Paging Dr. Woodruff

No doubt Judy Woodruff was unhappy to be at the CNN news desk last Sunday night. Congress decided to return for a midnight session to deal with the Terri Schiavo ruling and Woodruff was determined to get to the bottom of it. Below is an edited (for length) transcript of her interview with Dr. Sanjay Gupta:

WOODRUFF: I want to bring you back in, Sanjay, because I keep coming back to the dispute between the doctors, who the courts have depended on to make these decisions over the years, who have said Terri Schiavo's in a persistent vegetative state, and then the comments by her father and her brother that she is not. Why is it so difficult to make a determination once and for all of what her medical condition is?

GUPTA: For the most part, this is a clinical diagnosis. That's what makes it difficult. There's no single blood test, there's no signel scan of the brain that's going to tell you for sure that she is in a persistent vegetative state versus a coma versus something else.... What also makes it difficult, I think, is just the emotions that are sort of attached to someone who can be in a persistent vegetative state. And what I mean by that, a lot of people describe this as a state of wakeful unawareness.... It means someone might open their eyes, they might even look at you, they may close their eyes when it's time to sleep. They have the state of sleep/wake sort of cycle. They have some responsiveness to touch, perhaps, they can grimace, they can make noise. All of the stuff suggestive that the lower part of the brain, the brain stem if you will, Judy, does appear to be functioning.
The problem is that ... any of the higher brain functions ... are all gone. This is a difficult concept even for doctors to get their arms around....

WOODRUFF: But, but Sanjay, as we understand it, the doctors who have examined Terri Schiavo--and we just heard the professor at the University of Wisconsin Law School saying it's her understanding that the CAT scans have shown no higher brain activity. That the part of the brain that thinks, that senses being, is not there.

GUPTA: I heard that as well.... Again, there is no specific scan that's going to tell you for sure that someone is in a persistent vegetative state.... None of her brain was getting enough blood flow for awhile. So parts of her brain did die. And that is something that would be evident on a CAT scan. But exactly how profound an impact that's going to have on somebody is something that can only be told clinically, meaning you actually have to examine the patient. I should point out I've never examined Terri Schiavo nor have I looked at her scans. But everything that I'm hearing from the doctors that have say that she fits the clinical diagnosis of a persistant vegetative state....

WOODRUFF: And Sanjay, do you know of any instance where someone with that clinical diagnosis returned to normal, or reversed that condition?

GUPTA: No.... To be even more clear on this, once it passes beyond one year in terms of someone without any recovery from a persistent vegetative state, the appropriate term at that point is permanent vegetative state.... It is called permanent vegetative state because there have been no known cases for someone to return to having any function.

WOODRUFF: If it's that clear then, again, Sanjay, I'm sorry to be repeating the question, why is there such a dispute here?

GUPTA: Well, I think, again, because there is no absolute blood test or brain scan that's going to gell you for sure, it sounds to me--and I've been following this case along--that a few of the doctors have disagreed, at least a little bit.... It is a difficult problem even for doctors to try and get their arms around. You see someone opening their eyes, you see someone maybe even looking at you, responding like if you were to clap your hands really loud on their right of their head they might turn their head toward you. All of those things to the lay person mean, hey, that person is awake and aware. But as we probe deeper, as we look to see what is reflex and what is real, we find that in fact these are all just reflexes, that there is nothing there above just the basic human reflexes.

WOODRUFF: Dr. Sanjay Gupta telling us that in fact after one year of a condition like what it is believed Terri Schiavo has been in, it is a permanent vegetative state.
Sanjay, thank you very much.

And yet here is Dr. Sanjay Gupta this morning on CNN:

GUPTA: As part of this review, Senator Frist in this bill talks about actually getting a new panel of doctors, independently chosen, to come in and try and settle this in a more definitive manner, to really give her a diagnosis and to give a more objective sense, is she in a persistent vegetative state or not? I mean it's amazing, we still don't know that answer for sure and, more importantly, how would she do with or without a feeding tube.