It is the scene everyone knows from the movies. A family member leans over a hospital bed, whispering a secret or a plea into the ear of a loved one who hasn't moved in weeks. Suddenly, a finger twitches. Or a tear rolls down a cheek. Hollywood loves this trope because it taps into our deepest fear: being trapped inside a body that won't respond. But if we move past the cinema, the actual medical reality of whether can you hear people in a coma is way more complex, a bit haunting, and surprisingly hopeful.
Honestly, for a long time, doctors basically assumed a coma was a "lights out" state. If you weren't awake, you weren't there. We now know that's just not true. The brain is remarkably stubborn. Even when it's flickering like a dying lightbulb, it can still catch bits of the world around it.
The grey zone of consciousness
The word "coma" gets thrown around a lot. People use it to describe everything from a temporary drug-induced sleep to a permanent vegetative state. But medically, it's a specific lack of wakefulness and awareness. You can't be "aroused." You don't respond to pain, light, or sound in any way that looks meaningful to a bystander. However, the brain doesn't always follow the rules of the body.
Back in 2006, a groundbreaking study published in Science changed how we think about this. Dr. Adrian Owen and his team worked with a woman who had been in what was called a vegetative state for months after a car accident. They put her in an fMRI machine and asked her to imagine playing tennis. Then they asked her to imagine walking through her house.
To everyone’s shock, her brain lit up.
When she "played tennis," her supplementary motor area fired off. When she "walked through her house," her parahippocampal gyrus—the part of the brain that handles spatial navigation—became active. Her body was a statue. Her brain was an athlete. This study was a massive pivot point for the question: can you hear people in a coma? It proved that for a subset of patients, the ears are working, the brain is processing language, and the mind is following instructions, even if the eyes stay shut.
Not everyone is "there"
We have to be careful here. It is dangerous to assume every person in a coma is secretly a prisoner in their own mind. That leads to false hope and, frankly, a lot of unnecessary trauma for families.
Doctors generally categorize these states based on the Glasgow Coma Scale (GCS). It measures eye-opening, verbal responses, and motor responses. If you’re at a 3, you’re at the bottom. If you’re at a 15, you’re fully awake. But even someone with a low score might have "islands of awareness." This is what researchers call Cognitive Motor Dissociation (CMD). It basically means the "thinking" part of the brain is disconnected from the "doing" part.
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A study from Columbia University, led by Dr. Jan Claassen and published in the New England Journal of Medicine, found that about 1 in 7 brain-injured patients in intensive care units showed these patterns of brain activity when asked to move their hands. They didn't actually move their hands. But their brains tried.
The power of a familiar voice
If the brain is indeed listening, what is it actually hearing? Is it just noise? Or does the identity of the speaker matter?
It turns out, the brain is a bit of a snob. It prefers people it knows.
In 2015, a study conducted at Northwestern University and Hines VA Hospital looked at "Familiar Auditory Sensory Training" (FAST). They took coma patients and played them recordings of family members telling stories. We aren't talking about medical updates; we're talking about "Hey, remember that time the dog got into the Thanksgiving turkey?"
The results were wild.
When patients heard these familiar voices four times a day for six weeks, they recovered consciousness significantly faster than those who just heard silence or random noises. The fMRI scans showed that the familiar voices actually helped decrease brain inflammation and stimulated the parts of the brain responsible for long-term memory and language.
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So, if you’re sitting by a bed wondering can you hear people in a coma, the answer is: talk. Talk a lot. Talk about the mundane stuff. Tell them the weather is garbage or that their favorite sports team lost again. The familiarity acts as a sort of neurological bridge, helping the brain find its way back to the surface.
The auditory "Startle" vs. understanding
There is a big difference between hearing a bang and hearing a sentence.
Most people in a deep coma still have a functioning brainstem, which controls basic reflexes. If a nurse drops a metal tray, the patient might jump or their heart rate might spike. This is an "auditory startle." It doesn't mean they know what happened. It’s just the body’s hardware reacting.
