After Sudden Lucidity, Firefighter Is Less Animated
By JAMES BARRON
A brain-injured Buffalo firefighter who unexpectedly started speaking again on Saturday after almost a decade of silence has continued to have bursts of conversation since then, but he has not been as animated, his family said yesterday.
Hearing the firefighter, Donald Herbert, speak was "completely overwhelming," his wife, Linda, said yesterday. "We are still trying to cope with this incredible experience."
His doctor said the breakthrough - 14 hours that began when Mr. Herbert suddenly regained consciousness and asked for his wife - came three months after his medicine was changed. The doctor, Jamil Ahmed, said that he had figured the new drug regimen would take six months to become effective.
For the first time, Dr. Ahmed described Mr. Herbert's condition over the last couple of years as having been close to a "persistent vegetative state," a term that neurologists used to describe Terri Schiavo before she died last month in Florida. Someone in a persistent vegetative state appears to be awake but is unaware of what is going on around him.
Dr. Ahmed said he had paid close attention to Mr. Herbert's responsiveness, or lack of it, from the time he first examined him in 2002. "I was trying to understand and clarify, "Is he understanding? Is he aware of the environment?' " Dr. Ahmed said yesterday. "But there was no way to confirm that. I came to the conclusion that he was, you could say, close to the persistent vegetative state."
Dr. Ahmed, who appeared at a news conference at the Erie County Medical Center in Buffalo arranged by the family and attended by dozens of reporters, said that Mr. Herbert had spent much of the time since Saturday sleeping. Other relatives said they had been careful not to overwhelm him with information about everything he had missed since he was trapped by a collapse in a burning building in 1995.
Dr. Ahmed said Mr. Herbert thought that it had been only a couple of months since the accident, not a decade - in which a president was tried for impeachment; e-mail and cellphones became popular; and his hometown football team, the Buffalo Bills, made the playoffs four times.
Mr. Herbert found out that he had been sidelined far longer than he thought when, at his request, a staff member at the nursing home called his home on Saturday and his youngest son, Nicholas, 13, answered. Mr. Herbert could not believe it, saying of Nicholas: "He's just a baby. He can't talk."
But his doctors said he seems to be taking it all in. "He's in awe that it's been 10 years and that he's 43 years old now," said Eileen Reilly, a doctor at Father Baker Manor, the nursing home in the Buffalo suburb of Orchard Park where Mr. Herbert is a patient.
She said his awareness suggests that he has at least some short-term memory. "He knows the aides, knows the nurses in the nursing home, knows their names, says hello to them," she said. "He listens to the voice and follows where the voice is and greets them. It's amazing."
Dr. Reilly said Mr. Herbert's condition was remarkably different from what it was a month ago. "He is much more responsive and speaking clearly for the first time," she said.
But she said that Mr. Herbert was becoming tired. And Mrs. Herbert said yesterday that he had had several "infrequent" moments of clarity since Saturday but that the family had "much hope for further recovery."
Dr. Ahmed said that Mr. Herbert might "fluctuate" with time. "But the way he improved and woke up, we are hoping he will progress," he said.
Dr. Ahmed said that, on Saturday, "I was so surprised that not only was he talking but he was talking very sensibly."
"He was remembering his past. He just didn't realize how long he was asleep," Dr. Ahmed said. "He recognized people."
Some were relatives and some were fellow firefighters who rushed to the nursing home as word spread that he had regained consciousness. Dr. Ahmed said he was amazed this week, when he visited Mr. Herbert, to find him following commands to shake his head and move his hands, and counting to 200.
Mr. Herbert suffered a head injury and oxygen deprivation after he rushed into a burning apartment building in Buffalo on Dec. 29, 1995. The roof gave way, and he was knocked unconscious. Reports at the time said that he went without oxygen for six minutes before other firefighters rescued him. He was taken to Erie County Medical Center, where he was in a coma for two and a half months.
He regained consciousness for a while in 1996, but had speech and vision problems and could not eat or walk without help. His memory was all but gone, and he did not recognize relatives and friends.
Mr. Herbert's doctors said yesterday that they had tried using various combinations of drugs to revive him. Three months ago, when his condition worsened, they switched him to a cocktail of drugs that is normally used to treat depression, Parkinson's disease and attention deficit hyperactivity disorder. His doctors would not name the drugs they had administered, but a number of medications have been shown in the past to stimulate awareness in a handful of people who were minimally conscious, even after several years.
Gary Dockery, a Tennessee police officer who was left paralyzed and mute after being shot in the head in 1988, suddenly spoke up nine years later when his doctors gave him diazepam, an antianxiety medication. For about 18 hours, Mr. Dockery returned to life and started talking and recalling memories of camping trips. Just as unexpectedly, he relapsed the next day. He died about a year later from a blood clot in his lung.
Dr. Nicholas D. Schiff, an assistant professor of neurology and neuroscience at NewYork-Presbyterian/Weill Cornell hospital, said there have been cases in which people awoke from minimally conscious states after being given similar drugs, including zolpidem, another antianxiety medication.
In Mr. Herbert's case, he said, it was impossible to know for certain what his doctors might do and how he would respond. "This has not been systematically studied in a way that would allow us to recognize regularity in types of responses," he said.
David Staba, in Buffalo, and Anahad O'Connor, in New York, contributed reporting for this article. |
