April Fool’s Day Wake-Up Pranks, 2014

Well, Happy April Fools’ Day once again, everyone!

Last year I posted some funny sleep-related April Fools’ pranks:

https://sleephelpdesk.com/2013/04/01/april-fools-day-wake-up-pranks/

To expand on this tradition I’m posting some more humor today.  I present here some of my more favorite sleep-related practical jokes.  This year I’ve had a hard time finding video sufficiently clean to include in this post.  I’ve done my best to screen for language and out-and-out meanness.  As always, do not try any of these pranks at home.

 

Our first gag comes from Japan, land of crazy, well-orchestrated, and televised practical jokes.  The pranks the Japanese show on television would never float here in the U.S., where people sue other people just for looking at them wrong.  This is way over the top, quite literally.  I would hate to be the guy pranked here.  Check it out.

Here is a guy pretending to be so sleepy that he sleeps standing up, leaning in on other people, and generally freaking people out, especially the last guy.  For the record, falling asleep in public places is quite common, though usually not as dramatically as depicted here; people think of narcolepsy when they hear of people falling asleep in public like this, but actually the most common cause of sleepiness is sleep deprivation, such as from pulling an all-nighter.

Anyone who has seen the Japanese or American versions of The Ring will find this instantly familiar and hilarious.  The women who was pranked seemed to take the joke in her stride.

The classic wake-up prank involves an air horn.  There are hundreds of examples of this form of rude awakening on the web.  Here’s a quick one featuring the Burger King!

I also love rude awakenings in the car, particularly the ones that involve screaming and scaring the pants off of the unsuspecting, slumbering passenger.  You know what I’m talkin’ ’bout.  Here’s a nice example:

And here, at last, is my very favorite sleep-related prank video of the year.  It’s short and silent, but hilarious:  for a brief period of time, this man becomes a guitar hero to all who slumber.  Enjoy!

OK, OK, I have to give you one more.  This is a repeat from last year, but it’s so great I have to post it again.  Have a great day!

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Chicago O’Hare Train Accident Thought Related to Operator Sleepiness

You probably have heard by now about the recent commuter train derailment at Chicago’s O’Hare International Airport.  In the early morning of Monday, March 24, a Chicago Transit Authority (CTA) blue line train jumped its rails and crashed into an escalator, injuring more than 30 people.

 

It is so weird to see photos of such destruction in a place that I am so familiar with.

Anyhow, this morning it was announced that the train operator informed investigators from the National Transportation Safety Board (NTSB) that she had fallen asleep at the controls before the accident.

Here is the surveillance video that captured the incident:

According to lead investigator Ted Turpin, the train operator indicated that she had “dozed off prior to entering the [O’Hare] station and did not awake again until the train hit close to the end of the bumper.”  She also told investigators that in an earlier incident, in February, she had fallen asleep at the controls and subsequently overshot a train stop.

This accident at O’Hare occurred at 2:50 a.m. CST.

It kind of goes without saying that drowsy driving is dangerous, but you may be surprised as to how big of a deal this problem actually is.  According to the National Highway Traffic Safety Administration (NHTSA), roughly 100,000 police-reported motor vehicle accidents occur in the United States each year; of these, roughly 40,000 injuries occur and 1,550 people die.  These statistics don’t include the accidents that are never reported.  Unfortunately, work and driving accidents in the early morning are far too common, though usually not quite as dramatic as this particular event.  Many of these NHTSA-reported vehicular accidents occur in the early morning, between 2 and 7 a.m.

Further complicating matters is the fact that this tendency toward drowsy driving can be related to many potential underlying causes:  work schedules (particularly schedules that rotate in terms of the timing), home circumstances and social obligations, chronic sleep deprivation, a need to work two jobs, undiagnosed sleep disorders, and irregular sleep schedules.  Many of us can relate to most, if not all, of these causes, which again speaks to how common and problematic drowsy driving can be.

I can’t emphasize the following take-home points enough:

1.  NEVER DRIVE OR OPERATE MACHINERY (including any kind of vehicle) IF YOU ARE DROWSY!!!  It simply isn’t worth it to retain your job or get somewhere on time by risking your life or the life of others around you.  Pull over, stop your work, speak with your supervisor, whatever it takes.

2.  ALWAYS STRIVE TO GET PROPER AMOUNTS OF SLEEP (which for most adults is between 7.5 and 8 hours per night) AND KEEP YOUR SLEEP SCHEDULES REGULAR.  In other words, get as much sleep as your body needs, and get this much sleep regularly, every day at around the same time of day, even if you work night shifts.

