- Recovering from a coma
- Understanding Stages of Coma
- Three stages of coma
- Coma – the battle to survive
- After Coma; Vegetative State and Minimally conscious States – Waiting for signs of improvement
- Rehabilitation for People Who are Slow to Regain Consciousness
- Diagnostic Criteria
- UAE woman Munira Abdulla wakes up after 27 years in a coma
- ‘She hugged me to protect me’
- Years of treatment
- Hospital row
- Cases like Abdulla’s are rare
Recovering from a coma
A coma usually only lasts a few weeks, during which time the person may start to gradually wake up and gain consciousness, or progress into a different state of unconsciousness called a vegetative state or minimally conscious state.
- a vegetative state – where a person is awake but shows no signs of being aware of their surroundings or themselves
- a minimally conscious state – where a person has limited awareness that comes and goes
Some people may recover from these states gradually, while others may not improve for years, if at all. See the page on disorders of consciousness for more information about these conditions.
People who do wake up from a coma usually come round gradually. They may be very agitated and confused to begin with.
Some people will make a full recovery and be completely unaffected by the coma. Others will have disabilities caused by the damage to their brain. They may need physiotherapy, occupational therapy and psychological assessment and support during a period of rehabilitation, and may need care for the rest of their lives.
The chances of someone recovering from a coma largely depend on the severity and cause of their brain injury, their age and how long they’ve been in a coma. But it’s impossible to accurately predict whether the person will eventually recover, how long the coma will last and whether they’ll have any long-term problems.
Understanding Stages of Coma
Three stages of coma
Often lumped under the label of “Coma” are three stages of disordered consciousness. Disorders of Consciousness (DOC) are a set of disorders that effect a person’s ability to be awake. DOC includes coma, the vegetative state (VS) and the minimally conscious state (MCS). These disorders (see sidebar at right for further information about each of these stages) are among the most misunderstood conditions in medicine.1 Published estimates of doctors making mistakes among people with disorders of consciousness range from 15%-43%.2,3,4
Coma – the battle to survive
A coma is a state of unconsciousness when a person cannot be wakened with touch or noise. The inability to waken makes coma different from sleep. It is the length of time that a person remains in coma that has commonly been used to label the severity of a person’s brain injury.
What causes a coma is an area of great interest. The brain stem is often injured. The brain stem processes automatic, unconscious controls (often called the vegetative functions) of the body including heart rate, blood pressure, body temperature, and breathing. The reticular activating system (RAS) is located within the brain stem, and is the important “on/off” switch for consciousness and sleep.
- To be awake, the RAS and at least one cerebral hemisphere (we have two) must be functioning.
- If a person loses consciousness, either the RAS has stopped working, or both cerebral hemispheres have shut down.
- The reticular activating system stops working in two situations:
- When there is brain stem bleeding or loss of oxygen. This shuts off the reticular activating system.
- When there is swellingin the brain. The skull is a rigid box that protects the brain. Unfortunately, if the brain is injured and begins to swell, there is no room. Increased pressure within the brain (increased intracranial pressure) causes compression of the brain tissue against the skull bones. This swelling can affect other parts of the brain.
If the intracranial pressure continues to increase without being treated, the brain will continue to swell until it pushes down through the opening at base of the skull. This damages the brain stem where the reticular activating system is located. This also damages the breathing and blood pressure control centers of the brain and can be the reason for death in the hours or days after injury.
- The Battle to Survive – Acute Care Treatment of Coma from Swelling
When the members of the medical trauma team are concerned about swelling of the brain, an intracranial pressure monitor may be placed inside the skull to read the pressure inside. A small hole is drilled into the skull and the monitor tip is placed inside the skull. Or, surgeons may temporarily remove a portion of the skull to minimize the risk of further injury to the brain due to the pressure. Later, sometimes months later, the skull is repaired through a surgery called a “cranioplasty”.
Doctors may also give medications to “induce” a coma if they are worried about brain swelling. Medications can be injected similar to providing a general anesthetic. An induced coma is used to decrease intracranial pressure and to rest the brain. An induced coma can make it difficult to use the Glasgow Coma Scale as a predictor of TBI severity.
