Diagnosis – Brain Function / Coma / Persistant Vegetative State / Locked In Syndrome / Awakenings

PVS – Persistant Vegetative State

Jahi McMath: Brain Death Cases Similar to Oakland Teen Found Throughout State / Is it Really ‘Brain Death’?

Christopher Dolan, attorney for Jahi McMath’s family, shows an MRI of the 13-year-old Oakland girl during a press conference at Dolan Law Firm in San Francisco, Calif., on Friday, Oct. 3, 2014. Dolan showed photos and a pair of videos where McMath moves her foot and arm in response to the voice of her mother, Nailah Winkfield, in a home in New Jersey. She was declared brain-dead in California after tonsil, throat and nose surgeries to relieve her sleep apnea. (Ray Chavez/Bay Area News Group) Related Stories · May 23: California toddler, declared brain-dead, moved out of country May 17: Walnut Creek hospital mistakenly diagnoses woman brain-dead · Dec 23: Jahi McMath: Attorney files another lawsuit on behalf of family Jahi McMath: Family sues in federal court to have brain-dead girl declared alive Oct 23: Judge: Jahi McMath’s family can present evidence that she is alive Jul 29: Exclusive: Jahi McMath’s mother speaks on legal battle over brain death Mar 3: Jahi McMath: Suit filed against Children’s Hospital Oakland Jahi McMath: Oakland girl’s family sues hospital, surgeon Jahi McMath lawsuit: Timeline of events at UCSF Benioff Children’s Hospital Oakland SAN FRANCISCO — Attorney Chris Dolan got a familiar phone call this past month. It was from a Vacaville family who said their 2-year-old son was declared brain-dead. They planned to fight the diagnosis and wanted the San Francisco lawyer’s help. Since taking on the case of Jahi McMath, an Oakland teen declared brain-dead in 2013 following complications from tonsil surgery, Dolan has became an unlikely leader in a growing resistance to the medical establishment’s long-standing determination that the loss...

Maggie’s Powerful Story Raises Troubling Questions about How People with Serious Intellectual Disabilities are Diagnosed and Cared For

Comment: I saw this myself even in the early 1970s (before “vegetable” became a diagnosis) when some of our trauma and coma patients unexpectedly started to respond when we talked to and cared for them as if they were fully awake. We were surprised and humbled when we saw some of these so-called “hopeless” patients recover and resume their lives. N. Valko RN, 1 May 2016] As the tragedy of Terri Schindler Schiavo’s death by starvation illustrates, euthanasia advocates have long been quick to dismiss as worthless the lives of those people with intellectual and physical disabilities they label with the dehumanizing term “vegetative.” Even as Canada explicitly targets people with disabilities through legalized active euthanasia; and the campaign to expand the states in which assisted suicide is legal in the U.S. continues, iconoclastic physicians are instead demonstrating the potential to communicate with and provide assistive technology and rehabilitative services to this stigmatized population. In an article from the May 6, 2016, Newsweek Magazine entitled, “Given the right stimuli, brain activity in patients in persistent vegetative states can bear similarity to non-injured people,” author Don Heupel highlights two separate but related issues related to serious brain injuries. The first problem is the large number of patients whose brain injuries are misdiagnosed. The second is that these improper diagnoses lead to patients who could greatly benefit from therapies being denied these services on the mistaken basis that they would not work. What is worse, countless numbers of these patient’s erroneous diagnoses have meant an early death. The Newsweek article focuses on Maggie Worthen, a young woman who was set to...

Company Gets Approval for Trial of Drug That Could Reverse “Brain Death” in Patients

There is only one type of death but two means of declaring a person “dead.” One is the irreversible cessation of cardio/pulmonary function. Let’s call that “heart death.” The other is total brain failure, or the irreversible cessation of the brain–and all of its constituent–parts as a brain. This is popularly known as “brain death.” Neither means that all the cells in the brain or body are dead. The key question is irreversible cessation of essential function. Now, the CEO of a company called Bioquark writes me to tell me that his company has been given the go-ahead by a university ethics committee to commence “the first trial of its kind and a step towards the reversal of death.” From the NIH summary: This is the proof of concept study with multi-modality approach (using intra-thecal bioactive peptides, stem cells, laser and transcranial IV laser and Median Nerve stimulation as adjuvants) in cases of brain death due to traumatic brain injury having diffuse axonal injury to document possibility of reversal of brain death (BD). Here is the company press release – http://www.prweb.com/releases/2016/04/prweb13354004.htm A few points. First, this will apparently take place in India, not at Harvard, the Mayo Clinic, or Oxford. I don’t mean that as an insult, but I tend to be more skeptical of studies done in more remote places. Second, it seems more likely that these interventions, if successful, will not “reverse death,” but potentially treat profound brain injury. Finally, if brain death becomes truly reversible, if neurons that no longer function as a brain are restored to brain (not mere cellular) functionality, death by neurological criteria...

