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Jahi McMath Died and What Followed Has Been Tragic
This afternoon the latest chapter in the demise and subsequent saga of 13-year-old Jahi McMath has been started when a judge granted an extension of life support through Jan. 7. Since her surgery and subsequent cardiac arrest on Dec. 9, this case has become the topic of conversation throughout the nation. The unusual situation has attracted the commentary of medical providers, lawyers, ethicists, public relations agents, and religious figures. It has sparked an intense, emotional debate across water coolers and dining room tables. It deserves our considerate reflection for what it can teach us about medical science, the end of life, and the responsibility of physicians.
There is a paucity of known facts in this situation. The family and their lawyer have released few specific details. Oakland Children's Hospital, bound by the privacy restrictions of the Health Insurance Portability and Accountability Act (HIPAA), has offered even less. Jahi underwent three surgical procedures for the treatment of her sleep apnea. This included a tonsillectomy, uvulopalatopharyngoplasty (UPPP), and removal of nasal turbinates. Though initially described as a "routine tonsillectomy," this degree of surgery in children is not routine. It is extensive. When performed on a child, the risk is high. Bleeding and death can occur, as it did in her situation.
In recovery from surgery, about 30 minutes after its conclusion, it seems that she began to bleed profusely before she went into cardiac arrest. What may have triggered this? It has not been publicly disclosed, and it may not be fully known until autopsy. It is possible that she may have choked on her own blood and that this may have led to asphyxiation, depriving her brain of oxygen. Another equally plausible explanation would be that she lost such a volume of blood that her blood pressure dipped and, in a state of decreased blood flow to the brain, it was irreparably injured. Either scenario may be associated with a heart attack, as has been described. Regardless, the insult was fatal.
After she was stabilized, it is inevitable that a neurologist was called in to evaluate her. This is a position in which I have found myself many times. After cardiac arrest, a cooling protocol is often initiated. This is meant to preserve brain function by decreasing the metabolic demands of the damaged tissues. Once rewarming occurs, typically after a few days, the neurologist is summoned to perform a formal examination. This is done off of all sedation. This is a critical assessment because it can determine to what degree brain damage has occurred.
http://sleepdisorders.about.com/b/2013/12/31/jahi-mcmath-died-and-what-followed-has-been-tragic.htm
TreasonousBastard
(43,049 posts)and if it really went this way, why lawyers can't take the place of doctors.
Th1onein
(8,514 posts)Quote: Even despite multiple physicians attesting to her brain death, her family clings to the hope that she will come back to them. No one with brain death has ever done so.
More people than you would think have come back after a diagnosis of "brain death." And, in fact, Jahi's mother is now saying that she is seeing signs of life, but the doctors are telling her that they are only reflexes.
LeftyMom
(49,212 posts)and replaced by fluid.
Grieving religious fanatics are excellent at self-deception.
Th1onein
(8,514 posts)So she is not of issue in this regard.
LeftyMom
(49,212 posts)Her parents and their supporters swore she did things like respond and follow objects with her eyes that would require parts of the brain which she no longer had. Hope was making them interpret essentially random movements and noises as having meaning.
The claims of the family need to be examined in the cool light of reality, and not trusted implicitly. Self-deception is a real possibility.
Th1onein
(8,514 posts)I can tell you that the first thing the hospital did, when they wanted to pull the plug on my sister, who was conscious and communicating with us (she mouthed that she wanted a hamburger), was sedate her, so that she couldn't communicate with us.
You know what gets me? The family's claims must be examined in the cool light of reality! These are the people who care most for the patient! How about looking at the claims of those who are trying to pull the plug?
Did you know that there are more than THIRTY different sets of criteria for brain death? That's a hell of a lot of disagreement between the medical professionals, but we're supposed to view their word as the last word, and the family's as some sort of self-deception? Give me a break.
If brain dead is really dead; if it were identical and equivalent to death, why would it be necessary to coin a new term? The fact is that we don't have the technology to determine whether the brain is completely dead or not. We can only measure activity of the first couple of layers. And, if you're in doubt, and the parents or anyone else sees evidence of life, give them the benefit of doubt. After all, a life is at stake.
joshcryer
(62,276 posts)That's insane.
Th1onein
(8,514 posts)She finally died. But my family was put through hell trying to keep the hospital from killing her. We have a Futile Care Law in Texas (thanks, GW Bush), and if a doctor determines that it is futile to care for a patient any longer, they can simply let them die. Of course, they give you a few days to move them to another facility, but the caseworker at the hospital, who was supposed to help us find another facility, wouldn't even speak to us on the phone. She would actually hang up on us! And there was nothing we could do about it.
