A friend with muscular dysprothay has been unconscious in RPA hospital
in sydney for the last seven days.   My question is. -- Would he have
any memory or felt anything during this period of time?

Good question. Having been unconscious in a hospital once myself, I do
know that it is possible. But I don't want you to just take my word
for it, so here is some more "conclusive" data on the matter.

First lets take a look at the two different types of memory we would
be dealing with here. There is the explicit, and the implicit.
 The conscious recollection of stored information is termed explicit
memory, whereas the unconscious retrieval is termed implicit memory.
We have all had implicit memories. It's the stuff that you know, but
can't really recall how you know, or when you first became aware of
it.


Here are some examples of studies involving implicit memory:

http://www.omnihypnosis.com/canyou.htm
Excerpt: "To see if another scientist could achieve similar results,
Mainord contacted Chicago neuropsychologist Barry Rath. Intrigued,
Rath "leaned down to the ears" of 44 still-unconscious patients last
year, he explained recently. To half, he whispered "good suggestions"
such as, "You will feel little pain, you will be able to urinate
easily and you will recovery quickly." To the other half, he whispered
a "nonsense" message such as, "It's a beautiful day."
Like Mainord, Rath was amazed by the results. "The people getting the
'good suggestions' did substantially better post-operatively," said
Rath. "They reported less pain on a scale of 0 to 10, they asked for
and used less pain medication and they were discharged from the
hospital an average of one and a half days sooner than the others!
None of his patients consciously recalled anything being said to them,
though some in a hypnosis-like state, were able to recognize the
phrases that had been spoken to them."

http://www.imprint-academic.demon.co.uk/T2000/04-09.html
"Although the patient often cannot consciously recall events, he or
she may respond to suggestion given directly to an attentive
subconscious mind (Rossi & Cheek, 1988). "

So, from a scientific standpoint, it is hard to say whether or not
your friend will have any memory of this time. The perception of pain
or feelings will be there, but the chances of it being recalled at a
later time is doubtful. However, there is enough data to suggest that
even though unconscious or comatose patients cannot wake up and give a
word for word account of things heard or felt while unconscious, they
are certainly open to suggestions.
So, what memories you friend would have of this time would be only
implicit memories.
Nurses and doctors often recommend to visitors,  that they speak
positively about the patient, and will often take the visitors or
family members outside of the room to consult about the patients case
or outlook, as not to "upset" the patient. Numerous cases have been
documented showing the marked improvement in unconscious/comatose
patients, after stimulating therapies. While one may not be able to
recall things while unconscious, there is evidence that suggest that
what one hears and feels can play a role in the recovery process.

chellphill-ga


Some links on the subject matter that you might find helpful:

http://psyche.cs.monash.edu.au/v2/psyche-2-15-willingham.html
An abstract on implicit memory

http://www.artsci.wustl.edu/~philos/MindDict/implicitmem.html
"Implicit memory is evident when the performance of a subject on a
task is improved despite the inability of the subject to consciously
recollect memories which facilitate to the task. In the case of H.M.
(a bilaterally lesioned frontal patient) he was unable to recollect at
all his past practicing of a given motor task (such as a video game)
even though his performance on the task improved at a normal rate.
Such evidence is cited to show a clear distinction between implicit
and explicit memory systems in the brain. Importantly, the
implicit/explicit memory distinction has nothing to do with the
conscious/unconscious distinction. Implicit memory should, perhaps, be
understood as non-conscious."

http://www.artsci.wustl.edu/~philos/MindDict/memory.html
The dictionary of philosphy of mind's definition of memory


http://www.scahq.org/sca3/newsletters/aug_lit3.shtml
Evidence for unconscious memory processing during elective cardiac
surgery.
 
http://www.imprint-academic.demon.co.uk/T2000/03-09.html
Unconscious/conscious processes

http://216.239.57.100/search?q=cache:2rRoV8rYWQAC:www.arts.uwaterloo.ca/~pmerikle/papers/uncons-percept-full.html+%22unconscious+perception%22&hl=en&ie=UTF-8
A Google cached site on:  Psychological Investigations of Unconscious
Perception

http://www.tomrichards.com/coma.htm
Coma work

(search terms used, "unconscious patients and memory recall" "implicit
memory +of +the unconscious""memory recall comatose patients")

Dear doug14-ga:

You do not mention the reason for your friend being unconscious. Is he
unconscious with or without the assistance of sedative drugs? Is his
coma deliberate or not?

Assuming that your friend is being kept unconscious in the intensive
care unit with the assistance of intravenous sedation
(http://www.medstudents.com.br/anest/anest4.htm) then the degree of
unconsciousness or sedation will be altered on a regular basis by the
ICU nurse and doctor.

If the purpose of sedating your friend is to allow him to tolerate the
discomfort of being on a respirator then the sedation will be adjusted
such that he is as awake as possible without feeling pain or
discomfort. This is a very subjective decision and depends very much
on the ICU nurse detecting non-verbal indications of the patient's
pain or discomfort. Many patients and family prefer the patient to be
awake so that they can interact with them.

The vast majority of patients in this situation will have some recall
of their sedated stay in ICU, but mainly as a very vague, blurred
memory. They rarely remember any specifics, including any painful
experiences. Remember that many of the drugs that are used for the
purposes of sedation have the effect of causing periods of amnesia
(http://www.infomed.org/100drugs/midaind.html).

