Brain-injury case doctor hearing pleas for help

BUFFALO -- Soon after Dr. Jamil Ahmed stood before television cameras two weeks ago and told how his brain-injured patient had snapped out of a stupor lasting almost 10 years, the telephone calls and e-mails began pouring in.

Everybody wants a word with Ahmed, 43, who is just three years removed from his residency training at Boston University Medical Center, after earning a medical degree in Pakistan.

There are doctors calling about patients. There are family members of brain-injured people asking whether Ahmed can talk to their doctors. And just what drugs was the brain-injured former firefighter, Donald Herbert, taking when he turned from being barely aware and almost mute into a virtual chatterbox for 14 hours with his astounded family and friends?

''Why don't you just tell me the medications?" Ahmed recalls one woman demanding. ''You just tell me the name of the medications, and I'm not going to be calling you again."

Ahmed, who has been asked by Herbert's family not to identify the drugs, has returned a few phone calls, explaining his medication strategy in general terms and warning, ''There is no guarantee."

Ahmed was treading in largely untested waters when he put Herbert, now 44, on a combination of drugs usually used to treat Parkinson's disease, depression, and attention deficit hyperactivity disorder.

He said he had seen such drugs help his other brain-injury patients at Erie County Medical Center regain focus, memory, and powers of concentration, and become less agitated or irritable. He had even seen such drugs bring people out of comas -- the eyes-closed state of complete unawareness -- and other kinds of impaired consciousness, although not after nearly 10 years as in Herbert's case.

So when he heard that Herbert had improved, ''I was not surprised," Ahmed, a genial rehabilitation specialist, said the other day. ''I was expecting from the beginning he should make a change."

In the days since, Herbert has continued to have sporadic conversations and has even played with a soccer ball.

In a discussion about Herbert's case, Ahmed waved off a question about Terri Schiavo, the brain-damaged Florida woman in a persistent vegetative state who died in March after her feeding tube was removed. He had not examined her and so could say nothing, he said.

But he emphasized that family and doctors should not give up on trying to help brain-damaged patients.

''I'm confident that if we try the same way on other people who are in a coma [or other states of impaired consciousness], there could be a difference," he said. ''There could be a lot of people who could wake up."

''God will not help you unless you try something," said Ahmed, a Muslim who grew up in Karachi, where he attended college and medical school.

After receiving some training in New York, he did his residency at the BU medical center, where he was drawn to the idea of caring for brain-injury patients. Those patients present a variety of problems, with not only mental deficits, but also with fluctuations in mood and behavior that can put a severe strain on the family, Ahmed said.

When he joined the rehabilitation medicine department at the Buffalo hospital, his colleagues started referring brain-injury patients to him.

In December 2002, a few months after he started work, Herbert's wife, Linda, showed up to talk about her husband. He had suffered brain injuries when a roof collapsed on him while fighting a fire seven years before. Everybody said nothing could be done to help him, Ahmed recalled her saying.

In Buffalo, Ahmed already had seen promising results from medications such as the ones he would end up prescribing for Herbert. The idea was that such drugs might jog the brain's supply of substances that brain cells use to communicate and bring about other changes in the brain, maybe even helping to fix anatomical damage.

Others had been trying the medication approach too, but ''the evidence is not great," said Dr. Steven Flanagan, medical director of brain injury rehabilitation at Mount Sinai Hospital in New York.

Flanagan said he and his colleagues treat brain injuries with such drugs anyway, sometimes with success.

Ahmed went to work with Herbert, testing one medication after another. It was on April 30 that Herbert went on his talking jag.

An excited family member reached Ahmed at home. The doctor said it was good news and advised the family to relax and not push Herbert.

In the days that followed, Herbert had a brief setback, but he has since started talking more and smiling. More recently, he began physical therapy and has been walking with assistance.

It is not clear what will happen from here on. But the results so far are encouraging for a man who had been limp in a wheelchair. And they seem to back up Ahmed's philosophy of medicine.

''I never give up," he said. ''Don't give up. There should always be hope."