We finally had to PICKET the hospital. You can imagine us, with signs, in front of Methodist Hospital, in the Houston Medical Center. We were on TV, and on the front page of the Houston Chronicle. We embarrassed the hell out of the hospital, and they finally gave in and assigned another doctor to her case, who said that it wasn't "futile" to continue to give her medical care.
Now, if this is all so cut and dried and scientific, how can one doctor, all of a sudden, change the diagnosis of another? And, if we had given in, trusted the doctor, and agreed with the futility of continueing to give her care, our sister would have died sooner.
Now, you can say that it's just ten days, but you know something? Ten days of life is ten days of life. We give thirty days to people on Death Row, when they get a stay of execution. Who are we; what does it say about us, that we are okay with taking that away from people? For what? Money? So the insurance companies can make more profit (my sister was fully insured)?
Now, we've got this "brain death" thing, which was coined when we became able to transplant organs, coincidentally. And organ transplantation is a money making endeavor; billions have been spent on making us feel good about it. But "brain death" has 30 sets of different criteria, depending on where you're at. There is no agreement on what constitutes brain death; and we don't have the technology to even really test for it, because we can only test the first couple of layers of the brain for activity.
magical thyme
(14,881 posts)Per the law, the hospital had 2 doctors examine her and determined she was irreversibly brain-dead.
The family then requested that their own doctors examine her, and the hospital agreed. The family's choice of 3 more doctors examined her and determined that she is irreversibly brain dead.
So they took the hospital to court and the judge brought in a chief of neurology from a major hospital. That neurologist examined her and determined that she is irreversibly brain-dead.
6 doctors have found her irreversibly brain dead. Tests showed zero brain activity, including cerebral and brain stem. Tests showed no blood flow to the brain. And this has gone on for weeks now.
"How about looking at the claims of those who are trying to pull the plug?"
The hospital has been looked at closely. 4 independent neurologists have found her irreversibly brain dead.
Shivering Jemmy
(900 posts)That's the only part of the brain that does anything.
The rest is just wires.
Source: me, who has spent years dissecting brains and putting them back together.
Th1onein
(8,514 posts)FarPoint
(12,409 posts)Brain turned and filled with fluid....yea....not life.
joshcryer
(62,276 posts)No one.
Jahi will get 3 weeks.
Th1onein
(8,514 posts)Th1onein
(8,514 posts)There are cases where people have come back after weeks.
Kurska
(5,739 posts)She is dead, there is no coming back from that. After 30 minutes without blood flow the brain is long over, now try 2 weeks.
joshcryer
(62,276 posts)But that's an extremely rare case and he was determined to be alive after 2 days. I can't find any case that was longer than that. Jahi had her injury in early-mid December. It's been weeks, not days.
What a lot of people read about are people in vegetative or comatose (TBI) states making recoveries, in very very rare circumstances, but there has been zero cases of someone who was brain dead for weeks making a making a recovery.
I say give a family a week or so to mourn and see what happens since that's the state of the art there, but after that, with all scientific and medical knowledge, the family needs to leg go. Jahi is not going to recover. We've gone beyond anything reasonable, miraculous, incredible.
Kurska
(5,739 posts)In this case there is no blood flow to the brain and there hasn't been for weeks. There is no mistaking it, her brain was destroyed long ago.
joshcryer
(62,276 posts)But you're not incorrect.
In any event I have already said that it Jahi is dead as there exist no evidence of anyone lasting more than a day or two with that diagnosis.
Kurska
(5,739 posts)This young girl's brain was bled dry and has been bled dry for weeks. The brain starves in minutes like a person starves in weeks. At this point saying the young girl's brain might be alive is like saying a person who has gone without any food for a decade might not have starved.
joshcryer
(62,276 posts)Kurska
(5,739 posts)Th1onein
(8,514 posts)Doctors have made mistakes in these cases; many, many times. Doctors are not Gods, but they often like to play God.
joshcryer
(62,276 posts)Th1onein
(8,514 posts)Leave them alone. Enough is enough.
Response to joshcryer (Reply #6)
Kurska This message was self-deleted by its author.
magical thyme
(14,881 posts)and from the article it sounds like they were basing their diagnosis more on the level of trauma to the brain then anything else.
In this case, as posted above and elsewhere, tests have shown no blood flow to the brain. That, in itself, says the damage is irreversible.
madrchsod
(58,162 posts)cardiac arrest, blood stopped flowing for a minute or so ,and i was placed on a cooling protocol. the doctors told my wife to find a nursing home but she said no. a day or two later i woke up. my brain took over a month to recover from just a minute or so of blood stoppage.
i later learned that 2-10 % of the people who had the same level of trauma live.
LisaLynne
(14,554 posts)magical thyme
(14,881 posts)that's one of the times it's a good thing...
People have misconceptions about cardiac arrest, chest compressions, etc. Unlike television, a high percentage do not survive.