Coma (2007) - full transcript

Roxy, open your eyes...

mommy's gonna hold them. One, two...

And you're gonna hold them up.

Look, Roxanne, keep them open.
Where's mommy?

Wake up. Roxy, you can do it.

Wake up so everybody
can see your eyes.

In 1975, a drug and alcohol
overdose left...

Karen Ann Quinlan
brain damaged and in a coma.

We'll probably never know
the cause of the coma.

Mrs. von Bulow was brought here.
The coma lasted for a couple of days.

But then a year later, she was
brought back again. In a coma.



There's a deep coma from which
until this day, she never emerged.

They go from coma to
this persistent vegetative state...

to a minimally conscious state.
And they're tough diagnosis to make.

Twenty years ago, Terry Wallis was
thrown from a car in an accident.

He suffered severe brain injuries
but was able to survive...

in what doctors called
a minimally conscious state.

After nineteen years in
a state of minimal consciousness...

- Terry spontaneously woke up.
- Truely amazing story...

Nineteen years of silence
broken by the word mom.

Explain the difference between
his case and Terry Schivo's case.

From a medical professional's
point of view, they're really...

apples and oranges. This is
a big concern because a case...

like this could raise
false hope for a lot of people.

By contrast, Terry Schivo, the focus
of an intense court battle...



over life support in Florida,
is in what doctors call...

a persistent vegetative state
with almost no chance of recovery.

Don't give up on her.
We haven't given up with her.

- She hasn't given up on us.
- Dr. Peter Ban Becheedes...

calls it a vegetative state
that is permanent and irreversible.

Interestingly, they may even
laugh or seem to cry...

She's trying to answer
that question that yes, I'm in here.

Can you tell us 100%
she'll never recover?

Unfortunately if you've an injury to
your brain you're here to get better.

I'm Dr. McCagg, I'm gonna be
taking care of you while you're here.

Welcome to JFK.

What's the matter?

Okay Tom. You're doing really well.

You're here for an MRI.

Okay. You've had those before so it's
nothing to be worried about. Right?

Why?

Hey Tom, it's Steve. Can you hear me?

If you can hear me open your eyes.

Keep awake Tom. I'm gonna
play something and...

- you listen to it for me. Okay.
- Tom, you're going to now...

listen to some stories,
pay attention to them, okay...

they're going to be
really nice for you. Ready.

- Here we go.
- Hi, honey.

remember the day you proposed
to me. It was a Friday, June 3rd.

It was cold and nasty and rainy
and I was working late as usual.

A couple of seconds later you said,
"Okay, open your eyes" and...

you were down on one knee, with
my ring from Tiffany and you said...

"Lindsey Delorenzo, please spend
the rest of your life with me.

Will you marry me?" And I said
"Of course I will, oh my god yes.

I'm so looking forward to spending
the rest of my life with you and...

growing old with you and
I love you so much baby."

It's a little more information than
the CAT scan showed that's for sure.

So this left hemisphere
has several lesions in it.

The main injury he has
is here in the frontal lob.

- That's mostly on the left side.
- On the left side?

On the left side here.

Bruising or bleeding...

- It's injury. It's no...
- Okay.

at this point it's not
bruising or bleeding.

- It's just, it's injury.
- Okay.

- It's damaged tissue.
- Okay.

It's affecting the frontal lobe...

So if it's damage, like what does
that mean? Does it come back? Or...

Well, it's still early...

- Okay.
- so hopeful all of this stuff's...

gonna continue to resolve...

- over time. I mean we don't know...
- I wish you back at home.

what it's gonna mean
at this point. The one thing...

- we're really watching for...
- John.

is language. The left hemisphere's
dominant for language.

- Okay.
- The front part of the brain is...

particularly dominant for expressive
speech expressive language.

We don't know yet, he may have
no problem with it, we don't know.

- Right, thank you.
- Thank you.

- So how you been coping?
- Okay.

You didn't realize
how long it was gonna be.

- No. You know, because on TV...
- Oh yeah.

- they wake up from a coma like that.
- Sure.

everybody's fine.
So it's quite an experience.

I don't know what I was 'cause
I mean I've never known anyone...

who was in a coma but
I was expecting to...

for her to be talking and stuff.

- Hi
- Hi honey.

Hey Roxy. Let me put these.
She looks good.

She looks great doesn't she?

She looks so good.
Hi Roxy. Mommy's here.

Mrs. Sim, she looks great now.

That's all. You're so sweaty.

Roxanne, it's okay momma, it's okay.

Okay. Mommy gonna kiss you, okay?

You wanna kiss me? Kiss mommy.

Oh look at how pretty my baby looks.

- Joanie's here.
- Hello.

I don't know. Come here.

- Lookay, Joanie's here, Roxy.
- Hey Roxanne.

Roxy...

see Joane. Hi, Joane.
What they took the trinket thing off.

You're breathing on your own.
Mommy's so proud.

This is the first day I see her
breathing on her own.

Oh, yeah?

Mommy's so proud of you.
You can touch her hand.

- Look.
- She's so sweaty.

I know. I get a towel.

- Watch her for a minute.
- Alright, yeah.

Oh Roxy, move your head back.

You want this?

Roxy. Hey Roxy.
Here, put your head back.

Roxanne, put your
head back. Good girl.

Roxanne, look at mommy.

Look at those eyes. Roxy, look at me.

Come on Roxy, you're gonna
talk soon, I know.

Mrs. Sim, you remember her
from when she was a baby.

- Yeah.
- Remember, I used to take...

Joseph and Joan and
Roxanne all over the place.

- Then they grew up.
- Yeah.

Feeling a little overwhelmed?

Yeah.

- Understandable.
- But happy. 'Cause look.

You're happy because
what seems to be different for you?

She woke up,
she's progressing. Look at that.

Was there ever a period where
there was no eye opening at all?

Like the first month.

About the first month.

And then she opened.

That's the period of time that we'd
consider her to have been in a coma.

- Alright.
- So when the eyes open that's...

- the end of the coma
- Oh, Okay.

Great, when the brain's incapable of
processing any information and...

it's not able to sustain wakefulness
basic wakefulness, that's a coma.

So when the eyes open,
it's the end of the coma.

Following severe brain injury...

the first hurdle that
one has to clear is...

whether you survive
the injury or not.

Roxy, are you awake?
It's Dr. Giacino. My name's...

Of those who emerge from coma,
one group will open their eyes...

and that's the onset of
a vegetative state.

Roxy? Look at me.

Another group emerges from coma
into the mentally conscious state.

Yup that's me.

These are individuals
who show some clearly...

discernable behavioral science
of consciousness or awareness.

You know the hallmark sign of living
in a conscious state's inconsistency.

Your consciousness is gone
when it was here moments ago.

A little bit of tracking.
Roxy, look at me.

Look at me if you can do that.
I'm over here on your left.

Loosing her level of alertness again.
Let me wake her up again.

Roxy, touch my hand.
Excellent, good job.

