Coma Communication – reading the signs

Reading the Signs: Coma Communication by Ann Jacobann_stan_zps3b824773

A person’s essence is present in all states of consciousness, during times of wakefulness, sleep, delirium, dementia, coma, near-death, and dying. This belief inspires our work in coma communication, the art of cherishing and connecting with people seemingly unable to communicate. Arnold Mindell, (who along with Amy Mindell is my teacher), says that near death, people are “wakeful human beings going through one more meaningful step in their process” and that many people in comas “venture to the heights and depths to find some degree of ecstasy, prophetic insight, and self knowledge.” Mindell believes that at death, “people are prepared more than ever to live fully.”

In living into dying, we have the opportunity to cross thresholds and enter new worlds of experience through our altered state of consciousness. We continually change our consciousness through meditation and prayer, yoga and dance, walking, running, and even by loving and fighting. During the dying process, our transformation may be profound. The quiet person might share, the grump, love, the extrovert become introverted, and the kind person grow in kindness. An attentive person may lose interest in their outer life and instead focus on their inner life. The heart can open wider than ever before. Our role as carers is to find ways to support opportunities for transformation in those who are living as they die.

Coma communication provides a template for us to map uncharted landscapes when familiar patterns of relating have ceased and communication seems impossible. The work is cross-cultural and uses non-verbal methods to frequently create extraordinary and unexpected moments of meaning, relationship, and awareness. Although death may be difficult or painful, it can also be an ecstatic experience filled with radiance and love. It can be a time when important events occur within us.

Near end of life, there are four main themes people tend to explore. They review their life story, fight heroic battles, process relationships and deep loves, and sometimes they open the door of their spiritual heart. In experiencing these inner and outer processes, people may see (what and who is around them or have inner visual experiences and memories), feel (have bodily sensations), hear (inside and outside of themselves), move (in response to inner and outer events), relate (with inner figures or outer people and world events).

Altered consciousness and dying allow us to explore little known or expressed aspects of ourselves. We may shoot rays of love to the estranged child bringing peace to both of our lives. We might run like hell, arms and legs flailing, dodging the bullets of war in our delirium, revealing our energy, strength, and courage, even as our body is failing. We might say or do things we never thought possible, even if it is just reaching out to give a hug. Long after he had seemingly forgotten his son, my life partner, Stan’s father reached out and stroked his son’s hair. Stan’s father had advanced Alzheimer’s, and had not hugged his son since Stan was twelve.

To the onlooker, the dying person is changing in front of them, melting away, altered in consciousness and ability, and possibly so different to the person we knew and loved. For the carer, it can be hard to tell what, beyond dying, is going on.

As communication carers, our role is to find a way to be with and to further a person’s inner and outer dying process. We assist when invited, and our passion is to relieve the isolation felt by the dying person and their loved-ones. People are often more afraid of being trapped in “weird” states of consciousness than they are of death itself. When someone no longer talks, we can easily become shy or nervous. There can even be an urge to leave the room to escape the feeling of not knowing what to do.

When someone is delirious, we can say things like “I’m not your mother, I’m your daughter” in the hope the person will return to themselves. If that fails, a next step might be to become that “mother,” bringing forth positive mothering qualities, such as tenderness and sensitivity. In this way, we use the “mistaken identity” as a vehicle and a metaphor for what might be the next step this person needs for their journey.

Our role is to accompany the dying as they experience the various weather systems of their dying process: calm seas to wild winds, drought to rain, overcast skies to sunshine. “Please be with me as I am, how I am, for as long as this takes,” they ask of us.

There are many wonderful ways to be with the dying. We might take time to gather around the bed, holding our loved-one’s hands and telling them we love them.  Or, we might say, “It’s been quite a ride over these years!” We might hum or sing a family song, or a favorite tune from their era. A man once told his buddy and drinking partner, “I’ll keep our secrets, my friend.” He then sang a simple tune and was joined by members of the family. We noticed this created a feeling moment of union in the midst of the family’s grief, so we encouraged them to keep singing, which they enthusiastically welcomed. When we sit with awareness, we can respond to changes in the room and encourage and model these healing moments.

Stan and I were at home when we received an emergency call from a family we did not know. The caller informed us, “Our Dad is in the hospital with a stroke. He’s only 54 and in intensive care. We want to do everything we can to help him. The whole family is flying to be with him,” The caller had heard that we worked through visual Skype, reading signals coming from a person even when they are in a coma, and that we could enhance communication beyond what is often considered possible. Desperation and death opens strangers to each other, and we were welcomed as long lost friends by this family.

Entering an ICU is always shocking. The patients are in trouble. The family was gathered in the room and talking in groups of two or three. We could see and feel the fear and chaos along with the yearning to find new ways to connect. As their loved-one lay in a coma, we invited the family members to gather around the bed of the patient. They were relieved to have some guidance, and to be nearer their father, brother, uncle. A hush naturally descended and we encouraged everyone to pay attention to the patient’s breath and to breathe with him. In doing this, they spontaneously reached out for each other and laid their hands on their loved one. The atmosphere softened. Later that night, the patient died, bathed in his family’s love.

Breath is a vehicle for establishing deep connection and feelings of rapport. It is a bridge that allows us to join a person who is in an altered state, beyond country, culture, language and belief. We all have breath in common.

