To Him, It Was Still 1988: The 'Coma Cop' Awakens

GARY DOCKERY'S FAMILY THOUGHT the end was finally near. For 7 1/2 years he had lain in a nursing home, sometimes grunting or grimacing and occasionally blinking his eyes. Now fluid was filling his lungs, and doctors said that if he didn't have surgery, the 42-year-old former cop wouldn't survive much longer. His relatives gathered to consider the grim options: Was there any point in operating, when Gary was not expected to walk, talk or regain full consciousness? Was this the humane way to let him die after being shot in the head in 1988? As his sister, Lisa, murmured to him at his bedside at Parkridge Medical Center in Chattanooga, Tenn., last week, Gary suddenly replied. "Uh-huh." "You're talking!" she exclaimed. "I sure am," he answered. She quickly dialed their brother, Dennis, and put Gary on the phone. "Hey, buddy," he said. "I couldn't believe it was him!" said Dennis. "I started screaming his name -- "Gary! Gary!' "

Once he started talking, Dockery wouldn't stop. For the next 18 hours, he joked, reminisced and astonished friends and relatives with his recall of his former world. He recognized his sons, Colt and Sean, though they are teenagers now. He thought Ronald Reagan was still president. He remembered the names of his horses, the color of his Jeep -- everything but the gunshot blast that sent him into oblivion when he responded to a 911 call. Doctors finally sedated him in preparation for the lung surgery, and relatives braced to possibly lose him again, even as news reports were bursting out of Chattanooga, declaring "Man awakens from seven-year coma!"

Neurologists across the country didn't believe it. They said it was more likely a misnomer than a miracle. A real "coma" -- a state of sleeplike unconsciousness -- almost never lasts more than a month or so. Patients who don't die or recover then slip into a "vegetative state," where they may wake, sleep and move involuntarily but remain unconscious. There are only a handful of documented cases of patients awakening from vegetative states after more than a year, and experts concluded that Dockery hadn't been in one. "Everyone loves to think of this case as Rip Van Winkle, but it wasn't," said Dr. John Caronna, a neurologist at Cornell University Medical College. Instead, reports that Dockery had sometimes blinked once for yes, twice for no, indicated that he was in a twilight zone with some awareness -- a condition with no official name, even though it is more common than prolonged vegetative states. Neuropsychologist Joseph Giacino calls it a "minimally responsive state." He is chairing a task force for the Brain Injury Association to clarify the definitions to prevent misdiagnoses.

The distinctions are critical -- particularly when some ethicists are urging Americans to sign living wills and encouraging relatives to withhold treatment in cases where recovery seems impossible. Patients who have some awareness are more likely to respond to familiar sights and sounds than those in vegetative states, so their conditions may not be as "hopeless." But determining a patient's status can be difficult. Desperate family members may insist that a hand squeezed back or eyes blinked an answer when the action was only reflexive. Even some doctors misuse the terms. "If someone is in a minimally responsive state and a doctor calls it vegetative, that's a huge error," says Giacino.

Given the facts of Dockery's case, experts said his "recovery" should not bring anguish to families who have ended life support for loved ones -- or raise false hopes for those still lingering. They don't know what it means, because they don't know why he suddenly started speaking. But at the Coma Recovery Association, a support group in Elmont, N.Y., president Florence Manginaro was elated at the news. Her son, Scott, was burned in a fire, then given a massive overdose of morphine when he was 8 years old. Now 24, he has said only a few words in the last 16 years, but she still hopes he'll improve: "People say we're in denial -- but who cares? It took Gary Dockery seven years to let us know that he was in there."

Late last week, Dockery's prognosis was still uncertain. He was awake after the lung surgery, and moving his arms and legs, but doctors could not predict if he would speak again, or regain more body functions. That put the "miracle" into perspective, too. "I'll put it bluntly," said bioethicist Arthur Caplan. "If there is only a 1 in 10,000 chance that you might come out of a "coma' for one afternoon after seven years, and still be severely brain damaged, would you want to be kept alive?" If the question were put to Gary Dockery, would he blink once for yes, or twice for no?