In Roxy's case, the important thing
in her examination was that...

the point at which I put my hand up
and asked her to touch my hand...

Roxy, listen to me.

Her behavior changed directly
in response to my instruction.

Take the cup from me.

That's a clear indication of
consciousness, tells us that...

this is a minimally conscious state,
not a vegetative state.

So I want to hear you say something.

Okay? Listen, Roxy...

can you say mom?

Mommy.

I want you to say mom.

Look at me baby.

Mommy's here.

Say it again. Nice and loud. Mom.

She said it in some vocalized manner.

I know, you probably
couldn't hear it from there. So...

I know she means some.

Work.

Okay, so I'm gonna relocate.

- Do we ready?
- Ready

- He's moving his hands a lot.
- He was moving his hands a lot...

when I worked with him this morning.
We can play with that...

- a little bit more.
- Yeah, I, that was...

We're set now. Alright, we're going.

- Merry Christmas Peggy
- It's really cool.

This is gonna
wake you up a little bit Sean.

Yeah, sure enough.

Alright Sean you're coming up.

And his?

Hey Sean, we were
trying to move this finger before.

Can you try to lift that up for me?

Thumb up, thumb down. Now you do it.

Bring it up just please.

Sean, were you looking at your hand?

You're looking at it.

I don't know is the worst thing
you wanna hear your doctor say...

but that's what we hear all the time.

- Relax. Here we go. You're okay.
- Hey.

Sean is unique and the doctors've
said from the beginning that...

he's an enigma, he just
doesn't do exactly what you'd expect.

So, you know, there have been
lots of glimmers of hope...

so we're just gonna continue to deal
with it and find a way through it.

And find a, you know,
try and give Sean a path back.

It's all we can do.

Look how tall he is.

Hold that head up, Sean.

Come on. How tall are you?

That's not bad.

- Be strong, come on.
- Can you turn it?

I'm fortunate that I get to
stay here everyday till eight o'clock

So I do get to see the little signs
that we can't document and...

they just take my word for it.
I know we need documentation and...

I know we need consistency
but I'm a witness to a lot more.

I'm privy to a lot more
because I have the time.

So that helps me a lot.

This is a very critical time for him.

Yes, we've these still somewhat
ambiguous signs, some leads...

but we don't have
the conclusive evidence yet

that there's conscious awareness.

And, he is, now that's not
to say that he won't...

there's no magic to the one year but
we do know that the vast majority...

but more than 95% of individuals,
who cross that one year mark...

without clear signs of
consciousness are not...

going to recover
consciousness after that.

I told 'em I don't wanna work later,
that you already worked hard.

Proud of you. Now look right
at me, look at my eyes.

Yeah, good job.

I'm over here on your left side.

Look at me over here
on your left side, Khan.

There you go. Come on.
Let's wipe you up a little bit.

My hands are probably
cold enough...

to do that?

That's a good swallow Khan.

Look at me over here. Come on Khan.

He's been really sick...

but I think he's just beginning
to start to come around.

This is his first day of sort of what
maybe he's moving his stomach in.

I'm not quite sure about it.

Maybe just that I want him
to move it so much.

Khan, can you take
a deep breath for me? There you go.

You sound clear as a bell.

Can you watch this?
Come on. Look at the silver pen.

I don't think he's following.

But you're doing okay.
You're getting better.

Since I have seen it in the past
I keep looking for it again.

He hadn't had those periods where
he can respond then you wonder...

are we doing the right thing.
But, he has been able to...

I mean he can tell you his last name
and tell you his son's names.

He... there's something in there.

And of course, I have to admit
I'm so invested in him now.

I wanna keep going.

I wanna get him back at least
to the point where...

he was recognizing people
and communicating.

Okay, that's pretty good.

You looking at me?

Close your eye. Come on.
Close it. Thank you.

Thank you. Okay, baby,
very good. You're warm.

Okay, sweetheart, good. Okay.

You wanna go out? Or do you
want out of the chair?

What do you want baby? What? Tell me.

Do you want out of the chair?
Do you wanna go out?

I...

What baby? Very good.

Good job. Good job baby.

Okay, it's okay.
Hey, I'm calling Lynda.

- Do you want to talk to Lynda?
- Hello.

- Lynda?
- Hi.

- Guess who vocalized?
- Thomas.

Twice. Do you wanna talk?

- Sure.
- Okay. Hey, Lynda. Say hi Lyn.

Hi babe.

- What did he say?
- I couldn't understand it but...

he wanted out of his wheelchair.

Okay.

And he did it twice.
He's getting his feeding...

and he wants out but
he can't get out until he's done.

- I'll talk to you later hon.
- Alright.

Alright bye.

How are you Tom? I'm Dr. Giacino.

He vocalized to me this morning.

- What? Just sound or...
- Sound. He was trying to tell me...

he wanted out of
the chair. Twice. Sound.

One time very loud,
the second time a little softer.

Tom, I'm Dr. Giacino, I'm gonna do
a little bit of examination with you.

But you gotta stay in
your chair just as long enough...

for me to do it. And then we can
move you to the bed. Okay?

- Okay. Tell him we gonna put with...
- You just get...

- this chain, okay?
- set up a little bit.

Tom, I'm gonna
swing you around a little bit.

I want you to tell me
what hospital this is. This is what?

Alright, that's fine.

So even if you have
trouble talking...

I'm still gonna ask you
some things. Okay.

I want you to give me
a yes or no answer. Okay?

First question. Is your name Bill?

Yes or no.

Okay, I saw that. That's a no. Okay.

Is this my ear? Yes or no?

That my ear?

I didn't understand your answer yet.

Shake your head for no or
nod it for yes. Is that my ear?

Okay. And the last question.
Are the lights on in this room?

Yes or no? Remember to nod
your head or shake it for no.

Are the lights on in this room?

He's gonna just leave.

Yeah, he's annoyed.

How long has he been in this chair?

- This morning?
- No. I mean overall.

Oh, overall, gees.

- He's learned where the break is.
- With this chair, Friday. Last week.

Last week, so almost one week.

Yes.

Well he's definitely
across the threshold.

- Not minimall conscious.
- Not minimally conscious anymore.

- Well I mean, you know...
- Well.

- whatever that mans and clearly not
- Whatever that...

- in a minimal conscious state.
- That's great baby.

The reason for that is, you know,
he's communicating reliably now.

He's showing intentional behavior
that's only possible...

if he has a pretty good sense of
what's happening around him right now

He's way beyond anything
we might expect.

I just've to be a little concerned
at this point Tom...

that you can't speak and move
the way you want but that...

you're thinking it may be
pretty clear at this point.

One of the best predictors of
future recovery is the rate of...

immediate past recovery.
His trajectory's, you know...

sort of flat lined for a while
and then this slow rise and now...

he's got this abrupt increase
in his rate of recovery.

We should expect that that's gonna
continue at least for the near future

Will we say that he'll be speaking
in two weeks, we can't say that.

But I wouldn't be the least bit
surprised if within the next month...

or so we start to see
some evidence of verbalization.

