Awareness

Unfortunately the staff aren’t keen on us visiting Ladan from too early in the morning as they are very busy with all the patients, so it is not easy to spend as much as, let alone more than, half the day near Ladan as I did for those few days. I have always been aware that Ladan finds myself and other immediate members of her family very comforting as a presence, and it is also me considered opinion that there is some sort of cumulative affect on Ladan as well, that the more time we are not around her she becomes less settled and the more time that we are around her she becomes more settled. These beliefs come from repeated observations of certain patterns of behaviours in Ladan, from the earliest days of her time in the Newcastle General Hospital to the current day. The most frequent and clear indicator of this is the immediate settling influence that Ladan’s mother and I appear to have upon arriving to see Ladan, if Ladan is already in a wakeful state, however long the nurses say that she has been wakeful, she is often asleep within 5 or 10 minutes of our arrival. Here wakefulness and sleep refer mainly to whether Ladan has her eyes open or not, most people in comatose states have periods of having their eyes open, it is only in very deep comas that eyes are constantly closed.
If left for a considerable period of time alone, such as 15 hours or more, and particularly if she has such long gaps without company for several days running, then Ladan often appears quite agitated on arrival, very wide eyed, slightly tense, what would best be described as a frightened look, and then the affect of my mother-in-law or myself arriving is even more obvious and quite quick. I cannot say with absolute certainty that Ladan still does this as following on from my experiences in January where Ladan smiled after having company for extended periods I have rarely allowed Ladan to be alone for 15 hours.
Something else I like to do with Ladan is have family and friends speak to her on speaker phone occasionally, my mobile phone has this feature. When Shahla, Ladan’s mother, is unable to visit she always speaks to Ladan this way and occasionally friends do too. The more awake Ladan appears before this the more she seems to react to it. It is hard to say what the reaction is, the way her eyes move often seems to change the moment somebody else starts speaking over the phone, there is no way of knowing whether Ladan understands what is being said or even who is saying it, the best medical opinions would probably suggest that she can’t, but there is a response. There has always been something of a response to speech with Ladan anyway, with exception of a few of her most turbulent periods in the General Hospital, which were ironically the periods during which she had been assessed prior to the recent SMART testing. I am sure i have mentioned many times before that Ladan’s breathing and state of relaxation have a tendency, particularly when she appears wakeful, to change with the topic of conversation, Ladan’s breathing often becomes deeper when conversation changes to more emotional matters. This has been noticed by many friends who have visited and a correlation was also noted between breathing and auditory stimulation on at least one occasion by the Occupational Therapist carrying out the SMART programme. It is also not uncommon for Ladan to turn her head toward a conversation if relatives are speaking and then a less familiar third party comes in and makes conversation relating to Ladan.
Many people ask if Ladan is aware of us being around her. I usually answer that I believe she is aware at some level on the basis of the experiences I have described above.
It is quite likely that Ladan is not aware of things in the same cognitive fashion that most of us would be. It is not impossible that she does have some degree of cognitive/intellectual awareness but old test results and Ladan’s general state would imply that she probably doesn’t, at least not to a great extent. As a Baha’i I am often reminding myself that marriage in our religion is not just a marriage of two minds and two bodies which will eventually cease to exist in this world, but also of two souls, two spiritual entities which will go on to exist in unity through many worlds to come after this earthly existence. In the Baha’i Writings there is a lot written about this spiritual nature of man, and it is clear that anything that can exist independently of the human body and brain is not impaired by any damage or illness that they are subjected to. From the perspective of religious belief the “true” Ladan is the spiritual Ladan and that Ladan is unharmed by the strokes, infections and seizure that her body and brain have suffered. Since that spiritual nature of Ladan will have a very special link with her family members and, I suspect, her closest friends, it is quite conceivable to me that the presence of such people next to the body with which, so long as she lives, her spiritual nature (her soul) is still connected to will have a positive influence upon her soul and that that, in turn, has a settling influence upon her physical person. An example that the Baha’i Writings give of the powers of the soul to see and hear the world is the phenomenon of deja-vu, the ability that we have to see the future in our dreams. Without the body the soul can travel to any time and any place, it can see and hear all that happens, and according to the Baha’i teachings is capable of itself understanding the realities of what it sees. The soul alone may not, however, have the ability to store these experiences as memories, this is a power that requires the functioning of the brain which stores these experiences and builds them as a knowledge base.
In general when people have been a comatose state for a long period of time and make a recovery they do not feel that much time, if indeed any time, has passed. Family members may have had numerous experiences that they felt showed that the patients were aware of them and responding to them but the patient has little or no recollection of those occasions upon recovery. Assuming that the experiences of the family are valid, and I would expect them to be so, it may be that there is just sufficient brain power to have apparently meaningful responses from time to time but not enough function to record those experiences in memory, or it may be that our spiritual nature, which many religious people, certainly Baha’is, consider to be our true and primary nature to which our bodies and brains are servants, is responsible for the apparent awareness and precipitates a physical response while the inactivity of the brain means that these moments are not being stored in tour repositories of memory and knowledge.
It is certainly all very interesting. Whether any awareness is conceived by the brain or by the soul, the fact that patients who recover do so in the belief that little time has passed while they were unconscious implies to me that any degree of interpretation of the environment in which Ladan finds her self will be done so from the perspective of a 28 year lady who got married less than seven months ago and is in Newcastle to see her family for the first time since the wedding. It makes sense to me then that if Ladan was to repeatedly find herself alone, without her husband or family by her side, in any moments of awareness that she has then it may result in the kind of agitated or frightened appearance that we often feel we find her in after prolonged absence (actually it sometimes happens after short absences too, but moreso after prolonged absence), and it also makes sense that since Ladan – who was ill prior to falling into a comatose state – was always much happier when I was by her side and didn’t feel rested or particularly able to sleep without me there, it will continue to be the case that she is happier in my presence.
As for the meaning or relevance of those more encouraging things that we get to see as relatives who are by Ladan’s side so much, there isn’t much that they can mean other than that if/when Ladan recovers from her current state they indicate some of the abilities that Ladan should hopefully still have upon regaining consciousness. Encouraging things like smiling or following objects with her eyes for several minutes don’t help much with a therapy programme unless they are consistent enough responses to be tapped into.

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