Chapter 245: Brain Death (10)

Professor Kang Sung-Guk felt like all his previous medical knowledge was being turned upside down when he heard the news.

“He’s awake?"

He rushed to the intensive care unit after hearing the unbelievable news. When he found Kim Hyun-Taek, his jaw dropped.

Kim Hyun-Taek was fully off all life support devices. He was digesting food from his feeding tube in his nostrils. He was breathing on his own without a ventilator, and his heart was beating on its own.

“Is the brainstem working?” Kang Sung-Guk asked Miguel.

“Yes. The patient is now breathing alone and maintaining his heartbeat.”

“This can’t be... What stage of consciousness is he in? Is he in a coma? Or is he in a vegetative state?”

“Neither.”

“What?”

There was one more shocking fact.

“You don’t have sleep cycles in a coma, but this patient has one. And someone in a vegetative state doesn’t show any activity in the electroencephalogram, but this patient has activity,” Miguel said.

“The encephalogram has activity?”

“Yes. When someone talks to him or stimulates him to think of a scene, he responds by showing peaks in the EEG graph,” Miguel said, pointing to the monitor.

“Does he have cognitive function?”

“I wouldn’t go that far.”

Miguel shook his head.

“He’s in MCS.”

“You mean he’s in a minimally conscious state?”

“Yes. He doesn't have the ability to make rational judgements or think. But he has a minimal level of awareness of his surroundings.”

“My god...”

Kang Sung-Guk covered his face with his hands in surprise.

Miguel said, “The patient is more alive than in a persistent vegetative state. If the levels of recovery are brain death, coma, and then a vegetative state, then MCS is the next level of recovery. After this is just waking up.”

“... So the legal status would be a lot different.”

“Yes, I don’t know how it will be in Korea, but the legal status will be completely different in my country,” Miguel said. “In the case of a vegetative state, the medical law values the opinion of the guardian. Life-sustaining treatment can be stopped at the request of the guardian for the sake of the family, who are suffering from the economic and psychological burden of the treatment.”

“But not MCS?”

“No, not for MCS,” Miguel said. “The medical law recognizes MCS as a person to be treated. They believe they are a patient that the hospital is obliged to do its best to treat. If the guardian asks for life-sustaining treatment to be withdrawn and the hospital accepts, they are punished.”

“...”

Kang Sung-Guk turned his gaze to Kim Hyun-Taek. It was as if he was sleeping peacefully.

‘What the hell happened?’

Kim Hyun-Taek had myocardial damage and pulmonary arterial hypertension, requiring a simultaneous heart-lung transplant. His entire brain, including the brain stem, had lost all activity, so he didn’t show any brain waves. He felt like a cadaver when Kang Sung-Guk was cutting into his stomach.

‘But he came back to life? Not even a persistent vegetative state, but a minimally conscious state? Where did his consciousness and awareness come from?”

“This is... Then, this...”

Kang Sung-Guk, who was stuttering to say something, stopped. It was because there was a commotion outside the door.

—Please!

A middle-aged woman was pleading to the medical staff.

—Please let me go inside just one time. You let me see him often before the clinical trial.

“I think the guardian is here,” Kang Sung-Guk said.

They opened the door and stepped out into the hallway. In front of the door were three resident doctors, intern doctors, two nurses, and Lee Mi-Sook, Kim Hyun-Taek’s wife.

“H... Hello.”

Lee Mi-Sook greeted them anxiously.

“You can come in. Visits have been limited because we’re in the middle of the clinical trial and the patient just had a major operation, but... You can come inside and see him,” Kang Sung-Guk said.

Lee Mi-Sook burst into tears as soon as she came inside. It was because she saw that Kim Hyun-Taek was off the ventilator.

“Honey!” she shouted in a teary voice, running to his side.

That was when the EEG graph suddenly spiked. Kim Hyun-Taek had responded to his wife’s voice. He hadn’t understood what she was saying because he was not fully awake and conscious.

But one thing was clear: Kim Hyun-Taek’s brain had been revived enough to respond to familiar stimuli.

“...”

Chills ran down Kang Sung-Guk’s arms.

Kim Hyun-Taek was alive. Perhaps he was always alive, or maybe he was brought back from the dead, but either way, it was clear that Kim Hyun-Taek was now alive.

‘How far was Ryu Young-Joon’s medicine going to go?’

In the first year of founding A-Bio, he was able to conquer major incurable diseases like Alzheimer’s, glaucoma, and pancreatic cancer. Now in the second year, he cured brain death.

*

Young-Joon arrived at the hospital in the afternoon. More than a dozen medical staff gathered, including Professor Miguel, the doctor in charge of the clinical trial, and Professor Kim Sung-Guk, the cardiopulmonary transplant surgeon. Carpentier, Song Ji-Hyun, principal scientists from Cellijenner, and the Life Creation Team were here as well.

The hospital room was packed.

Lee Mi-Sook glanced at the scientists, afraid they might send her away, but they were too busy talking about Kim Hyun-Taek to care.

“The trial was successful. It’s clear the brain stem has recovered, and he is breathing and maintaining his heartbeat,” Carpentier said to Young-Joon.

“Good work. Doctor Song, you will be the first author of a monumental paper that will make a mark in the medical world. Congratulations,” Young-Joon said.

“Haha... There are so many other people who worked hard...” Song Ji-Hyun said in embarrassment.