Roxanne? How you doin'?

Good.

So that's the first time
I've heard you speak.

So when did you start
to see speech clear-cut?

About three or four days ago.

Just three or four days ago?

- Three or four days ago, yeah.
- Yeah.

And then what did she say
when I walked in.

She says "Oh mom, they hurt me
so much today.

What are you gonna do about it?"

- So, she's conscious.
- Yup.

Roxanne, it's Dr. Giacino again.
I'm gonna ask you some questions.

So what's your full name?
Tell me your full name.

Roxanne Marie...

Okay, very good. How old are you?

Thirteen.

So you said that
you were thirteen years old.

Is that right? Are you
thirteen years old?

- Yes.
- Okay.

So mom, what's the actual age?

Nineteen.

Roxanne.

Yes?

Your mom says that
you're nineteen years old.

- Yes.
- That sound right?

Shut up.

Is it too much?

- Should we continue?
- Yes.

Okay. So we don't really know
if she really means that or...

if it's just sort of
a release of just impulse.

I'm gonna show you something.

Roxanne, look at me
over here. What's that?

- Screwdriver.
- A screwdriver?

Yes.

It's actually not a screwdriver.

Let me get you to take
another look at it.

- Screwdriver.
- And what do you do with it?

Screw screws.

Okay.

- And what's that?
- Hairbrush.

Good job. Very good.

And what's that?

Hammer.

Good.

So maybe again a little bit
just kind of, she gets the category.

It's a tool, but a little bit of
looseness in which tool it is.

Okay. And she shutters.

Is that gonna go away?

I think we expect that
to get better definitely.

We expect that to get better.

Being out of the minimally
conscious state...

there's is no longer
a disturbance in consciousness...

that we're worried about, it's
the specific cognitive deficits...

that are the focus of attention.

Roxanne, you're doing fine?

That my mom?

- Your mom's here actually.
- I'm here, Rox.

- Get her.
- I'm over here. What do you want?

Mom come here?

Why?

- I'm in here baby. I'm here.
- Come over here.

- Wanna come?
- What do you want?

- What?
- I love you.

I love you too. Give me a kiss.

You know, certain days
it gets to you.

Sometimes I go home
at night and my head.

Then the other day
when she said, "Oh mommy...

stay with me 'cause I get scared."

Then that, for two days
I couldn't even sleep.

You know, and I cry 'cause
you can't bring 'em home...

You know, it's just nobody
wants to watch their child suffers.

So it's a toug trip here.

Roxy, where are you?

- You're tired right?
- The hospital.

You're in the hospital.
Do you know why?

- No.
- Good, don't worry about it.

What's to worry about right?

Don't worry about it,
you're just taking a vacation.

I lie.

That's what mother's do, they lie.

Here Roxanne. Okay,
mommy's gonna pick up your head.

Okay, good girl. Yeah, she's...

That's what's gonna happen.
Next week you're gonna be walking.

Are you hungry?

Extended recovery unit,
this is Tira, can I help you.

- Come on back.
- I like that.

Come on. That's it,
come on. You can do it.

- Go forward. Pull with your feet man
- Walk with your feet.

- what I told you.
- Remember what daddy showed you...

- last night.
- Come on.

There you go and pull. That's it Tom.
You got it. Awesome. Step.

Yeah, I don't place...

This is too much work.

Come today, man.

Are you pooped?

Have you had enough, Tom?

Can I get a hug? You can. Come on.

I get hugs.

Can I kiss?

You're doing so good.

Good job.

Yeah. Who's that?

Son, you're making me
jealous now. Can I get a hug too.

You got one for me?

Yes! You're getting one.

So...

- Doctor says, what's he doing?
- Thumps up.

- Thumps up
- Thumps up. Yes he is.

Sean's missing the way, he'll always
be missing the way we knew him.

But...

he's not gone.

And we have to help him recover.

We have to help him recover to
whatever he can and come home...

getting things back the way
they were, our family back.

Giving him some quality
and some pleasure.

That's what really what
we're all working toward.

That's it, that's better.

Let's find the sports section.

You make yourself do everything...

'cause that's what mommy's do. Yeah.

Happy Halloween, here you go.

Whoever ordered Chinese food,
it's here downstairs.

Please go downstairs and get it.

- Okay. So what's we need...
- Who ordered Chinese food?

- Okay.
- That was a Chinese person?

Wake it up.

You got your Yankee stuff on.

This is for Halloween I guess.
He's a Yankee. Is that what it is?

Is it good?

Welcome to my house.

- I'm si...
- I wanna view.

Do you feel that?

Khan...

look at me back.
You're gonna be back, Khan.

- You'll be back alright.
- Give the girls a kiss, Khan.

- Come on.
- Hang in there.

- It's alright baby.
- We'll see you soon, okay.

Massage your jaw?

Massage your jaw?

How are you?

I've to tell you
I feel much better seeing him.

All the reports that
I got of it. All the...

Oh Khan, you look fabulous.

You look my... hi...

It's Dr. McCagg, you don't even
remember me, do you?

Khan, are you having pain?

That expression looks a little
as though you're having some pain.

But you look good.
Let me see how you in the...

- I forget that he's not my child.
- Khan. Hey Khan.

- I'm only his JFK mother.
- Hey Khan.

Its Dr. McCagg's here, she wants
to know if you have any pain.

Do you have a little bit of pain?
Are you in pain?

No?

What?

I think he's trying to
say yes, I'm not sure.

Khan, I need you to blink it...

more than once for yes.

Just one time for no.
Okay, you know how we do it?

Are you in pain?

- No.
- Yeah, good.

That looked pretty reliable to me.

You know, his eyes are wide open
and he's definitely fixating so...

this is not the best I've seen him
certainly in terms of his neurologic.

What he is doing neurologically but
it's so much better than I feared.

He's just not ever been
medically stable enough...

for us to really get
a good handle on what he can do.

But, you know, I think it's hard
because we don't want to...

you know, we see how much
suffering he must also be having...

on the other hand.
Look at that face.

Yeah. What's the matter Khan,
you don't want your face wiped?

We gotta get your face wiped.
Open your eyes.

- Stop scrunching up your eyes.
- That's a good reaction.

That's the purposeful
reaction I think.

Okay, well. Khan, I'm gonn
leave you know.

Tell her bye-bye.

Nice to get to meet you.

Khan.

Hey Tom.

Did I tell you,
it's raining outside today.

You're singing with me?

What's the matter?

What's the matter?

Tom, are you gonna
brush your teeth?

Yeah, that's raining dear.
Keep moving.

Okay?

Is that good?

No?

You loved this the other day.
You don't like it?

- I'm leaving.
- You're leaving. Where you goin'?

- Upstairs.
- Upstairs. What's upstairs?

Do you wanna get in your chair? Yeah?

- Yeah.
- Okay. Hang on.

Let me change my shoes.

Can I get in here right?
What do you want?

- What do you want?
- Help me get out.