Hospital staff may ask family members and friends to be very quiet when visiting when there is a concern about high pressure spikes in the brain. The lighting of the room may be kept low and the room kept cool. This is called “keeping the stimulation low” so that the brain can rest and recover.
Coma usually evolves into the vegetative state or a higher level of consciousness within two to four weeks for those who survive. 5,6
After Coma; Vegetative State and Minimally conscious States – Waiting for signs of improvement
There have been improvements in taking pictures of the brain and measuring the electrical activity of the brain in the last five years. The results of new studies, and the well-documented reports of recovery months after the initial injury, challenge the long held view that people with long periods on unconsciousness cannot recover. Cases of late recovery point to the remarkable plasticity of the human brain and its potential for long-term recovery.1
The Vegetative State (VS) and the Minimally Conscious State (MCS) are stages on consciousness that can follow coma. They are different stages. The person’s awareness of their surroundings and prognosis (ability to recover) is different for VS and MCS.
■ The vegetative state can be a temporary or long-term state following coma in persons who have experienced TBI. Both the terms “persistent” and “permanent” are controversial, with a practice guideline that the term “permanent” not be used until the VS state has lasted 12 months.7 Persons in VS may move in a non-purposeful manner and may smile, grimace, have tears in their eyes, and may moan. Individuals in VS generally do not follow people or objects with their eyes or remain visually focused on people or objects. If a person can keep eye contact or follow movement with their eyes, it can often mean that the person is transitioning to MCS. Some people in VS have episodes of “autonomic storming” (refer to separate article in Visions). A sleep/wake pattern is reestablished and the “vegetative functions” of breathing, body temperature regulation start to normalize.
- Prognosis for Recovery after months in a VS stage: In the TBI population, 35% of individuals who remain in VS for 3 months will recover consciousness by 12 months post-injury. Among this group, 20% will be left with severe disability, while the remaining 15% will have a moderate to good outcome.1
- Persons with MCS retain the brain functioning responsible for understanding language, despite their inability to communicate reliably. Persons may have a delayed and an inconsistent way that they respond to “yes” and “no” questions. Persons may show different emotional response when loved ones are present. He/she may show different facial expressions depending on the topic of conversation and may laugh or cry. The storage of new memories and short term memory (knowing what day it is, knowing who visited yesterday) is thought to be impaired thought it is difficult to measure.
- Prognosis for Recovery after months in a MCS stage: The recovery for this population is slow and long. In the MCS group, 50% will have moderate to severe disability while 27% will have mild to moderate disability.8,9
Rehabilitation for People Who are Slow to Regain Consciousness
Hospitals will start discharge planning as soon as life-threatening medical problems have resolved. People who are in a VS or MCS when they become stable medically (despite the fact that they still may have tubes) will need to leave the hospital.
There is no doubt that people who experience severe TBI need rehabilitation after their hospital stay. And chances are good that further recovery will occur. Choices of where to go next could be a rehabilitation facility (like Rainbow), a skilled nursing facility, or home with 24 hour family/caregiver assistance. In some instances, a person who is VS or MCS may be admitted to a rehab hospital for a short stay (2-4 weeks) for family teaching and the development of needed rehab equipment.
Rehabilitation for persons at this stage of recovery takes into consideration their unconsciousness and/or memory problems.
Rehabilitation and nursing goals can include:
- To establish a normal pattern of being up and out of bed with the right wheelchair
- To start sitting on the edge of the bed or matt and using a tilt table or standing table to put weight on feet
- To get good nutrition for healing through a tube
- To move and position the injured person regularly so that skin stays healthy
- To establish a “yes”/”no” system through movement of eyes or mouth or hands or feet
- To work on swallowing, a prerequisite of eating, and to keep lungs clear and healthy
- To combat abnormal muscle spasticity that can occur when the brain is injured which can cause joints to get tight
- To use medications and therapy that could improve wakefulness/arousal
All of the following criteria must be evident on bedside examination:
- No eye opening and absence of sleep-wake cycles on EEG.
- No evidence of purposeful motor activity.
- No response to command.
- No evidence of language comprehension or expression.
- Inability to discretely localize noxious stimuli.
