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Transcripts

"Coma"

PBS Airdate: October 7, 1997
Go to the companion Web site

ANNOUNCER: Tonight on NOVA, head trauma in the ER.

DR. JAM GHAJAR: I think we probably keep it out of our minds that an accident could happen. You know, "It's not going to happen to me." And you know what? It is going to happen to you. It's going to happen to your kids. Alex? Open your eyes.

ANNOUNCER: This doctor practices a simple life-saving technique. Would your own doctor do the same?

MRS. DEBORAH WARD: The fact that it is not performed more routinely is appalling.

ANNOUNCER: COMA.

Major funding for NOVA is provided by the Park Foundation. Dedicated to education and quality television.

...by the Corporation for Public Broadcasting, and viewers like you.

REPORTER: Police scour Central Park for evidence after a vicious attack on a woman found beaten and unconscious...

REPORTER: It happened in broad daylight. She was found unconscious on the path at 4:08 in the afternoon...

REPORTER: She was discovered bleeding from the head and rushed to New York Hospital...

TERRY GROSS: Dr. Jam Ghajar is my guest. Now, the woman who was beaten in Central Park, she was in a coma when she arrived?

DR. JAM GHAJAR: Right. She was beaten severely about the head. I mean, when she came into the emergency room and I saw her, her head was swollen the size of a pumpkin.

ROY SCHEIDER (NARRATOR): Jam Ghajar is a surgeon who treats severe head injury. In June 1996, he was called into a highly publicized case—a woman beaten in New York's Central Park. Using controversial methods, Ghajar tried to save his patient's life.

REPORTER: Her face battered almost beyond recognition, the woman savagely beaten in Central Park remains unconscious...

REPORTER: She required emergency surgery overnight at New York Hospital...

REPORTER: The crime scene near 82nd Street on the West Side of the Park is still cordoned off.

ROY SCHEIDER (NARRATOR): Twice, the patient came close to dying. Both times, she survived. To New Yorkers, it seemed like a miracle. But Ghajar called it science.

DR. JAM GHAJAR: The public tends to personalize medical therapies and say, "A miracle's happening somewhere." And it would be nice. I think miracles are great. We can use them whenever we get them. But this is an application of good scientific methods.

ROY SCHEIDER (NARRATOR): Ghajar is one of the leaders of a campaign to ensure that coming out of a coma doesn't depend on miracles. The goal is to improve every patient's chance for survival.

HOSPITAL ER DISPATCHER: Trauma Team, Emergency Room.

DR. AMY LU: Find out what the trauma is that's coming.

TRAUMA TEAM MEMBERS: It's head trauma. Head trauma.

POLICEMAN: Let's go, guys. Let 'em work. Back up, let 'em work.

ROY SCHEIDER (NARRATOR): Struck by a car while crossing the street, a child lies in a coma.

DR. RICHARD GLICK: There's a child who's been hit in the head—

PARAMEDIC: Step back.

DR. RICHARD GLICK: —who's posturing now.

PARAMEDIC: He was hit first under the car, prone.

ROY SCHEIDER (NARRATOR): Paramedics report that the child was rigidly extending his arms, called "posturing," a sign of severe head trauma.

DR. RICHARD GLICK: Why was he intubated?

PARAMEDIC: He was posturing.

TRAUMA TEAM MEMBERS: He was posturing. He was posturing, right-sided gaze.

NURSE: IV tray, Christine.

DR. RICHARD GLICK: Check his extremities.

NURSE: He's got distal pulses.

PARAMEDIC: We got on the scene. He was already in the back of the EMTs' truck. They told me that he was underneath the car. They don't know if it was the car that hit him. They don't know if he was thrown underneath that car. But he was hit by a car.

DR. RICHARD GLICK: So, we don't have a witness, we don't know exactly what happened?

PARAMEDIC: Right. They're all back at the scene.

DR. RICHARD GLICK: And when you found this child, he was unconscious, underneath?

PARAMEDIC: He was unconscious, posturing—

DR. RICHARD GLICK: Posturing.

PARAMEDIC: —in the back of their truck. Right, with the right-sided gaze.

NURSE: Can we have a four by four?

ROY SCHEIDER (NARRATOR): Head trauma is a leading cause of death and injury.

DR. RICHARD GLICK: Can we page Neurosurgery as well?

ROY SCHEIDER (NARRATOR): The ER alerts Dr. Ghajar, who has been trying to bring this problem to the public's attention.

TRAUMA TEAM MEMBER: Hi, I'm calling from Trauma Room 1. Can we page Neurosurgery, please?

DR. JAM GHAJAR: There's a trauma team in the trauma center, and they see the patient immediately when they come in, and they follow the ABCs—airway, breathing, and circulation. They make sure the patient's got an airway, they're breathing, and they've got blood circulation, because before you do anything, you have to be assured of that.

PARAMEDIC: There's a lot of blood in his mouth. We had to suction him. We couldn't intubate him at first.

DR. RICHARD GLICK: He's a nine-year-old child who was hit by a car, and he was found unconscious, under the car, posturing.

DR. AMY LU: When the patient came in, it was obvious that it was a severe head trauma case, because he was not moving. He was unconscious, and the paramedics were reporting that he was agonally breathing, which means that it's a type of shallow breathing that is usually associated with impending death.

ROY SCHEIDER (NARRATOR): The team hooks the child up to a respirator and quickly monitors vital signs...

DR. RICHARD GLICK: Can we get a monitor?

ROY SCHEIDER (NARRATOR): ...before it can focus on the head injury.

DR. RICHARD GLICK: Does anyone have any pressure yet?

NURSE: He's palping at 120.

DR. RICHARD GLICK: One-twenty?

NURSE: Palping at 120.

DR. RICHARD GLICK: One-twenty systolic. We're going up to head CT. I'm just going to scan the whole way down. I just think that this kid really needs a head CT in a big way.

DR. AMY LU: Someone get some blankets, warm sheets. Let's keep the kid warm.

ROY SCHEIDER (NARRATOR): The team rushes the child to the CT can to take special x-rays of the brain to determine what's happening inside the head.

DR. AMY LU: Ready?

CT SCAN TECHNICIAN: OK.

DR. AMY LU: One, two, three.

CT SCAN TECHNICIAN: Watch the IV lines. Watch the IV lines.

DR. AMY LU: Yeah.

CT SCAN TECHNICIAN: Oh, OK, great.

DR. AMY LU: Bag. Bag a couple of times.

CT SCAN TECHNICIAN: OK.

ROY SCHEIDER (NARRATOR): Before the x-rays are taken, the patient starts having seizures.

TRAUMA TEAM MEMBER: Dilantin's in.

ROY SCHEIDER (NARRATOR): Seizures may be a sign that blood has leaked in the brain.

DR. AMY LU: He's seizing.

TRAUMA TEAM MEMBER: He's seizing. See that?

ROY SCHEIDER (NARRATOR): These areas of injury will cause swelling, which could be life-threatening.

