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Q and A: Can My Character, Who Has Been in a Prolonged Coma, Awaken, Fake His Coma, and Commit a Murder?

23 Jan

Q: I plan to have someone awaken from a coma to commit a murder. My current thinking is that the subject will have been in a genuine coma but awakens and, with the help of an accomplice, decides to carry on as if they are still in the coma.

Is it possible to fake a coma and fool the staff looking after them? Can a coma patient be cared for at home and simply have visiting medical professionals? This would obviously make it easier to carry on the deception when required. Is it plausible that someone could surface from a coma, carry out the murder, and still maintain the wasted appearance of someone who hasn’t moved in several years?

T. Cartledge

A: All this works except for your time frame.

Comas are funny things. They can last for a few hours or many months, even years and decades. When someone begins to awaken from a prolonged coma they usually do so gradually and in fits and spurts. That is, they will begin to become restless, open their eyes off and on (at first unfocused and then more focused), move their extremities (initially without purpose but gradually progress to more purposeful movements), and then speak (progresses from non-sense or just random words and sounds until they gradually begin to communicate). Though it is possible that someone in a long-term coma could suddenly awaken and be fully alert, the progression I described above would be more likely.

He would have no memory for the time he was comatose and might or might not remember what came before. This is called retrograde amnesia. This loss of memory could go back any period of time before the incident that caused the coma—a few minutes, a few hours, days, months, years, or forever. And his memory of previous events might be partial, spotty, or complete. It may return slowly over days, weeks, or months or very quickly. All is possible.

This is very general and each person reacts differently. This process from first arousal to full wakefulness might take a few hours, days, weeks, or months. This process is highly variable, but in general, the longer the coma, the slower the return to normal.

Yes, he could fake the coma but the problem is that with his slipping out of the coma slowly and erratically, he would not be “with it” enough to fake it and to enter into a conspiracy with another person. This takes full control of his faculties and that’s just not the case with long-term comas. But once he was fully awake and ware he could fake his coma.

Yes, a coma victim could be treated at home and this is not uncommon. It often requires special care but this is available. The main thing is that he is fed, kept well hydrated, moved frequently to prevent bed sores.
If he were indeed in a long-term coma, he could not simply wake up, get out of bed, and go kill someone. It would take weeks before he could even walk. That’s the problem I have with your time frame. Besides all the things above about awakening from a long-term coma, a coma of several years would cause severe muscular wasting in the victim. It would take weeks or months of physical therapy and strength training before he could go out and harm someone.

But, if you make the coma only a few days or a few weeks, then he could awaken quickly, fake his coma, and then have the strength to sneak out and do the deed.

 
6 Comments

Posted by on January 23, 2012 in Medical Issues, Q&A

 

6 responses to “Q and A: Can My Character, Who Has Been in a Prolonged Coma, Awaken, Fake His Coma, and Commit a Murder?

  1. Fritz Strobl MD

    January 23, 2012 at 1:55 pm

    Great answer by Dr. Lyle! As a neurologist, let me add a couple other things – after a few weeks, most patients will need a nasogastric (NG) tube for nutrition and ultimately a trans-abdomenal gastic feeding tube. Then there is the unpleasant foley cather in the urinary bladder that has been there since day 1. It could just be clamped and re-connected when they run out and do their deed, I suppose. As could the feeding tube. Just a couple practical considerations.

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  2. Laura Mitchell

    January 24, 2012 at 7:55 am

    If your character is in a coma for more than about 3 days, he/she will have difficulty walking at the very least, and possibly difficulty with fine motor movement. Research in the 1990s on the efficacy of bed rest for preterm labor found that after about 72 hours, muscle atrophy starts and the gastrointestinal system slows way down (as I recall, the investigators looked at previous studies about bed rest and immobilization and I believe the nurse researcher was Judith Mahony).

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  3. M.E. Anders

    January 24, 2012 at 1:45 pm

    Thanks for answering this question! I have one of my characters in a coma, and she awakens in a crucial point in the story. I was wondering what side effects she might experience as a result. I appreciate your clueing us in.🙂

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  4. wil a emerson

    January 28, 2012 at 10:27 am

    One patient I remember well who had been in a coma for about two weeks asked one simple question when fully awake and coherent:
    “Who killed J.R.?” Of course, the answer had been revealed years before but that was the state of her brain. She was being cared for by several people too young to know the show Dallas…and at first thought something suspicious was going on. Luckily, medical settings are full of people of various ages…everyone had fun discussing the event and informing the neophytes. And the patient slowly regained a marginal degree of awareness to present day events.

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  5. Carolyn Perry

    May 18, 2013 at 4:04 pm

    Is this possible: The patient has liver failure. Is admitted to hospital. Just before being dismissed goes into a ‘coma’. The family is told she is not expected to live. A little over 36 hours later, she wakes, gets out of bed ( which for months has had to have help), and asks :”What’s going on?’ Doctors dismiss her within 2 hours.???

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    • D.P. Lyle, MD

      May 19, 2013 at 7:00 am

      Carolyn–This sounds like a real life situation and for Medico-Legal reasons I never comment on such cases. If it is for a work of fiction, please visit my website and submit your questions according to the instructions there. Thanks. DPL

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