All of the following criteria must be evident on bedside examination:
- No evidence of awareness of self or environment.
- No evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli.
- No evidence of language comprehension or expression.
- Intermittent wakefulness manifested by the presence of sleep-wake cycles.
- Sufficiently preserved hypothalamic and brain-stem autonomic functions to permit survival with medical and nursing care.
- Bowel and bladder incontinence.
- Variably preserved carian-nerve reflexes and spinal reflexes.
Minimally Conscious State
At least one of the following criteria must be clearly evident on bedside examination: 1
- Simple command following.
- Gestural or verbal yes/no responses.
- Intelligible verbalization.
- Movements or affective behaviors that occur in contingent relation to relevant environmental stimuli and are not attributable to reflexive activity. Any of the following examples provide sufficient evidence for this criterion:
- Pursuit eye movement or sustained fixation that occurs in direct response to moving or salient stimuli.
- Episodes of crying, smiling, or laughter in response to the linguistic or visual content of emotional but not neutral topics or stimuli.
- Vocalizations or gestures that occur in direct response to the linguistic content of comments or questions.
- Reaching for objects that demonstrates a clear relationship between object location and direction of reach.
- Touching or holding objects in a manner that accommodates the size and shape of the object.
Tools used to measure level of consciousness10
Since consciousness cannot be directly measured, clinicians must observe behavior and draw conclusions about an individual’s underlying state of consciousness. Those observations are then used to fill out measurement scales. Different scales are used in different settings. Two measurement scales that are important to life saving, establishing a prognosis, and tracking recovery are as follows:
The Glasgow Coma Scale is used at the scene of the accident, in the Emergency Department, and during the life saving hospital stay. It is a useful scale for doctors and nurses who want to track improvements in brain recovery or predict recovery. A sudden decline in being awake can mean that the brain pressure is changing for the worse or that there may be an area of bleeding in the brain that needs attention. An increase in the number means that the brain is getting better. The Glasgow Coma Scale is rarely used after the initial hospital stay.
|Glasgow Coma Scale|
|To loud voice||3|
|Withdraws from pain||4|
|Abnormal flexion posturing||3|
A fully conscious patient has a Glasgow Coma Score of 15.
A person in a deep coma has a Glasgow Coma Score of 3 (there is no lower score).
The Rancho Level of Cognitive Functioning Scale (LCFS) is a scale used to assess cognitive functioning in people with brain injury.11 The first three levels are similar to the stages of coma, VS, and MCS. This scale is most often used in the first year after brain injury. This scale is available for free in its complete form at : http://www.tbims.org/combi/lcfs/index.html
|I – No response||Patient appears to be in a deep sleep and is completely unresponsive to external stimuli. COMA|
|II – Generalized||Patient reacts inconsistently and non-purposefully to stimuli in a non-specific manner. Responses are limited in nature and are often the same regardless of stimulus presented. Responses may be physiological changes, gross body movements, and/or vocalization. Often the earliest response is to deep pain. Responses are likely to be delayed. VEGETATIVE STATE|
|III – Localized||Patient reacts specifically but inconsistently to stimuli. Responses are directly related to the type of stimulus presented, as in turning head toward a sound or focusing on an object presented. The patient may withdraw an extremity and/or vocalize when presented with a painful stimulus. Simple commands may be followed in an inconsistent, delayed manner, such as closing eyes, squeezing or extending an extremity. Once external stimulus is removed, the patient may lie quietly. A vague awareness of self and body may be shown by responses to discomfort produced by pulling at tube. Bias may be shown by responding to some persons (especially family/friends) but not to others. MINIMALLY CONSCIOUS STATE|
- Berube J, Fins, J, Giacino J, et al. The Mohonk Report: A Report to Congress. Disorders of Consiousness: Assessment, Treatment, and Research Needs. 2011.
- Tresch DD, Sims FH, Duthie EH, Goldstein, MD, Lane PS. Clinical characteristics of patients in the persistent vegetative state. Arch Internal Med. 1991;151:930-932.
- Childs NL, Mercer WN, Childs HW. (1993). Accuracy of diagnosis of persistent vegetative state. Neurol, 43:1465-1467.
