Life-or-death choices

When Sandy Burke looks at Terri Schiavo, she sees her son.

Fifteen years after his car crashed into a tree, Richard Burke hovers between what doctors say is a persistent vegetative state and minimal consciousness. He sits propped in a wheelchair during the day, his face largely blank, his eyes flickering open and shut. At 43, he relies on others for every need.

When his mother speaks to him, he sometimes turns his eyes in her direction and smiles or offers a thumbs up or down. Sometimes, he doesn't. No one knows how much he understands.

A few years ago, Sandy Burke asked doctors not to revive her son if he went into cardiac arrest. But the Middleborough woman can't bring herself to withdraw his feeding tube. ''I know he wouldn't want to live like this, but I couldn't do it."

Many families with a brain-injured loved one face such a struggle. But the road to each family's life-or-death decision is unique. Here are three of their stories.

Deciding to let her son die, then live

Kim Avery made the decision to let her son die once. She will not do it again.

The agonizing day was in 2001, three weeks after James M. Avery fell from the corporate yacht he worked on, struck his head on a dock and slipped under the boat in Newport Harbor in Rhode Island. He was in a coma, with a ventilator tethering him to life. Doctors had told the family he would never recover. Three times doctors had brought him back from death, and when his fever spiked to 107, they packed him in ice.

''How could we keep putting him through that?" Kim said.

The family decided to turn off the ventilator. Doctors predicted he would die within hours. Instead, James began breathing on his own. His mother stood vigil, waiting for the end.

''On the seventh day, I said, 'No more,' " Kim said. ''I told the doctors, 'You made a mistake.' "

A month later, James blurted out his first word since the accident -- ''Mom" -- and began the slow climb out of what doctors had called a persistent vegetative state. Now at Middleboro Skilled Care Center, a nursing home specializing in head injuries, James, 22, is entirely dependent on others. He is unable to see more than shadows and has little control of his body. Yet, he understands more than he can express. He roars at jokes and follows the sound of his mother's voice.

Last week, Kim Avery was talking about Schiavo. ''Jamie and I never discussed a living will," she said. ''I will not make that decision."

Then, she turned to James, who sometimes communicates by blinking. Two blinks for yes; one for no.

Would he want his feeding tube pulled if he were in the same state for 15 years?

Two blinks.

Is he getting better?

One blink.

Last week she 'danced,' and her relatives are thankful they never gave up hope

Colleen Soroka developed strong views about death after an accident in 2001 left her cousin Matthew brain dead. When his parents disconnected the ventilator that was breathing for him, Colleen was outraged and let everyone know it.

Now she was in a coma. And her family was hearing the worst.

A month had passed since the rainy day last July when Soroka crashed her car into a tree. Doctors said she would probably never breathe on her own. But the Middleborough family was not ready to give up.

''We knew if there was a chance, she'd want to go for that," said her mother, Susan.

So two days later, to see if she could breathe on her own, a respiratory therapist took Colleen off the ventilator -- and she began sucking in air. Two days after that, she coughed and opened her eyes.

Last week, Colleen, 23, ''danced" at her brother's wedding, as he led her wheelchair around the floor. She follows instructions and communicates with gestures. She can bring a cup to her lips with her good hand, but still needs a feeding tube.

''Every day she wakes up is a battle," said her sister, Katie Soroka. ''But it's better than her not being here."

Katie held out her 16-month-old son to her sister. Colleen gave him a hearty high-five.

'Why didn't you let me die?' son asks mother

Twice, Inta Hall got the call all parents dread. The first time, rescue workers had pried a young man from a wrecked car. Could she come to the hospital to confirm that it was her son? It was 1980, and the baby of the family, then a 17-year-old junior at Hingham High School, was in a deep coma.

Doctors operated to relieve pressure from blood pooling in the brain, and the coma began to lift. It took him six months to start speaking, longer to walk again. Even the simplest tasks were daunting.

''When we took the feeding tube out, he had to relearn what utensils were for," she said.

A year later, the call came again. Another car accident. This time, it was about Bill, the 22-year-old charmer of the family.

His frontal lobe was shattered. The machines showed only an occasional blip of brain activity. After his younger brother's accident, Bill had made his wishes clear. ''Don't you ever, ever allow me to be in that condition," Bill told his mother.

When the moment arrived, the family struggled, but Hall knew what they had to decide. They turned off the ventilator, donated his organs, and grieved.

Her surviving son, now 41, lives at home and works in a mailroom. He has the mental capacity of a child, she said, and his high school friends have deserted him.

''My son has said many times, 'My brother was lucky. Why didn't you let me die?' " she said.