- Help me get out.
- Help you get out. I will.

You've to get in your chair.

Chair?

Well, what are you gonna do
when you stand up?

I'm gonna go upstairs.

But you've to sit in your chair.

- Took upstairs.
- No.

- Not taking it.
- You're not taking that?

No.

I'll help you up there but
we've to get in your chair.

- Help me out now.
- I'll but you've to sit...

- in your chair. Okay?
- No.

- You're gonna...
- Walk me out now!

- Babe.
- Walk me out.

- Hang on a sec.
- No.

- Wait a minute, I have to...
- No.

- When you stand up...
- No.

- When you stand up...
- Yeah.

- then what?
- Then I'm gonna walk.

You're gonna walk
and you're gonna leave?

But you can't walk by yourself.

Yes.

I don't think Linda and
Laura would let me do that.

Bull shit.

Okay?

Come on.

Hold me. Okay.

Come.

- Okay?
- I want you to stay here.

Me? Okay. I will.

Want me to unlock your wheels?

Yeah.

I'll unlock them for you.

Just watch behind you.

Awesome baby.

That's great.

Awesome. Yeah, you are.

- Yeah, I did hear you.
- You didn't.

I'm taking you upstairs. Ready?

One of the questions
I always ask patients' families...

through the whole thing is
how do they get through this?

How do you cope with this?
So what's been working for you?

What a, how do you feel
you've been doing?

What's been the thing
that's been getting through?

You don't really have a choice.

You're, this is what it is.

You know, there's some plan
and I don't know what it is but...

I believe with all of my heart
that Tom is going to recover, and...

we are, you know, gonna
get married and have a family...

that's what gets me through is that
I just I know deep in my heart...

that, you know, he's gonna be okay.
As far as the day to day...

how do I do it? It just,
you don't have a choice. You know...

you have to go to work...

you have to do the things
you have to do...

the most important part is
coming here and visiting and...

spending time with Tom.
And... that's...

Is there anything you wanna ask me?

What's the next step from here?

Like if he, when he gets discharged
here what, is there an outpatient?

There's a couple options. There's,
sometime patients leave us and...

go home and can have
outpatient therapy.

But those are all things that
we're much further down the pipe.

Brain injury recovery takes
a really, really long time.

You know, they used to say
it would take at least a year.

Now from what Dr. Giacino always says
she has a waitres saying...

it takes much longer than that.

Yup. That everyone says everyone's
different, so you can't really...

go by go by anybody else's timelines.

Yes, all the patients are different,
all the brain injuries are different.

- Yeah.
- Yeah.

Comfy?

The better they get the harder
it gets on the family...

is because they want more.

First of all it's fine
that they survive...

and then it's fine they get off
the respirator and then...

it's fine that they start
taking food by mouth.

Do you want your movie back on?

But, you know, then they
want more. You know, the closer...

the approximation comes back to
the person they knew before...

the more they want it. And that's
head injury patients don't usually...

get all the way back
in terms of the fact that there's...

often something
that's not quite the same.

- Great. Relax your right hand.
- Okay.

Okay. I want it down.

- You want it down?
- Yeah. Don't touch me.

- I'm not touching you.
- You stupid bitch.

- Okay.
- You're evil.

- Just relax.
- Say your sorry.

- Sorry that you're evil.
- No.

- It's okay.
- Okay.

- Say I am evil, I am.
- Okay, Roxanne.

We see a lot of times with
the head injuries...

it's almost like a child, a child
will say whatever they think...

'cause they don't have
that inhibition.

So anything that comes to...

their mind comes
out their mouth.

If it comes to their mind to punch me
they're gonna throw a punch at me.

Just stay still, I'll take it
and then I'll let go.

Okay, don't start that.

You've to have a little bit of
a tough skin.

You're telling me you're dizzy,
I gotta check your pressure.

Make sure it's okay. It's a stage
that some will move through it...

literally in two days.
Some take months.

- Press your head back.
- And then unfortunately there are...

a select few that might not
move through it at all.

- Get off me.
- Please don't scratch me, Roxanne.

I'll let go if you keep
your head up. Can you do it?

Okay, hold it up. Up.
You're not holding it up.

Hey Roxanne, okay, lift your head up.
You want me to hold it?

- Yeah.
- Okay. Keep trying though.

Okay. Keep trying to
hold it up yourself.

- Mom.
- You can do it. Do it for mommy.

- Do it, Put it in...
- Look right at it.

- Go girl. You got it.
- Good. Nice job

- They're gonna kill me.
- No.

- No I'm not.
- Yes, you are.

- No, we're helping you Roxanne.
- They teaching you...

- how to walk again.
- Maybe you won't see me walk.

She's almost finished.

Can you bring that arm in
so it's not hanging out there.

- You put it on your...
- Roxy, I'll be right back.

We've a meeting.
I'm coming right back.

Mom.

- She did really good.
- Yeah.

Being out of the minimally
conscious state entirely...

and she's now in what
is considered...

- a post traumatic confusional state.
- Okay.

So this is really the next
expected phase of the recovery.

I'll sort of just skip ahead for
a moment. I mean at this point...

she has, I think this is worth
talking about for a minute...

a lot of what I would call...

Bear with me with this...

sort of delusional beliefs about
what's going on.

What that means is, you know,
she thinks that she...

I think really believes at times
that she's being tortured by people.

And so there's this sort of
pervasive feeling of fearfulness...

about all that's going on around her.
Now not everybody has this...

but she's these persecutory beliefs.
That's the theme that you see.

She thinks she's gonna get killed.

Right. She has a lot of fears
of dying et cetera.

She kept mentioning call 911.

- Yeah.
- I need help.

And she mentioned the bus. And when
she mentioned the bus I thought...

- her memory was coming back and...
- Coming back.

- and then she kept telling me...
- Yeah.

she was scared and the last thing
I want her is to get that memory...

- hold it in her mind and be afraid.
- I see.

I think you can feel
very comfortable that...

she'll not get much of the memory
from the event if any.

- The way to think about it's...
- Story...

- from the situation.
- You know, the person's fine.

The brain's fine. Then in
a matter of seconds...

there's an insult to the brain.

So its ability to process information
is immediately disrupted.

So that blocks the memory formation.
Memory formation isn't instantaneous.

It takes time for a memory to form.

It must be very, very difficult...

when she starts going on I'm scared,
I hurt and that's partly...

that's just gotten stuck in
her brain and it is, I'm sure...

very scary to wake up.
It's like waking up in...

some sort of foreign country
where you don't speak the language...

and don't quite understand
what's going on and...

people are unfamiliar to you.

And you can't lay down
the new faces so that...

they become familiar and that's why
so much stress gets laid on...

on your shoulders because
you are the familiar face.

I remember saying and
doing things to her now...

that I did and said
when she was little.

Besides the diaper and
the feeding and the baby talk...

it's like, you know, having a two,
three or four year old again.

You've to protect yourself
and when it gets too much...

she's gonna be alright,
don't wear yourself out.