- Andrews K, Murphy L, Munday R, Littlewood C. Misdiagnosis of the vegetative state: Retrospective study in a rehabilitation unit. BMJ. 1996; 313:13-16.
- Plum F, Posner J. The diagnosis of stupor and coma, 3rd Edition. Philadelphia: F.A. Davis. 1982.
- Multi-Society Task Force on the Persistent Vegetative State. Medical aspects of the persistent vegetative state, part I. N Engl J Med. 1994; 330:1499-1508.
- American Academy of Neurology. Practice parameter: Assessment and management of persons in the persistent vegetative state. Neurol. 1995; 45:1015-1018.
- Giacino JT, Kalmar K. The vegetative and minimally conscious states: A comparison of clinical features and functional outcome. J Head Trauma Rehabil. 1997; 12(4):36-51.
- Whyte J, Katz D, Long D, et al. Predictors of outcome in prolonged posttraumatic disorders of consciousness and assessment of medication effects: A multicenter study. Arch Phys Med Rehabil. 2005; 86: 453-462.
- Huff JS, Martin ML. Altered mental status and coma. In: Worlfson AB, Hendey GW, Ling LJ, et al., eds. Harwood-Nuss’ Clinical Practice of Emergency Medicine. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009: chap 14.
- Hagen C, Malkmus D, Durham P. Levels of cognitive functioning. Downey (CA): Rancho Los Amigos Hospital; 1972.
MAINZ, Germany — A doctor who treated a woman who woke up 27 years after a car crash left her in a coma has spoken of the “ecstatic” moment she began to talk again and said how rare her case is.
Munira Abdulla was injured while driving her son, Omar Webair, home from school in their native United Arab Emirates in 1991. She was 32 and he was 4 the time.
While Webair escaped with some bruising, his mother sustained a serious brain injury. Despite treatment at hospitals in the U.A.E, the U.K. and Germany, it was believed she would never wake up.
Munira AbdullaOmar Webair
Then suddenly, last June, she did. Her family has gone public with her story in the last few days to give hope to people with loved ones in long-term comas.
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In a phone interview, Dr. Friedemann Müller, the head physician at the Schoen Clinic in Bad Aibling, Germany, where she was being treated, told NBC News that Abdulla gained consciousness after months of therapy. Müller said that when she arrived, only her eyes showed some movement and were able to fixate on persons or objects.
“It’s not like waking up in the morning,” he said. “It was a process over weeks as reactions and vocalizations increased and improved.”
Abdulla’s son was most optimistic when he heard his mother making sounds, Müller said, but it took a while for doctors to make out words. Soon, Abdulla clearly pronounced her son’s name, greeted doctors in Arabic, and started to cite Quran verses.
Schoen Clinic in Germany.Schoen Klinik
“When we realized that she was talking with us, we were ecstatic,” Müeller said.
The clinic regularly treats patients who have been in a coma for weeks or months who then regain consciousness — but the sheer length of time Abdulla had been in a coma made this an extremely rare case.
“None us had ever experienced that someone wakes again after 27 years,” he said.
Webair told The Emerati-based newspaper The National: “She was making strange sounds and I kept calling the doctors to examine her. They said everything was normal.
“Then, three days later, I woke up to the sound of someone calling my name. It was her. She was calling my name. I was flying with joy. For years I have dreamt of this moment, and my name was the first word she said.”
Webair has said he shared his mother’s story to give others hope.
Now back in the U.A.E. and receiving regular hospital care, Abdulla is still suffering the long-term consequences of brain damage. She is confined to a wheelchair, although doctors have seen improvement in her hand movement recently. Müller said she will likely always be in need of care, but is now able to consciously perceive her environment and communicate using speech.
“She takes part in family life and if somebody is gone traveling she notices and wants to know where that person is,” Müller, who is still in touch with the family, said.
UAE woman Munira Abdulla wakes up after 27 years in a coma
Image copyright Science Photo Library Image caption Prolonged disorders of consciousness are usually caused by a sudden brain injury
A woman from the United Arab Emirates (UAE) who was seriously injured in a traffic accident in 1991 has made a seemingly miraculous recovery after emerging from a 27-year-long coma.