Last Stand

[Comment: I have been privileged to know this great writer and doctor, Wes Ely. He has also published two wonderful articles in the Wall Street Journal that I have sent in the past. As a nurse, I wish that every doctor could be a doctor like Dr. Ely with great clinical skills but more importantly, great humanity and understanding. N. Valko RN] The first time I saw Jessa, she lay crumpled in the ICU bed, paralyzed, expressionless and unable to speak. A military veteran, she had fought in Desert Storm, but she now was facing a deadlier and more inexorable foe: amyotrophic lateral sclerosis (ALS), aka Lou Gehrig’s disease. This disease causes progressive loss of muscle control, and Jessa was unable to speak, eat or breathe on her own. Her only means of communicating was through small facial movements–opening and closing her eyes or mouth, raising her eyebrows. A dozen people made up her ICU team: three interns, three residents, a pharmacist, a nurse, a respiratory therapist, a social worker, a hospital chaplain and myself–the lead physician, or intensivist. My intensivist mind, trained to seek solutions, skitters down a patient’s problem list in search of answers. And Jessa’s list was extensive: she needed a feeding tube, IV fluids, diapers and a special bed to prevent bed sores, antibiotics for a newly contracted pneumonia, intermittent sedation to ease anxiety and narcotics for chronic back pain. But now, listening to the respirator pumping air into Jessa’s lungs and felt her intense cobalt gaze on me, I saw one thing clearly: any concerns about antibiotics or nutrition took second place to a...

Court Says Disabled Patient Can be Starved to Death Against His Will, Just Like Terri Schiavo

After a European court issued a ruling saying a disabled patient can be starved to death against his will, the brother of Terri Schiavo says the parallels in the case are eerily similar to what happened to his sister. Vincent Lambert, a tetraplegic patient who has been in a state of minimal consciousness in hospital for six years following a car accident, is current receiving food and water via a feeding tube. The decision to cut his intravenous food and water supply has divided his family. Lambert’s doctors and wife wanted to starve him to death while his parents, who are vehemently opposed to ending his life, took his case to court. In January 2014 a court in France ruled against starving Lambert to death. But, in June, the European Court of Human Rights issued its decision and, by a vote of 12-5, the Grand Chamber held that a State may take Lambert’s life against his will. As Terri’s family did when courts determined her estranged husband could starve her to death, Lamberts parents plan to appeal the decision. In comments to LifeNews.com, Bobby Schindler, Terri Schiavo’s brother, says the case reminds him of how poorly the court system treated his sister. “With so many questions in this case, why would you err on the side of death? As in my sister’s situation, we don’t know what Vincent’s wishes are,” he says. “Vincent’s parents are willing to care for him and have the right to do so. We strongly support their efforts and oppose the court’s ruling.” “This case parallels my sister Terri’s case in so many ways,” says...

How One Brain Came Back From Unconsciousness

A car accident left 19-year-old Dylan Rizzo in a coma. This is the story of the long, perilous crawl to recovery. Dylan Rizzo, April 2015. Photo: Dylan Coulter for New York Magazine Day Zero Despite its encircling fortress of bone, the human brain is especially vulnerable to physical insult. There are approximately 1.7 million traumatic brain injuries in the United States each year, and although most of them are mild or moderate, thousands result in severe brain damage. Those injuries always happen on the same day: day zero, a day that marks the start of a fateful and often flawed prognostic calendar. For 19-year-old Dylan Rizzo, day zero was December 28, 2010. Tall and slender, with dark hair and a sly sense of humor, Dylan possessed bright eyes and a wry arch to his smile, like a younger James Franco. In word and deed, he was a sports nut. He played hockey and high-jumped at his high school in Lynnfield, Massachusetts, just north of Boston, and rooted passionately for the Bruins. During the normal part of day zero, Dylan and his father, Steve, watched a local hockey tournament, then went to a family dinner at his grandmother’s house. Around 8:30 p.m., Dylan left in his car, stopping to drop his sister off at home. Before heading to play video games at his friend Ryan’s house, he called his mother to complain. He couldn’t find his Xbox controller. “You always move my stuff!” he said. “No, I don’t,” Tracy Rizzo replied firmly. After hanging up, Tracy found the controller in the backseat of her car. “I called Dylan,” she recalled....