It will get easier.

Come here, momma's gonna rub you.

Al'Khan, put your thumb down for me.

Nice work.

Keep it down.

We should've mom here more often?

He's like moving his mouth like crazy

Sean, I'm gonna
show you some objects, okay.

Here's the ball
right there, orange ball.

Here's a brush over here.

Sean, I want you to look at
the brush. Look at the brush.

Tom, talk to me and
tell me what you haven't done.

Talk to me. What do you want?

What do you want?

Show me what you want.

Are you gonna lay down?

Mommy, are you coming?

Mommy...

Hey buddy, sorry it took so long.

What's up Sean?

How you doin' today?

Brendan's here. Do you
hear him talking?

What's up buddy?

- Brendan's here.
- Hey Sean.

- Here, I'll let you have some time.
- What's up, man?

What's going on?

Hey Sean.

You're looking good today.
You have a good day? Yeah?

What did you do today?

- He looks good.
- Yeah.

So, how you been? I haven't
seen you for like a week.

Tell him what you've been up to.

I gotta lot of work to do.

So it's tough for me
to come see ya. A lot. But...

You talk to him on the phone.

- Brendan brought his book bag Sean.
- He knows.

Yeah, I brought
some books for you. I can read.

- Say please don't.
- I can read. Yeah.

- Contracts.
- I can read civil procedure to you.

It's really good. So...

So what do you wanna know?

- It's a start. Getting there.
- Yeah. There you go.

You can swallow. You know
how to swallow. Alright.

- You look really good man.
- Brendan, we know.

- Seriously.
- When I see you everyday...

sometimes I can't tell
the difference.

But Brendan this has been a stretch
for Brendan, he hasn't seen you...

- in a while.
- See his eyes. I've never seen that.

- What's he doing?
- I've never seen that.

- What's the matter honey?
- He's making that face.

What's the matter honey?

There's something in your eye maybe?
Here, relax your eyes.

Check that.

Okay.

See.

It's alright. It's alright buddy.
It's alright.

Come god.

Why are you crying?

Sean, you know you're working
on those puzzles, right?

Yeah. And we'll figure out a way.

I know sweetie.

We all love you.

It's alright, bud.

You know what Brendan said
a long long time ago...

when you were still in your coma.

What did I say?

You said Brendan, what do you think,
and you said, Sean's not giving up...

so we're not giving up.

And that's the way it is.

Okay? That's why
we're here all the time.

I've never seen him be like that.

Okay, now.

Help.

We're over right here helping you.

You got a...

Yeah, barely can stand up and you...
we're helping you doctor...

- You know what and...
- Forty.

Fuck!

Trying to help you out.

Good job, Tom.

Now stand up straight.

So, you're a little tough.

Ready go, one, two, three.

Ready go, one, two, three.
And let it go.

Looks ready junior.

- Yeah.
- That's why.

We should help him to drop it down.

'Cause he takes a long time okay.

- Yeah.
- That's sometimes part of...

the brain injury too. What's wrong.

Okay. I'll let go of you
if you balance. Alright, go ahead.

Sometimes you can't
stop things like your grip...

'cause it all comes from your brain.
It sends down those messages and...

if they're not working as
they used to be it's kind of hard.

Okay, go ahead and have a seat.
We'll let Tom go one more time...

and then we're good.
Is this close enough?

Right there? Okay, let's do it.

Can we stand?

Let's stand. Let's try.

- No.
- No?

What would you rather do in group?

Nothing.

Nothing. Nothing doesn't count
in therapy usually, right?

Do you need to work on stuff
like standing balance?

What do you need to work on?

- No.
- No what?

No, please.

Alright. Let's try it. One more time
standing and then we're done.

- Damn.
- Damn again. Did we get any on?

Did you get any points? No, okay.

You're not interested in group today?

Okay, so this is called
neuro behavioral clinic.

Basically it's a clinic that...

allows us to get a
additional information...

when somebody is getting treatment
here at the rehab facility.

Your therapists have asked me to...

give some input into
your treatment program. Okay?

First question,
what's your full name?

Tom Segars.

Okay.

How old are you?

- Thirty-five, thirty-six.
- Thirty-five, thirty-six.

Let's see.
Does anybody know off hand.

Thirty-two. Thirty two.
Does that sound right?

Okay. Tom, what place is this?

Rehab.

Right. Why are you here?

Because I fell.

You fell. Okay. How long ago?

Any idea?

Okay. It was about six months ago.

Okay. Now, have you'd noticed
any problems since you fell?

Did anything, is anything
different for you physically...

or mentally since you fell?

Everything's the same?

Okay. I'm gonna say something.
You repeat it after me.

Okay? You ready? The dog barked.

- Can't.
- Okay.

I will say something and
then you repeat it after me. Okay?

Thanks.

The dog barked.

The dog barked.

Limes are sour.

Lime...

Limes are sour.

- Say.
- Limes are sour.

Perfect.

Alright.

So take all the rehab
you've done so far.

And reappraise it and deal with this.

So we still have to get to
the bottom of this obviously...

figure out why it's not getting in
but it's not getting in.

Everything shifts now.
Can rely on nothing, verbally.

Well actually, just in case,
I'm gonna take it up a level here.

Okay, Tom...

I want you to point to the source
of artificial illumination...

in this enclosure.

Okay.

Alright. So language
I think we can say is a okay.

I tell you what... Okay.

Yeah.

So the jump out,
gigantic finding here is that...

his hearing's a major problem
and you can't rely on it at all.

And is that why
he's getting so frustrated?

I think that's a major contributor.

- Maybe not the entire story...
- Right.

but could very well be
a major contributor to why...

he's having
these episodes of frustration.

We also suspect may not have
full appreciation of his problems.

So that's problem one.

He's in the midst of this kind of
therapy program...

that's geared to
help him with his problems...

but if he doesn't have full
appreciation of what they are...

people are wasting his time.
They're getting in his face...

for no good reason. Add to that,
he can't hear what they're saying.

It's a perfect formula for
a lot of frustration.

The one thing I think is interesting
we talked about is that...

he doesn't communicate
that he's not hearing.

He doesn't give any indication.

So there is the possibility
he's not aware of this problem.

As weird as that sounds.

Anosognosia is one of
the most enigmatic disorders...

that follows brain injury.

What it means is it's a loss of
awareness of oneself.

Specifically in brain injury...

it means a loss of awareness of
one's deficits, acquired deficits.

Close your eyes while I talk to
Dr. Casey and then we'll rest.

In Tom's case, he goes through
his interactions as though...

he hears appropriately.

The bottom line is
you can talk with him...

but anything you said to him...

should absolutely be
translated to written form.

Well, it's a little painstaking,
a little slow.

That's alright, as long as he can

- understand us.
- But I think you'll be amazed...

- Okay. Great.
- at the difference.

Well, you know what?
That can be dealt with.

- So you know we'll go from there.
- Okay.

Okay. I'm gonna call her
right now, okay?

Okay.