DR. AMY LU: All right. Thanks a lot, Dr. Ghajar. All right, bye-bye. He's going to send—

TRAUMA TEAM MEMBER: Take him off?

DR. AMY LU: Yeah, yeah. Yeah. Take him off. Repeat his blood pressures and get a thoracostomy tube set up to the right.

ROY SCHEIDER (NARRATOR): A beep from his pager, and Dr. Jam Ghajar heads across town to the hospital.

HOSPITAL OPERATOR: Good evening, Jamaica Hospital.

DR. JAM GHAJAR: Yeah, hi, it's Dr. Ghajar.

HOSPITAL OPERATOR: Yes, Dr. Ghajar?

DR. JAM GHAJAR: Can you reach Dr. Venu for me?

HOSPITAL OPERATOR: Yes, Doctor, one moment.

ROY SCHEIDER (NARRATOR): On call, Ghajar responds to emergencies 24 hours a day.

DR. JAM GHAJAR: Hell, Venu?

DR. VENU: Yeah?

DR. JAM GHAJAR: Yeah. Did you examine him?

DR. VENU: Yeah.

DR. JAM GHAJAR: Does he open his eyes?

DR. VENU: No, he's not.

DR. JAM GHAJAR: He's not opening his eyes?

DR. VENU: No.

DR. JAM GHAJAR: OK. Can you have the ventric set up and a cut-down set?

DR. VENU: Yeah. The ventric is already set up.

DR. JAM GHAJAR: OK. Is the mother there?

ROY SCHEIDER (NARRATOR): Ghajar is planning a course of treatment designed to prevent the so-called "second accident" of head injury.

DR. JAM GHAJAR: All right. OK. I'll talk to her when I get there. All right, I'll see you in a few minutes. I'm on my way.

DR. VENU: OK.

DR. JAM GHAJAR: We used to think that all the injury occurred at the moment of impact. But now, we know that actually a lot of injury occurs afterwards, in the first week in the hospital. The brain swells up, the brain doesn't get enough blood and oxygen, and then, parts of the brain die. That injury in itself can be far worse than the first injury. Yeah. Where's the—Do you have the scan? The copy of the scans?

DR. AMY LU: I talked to the family. I told them you were on the way in, that you would talk to them when you got here.

DR. JAM GHAJAR: All right. This is his CT scan. This white little area here is a blood clot. And he has two more here, one over here in the left hemisphere, one over here in the right hemisphere. So, he's got shear injuries.

ROY SCHEIDER (NARRATOR): At the moment of impact, the patient's brain rocked back and forth inside the skull, tearing blood vessels and pulling nerve fibers. These injuries cause the brain to swell, blocking the flow of oxygen-carrying blood. The brain could strangulate without more room. And one way to make space is to drain clear fluid that normally accumulates.

DR. JAM GHAJAR: The best way to do that is to put a tube into the brain, and to place the tube somewhat in the center of the brain where the spinal fluid is made, so that if the pressure gets too high, you can just drain some of this fluid and relieve the swelling. All right. OK. Can you hold his head from down there? We drill a hole through the skull, and then we puncture the lining of the brain, called the dura, and then we put the catheter in. And usually, about five to seven centimeters from the scalp, we hit the spinal fluid. And you'll see it come out.

ROY SCHEIDER (NARRATOR): Ghajar invented a device to assist in this procedure, and other techniques are readily available.

DR. JAM GHAJAR: Can I get a suture set?

ROY SCHEIDER (NARRATOR): But many hospitals consider this first step costly and unnecessary.

NURSE: Can I bring Mom in for a minute? OK, Mom! Come in.

ALEX'S MOM: Hi, baby. I'm here. Don't give up.

ALEX'S DAD: I know you can feel me. I'm here. Hmm? Puppa? I know you can hear me.

ALEX'S MOM: You know what I always tell you, that you're my baby. Right?

ALEX'S DAD: I love you.

ALEX'S MOM: You're my first born, my son. You're the only son I've got, so you've got to hang in for me, OK? I love you, pup.

ALEX'S DAD: OK, puppa?

ALEX'S MOM: Mommy's right here. OK? He's into cars, football.

ALEX'S DAD: Yeah. He loves all that.

ALEX'S MOM: Bikes.

ALEX'S DAD: Yeah, motorcycles.

ALEX'S MOM: And his karate, of course, which is—

ALEX'S DAD: Yeah, which he just—

ALEX'S MOM: —when he was coming home.

ALEX'S DAD: He had just gotten his yellow belt, also, yesterday.

ALEX'S MOM: Second yellow belt.

ALEX'S DAD: His second yellow belt.

ALEX'S MOM: He was on his way home to tell me.

ALEX'S DAD: Yeah, so...

ALEX'S MOM: Yeah. He's a very loving child, that I can say for Alex. Everybody loves him, because he just—He's very loving. He's very affectionate. You know, he's always touching you, you know, hugging you.

ALEX'S DAD: Lots of things run through your mind. Is he going to make it? Is he not going to make it? And the neurosurgeon pretty much told us it's a fifty-fifty chance. He told us, just, you know, like that. And you know, you stop and you say to yourself, you know, how much you appreciate your child. I love you.

ALEX'S MOM: We're right here, OK?

DR. JAM GHAJAR: The most common cause of death and disability in young people in the age of one to 44 is head injury. I think we probably keep it out of our minds that an accident could happen. You know, "It's not going to happen to me." And you know what? It is going to happen to you. It's going to happen to your kids. Yeah, hi. It's Dr. Ghajar from Neurosurgery. Did you hear about the pediatric transfer? It's a nine-year-old boy who was hit by a car, brought to Jamaica Hospital Emergency Room. He was comatose and then had a seizure.

PARAMEDIC: You ready to go?

DR. RICHARD COFFEY: Yeah.

ROY SCHEIDER (NARRATOR): Shortly before midnight, Alex is transferred to New York Hospital, which has a special intensive care unit for children.

PARAMEDIC: No, you've got the tube. You count.

DR. BRUCE GREENWALD: OK, one, two, three, go.

ROY SCHEIDER (NARRATOR): At 1:00 in the morning, Alex's mother gets an update from Ghajar, who practices at New York Hospital as well.

DR. BRUCE GREENWALD: Well, I know that you have met Dr. Ghajar over at Jamaica. And he probably gave you as much information as we have right now. Do you want to lead it off?

DR. JAM GHAJAR: Yeah. We—You know, we've measured the pressured. I want to tell you, when we first put in a tube in his brain over at Jamaica, the pressure was high. And here, we have it connected to a monitor now. We can get an actual number.

ALEX'S MOM: Right.

DR. JAM GHAJAR: And it's a good number. It's not too high, and we're hopeful that it will stay at that level. Everything else is stable as far as neurologically is concerned. But you know, the next three days are really crucial, to see how much his brain swells up.

ALEX'S MOM: Right.

DR. JAM GHAJAR: But the good news is that right now, his pressure's not too high. And you know, the question is, what will he be like ultimately? Right now, we don't address those kind of questions. Right now, it's kind of life and death. We're trying to prevent the brain from swelling further, and that's why he's here in the intensive care unit.

