Does modern medicine give patients with major brain trauma really fair care?

alive-300x115Nick Tullier once was a handsome, strapping sheriff’s deputy in Baton Rouge, La. Then, in a blink, he and five others were gunned down by a former Marine and black separatist who had come from Missouri to Louisiana to kill cops. Tullier was one of three deputies who survived the attack.

What happened next to him is part of a series worth reading in the Houston Chronicle, a year-long dig the newspaper has dubbed “Alive Inside.” The work asks whether doctors and hospitals across the country have stayed current with medical advances that maybe, just might, possibly offer greater glimmers of hope to patients like Tullier who suffer traumatic brain injuries.

Such individuals, the Chronicle carefully says, may too quickly be deemed too injured to survive. Doctors, in sincere acts of perceived compassion, may be too fast to urge family and loved ones to withhold or halt medical services for the brain-injured, partly out of the pragmatic reality that their recovery prospects remain poor.

But, the newspaper suggests, there are some experts—including in Houston’s booming medical-scientific community—who may be more attuned to the possibility that brain-injured patients like Tullier have greater consciousness and awareness than they can show to doctors giving them life-and-death cognitive tests. They’re alive in their minds but trapped inside malfunctioning bodies.

To be sure, the series seeks to paint a nuanced portrait of the situation of Tullier and others like him. He and his fellow gravely wounded law enforcement officers got major public attention, including from President Obama, Vice President Biden, and the top docs who care for the nation’s No. 1 and No. 2 leaders. The deputy’s family showed great grit, declining to accept diagnoses that his trauma was so great that they should abandon hope for him.

Chronicle reporter Mike Hixenbaugh reviews well the awful mix of medicine and personal beliefs, including those of a religious nature, that attend to caregiving decisions about patients comatose from grave brain injuries. He reminds readers about the political mess that erupted around the late Karen Ann Quinlan, and how that donnybrook  long has shaped not only public but medical views surrounding individuals deemed to be in a “vegetative state.”

But medical science, especially surrounding the brain and its regenerative capacities, has advanced significantly in the years since, Hixenbaugh noted. Doctors can offer more brain trauma treatments than before, many with much greater effect. They also still must avoid  raising false hopes, including for patients like Tullier and his loved ones. The deputy survived, but he’s on an arduous, painful recovery path, with huge questions persisting as to how much of his previous capacities and life he ever will regain.

In my practice, I see not only the significant harms that patients suffer while seeking medical services but also how profoundly their lives can be upended by brain and spinal cord injuries. It’s great to see a regional news organization devote big resources to tackle difficult, complex medical matters like brain and spinal cord injuries and how modern medicine may lag in its care of these huge traumas. The issue likely will rise to national prominence again, depending on advocates of various stripe and no doubt a tough, murky, and sad individual case and story.

There is a huge take-away for me in this Chronicle series and the background it provides: For patients, family, friends, and loved ones, brain and spinal cord injuries become a 24/7, all-consuming challenge. Patients need care that can be costly and overwhelming, not only to overcome their immediate and constant medical issues but also if they are to get rehabilitative services that can help them refashion their lives. These are issues that politicians, policy-makers, doctors, hospitals, and insurers must keep in mind when they look at sums that jurors and judges may order defendants to pay harmed plaintiffs in trauma suits. Some of the figures may seem big. But when they must fund a lifetime’s effort to not just care for but also to provide new lives to public servants like Tullier, the sums may not be large enough.

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