3.  If you don’t know WHY you are drowsy when you’re supposed to be awake, SEEK MEDICAL ATTENTION.  If you are sleepy despite proper amounts of sleep and regular sleep timing, you may have an intrinsic sleep disorder.  Fixing abnormal sleepiness is one of the functions of a physician sleep specialist.

In closing, I want to give a shout-out to our nation’s first responders.  May we never take them for granted.  We’ve had a lot of disasters recently, it seems, including one geographically very close to me (the tragic, huge March 22 mudslide in Oso, Washington).  Here is a link for those who wish to help in the Oso landslide relief efforts:

http://www.king5.com/news/breaker1/Northwest-Response-Oso-Mudslide-Relief-252007821.html

Stay SAFE, everyone.

Happy Insomnia Awareness Day!: Insomnia, Defined

The American Academy of Sleep Medicine (AASM) has declared today, March 10, Insomnia Awareness Day this year.  The timing of this auspicious occasion is in keeping with the daylight savings time change from over the weekend.

We in sleep medicine circles call today “Black Monday,” the first workday following the one-hour time change each spring.  Our body clocks don’t like making changes in their sleep shifts, even if only by a mere hour; anyone who has experienced jet lag knows what I mean.  As you know, “springing forward” one hour means having to get up one hour earlier than what our body clocks are accustomed to and thus “prefer.”  For those who do not adjust their bedtime schedules accordingly, getting up to get to work, school, or appointments on Black Monday becomes all the more difficult.  At the same time, the mild dysregulation of sleep scheduling can also lead to insomnia, particularly if there is already baseline insomnia to begin with.

 

I’ve covered insomnia in previous posts, and I will go over it and its management in future posts too, because it is such a huge, prevalent clinical problem and growing public health concern.  For the purposes of today’s Insomnia Awareness Day post, however, I will concentrate simply on what insomnia means.

The definition of insomnia, as accepted by the AASM, is the “subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.”  [Schutte-Rodin S; Broch L; Buysse D; Dorsey C; Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4(5):487-504].

As such, insomnia is by its very nature subjective, meaning that you can have insomnia no matter how much actual sleep you really get, and implying that the time spent awake in bed is bothersome.  Among the many impairments associated with insomnia are a feeling of unrefreshing sleep, low energy levels during the day, daytime sleepiness, emotional problems (like depression and anxiety), morning headaches, difficulties with memory and concentration, reduced work productivity, and a propensity toward industrial and motor vehicle accidents.

This definition is important.  You can have insomnia even if you get a full 8 hours of sleep each night (such as if you are spending 12 hours trying to sleep each night).  Conversely, 4 hours spent in bed spent awake each night casually watching television but not trying to sleep do not constitute insomnia.  Note also that the definition does not address potential causes, of which there are hundreds–causes can range from a can of Mountain Dew at 10 p.m. to one’s mental perception of dread and frustration associated with previous difficulties falling asleep.  The definition of insomnia also helps provide a rough roadmap to therapy.  My own practice philosophy for patients with chronic insomnia (i.e., insomnia that lasts for a month or longer) is to identify the underlying causes and to improve the insomnia by improving or resolving the problems causing it.

From a clinical perspective, chronic insomnia management can range from relatively straight-forward to extremely challenging.  Doctors that identify themselves as “physician sleep specialists” should have the expertise and willingness to handle cases of insomnia, including the tough ones.  Enlist their help should your insomnia become sufficiently problematic.  Help IS available.

Sleep well tonight, everyone.  Black Monday is almost at its end!

Dinosaurs and Seahawks: Defense Wins Championships

I was one of those dinosaur kids.  I grew up completely, hopelessly enamored by dinosaurs.  I found them endlessly fascinating.  As a preschooler I strived to learn about and memorize as many prehistoric creatures as possible.  I could tell you which eras and periods in which various dinosaurs lived, what their bony structures told us about their ways of life, where their fossils were first discovered, how they walked, what they ate.  In my young childhood days long before the Internet, I satisfied my interest in paleontology through books, flash cards, and models.  I carried dinosaur books and drawings everywhere I went.  The librarians at Whitewater, Wisconsin’s public library all knew my name and knew my favorite place to camp out while I drank in as much dino-knowledge as my young brain could handle.  My fervor for the topic even earned me and my tattered book of drawings an article in Whitewater’s newspaper when I was four:

 

Anyway, everyone I encountered as a young child asked me the same question:  “What’s your favorite dinosaur?”  That was an easy question to answer.  Of course it was Ankylosaurus.

