article presents process oriented coma work in the field, including
workshop setup and presentation, finances, case consultation, hands on
coma communication, family participation, and community involvement.
All of these can help in presenting and accomplishing coma work. Our
society commonly regards those in coma as individuals in "vegetative
states". Contrary to this idea, comatose people are part of a larger
system of networks: family, friends, caregivers, community groups, and
the community as a whole. I hope and believe the more levels coma
workers can become involved on, the better the chances that patients
and community can grow and accomplish what they need to. Benefits can
include: improved connection with patients; processing grief and other
emotions; managing difficult or dangerous patient behavior; reduction
of caregiver hopelessness, depression and burnout; dispelling the
common misconception that no one is "home" when comatose; and
appreciation that people in coma states perform inner work useful to
themselves and possibly others in the community.
wish to express my deep admiration for Dwane Keehn, Karen Keehn, and
the extended Keehn family, for their courage and tenacity in the face
of daily struggles with the tragedy of traumatic brain injury. They
have opened up to the world about their trials and efforts to
understand those in coma. Many thanks to Alida Hilbrander, Hospice
Volunteer Coordinator, and members of Shuswap Hospice for encouraging
and sponsoring coma work in their community. Also much love to
parents, friends, volunteers and professionals that suffer and have
sacrificed parts of, or their whole lives to care for people in
extremely remote states.
below an attempt to share the intimacy, tragedy, patience,
frustration, compassion, love, spirituality, detachment, openness,
ordinariness, and excitement of working with those in withdrawn states
Interacting with families in the impossible situations that coma
presents, has left me in awe of people's love and commitment toward
each other, and their faith in the human spirit, and greater powers.
Coma and coma communication
is an extremely withdrawn condition resulting from injury, lack of
oxygen, disease, poisoning, metabolic changes, and/or psychological
causes. "The duration of coma depends upon the extent and severity of
the pathological process, the ability of the helpers to process its
contents, and the psychology of the individual." (Mindell,
observed that many people who sit with relatives and friends in coma,
take note of patients' small cues and nonverbal reactions. They
endeavor to develop communication systems that bring mutual support
and growth. Regardless of patients' prognoses, I believe these efforts
worthwhile for our culture and spiritual lives. The states that
comatose people enter may provide new information for themselves and
others. Mary Kay Blakely gives a detailed report of her experiences in
a two weeklong diabetic coma. Her perceptions include information for
herself, her family, caregivers and the world. [Blakely] Others recall
nothing from their coma states, but change their lives dramatically
upon recovery. Many do not return to normal consciousness, but even in
these situations people can learn to communicate more fully. Those
that do not return to cultural norms, challenge their families and
communities to adapt and learn more about altered states of
Process oriented coma communication
want to thank Drs. Arnold and Mindell, and also teachers, students and
clients of process work for the ongoing development of process
oriented coma communication. Through doing process work with hundreds
of comatose people, Arny developed hypotheses and techniques for
supporting and communicating with these folks. Many of the techniques
will be presented below, in the transcript of Dwane's work. (also see
Process oriented hypotheses include the following: We look upon coma
as a call to inner work. Even though severely damaged, some parts of
comatose patients are "home" or present within their remote state.
These parts can be communicated with. People in coma do their best
under the circumstances they find themselves in, though they may have
little or no awareness of what is transpiring in their inner and outer
worlds. The coma worker acts like an awareness assistant, helping
bring inner and outer events to greater consciousness. This aids those
in remote states to process information and make decisions based on
their experience. As coma communication facilitators, we trust what is
in front of us and interact according to negative and positive
feedback from patients. When those in coma complete their inner work,
they will spontaneously emerge into more ordinary states, as far as
their condition will allow.
the summer of 1990, five of us present coma work theory and techniques
at the British Columbia Hospice/Palliative Care Association Conference
Volunteer coordinator Alida Hilbrander attends from Shuswap Hospice,
located in Salmon Arm, a rural community of 15,000 located in British
Interior. In general, hospice volunteers demonstrate keen interest and
spend a great deal of time with patients. Many volunteer coordinators
promote new skills that help volunteers with hands on work.
believe coma communication work can help resolve some of the care
problems for those in remote states, and their caregivers:
rambunctious behavior; difficulties in day to day care; staff burnout;
family hopelessness and depression. Coma work can often support and
help complete difficult behaviors quickly and safely. When staff and
family see how coma work can improve communication, they often become
Alida organizes a workshop in Salmon Arm for May of 1992: "Relating to
Loved Ones and Patients in Coma or RemoteStates."
