A Syndrome without a Name

The persistent vegetative state (PVS) was first described – and given its name – in 1972 in the prestigious British medical journal, The Lancet, by the Scottish neurosurgeon Bryan Jennett, known for creating the Glasgow Coma Scale, and the American neurologist Fred Plum, who less than a decade earlier had described the Locked-in-State with his longtime colleague Jerome B. Posner.

Dr. Plum was the revered chairman of neurology at the then New York Hospital-Cornell Medical Center where he was my teacher and eventual colleague. He was an astute observer of detail who had the ability to synthesize information across the neurosciences through beautifully executed prose.

One example of his extraordinary fluency was the paper on PVS he wrote with Dr. Jennett. In the most parsimonious of phrases, Jennett and Plum, described the vegetative state as a state of “wakefulness without awareness.” By that, they meant to describe the paradoxical state of what Plum would also describe as “wakeful unresponsiveness,” a state of unconsciousness in which the eyes are open but there is no awareness of self, others, or the environment. It is paradoxical because we arise out of our nightly slumber by opening our eyes and taking in the world. We express ourselves with our eyes. They are the portal to awareness, communication, and humanity community. That is, except for in the vegetative state when the patient is awake but the eyes are unaware and undiscerning. They move randomly about the room with neither intent nor direction like an unmanned sail boat on a gusty day. These usually sentient orbs are now propelled by the primal forces of an intact brainstem that charts no course but simply keeps the body afloat, directing autonomic function like our heart beat, breathing, and sleep-wake cycles.