 

(This, by the way, is my all-time favorite depiction of Ankylosaurus, taken from my all-time favorite dinosaur book.)

Strange and turtle-like in appearance, Ankylosaurus sported much more than just a hard-shell carapace to protect itself from predators.  If you examine its body further, you will notice several additional features that surely served it well:  hard lateral spikes, a series of protective horns on the crest of its head, and–the pièce de résistance–a hard, bony club at the end of its tail, great for whacking the legs of would-be aggressors that ventured a little too close.  Seriously, imagine yourself as a Tyrannosaurus Rex trying to get a piece of this guy.  Good luck.

 

I’m sure I was asked somewhere along the way by curious adults, “Why do you like Ankylosaurus so much?”  I doubt I would have been able to give a cogent reply to this more challenging question as a young child.  But as an adult, I think I now know the answer:  Ankylosaurus was a giant, living, walking, breathing defensive weapon.

In our modern world we’re constantly assailed by all sorts of crazy stuff:  an overwhelming mountain of information, people, advertisements, opportunities, and threats, coming at us like a slow-moving, never-stopping avalanche as we move through life.  Though I am probably the worst possible person to assess my own personality, I know I identify easily with the idea of hunkering down and going into shield mode, on behalf of myself and my family.  I’m more of a protector than a predator.  I suppose, then, that it’s natural that I identified with the Ankylosaurus more than I did the T-Rex as a young child.

So–and I recognize this may be the weirdest segue in the history of blogdom–I found last week’s Seattle Seahawks Superbowl win over the Denver Broncos particularly gratifying, and not just because I’m a proud Seattle resident and Seahawks fan.  After hearing for two solid weeks various commentators and pundits crowing about Payton Manning and Denver’s offensive records this season, there was a clear sense of satisfaction in watching all of that not matter as the Seahawks dismantled the Broncos with its smothering, overwhelming defense.

 

Seattle’s domination was so complete, in fact, that it had ESPN’s Stephen A. Smith and Skip Bayless eating crow and paying respect where it was due:

Sometimes a formidable offense just doesn’t matter.  The fact that the phrase “defense wins championships” is a cliché doesn’t matter either.  It’s a cliché because it’s true.  Just ask Ankylosaurus, who isn’t too ancient to provide us all a little lesson for these crazy modern times.

Recent Brain Death Cases: My Interview With Dr. James Bernat

Earlier this week I published a post regarding the differences between brain death, coma, and vegetative state:

https://sleephelpdesk.com/2014/01/12/the-differences-between-brain-death-coma-and-vegetative-state/

In it I aimed to clarify terms that are often used incorrectly or even casually by the public and the media.  Numerous recent news stories–such as that of the passing of former Israeli Prime Minister Ariel Sharon–have invoked these clinical terms.  Among the most gut-wrenching of these recent stories are the Marlise Muñoz case from Fort Worth, Texas, and the Jahi McMath case from Oakland, California.  I have received a lot of feedback regarding my January 12th post, so I’d like to expand on this important subject further.  In today’s post, I briefly review the background of these two cases and bring in the expertise of a world-renowned medical ethicist to weigh in on how brain death and our understanding of it may affect their courses and outcomes.

The Muñoz case involves a pregnant 33 year-old woman who collapsed following a blood clot in the lungs.  Reportedly Muñoz is now brain-dead, though as of this writing I have been unable to find documentation of a physician or hospital spokesperson officially and publicly announcing that she has been declared brain-dead.  The health status of the fetus is not clear.  Muñoz’s husband, Erick, has requested that mechanical ventilation be terminated, in keeping with what he strongly believes her wishes would be (both he and his wife worked as paramedics, and he states that she had made her wishes very clear to him regarding what she would want in such a clinical setting).  However, the hospital where Muñoz resides has declined to do so, citing a Texas law prohibiting the withholding of “life-sustaining treatment” from a pregnant woman.  As I understand it, this Texas law is intended for pregnant women who are comatose, not brain-dead.  Muñoz’s husband has now filed a lawsuit against the hospital.  The central issues in this case are whether Muñoz is in fact brain-dead, and the degree to which a hospital may or may not have the right to operate against the wishes of the spouse given the pregnancy.