ROY SCHEIDER (NARRATOR): Throughout the night, the team will watch for any change in Alexander's brain pressure. Ghajar believes that this intense bedside vigil is absolutely key—and yet, dangerously missing from many hospitals.

DR. JAM GHAJAR: I did a survey with the Brain Trauma Foundation of 260 trauma centers throughout the United States that took care of severe head injury. And we asked them basic questions, like, "How many head injury patients do you see a month? Do you monitor the pressure in the brain?" Let's see if it drains.

DR. BRUCE GREENWALD: Go on.

DR. JAM GHAJAR: One fact we found out in the survey is that 70% of the centers were not monitoring the pressure in the brain routinely. And we knew from the literature that patients that did not have their brain pressure monitored and were not treated aggressively had a much higher death rate and poorer outcome than patients that did have their pressure monitored. So just that, we could see there was a problem.

TERRY GROSS: Back with neurosurgeon Dr. Jam Ghajar. Have you ever been in a coma, or has anyone close to you been in one?

DR. JAM GHAJAR: Well, I had a head injury when I was seven years old. But actually, my real experience with brain injury was from my older sister, who's retarded. And I don't know, as a child, I guess—You're growing up always—I was always trying to figure out how to make her normal. And it was almost like forcing her every day to make her normal. I couldn't figure it out. And I think that was one of the reasons I went into studying the brain. Well, on the second day, Alexander started dilating one of his pupils. And that's a very bad prognostic sign. There's a nerve that goes to the pupil. And if the brain gets very swollen, it can actually squish that nerve within the skull. And when it presses on that nerve, the pupil dilates. So, he was in a very serious condition at that point.

NURSE: Ready. One, two, three. Sorry, Alex. We'll be done in a second, big guy. I'm just going to take a picture of your head.

ROY SCHEIDER (NARRATOR): A second CT scan is ordered, which confirms that brain swelling has increased overnight.

DR. JAM GHAJAR: These are cuts through the brain with a CT scan. And here are the eyes here, and this is the middle of the brain that's going through it. And this is the base of the brain. And we look at this area around here, and because if there's a lot of swelling, the brain sort of crunches in. And these black areas here are spinal fluid, and you don't see it very well. That means there's a lot of swelling. So, it's like you slam your finger in the door; this finger swells up. The brain is now swelling.

NURSE: Well, there was family members in here, and then he just started to get very agitated. ICP went up. His hands and his legs started going.

DR. JAM GHAJAR: Oh, really?

ROY SCHEIDER (NARRATOR): Despite the draining of brain fluid, the pressure inside Alex's skull continues to rise. Called ICP, for intracranial pressure, it climbs into the 30s, well above a safe level.

DR. JAM GHAJAR: The tube that's in the brain, which is draining spinal fluid, that's actually hooked up to a pressure monitor. Usually, if the number is between zero and ten, that's normal, I'm not worried about it. When it gets up to 20, start anticipating some bad things. Now, his pressure is 30, which is very high for a child.

ROY SCHEIDER (NARRATOR): When swelling can't be controlled, the brain chokes off the supply of oxygen-carrying blood. The strategy now is to raise blood pressure, keeping it 70 points higher than brain pressure, using medication. If the plan works, it will force blood through the brain, during this critical stage.

DR. JAM GHAJAR: When you're in there with him, right now, try not to talk to him. You can just, like, hold his hand or stroke him or whatever. But don't—Try not to stimulate him. OK?

ALEX'S MOM: Stimulate him too much.

DR. JAM GHAJAR: And then, if his pressure's low tomorrow, then you can start doing more things.

ALEX'S DAD: Seems to be kind of tense. Hi, pup. Oh, it's going up.

ALEX'S MOM: He responds. He knows that there's people around him. Yesterday, a lot of family members came around, and that made his intercranial pressure go up. It's been very high, and it hasn't gone down, no matter how much they drain. It's very hard on any parent. I mean, he's still with us. He's still alive, so it's not—I can't say it's a loss of a child. But just the thought of it, and seeing, you know, a child under those conditions, where you know that—you know, the pain and the suffering that he's going through.

ALEX'S DAD: You wonder how you keep your sanity, you know? But I just keep myself up to keep my wife together so that she won't lose it, and just hang in there. You know, a lot of prayers.

ROY SCHEIDER (NARRATOR): As Alex enters day three, the pressure inside his skull is finally dropping. Numbers measuring the amount of blood flowing through the brain are good as well. But Ghajar wants an outward physical sign from Alex that the crisis is indeed under control.

DR. JAM GHAJAR: Hi. How's he doing?

NURSE: OK.

DR. JAM GHAJAR: When physicians examine a patient after head injuries and coma, there are very few signs that we can look for in terms of brain functioning, What we usually do is we pinch them just below the collarbone. Did you pinch him ever? Let's see what he does. That's good.

ROY SCHEIDER (NARRATOR): Alex's brain has just identified a source of pain and sent a signal to his hand to reach toward it.

DR. JAM GHAJAR: So, does he move spontaneously at all?

NURSE: He has been moving his head from side to side. He moves his left more than his right.

DR. JAM GHAJAR: More than his right. OK.

ROY SCHEIDER (NARRATOR): This is a sign that his level of consciousness is changing.

NURSE: His hand and his legs start going.

DR. JAM GHAJAR: Oh, really? All right.

NURSE: So, he definitely seems like he can hear, but he won't follow commands right now.

DR. JAM GHAJAR: Yeah. Good. Our goal is to improve the outcome of patients with brain injury. And that first week, immediately after the accident, is an incredibly fruitful area for intervention and making a difference. But you have to really pay attention to these small fluctuations, blood pressure, brain pressure, doing operations. It's very, very intense.

TRAUMA TEAM NURSE: We have a male, approximately 30 years old, found hypotensive, unresponsive. Medics tried to intubate unsuccessfully.

ROY SCHEIDER (NARRATOR): At a teaching hospital in New York, Jam Ghajar critiques a trauma drill.

TRAUMA TEAM NURSE: He was severely battered about the head.

TRAUMA TEAM RESIDENT: OK. Someone call neurosurgery.

ROY SCHEIDER (NARRATOR): Residents practice the first steps of the head-injury protocol Ghajar is using on Alex.

TRAUMA TEAM RESIDENT: OK. Let's put some monitors on. Get a blood pressure cuff on, O2 sat.

NARRATION: The team checks the ABCs—airway, breathing, and circulation. And so far, this looks no different than other ER scenes.

TRAUMA TEAM RESIDENT: I got your tube.

TRAUMA TEAM RESIDENT: I'll take the tube. I see a little vomitus around the cords.

TRAUMA TEAM RESIDENT: Ambu-bag.

TRAUMA TEAM RESIDENT: OK. Tube's in.

ROY SCHEIDER (NARRATOR): But the residents are about to make a controversial move.

TRAUMA TEAM RESIDENT: OK, is the fluid running in?