Mom Who Refused Brain Surgery and Gave Birth in a Coma is Improving, Baby Headed Home (2014)

The brave woman who refused brain surgery to give birth to her unborn baby free from the effects of the surgery, is improving and her baby is headed home. Melissa C., 39, is a modern-day hero. Her dreams of becoming a mother finally came true even if she wasn’t awake and aware when she gave birth to her adorable baby boy. For entire article, visit this link:...

Sleeping Pill Awakens ‘PVS’ Patients (2006)

Sleeping Drug Broke Man’s 3-Year Coma A 28-year-old South African man who has been comatose since an accident three years ago is able to wake up with the unlikely help of a sleeping medication… Louis Viljoen was hit by a truck on a highway in 2003, and has been in a persistent vegetative state since with massive head injuries. The Daily Mirror reported he recently became restless, and Dr. Wally Nel prescribed the common drug Zolpidem to calm him down. Instead, Viljoen’s eyes fluttered and he awoke. The report said his brain function is improving slowly, and he is given half a dose of Zolpiden in the morning and again at noon to keep him awake for eight hours a day before he lapses back into a coma. Nel said Viljoen talks and recognizes friends, but doesn’t understand why he is hospitalized. In July, the British firm ReGen Therapeutics will begin six months of clinical trials on 30 coma patients to see if the drug works on them too, the Mirror said. [http://www.physorg.com/news68372093.html, N Valko RN, 2 June06]   Sleeping Pill Awakens ‘PVS’ Patients As reported earlier, a South African man thought to be in PVS for 3 years, was prescribed a sleeping pill to calm him down. Within 25 minutes of receiving the pill, the man awoke and began talking. Louis’ case was one of 3 such cases reported in the May 2006 issue of the medical journal NeuroRehabilitation. All 3 cases involved males around age 30 who had been in ‘PVS’ at least 3 years. All were given daily doses of Zolpidem (brand name Ambien) twice each...

Italian Coma Victim Awakens, Says He Was Conscious (2005)

In a coma for 2 years following a car accident, Salvatore C., father of 4 children, awoke suddenly and told doctors and family that he heard everything going on around him, despite doctors who told family he was not conscious. “I understood everything and I cried in desperation.” At the same time, Italy’s national bioethics committee had just released guidelines that incapacitated patients should be provided normal medical care, including food and water. [LifeNews.com, 5Oct05; HLA Action News, Fall...

PVS & Ambien (2006)

We have always been told there is no recovery from persistent vegetative state. But across three continents, severely brain-damaged patients are awake and talking after taking … a sleeping pill. And no one is more baffled than the GP who made the breakthrough. For three years, Riaan Bolton has lain motionless, his eyes open but unseeing. After a devastating car crash doctors said he would never again see or speak or hear. Now his mother, Johanna, dissolves a pill in a little water on a teaspoon and forces it gently into his mouth. Within half an hour, as if a switch has been flicked in his brain, Riaan looks around his home in the South African town of Kimberley and says, “Hello.” Shortly after his accident, Johanna had turned down the option of letting him die. Three hundred miles away, Louis Viljoen, a young man who had once been cruelly described by a doctor as “a cabbage”, greets me with a mischievous smile and a streetwise four-move handshake. Until he took the pill, he too was supposed to be in what doctors call a persistent vegetative state. Across the Atlantic in the United States, George Melendez, who is also brain-damaged, has lain twitching and moaning as if in agony for years, causing his parents unbearable grief. He, too, is given this little tablet and again, it’s as if a light comes on. His father asks him if he is, indeed, in pain. “No,” George smiles, and his family burst into tears. These awakenings have come as the result of an accidental discovery by a dedicated – and bewildered –...