The McMath case involves a 13 year-old girl who underwent nasal and throat surgery–including a tonsillectomy–as surgical management for sleep apnea.  She suffered cardiac arrest post-operatively, and according to hospital spokespeople she subsequently has been declared brain-dead–and therefore clinically dead–by several independently-evaluating physicians.  As such, the hospital released Jahi’s body to the coroner, who then released the body to Jahi’s mother.  At the center of this impassioned debate is the question of whether or not Jahi is dead.  The McMath family’s attorney, Christopher Dolan, reportedly said in an interview that Jahi “has not passed.  Her kidneys function, she regulates her temperature and her body moves now more than ever.  This is a real human being, not a dead body.”  Jahi’s uncle, Omari Sealey, reportedly has told interviewers that he hopes “to have her come back home with 100% full recovery.”

These are heartbreaking situations, clearly, with no simple answers or methods of resolution.  So yesterday I spoke with my former teacher and mentor, Dr. James Bernat, professor of neurology and medicine and the Louis and Ruth Frank Professor of Neuroscience at Dartmouth’s Geisel School of Medicine in Lebanon, New Hampshire.

 

Dr. Bernat is a well-respected clinician with a scholarly interest in ethical and philosophical issues in neurology.  He is extensively published in the discipline of medical ethics; his textbook, Ethical Issues in Neurology, is widely considered a seminal publication in the field.  He has particular expertise in impaired consciousness, including brain death and the vegetative state, and has provided guidance, testimony, and consultation for many organizations regarding these topics over the years.  On a more personal level, Jim is just a great guy, one of the most caring, compassionate instructors I’ve ever had.  It’s an honor to call him my mentor and friend.

(Here’s a grainy old photo of us at an Academy meeting, back in the day.)

Image

Dr. Bernat was kind enough to provide his thoughts and expertise regarding these two complex cases.

MC:  Jim, do you get a sense that people in general have a firm understanding of what “brain death” really is and what it means?  

JB:  Most people do not understand the concept of brain death. They regard it as a metaphor for severe brain damage causing coma but fail to understand its totality and irreversibility, and particularly do not realize that it represents a medical and legal standard for death determination in the United States.  The public press compounds the confusion when journalists who also do not understand the concept discuss “brain death” incorrectly and confuse it with coma and the vegetative state.

MC:  As a neurologist, my concern is the confusion that may arise when the public hears in the media terms like “life-sustaining treatment” and “life support” when referring to a brain-dead patient receiving mechanical ventilation and medications.  Could you speak to this concern, and are there better, more accurate terms you would suggest the media use?

JB:  In the context of the brain-dead patient, the use of the term “life support” to refer to tracheal positive-pressure mechanical ventilation is seriously misleading and further confounds the question of whether such patients are alive or dead.  The medical and legal standard of brain death means that the patient is dead so the ventilator or other treatments should not be referred to as means of “life support.”  I prefer the term “physiological support” or simply that the dead patient’s respiration is being provided entirely by a machine which thereby permits their heartbeat and circulation to continue.

MC:  Every American state has its laws defining death.  As I understand it every American state defines death as either complete and irreversible cessation of cardiac and breathing functions or complete and irreversible cessation of brain and brainstem function.  Therefore, state law defines brain death as equivalent to the actual death of an individual.  What can be done and recommended in situations in which one’s individual opinions or religion differ from state law?

JB:  Your understanding of state law is correct.  Each country adopts a unique perspective to this problem.  In the United States, where our traditions emphasize respect for religious beliefs, enforce the rights of the individual, and promote the value of a pluralistic society, we allow states to amend their death statutes or their department of health administrative regulations to provide a religious exemption to declaring brain death.  Currently, New Jersey and New York have chosen this route.  In these states, in the presence of a qualifying religious exception, physicians must use the circulatory-respiratory tests for death.  Some scholars have advocated even more personal choice over the standards for death determination but I fear that this proposal would yield chaos in hospitals.

MC:  The news reports pertaining to these two tragic cases often refer to state law and hospital policies.  If you could communicate directly with state officials and physicians caring directly for these two individuals, what clarification would you ask for to assist in a better public understanding of their situations?

JB:  Hospitals are constrained about how much specific patient medical data they release to the public by HIPAA regulations and by their internal risk management-legal advice.  The dearth of specific information complicates the role of commentators because they lack a clear and complete understanding of the facts of the case.  Additionally, when hospitals’ every decision or statement is exposed to public scrutiny by an interested press, it is understandable that they become cautious in their decisions and public statements.  Despite these constraints, the public relations aspects of the cases require optimal management to provide sufficient facts and clarity for commentators and the public to understand the reason for their actions.  These facts include the diagnosis, how the diagnosis was made, whether brain death was formally determined, and the reasons for the hospital’s actions in each case.