ROY SCHEIDER (NARRATOR): They decide to give the patient plenty of fluid.

TRAUMA TEAM RESIDENT: OK, let's see the blood pressure. How much fluid has he gotten?

TRAUMA TEAM RESIDENT: Eight hundred.

TRAUMA TEAM RESIDENT: Up his fluids, both lines.

ROY SCHEIDER (NARRATOR): Faced with this very same case, Ghajar has discovered, many hospitals would do the complete opposite.

TRAUMA TEAM RESIDENT: Open his—both lines wide.

DR. JAM GHAJAR: Basic care is so variable, and in many cases can be detrimental. We have to straighten this out before we can move forward. Randy put in secondary brain insults.

ROY SCHEIDER (NARRATOR): Ghajar had discovered an alarming number of discrepancies in care when he gathered leading neurosurgeons to develop a protocol called the Guidelines.

DR. JAM GHAJAR: I mean, that would be a real service if we could—We spent two years meeting all over the country, reviewing 3,000 scientific research articles on head injury, and then came together with a document which gives the best current treatment for managing patients with severe head injury.

DR. RANDY CHESNUT: Hopefully, when we're done with this document, we will have the data here, as best summarized. We'll say the best things we can.

ROY SCHEIDER (NARRATOR): Randy Chesnut, a neurosurgeon from Oregon, is part of the Guidelines movement.

DR. RANDY CHESNUT: The best trauma system is done bang-bang-bang-bang-bang, like a machine gun. The patient is injured, the endotracheal tube goes in, the IVs go in, the blood pressure goes up, they go to the CT scanner. You don't have time to think. And the Guidelines basically give you the building blocks to do that. They make that bang-bang-bang-bang-bang thing happen that saves lives.

TRAUMA TEAM RESIDENT: Right pupil still dilated.

ROY SCHEIDER (NARRATOR): Using the Guidelines, these residents reject some of the old ways of treating head trauma, which can actually do more harm than good.

DR. RANDY CHESNUT: The standard of practice in head injury has been to keep patients' fluid restricted, with the idea, like a sponge, it keeps the brain from swelling.

TRAUMA TEAM RESIDENT: Is the fluid running wide open?

TRAUMA TEAM RESIDENT: Yeah, it's wide open.

TRAUMA TEAM RESIDENT: OK.

ROY SCHEIDER (NARRATOR): But intravenous fluids are needed for adding volume, and therefore pressure, to the circulatory system. And strong blood pressure forces oxygen-carrying blood to the brain.

DR. JAM GHAJAR: The problem was that by restricting fluids, the blood pressure would drop.

TRAUMA TEAM RESIDENT: His pressure's dropping.

TRAUMA TEAM RESIDENT: Pressure's dropping?

TRAUMA TEAM RESIDENT: Pressure's dropping.

TRAUMA TEAM RESIDENT: All right. Let's bring up his blood pressure while we're getting the volume in.

DR. JAM GHAJAR: Studies since then have shown that this actually causes a worse outcome in patients.

TRAUMA TEAM RESIDENT: What's his mean pressure?

DR. RANDY CHESNUT: So, although what sounded like a good idea once, and is sort of the dogma—it's wrong. And by pointing out the science of that, we hope to change practice.

ROY SCHEIDER (NARRATOR): At a trauma conference in Oregon, Ghajar and Chesnut push the Guidelines and gauge whether they're being accepted in the field.

DR. DONALD TRUNKE: You've heard really a radical departure on the treatment of severe brain injury, and trust me, not all neurosurgeons even agree on these Guidelines. So, if you have questions, this is the time to ask the panel about it.

DOCTOR: I work at a number of different shops in Los Angeles, and the practice is very, very variable.

DR. DONALD TRUNKE: Oh, you mean the neurosurgeons don't agree with these Guidelines?

DOCTOR: They don't practice them, by and large.

DR. STEVE MIRHOFF: Some fo them haven't read them, I don't think. The Guidelines are there. The Guidelines are evidence-based. Those of us in community practice did receive them. Unfortunately, the neurosurgeons in the community are of differing generations, let's say. (laughter) And there are—There is a resistance that you meet that "I've been doing something for 30 years, for 40 years, for 20 years, and it's always worked for me." There's a resistance.

DR. JAM GHAJAR: When I talk privately to doctors, they say, "Yeah, I know about the evidence, but I still do what I do." Well, that's just not good science. And I don't think the public wants to be exposed to this kind of variability.

ROY SCHEIDER (NARRATOR): Like many Americans, Deborah Ward never thought twice about standards of care in medicine. Then, one rainy afternoon, her daughter was in an accident.

MRS. DEBORAH WARD: Nicole was driving to field hockey practice on October 23rd. And this was the way that she went. So, she had—She was driving her Volkswagen Cabriolet. So, she would have turned left here. And right down ahead on the right, there's a house with a very deeply sloping roof. It's a stone house. This is where the accident happened. The tree's been cut down. You can see the stump of it there. But her car crested the lawn and went up and hit the tree on the driver's side. The impact of the tree against her head was what caused, you know, her injury. There was no—nothing to cushion her from that. Her head struck the tree.

ROY SCHEIDER (NARRATOR): Nicole was taken to the ER of the nearest hospital, in a coma and having seizures. Her brain pressure was not monitored.

MRS. DEBORAH WARD: Some time later, one of the doctors said, "It's not probable that she will make it. If you are a religious person, you should contact your pastor or your priest and have them come." We were told clearly that Nicole's prognosis was terrible, that there was really nothing that they could do for her. And Nicole was administered her last rights, which is hard to see.

ROY SCHEIDER (NARRATOR): Nicole was a senior at Greenwich High School, captain of the field hockey team, working hard on college applications. In a split second, this had all changed. But Nicole's mother wanted her daughter back.

MRS. DEBORAH WARD: As the evening was progressing, my husband and I concluded that we needed to take her to another hospital. I guess I always thought, based upon my family history—My mom's a nurse, my sister's a nurse—that when you have a big problem, you go to a big city hospital.

ROY SCHEIDER (NARRATOR): A transfer to New York Hospital was arranged by a doctor in Greenwich, who by chance, had been a roommate in medical school with Jam Ghajar. Here, Nicole received the same treatments that would later be used on Alex, including a tube in her brain to monitor and relieve pressure.

MRS. DEBORAH WARD: What I have learned subsequent to Nicole's accident is that in many hospital facilities around the country, even trauma centers, that they do not perform this simple—and it's apparently a relatively simple surgery to perform. The fact that it is not performed more routinely is appalling. And the closer to the time of injury that it's done, the better the, perhaps, outcome can be. I could at that point only hope and pray that we had reacted quickly enough.

ROY SCHEIDER (NARRATOR): Two years later, on the same intensive care unit where Nicole Ward was treated, Alexander enters day five.

NURSE: He was really awake this morning when I first got here.

DR. JAM GHAJAR: What was he doing?