“But the first author should be you, Doctor Song, because you came up with the method to inject stem cells into the subventricular zone, which is the key to brainstem repair, and performed the base experiments. After that, it’ll probably have over a hundred authors, starting with the Life Creation Team and then the medical staff.”

“It makes sense because it was such a big experiment. You usually have a couple hundred authors for a huge paper like photographing a black hole, right? This is of that magnitude,” Carpentier said.

“There will be at least four corresponding authors besides myself. There’s Doctor Carpentier, the project leader, Professor Miguel, and the two surgeons who lead the cardiopulmonary transplant,” Young-Joon said.

“Will he recover more like what happened in the preclinical trial?” Miguel asked.

Young-Joon looked at Kim Hyun-Taek in Synchronization Mode.

“You said he was minimally conscious, right?” Young-Joon asked.

“That’s what it looks like.”

Young-Joon stared at Kim Hyun-Taek, thinking.

A coma, semicoma, minimally conscious state (MCS), persistent vegetative state (PVS), and locked-in syndrome all looked similar, but they were all medically different. These states were hard to distinguish in the past, but now they were starting to find subtle differences between them. In fact, there was a recent paper that suggested that about forty percent of individuals who were previously diagnosed to be in a vegetative state were found to be minimally conscious through an EEG.

“I once read a paper that the location and cause of brain lesions are important for the recovery of patients with severe disorders of consciousness,” Young-Joon said. “What do you think, Professor Miguel?”

“As Doctor Ryu said, it can improve or worsen depending on the location and cause of the lesion. But once it gets to the MCS, it’s relatively common for the patient to recover. But in this patient’s case, he has unusually recovered into a severe disorder of consciousness,” Miguel said.

“Before that, he was brain-dead, so it makes sense. We think that he may recover further if the stem cells injected into the subventricular zone continue to expand and repair the nerves.”

Young-Joon grinned.

“I think he’s already going past the MCS stage.”

“What?”

Miguel’s eyes narrowed.

“Because there’s something suspicious about the fMRI from the preclinical trial.”

“What do you mean...”

“Shall we turn on the fMRI?” Young-Joon said.

*

An fMRI was a medical imaging device that captured blood flow in the brain. When specific neurons in the brain were activated, they required more energy, and blood naturally rushed to oxygenate the area. By measuring that, one could determine the active areas of the brain.

After the fMRI was set up, Young-Joon approached Kim Hyun-Taek and spoke loudly in his ear.

“Kim Hyun-Taek.”

The fMRI imaging showed blood flow in the brain. The auditory cortex on the left and right sides of the cerebrum turned red. The “C” surged.[1]

It was incredible. The fact that Kim Hyun-Taek responded to sound and that the auditory cortex, the processing center of auditory signals, was working showed that his cognition was alive.

After some time, the two neural signals slowly subsided and returned to their resting state.

“A-Bio.”

Young-Joon gave him another word. Kim Hyun-Taek responded similarly.

“Hospital Generation Next,” Young-Joon said.

Most of the doctors, along with the scientists, scratched their heads, not understanding what he was saying.

“Did he just say Next Generation Hospital backward?”

Park Dong-Hyun and Jung Hae-Rim murmured amongst each other.

Meanwhile, there were two people who were stunned by what Young-Joon said: Carpentier and Miguel.

“No way...”

The fMRI showed activity, like before. The auditory cortex responded and the EEG spiked. But this time, instead of dropping straight down, the EEG made a messy peak and stayed there for a few seconds. In addition to the auditory cortex, the fMRI showed blood flow to the hippocampus, and thalamus, along with Broca’s area and Wernicke’s area of the left brain.

“It’s just as I expected,” Young-Joon said.

“What’s different?” Park Dong-Hyun asked Cheon Ji-Myung.

“Doctor Ryu gave the patient an unfamiliar word on purpose,” Carpentier said.

“MCS patients have minimal cognitive abilities, so they respond to the sound itself, but they don’t have the thinking skills to analyze the meaning of the sound,” Young-Joon said. “So, they react the same whether they hear familiar or unfamiliar words. But it looks different in a normal person’s brain. In this case, the parts of the brain that control language are activated to understand the meaning of the unfamiliar word.”

“...”

Silence filled the room; everyone was too stunned to speak. Then, Lee Mi-Sook interrupted the silence.

“T... Then... Then are you saying that my husband is conscious?”

“Probably not at the level of a normal person because there are many levels of consciousness. Right now, his awareness is only a little better than the minimal level. But he can’t move his body or make sounds because his motor skills have not recovered yet,” Young-Joon explained.

“You can think of him as having a slightly recovered consciousness from a vegetative state. When you’re very drunk or high on drugs, your cognitive abilities drop drastically, right? In that state, your sentences don’t make sense, and you can’t understand what others are saying. It’s kind of like that,” Young-Joon added.

“This state has never been reported in medicine,” Miguel said. “It’s similar to locked-in syndrome, but the consciousness level is lower, and...”

“It will become similar to locked-in syndrome by tomorrow,” Young-Joon said.

Carpentier flinched.

“And he will wake up,” Young-Joon added.

1. The electrodes for the EEG are placed in specific areas of the brain. One of the electrodes is placed in the central area, or “C.” This position represents EEG activity more typical of frontal, temporal, and some parietal-occipital activity. ☜