Going into a coma can be a frightening and mysterious experience. For those who have emerged from a coma, there is often confusion about what happened to them and uncertainty about recovery. While comas can vary dramatically, some common themes emerge from personal accounts of coma experiences.
What is a coma?
A coma is a profound state of unconsciousness in which a person cannot be awakened. It is usually the result of a serious brain injury, such as from an accident, stroke or lack of oxygen. The brain damage causes the person to become unresponsive to their environment. They do not open their eyes, speak or follow commands. Comas can last for hours, days, weeks or sometimes even years.
There are different levels of coma, from deep comas where there is no response at all, to more shallow states where the person may respond minimally to touch or sound. Doctors often describe comas in ranges from a 3 to 15 on the Glasgow Coma Scale, which measures eye, verbal and motor responses. A lower score indicates a deeper coma with less response.
Going unconscious
For those who remember their experience going into the coma, the process is usually described as drifting into unconsciousness. Some may recall a specific moment of suddenly feeling sleepy or dizzy before blacking out. Others describe more subtle sensations of their thoughts slowing down and a gradual inability to respond to surroundings.
The last thing people often remember before going into coma is an emergency situation or traumatic accident that caused the brain injury. The moments leading up to the coma are often marked by pain, fear, confusion or desperation as they try to process what is happening.
Causes of slipping into coma
Common causes of going into coma include:
- Severe head trauma from an accident or injury
- Lack of oxygen to the brain from near drowning, heart attack, stroke or other conditions
- High or low blood sugar, liver or kidney failure
- Exposure to toxins or drugs
- Infections like encephalitis, meningitis, seizures
In many cases, a combination of factors contributes to the coma, such as both head injury and loss of oxygen.
Being in a coma
The experience of being in a coma varies dramatically from person to person. Some common themes emerge, though each journey into the depths of unconsciousness is unique:
Nothingness
For many coma patients, the experience is simply one of nothingness. Some describe it as being in a void or thick, black darkness. With the brain so impaired, they have no sense of time, space, sensations or any ability to think or feel.
Confusion
As coma patients start to regain some level of awareness, they often describe profound confusion. They may have no understanding of where they are or how much time has passed. Simple cognitive functions feel impossible. Processing information from senses like hearing or touch becomes challenging.
Detachment
Along with confusion comes a sense of detachment from oneself and one’s environment. Coma patients with minimal consciousness may have fleeting awareness of voices or activity nearby but feel completely separate from it, like an outsider looking in.
Dreams
Some coma patients experience vivid dreams and nightmares, while others report no memory of any internal experience. Dreaming likely depends on the level of brain function. Deeper comas may not have the neural activity needed to generate dreams.
Trapped
A common theme is feeling trapped inside one’s own body, unable to communicate or move. There may be terror, loneliness or desperation associated with this isolation. Patients often try desperately to reach out but can’t make themselves heard or understood.
Impaired senses
Coma patients may retain some sensory awareness but have a hard time interpreting it. Auditory input like voices may sound distorted or far away. Vision is often impaired, with blurred shapes and difficulty making sense of visual stimuli. Sensations like touch or pain may be dulled or muted.
Time distortion
With no internal sense of time, minutes, days or weeks may blur together. Some report losing all concept of time passing, while others describe time slowing down significantly. Moments seem to stretch out indefinitely.
Alertness fluctuations
Coma rarely involves a continuous state of unconsciousness. Patients describe drifting in and out of higher levels of alertness periodically. There is huge variation in responses depending on factors like severity of injury and medications.
Memory gaps
Most coma patients have spotty memory at best from their time unconscious. Periods of the coma are often completely lost. Others have brief flashes of specific sensations or moments that stuck with them.
Drug-induced effects
Medications like sedatives or pain killers can also impact the coma experience. Some patients report having bizarre, drug-influenced dreams. Others describe numbed emotions or sensations from medications.
Coming out of the coma
Waking from a coma is usually a gradual process as the brain recovers enough to regain consciousness. Some key phases and experiences may include:
Seeing light
Blurry visual sensations like seeing light or color are often an early sign of returning awareness. Eyes opening or moving in response to stimuli also indicates emerging consciousness.
Sound awareness
Stirring in response to voices or noises nearby is another indication of rousing from coma. Sounds may still be muffled or distorted.
Reflex responses
Involuntary physical reactions like swallowing, coughing, yawning or moving arms and legs can precede conscious responses. Reflexes suggest the brain stem is reconnecting.
Touch reactions
Responding physically to touch, such as by pulling away or reaching out, is a promising sign of returning awareness. Reacting indicates some recognition of sensations.
Regaining consciousness
As brain activity increases, coma patients describe drifting back to consciousness. They may cling to last memories before the coma or have no recollection of what happened.
Communication attempts
Patients may try to speak or respond to questions but have great difficulty formulating words and language. Communication comes haltingly at first.
Confusion and agitation
Confusion often accompanies the return to wakefulness. Patients struggle to understand where they are and what happened. Agitation is common as well.