MC:  What else can be done to ease the suffering of the families of these two unfortunate people?

JB:  These are both tragic cases of young people who died from massive brain damage.  As a parent, I cannot imagine the extent of suffering that these tragedies caused to their loving families.  In addition to taking every measure to inform and comfort such families, I strongly recommend offering the opportunity for organ donation.  Although some may criticize this approach as a predatory action, organ donation offers transcendent meaning to the families of brain dead patients.  Numerous studies have demonstrated that families later emphasize how important and meaningful they found the donation process because it helped mitigate their suffering by creating good for the organ recipients from an otherwise senseless tragedy.

Football and Bridgegate: People Losing Sleep in the News

 

Last week we were bombarded by the media over the controversy surrounding New Jersey Governor Chris Christie‘s staff and “Bridgegate.”  During his recent press conference regarding this matter, Christie indicated at 2:27 in this video clip below, “I haven’t had a lot of sleep the last two nights, and I’ve been doing a lot of soul-searching.”

I want to make clear this is not in any way a political post, and is not intended to defend or criticize Christie or anyone else.  I present this here simply to illustrate one generally well-understood point, which is that emotionally significant life events–whether they be good or bad–commonly cause difficulties sleeping.

There are several potential reasons for this.  First, problematic life events–such as Christie’s–are often accompanied or followed by mood problems and anxiety, both of which can cause difficulties falling and staying asleep.  Depression is commonly associated with insomnia–in particular a phenomenon called “early morning awakening,” in which the depressed person tends to awaken spontaneously several hours earlier than the normal or desired time, with very substantial problems returning to sleep.  Second, anything that you think about in bed that is of emotional value can cause difficulties sleeping, because those thoughts have a stimulating effect which makes you more awake and alert.  The more intense the emotions or concerns (I suppose that would include “soul-searching”), the more psychologically and physically stimulated you can get (an extreme example might be the feeling of sweating and heart-pounding upon hearing devastating news), and this stimulation can cause your insomnia to snowball.

OK, I will add just one brief, slightly political point here.  I wish people in the media would stop calling Christie fat and teasing him for it.  I NEVER use this term in my clinic or socially to refer to one’s weight.  Plus, he’s lost a substantial amount of weight following his gastric lap band surgery last year.  I’ve heard several Christie “fat jokes” on national radio and television programs in the past week.  Really?  Come on, folks, let’s at least be civil, yeah?

Anyhow, in a completely different matter, Pete Carroll, head coach of the Seattle Seahawks, said in a television interview last week that he hasn’t been sleeping much lately either, but that’s probably because of how crazy his schedule must be right now in addition to the excitement of prepping his team for the playoffs and, now, Sunday’s NFC championship game!  There must be some anticipatory anxiety, for sure, and this kind of emotion certainly can lead to sleepless nights as well, though for reasons quite different from (and in many ways the opposite of) Christie’s.  And hopefully–understand, I live in Seattle–he won’t have any sleepless nights due to game losses in the next several weeks!

Finally, continuing with the football theme, I will leave you today with this recent video clip of ESPN analyst and former Chicago Bears coach Mike Ditka dozing while on air during ESPN’s Sunday NFL Countdown Show.  Keyshawn Johnson had to nudge him awake!  Glad Coach was behind a desk and not behind the wheel at the time.

I have no idea what the circumstances were that led to Ditka’s on-air snooze.  Maybe he was watching George Wendt‘s State Farm commercials over and over late the previous night.

Enjoy the playoffs, everyone, no matter who you’re rootin’ for!

 

The Differences Between Brain Death, Coma, and Vegetative State

You may have noticed over the past week several major news stories of brain dead or comatose people, their loved ones, and their unfortunate circumstances.  For many years neurologists have been concerned about the substantial confusion that exists regarding what is meant by certain terms that are utilized by the media pertaining to types of impaired consciousness.  Brain death, coma, and vegetative state are in fact very specific terms in clinical medicine, and there are volumes of medical literature describing and discussing all of them.  So today I will take off my sleep medicine hat, put on my neurology hat, and do my best to define these terms and distinguish them from each other for you, as briefly and succinctly as possible.