Munira Abdulla, who was aged 32 at the time of the accident, suffered a severe brain injury after the car she was travelling in collided with a bus on the way to pick up her son from school.
Omar Webair, who was then just four years old, was sitting in the back of the vehicle with her, but was left unscathed as his mother cradled him in her arms moments before the accident.
Ms Abdulla – who was being driven by her brother-in-law – was left seriously injured, but last year regained consciousness in a German hospital.
Omar has opened up about the accident and about his mother’s progress following years of treatment in an interview with the UAE-based newspaper The National.
‘She hugged me to protect me’
“I never gave up on her because I always had a feeling that one day she would wake up,” Omar told the newspaper on Monday.
“The reason I shared her story is to tell people not to lose hope on their loved ones; don’t consider them dead when they are in such a state,” he added.
“My mother was sitting with me in the back seat. When she saw the crash coming, she hugged me to protect me from the blow.”
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He was unharmed, suffering just a bruise to the head, but his mother was left untreated for hours.
Years of treatment
Ms Abdulla was eventually taken to hospital, and later transferred to London. There, she was declared to be in a vegetative state – unresponsive, but able to sense pain – The National reports.
She was then returned to Al Ain, a city in the UAE on the border with Oman where she lived, and moved to various medical facilities according to insurance requirements.
She remained there for a few years, fed through a tube and kept alive. She underwent physiotherapy to ensure her muscles would not weaken through lack of movement.
In 2017, the family was offered a grant by the Crown Prince Court, a government body in Abu Dhabi, for Ms Abdulla to be transferred to Germany.
There, she underwent a number of surgeries to correct her severely shortened arm and leg muscles, and she was given medication to improve her state, including her wakefulness.
A year later, her son was involved in an argument in her hospital room, which seemed to prompt his mother to stir.
“There was a misunderstanding in the hospital room and she sensed I was at risk, which caused her a shock,” Omar said.
“She was making strange sounds and I kept calling the doctors to examine her, they said everything was normal.
“Then, three days later, I woke up to the sound of someone calling my name.
“It was her! She was calling my name, I was flying with joy; for years I have dreamt of this moment, and my name was the first word she said.”
She became more responsive, and can now feel pain and have some conversations.
She has returned to Abu Dhabi, where she is undergoing physiotherapy and further rehabilitation – mainly to improve her posture when sitting and prevent muscles from contracting.
Cases like Abdulla’s are rare
There are only a few cases of people recovering consciousness after several years – and even then, recovery can be protracted.
It is impossible to predict the chances of someone in a state of impaired consciousness improving, says the UK’s National Health Service.
People who do regain consciousness often have severe disabilities caused by damage to their brain.
One notable recovery case is that of Terry Wallis, an American man who was involved in a car accident when he was 19, and made a dramatic recovery after spending 19 years in a near-vegetative state. It was thought he had been able to re-grow brain tissue.
Image copyright Getty Images Image caption Former F1 world champion Michael Schumacher was placed in an induced coma after a skiing accident
Former Formula 1 racing world champion Michael Schumacher suffered a head injury in a skiing accident in France in 2013. He was placed in a medically induced coma for six months before being transferred to his home in Switzerland to continue his treatment.
- Michael Schumacher: Coma challenges
Only a handful of people are known to have made similar recoveries.
Terry Wallis, from Arkansas, was 19 when he skidded off a bridge in a pickup truck. He uttered his first word since the accident, “Mom,” nearly two decades later, in 2003.
His recovery was so unusual that scientists used it as an opportunity to study how the brain functions and to help determine which patients with severe brain damage had the best chance of recovering.
The issue is often of vital importance. In a landmark ruling in 1976, the New Jersey Supreme Court found unanimously that the father of Karen Ann Quinlan had the right to decide to forgo life-sustaining treatment on her behalf. Ms. Quinlan died in 1985, a decade after she slipped into a coma.
The case of Terri Schiavo, a Florida woman who spent 15 years in a persistent vegetative state before her feeding tube was removed in 2005, stoked further debate in the United States and beyond about a person’s right to live or die.