Alida phones two weeks before the workshop date. Fifteen people signed
up. She needs forty five to make it a go. We cancel. I suggest she
consider her effort as pre advertising for the next time we schedule.
feel reticent talking about business and money matters concening coma
work. In traumatic situations, I believe family and friends should not
have to think of anything but their loved ones. This can be a tragic,
awful time. If the coma has gone on for a long time, families may have
run out of resources for therapy. Until coma communication work
becomes more thoroughly included in medical insurance plans, coma
workers will need to explore ways of supporting families in trauma,
and themselves financially.
the other hand, coma work can bring different types of rewards.
Clients have reached for hands from above, traveled to heaven, and
shouted, 'Holy God!' They have seen visions, heard voices, sung songs,
felt awe, battled oppressors, and embraced loved ones. Comatose people
take me beyond my normal earthly boundaries and connect me with
thoughts and emotions bigger than myself. I am grateful.
early 1993 two colleagues and I journey to Calgary,
to give a coma workshop at the Faithful Companions of Jesus Centre.
One of the participants, Karen Keehn, comes from Salmon Arm, BC.
Twelve months previous her husband Dwane suffered a heart attack
followed by 15-20 minutes of anoxia (oxygen deprivation). She asks us
to come to Salmon Arm to work with him. Her funds are limited, so we
brainstorm. Karen and Dwane's extended family will pay our travel
expenses and put us up, plus an hourly rate for working with Dwane.
Alida will organize a workshop again. Many of Dwane's relatives will
attend to enhance their communication with him. Karen and Alida will
organize additional private consultations for us. We are all
encouraged. We will work with Dwane, his family, caregivers,
institutions, and community.
way of preparation I ask Karen to send a videotape of Dwane in each of
his various moods, both by himself and interacting with people. I show
the tape and consult with Arnold Mindell at the spring quarter's Case
Consultation Class at the Process Work Institute in Portland,
tape reveals a middle aged man lying in a hospital bed, head tipped
back slightly, neck arched. Occasionally he moves his head from side
to side. He vocalizes guttural sounds. My notes on Arny's comments
There's a struggle in his
neck. Work with the tension there. Put your hands on his neck and
(When Dwane arches his neck, he pushes back or "struggles" against
Put your mouth to his ear
and make noises similar to his noises. He may not be hearing himself,
so he would need amplification of his sounds to complete a feedback
can form one of the main reasons people get stuck in comatose states:
They lack full awareness of what they are communicating. By increasing
the volume of Dwane's sounds he may become more aware of his own
communication. From receiving this feedback he may alter his
communication behavior.) The
growls are winning sounds (that have a good chance of developing
into further communication).
They come closest to the surface of consciousness, of all of Dwane's
The initial anoxia (oxygen deprivation)
process may still be in progress. His labored breathing indicates this.
(He may be attempting to get more air.) Try giving him more
Parts (of his
personality) are intact, even though damaged.
Check with the
institution about intervening with Dwane.
(Be careful to follow rules and routines and ask permission to go
outside these procedures.)
Followup with Dwane and the family at
least once a month. He needs a lot of ongoing attention.
Stay conservative, not making the family over optimistic. Take care to
tell it how it is rather than how you think the family wants things to
be. Find out how much they want to work with Dwane, since they will
provide most of the hands on work.
If you maintain a general
air of enthusiasm this helps the whole field
(loved ones, institution, and community)
which will help Dwane.
Friday morning, June 11, 1993,
Judith and I fly to Salmon Arm. On the flight we discuss how honoured
we feel, to be invited to the bedside and intimate family situation of
the Keehns. We plan to work with Dwane and help family members work
with him. They can learn to relate with Dwane in new ways and practice
techniques to continue working with him. We will videotape our first
session and study it at the workshop the next day. Many of Dwane's
extended family members and hospital staff that care for him will
attend the workshop: relatives; friends; professional and volunteer
caregivers. We will also connect with folks who support the relatives
and friends. The whole setup exemplifies coma community networking.
