More on Terry Wallis, who emerged from a coma after 19 years, in the news today:
Coma patient Terry Wallis gets help with a drink from his mother Angelee Wallis at Stone County Nursing and Rehab Center in Mountain View, Ark, last July. Terry, who had been in a coma after a 1984 automobile accident, began talking in June 2003.
LITTLE ROCK, Ark. - On the surface, it seems so simple: Why end a brain-damaged Florida woman's life when an Arkansas man this summer emerged from a yearslong stupor and asked for a Pepsi?
But answers among doctors show how complex the Terri Schiavo question really is, especially when compared to Terry Wallis, who spoke in June for the first time in 19 years.
"Some people have tried to compare these two and say that he is proof that she can recover," said Dr. James Zini, the Wallis family doctor. "But you cannot prove that."
Schiavo is at the center of a battle among her parents, her husband and Florida Gov. Jeb Bush, who ordered a feeding tube returned to Schiavo's body after her husband won a court order that it be removed.
A chemical imbalance shut down her heart, causing brain damage that pushed her into what some doctors say is a vegetative state.
Wallis, meanwhile, suffered head injuries in a car accident and slipped into a coma for a few months before emerging into a long fog that ended this summer - though his brain function remains limited.
Doctors say that despite several similarities, the two cases have little in common medically.
"Her injury appears to be more significant than Terry's," Zini said.
In addition, the media's imprecise use of terms such as "coma" and "vegetative state" have unfairly blurred the lines between the two cases, said Dr. Michael Wienir, associate clinical professor of neurology at UCLA.
"These are complicated terms that deal with awareness of environment, cognitive capability and intellectual function," said Wienir, who consulted on the Wallis case at the end of the summer.
The American Academy of Neurology sets guidelines for states of consciousness. Wienir describes two separate scales for people with brain injury, one for responsiveness and another for consciousness or brain activity.
"Coma can be thought of as an on-off switch with a dimmer," he said. "The levels between on and off are awareness. But then, to be human, there must be cognitive ability, the ability to use language and think."
The awareness scale is used for a short-term diagnosis. If the person's only response to pressure is a reflex action and nothing else, he or she is in a coma. A patient in a "stupor" can be briefly aroused but is still not aware.
The consciousness scale is used to describe longer-term mental status. If the patient isn't arousable and not aware and doesn't follow normal sleep patterns, he or she is comatose.
Once the eyes open, he or she is said to have come out of a coma, but may remain in a "vegetative state," incapable of responding voluntarily. After a month, the term "persistent vegetative state" is used; after a year, "permanent vegetative state" may be the diagnosis.
"When a patient is comatose, the switch is off; when they're vegetative, the current is on but all the lamps are burned out," Wienir said.
A third status, "minimally conscious state," has been added recently to describe people who display inconsistent but clearly discernible evidence of consciousness.
Wienir has only seen Schiavo in home videos shown on television, but he believes she displayed at least minimal consciousness.
Wienir said Wallis was probably fully conscious almost immediately after coming out of his coma in the fall of 1984 and was simply too brain-damaged to communicate for some time.
Also, Wallis was placed on the anti-depressant Paxil just months before he began talking again, which Wienir suggested may have helped him overcome other hindrances to speaking.
"Neither Terri Schiavo now, nor Terry Wallis before he began to talk again, were in comas," Wienir said. "And my supposition is that Mrs. Schiavo is even a step above being vegetative, but she is in much worse shape than Terry. It's highly improbable that she would be rehabilitatable."
Still, some similarities are striking.
Both are 39 years old, suffered serious brain injuries as young adults and lived for more than a decade with their eyes open but their brains apparently closed to the world around them.
Both went from vibrant and attractive to middle-aged invalids with sagging facial features.
Schiavo has been on a feeding tube throughout. Wallis was on a feeding tube for the first three months after his accident. Doctors said he wouldn't take food by mouth, but his mother, Angilee Wallis, said she coaxed him to drink some broth on Thanksgiving Day 1984.
Both had family members who fought for them against doctors or other family, insisting they were responsive. For Wallis it was grunts at the mention of a car he didn't like. For Schiavo, it was her eyes following balloons and smiles after kisses from her father.
But medical experts in Florida have testified in Schiavo's right-to-die case that she is in a persistent vegetative state, which means she cannot possibly respond to the outside world voluntarily. Zini and other doctors who diagnosed Wallis were not convinced for many years that Wallis' utterances were voluntary.
The similarities even piqued the interest of Wallis' daughter, Amber, who was born just before his accident and has recently broken away from Wallis' estranged wife to participate in his daily care.
Angilee Wallis says Amber e-mailed Schiavo's parents, touched by their fight against Michael Schiavo, the husband who wants to remove Terri's feeding tube.
Angilee says she thinks parents know more than spouses about their children's well-being, although there are more legal bonds for spouses than in the parent-adult child relationship.
But Wienir and Zini, both of whom say they hope Schiavo keeps her feeding tube as long as her family wants it, said it is important to separate emotion from the medical facts.
Wallis' sister, Tammy Baze, was able to take that to heart.
"I never give up," said Baze, who was told by St. Louis doctors that she would need a heart and liver transplant and then found out she was fine just a few weeks before Wallis started talking again.
"But I couldn't really give an opinion on (Schiavo) because I'd have to know the person. Each one's different, and even the doctors can't know for sure whether they can recover."
Answers everywhere, proof impossible in debate over comas -
All sides in debate over comatose find beliefs hard to prove -
Media's imprecise use of terms such as "coma" and "vegetative state" have unfairly blurred the lines between the two cases, said Dr. Michael Wienir, UCLA associate professor of neurology, on deceptive, imprecise terms like'coma' and 'vegetative' state. "These are complicated terms that deal with awareness of environment, cognitive capability and intellectual function," said Wienir, who consulted on the Wallis case at the end of the summer.