With medical care, some can stay in a state of reduced consciousness for decades. Aruna Shanbaug, an Indian nurse, spent more than 40 years in such a condition until her death at age 66 in 2015. She had been left in a permanent vegetative state after being strangled with a metal chain during a sexual assault.
Mr. Webair, Ms. Abdulla’s son, said he had avoided serious injury in the accident in 1991 because his mother had seen the crash coming and managed to embrace him before the impact.
“To me she was like gold; the more time passed by, the more valuable she became,” he told The National.
According to the newspaper, Ms. Abdulla, who has returned to the United Arab Emirates, is being treated at a hospital in Abu Dhabi.
— For two weeks Claire Wineland kept picturing herself in Alaska looking at forests, caves and wildlife.
“I remember sitting there and staring at the most beautiful scenery ever for hours and hours … it would be freezing cold but I didn’t care,” she recalled in a recent video. “Turns out I was being ice-packed the whole time.”
While in her mind she was in Alaska, in reality Wineland was in a California hospital in a medically-induced coma. Following a routine surgery, Wineland, who has cystic fibrosis, contracted a dangerous infection called blood sepsis. In the years after her coma, Wineland has started a non-profit and video channel sharing her stories of surviving life as a sick person. She shared her story this week in a video titled “What It’s Like to be in a Coma.”
During those two weeks, Wineland said, she remained aware of noises and people around her.
“Everything that happens in the real world, you hear, you’re aware of,” she said In a new video. “You kind of know what’s going on. But it goes through this weird filter thing… It turns into something else when it hits your consciousness.”
Experts say it’s helpful to hear stories about what patients go through in the ICU when under heavy sedatives. Dr. Michael DeGeorgia, a neurologist from University Hospitals Case Medical Center, said patients can face post-traumatic stress disorder or other trauma from being left in the dream-like state during sedation. He clarified that a medically-induced coma is different from a coma caused by traumatic brain injury.
“When you’re dreaming, your entire brain is not . When you wake up from dream, the memory is almost there but can’t quite get it,” DeGeorgia said “When you’re in and out of sedation not quite synchronized in laying down memories.”
DeGeorgia said sedated patients will try to make sense of their surroundings, even though they may appear unconscious or out of it. For Wineland, this meant she thought she was in Alaska when ice packs were applied to her body and that she was on a hammock when she was inverted to drain fluids.
“My brain would make up a story for while I was in those positions,” Wineland said in her video. “I was upside down and swelling like a balloon. In my head I was in this weird hammock thing and my foot was stuck.”
DeGeorgia said in recent years doctors are now recommending using less sedative because patients can have traumatic experiences from their time in sedation when they can’t make sense of what’s going on or what procedures they may need.
“We now know that to varying degrees that patients can be aware of what you’re saying,” said DeGeorgia. “ They may indeed be partially aware of what they’re saying. You have to be attentive to patient and assume they’re listening to you.”
Wineland told ABC News even after she “woke” up from her coma she faced problems. As the drugs were slowly reduced she was unclear when she was hallucinating. “I can’t remember what was real and what wasn’t real from that week,” she recalled of the week when she first woke up. “Every time I talk about it, I remember something else.”
Wineland, a recent high school graduate, said she wanted to share her story on her website and Youtube channel so that people could understand more about what cystic fibrosis and other chronic disease patients face.
“ hidden world and subculture of being sick,” said Wineland. “No one really talks about it, it’s a story of dying person and not a sick person. The life of a sick person is incredibly fascinating.”
On July 7, former French soccer star Jean-Pierre Adams will reach an unwanted milestone, when he becomes the person in the third-longest coma in recorded history. He is already the male who has spent the most time comatose.
After a botched routine knee operation at the age of 34, the athlete was left in a persistent vegetative state. That was in 1982. As decades have passed his wife Bernadette Adams has dedicated her life to caring for her husband, in the hope medicine will advance and doctors might one day wake him up.
Jean-Pierre was born on 10 March 1948 in the former French colony of Senegal, to a devout Catholic family. Aged 10, his grandmother enrolled him in a school in France during a religious pilgrimage, before a couple from an area to the south of the capital Paris adopted him.
