Good morning. After 21 hours of negotiations, the United States and Iran failed to agree to a peace deal. We have more on that below. But first, a study found that some people in vegetative states may have more awareness than we thought.
A wake-up
Let’s say something bad happens — a crash, a fall, a stroke, an overdose. Your brain absorbs a violent shock or a period without oxygen. But your heart still beats and your lungs still heave. Now you’re unconscious in the hospital, unable to respond when your spouse calls your name or your doctor prods you with a reflex hammer. For years, these patients were said to be in a “persistent vegetative state”: bodies without minds. They idle, mostly in care centers and nursing homes, with little attention. But new research shows that many such patients — tens of thousands of Americans — may actually be hearing and thinking. That is the (somewhat horrifying) subject of Katie Engelhart’s new article for The Times Magazine. I asked her about it. Adam: Now we know that some people declared vegetative can actually perceive and understand things around them. How many people are we talking about? Katie: Nobody is counting. By some estimates, around 50,000 Americans are in a chronic vegetative state, meaning that they are technically awake, but have no awareness of what is going on around them. Another 200,000 to 400,000 are in a “minimally conscious state,” with fleeting periods of awareness. Research suggests that about a quarter of all these patients are able to follow commands like, “Imagine opening and closing your hand.” How did researchers figure out that this set of patients was conscious? Back in 2006, a neuroscientist at Cambridge University put a 23-year-old woman, who had been diagnosed as being in a vegetative state, into an fMRI scanner and asked her to “imagine playing tennis.” And she did! The area that controls motor planning in her brain lit up in just the same way that a healthy person’s brain would. The phenomenon was widely replicated. The scary thing is that it doesn’t seem like there’s any way for ordinary patients to get tested for this awareness. Exactly. Researchers have been able to find covertly conscious patients for 20 years, but the testing is almost exclusively done through research trials. I interviewed many people whose loved ones had been diagnosed as being in a vegetative state — and whose doctors never even raised the possibility of covert consciousness. But family members are doing their own research, and they want access to the cutting-edge science. If you had a loved one who was unresponsive and breathing through a ventilator, what would you do? Unless I were in Boston or London, Ontario, where they test patients at a few I.C.U.s, I wouldn’t know if he were covertly conscious. So I would speak to him as if he were aware. Doctors tend to discourage people who think a vegetative patient’s smile or sigh is a conscious response to them. “They don’t want to give you false hope,” says a woman you profile. But at the same time, most of these patients won’t recover, even if a few of them show signs of awareness. Are physicians changing the way they talk to families and manage expectations, given the new science? On the one hand, numerous researchers told me about the “culture of pessimism” in American I.C.U.s: Neurologists sometimes seem quick to conclude that a brain-injured patient won’t improve — or won’t improve enough. On the other hand, what does “improvement” mean? Most people who emerge from the vegetative state end up with severely impaired consciousness and significant disabilities. For some people, that’s OK. That’s a good-enough life. For others, it’s a fate worse than death. Most patients with locked-in syndrome — people who communicate with eye movement — say they’re happy to be alive, even with their limitations. That moved me. That comes from a 2011 study. Amazingly, the patients who were locked in longer were even more likely to be happy. Only 7 percent of the respondents wished for euthanasia. Read Katie’s story about how one woman dealt with the uncertainty about her husband’s consciousness.
Iran Negotiations
Lebanon
Our colleagues traveled to a city in southern Lebanon that Israel has been bombarding. There, they met a woman sitting on a curb clutching a phone with a photo on it. Read her story, and an excerpt below: The photos were all she had left of her sons — the sons who had just bought her hair dye so she could color her wispy, gray curls, a respite from the Israeli bombing. The sons who had kissed her cheeks that morning as they left for work harvesting oranges in an orchard nearby. The sons who were killed on that orchard in an airstrike. Hungary
Moon Mission
Other Big Stories
Changes to the N.C.A.A.’s transfer rules allow college athletes to switch teams as often as they wish. This month, Michigan won a men’s basketball title with an all-transfer starting lineup, and Trump signed an executive order trying to limit transfers. How is this new era affecting college sports? We sought out opinion articles from student journalists, who have seen these changes up close. It’s bad for fans, writes Bethany Mann in The Battalion of Texas A&M University. “When people transfer every year, it’s hard to keep track of the players, loosening the ties between the fans and the team,” Mann writes. “If there are players consistently moving in and out every year, fans have no one to cling to in hopes of a winning season.” It’s good for athletes, writes Serena Thiede in The Times-Delphic of Drake University. “It creates possibilities for athletes to follow their dreams,” Thiede writes, adding, “It also challenges the decade-long tradition of staying at a struggling school despite coaching changes, team issues or overall program cuts.”
The United States is on the cusp of a humiliating strategic defeat in its war with Iran, the editorial board writes. Here are columns by Michelle Goldberg on Hungary’s election and Ross Douthat on Washington’s foreign policy failure in the Middle East. Morning readers: Save on the complete Times experience. Experience all of The Times, all in one subscription — all with this introductory offer. You’ll gain unlimited access to news and analysis, plus games, recipes, product reviews and more.
Stealing a subway: Meet the vandals who want to break into the operator’s booth, fool around with the control panel — and maybe take a quick joyride. A taste of your own medicine: More doctors are learning how to cook and use food as a tool for treating patients.
Golf: Rory McIlroy surrendered a record six-shot, 36-hole lead in the third round of the Masters. He shares a lead with Cameron Young, and they will begin the final round today at 11 under. Hockey: The Denver Pioneers are national champions for the third time in five years after defeating Wisconsin 2-1 in Las Vegas. Boxing: Tyson Fury beat Arslanbek Makhmudov in 12 rounds. Fury won his first bout after 16 months out of the ring after back-to-back losses to Oleksandr Usyk.
“London Falling” by Patrick Radden Keefe: In 2023, Keefe, a writer for The New Yorker, was in England working on the television adaptation of his book “Say Nothing,” when he struck up a conversation with a stranger who told him about the mysterious death of a 19-year-old Londoner named Zac Brettler. The status-obsessed teen — who’d been posing as the son of a Russian oligarch — fell from the fifth-floor balcony of a riverfront apartment after spending time with two shady older men. There were many confounding aspects of the story, yet Scotland Yard’s response seemed sluggish to the point of disinterest. Keefe began his own investigation, one that took him from the depths of a criminal underworld to the heights of parental devotion. “He is a master builder of intricate narratives, arranging the many pieces just so,” our critic wrote in her review. “‘London Falling’ suggests that Zac’s story is ultimately a crime story, in a city so warped by money that it’s losing its bearings.” The Times has a new profile of Keefe, “one of the last household names in nonfiction at a time when the entire future of the enterprise — writing — is up in the air.”
This week’s subject for The Interview is the divisive former “Girls” star Lena Dunham. Her new project is “Famesick,” a highly anticipated and extremely revealing memoir due out this week. At the beginning of the book, you write about your name and how it started to carry negative connotations. For you, not even for other people. What did your name represent? Myopic millennial thinking or hapless feminism or man-hating or liberal twit-dom or — It’s a long list! It’s a long list, and there were people who maybe shared my politics and my lifestyle but were irritated that I was talking. I remember, and this is not in the book, I was going to vote with my father. I’d been campaigning for Oba |
