Physician perspective: Stephan Mayer, MD, Columbia University
When a 31 year old stroke and seizure patient, who had been comatose for weeks, walked into Dr. Mayer’s office nearly a year later, he reacted with shock. “When he walked in, I almost fell over. I really thought there was no hope. It was at that point that I realized that we knew absolutely nothing about the recuperative power of the brain,” Mayer remarked. As the field of neurocritical care advances and pushes the envelope of technology and innovation, hope is renewed for patients who once were consigned to death or severe disability. “Doctors are telling people there’s no hope when, in fact, there is. We have to push the envelope and do things that at least are well-grounded in the scientific evidence that is available.” Dr. Mayer notes. Remarkably, the patient mentioned later said he was able to hear nurses and doctors speaking about him, even when he appeared to have limited brain activity. According to Dr. Mayer, “[The patient’s] great recovery reflects the brain’s innate resilience and ability to recover, which I believe has been vastly underestimated to date. It has been underestimated because we never saw any long-term outcomes, because we have always let them die assuming the outcome would be terrible.” Today, many neurointensivists apply a variety of new monitoring and interventional techniques that are improving outcomes each year.