‘I Felt Trapped Inside My Body’ (2006)

Kate, 36, communicates through a keyboard. Scientists have shown for the first time that a person diagnosed as being in a vegetative state can communicate. In 1997, when Kate was 26, she caught an acute viral infection. It was so serious that it confined her to a vegetative state for six months. While she was in hospital, unresponsive and seemingly unaware of her surroundings, Cambridge neuroscientist Dr Adrian Owen, who went on to make this latest discovery, scanned her brain. He showed her familiar photographs, and realised from her brain activity that she was aware of the images that had been placed in front of her. As the months went on, and Dr Owen repeated the experiment, he found that Kate was becoming increasingly aware. The first memories she had, she says, lasted for a few minutes when her occupational therapist came in. “I could not move my face, so I could not show people how scared I was. Not being able to communicate was awful – I felt trapped inside my body. I had loads of questions, like ‘Where am I?’, ‘Why am I here?’, ‘What has happened?’.” She said the scans changed everything. “I just have to look and see what the scans did for me. They found I was there inside my body that did not respond.” Her parents, Bill and Gill Bainbridge, whom Kate lives with in Cambridgeshire, agree. “The scan meant an enormous amount to us,” says Gill. “Up until then it had been very difficult for us to cope with the fact that she was in this vegetative state, and although she could...

Functional MRI Tests Indicate ‘PVS’ Patient Aware (2006)

PVS & Ambien: Several studies are being conducted worldwide on patients thought to be in PVS, using zolpidem (Ambien) which actually wakes up to sixty percent of these patients. Tests conducted on a 23-year-old, severely brain damaged woman—clinically diagnosed as being in a persistent vegetative state (PVS) as the result of a 2005 car accident—have provided researchers with surprising evidence that she is aware but unable to communicate that awareness. “I was absolutely stunned,” remarked lead British researcher Dr. Adrian M. Owen from the Medical Research Council Cognition and Brain Sciences Unit in Cambridge. The tests showed that “she is aware,” he said. [LA Times, 9/8/06] According to the study published in the journal Science, researchers in the U.K. and Belgium conducted functional MRI (fMRI) tests on the woman and compared the scan results with identical tests performed on 34 healthy volunteers. Unlike ordinary MRI scans which show structural brain damage, the newer, more advanced fMRI tests can measure function in specific regions of the brain. When researchers gave the woman verbal instructions, the fMRI picked up activity in the same brain areas as seen in scans of the healthy volunteers. When she was told to “imagine playing tennis,” her brain fired in the supplementary motor area that controls motor responses. In contrast, when she was asked to “imagine visiting all the rooms in your home, starting from the front door,” brain activity was seen in the areas responsible for spacial mental images. Her test results were indistinguishable from those of the 34 healthy volunteers. Researchers concluded, “These results confirm that…this patient retained the ability to understand spoken commands...

Boy in ‘Hopeless’ Vegetative State Awakens and Steadily Improves (2006)

A young boy, who had previously been diagnosed as being in a “permanent vegetative state,” has awakened from a 22 month-long coma and is breathing on his own. Devon Rivers collapsed in a seizure during a phys-ed class in 2004 and his condition was never explained, though some doctors suggested it was caused by an unknown viral infection. Doctors agreed, however, that he had little hope of recovery. His mother, Carla Rivers, visited him regularly and, in addition to physical therapy by his pediatric nursing home to keep his limbs supple, she talked to him in the belief that coma patients can retain their hearing and some understanding. “For two years the doctors said there was no hope,” said Carla Rivers. “Everything that happens in Devon’s life is a gain. There’s no losses.” Despite the doctors’ gloomy prognosis, eleven year-old Devon is now being prepared for occupational therapy to help him re-learn motor skills and is able to play with his siblings. Doctors cannot explain the reason either for his unexpected awakening or for his steady recovery. In August of this year his mother noticed that he began turning his head to follow movement; instead of a blank stare, he was reacting to his environment. Days later Devon was breathing without a respirator. Carla Rivers said, “Devon may make a full recovery or what we see today may be what we get…God’s plan is greater than ours. There’s nothing we can do to force it any sooner or hold it back,” she said. Coma patients and others with severe cognitive disabilities have been labeled “hopeless” only to recover frequently...

