The Los Angeles-based hard-rock band Guns N’ Roses released Use Your Illusion albums (I and II) at the height of their fame. Their lesser known but no less monstrous song Coma, from album I, has no chorus, is more than 10 minutes long and is in five distinct parts. It provides interesting insight about its writers, Axl Rose (lead vocalist) and Slash (lead guitarist), who struggled with mental illness and drug and alcohol misuse.

The song begins with four regular heartbeats before the bass, drums and guitars join following the heart rhythm. Throughout the song more heartbeats and beeps of an ECG machine are heard. The initial lyrics include ‘kinda like it in a coma’ and on two occasions a man yells ‘get the crash cart!’ Four minutes into the song Axl sings more blissfully; but then the drums beat rapidly, perhaps indicating ventricular tachycardia as the defibrillator is applied for the second time. Subsequent to again being ‘zapped’ the song becomes more melodramatic before turning sinister. A woman’s voice is heard talking to Axl, in the second person, mainly with a derogatory content. In the final part there is a dreaded sense of destiny with lyrics that include ‘gotta one way ticket to your suicide’.

Acute confusional state, or delirium, is not uncommon in patients who have been in comatose states. It can present with confusion and surreal fluctuating states of mind sequentially not dissimilar to the five parts of this song. These include being in and out of tranquil states, hallucinations and out of body experiences; the song makes four references to floating or sailing.

Axl Rose was diagnosed ‘manic-depressive’ and prescribed lithium. He started writing Coma after impulsively overdosing and being treated in hospital. Slash, in his autobiography, confesses to having used heroin, ecstasy and cocaine. He experienced drug-induced psychosis with episodes of acute paranoia, once running away naked from little versions of the aliens from the film Predator. Slash described the period 1999 to 2001 as his darkest, when ‘I started drinking from first thing in the morning’. He was comatose with cardiomyopathy, at one stage was given 6 weeks to live, and eventually had a defibrillator implanted.

Axl and Slash are currently well and abstinent but have not spoken for years.