 

These 3 terms all refer to altered states of consciousness.  They are distinctly different from conventional sleep, which is a normalpredictable, temporary, diurnal and readily reversible state of unconsciousness necessary in and common to virtually all animal species.  All 3 of these states are generally bad–that is, with very few exceptions (such as drug-induced coma to prevent prolonged and life-threatening seizures, for example)–but neurologically speaking they are associated with varying levels of badness, not only in terms of unawareness of the patient’s environment but also in terms of prognosis for eventual “meaningful” neurologic recovery (i.e., return of consciousness with abilities to function independently, engage in basic activities of daily living, and enjoy the process of life).

Coma refers to deep sustained unconsciousness.  The patient is alive, but there is no sign of conscious or behavioral movement, vocalization, or voluntary eye opening.  The patient cannot be awakened; he or she does not respond to verbal commands or other conventional stimuli.  However, physical examination may demonstrate basic neurologic reflexes and variable (usually primitive or abnormal) responses to painful (“noxious”) stimuli.  There are a great many potential causes, including stroke, brain hemorrhage, severe closed head injury, medications, hypothermia, drug overdose, and prolonged deprivation of oxygen (such as from drowning or cardiac arrest).  The chances of someone regaining consciousness and substantial neurologic function depend on a variety of factors, including the nature, duration and severity (and potential reversibility) of the underlying cause(s), the duration of the coma, and how severe the coma is based on a thorough physical neurologic examination conducted by physicians.  In general, however, if the cause is severe and irreversible, and if the patient remains comatose for a long time (such as several weeks) following an injury, the likelihood of meaningful neurologic recovery is unfortunately small, even if he or she remains technically alive.

Vegetative state is a term is so deeply entrenched in the medical and popular literature that it is still utilized clinically.  In this form of impaired consciousness, the patient episodically appears awake but does not demonstrate evidence of awareness of self or environment; some refer to this as a state of “wakeful unconsciousness.”  The patient may appear awake upon casual observation, open and move the eyes, and exhibit sleep-wake cycles.  However, voluntary movements or vocalizations and purposeful behavioral responses to conventional stimuli are not observed.  It is usually associated with severe injury to the brain and it is prolonged in duration.  Basic brainstem functions are preserved, allowing the patient the possibility of many years of life in this fashion.  Unfortunately, this neurologic condition can be confusing (and often agonizingly so) for family members and clinicians, because signs on neurologic examination, the “depth” of neurologic impairment, causes and outcomes can all be so highly variable, and because the patient appears awake, though signs of awareness remain absent.

Brain death is the ultimate badness, referring to the complete and irreversible absence of all neurologic activity in the brain.    Physical examination demonstrates an absolute lack of response to stimuli; there are no movements or reflexes.  Diagnostic tests, such as electroencephalography (EEG), demonstrate an absence of brain and brainstem electrical activity.  The patient does not breathe without the assistance of a mechanical ventilator; when the ventilator is stopped, there is sustained apnea.  If other potentially reversible “mimics” of brain death (such as barbiturate intoxication and hypothermia) are ruled out, and if brain death is certain, there is no coming back from this; there is no chance of return of neurologic function or meaningful neurologic recovery.  Though historically people have thought of death as the permanent cessation of heart function and breathing, many people and most clinicians consider brain death consistent with clinical death, even if mechanical ventilation can keep vital organs of a brain-dead person functioning for long periods of time.  The Uniform Determination of Death Act (UDDA) is a draft state law approved for the United States in 1981 and has been adopted by most states.  It defines death as “either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem,” the determination of which is made “in accordance with accepted medical standards.”

There are several important issues to bring up briefly here.  First, it’s important to recognize that these terms may be confused with each other in the media, and sometimes even used interchangeably; be very careful of what you read and hear, and be prepared to challenge terms that are used.  Second, the clinical condition and neurologic status of the comatose or vegetative patient can change and evolve over time, and sometimes highly improbable or unexpected outcomes have been reported to occur without explanation or warning, such as spontaneous neurologic improvement following sustained coma for example; as one of my mentors once told me during my residency, “patients don’t read the textbooks.”  Finally, and importantly, there is an ongoing debate regarding the ethics of what these decreased levels of consciousness may mean for the patient, how loved ones should make decisions on behalf of the patient, and how society defines or views the concepts of death and a meaningful life over time.  These are all obviously very complex issues, affected and influenced by individual, ethnic, generational, and religious differences.  But we all–particularly those in the media–should at least strive to keep our terms and definitions as accurate and appropriately descriptive as possible, for the sake of ourselves and our loved ones.