40% of PVS Patients Misdiagnosed, Half Recover: Two Articles (2007)

An international study finds that about forty percent of patients like Terri Schiavo who are supposedly in a persistent vegetative state are misdiagnosed and another fifty percent of them recover from their situation. The study finds the patients in question were in a minimally conscious state and could improve. The studies, conducted by researchers in Belgium, found that the level of misdiagnosis has not decreased in the last 15 years. The findings were presented at the European Neurological Society Meeting in Greece. Dr. Steven Laureys, from the Coma Science Group at the University of Li?ge, stressed during the meeting that the vegetative state in a significant proportion of patients admitted to intensive care may be transitory. “The study underlines the importance of extreme caution in any decision to limit the life chances of patients during the acute phase of a vegetative state,” he said. Laureys and his team studied whether the so-called PVS state is a long-term proposition for patients and he analyzed data collected over a five year period at the 26 bed intensive care unit at the university hospital. He and his colleagues examined 5900 patients and found that just over half of those who showed some degree of impaired consciousness on admission were diagnosed as in a vegetative state. Of these patients with serious brain damage, 28% died in the intensive care unit. 15% were classified as still in a vegetative state when they left intensive care. However, just over half of those who had originally been considered to be in a vegetative state left the unit having recovered consciousness to some degree. The largest group,...

Woman Woke from Coma (2007)

After two weeks and no change Ryan Finley took his wife Jill off life support and suddenly she awoke. Imagine being 31 years old and having to make the agonizing decision to discontinue the life-support keeping your comatose spouse alive. Now imagine that spouse waking up and asking for Mexican food. “It’s crazy. It’s absolutely crazy,” Jill Finley, the woman who was supposed to die, told TODAY co-host Meredith Vieira during an interview Monday. “It is truly a miracle that I’m here talking to you today.” On the morning of Saturday, May 26, Jill’s husband, Ryan Finley, tried to wake her up and found her unresponsive. The couple would learn later that Jill had a congenital condition that had caused her heart to stop. When Ryan realized she wasn’t breathing, he reached back 10 years to a CPR course he had taken, dragged her out of bed and onto the floor, and started to apply those never-used lessons. He called 911 and continued to work on his lifeless wife until paramedics arrived and shocked her heart back to life. They rushed her to the Oklahoma Heart Hospital, where the medical staff put her on a respirator and dressed her in a special suit that lowered her body temperature to attempt to minimize damage to her brain caused by lack of oxygen. She was alive in that she was breathing and her heart was beating, but she was in a deep coma. Ryan, a plumbing contractor in the Oklahoma City suburb of Edmond, stayed by her side, reading the Bible to her and sometimes lying on the bed next to...

Percentage of Traumatic Brain Injury (TBI) – Related Deaths — United States, 2013

The bar chart shows the causes of injury that result in traumatic brain injury (TBI)-related deaths vary by age group. In 2013, 77% of the TBI-related deaths among infants aged <1 year were from causes other than transportation, firearms, or falls, and primarily resulted from assault and maltreatment. Transportation accounted for 53% of the TBI-related deaths among children aged 1-14 years. Firearm-related injuries accounted for 50% and 52% of the TBI-related deaths for persons aged 15-24 and 25-64 years, respectively. Most of the firearm-related TBI deaths in these two age groups were suicides (62% and 83%, respectively). The majority (61%) of TBI-related deaths for those aged ≥65 years resulted from falls. Source: National Vital Statistics System mortality data. Available at http://www.cdc.gov/nchs/deaths.htm. Additional information on TBI available at http://www.cdc.gov/traumaticbraininjury/. See link below for chart. [CDC MMWR Weekly, May 22, 2015 / 64(19);539-539, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6419a9.htm?s_cid=mm6419a9_e...

Woman Wakes After ‘Brain Death’ Raises Questions About Organ Donation (2008)

A Virginia family was shocked but relieved when their mother, Val Thomas, woke up after doctors said she was dead. Mrs. Thomas, 59, while being kept breathing artificially, had no detectable brain waves for more than 17 hours. The family was discussing organ donation options for their mother when she suddenly woke up and started speaking to nurses. Ethicists have strongly criticised developments in organ donation criteria that would have made Mrs. Thomas a candidate for having her organs removed before she woke up. [http://www.lifesitenews.com/ldn/2008/may/08052709.html Life Site News; ALL Pro-Life Today,...