- Tommy?
- Hi Lyn, it's me.

- Hi.
- It's Tom's hearing.

- It is...
- It is Tom's hearing.

- Talk to me.
- Dr. Giacino said it's good that...

it was hearing and not damage,
brain damage from the fall.

- Right.
- Because this can be worked out.

He really wants to tap into
Tom's higher level of brain function.

See where he's at,
because he thinks he's up there.

- Great.
- Okay.

- Okay.
- Alright, bye.

Bye.

Tom?

So what's his current
schedule for PT?

Right now he gets it three times
a week, and then two times a week...

- When, what's the schedule? At what?
- I don't know his exact schedule.

- Do you know?
- I think she does Monday...

Wednesday, Friday at ten o'clock.

And the OT is?

- Monday, Thursday, Friday at 9:30.
- He's not generally out of bed...

- by 9.30 on Monday...
- No.

- Thursday and Friday.
- I usually see him bedside.

Bedside. Would the therapy
be better if he was out of the bed?

I've seen Sean since he first
came here last December.

I've seen him at
all different types of time.

I don't think the type of therapy
that I'm doing at this point...

it'd really that it really matters
whether he's in bed...

or he's in the chair.

When he moves over to...

the therapy aides working with him,
will they work with him on the mat?

They won't work now...

- they'll do range in the bed.
- Range in bed...

- Made the motion on the bed.
- Yeah.

- But...
- Until be getting him out of the bed

I didn't understand that question.

What do you mean when
he moves over to the therapy?

I guess what we're all saying
is that they don't feel that...

their particular skills are making
a difference in Sean's performance.

So at this point our plan is
to change into...

working with the therapy aides
under their supervision.

Then to re-evaluate in a month
to see if there've been...

any changes one way or the other.

But that's essentially...

what I think we're gonna have
to be looking at at this point.

- OT/PT, or OT/PT Speech.
- Okay.

- OT/PT and Speech.
- Okay, I'm just...

without our knowledge,
his therapy schedule...

went from five days a week
to three days a week.

We were never told.
And now I'm hearing that...

- a decision's been made to go...
- That's what we did. Yeah.

from therapists to therapy aides.
Are we giving up on Sean?

No, I don't think we're giving up.
At least, I don't feel that...

we're giving up. I think
we're changing our approach.

But I think that at this point
the therapists have not felt...

what they're doing per se
is making a difference.

Well, what if there was an approach
to say "double" the therapy?

- That might have an effect.
- Well, I think if you cou...

I happen to be
a great believer in therapy.

More therapy is always better
all the time but that's not a reality

- Because?
- because he was on double...

that amount of therapy
for a very long period of time.

- So I think...
- In terms of physical therapy...

it would seem to me that that's like
part of the basic human condition...

and not getting
daily physical therapy, to me is...

What you really raise is, you know,
what's the standard of care?

What's a standard of care means
that you've strongest evidence...

in the literature that
this intervention works.

And you know who it works for
and for what period of time.

- So we don't have that.
- Right.

But what we have is basically
a much softer standard of care.

And it's based on
temporal parameters...

and this is I don't think
new information for you.

This period of time that
after traumatic brain injury that...

one'd expect to see further recovery
from the vegetative state, okay?

Is twelve months. So, you know,
we're at twenty month mark now.

Aggressive therapy and I'll tell you
with no uncertainty...

there's not another place that
would stay this aggressive this long.

I mean, if you can find it,
go there. Really.

- Yeah.
- Because...

- That's not the issue. I'm just...
- Yeah, no, I understand...

that earlier question as well.
But the point is you know that...

at least you know
what the standard says.

So any service that could be
done by somebody other...

than a licensed professional with
adequate training should continue...

to be done and it's true, I mean,
you could get to the point...

where you're almost as good as
the therapists in terms of ranging...

- and positioning and those things.
- Well, I hear ya.

Unfortunately I have
a day-job too, Joe.

- I'm not saying...
- I'm a practicing lawyer.

So I need, what I need,
I... since he was a baby.

I've been trying to attend
to the needs of this young man...

which I'm still trying to do.

If you're telling me that...

he's better off with five days of
physical therapy than three...

I think that's right.

I actually think
that's the right answer.

- No.
- Question is, What do I have to do?

Is there a paraprofessional available

- who can, to give him the therapy...
- We're getting one.

the other two days
when he's not getting it?

Well, let me answer
the first part first. And...

One of the most pessimistic meeting
we've had.

Right. You think it can't hurt
much more, but it always does.

It always does, so.

Yeah.

First one goes to...

We're very close to each other
here, but we don't wanna be...

you know, like these are
all people that I feel close to...

I wish I never met them.

They've a perspective that
other people don't but...

I honestly don't think
anybody can understand...

what I'm going through,
not even my husband.

And I don't even understand
what he's going through.

It's very private and
independent trauma.

- Wouldn't it be nice no more board?
- Yeah.

This is huge for us.

It took a long time for us
to find out that Tom couldn't hear.

It's the thought of the possibility
that today he may be able to hear...

for the first time in seven months,
for us is huge.

Got it. Okay.

Okay, I got it.

Okay.

Alright, Tom, how does
my voice sound to you?

Does it sound comfortable for you?

Nothing. You don't hear anything.

You're not hearing my voice at all?

You don't hear me
talking to you at all.

You're not hearing any amplification?

Let's see.

Your hearing aide's all...
it's working.

I'm just wondering. Maybe
we need to write that down.

You know, Lynda,
why don't you just talk to him.

Just while you're writing
and see if he can...

Can you hear my voice, babe?

Can you hear me
say anything right now?

- No.
- No?

- Even a little bit?
- No.

- No. Okay.
- So I think...

what I'm going to do is
sort of go through it...

with the hearing aide in place,
because it is programmed...

according to the hearing test results
we got the last time...

which we thought
were pretty accurate.

Doesn't it do it today,
if he's not hearing you?

Actually, I think...

the reason I would prefer
not to have do adjustments...

is because I think that
we spent a lot of time...

trying to get accurate
hearing data on him.

- Okay.
- The hearing aides are programmed...

according to the hearing loss
that they measured on that side.

Do you not hear me?
Or do you not understand me?

I don't hear her.

You don't hear her?

You know, I know that
he's saying he's not hearing.

We're gonna give him
a couple of days with...

the hearing aide to see if he becomes
more aware of his surroundings.

Now, if he can't hear now...

what would changes
to make him more aware?

I think that there's
a question whether or not...

Tom is not hearing or
not knowing what to do with...

the auditory information
that he is hearing.

So even though he's saying
that he's not hearing.

It's not that he's not hearing it.
His ear is actually hearing it...

but then the brain is actually
what does all the work.

The brain is really what figures out
what it is that's being said.

He's not hearing anything.

And that's again, if this is working
and it's working where he like...

you're saying he can hear
with that the way it is.

Wouldn't he just hear noise then?

Look at her.

- There should be some reaction.
- Some reaction.

- It's not a very...
- There's nothing.

black and white issue.
It's not a very simple issue.