“I was like a little lost puppy without a collar,” Jean-Pierre later said of being left in France.
The boy brought a love of soccer with him to his new home, which he likely partly caught from his uncle Alexandre Diadhiou, who played for the Jeanne d’Arc in Mali. After playing for an under-13s squad, he joined the French Military team during conscription.
French soccer player from Nimes Olympique Jean-Pierre Adams pictured on 19 September, 1972. Getty
In 1968, Jean-Pierre met a girl named Bernadette at a dance in the town of Montargis. Bernadette, the daughter of a builder from central France, loved dances.
She told British newspaper The Times in 2014 the 5ft 10in 20-year-old was a “mountain of muscle” who had an easy-going, “joyous” attitude towards life.
The pair soon moved in together. At first, her parents were unsure: a white woman and a black man was a controversial pairing in France at the time. But their initial prejudice was no match for Bernadette’s feelings.
Recalling a conversation with her mother at the time, Bernadette told The Times in 2014: “I left home. I told her: ‘It will be him and no one else’.”
“When I’ve decided something, I don’t waver,” she said.
Bernadette’s perseverance paid off, and her parents quickly fell in love with the then-amateur association footballer who was completing his military service. The pair got married in 1969, and would go on to have two sons: Laurent and Frédéric.
Aged 22, Jean-Pierre went professional: his talent spotted by the first division team in Nîmes, southern France.
Drawing on the reptilian nickname of the club, legendary Nîmes trainer Kader Firoud told the young player: “You already have all the qualities of a young wolf, and if you are not afraid to work you will become a true crocodile.”
Half a season later, France Football magazine lauded Jean-Pierre in its pages for his ability to act out “dramatic fantasy” on the pitch.
Jean-Pierre’s talents saw him regularly playing for the French national team in the 1970s, earning 22 caps. He left Nîmes for bigger teams, eventually playing for both Paris Saint-Germain and Nice.
As well as his impressive athleticism, his personality shone through. Bernadette told CNN of her husband in 2016 he “was the ‘joie de vivre’ embodied in human form” and “loved the good life.” Jean-Pierre was always smiling, she said, and loved by everyone.
By 1982, Jean-Pierre was getting old—for an athlete at least—and he moved into coaching. Jean-Pierre juggled his new commitments with running a sports shop with Bernadette in the center of the city of Chalon-sur-Saône.
While training to be a coach in Dijon that March, he hurt his tendon.
At Édouard Herriot Hospital in Lyon, a doctor booked Jean-Pierre in for surgery on Wednesday, March 17: a date that coincided with a strike at the hospital.
When Jean-Pierre had his surgery for his relatively minor injury, the facility was running on empty: staff were stretched and providing care they weren’t qualified to give.
Jean-Pierre Adams (left) from France and Baptista Tamagnini Nene pictured on 26 April, 1975 during a friendly international match between France and Portugal. Getty
Still, Jean-Pierre was unfazed. “It’s all fine, I’m in great shape,” he told his family on the morning of the operation.
But during what should have been a routine procedure, staff failed to put Jean Pierre under correctly. Oxygen wasn’t sent around his body, causing a cardiac arrest.
After three weeks, he woke up. But the accident had left him with catastrophic brain damage and without his bodily functions.
Jean-Pierre spent the next 15 months in hospital. Declining the advice of the authorities, Bernadette took her husband home instead of putting him in an old people’s home.
Now, Adams can only open and close his eyes, and digest blended food, according to CNN.
The couple live in their home in the village of Caissargues, near Nîmes in southern France.
Jean-Pierre Adams and fellow French football national team player Marius Trésor (right) pictured on October 11, 1974, leaving Paris by train towards Bruxelles in order to play against Belgium football national team as part of the European Championship qualifying round. Getty
Every day, Bernadette blends and feeds Jean-Pierre his breakfast, lunch, and dinner. And with the help of nurses and physiotherapists who visit multiple times a day, she provides round-the-clock care. Sometimes she stays up all night tending to her partner. Bernadette is able to pay for her husband’s care after she won a 12-year-long battle with an annuity court.
“There is an activity in his mind, but it is not the right sort of activity because there was so much destruction of his brain,” Bernadette told The Times.
