As many of you know from my Facebook post last week, my father had a cardiac arrest. The cause was the typical culprit of coronary artery disease. He was exercising and his heart wasn’t getting enough oxygen. So, it just quit. My mother was in the house and was able to call 911. The Police defibrillated him. At the hospital, they put him into a drug-induced coma and implemented a therapeutic hypothermia protocol. (Good layperson description: http://www.sciencedaily.com/releases/2011/02/110218111823.htm) After 24 hours in a hypothermic state, they began to allow him to warm up and reduced the sedation. Then began the wait.
During this whole event, I found my brain divided into three equal parts A) the speech-language pathologist with neurorehab experience; B) the daughter; C) the practicing Buddhist. These three lovely ladies have had different reactions to everything that followed. There are many perspectives I could discuss, but the first thing I want to toss around is the question of “what is awake” and the reality of anatman (no self).
Being fully awake to the world is what we strive for as Buddhists. Buddha itself merely means Awakened One. Outside of existential debates we can get into in terms of recognizing emptiness and no ground, most of us take our ability to recognize the alternation between the state of being awake or not awake for granted. Yes we recognize the existence of a fundamental nature called clear mind but we wrap it up in our ability to discern clear mind and our ability to consciously manipulate our relationship to it. When consciousness-severing injury is involved, however, these distinctions become less clear.
Waking from a coma is not like it is in the television. Instead of waking suddenly with clear eyes and coiffed hair, one must struggle toward consciousness through a jungle of mental fuzz and messed up physiology. There are in fact various stages of consciousness that are described in the medical literature to help clinicians respond appropriately. Consciousness is not merely an on or off thing.
The first attempt at what the doctors termed a “sedation vacation” did not go well. My father became agitated and his body started fighting the ventilator instead of taking over his own breathing. We decided to leave a family member in the room for the next attempt and I was elected.
For about an hour, there was no change. Then I noticed some tension in his shoulders every time the automatic bed changed position. I talked him through relaxing his shoulders each time (Awake? Not awake? Don’t know).
Then he started moving his arms and shifting his head side to side. I continued talking to him. Occasionally, he reached his arm toward me. (Awake? Not awake? Don’t know.)
He opened his eyes. I can’t say he was looking at me per se, but he definitely didn’t have his eyes rolled back in his head. His eyes opened a few times and closed. (Awake? Not awake? Don’t know.)
The respiratory rate on the ventilator increased and the breaths became less metered. He was breathing over the ventilator support. (Awake? Not awake? Don’t know.)
Eventually, he became uncomfortable. They re-sedated him in order to get a good night’s sleep.
I planned to go to work the next day. I figured he would wake to the same state and maybe rise to the level of being able to be extubated before I could see him in the afternoon. Then I got the call from my sister – “He’s awake. He’s talking.” Okay. Cancel clients. Rush over. Sure enough there he is, eyes open conversant and answering questions on Who Want’s to Be A Millionaire - correctly. Ummmmm…okay. Awake! But…
He asked what happened to him. The clinician in me stepped forward and frankly explained the situation. He looked incredulous. Then we all talked some more. Then he asked us again – what happened? Oh dear. I explained again. And again. And again. (Awake? Not awake? Don’t know.)
It was clear that he was not forming new memories. The clinician in me recognized this is a normal part of the process, but she also knew there was no way of telling if the situation would get better. My dad was able to discuss the development of the nation’s cellular network and posit his predictions for bandwidth and functionality, but he couldn’t remember that my brother had stepped out of the room and come back. (Awake? Not awake? Don’t know.)
The clinician in me was thrilled to see he was having no trouble with word retrieval or formulation of sentences, that he could retrieve old memories and use logic to interpret and discuss information he was familiar with. The clinician was also thrilled to see him respond to abstract language and humor without a processing delay. But his brain was still dumping new information it was given.
The Buddhist in me kicked in saying: Boy, talk about living in the now! The daughter glared at the Buddhist and the clinician sent them both to separate corners of the room to cool down.
There is consciousness and what we call consciousness. As humans there are all of these attributions we make in regard to consciousness; things we think of as fundamental to it which in fact are not. Language, the ability to analyze our surroundings, memory. These things are actually merely a manifestation of the skandhas (http://buddhism.about.com/od/whatistheself/a/skandhasnoself.htm). Observing my father being stripped every skandha but form placed me in intimate contact with the reality of anatman (no self). That is probably why most people are so frightened to be with their family and friends in these circumstances. There is no avoiding the truth. We have no inherent self that transcends what happens to our form (the body). Anything truly substantial is beyond that and having not been enlightened yet, it is very difficult to see that as anything but pessimistic.
My father has started forming a few new memories now, but it is still sketchy. There is no way to know how his progress will play out, but it seems the worst has passed. In maintaining my daily practice throughout this process, I have reached a point where I can feel my ability to have such close proximity to the fundamental reality of anatman was a blessing. Nonetheless, I am still rejoicing that it appears my trip to anatman was merely a complementary tour – for now.
Now buy the Book!