COMA COMMUNICATION Sharing Coma Communication and Process-oriented facilitators deal with patients, health practitioners, caregivers, and families - Victoria, BC, Canada
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By Tom Richards © 1991, all rights reserved, used by permission

Sunday, October 20, 1991

At 10:30 am, my mother, Marj, receives a call from the nursing home where my grandmother resides. My grandmother, named Gladys, nicknamed Gam, is ninety two years old. The nurse tells my mother that Gam's pulse and blood pressure have dropped, becoming too weak to measure. Gam also has a 103 degree temperature and is non-responsive. The nurse suggests this as the time to say final goodbyes. 

During the phone call my mother repeats the family's standing orders for comfort measures only, no hospitalization, no extraordinary or heroic measures. The doctor has prescribed Tylenol suppositories for the fever. Gam is also on oxygen.

My mother calls her sister and they hurry to the nursing home. As the day progresses all of Gam's friends including staff and residents stop by to look in on her. By 4:00 pm, no change, the daughters feel resigned and despondent.  A death vigil is in progress. 

My mother calls and informs me of the situation. She knows I have been studying Process Work and hopes it can help Gam. I am petrified! I am a layperson being called into an institutional setting to do unconventional work with my own family members, all of whom are in altered states, either from physical causes or emotional reactions to Gam’s condition. Gam's coma is now a family matter.

I arrive at 4:30 pm and join my mother and aunt at Gam's bedside. I announce my presence to my grandmother and ask permission to visit. I assume she may be very sensitive and don't want to startle her or scare her away. I tell her I am going to hold her left hand. As I begin to touch her hand I tell her what I am doing, and I confirm that I am touching her after I do it. I tell her where her daughters are also touching her. She gives no initial response.

I proceed giving feedback as I am working. I report out loud what she does. People don't have much awareness of themselves in coma and remote states, so outside feedback can be very useful: Gam, you are taking shallow breaths . . . I am going to breathe with you. This helps me focus my attention and empathize with her. I also speak on her out breath, another way of interacting at her pace.  You are doing great . . . Go ahead with what you are doing. This "cheerleading" stage lasts about fifteen minutes.

Your breathing just changed . . . Now you are taking deeper breaths . . . a small sound in your throat . . . sounds great . . . I try to imitate it. I 'gargle', she gargles much the same as before. I try this several times repeating her sounds making them slightly louder and longer. This gives her feedback and may help her go farther with her vocalizations. Despite the strength of this signal there is no change anywhere in her body, indicating negative feedback. But then after a few minutes she moves. Your left foot just moved . . . Ahhh, you just moved your left leg. That's great! . . . You just took a really deep breath, feels good . . . Your eyes are open . . . Yes, they've got a tube stuck up your nose. That's for oxygen . . . You just swallowed.

By 5:30 pm, Gam drinks a cup of water and asks for another. She speaks in mumbles but gets the words out. As the three of us prepare to leave, she exclaims, take me with you! At 7:30 pm the nurse reports by phone to my mother that Gam has eaten some ice cream. Gam loves ice cream. My mother rests easy knowing that "ice cream" means the crisis has passed.

Before leaving Gam, I had set the stage for continuing work by telling her an important message. Shortly after Gam entered the nursing home nine months earlier I paid her a visit. During that visit a fellow nursing home resident began talking "gibberish" to us. After the resident had gone, Gam remarked to me, That guy is off in the boondocks and that is where I will be soon. I say to her after the coma work session, Gam, I'll be back tomorrow morning at 10:00 am. If you want to go to the boondocks it's okay. Do you remember the boondocks?   She nods yes. Okay, but I want you to know that I'll be back tomorrow at 10:00 am so if you want to visit we can do that too. Okay!?!  She nods yes again.

Upon returning home, my wife who is a nurse, asks me medical questions for which I have no answers. “Has the doctor actually seen her? What is causing her fever? Does she have an infection? Are her lungs clear? Are they going to do a blood test?” I feel negligent having neglected the obvious medical diagnostic approach to her condition. I spend the night wrestling with the question whether the order "comfort measures only" means the absence of normal care such as locating and treating a common infection with antibiotics.

At 10:00 am on Monday I return to the scene armed with these medical questions. I check in at the nurses' station for a report. The nurse reports that Gam is weak but responding. Her fever is gone and her lungs are clear. No medications are necessary. She is still on oxygen. However, upon entering the room, the nurse and I discover that Gam has removed the oxygen tube herself.