Despite not having a conversation with her husband for decades, Bernadette is certain Jean-Pierre has some semblance of awareness.
Jean-Pierre Adams photographed on July 26, 1977 in Paris on the grounds of Paris St. Germain. Adams, 22 caps for France A, between 1972 and 1976. Getty
“I think he feels things,” she told CNN in 2018. “He must recognize the sound of my voice as well.”
“I talk to him all the time—about TV, what’s in the mail, anything!” Bernadette told CNN. “There is always movement around him. He is always next to us.”
Her devotion partly lies in the hope that one day medicine will advance enough to break her husband from his coma.
“The more time that passes, the more bothered I get,” she told CNN. “His condition does not get any worse, so who knows? If one day, medical science evolves, then why not? Will there be a day when they’ll know how to do something for him? I don’t know.”
For 23 years Rom Houben was imprisoned in his own body. He saw his doctors and nurses as they visited him during their daily rounds; he listened to the conversations of his carers; he heard his mother deliver the news to him that his father had died. But he could do nothing. He was unable to communicate with his doctors or family. He could not move his head or weep, he could only listen.
Doctors presumed he was in a vegetative state following a near-fatal car crash in 1983. They believed he could feel nothing and hear nothing. For 23 years.
Then a neurologist, Steven Laureys, who decided to take a radical look at the state of diagnosed coma patients, released him from his torture. Using a state-of-the-art scanning system, Laureys found to his amazement that his brain was functioning almost normally.
“I had dreamed myself away,” said Houben, now 46, whose real “state” was discovered three years ago, according to a report in the German magazine Der Spiegel this week.
Laureys, a neurologist at the University of Liege in Belgium, published a study in BMC Neurology earlier this year saying Houben could be one of many cases of falsely diagnosed comas around the world. He discovered that although Houben was completely paralysed, he was also completely conscious — it was just that he was unable to communicate the fact.
Houben now communicates with one finger and a special touchscreen on his wheelchair – he has developed some movement with the help of intense physiotherapy over the last three years.
He realised when he came round after his accident, which had caused his heart to stop and his brain to be starved of oxygen for several minutes, that his body was paralysed. Although he could hear every word his doctors spoke, he could not communicate with them.
“I screamed, but there was nothing to hear,” he said, via his keyboard.
The Belgian former engineering student, who speaks four languages, said he coped with being effectively trapped in his own body by meditating. He told doctors he had “travelled with my thoughts into the past, or into another existence altogether”. Sometimes, he said, “I was only my consciousness and nothing else”.
The moment it was discovered he was not in a vegetative state, said Houben, was like being born again. “I’ll never forget the day that they discovered me,” he said. “It was my second birth”.
Experts say Laureys’ findings are likely to reopen the debate over when the decision should be made to terminate the lives of those in comas who appear to be unconscious but may have almost fully-functioning brains.
Belgian doctors used an internationally-accepted scale to monitor Houben’s state over the years. Known as the Glasgow Coma Scale, it requires assessment of the eyes, verbal and motor responses. But they failed to assess him correctly and missed signs that his brain was still functioning.
Last night his mother, Fina, said in an interview with Belgian RTBF that they had taken him to the US five times for reexamination. The breakthrough came when it became clear that Houben could indicate yes and no with his foot.
“Powerlessness. Utter powerlessness. At first I was angry, then I learned to live with it,” he tapped out on to the screen during an interview with the Belgian network last night, AP reported.
Laureys, who is head of the Coma Science Group and department of neurology at Liege University hospital, has advised on several prominent coma cases, such as the American Terri Schiavo, whose life support was withdrawn in 2005 after 15 years in a coma.
Laureys concluded that coma patients are misdiagnosed “on a disturbingly regular basis”. He examined 44 patients believed to be in a vegetative state, and found that 18 of them responded to communication.
“Once someone is labelled as being without consciousness, it is very hard to get rid of that,” he told Der Spiegel.
He said patients suspected of being in a non-reversible coma should be “tested 10 times” and that comas, like sleep, have different stages and need to be monitored.
Houben hopes to write a book detailing his trauma and his “rebirth”.