Module 2: Portraying Patients

2.4 Moving images

One of the key differences between short comas and the vegetative state is that vegetative patients can make facial expressions and may even sometimes move their head or limbs.

Eye-opening is often used in the media as a sign of a patient becoming conscious, and if a patient cries, smiles or turns their head a common-sense interpretation is that they must be aware. However, all these signs are compatible with a vegetative diagnosis and being completely unaware of yourself or your environment. Interpreting any behaviours can be a complex process and families may be encouraged by the patients clinical team to film such moments on their mobile phone to enable discussion and assessment.

The family members that we interviewed often talked about the hope they felt when they first witnessed such things, but over time, with no further changes, and when they could see these behaviours occurred rather randomly, most eventually came to accept the clinical diagnosis. But they were sometimes left with questions. Might clinicians be wrong? Is there more to consciousness than is understood by current science?

Listen to one man describe visiting his brother in a vegetative state.

Many families, and staff, often treat vegetative state patients as if they might be aware. This is partly to allow for even the slightest possibility that there is any momentary or fragmented awareness, and partly because it can seem the only dignified way of treating a warm, living body or respecting the individual’s ‘personhood’.

Video/film of unconscious patients apparently responding can become generate intense interest. One famous patient who’s case attracted considerable interest is Saudi Arabia’s Prince Saud bin Abdullah bin Faisal bin Abdulaziz Al Saud. He was  injured in  a car crash in 2005. After many years of unconsciousness he became known as ‘the sleeping prince’. When  video was shared in 2019 of  him moving his head this went viral with many people on social media interpreting this as meaning there was some sign of recovery. (He died in 2020, again, apparently without ever regaining consciousness).

 

Khalee Times

Such images can also become very politicised when families are in conflict with doctors, or one another, about whether or not a patient is conscious or what the right way forward is for their treatment. Videos can be released into the public domain as ammunition in such disputes via the mass media (and also, now, via platforms such as Youtube). This is what happened in the Terri Schiavo case, when her parents provided video clips to be shown on TV news. They wanted to demonstrate that their daughter was conscious, and some journalists, and members of the viewing public, took the clips at face value. The video clips appeared to show her smiling at her mother or her eyes following a balloon (Walker, 2006; Walman, 2006). In addition, analysis of newspaper reports about Schiavo found that one quarter of the reports held out the possibility that she might improve or recover (Racine et al., 2008). However, everything shown on the videos was compatible with the permanent vegetative state. There was no inconsistency between what the videos showed (as opposed to how they were interpreted) and her formal clinical diagnosis.  Information revealed at her post-mortem also showed that she had cortical blindness – loss of vision caused by damage to the brain’s occipital cortex.

Terri Schiavo’s brother, Bobby Schindler, continues to be a strong campaigner for the ‘right to life’. He has been involved recently in supporting parents in the UK fighting for continued treatment for their young children such as Charlie Guard.  (See an example here: https://www.lbc.co.uk/radio/presenters/ian-payne/killing-is-not-the-answer-says-brother-of-uss-char/)

You can hear him give his account of what happened to his sister on the website https://terrischiavo.org which ‘serves as a tribute to Terri’s memory and a resource for those looking to understand what her life was like, what happened to her, and why we should remember.’ Some of the original videos are available there too.

Journalists can sometimes fail to understand, or to convey, the nature of the vegetative condition and this can lead to misleading messages being presented to the public (and to family members). Formal film analysis is particularly powerful here, and there are some fascinating studies about the careful selection of home video clips and how they are used on TV news. See below, for reference to a couple of very pertinent articles.
Activity 1  – revisit your drawing

Look back at the drawing of a vegetative patient you sketched at the start of the course. Does the person have their eyes open or closed? Are they lying down or sat up in a chair? Are they alone or with other people, such as staff or family and friends. If you included any family or friends are there efforts to engage the patient in any way (reading a book to them, leaning over to try to make eye contact?). What imaginations about the vegetative state are captured in your drawing?

Now click on the two rows below if you want to see additional activities that might be pursued (when this is done as part of a formal University degree programme) or move on to the next unit

Activity 2 - additional option: Engage with formal film analysis of family videos released into the public domaine. (Click here for further details)

(Estimated time 1 hr)

If you’re interested in visual or film analysis you will be very interested in these articles from the film journal, JumpCut:

  • Walker, J (2006) ‘The videographic persistence of Terri Schiavo’- https://www.ejumpcut.org/archive/jc48.2006/SchaivoWalker/index.html
  • Waldman, D (2006) ‘Schiavo videos, context and reception: timely triage’.https://www.ejumpcut.org/archive/jc48.2006/SchiavoWaldman/index.html

You also might want to read Cranford, R (2005) ‘Facts, Lies, and Videotapes: The Permanent Vegetative State and the Sad Case of Terri Schiavo’.

Full references and links are in the penultimate module of this course (in “Resources”).

Activity 3 - additional option, write a review an episode of a TV series (Click here for further details)

(Estimated time: 2 hrs) 

Watch the Series 2 Episode 12 of the medical drama series, New Amsterdam. Write a review drawing on your media analysis skills combined with the additional learning from this course. Questions to start you off might include:
  • What is the significance of the title of this episode: “14 Years, 2 Months, 8 Days”
  • How is eye-opening and the sounds the patient makes explained?
  • How is this similar to, or different from, how these are represented in other TV dramas or films?
  • What evidence is there of efforts to be informed by medical expertise about the vegetative state and to attempt realism?
  • What part in the narrative is played by different characters and how is dialogue used?
  • What image is promoted of doctors and other people involved in caring for the patient?
  • How does the representation of the permanent vegetative state shown in this episode fit with the genre and approach of New Amsterdam as a series?