NURSE: He was, like, moving his feet and his arms—

DR. JAM GHAJAR: Really?

NURSE: —opening his eyes.

DR. JAM GHAJAR: Oh, opening his eyes? All right. Alexander, open your eyes. Alex, open your eyes. Oh, great. Hi.

NURSE: Good boy.

DR. JAM GHAJAR: Aah, there we go. Hello. Hi. Hi. Boy, that's great, huh? Does he follow any commands?

NURSE: Not yet that I've noticed.

DR. JAM GHAJAR: Can you squeeze my hand? Squeeze my hand. Open your eyes some more, huh? Wake up.

NURSE: Oh, this is the first time he opened his eyes?

DR. JAM GHAJAR: Yeah. Oh, yeah.

NURSE: Oh, that's great.

DR. JAM GHAJAR: Yeah.

NURSE: Yeah, he was real awake this morning.

DR. JAM GHAJAR: He wasn't following commands, though, huh?

NURSE: No.

ROY SCHEIDER (NARRATOR): Alex's brain is re-establishing cycles of sleeping and waking, signaling a new level of consciousness. Technically, he's no longer in a coma, and Ghajar is no longer concerned about the pressure inside his brain. The chance of Alex surviving has now greatly improved.

DR. JAM GHAJAR: Hi. So, we had some good news this morning. Oh, this is his baby sister?

ALEX'S DAD: Yeah.

DR. JAM GHAJAR: Oh. Hi, how are you?

ARIANA: Hi.

DR. JAM GHAJAR: Hi. What's your name?

ARIANA: Ariana.

DR. JAM GHAJAR: Ariana. That's a beautiful name. How old are you?

ARIANA: Three.

DR. JAM GHAJAR: Three. Oh. How old's your brother?

ARIANA: Nine.

DR. JAM GHAJAR: Wow. (laughter) That's pretty good.

ALEX'S MOM: She got it right.

DR. JAM GHAJAR: Anyway, so, you know, he opens his eyes. So, that's great.

ALEX'S MOM: All right.

DR. JAM GHAJAR: So now, we'll start, you know, weaning him off the respirator. Then, we can take the tube out of his brain.

ALEX'S DAD: Say, "Hi Alex."

ARIANA: Hi, Alex.

ALEX'S DAD: Touch his hand. See?

ARIANA: Oh, he grabbed my hand! He grabbed my hand. (laughter)

ALEX'S DAD: Yeah.

MERLE SPRINZEN: A lot of the people who end up in brain trauma instances are kids, so parents are one of those groups who are advocates for proper care of their children. So, what I thought of was to aim the PSAs really at parents.

ROY SCHEIDER (NARRATOR): Convinced that there is a right way—and a wrong way—to handle head trauma, Ghajar considers taking his case to the public.

MERLE SPRINZEN: Well, I think we have some choices to make about how hard-hitting we want the message to be.

ROY SCHEIDER (NARRATOR): A consulting agency in New York gives him ideas for public service ads.

MERLE SPRINZEN: This one features a very close-up shot of a little kid. So, it's so close-up that he's sort of out of focus. And it says, "Your child suffered serious head injuries in an accident. Now, for the bad news." And the text that would go under here would be, "There's a choice. Monitor brain pressure. If you don't do something, there could be an even more severe outcome."

ROY SCHEIDER (NARRATOR): The ad campaign presents a dilemma. It could save lives. But by publicizing a division in the field, it could alienate the very doctors Ghajar wants to convince.

MERLE SPRINZEN: And it says, "The wrong treatment could hurt more than the accident."

DR. JAM GHAJAR: Hmm. That's fairly strong.

RALPH ISHAM: Yeah, that's—I would say that's—You've got to be a little careful there.

DR. JAM GHAJAR: And we're not trying to put blame anywhere. I think the doctors want to do what's best for the patient. We're just trying to get the word out. OK. All right. How are you? Hey. Can you look at me?

ROY SCHEIDER (NARRATOR): For days after Alex opens his eyes, the pressure inside his skull remains low. Ghajar proceeds to remove the tube from his brain.

DR. JAM GHAJAR: Out comes the ventriculostomy. This is the tube we had in his brain. And there it goes. It's all out. OK. All right. The first stage is the coma where they don't open their eyes. That's about the first week. Then, the second week, they open their eyes, but they don't do anything.

ALEX'S DAD: Yeah.

DR. JAM GHAJAR: And then the next stage is, they open their eyes and they do purposeful things.

ALEX'S DAD: Right.

DR. JAM GHAJAR: So, when he opens his eyes, he's no longer in coma, but he's not doing anything. So, he's just aroused, which means he's in a vegetative state.

ALEX'S DAD: Right.

DR. JAM GHAJAR: Now, some people stay there. You know, we don't want that to happen.

ALEX'S DAD: Um hmm. Right. Right.

DR. JAM GHAJAR: So, I want to see something purposeful from him. Squeeze my hand over here. Squeeze my hand. Squeeze my hand. About 5% to 10% of all severe head injury patients end up vegetative, which most of the public think of as prolonged coma. And I think it's because of the initial injury, the car accident or whatever. Maybe they didn't get enough oxygen in time, or maybe they have damage to their parts of the brain that are really vital for conscious behavior. Hi. Hi.

ALEX'S DAD: Let's see your thumb.

DR. JAM GHAJAR: Show me your thumb.

ALEX'S DAD: Show the doctor your thumb, baby.

DR. JAM GHAJAR: They don't follow commands. They don't speak. They don't interact with their loved ones. And it's a very, very unfortunate outcome. Open your eyes up. Open them up. Can you open your eyes, Alexander?

ALEX'S MOM: When the doctor told me, you know, he's in a vegetative state, I wanted to die. You don't want that word being used in the same sentence with anyone that you—you know, with any human being.

DR. BRUCE GREENWALD: I had a conversation with Mom yesterday. She's becoming somewhat discouraged, because now, the progress is slow.

DR. JAM GHAJAR: Right.

DR. BRUCE GREENWALD: And I told her she has to expect that things will move very slowly now, and that she has to measure his progress over weeks, and maybe months, rather than day to day now.

DR. JAM GHAJAR: Great.

TERRY GROSS: Back with neurosurgeon, Dr. Jam Ghajar. I'd like you to choose a case that you've worked on.

DR. JAM GHAJAR: Right.

TERRY GROSS: Maybe we'll talk about a woman who was beaten over the summer in Central Park.

DR. JAM GHAJAR: Yeah. That was a well-publicized case. It was a young woman who was walking in Central Park at 4 o'clock in the afternoon, a piano teacher. And she was severely assaulted.

ROY SCHEIDER (NARRATOR): The woman's head had been repeatedly beaten against pavement. She had multiple fractures of the skull, a black eye, a bloody face.

DR. JAM GHAJAR: She looked absolutely terrible, because her whole head was swollen. She didn't look human.