The real goal is "receptive language." This is where the temporal lobe processes the sound into meaning. This is much rarer in deep comas but becomes more common as a patient moves into a "minimally conscious state" (MCS). In MCS, the person might occasionally follow a simple command or reach for an object, but they can't do it consistently. Hearing is often the first sense to return and the last to leave.
What it actually feels like (from those who came back)
We can look at all the brain scans in the world, but the best data comes from the survivors.
Take the case of Martin Pistorius. While technically in a "locked-in" state rather than a standard coma, his experience is the gold standard for understanding hidden consciousness. He spent over a decade unable to move or speak. He later wrote in his book, Ghost Boy, that he was aware of everything. He heard the conversations of his caregivers. He felt the frustration of people talking over him as if he were an object.
Others describe coma "hearing" as being like a dream.
- "I could hear my mom, but she sounded like she was underwater."
- "I heard the doctor say I probably wouldn't wake up, and it made me so angry I wanted to scream."
- "The sound of the heart monitor became the beat of a song I was hallucinating."
This tells us that the input is often distorted. The brain is trying to make sense of data with half its processors offline. Imagine trying to watch a movie on a broken screen with the volume fluctuating—that’s the reality for many.
Factors that change the "Hearing" equation
Not all comas are created equal. The cause of the injury matters more than almost anything else.
- Traumatic Brain Injury (TBI): If someone was in a car wreck or a fall, the damage is often localized. Some parts of the brain might be totally fine while others are shattered. These patients are often the ones who show that "tennis-playing" brain activity.
- Anoxic Brain Injury: This happens when the brain is deprived of oxygen (like a drowning or a heart attack). This damage is usually global. It hits everything. In these cases, the likelihood of the person "hearing" or "understanding" is unfortunately much lower because the auditory cortex itself may have been damaged.
- Drug-Induced Comas: These are controlled. Doctors use sedatives like propofol to let the brain rest. In these cases, the hearing is suppressed on purpose, though some people still report "echoes" of the room.
Why it matters for caregivers
If you’re currently visiting someone in this state, the "expert" advice is simple: act as if they can hear you. Even if the doctors are skeptical. Even if the monitors show nothing.
Why? Because the risk of talking to someone who can't hear you is zero. The risk of staying silent when someone is "in there" is devastating.
There is a psychological phenomenon called "social death." It happens when we start treating a living person like they are already gone. We talk about them in the third person while standing right next to them. We stop using their name. We stop touching their hand. If that person has even 1% awareness, social death is a nightmare.
Sensory stimulation beyond sound
Since hearing is so tied to the brain's recovery, many ICUs are moving toward "multimodal stimulation." You don't just talk. You bring in their favorite perfume or the smell of coffee. You brush their hair. You put a piece of rough fabric and then a piece of silk in their hand.
The idea is to bombard the brain with familiar, "safe" signals. It’s like trying to wake someone up from a very deep sleep—you don't just yell; you use every tool you have.
Actionable steps for the bedside
If you are navigating this right now, here is how you should handle communication based on current neuro-rehabilitation standards:
- Introduce yourself every time. Even if you’re their spouse. "Hey, it’s Sarah. I’m here." It grounds the brain in a specific identity.
- Tell stories, don't just give updates. The brain responds better to narrative and emotional content than to a list of lab results.
- Keep it positive but real. Avoid screaming or being overly loud. Use a normal, warm conversational tone.
- Monitor the environment. If the TV is blaring a loud, stressful news program, turn it off. Coma patients can't "filter" background noise well. They need a focused auditory environment.
- Touch while you talk. Physical contact combined with sound creates a stronger neural signal than sound alone.
Science hasn't mapped every corner of the human mind yet. We don't have a "consciousness meter" that works with 100% accuracy. But the evidence we do have suggests that the window between the world and the mind isn't always slammed shut. Sometimes, it’s just cracked open a tiny bit, and your voice might be the only thing keeping it from closing.