Nevertheless, there are rare situations where patients can have
complete recollection of a period where they have been considered
unconscious. Excepting the paranormal, these situations occur when the
patient is effectively awake but unable to respond, for example when a
patient has been given a paralysing drug (either intentionally, or as
a venomous poison) but no sedating drugs. This almost never happens in
the Intensive Care Unit. Paralysis can also occur in patients who have
had very specific patterns of brain injury, such that they have the
sensation of being "trapped". You may also have experienced this
sensation when waking from sleep.

In the vast majority of situations doctors and nurses are able to
clinically assess the degree of "wakefulness" of a patient using
systems such as the Glasgow Coma Score
(http://www.trauma.org/scores/gcs.html) in combination with vital
signs such as heart rate and blood pressure. Doctors can also perform
detailed brain function testing to assess the ability of the brain to
perform complex and basic functions. These are essential before any
decision is made on brain death.

More technologically complex methods also exist to assess wakefulness,
such as Electroencephalography (EEG -
http://www.vh.org/adult/patient/neurology/electroencephalogramtest/)
which charts so-called "brainwaves". A more recent and simpler version
of this called the BIS monitor
(http://www.aspectmedical.com/newsletters/2002/fall/bis_needed.aspx)
has been used to check on patient wakefulness during anaesthesia for
elective surgery.

Ultimately, while it is likely that your friend may retain some vague
memories, he will probably not remember anything specific, or remember
any painful experiences.

The second question of whether he feels anything is a completely
separate issue. Even when we are completely asleep our nervous systems
continue to work. If you jab someone when they are mildly asleep they
will (usually) still withdraw. But they may not experience that pain
in their mind, and they may not even wake up or respond in any other
way. Dissociative anaesthetics (like Ketamine) often allow people to
be aware of pain, but not associate it as happening to themselves.
This may be because the pain signals are stopped before they reach
your brain, either by a local, regional, or other anaesthetic agent.
Thus if you know that something painful is happening to you, but you
don't "experience" a reaction of pain, then did you "feel" pain or
not? This is a philosophical question.

On the other hand, if you experience pain but nothing caused it, did
you have pain or not? Perhaps a question for next time.

regards,

jxc-ga

i am a non medical person. i can,t understand how my friend is
surviving. he is beng fed a light choclate coloured fluid through a
nasal tube. he has a tube connected to his penis. his bowels
apparently are non functioning and are expressed onto an absorbent
mat. he has a tube that is used to clear his lungs and has physio
twice a day to assist with phlegm in his lungs. but all the time he
appears to be asleep or barely aware of whats going on. his mother is
with him for 10 hours a day and when she feels that he may be aware
she reads to him. as he suffers from muscular dysprothay i wonder if
this is typical for this complaint?

Before continuing, please note that the following information is given
on the basis of your description. It may or may not be medically
applicable to your friend and you and the family should clarify the
situation with the doctors caring for your friend.

It sounds very much like your friend is critically unwell with a
severe stage of muscular dystrophy  such that he has no ability to
move voluntarily or breathe adequately for himself. In this situation
there is little option but to support his breathing for him by placing
him on an artificial respirator which can be performed through an
endo-tracheal tube (a tube through the mouth), or a tracheostomy (a
hole in the neck). This tube can also be used to suction out sputum
and other secretions. Usually these are temporary interventions but a
tracheostomy can be permanent.

The tube in his nose is probably a nasogastric tube placed into his
stomach used to feed him as he is unable to eat for himself. This is
necessary to try prevent him from becoming critically malnourished.
Unfortunately, he also has no ability to control his bowel actions,
either, hence the absorbent towel.

The tube in his penis will be a urethral indwelling catheter placed
into his bladder so that urine can be drained as your friend will not
have the strength or co-ordination to urinate for himself

One of the best sites I have found describing the equipment I have
mentioned above is:
http://www.icu-usa.com/tour/equipmentlist.asp?Name=Breathing+Tube+%28Endotracheal+Tube%29
http://www.icu-usa.com/tour/equipmentlist.asp?Name=Tracheostomy+Tube 
http://www.icu-usa.com/tour/equipmentlist.asp?Name=Nasogastric+%28NG%29+Tube
http://www.icu-usa.com/tour/equipmentlist.asp?Name=Urinary+Catheter+%28Foley+Catheter%29

There are many types of Muscular Dystrophy, and a great number of them
have a hereditary component. If that is relevant then the doctors will
discuss this with the family. The prognosis varies greatly between the
types of Muscular Dystrophy but unfortunately in most cases the
outlook is poor.

I am sure that the doctors at the hospital will be looking into what
kind of muscular dystrophy is present and what the options are. You
may have to face the possibility that your friend will not recover,
but again it would be best to discuss the situation with the doctors
in the Intensive Care Unit and the Physician or Medical Registrar in
charge.

Support sites for Muscular dystrophy include:
http://www.ninds.nih.gov/health_and_medical/disorders/md.htm
http://www.nlm.nih.gov/medlineplus/musculardystrophy.html
http://www.mda.org.au/
http://www.muscular-dystrophy.org
http://www.mdausa.org

A stay in the Intensive Care Unit is never a good sign, and you should
have no doubt that your friend is anything but critically ill. If he
recovers then that will be wonderful, but you should be prepared for
all eventualities.

regards,

jxc-ga