ROY SCHEIDER (NARRATOR): The patient was given only a 20% chance of surviving. But no experimental drugs were administered, or new technologies employed. Instead, a slender tube was placed in her brain, just as in Alex's case, to monitor pressure. The night, the tube rang out an alarm that something was terribly wrong. A CT scan confirmed trouble. A blood clot was growing, and dangerously pressing against the brain.

DR. JAM GHAJAR: So, I had to do something right away. Because if that big blood clot sat there expanding, producing a lot of pressure in the brain, her blood flow would have been compromised, and she would have suffered a massive stroke.

ROY SCHEIDER (NARRATOR): When Ghajar drilled through the skull to remove part of it, the patient's brain was so swollen, it started to come out.

DR. JAM GHAJAR: I could see the whole brain was completely swollen. I mean, it was very, very dramatic. The brain was so swollen, in fact, that I couldn't put back the bone plate. I actually had the bone plate stored.

ROY SCHEIDER (NARRATOR): Twice, the patient needed emergency surgery to remove blood clots that would have killed her. And they might well have gone undetected if the team had not been diligently monitoring pressure.

DR. JAM GHAJAR: Well, you can see there's an immense concentration of physician and nursing resources on these patients. You just can't plug them in and walk away and come back next week, because half the patients will be dead then.

ROY SCHEIDER (NARRATOR): After the surgeries, the entire city seemed to wait, day after day, for a sign that the Central Park patient would come out of her coma.

DR. JAM GHAJAR: It wasn't until the third week that she started following commands. I asked her her name. I mentioned her name to her, and I said, "Is that your name?" And she nodded her head. And I asked her, gave her another name, and I said, "Is that your name?" And she pulled her head the other way and said, "No." That means that she heard what I said, she comprehended it, and then followed the command, which is—That was a great moment, because then, we're assured of some kind of recovery, and she would not be vegetative.

ROY SCHEIDER (NARRATOR): On the one-year anniversary of her assault, the patient's community gathers to celebrate her continuing recovery. Cameras are asked not to film family members, because the patient wishes to keep her identity a secret.

MAYOR RUDOLPH GUILIANI: The single greatest expression of her recovery is that she has now been able to return to play the piano. I know that she'll continue to make a recovery, and we'll have a true miracle.

PRIEST: Let us pray to the Lord.

DR. JAM GHAJAR: It's not a miracle that these patients recover and do well. That's the point about this case, that's it's not a miracle on the Upper East Side. It doesn't require a magician. It doesn't require a guru. It can happen anywhere. Hi. How's' he doing?

NURSE: I'm just covering for now.

DR. JAM GHAJAR: Yeah?

NURSE: But he's febrile.

DR. JAM GHAJAR: He's febrile?

NURSE: Yeah.

DR. JAM GHAJAR: Oh. We got a chest x-ray on him?

NURSE: I'm going to order one, so we're all set.

DR. JAM GHAJAR: Yeah. Alexander?

ROY SCHEIDER (NARRATOR): It's now day 13, and Ghajar is still waiting for Alex to show conscious behavior.

DR. JAM GHAJAR: Oh, yawning, which is—That's a very primitive reflex. What I'd like to see him do is track and follow commands. That would be terrific. But we're not there yet. There's this period of time and it's a few days to a week—It can even last up to months—where there's no conscious behavior. And it is the most difficult time for me, and for—I mean, for all medical personnel—where you're worried, is this patient going to be one of those 5% to 10% of patients that's going to be permanently vegetative? He was opening his eyes, but not following any commands, not making any purposeful gestures with his arms or legs. There was no conscious behavior. Now, we're going to go up and look at the MRI he had yesterday. So, we usually get these after a couple of weeks just to see what the extent of injuries are. You see, here's the base of the frontal fossil where the frontal lobe sits. And you can see if the head moves forward, the brain moves at a different speed and glides across this surface here. And this surface here is not smooth. It has ridges in it. And what happens is the brain hits those ridges and it caused little bleeding, little tears, and all that.

CT SCAN TECHNICIAN: And that's this over here, these little areas of hemorrhage. The white areas are little areas of hemorrhage in the interior aspect of the frontal lobe.

DR. JAM GHAJAR: The frontal lobes are involved in tracking and also sense of self. And they're involved in arousal mechanism as well. So, that's why he's having problems. Where's his teddy bear? He likes looking at his teddy bear. Let's see if he follows this. It's your friend here, look at this. Look at your friend. Look over here. Look at your friend. He's having a difficult time following things. You can see here. Here's the bruise where he was hit by the car. See this? Maybe this the bumper of the car. And he also got hit across his head. It was a really significant injury. When a child doesn't do well, it affects physicians and nurses much more than I think if an adult doesn't do as well. A child is just starting. And look at, you know, what kind of disability they can have. And it's just a horrible thing to see. It affects you for a very long period of time. Come on, Alexander, follow me.

MRS. DEBORAH WARD: The Hollywood version of coming out of a coma is that the person looks beautiful and is asleep, and that all of a sudden, their eyes open, and it's a beautiful sunny day, and birds are chirping, and everything's great. The reality of coming out of a coma is very different. It's very slow. Nicole's eyes were open for a long period of time before she could actually really respond to me. And that was almost harder than when they were closed.

NICOLE WARD: After the accident, the first thing I remember is being transported from New York Hospital to Gaylord Rehabilitation Hospital. I remember being in a reclined position, like I was lying down. I remember two sets of sliding glass doors that went like that. And that's it.

NICOLE WARD (conversing with student): ...because I think I'm going to stay in Boston this summer.

STUDENT ON BC CAMPUS: Good.

NICOLE WARD: The predictions were that I would be a permanent vegetable. I would never do anything for myself ever again. They never thought I would be here at BC, a sophomore, right on schedule.

NEW ENGLAND CABLE NEWS ANCHOR: Now, here's a check of some of the other stories making headlines today.

ROY SCHEIDER (NARRATOR): At a cable news station in Boston, Nicole interns after classes.

NICOLE WARD: New England Cable News.

ROY SCHEIDER (NARRATOR): She hopes someday to be a correspondent. But between that bright future and her car accident lay the difficult road of recovery.

NICOLE WARD: When I first started my therapy, there were definitely times—many times—when I thought, why am I even here? Why didn't I just die? Because everything is so much harder now. It's such a struggle to live, why do I have to go through it?

NE CABLE NEWS STAFF PERSON: So, just write "Lawrence Live, 9 and 10" and then "Lawrence Live 9 and 10" down here.

NICOLE WARD: OK.

NE CABLE NEWS STAFF PERSON: OK?

NICOLE WARD: Yeah.

ROY SCHEIDER (NARRATOR): In many ways, Nicole feels like she's still emerging from a coma, two and a half years later.

NICOLE WARD: It's not like sometimes, I have to deal with some of the effects. It's every day. Things like walking. I walk sort of, not right, and I can feel that in myself, and sometimes after I've said it to people, then they notice it, too. I always feel a little bit different than the average student. I take four classes per semester, not five. But I can walk. I can think. I can write. These very basic things that are taken for granted are really a big accomplishment. I'm so lucky, really, that my mother randomly selected a doctor out of the bunch who were standing in front of her and said, you know, "This isn't right. I want my daughter to get better care. What can we do?" And so, I happened to be taken to New York Hospital, where Dr. Jam Ghajar did the ventriculostomy on me. And that was all happenstance. It was all luck.

