Q. What is the difference between being in a coma and being brain dead? When are you considered officially dead?
A. A coma is a state of impaired consciousness that can vary in intensity. Doctors gauge the depth of a coma by noticing whether the patient responds to outside stimuli and whether automatic processes like breathing or body temperature control are impaired. If the areas of the brain that control automatic functions continue to operate, breathing and heartbeat continue, although the patient may not hear or be able to react to outside stimuli.
The causes of coma vary: some are due to structural damage after a head injury, others are due to poisoning or metabolic imbalances caused by disease.
The electroencephalogram (EEG) which uses electrodes attached to the scalp to record the electrical activity of the brain, is very useful in helping doctors decide what is causing the depressed state of consciousness.
When a patient is brain dead, there is no electrical activity on the EEG and there are no brain stem reflexes for at least twelve hours. A brain-dead patient in whom no electrical activity can be demonstrated after twenty-four hours is officially dead, although automatic functions like breathing can be maintained indefinitely by external machines.
Dr. Marianne Legato, Professor Emerita of Clinical Medicine at Columbia University is an internationally known academic physician, author, lecturer, and specialist in gender-specific medicine. She is founding member of the International Society for Gender Medicine and also the founder and director of The Partnership for Gender-Specific Medicine at Columbia University and its next iteration, The Foundation for Gender-Specific Medicine. These enterprises are the first collaborations between academic medicine and the private sector focused solely on gender-specific medicine: the science of how normal human biology differs between men and women and of how the diagnosis and treatment of disease differs as a function of gender and sex. Her ground breaking textbook on Gender-and Sex Specific Medicine has been published in 2017 in the 3rd edition.
She has published extensively on Gender and Sex Specific Medicine, both scientifically and for the lay public. She is also the founding editor of the journal Gender Medicine, and the Journal Gender and Genome, published for the scientific community. In 1992, Dr. Legato won the American Heart Association’s Blakeslee Award for the best book written for the lay public on cardiovascular disease. She is a practicing internist in New York City and has been listed each year in New York Magazine’s “Best Doctors” since the feature’s inception in 1993.