Response

Pay close attention to all signals a comatose person sends

To reach a comatose person, we will have to part from our usual ways of communication. We need to adapt to the world of coma, so we must try to speak in its language. Even if you don't possess proper knowledge and skills regarding, a loving approach in which you show you're willing to accompany, will help establishing a form of contact. Show yourself willing to communicate and sympathize with his/her possibilities, knowing that those are often very limited. Try to pick up the (form of) language he/she wants to speak with you.

When a reaction is perceived,  however small or subtle it may be, tell the comatose person you noticed it, after which you encourage to repeat and fortify it. The more response is given, the better a communication can be build, that's the rule in general, but do know that also a very small reaction can be of great significance.

Be patient and take your time. When no response is noticed, or reactivity is reducing, take a break, take your time and try again later, perhaps in another way. Reactivity can be influenced by medication (morphine, painkillers) which have a possible delaying effect on response. In case of brain damage it can take a while, or be harder to communicate with the comatose person, depending on the level of damage, or depending on the length of the coma. Response can be minimal at first or hardly noticeable, and building contact or gaining response might take time and also patience. On the other hand, people don't function as machines do, creating the possibility of someone heavily injured rehabilitating faster than expected even in a case of less injury. The way things will go is hardly predictable.

Keep a diary with all reactions you've perceived, including the circumstances in which there was response, for example; a twitch of an eyelid happening when someone approaches, a distinct response to music, speech, touch, or any other approach to establish contact. Pay close attention to consistent or frequent forms of signal, those can soon be used creating a binary communication, which allows the comatose person to respond with these signals, in a “yes” or “no” kind of way.

Response can occur in many shapes; a subtle movement of a finger, toe, mouth, nostril, eyebrow, an arm or leg, a hand, or any other moveable part of the human body. Also, coughing, gargling, swallowing, sighing, tears, making any sort of a noise,  a small tic, looking in a certain direction, and opening or closing his/her eyes can all be important signals from out the comatose world. Whenever you let know that you noticed his/her signals, however small they may be, this person will know that you are able to understand these signals. He/she will understand that the language chosen enables the both of you to connect with each other.

Do know, that even the smallest of reactions can be a doorway to communication.

CONTACT

A minimal response might be an important step

In the impressive movie “Lorenzo's Oil”, a 10 year old boy went into a coma, due to a brain disease. At a certain point, he's able to tell his parents by rolling his eyes away, that he doesn't enjoy them reading him a certain book. Because of this repeating signal, the parents start to understand that they're able to communicate, and can now gain an answer to an asked question. Lorenzo answers “no” when rolling his eyes back, and “yes”  by looking up and doing nothing. Later on, they stimulate Lorenzo gently by repeating the words: "Tell your brain to tell your hand that he is able to move your little finger." A small, minimal movement of the little finger will later on be a starting-point for further communication.

Two important things to keep in mind in dealing with a comatose person, is that all can be considered information, and information has to be communicated, and will be repeated for as long as it takes for it to be received.

An example from practical experience: a man went into a coma puts his left hand and fingers in a unnatural crooked position. The person with him puts her finger in the palm of his hand, whereupon he softly bends his fingers over hers. This is a positive response in which she replies by softly squeezing his hand, saying she has noticed the bending, and also saying she is squeezing his hand. She squeezes his hand, and he squeezes back harder, she squeezes again and he clenches. She says: you squeeze with your left hand which is very good, keep going as long as you want. He firmly squeezes her during several minutes, after which he relaxes, the woman relaxes her hand at the same time, and when she lets go, she sees his hand is now calmly stretched, and no longer in this artificial crooked position.

A communication has taken place. What the exact content of the communication was, can be subject of psychological contemplating, but to the helper, the woman in this example, merely unimportant. What is important, is that contact is established, and it's very understandable that a comatose person can yearn for communication. It’s good to know that this needn't take place in a spectacular kind of way, and can be happening in a short amount of time. Supporting someone in making a communication happen, can be an important link in completing his/her inner processes. We don't have to interpret with these processes.

Your nearness and loving effort to be in contact, can already be of great meaning to him.