ALEX'S MOM: On Friday, the chaplain was in there speaking to me. He was saying good morning, and Alexander all of a sudden opened his eyes and looked at him. I was like, "Did you see that? Did you see that?" But he closed them right away again. So, I came on to the other side of the bed where I would be in his view. And he opened his eyes and he smiled at me. That was like the greatest. I can hear you, puppy.

ROY SCHEIDER (NARRATOR): Twenty days after his accident, Alex recognized his mother, passing a major milestone.

ALEX'S MOM: I can't hear you, puppy. We're going to go to that other hospital, where you're going to get physical therapy for this. You've got to get strong again, I told you, for karate. I tried to feed him Saturday, and I noticed that he was chewing kind of funny. You know, because he was trying to close his mouth, but it wouldn't close in the front. So, his jaw's broken in two places. It's broken on the left side in the back and the left side in the front. So, it looks like when the car hit him, it just like, knocked it out of place.

DR. JAM GHAJAR: Yeah. OK.

NURSE: Is that good?

DR. JAM GHAJAR: Hey. How are you doing?

NURSE: Sit up a little more?

DR. JAM GHAJAR: Can you—Can you lift your leg up? Lift your leg up here? The best moment is when they follow commands. And that's a great time. They may even track you, follow you with their eyes first. And then you say, "Show me two fingers." Can you show me all five fingers? Good. Show me two fingers. That's great. That's fantastic. How about three? Hey, that's very good. That's very good. Give me a squeeze over here.

ROY SCHEIDER (NARRATOR): Following commands is a sign that Alex has finally emerged from a vegetative state.

DR. JAM GHAJAR: Are you going to leave the hospital? Yeah? Where are you going to go? Go someplace that's more fun, huh?

TRANSFER EMT: One, two, three.

NURSES: Bye, Alex.

DOCTOR: Bye, Alex.

ALEX'S MOM: Thank you. Bye-bye. Thank you.

NURSE: Good-bye, Mrs. [family name].

ROY SCHEIDER (NARRATOR): No longer in need of intensive medical care, Alex leaves New York Hospital for a nearby rehabilitation center.

DR. PAUL BERGER-GROSS: You're welcome to join anybody on the team, which is all the rehab therapists, the school teachers, me—I'm the psychologist—in any of the therapies.

PHYSICAL THERAPIST: Now, you're going to start swinging.

NURSE: Fifty-five pounds.

ALEX'S MOM: He's always been skinny like that.

PHYSICAL THERAPIST: Now, we get to do this once a week. Every Tuesday, we'll be taking your weight.

DR. PAUL BERGER-GROSS: Do you have any questions for me?

ALEX'S MOM: Alexander's a very well-mannered child. He's a perfect child, really. And one thing he has is a lot of respect for his Dad and me. And I've noticed, like, when I speak to him, I feel like he's ignoring me. And he would never have done that before this. So, I was wondering if that's like part of that? Will that go away?

DR. PAUL BERGER-GROSS: Some children lose—

ALEX'S MOM: Personality changes?

DR. PAUL BERGER-GROSS: Yeah. Some children—Their personality changes from the accident. But it's too early to predict anything about that.

ALEX'S MOM: Hello. Hello. You OK?

PHYSICAL THERAPIST: Now, pick up that behind. Pick it up. Pick it up. Pick it up. Yay! Good boy. A little more. Another quick shimmy. One more shimmy over there. Good job. OK. We're going to kick Ernie with it, OK?

PHYSICAL THERAPIST: It's a karate chop to Ernie, OK?

PHYSICAL THERAPIST: Give him a "hi-yah!"

ALEX: Hi-yah! (laughter)

PHYSICAL THERAPIST: Is that funny?

KARATE TEACHER: We're going to give a punch kick on the left. Punch, ready? One!

KARATE CLASS STUDENTS: Ho!

PHYSICAL THERAPIST: Can you catch with both hands? Good.

PHYSICAL THERAPIST: Hold it up there for me. Hold it up there.

PHYSICAL THERAPIST: Maybe you could say, "Hi-yah!"

ALEX: Hi-yah.

KARATE TEACHER: Three.

KARATE CLASS STUDENTS: Ho!

KARATE TEACHER: One.

OCCUPATIONAL THERAPIST: OK, now, can you make a picture of a person?

PHYSICAL THERAPIST: Can you see it? You've got to get out of your chair first. You've got to scoot forward. All right. Here we go.

PHYSICAL THERAPIST: That's a good one. How about the one down by that couch? Is that too far?

DR. PAUL BERGER-GROSS: There's a great difficulty in getting people to realize that no matter the early gains, there can be pretty serious long-term consequences. We don't expect parents to accept all of that immediately, and we're not in the business of destroying hope. Hope helps support all the interventions that are going to be necessary three months from now and six months from now, and two years from now. "See how I grew. Newborn." Go ahead.

ALEX: Newborn. Three days old. Two weeks old. Six months old. One and a half years old.

DR. PAUL BERGER-GROSS: Very good. OK.

ALEX AND ARIANA: (laughing and running)

ARIANA: Alex, come on.

DR. JAM GHAJAR: Hey, this isn't the man, is it?

ARIANA: This is Alex.

DR. JAM GHAJAR: Wow, you look terrific.

ARIANA: This is my brother, Alex.

DR. JAM GHAJAR: It's your brother, huh?

ARIANA: Yeah.

DR. JAM GHAJAR: How are you feeling?

ALEX: Good.

DR. JAM GHAJAR: Huh? Do you feel good? Are you looking forward to going home? Give me a big squeeze. Squeeze, squeeze. Oh, oh, don't break my fingers. OK. How about this one? Hey, that's pretty good.

ALEX: Can I show you something? (performs a split)

DR. JAM GHAJAR: OK, go ahead. Whoa. That's very impressive. I can't—I can't do that. (laughter)

ALEX: I know.

ARIANA: Maybe I can do it.

DR. JAM GHAJAR: Well, all right. Well, it's great seeing you, Alex. Bye.

PHYSICAL THERAPIST: Children who have sustained head injuries, because of the change in their behavior and the change in their judgment, have high percentages of secondary head injuries. And that's what we need to prevent. So, we'll have to do a lot of educating for Alex as he grows older.

DR. FRANCO SERVADEI: We have more than 500 people at the conference from 47 different countries.

ROY SCHEIDER (NARRATOR): Ghajar and colleagues now are traveling around the globe to spread the word about the treatment protocol they so believe in.

CONFERENCE PARTICIPANT: After Dr. Ghajar. I mean, Dr. Ghajar's—

DR. JAM GHAJAR: Hi. How are you? Where are you from?

CONFERENCE PARTICIPANT: Romania.

DR. JAM GHAJAR: Romania?