With brain injury, there does come
a complication...

with the different modalities and
once again, it could be that...

the peripheral ear is hearing it...

but the brain doesn't know
what to do with the information.

- This doesn't make any sense.
- You hear it? Yes.

- Don't hear it. Nothing happens.
- That's what he's saying right now.

That's not a matter of the brain
processing sound, it's a matter of...

- Whether he hears any sound or not.
- Whether he hears it.

There's a possibility with Tom...

that the hearing loss,
it's beyond the ear...

and it's include and
now it's into the brain.

They call it, what they
call it is "central deafness".

You can've this with normal hearing.

You can literally've someone that's
got normal peripheral hearing...

in the ear but then once
that information goes to the brain...

the person is unable
to make any sense out of it.

So they their behavior is
such that as a deaf person.

- It called central deafness.
- I'm just gonna take him out.

That's fine.

Do you've any questions for me?

It's a lot of information,
I know, that we gave you...

on top of all the other information
that we went to that.

That seemed to be unexpected.

Very unexpected.

So...

So really that's it.

Okay.

Khan, wake up right now. You can
go back to sleep when we leave.

Khan.

C'mon Khan. Wake up.

Khan.

Hey Khan.

I'd talked to Dr. McCagg,
and she was just saying that...

he just was still on a ventilator.

So then she was saying,
when I came in...

then she would talk to me,
so, but it's...

that's the only thing that I know
that he's just still on a ventilator.

But everything else, I know,
has been pretty good.

- I think they gave him something.
- Khan!

- Open up your eyes.
- Khan! You gonna wake up?

What happened today?

- Khan!
- This boy is out!

He gotta've some drugs in his system.

Something! Khan!

Oh, here come Dr. McCagg.

- Hello, how you doing?
- Hi, I'm Dr. McCagg.

- I'm Dr. McCagg. How are ya?
- Hi, how are you?

- How are ya?
- I'm doing okay.

- How's our boy today?
- I told him, Khan!

I asked him, they did...

they have some drugs in
his system because he is out!

- He'd some sedatives or something.
- Yeah.

I haven't gotten any responses
from him recently at all.

- For real?
- Since he's been up here.

But let me go take a look at
his chart because I wanna catch up...

and then maybe we could talk
a bit about what's going on.

Okay.

Hey! Open up your eyes.

Khan, squeeze my hand.

Unfortunately, he's not sedated.
He's just not responding.

Oh, okay.

And what's different about
what's happening now...

than what happened before
is the seizures.

Since he's been back up here,
the seizures have been controlled...

but with major medications.
He's on three medications.

His EEG, which measures the function
of the brain is terrible.

And it doesn't show
any responsiveness...

so I don't know whether he had
further damage while he was having...

all those seizures, or whether there
this was just gonna come.

- And you know I've been...
- Yeah.

his greatest advocate,
but I think this time...

that I've to say that
his chances of any kind of...

good recovery
are really non-existent.

You look at how bad the EEG is.
I just think the damage is

it's just too extensive.

You know that
I don't say that lightly.

Yeah.

So you know, I think as a minimum...

you might want him
to be a "Do Not Resuscitate".

And then there are
other options that...

I think you need to
think about in terms of...

you know, should we just
take him off the ventilator...

or if he comes off the ventilator,
and he needs to go back on...

make the decision
not to put him back on.

That, you know, that's nothing that
you have to decide right away.

But I think, you know, you need to
realize that I don't think...

this is gonna have a good outcome.

You've any questions I can answer,
anything more than I can explain?

No.

No.

Pretty much know everything.

- Yeah.
- Yeah.

- How do you think his sister and...
- Is he going...

your mother are gonna
feel about making him a DNR?

- I don't know.
- Her mother?

She gonna want you know
just let him hold on...

- Yeah.
- because God, she...

Well, this isn't
really undoing God's work.

It's just if God makes his decision.

- We don't fight him.
- Yes.

And I think that's really
we've been fighting God...

- I think, for quite some time.
- Yeah.

- And I think... Yeah.
- You've been fighting a good battle.

But I think he'd, I think
this time God really wants him.

All of us have kind of felt that
Khan's just not there any more.

- Yeah.
- Okay.

And I just don't feel that
he's going to be.

Should I continue? Yeah?

You put your thumb up
if you want me to continue.

This one.

Try really hard. I know.

I know you're trying. C'mon.

Move this one.

I'm very discouraged about
the therapies being cut.

What I'm hearing's you're giving up.
That's what I'm hearing.

And of course, I don't want to
hear that, but...

if you're not trying anything new...

what else are you doing?
I don't have that option.

Look at me.

Open your eyes more,
c'mon, and look at me.

Do you wanna look at some pictures
from a couple years ago?

Look.

Do you see Brendan?

And Sean. Both of you guys,
what're you doing?

I think you're playing
PlayStation, right? Yeah.

I just miss him so, you know?

Sean has to get better.
I... better than this.

He has to improve. This is just
an unacceptable state...

to expect anyone to be in.

This is stuck in
the middle of nowhere.

I've often said he has to get better
or he has to get worse.

When we were at Kessler, I remember
there was a young girl across...

the hall from Sean
who died one night.

The doctor told me the next day,
I said, "I feel so bad for the mom".

And he said, "Well, you don't know
who the lucky one is here".

And it didn't makes, that comment
didn't make sense...

but I knew it stuck with me.

It's a lot harder.

I have no doubt about it.

See what happens.

Been like this forever, right, Sean?

Sean, talk to me. Sean!

I love you.

Hey, you want to get up and walk?

Tom, what's wrong?

We'll try the parallel bars.

How are ya?

Tom, are we walking?

Are we gonna walk?

Maybe?

Alright, we'll try.

- Do you wanna do something different
- No.

- Do you want to do exercise?
- No!

Okay!

Tom, this is so
we strengthen your legs.

I can't. I can't try.

- Do you wanna do anything?
- No.

- Then you can go if you want.
- Fuck off.

It's a brain injury.
We just, we don't know.

We don't know if he's stuck, if he's
gonna keep going the way he's going.

It's a whole new world.

Herb and I talk about it.
Tom was going to take...

the business over next year.
He was going to retire.

We don't know.

He's certainly not retiring.
Not for him.

So we don't know.

As well as Tom is doing...

is he gonna recover completely?

It's in God's hands, and Tom's.
We don't know.

They have to. That's how you're
gonna get better and then come home.

Okay? No?

How're you gonna get better?

Are you gonna get better on your own?

Can you talk to me?

They tell us that we have to
let him do it. And we know that.

But when you see him struggling...

the first thing you wanna do
is pull him along.

It helps us, but it doesn't help Tom.

I've had a couple of my friends say,
"Well, why don't you bring him home?"

I want to. It's not gonna help him,
because he needs to be here.

He needs the therapy.

He needs to learn how to deal with...

any type of disability
that he may have.

But I'd love to fix up his room
at home and bring him there.

What mother wouldn't?