Recognition of family/friends
Connecting with familiar faces and voices of loved ones represents a major milestone toward rejoining the conscious world. Memory and emotional bonds start to re-form.
Regaining sensation
Sensory awareness like pain, touch and temperature return, though may still be dulled. The environment feels more real as senses revive.
Grasping situation
Comprehending what caused the coma and the consequences of lingering deficits takes time. As thinking clears, questions and emotions run high.
Physical sensations in coma
In addition to mental experiences, some physical sensations are commonly reported by coma patients as well:
| Sensation | Description |
|---|---|
| Hearing | Muffled, echoed voices or inability to comprehend sounds |
| Vision | Blurry, unfocused vision with difficulty seeing |
| Numbness | Lack of sensation in parts of body, tingling or paralysis |
| Pain | Headaches, muscle pain or intense discomfort from injury or immobility |
| Dizziness | Spinning, floating or unbalanced sensations |
| Weakness | Heavy limbs, inability to voluntarily move body parts |
| Sleepiness | Irresistible urge to sleep, constant drowsiness |
| Fatigue | Exhaustion, lack of energy, feeling drained |
| Nausea | Urge to vomit, gagging reflexes, queasy stomach |
These kinds of physical responses provide clues about recovering brain stem function and transitioning out of deeper coma states.
Coma patient experiences and stories
Listening to personal accounts from coma survivors sheds light on this perplexing experience. Here are some real examples:
Ben McMahon – diving accident
Ben McMahon slipped into coma after nearly drowning in a diving accident. He remembers suddenly feeling pins and needles all over before passing out. During the week-long coma, he had vivid nightmares of being murdered by a man with an axe. He felt completely conscious but trapped in darkness.
Trenton McKinley – bull riding accident
A serious head injury while bull riding left Trenton McKinley in a medically induced coma. He described the experience like being asleep and waking up periodically to glimpse hospital staff before fading back to unconsciousness. He had no sense of time passing.
Raijon Daniels – car accident
After a car collision, Raijon Daniels spent 3 weeks in a coma. He recalls having bizarre, frightening dreams involving demons that felt intensely real. When he started emerging, he remembers staff moving his limbs in physical therapy before he could move voluntarily.
Natalie Købke – pancreatic tumor surgery
Natalie Købke went into coma during pancreatic surgery. She felt trapped inside her own mind, unable to speak or communicate despite hearing doctors working to revive her. She experienced powerful hallucinations influenced by medications.
Nancy Robertson – encephalitis
Nancy Robertson contracted encephalitis which caused coma. She described feeling like she was drifting in a void of nothingness for an eternity. She believes she occasionally perceived loved ones at her bedside on some level.
Andrew Marr – stroke
A stroke left BBC reporter Andrew Marr in coma for 3 weeks. He recounts floating in a dreamlike state and having to slowly relearn words and speech when he first woke up, which was terrifying.
Eben Alexander – bacterial meningitis
Neurosurgeon Eben Alexander recalls his week-long coma from meningitis as experiencing vivid, hyper-real dreams and sensations. He felt guided towards unconditional love and inner peace.
Stages of coma recovery
If the coma was medically induced, return of consciousness can begin soon after sedation is lifted. For ongoing comas, recovery follows a rough progression as the brain heals:
| Coma stage | Level of consciousness |
|---|---|
| Deep coma | No eye opening, no response to stimuli |
| Minimally conscious state | Inconsistent but detectable awareness |
| Emergence from coma | Gaining more consistent responses |
| Post-coma amnesia | Conscious but disoriented, memory gaps |
| Coma recovery | Orientation improves, follows commands |
| Brain rehabilitation | Relearning cognitive skills, regaining function |
The pace and extent of recovery depends on the severity of injury and area of the brain impacted. Some may progress steadily while others plateau at certain stages.
Prognosis after coma
The longer someone remains in a deep coma with no signs of waking, the less promising the prognosis. Many patients emerge within 2-4 weeks. Potential complications include:
- Permanent vegetative state – no awareness, only basic reflexes
- Minimally conscious state – intermittent, minimal awareness
- Lock-in syndrome – awake but unable to communicate or move
- Brain death – no brain activity, brain stem failure
- Multi-organ failure – other organs shutting down
- Secondary infections – pneumonia, blood clots, etc.
Patients who regain consciousness face a long rehabilitation. They may have problems with:
- Speech and language
- Vision and hearing
- Memory and thinking skills
- Behavior and personality
- Physical abilities like sitting, walking
- Self-care like eating, dressing
- Bladder and bowel control
Support from specialists in neurology, physical therapy, occupational therapy, psychology and rehabilitation medicine improve the outlook.
Conclusion
Going into and recovering from a coma can be a perplexing, frightening ordeal. While rarely experienced, accounts from survivors provide a window into this phenomenon. Though each case has unique features, common themes around sensations, time perception, dreams, confusion and gradual awakening emerge. Understanding some of the typical phases and sensations may provide comfort and insight to those recovering from coma.