Karen and her daughter Vicky pick us up at the airport and we get
acquainted on the hour and a half drive to Salmon Arm. We drop our
bags at Karen's and head for the hospital. Karen, Vicky, Judith and I
meet up with Dwane's son Darcy, daughter-in-law Cindy, and
grandchildren Justin age four, and baby Cody. We hold a conference in
the hospital parking lot on the shore of a little lake. Canada
geese waddle by under the bright Interior sun. Then we spend two hours
working with Dwane, first some history:
Dwane is 54 years old, and worked as a saw filer at a local lumber
mill. Fifteen months previous he suffered a heart attack at
while sleeping. Karen reports that he yelled, "Help! I think I'm
having a heart attack!" He helped sit himself up and held his chest in
the heart area. He fell off the bed and stiffened his body. The
ambulance arrived quickly and took Dwane to hospital. He was without
adequate breathing for 15 to 20 minutes. A CT
brain scan indicates diffuse brain damage.
these details we can infer possible directions in his coma process: He
wants help. He gets "attacked" in or by his heart when unconscious or
sleeping. We can ask ourselves what "attack" means for Dwane, and how
it might appear in his behavior? We later work with this part of his
process by giving resistance to stiff and rigid muscles in his neck,
feet, legs, and arms. Hypothesis: he unconsciously counterattacks or
fights off the attack in these places. We give verbal feedback while
working: Now I'm pushing your right foot . . . You're pushing back
against my hand! . . . Great! These statements hopefully will help him
become more conscious and re-establish damaged brain-muscle-auditory
connections. People with severe brain damage may require hundreds or
thousands of hours of this type of work.
Another big process involves the anoxia (oxygen deprivation). Readers,
you may want to stiffen both arms and legs and stop breathing for ten
or twenty seconds, to enter your own mini-version of the powerful
altered state that overtakes Dwane. We encouraged him to sustain the
long pauses in his breathing. When he stopped breathing, we pushed
down on his chest with light pressure while reporting verbally: Now
you have stopped breathing . . . Now your chest is still . . . Now you
breath in . . .Now you breath out . . . Now you have stopped breathing
. . . Now you hold your breath . . .These statements and hands on work can help amplify awareness
of his body sensations and movements. At first Dwane held his breath
for approximately 30 seconds. After working with him for 10 minutes he
shortened the pauses until he breathed at a near normal rate.
asked Karen for any early childhood dreams or memories that Dwane
might have told her. This information can provide one way to
investigate what Arny Mindell calls the background dreaming process.
Taking off from Jungian psychology, Arny hypothesized that early
dreams and experiences demonstrate a pattern for what is transpiring
in the present. The current representations of these early experiences
may be occurring as body feelings or movements, relationship
interactions, or interaction with the larger world.
Karen reports a powerful dream of Dwane's:
Dwane was born on a ranch in
Alberta. In his teenage years he
dreamed this just once, but the feelings around it were powerful. He
got caught in a gravel crusher. He could see the light in the hole at
the end of the crusher tube, but couldn't get out. During the dream in
his sleep, he actually lifted the wood heating stove off the floor.
Apparently the red glow from the heater resembled the light in his
Knowing Dwane's early dream experience, we can work from the
hypothesis that the process of the gravel crusher will reappear in his
body experiences. "Crusher" implies strength. The long pauses at the
bottom of his exhalations might represent the temporary stage of being
crushed. The inhalation and stiffening of his neck and limbs could
coincide with struggling against the crushing, or even becoming strong
like the energy of the gravel crusher.
We present the workshop that
Alida and Hospice organized, Saturday, June 12. Thirty people attend,
including ten members of Dwane's immediate and extended family. Their
love and commitment touches us.
Agenda of lecture and
1)Awakening to inner work: coma as symptomatic of a call to deep
inner work, rather than only a “vegetative state” with nothing going
2) Ethics and feedback:
all states; normal and remote; deserve encouragement, because they may
help access meaningful information attempting to come into patients’
3) Cultural bias about
coma: exploring our familiarity with some altered states and becoming
more familiar with others.
4) Information theory:
Everything can be understood as information, and information continues
to be communicated until received (Diamond). We keep investigating
clients’ perseverations (repetitions) until we find how to help
5) Blank access
statements: statements that refrain from projecting helper's ideas
into clients. For instance: “Go ahead and experience what you're
experiencing and know that will show you the way.”
6) Minimal cues: often
overlooked bits of information such as twitches, sighs, coughs,
swallows, eye movements, breathing patterns, groans, etc. Increasing
awareness of and encouraging
these signals can form the beginnings of significant communications.
7) Relating through
channels: noticing and using the way a patient perceives and express
theirself: auditorally, visually, through body sensations, body
movement, in relationship, with the larger world environment
8) Burnout: wanting to
quit as an attempt to gain more detachment; staying in touch with and
processing helpers inner reactions as a way to be present and
gain distance from highly charged emotional situations.