This is a pretty
rare syndrome, period.

So he, diagnosis is central deafness?

It's peripheral as well as central.

Is there a possibility that can heal?

I mean, are we too far along that
at this point you could say...

- No it's not gonna get any better?
- This here's where I think...

you fall back on, behavioral changes
that he's showing.

- And he's showing changes. I mean.
- We've to find a way to help him.

Be willing to work with that.

But I'm thinking that
that's the positive.

So.

You know Lynda. You know how private
she is. She's probably exhausted.

She's an incredible,
amazing young woman.

She loves my son,
and he loves her. So.

It's upsetting because,
you know, he's not...

gonna hear music tomorrow,
or you know, things like that, but...

I just don't see it
as the end of the line.

I just feel like there will be
some way to, you know, help him.

I just... I don't accept it
as the final word like...

"This is it. You're gonna've to live
with this for the rest of your life."

- Where's your calendar?
- It's right over there.

What're you gonna do Saturday
when you get home?

- Hug you.
- And?

- Sleep in my bed.
- Yeah! Look at me, Roxy.

When you go home, you're not
gonna see that nice handsome boy...

who works here.

You're gonna have to
come and visit him.

- No.
- Remember you've to get his number.

Roxy, are you gonna get
his number before you leave?

- I want to.
- What's his name?

- I don't know.
- You better ask the nurses to get...

the phone number for you.

Are you gonna call him
from the house?

What're you gonna say to him?

Hi, cutie!

- Move here.
- Okay.

And we're here, right?
She tends to shoot back.

- But I love you.
- Okay. Listen.

- I love Shannon, and I love...
- Can you look at me?

- You've to hold her legs like that.
- I need you to lay down...

- That's it.
- let mom try that, okay?

I know not everybody can do it.

I just rounded up enough people
and support that I can do it.

- And now pushing...
- I stopped working.

I'm living off money that my mom
and my brother gives me...

and some money that I had.

I can hold on for another
five six months on my own.

- I love you.
- I'm gonna make it work!

We're not going to go anywhere,
we're just gonna lift straight up...

- let's see if you have her, okay?
- Okay.

- You count for me.
- One, two, three.

Oh, my god!

- No way, mama.
- Okay, you're doing all back...

- Right.
- and you're gonna end up either...

being very sore or you're gonna pull
a muscle out or hurt yourself.

Do you've many family members
taking patients home at this stage?

Not at this stage.

She really feels she needs to do it,
and I just...

it's hard to get
the intensity of therapy...

that she needs right now,
but it's doable.

Many ways to skin a cat,
as my mother used to say.

This is just a very tough way
of doing it.

Okay, I'm just loading things up,
we're all set to go.

Alright, Steve, I think
we're okay here.

We just passed our two-year
anniversary date of his injury...

It's just time is starting to weigh
a little heavy on us.

Three, two, four...

So you can see
all this black is loss of tissue...

This is the very damaged portion...

of the left hemisphere,
which happens to overlie...

the language area of the brain.

We're looking for red and yellow
activations...

to show up around this area...

'cause these are the temporal lobes
where language lives in the brain.

We don't see it.

So whatever residual tissue for
language processing he might have...

is not activating
when he's listening to your voices.

So the, what's the best way
to do this now?

So again we're at the same spot.

And we should be seeing activation
here and here essentially.

But we don't. So in fact,
there's agreement...

between the two analyses
that he's not...

activating the language area
in response to the voices.

The right remains a mystery.

That's that.

So I mean, I think
it's good that we did it.

I mean, it does give us
information about that left side...

you know, that it is really down.
You know, it is really down.

Beyond that...

you know, I think
it's just speculation.

So where does this leave us?

You know, I don't I think it changes
our impressions up to this point...

which we know have been...

most consistent with
vegetative state.

So...

what are your thoughts?

I have none.

I think this is...

probably the best we could've done
at this point.

- Alright? Okay.
- Thank you.

- Alright.
- Thanks, Joe.

- Yeah.
- Thank you.

Sure.

Alright, have a good evening.

Thank you.

Do you mind if we stay with you guys
for like fifteen more minutes.

I think I sort of
want to be alone. I'm sorry.

I think it's the first time
I've ever said that to you.

So if it's okay.

- Thank you.
- Thank you...

- Alright.
- for the care.

- Bye-bye.
- Bye-bye.

You know, with going this long
without showing clear evidence of...

conscious behavior...

he's a traumatic injury, so he gets
a longer window for recovery...

but that window starts to close...

starts to close, you know, at a year.

So, and he's past a year,
and we still can't show...

clear evidence of conscious behavior.

And then his scans
don't help that picture.

So I mean, I think
it's a definite possibility that...

you know, he is at
the end of the line now.

But, you know.

You know, so, and again,
I think they're doing...

- as well as they can do with this.
- Yeah.

You know, what do you do?
If you come to that point...

you know, and you just decide
that's it forever...

then what is your next step?

So...

We're going to the wake for Al-Khan.

It seems very strange
to be going to his wake...

even though it was
certainly time for him.

I just was feeling guilty that
perhaps I had instilled...

some sort of false hope
that they couldn't let go.

And that they were misinterpreting
perhaps things that...

I had originally been
quite positive about as things...

that were maybe meant more than
I think they did in the end.

I just want to let them know
that we cared and...

I hope they don't think it's...

sometimes I think that families think
it's a little bit strange...

when I come to their services.

- Al'Khan Edwards.
- Yeah, he's right down here.

- Okay.
- Are they expecting you all?

- Yeah.
- They are?

Yes.

- You most beautiful.
- He looks so handsome!

I know.

- Can I do anything for you?
- No.

Bless you.

It's been a privilege.

You're a wonderful person.

I'm sorry you've had this outcome.
Thank god he's peaceful now.

Wanna go backwards?

Yeah.

- Thank you so much!
- You're welcome!

- What happened to me?
- You know what happened.

- Why today?
- The truth is you already know.

- You know what happened.
- The truth is we...

Alright, Roxy,
we're gonna pull you over.

- Don't be scared, okay?
- Don't be scared.

- One, two, three.
- Three!

- There we go.
- Okay.

- Alright. Thank you, guys!
- You're welcome!

Aren't you gonna tell him...

- Thank you.
- You were looking at his eyes...

when you go,
"You've pretty blue eyes."

You see the balloons?

Welcome home for good!

Do you see your name up there?

Welcome home, Roxy.

Boy, you have good eyesight.

- Can you, how about that one?
- I think it got better.

They coming for Roxanne.

We love you very much.

- You're doing really good.
- Am I home for good?

I can't walk yet.

No, but you're gonna walk soon.

And what do you want for dinner?

Chicken Parmesan, pizza, or...

Or she, I have that, too,
but I've got to get it in the oven.

- Alright?
- Don't be stingy with money though.

Don't' be like every other part of,
and you're so sweet.

Pretty soon it'll be nice and warm,
and then we can walk.

Such a nice tree, isn't it?

C'mon, Sean.