I get back to work with Gam and this second session tells an important tale in the dialog.

Tom: Gam, there is water in your eyes. I used "water" because I want to give her the chance to tell me her connections rather than make interpretations like "tears of sadness."

Gam: If they are tears, they are good ones. I could have asked more about the "good ones." Instead I followed with a spontaneous remark.

Tom: Your daughters learned a lot from you yesterday.

Gam: I hope they did!

Tom: You have a lot of work to do . . . a lot of family history to teach . . . a lot of stories to tell.

Gam: Cute little ones . . . darlings . . . we've always had a lot of darlings . . . a lot there . . . a lot of love has come a long way . . . a lot of good looking boys . . . a lot of pretty mommies . . . a lot of pretty huggin' . . . and handsome daddies, can't leave them out . . . I can't believe it . . . part of it all . . . what a wonderful thing . . . to think of family and grow like that! I never thought of telling stories . . . I'll get my mind busy . . . there must be a lot of stories . . . they are important! On the word "important" she squeezes my hand.

I depart at 11:00 am. At 3:00 pm my mother and the doctor pay a visit. Gam is responding well. Doctor's diagnosis is fever induced by a stroke in the brain evidenced by speech impairment. Doctor and staff express surprise at her recovery. Gam instructs my mother to write out the family tree. She wants to review everybody! At 8:30 am on Tuesday Gam wakes up hungry and wants to go to the dining room for breakfast. So, off she goes three days later, stroke, recovery, breakfast at age ninety-two. The staff reaction is best summed up by the experienced orderly who works on Gam's wing. He says to my mother, Why even when I worked in Europe, few people in her shape ever came out of it!

Gam says to my mother, I love the family!

Gam's advice

The rest of the week I stay away. I feel elated but embarrassed, like the rookie who hits a home run in front of his hometown crowd first time up at bat. My mother reports to me that all is well.

On Saturday, October 26, 1991, six days after her stroke, I pay a visit.

Tom: Hi Gam!

Gam: Oh, hello dear . . . I didn't know you were here . . . my voice is croaky.

Tom: Do you want to croak?

Gam: No.

My remark had been reflex feedback of the word "croak." Only later upon reviewing my notes did its intuitive significance hit me. Gam had made a life and death decision. Having been given support to stay or go off in the boondocks, she had decided to stick around for breakfast.

Tom: Gam, you have been sick.

Gam: I have? . . . They didn't tell me . . . That gives me something to think about.

I wish to reiterate that she did not feel sick. She lived through an intense inner experience. It was not useful for her to talk about her "sickness." It might have been useful to encourage her to share as much of her experience as she wants to. I wish I could have tried helping her think about it more.

Gam: My voice is back now.   

Tom: It comes back when you need it. She smiles. She hears traffic out in the hall.

Tom: Your hearing is good too. I think you hear what you want to hear.

Gam: Yeah, I do.

Tom: You can be anything you want to be for Halloween. What do you want to be?

Gam: I want to be right here. She points to her chest. I interpreted this as the word "me." Looking back, I wonder if she meant anything further by pointing to her chest. Was there some physical or emotional process occurring in her chest? Was a "Halloween party" already occurring in the moment? Was this signal an opening to a possible mystery?

Tom: I'll save you some pizza from the party. She indicates how much with her thumb and forefinger.

Monday, October 28, 1991

Gam: I hope it will go good tomorrow! I'm having you play.

Tom: What?

Gam: Anything and everything . . . it was going real good . . . boop, boop, boop   . . . players . . . music . . . bringing the house down . . . you and me . . . ask the boys, they were really doing just beautifully!

Tom: Are you singing?

Gam: Oh yes! I go bing, bing, bing and I'm fine!

Tom: Last night Paul, my seven year old son, and Gam's great grandson, said to me, "Dad, did you know that Grandma is my favorite old lady geezer?" Referring to Gam's daughter, my mother Marj.

Gam: Cute . . . the primary geezer is all right. We'll keep her going.

Tom: Am I talking to the primary geezer? She smiles and nods. Then she thoughtfully offers me this counsel.

Gam: The boys . . . you got to get them over the hump . . . you go eat. I'll take a nap.


A couple weeks later

My mother asks for a copy of Coma Work and Palliative Care (Tomandl). She reads it before her youngest sister arrives from New Jersey to visit Gam. They see Gam and use the Process Work techniques presented in the manual. After their visit my mother enthusiastically reports, We followed Gam's process and had a wonderful time!