9) Supervision of issues
and difficulties that participants are encountering with patients in
their workplaces or families.
10) Metaskills: The main
attitudes and beliefs that underpin the interactions we attempt with
clients. Metaskills: compassion; love of human nature; patience;
remaining open to mysterious occurrences; awareness of
interconnections between people and with the environment; disease and
accidents have meaning and are not only pathological; willingness to
take seemingly small or useless events seriously. (Mindell, Amy 1992;
Mindell and Mindell)
After a lunch break we launch into the video study. The tape
graphically depicts Dwane's ability to relate with the outer world, at
least for short periods of time. Without intense interventions,
Dwane's consciousness would probably rate 3 on the Glasgow Coma Scale.
Three is the lowest rating and 15 is normal on a scale that measures
consciousness by visual, verbal, and motor responses. After relatng
with Dwane for an hour using process oriented coma communication
techniques, he rates possibly as high as 12 for brief periods. (Ross:
Demonstrating more presence in the outer world is naturally what his
loved ones want. The fact that he only surfaces to the outside
environment for short intervals of time seems to indicate two things.
He needs a large amount of time and coma work support, to remain
inside and work on himself; and concentrated outside feedback to
relate with the outer world.
below verbatim sections from the videotape. We've been interacting
with Dwane for about an hour previous. He's in a hospital room by
himself which allows us to interact freely.
Names in plain type followed by colons, indicate speakers. Commentary
is also in plain type. Italics denote speech.
Stan: We're going to look at
your toes here. Karen lifts the sheet from Dwane's feet. Darcy
repositions the camera giving a full length body shot from the bottom
of the bed.
Karen: I'm touching your foot.
I'm touching your toes.
Dwane: Snort! on
inhalation. He moves his toes before Karen touches them. Positive
Stan: There you go! You say
toes and Dwane moves his toes!
Judith: You just did it. Your
big toe on the right foot just moved. She encourages with
"cheerleading", and works at raising Dwayne’s body awareness with
Karen: Can you do it again? Can
you wiggle your toe, Dwane? (pause)
I'm going to touch your toe.
She touches his right big toe and it goes strongly decerebrate
(extends toward his head).
Stan: Oh yeah! Right on! Great!
Boy that right toe just went right up straight in the air. Wow! Look
at that right big toe.
Karen: Now I'm going to touch
your other one. Dwane's left toes extend before Karen touches him.
Whew! Both of them! Right
and left big toes.
Stan: That was great. Keep
Karen: Oh boy, we've really got
Stan:When you say, "We've really got
movement" say the placement. Whew! And now the right big toe again.
of the work with traumatic brain injury patients involves
re-establishing and reinforcing the neural connections between body
sensation, movement, auditory, and visual modes of communication.
Countless hours of interventions like, "Now as I touch your left
forearm your right leg moves, also notice what you're looking at." The
helper acts as metacommunicator, a person that observes and feeds back
information to the patient.
Karen: Move your left big toe,
Dwane. Can you move your left big toe? Do you want me to show you
which toe, which foot? She lightly rubs his left instep. He
extends his left toes.
Group: Yep, whew, gee, wow,
yea! You moved your toe. You can do it. That's big time.
Karen: She takes her hands away from Dwane's feet entirely.
How about your right toe. Can
you move your right toe? Dwane extends his right foot about four
Group: Cheers and exclamations. We all experience a tremendous thrill.
makes the third time Dwane extended his toes after an auditory
intervention, no touching. He goes on to do it twice more. At this
time his awareness is close to the surface. He has some command over
some of his muscle movements.
I push on the bottoms of his feet and Dwane pushes back strongly. I
compliment him on his power. This may be the rigidity and force
expressed in his heart attack experience and his childhood dream.
minutes later in the session Dwane's four year old grandson, Justin
interacts with Dwane. As Justin and Karen talk about how Dwane and
Justin used to wrestle and fix toys, Judith and Vicky take turns
pushing on Dwane's feet. When Justin mentions "Jeep", Dwane's closed
eyelids start flickering, indicating a possible inner visual process.
No direct contact takes place between the two, but we can hypothesize
that certain of Justin's words activate visions and possibly memories.
Dwane loved Jeeps before he went into coma.We encourage Dwane to look at what he sees.
Justin: He's grandpa.
