Medical Miracle – Woman awakes after 6-year coma, slips back

Woman awakes after 6-year coma, slips back

Woman’s alert cycles stun M.D.

By Erin Emery and Karen Augé
Denver Post Staff Writers

Colorado Springs – Minnie Smith is a true believer.

For more than six years, the 73-year-old woman has cared for her daughter Christa Lilly, who, since a cardiac arrest and stroke Nov. 4, 2000, had lain in a minimally conscious state.

Sunday morning, Smith greeted her daughter as she always does: “Hey, babe, how you doing today?”

“Fine,” Christa answered.

It was just the fifth time in more than six years that Lilly, 49, had been fully awake.

She was talking, eating and laughing as if six years hadn’t passed.

Physicians say they too are astounded by Lilly’s awakening, but they caution that she didn’t wake from a coma or a true vegetative state.

It is rare enough for someone to wake spontaneously after years of unconsciousness, said Dr. Don Smith of the Colorado Neurological Institute.In the exceptional cases when they do, they generally are patients who lost consciousness because of a traumatic injury – not because of the kind of oxygen depletion caused by cardiac arrest, said Smith, who is also director of the Swedish Medical Center stroke program.

“It would be extraordinary for someone to awaken from persistent vegetative state caused by cardiac arrest,” Smith said. “That would be miraculous.”

Smith and Dr. James Kelly, a neurologist at the University of Colorado Hospital, don’t believe Lilly woke from a persistent vegetative state.

Lilly has spent the past six years in what Kelly and Smith describe as a “minimally conscious state” – a term Kelly said was coined by neurologists meeting in Aspen in the late 1990s.

Since her cardiac arrest, Lilly has been awake 12 days during the 21st century, sometimes for a day and sometimes for several days.

But most of the time Lilly lies in bed with her eyes wide. Her mother says she watches TV and listens to the radio. Lilly nods to her mother but never speaks to her.

About a year ago, Minnie Smith told Colorado Springs neurologist Dr. Randall Bjork that her daughter has intervals of lucidity, that she wakes up, eats and drinks from a cup.

Initial skepticism

“I didn’t believe her,” Bjork said. “It seemed utterly preposterous to me that this would happen because we just don’t know about this.”

Bjork invited Smith to bring her daughter to his office the next time she had an awakening.

Tuesday, Lilly showed up – with a TV crew from CBS affiliate KKTV in tow.

“He was quite shocked,” Minnie Smith said. “He asked her: ‘How you doing?’ and she said, ‘I’m doing fine, how ’bout you?’

“He almost fainted,” Smith said. “He’d never heard her voice.”

Bjork asked Lilly, whom he has seen 10 times previously, whether she recognized him. She did not.

Lilly said she thought it was 1986 and that she was in a nursing home. She hesitated before telling him that the president was George H.W. Bush.

In a “minimally conscious state,” people seem aware of their surroundings and often even communicate through facial expressions, Kelly said.

It is common for those patients to have cycles of comparative alertness that alternate with periods of deep withdrawal, he said.

“It may be that people lapse into a true vegetative state at various times and then at other times become more awake and interactive,” Kelly said.

Having patients sit up, as Lilly does, rather than lying in a bed seems to help stimulate neurologic activity, Kelly said.

To become so awake and interactive that they can carry on a conversation – that is beyond unusual, he said.

End of the wakefulness

On Tuesday night, Lilly drifted back into her minimally conscious state.

Bjork calls the awakening a miracle and a testament to “Mrs. Smith’s love.”

“There’s really no reference point in our medical literature,” he said.

Minnie Smith runs the Golden Age Care Center for seniors and the mentally impaired. She is licensed to administer medication.

Bjork said he is developing a theory that because of brain damage from the cardiac arrest and subsequent clinical course, Lilly has limited energy reserves.

“Christa’s brain is literally on the ropes, so to muster up enough energy to have three days of conversation, she has to be in relative hibernation for months,” Bjork said.

The first time Lilly woke up fully was eight months after the cardiac arrest and stroke. She talked for about 90 minutes, then drifted back into unconsciousness. Each time she fully wakes, Minnie Smith talks to her about how long she’s been gone.

“We tell her: ‘We’re glad that you’re awake,’ and we tell her, ‘You’ve been asleep for years,’ because it’s been seven years now,” Smith says.

“She says, ‘I have? Why didn’t you wake me up?”‘

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