You can breathe with a person for a few breaths. Breathe into the same place in your body that they are breathing into — upper chest, belly, diaphragm.  If the breathing is too fast, slow, or shallow for you to keep up with them, it is still worth trying, if only for a brief time, because it is a way for you to be able to enter into their experience. Give yourself permission to do with your breath, what you observe in the other. This may be new for you, but it is straightforward to learn.

Another way to connect using the breath is to speak when the patient is exhaling.  You might only be able to say a few words at a time, slowing down your speech to a pace where the person is more able to follow you. For example, speaking on their out-breath you might say, “I am here . . . with you . . . we are in this together . . . forgive me . . . I forgive you . . .thank you . . . I love you.” Your inner attitude and healing words can include, “Believe in your experiences they are meant for you.” This opens up worlds of possibility and provides a sense of relief for all.

Each time you speak, notice if anything changes in the person who is dying. Do they take a deeper breath? Do their eyelids flicker? Does a feeling of peace enter the atmosphere? Does the sun burst into the room? These can all be signals of response from the patient. We are all in a great field together. If you ask, “How are you?” and a plate crashes in the hallway, you might bring that to the bedside and say something like, “Things are crashing!” Then watch to see if there is any response, any tiny or large change in the person. If there is, you have found each other in some “magical” way that is non-linear and meaningful. Remain open to taking the “conversation” further. For instance, if the person’s arm moves, even a little, “Yes, that left arm is wise. Follow its movement. It will show you the way.” Provide plenty of positive encouragement, watching carefully to check if you are speaking “their language.” If you notice that the patient’s arm moves more, their eyelids flutter, their mouth shifts slightly, they swallow or water comes from their eyes, encourage them more. You could say something like, “Ah, moving!” or “Feel what you are feeling as you move,” or “Water coming from your eyes.”

Use every signal as a potential portal for communication and conversation with the soul of the other. Try to be neutral, using what we call “blank access words” to encourage open-ended exploration and awareness. Ifnothing changes, sit and wait for the next moment of possibility. There will always be another chance. You too, might need to take a break.

“Pacing the breath” is another way of working with breathing. Inform your client or loved-one before you touch them, then place your hand on the back of their hand, their wrist, shoulder, or ankle. Watch for the next inhale and then squeeze gently as they inhale. This meets the expansion of the patient’s inhalation. As the person exhales, relax your hand while maintaining contact, allowing you to connect gently but strongly with those in deep, inner states. As the person inhales, squeeze again. As they exhale, relax. You can practice this on yourself first to get the hang of it. This is a calming and centering practice that draws you inwards. When practiced on someone else, it can deepen and amplify sacred connection.

“Pacing the breath” can also include sounds or sighs, even those of patients on ventilators. If someone is moaning, we can moan with them, a little bit louder and longer. This helps them to perceive that we are willing and able to speak their language. With children, we do this all the time, making sounds and pacing our reactions in accordance with the expressions of the child. So too with the dying. Sometimes, incoherent sounds, fed back with compassion, are the feedback the person needs to make the thoughts inside their head come out in a way that is understandable. This was the case with one woman who had been speaking gibberish. After hearing her sounds lovingly reflected, she found her way to saying clearly, “I’m ready now. May I go?” We could then respond directly, “You can stay or you can go, whatever is right for you.” She took one more breath and left.

Following a stroke, a man could only make loud, raucous noises. His family members were anxious that this was from pain. We encouraged them to say their goodbyes. We noticed that whenever someone said, “I love you,” the loving father let out a loud mountain-sized roar from deep within. The roar was his best attempt at echoing back, “I love you.” Reframing his roar changed the atmosphere in the room from anxiety and fear to excitement, wonder, and closeness. The family stories of appreciation for their father’s life began pouring out.

Sometimes what appears to be pain is the beginning of an expression of profound joy. After we had been breathing with a dying woman for a few breaths, she began to quiver and grimace. Her daughter’s first thought was, “Oh, she is in pain!”  “I don’t know your mother, is that how she looks when she is in pain?” I responded, staving off the rush to “do something, anything.” With the daughter’s permission, I told them both what I was about to do and placed one of my hands under the mother’s elbow and the other under the wrist of the arm that had quivered. In Coma Communication, we contact bony structures to facilitate rather than to impose on muscle movements. This gives the person an opportunity to move freely, even if they no longer have the strength to move on their own. The dying mother’s frail arms, now supported, began rising up over her head, her face bursting into an ecstatic beam, lighting up the whole room, her eyes gazing attentively upward. The daughter, relieved and grateful to see her mother doing so well during these last moments on earth, envisioned her mother, greeted by the love of her spiritual guide.

There are so many ways we can be with the dying, joining with them, cherishing and connecting with them. Each moment is precious and it is a privilege to be with all that is present: wonder, pain, love, joy. Hearts beating together, even as one heart is stopping.

This article is reprinted from Vol3#1 Communication of Natural Transitions Magazine. Subscribe and join our community.

JOIN OUR BOULDER WORKSHOP that is on Day 2 of Natural Transitions’ FILM FEST plus.October 13, 2013, Boulder, CO. More information HERE.


Coma Work and Palliative Care: A Communication Skills Manual for Supporting People while Living in Delirium, Vegetative State and Coma. Stan Tomandl

Coma: The Dreambody Near Death. Arnold Mindell


Ann Jacob is a coma communication counselor, consultant, and  trainer based in Victoria, British Columbia, Canada. She works with her partner, Stan Tomandl. Jacob is also a faculty member of the Sacred Art of Living and Dying Center.

You can reach her at

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