Dr. Adrian Owen “Into the Grey Zone” – book review

I have a highly subjective view of this book. My grandmother fell over in November 2016. She injured her head (before that day she was still working as a GP part-time, at the age of 78). Ever since then she has been in a coma, or more accurately “minimally conscious”. What that means is that she opens her eyes of her own will and responds to pain and other stimuli: sometimes she will squeeze your hand when you ask her, and sometimes she won’t. How exactly conscious is she of what’s going around her, we don’t know, and we don’t really have a way to find out yet.
I was looking for a book that had a scientific perspective on what Dr. Adrian Owen calls “the grey zone”. If I had to read something about many miraculous awakenings, I think I would want to set it on fire. But likewise, if I had to read a book about the necessity of euthanizing all those patients, I would also want to set it on fire. So yeah, let’s say, I was looking for “balanced”.
Owen’s account is highly readable and highly scientific. He describes the story of his research into various comatose states in a way that is easily accessible to those without a medical background. His narrative includes events of his own life that had an effect of his work – his mother’s death of brain cancer, and his ex-girlfriend’s vegetative/minimally conscious state.
His insight into both the clinical and personal aspects of taking care of those patients makes a crucial difference. He obviously acknowledges that families might imagine consciousness when it’s not there. But he is also happy to acknowledge that in many cases families know the patient much better than their doctor—especially in cases when the medical practitioner has never known a patient in their conscious state—and might actually notice reactions much better than the assigned doctor. Owen’s tact and ability to compromise make this book particularly appropriate for relatives of sufferers.
Here are some of the crucial insights I got from this book:
1. We are learning more and more about the brain, and it is possible for Owen to make contact with about 20% of vegetative patients in a PET scanner (see more here).
It is a sensational discovery, but remember – it still means that in 80% of cases there was no way of making contact. However, there are still a few caveats. Owen reports a case in which his team could not discern any brain activity when a patient was watching a movie. The patient, however, was one of the lucky few who recovered from his comatose state. He remembered not only the movie but also meeting Owen and his team. Basically, we’re learning a lot about “the grey zone”. But there’s still a lot we don’t know about how the brain works.
2. Minimally conscious patients are more difficult to communicate with using the PET scanner. We don’t know exactly why that is. Owen suggests a hypothesis that these people are drifting in and out of consciousness– as we would out of sleep, which makes them difficult to communicate with.
3. When people are watching a movie in a cinema together, the same basic areas of the brain activate. The details will be different, but we have the same response to surprises, loud noises, and new faces. This is a digression, but I found this fact fascinating. So there you go.
4. Last, but not least: Human life is incredibly fragile. Reading about the cases described in Owen’s book reminded me of that: whether young or old we never know exactly how much we have left. We need to make the most of the time we have.

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