person will not immediately begin to regain consciousness but will instead progress into a vegetative state (VS) or a minimally conscious state (MCS). These are called prolonged disorders of consciousness (PDOC). In a state of PDOC, the person is no longer in a coma, but they are not yet fully alert or conscious.

They might also behave unusually, for example they might shout, swear, try to pull hospital tubes out or behave inappropriately. This can be very upsetting for family, especially if the behaviour is out of character. Be assured however that it is a normal and temporary part of the recovery process known as post-traumatic amnesia. Your loved one is not intentionally behaving in this way and probably will not remember their behaviour during this time.

Upon emerging from a coma, the person will eventually be transferred to a neurological ward, where their treatment will continue. They may undergo a period of rehabilitation to cope with the long-term effects of brain injury.

Find out more about the various effects of brain injury and how to cope by visiting Living with brain injury.

Withdrawing care

Unfortunately, in some cases of severe brain injury, continuing to treat someone in a coma may no longer be of any benefit to them, or may only be prolonging a death that would naturally have happened at the time of the injury. In these cases, withdrawal of the person’s care may be considered.

Making the decision

This is a very difficult decision to make for all involved and will be particularly distressing for families.

Any decisions regarding withdrawal of treatment will always be made in your loved one’s best interests, for instance if their brain injury is so severe that they are unlikely to ever regain any quality of life. Decisions should always be made under medical, ethical and legal frameworks, and should involve the family and specialists.

In cases where there is a disagreement between family and the clinical team, the case can be referred to the Court of Protection and examined under legal proceedings. Loved ones are allowed to make these applications to the Court of Protection if they have concerns about withdrawal of treatment decisions.

What happens next?

If it is agreed that the process for withdrawal of treatment will begin, nurses should explain the next steps to you very carefully and sensitively. You will be given the chance to spend time with your loved one and should have the opportunity to ask any questions or raise any concerns that you may have.

The change that takes place over your loved one will be gradual, over a period of days and weeks. There is no standard way that treatment is withdrawn, as this will depend upon the treatment that your loved one has been receiving.

You should be offered appropriate emotional support and information throughout this process. Remember, there is no right or wrong way to feel during this time; all emotions are understandable.

The time after the loss of a loved one is often very difficult for people. There may be many mixed emotions, and you may not even know how to feel. In addition to dealing with the emotional consequences of the loss of a loved one, people may feel traumatised or distressed by their recent experiences in hospital.

Take your time with processing your feelings and consider seeking support from bereavement services or counselling. If you are struggling, consider talking to your GP about accessing psychological support.