Justin stands on a chair at the head of the bed.
Nee, nee, nee, nee, nee. Hi!
Karen: Hold grandpa's hand.
Karen places Justin's hand in Dwane's hand.
Justin: I don't want to. He's
awful sick. Real sick. Hey grandpa!
feel Justin brings some much needed levity and bluntness to the
session. He expresses things that the rest of us might feel shy or
uncomfortable saying. "Out of the mouths of babes." Dwane does inner
work here. He gives positive feedback via increased eyelid movements,
even though his response may not fit hoped for reactions. Justin
leaves and Karen initiates a new interaction.
Karen: Dwane, I've got a wet
cloth. Do you want me to wipe your mouth? She begins gently wiping
his open lips.
Dwane: Snort! He turns his
head closer to her and closes his mouth. Positive feedback in that
Dwane gave a strong reaction that conveys a message to us.
Karen: You like that don't you.
Stan: Look at that big smile.
I'm touching your face a bit here. I touch Dwane on the upper
cheek and pull slightly in the same direction that Dwane's smiling
cheek muscles move. I help Dwane be more aware of how his face
crinkles up. Wow, look at that,
Karen: She continues to wipe his mouth.
Open your mouth, Dwane. Do you
want some moisture in your mouth? He opens wide.
Stan: Wow! Right on. Wow!
He bites down and then chomps up and down. Karen pulls out the cloth.
Put it back in. Watch your
Karen: Ohhhh. Boy, you're
biting down on that cloth pretty good.
Stan: Let's wet this one. I
had previously prepared a cloth wrapped around a tongue depressor.
Peoples' jaw muscles are strong. I had been bitten fairly hard on my
fingers a few months earlier by a client.
Stan: Yeah, that's quite the
expression. Dwane turns his head toward Stan.
Hi. He focuses his eyes on
Stan's face. Hi, I'm Stan. Time
to look at you, yeah.
Dwane: Snort, chomp. Broad
Stan: Sure looks like you're
looking at me and I'm looking at you. Right on.
Karen: She moves the moist cloth covered stick close to Dwane's mouth.
Nice and wet, open your mouth. She pauses. Dwane opens his mouth and
chomps and sucks on the cloth.
makes twice that Dwane opened his mouth after a verbal interaction.
Karen removes the stick and they make eye contact.
Dwayne: Grrraaghh, snort. I
remember that Arny said Dwane’s sounds are closest to the surface of
all his signals. As Karen puts her face close to his. She tries the
stick again, but he focuses on her with his eyes. After another two
minutes of eye contact, Dwane closes his eyes and goes back inside.
His eyelids flicker. He breathes into his lower stomach and pushes
with his feet.
Stan: Go ahead and see what
you're seeing. . . Feel how
you need to feel. . . . Push
how you need to push. I place my finger under Dwane's chin and
apply slight pressure to help him go further with tipping his head
back. Dwane swallows.
Judith: Those legs are stiff
all the way up to the knees! This is new muscular tension, an
addition to his strength process.
Stan: If there's a thought that
just came up, hang onto it. This responds to his swallow. A
swallow can indicate something coming up and then the person swallows
it back down. Acting as an awareness reporter here can help the person
catch the thought.
Dwane stays mostly nonresponsive a couple more minutes as we work with
him. Then Justin starts calling:
Justin: Grandpa, grandpa.
Dwane comes back out to look at his grandchildren. Cody, the one year
old, musses up Dwane's hair and Dwane smiles.
video study produces good effects in the workshop. The tape helps
dispel the common misconception that no one is home when someone is
comatose. Participants see that Dwane can be present to some degree.
Communication can go two ways if helpers track and interact in those
channels the client communicates in.
Extended family visit
next morning, Sunday, we go to the hospital to meet with Dwane and
fifteen members of his large extended family. Dwane stays more
interior this morning. This is disappointing. Is the time of day not
as good as on Friday? Is he shy with the crowd? Is he just more
introverted today? Regardless, we work with him where he is at. We
support his withdrawn state. We also involve more family members that
weren't present on Friday. We have to gently push people into doing
interventions. Naturally, they shy away at first from this new style
of interacting with someone they may consider minimally present.
Persistence pays off, and several get into the swing.
Simply gathering everyone together around the bedside proves a
touching and bonding experience for the family. We wheel Dwane in his
bed out onto the patio. He experiences the outdoors for the first time
in fifteen months.
