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The rapper suffered a heart attack the weekend before his death.

By Karen Pallarito
April 05, 2021
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Earl Simmons, better known as the multi-platinum rapper DMX, died Friday morning after suffering a heart attack the previous weekend, according to media reports.

The 50-year-old artist was admitted to White Plains Hospital in New York's Westchester County late Friday after paramedics received a 911 call, per police, the Wall Street Journal reported. Some media organizations attributed the heart attack to an apparent drug overdose, but the rapper's longtime attorney, Murray Richman, could not confirm the reports, according to the WSJ.

DMX vegetative state
Credit: Getty Images

The New York Times on Sunday quoted the rapper's former manager, Nakia Walker, saying Simmons was in a "vegetative state." Walker also told BuzzFeed News that the rapper had "lung and brain failure and no brain activity."

What is a vegetative state, and how does it differ from a coma?

Severe brain injury, whether due to a head injury or a medical event that deprives the brain of oxygen, can lead to a change in consciousness. The end result is that your awareness of self and the world around you is altered, explains the Brain Injury Association of America (BIAA).

There are different states of altered consciousness. A coma is a deep, prolonged state of unconsciousness with no eye opening. A person in a coma may appear to be asleep but cannot be awakened, per Harvard Health Publishing.

Someone in a vegetative state, by contrast, may appear to be awake—with eyes open at times, as the person cycles through periods of wakefulness and sleep, BIAA explains.

"The best way to describe vegetative state is that the patient is awake, but they're not responsive," says Jacob M. Appel, MD, associate professor of psychiatry at the Icahn School of Medicine and an emergency room psychiatrist with New York City's Mount Sinai Health System.

People in this state of consciousness can breathe and may even grimace, cry, or laugh. What they cannot do is speak or respond to commands. While they are not considered brain dead, they lose their higher brain functions, says the National Institute of Neurological Disorders and Stroke (NINDS).

What’s the treatment and prognosis?

Whether or not someone recovers from a vegetative state depends a lot on the cause, Dr. Appel tells Health. As BIAA notes, about half of people in a vegetative state a month after sustaining a traumatic brain injury (due to, say, a car crash or fall) recover consciousness. Among those types of injuries, there are some reported cases of people who make meaningful recoveries, Dr. Appel says.

However, folks in a vegetative state due to a stroke or loss of oxygen to the brain may not fare as well. They may survive for an extended period of time but often experience pneumonia, respiratory failure, infections, or other complications, BIAA explains.

"You hear these stories of people waking up after 20 years and suddenly speaking to their relatives—those are all the result of usually blunt-force injuries," Dr. Appel points out. They're not people recovering from a cardiac event, such as a heart attack, which deprives the brain of oxygen-rich blood for some period of time.

There's currently no proven treatment to speed up or improve recovery from a vegetative state, BIAA states. Treatment consists of providing care for any issues that may interfere with recovery, for example draining fluid from the brain. Most of the care provided is supportive, says Australia's Brain Foundation. The patient will be fed through a feeding tube, toileted via a catheter, and moved to prevent bed sores.

As for sensory stimulation (such as singing songs, holding hands, speaking to the patient, etc.), BIAA says medical facilities and clinicians differ on their use of such therapies. "Because the amount of recovery from disorders of consciousness varies so greatly, it is difficult to judge the value of these and other treatments outside of research studies," BIAA says.

Some people regain some degree of awareness after being in a persistent vegetative state, while others remain in that state for years or decades, per Cleveland Clinic. The truth is we still don't know a lot about this state of unconsciousness, underscoring the need for continued research.

"There's a whole field of ethics and law devoted to this subject," Dr. Appel adds. There's the dilemma of not knowing what people's wishes would be in such circumstances or how to protect their rights. "So, yes, both clinically and ethically, we need to do a lot of work."

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