CONFERENCE PARTICIPANT: Yes.

DR. JAM GHAJAR: I'd like to thank the organizers for allowing us to present the Guidelines here. Our goal is to take these Guidelines and apply them throughout the world so that no matter where you have a head injury, you will get the best available treatment.

DR. FRANCO SERVADEI: He had a crash. He was in a motorbike, sitting behind the one who was driving. So, he was intubated on the scene of accident, brought him immediately to operating theater, and placed an ICP monitoring in the ventricle.

DR. JAM GHAJAR: Monitoring brain pressure is not high-tech. These things get clogged up. They don't drain properly.

DR. FRANCO SERVADEI: We always have problems with the drainage, when they fill up.

DR. JAM GHAJAR: You should get ones without filters on them. Once you start monitoring brain pressure, you've got to start doing things. It's a lot easier just to put the patient on the ventilator, give them some drugs, and come back next week and see how they're doin. His pressure went up.

DR. FRANCO SERVADEI: Nine o'clock. Because the pressure went up and he was moving.

DR. JAM GHAJAR: You know, they're lying there in a coma. They're not screaming out for help. They're not saying, "I'm in pain." I think if these patients were awake and saying, "Listen, do something for me," we'd be doing a lot more for them.

KARATE CLASS STUDENTS: 16,17,18,19,20,21,22,23,24,25,26,27, 28,29,30...

ALEX: So, we're near the house?

KARATE TEACHER: Alex has made a very miraculous recovery from his injuries, and that's a good indication of just how strong he really is inside. He's a real warrior. I gone and visit him several times in the hospital when he was in a coma. And I remember at one point, they told me that he wasn't responding anymore. And I was terrified. And when I found out that he actually pulled through it, I just couldn't believe it. It was so fantastic. So Alex, welcome back, Alex.

ALEX: Thank you.

KARATE TEACHER: OK, and today, we're going to present him with his second yellow belt, which is where we left off when he last left us. So, Alex, turn around and take your belt off, please. OK, is that too tight?

ALEX: No.

KARATE TEACHER: OK. Kick bow. (applause)

KARATE CLASS STUDENTS: Eh! Eh! Eh! Eh! Eh! Eh! Eh!

HOSPITAL OPERATOR: Jamaica Hospital

DR. JAM GHAJAR: Yeah, hi, it's Dr. Ghajar. Could I have the CT scanner, please?

HOSPITAL OPERATOR: Hold on just a moment.

DR. JAM GHAJAR: What motivates me is there are deaths occurring every ten minutes as we're talking, that are potentially salvageable patients that could go on and have a very good quality of life.

CAPTION ON SCREEN: The Guidelines for treating head trauma were approved by the World Health Organization on May 15, 1997.

DR. JAM GHAJAR: You're going to end up, when you're in a coma, in the closest trauma center. You do not have a choice. So, it comes upon society to say to you, "You don't have a choice. We're going to take care of that for you so that no matter where you or your child goes, you will receive this standard of care."

CAPTION ON SCREEN: After the publicity surrounding the Central Park case, New York State's Department of Health endorsed the Guidelines as well. It is the only state to have taken such action.

KARATE CLASS STUDENTS: Eh! Eh! Eh! Eh! Eh! Eh! Eh!

ROY SCHEIDER (NARRATOR): Alex returned to his elementary school three months after his accident. He is slower to learn, and the right side of his body is weak. But he has been returned to his family.

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ANNOUNCER: Coming up on NOVA, an IRA bomb has been planted. Someone must defuse it—quickly, safely.

BOMB DISPOSAL SOLDIER: If there's a piece of fishing line dangling off one of the doors, you might be in trouble.

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ANNOUNCER: Politics and science make an explosive mix in Bomb Squad.



PRODUCTION CREDITS

Coma

Written, Produced and Directed by
Linda Garmon

Editor
Jean Dunoyer

Director of Photography
Tom Hurwitz

Narrator
Roy Scheider

Production Assistant
Caroline Toth

Second Camera
Jeffrey Victor

Sound Recordist
Peter Miller

Inspired by
"Conquering the Coma"
by Malcolm Gladwell
The New Yorker

Radio interview by Terry Gross,
Courtesy of NPR's "Fresh Air", WHYY

Music
Sheldon Mirowitz

Additional music from
the Warner Bros. soundtrack
"The Client" by Howard Shore

Sound Editor
Geof Thurber

Sound Mix
Greg McCleary

Special Thanks
Alex
Ole Pedersen, Jamaica Hospital Medical Center
Dr. Bruce M. Greenwald, The New York Hospital- Cornell Medical Center
Dr. Donald Trunkey, Pam Frankel, Northwest States Trauma Conference, Oregon Health Sciences University
George A. Zitnay, Brain Injury Association
Dr. Franco Servadei, Ospedale Bufalini
Peter Quinn, Soraya Ghahremani, Aitken Neuroscience Ctr.
Dr. Paul Berger-Gross, St. Mary's Foundation for Children

Trauma drill coordinated by
Dr. Jamie Ullman
Elmhurst Hospital

Patient simulator courtesy of
Louis H. Oberndorf
Medical Education Technologies, Inc.

Stills Animation
Visual Productions

Additional Cinematography
Don Lenzer
Dyanna Taylor

Additional Directing
Caroline Toth
Jonathan Sahula

Stock Footage Researcher
Lewanne Jones

Advisor
Dr. Harvey Fineberg

The name of the Central Park
patient has been withheld because
she wishes to maintain her privacy.

Archival Footage
NBC News Archives
ABC News Video Source
WCBS-TV
1010 WINS Radio

Reporter Voiceovers
WINS News Radio: Alice Stockton Rossini
WNBC-TV: Andrew Glassman
Sue Simmons
Paul Moniz
Chuck Scarborough
Mary Civiello

Production Assistance
Brad Puffer

Researcher
Megan Reilly

Additional Sound Recording
Keith Rodgerson
Bill Wander

Assistant Camera
Jeffrey Victor
Paul Carter
Antonio Rossi
John Romeo
Mark Schmidt
Jerry Risius

Gaffer
Ned Hallick
Steve Kaye

Field Production Assistants
Michael Galinsky
Will Rigby
Shawn Cafferata
Michael Aubin
Ben Brumfield
Marco Ajello
Tim Prudhomme

Translator/Fixer, Italy
James Walker

Online Editor
Ed Ham

Colorist
Brian Lovery

NOVA Series Graphics
National Ministry of Design

NOVA Theme
Mason Daring
Martin Brody

Closed Captioning
The Caption Center

Production Secretaries
Queene Coyne
Linda Callahan

Publicity
Stella Giamassi
Paul Marotta
Lisa Cerqueira

Paralegal
Nancy Marshall

Post Production Associate
Sandra Rizkallah

Post Production Editor
Rebecca Nieto

Post Production Online Editors
Mark Steele
Doug Martin
Jim Deering

Post Production Director
Alison M. White

Unit Managers
Laurie Cahalane
Amy Trahant

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