Young people and head injuries
rest of the day we spend working with a young woman in Salmon Arm and
a young man from Armstrong, the closest town to Salmon Arm. Both
mothers had attended the workshop the day before. Both patients had
been in car accidents as teenagers a few years previous and had
suffered massive diffuse traumatic brain injury. Judith and I are
amazed at the immense amount of effort, love, and time the families
had devoted to their children. They had rebuilt their houses and drove
special vehicles to accommodate special needs.
attempt to help in two main areas. The first involves supporting
parents to trust their children’s' inner work and remote states.
Something goes on inside people even when communication signals remain
minimal and nonverbal. The second area poses more difficulties: how to
support the expression of angry and aggressive energies. Working to
oppose stiffness in the muscles may help release tension left over
from the impact of a violent accident. Also yelling and screaming can
Elder and Alzheimer’s
Later we work with the workshop participant's mother who has
Alzheimer’s/dementia. During her withdrawn states we use coma work
techniques. When she comes out more and verbalizes "nonsense"
sentences, we use symbolic language to communicate with her. This
involves going beneath the content of her speech into what she
implies. For instance: I want to go home.
Stan:Feel all those homey feelings,
see the sights, go to your favorite place in your mind and heart.
She needs the experience of home, even though she can't physically go
Last session and goodbyes
the evening Dwane's mother Emma takes Alida, Karen, uncle Art and
Judith and me out for a lovely dinner. We discuss followup and
encourage Emma and Art to come to the hospital with us tomorrow
Monday morning, we meet Dwane and Karen, their children, Dwane's mom,
Uncle Art, and hospital staff to work with Dwane. This is our last
session. We have all lost some of our shyness. We get to work quickly
and intensely as a team, spelling each other and attempting new and
creative interventions. We work with his anoxia process when he pauses
in his breathing pattern. He surfaces much more than he did on Sunday
morning. This is the team of people that spends the most time with
Dwane, so Judith and I feel gratified that we have a productive last
say heartfelt goodbyes to Dwane and family and staff. We thank them
all for giving us the opportunity to learn more about coma and
communities. We express appreciation for the supportive atmosphere of
this rural community. In the afternoon, Karen drives us back to the
airport in Kelowna.
We exchange hugs and fly home to Victoria.
article has attempted to delineate some of the ways that coma work and
community involvement can further growth in awareness about coma and
its effect on individuals and groups. Mulling over our experiences in
Salmon Arm, I wonder how coma workers can further utilize the networks
already present, to facilitate those in coma and the human environment
surrounding them? How can we as communities work better with coma
communication, its meaning and purpose, and the essential experience
of humans and humanity with deep remote states? If, dear readers, you
have insights or experiences you wish to share regarding these
questions, please write to us.
References and readings
Blakely, Mary Kay. Wake Me When
It's Over.New York:
Times Books, 1989.
Diamond, Julie. "Patterns of Communication." Manuscript available
from: The Process Work Institute.
Hunter, Edna Lissett. For the
Love of Mel.Calgary,
Melaney Hope Publishing
Society. #202--401517th Ave. SE,
Mindell, Amy, "Coma and Deep Body Work." Class presented at The
Process Work Center of Portland: Winter quarter, 1992.
Mindell, Amy. "Training Issues in Coma Work: edges and personal
freedom." The Journal of
Process Oriented Psychology. Vol. 5, No. 2, Fall/Winter 1993:
Mindell, Amy and Mindell, Arnold. "Coma, the Key to Awakening."
Seminar in Seattle:
Oct. 30-Nov.1, 1992.
Mindell, Arnold. Coma: Key to
Ross, Kay. "A Comparison of the Medical/Nursing and Process Work
Approaches to Coma: a journey through the minefield of
unconsciousness." The Journal
of Process Oriented Psychology. Vol. 5, No. 2, Fall/Winter 1993:
Tomandl, Stan. Coma Work and
Palliative Care: An Introductory Communication Skills Manual for
Supporting People Living in Coma Near Death.Victoria,
White Bear Books, 1991.
Copyright 1995 by Stan Tomandl
All rights reserved.
We are available as keynote speakers, workshop facilitators, and
for private training sessions. For more information contact:
Stan Tomandl, MA, PWD ~ Ann Jacob, BA Ed
COMA COMMUNICATION ~ PROCESS ORIENTED FACILITATION
#502--620 View Street, Victoria, BC, Canada V8W 1J6
1.250.383.5677 email@example.com www.comacommunication.com