November 8, 1991

Gam's speech has now totally returned to normal. During our visit she delivers an important message for her children.

Gam: I don't know what comes next for us, but the kids are going to have to hunker down and find their own nook. She reaches out with a grasping motion that turns into a tight fisted grip as if holding on to something.

Gam's blessing

November 23, 1991, Thanksgiving weekend, both my brother Dick and friend Stan are in town for the holidays. Dick wants to visit with Gam, who he hasn't seen in the last five years, and share the news of his recent marriage. I am aware that Stan and I could help facilitate Gam's communication with Dick, but I have lost sight of the possibility that Dick might share my former fear of nursing homes. Stan and I volunteer to accompany Dick to visit Gam in the nursing home. Our presence turns out to be helpful.   

Tom: Hi Gam!

Gam: Oh hello dear . . . It's cold in here. Gam is in bed in a two bed room. Her roommate Evelyn is present. Dick, Stan, Gam, and Evelyn exchange greetings. Dick acts awkward and shy under the circumstances.

Gam (To Dick): Oh how wonderful! . . . It's chilly in here! . . . Dear, would you light a fire . . . get some matches . . . go down and light a fire . . .   

Evelyn: Don't give her any matches!

At this point Stan has observed Gam's cycling. Gam has repeated herself several times about "cold, chilly, fire, etc." The temperature of the room, of course, in this modern facility is climate controlled and actually warm for us visitors. Stan choreographs an intervention. He walks around to the right side of Gam's bed, lowers the guard rail and suggests to Dick that he sit on the side of the bed and hold Gam's right hand. He does the same for me on the left side. Gam stops repeating herself; the subject of the "chilly" room has been settled. The message contained in the communication has been received. It is now "warm" in the room for her too. This indicates that Gam was speaking symbolically when she used the word "cold." It also makes sense culturally that her communication would be indirect. After all it is improper for a lady of Gam's generation to directly ask a gentlemen to hold her hand, or come closer, or sit on her bed, even if it is her adult grandson.

Despite my presence sitting on her bed and holding her left hand and despite our long established familiarity and pattern of communication, Gam doesn't glance at me the rest of the visit. She keeps her eyes on Dick. This is his visit, his time with her. She asks him questions about his life. Dick answers. 

Dick: I got married and I'm living in Los Angeles now.

Gam: That's wonderful dear! Los Angeles? . . . so far . . . so far . . .  Dick tells her much more but Gam keeps repeating "so, far." Stan observes this and whispers a suggestion to Dick.

Stan: Tell her you wish you were closer. Dick does so and Gam moves on to other topics.

Gam and Dick appear "closer." She relaxes and lets go of our hands. We finally completed the communication.

Gam: I don't know where I lost my voice. My lips are dry.

From a prior visit, I recognize Gam's symbolic language and decode the phrase "My lips are dry." 

Tom: Maybe you need a kiss. Dick gives her a kiss. This may also relate back to her request for a "fire" as in more "passionate" exchange. She appears content. Her face glows.

Gam: Married! . . . That's wonderful dear! . . . Are you getting wired down? She moves her hands in a downward spiral. We'll have a hoedown! . . . I'll light a candle for you and Marlene!

With that very heartfelt and lucid blessing, Dick is deeply touched. This visit has transformed into a sacred ceremony blessing his marriage.

Dick's experience

When I entered Gam's room, I was feeling awkward and emotionally aloof with the attitude, "I'm tough; I'm made of stone; I’ll get this over with quick." I thought Gam picked up on that. I felt she repeated herself because she was always the perfect hostess and was not about to let the visit continue until I felt warm and welcome.

When I came to visit Gam I thought I was coming to see a dying person. What I discovered was that she was closer to life than I was. She was the living person and while I held her hand, she gave me life. She blessed me and gave me a longer life. I didn't want to leave. I wanted more!

Old, not sick

Because my grandmother is very old some may tend to mistake her life and her communication methods as illness. My grandmother is not sick; she is old. She has a long life behind her and a deadline ahead of her. Her communications do not always conform to our expectations. That is our problem. She speaks with her heart; she is harvesting her life. She is beautiful. Despite her bed ridden outward appearance, I believe Gam has a rich inner life and a great deal of wisdom to contribute as one of our family elders.

Copyright 1991 by Tom Richards
Used with permission



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