Computerized Brain Connections Show Better Quality of Life in ALS Patients (2006)

Research, recently published in the journal Psychophysiology, sheds new light on the condition known as the completely locked-in state (CLIS), a state where the patient’s total lack of muscle control makes communication virtually impossible. Patients totally paralyzed with advanced ALS (Lou Gehrig’s disease) are among the patients considered to be in CLIS. ALS is a motor disease which progressively destroys the peripheral and central motor system in the body. German researcher Niels Birbaumer [University of Tübingen] found that when brain-computer interfaces (BCIs) are used before the patient goes into the CLIS state, the patient can learn to communicate using the electronic device and continue that skill in the CLIS state. BCIs use activity in the brain to communicate by means of external devices like computers. One of Dr. Birbaumer’s most significant findings was that the ALS patients studied rated their quality of life far better than their caretakers or family members did, even when the patient was completely paralyzed and on a respirator. He also found that “only 9% of the patients showed long episodes of depression, most of them in the time period following the diagnosis and a period of weeks after tracheostomy.” “In fact,” he wrote, “they are in a much better mood than psychiatrically depressed patients without any life-threatening bodily disease.” According to Dr. Birbaumer, most ALS patients choose not to have artificial respiration or feeding and then die of respiratory problems. They are often pressured into foregoing such treatment by doctors and family members who think their quality of life is too low for such measures. In the Netherlands and Belgium where euthanasia is legal,...

Doctors Missing Consciousness in ‘Vegetative’ Patients (2009)

If there’s one thing worse than being in a coma, it’s people thinking you are in one when you aren’t. Yet a new comparison of methods for detecting consciousness suggests that around 40 per cent of people diagnosed as being in a vegetative state are in fact “minimally conscious”. In the worst case scenario, such misdiagnoses could influence the decision to allow a patient to die, even though they have some vestiges of consciousness. But crucially it may deprive patients of treatments to make them more comfortable, more likely to recover, or to allow them to communicate with family, say researchers. In a vegetative state (VS), reflexes are intact and the patient can breathe unaided, but there is no awareness. A minimally conscious state (MCS) is a sort of twilight zone, only recently recognised, in which people may feel some physical pain, experience some emotion, and communicate to some extent. However, because consciousness is intermittent and incomplete in MCS, it can be sometimes very difficult to tell the difference between the two. In 2002 Joseph Giacino at the JFK Rehabilitation Institute in New Jersey and colleagues released the first diagnostic criteria for MCS. Then in 2004, Giacino released a revised coma recovery scale (CRS-R) – a series of behavioural tests based on criteria that can be used to distinguish between the two states. Alarm ‘appropriate’ To see if the revised scale improves diagnoses, Giacino and Caroline Schnakers of the Coma Science Group at the University of Liege in Belgium, with colleagues, spent two years using CRS-R to re-diagnose patients admitted to a network of Belgian intensive care units and...

“Brain Dead” Teenager Awakens From Coma After Life Support Turned Off (2015)

LifeNews has repeatedly chronicled cases of people who were prematurely declared dead or said to be in supposedly persistent vegetative states who ultimately recovered. We have also covered miraculous cases where an act of God appears to be the only reason or only answer as to why a patient has recovered. Taylor Hale, then 14, suffered traumatic brain injury when she fell off the hood of a car while horsing around with friends in 2011. She spent a week in medically induced coma to help her brain heal, but she suffered a brain hemorrhage and her brain has supposedly “turned to mush.” Doctors declared Taylor brain dead and took her off life support, but later she woke up. Right before Taylor came out of coma, a devout family friend visited her and prayed for her recovery. Jeff Stickel, a chiropractor, laid his hand on Taylor’s neck while praying with family. Hale, now 17, will be graduating from high school on Monday. Here’s more about her amazing story: The family of Taylor Hale gathered in her hospital room nearly four years ago. They assembled to say goodbye. The date was Sept. 17, 2011 — six days after what normally would have been a silly teenage moment spawned a terrible sequence of events that resulted in two parents preparing to say goodbye to their 14-year-old daughter. Taylor was at a friend’s house on Sept. 11 after the first Waukee High School football game. A friend was leaving, and Taylor and another friend teased him. They didn’t want to leave. They sat on the hood of his car to stop him. He...