The doctor told Joan Brown that her 30-year-old son was in a persistent vegetative state, but she sensed he was conscious, at least some of the time.
For three years after his car accident, the Nova Scotia woman spent every day with her son, Arnie Hake, in the hospital, reading him Westerns and mysteries, chatting to him as if he could understand. Small signs boosted her resolve.
"Every day I'd kiss him and say 'pucker up, give Mum a kiss.' After a while, I started to see his tongue move or his lip move," Mrs. Brown said.
In 2001, she arranged to have him tested by a team of researchers in Halifax, who were working on a new way to assess conscious awareness in patients who can't communicate. The results confirmed a mother's intuition: Her son was in there and could understand what was said to him. The technology had worked, but it was too late to be any help. Mr. Hake developed serious complications and died six months later of pneumonia at age 33.
Today, nearly a decade later, there is new hope for patients who are prisoners in their own bodies, still conscious but unable to let anyone know. The researchers have recently developed a portable, modified version of the test that was used on Mr. Hake. It is called the Halifax Consciousness Scanner, and it could eventually be used in emergency rooms in hospitals across the country.
The diagnosis that someone is in a permanent vegetative state is a difficult one, and is based on how patients respond to sounds, touch and other stimuli. But what if they can't move, talk or make any kind of noise?
"Mercifully, these kinds of cases are rare," said Don Weaver, a neurologist and neuroscientist at Dalhousie University in Halifax. "But recognizing it is pretty bloody important."
New tools are needed, Dr. Weaver says. The test the researchers have developed measures electrical activity in the brain in response to various stimuli, including nonsense sentences such as "The pizza was too hot to sing."
If your brain is working properly, it will react to that sentence with a distinct signal known as an event-related potential, or ERP. Patients whose brains aren't working don't react.
"Arnie showed the same neural response you or I would," said the National Research Council's Ryan D'Arcy, who works with Dr. Weaver.
The case had a profound impact on him, Dr. D'Arcy said. "When we knew it was possible to do this, the critical problem became: How do you move this into everyday clinical care? The solution was to create a new diagnostic device."
The new, modified version of the test takes only five minutes to use, and doesn't require an expert to analyze the results. "The beauty of this is it doesn't require a skilled person," Dr. Weaver said. "You put it on the head and press go and you get a number."
It could also be used to help track the progress of patients who have a stroke or brain injury, and perhaps to quickly assess the damage from a concussion.
The two Halifax-based researchers are planning to test it on patients at Queen Elizabeth II Health Sciences Centre. They want to assess stroke patients shortly after they are admitted, then track them, to see whether their early scores are predictive of how well they recover.
John Connolly, who had been part of the Halifax team, moved to McMaster University in Hamilton in 2008, and his colleagues there are planning experiments with the more comprehensive version of the test that was used on Mr. Hake. It is called NeuroVox and involves a modified electroencephalograph, or EEG.
There have been plenty of small studies on it, involving up to 10 patients, but a larger-scale study is needed, Dr. Connolly says.
The first patient he tested in 1994 had been stabbed through the skull with a foot-long knife, and was unable to walk, gesture or communicate in any way. The test showed the 22-year-old could understand speech, and, after more than four months of therapy, he was able to walk, read, feed himself and play Nintendo.
It is impossible to know whether Mr. Hake's condition would also have improved with intensive therapy, Dr. Connolly says.
Mrs. Brown wishes he could have had that chance. Still, the progress the researchers have made is a comfort to her, as is the knowledge that her son understood all those one-sided conversations.
Mr. Hake was the youngest of her five boys. He was the wild one, and on the night of the accident he had been drinking in a bar with friends. They tried to get his car keys, but he wouldn't give them up. Mr. Hake's black Trans Am went off the road and hit a pole.
"Not a day goes by that I don't think of it. I see him flying through the air," said Mrs. Brown. She lives in Centreville, N.S., and remarried after her divorce from Mr. Hake's father, who also visited his son every day in the hospital.
After the accident, their son was airlifted to Halifax, but a month later he was transferred to a regional hospital. Occasionally, he would blink or move a foot at Mrs. Brown's request, but never when doctors or nurses were present. She remembers balking when a doctor suggested she consider removing the feeding tube that was keeping her son alive.
"I knew there was someone in there," she said.
Dr. Connolly remembers the silence that fell over his lab the day they heard Mr. Hake had died.
"We don't want to miss any more Arnies," he said.