Monday, 6 January 2014

Jahi McMath FAQ

Repetition as a concept is bad.  Repeated repetition is worse. Add ignorance, stupidity, blind faith, half-truths, or outright lies to the repetition, and it becomes completely intolerable.  I engaged in my first Twitter argument regarding Jahi McMath a few nights ago, and I kept hearing the same stupid questions and the same ignorant comments.  Perhaps if I had a TARDIS I could find every one of these ignorant people who are undermining the reputation of Children's Hospital Oakland and their staff (and the entire medical community in general) and try to talk (ie slap) some sense into them. Unfortunately, I haven't the time, patience, or TARDIS to do so.

So instead I decided to put some of the more poignant questions here in order to answer them as clearly and concisely (read: using small words so the simple-minded can understand) as possible.  Brace yourselves, folks.  It's about to get deep.

Q: Jahi is in a coma, so she could just wake up!  People like this wake up all the time.  They need to give her more time so she has a chance to get better. 
A: That's clearly not a question, but I'll address it anyway.  This seems to be the main point that people just don't seem to get, so read this very carefully: She is NOT in a coma.  She is not in a persistent vegetative state (PVS).  She is brain-dead.

Q: Ok fine, but there's no difference anyway.  They're all the same!
A: Again, not a question.  You're not even trying, are you?  Anyway, no NO NO!  They are NOT the same thing, not remotely.  A coma is an unconscious or semiconscious state, while a persistent vegetative state is a prolonged coma, often due to permanent brain injury.  There are countless reports of coma patients waking up, and reports of people in a persistent vegetative state getting better to varying degrees.  This is because with comas and PVS, the brain is still alive.  But with brain death, the brain has been deprived of oxygen and has died.  In the entire history of humankind, no person who was actually brain-dead has ever woken up.

Q: But why? All these reports can't be false, can they?  I've read it on the Internet, so it must be true!  The Internet would never lie to me!
A: Of course they can all be false.  The short answer is because the central nervous system has no capacity to heal.  None.  Ever.  The longer answer is when the brain, brainstem, cranial nerves, or spinal cord is injured, it is injured forever.  If these cells die, they are dead forever.  Jahi's brain and brainstem were deprived of oxygen for too long, so they have both completely died.  Therefore there is a 0% chance of those cells ever healing.  Not a 1% chance not a 0.01% chance, not a 0.000001% chance.  Zero.  It is physically impossible for her to ever wake up.

Q: But you haven't examined her!  How could you possibly know this?  Are you making this all up?  
A: No, but I have read the report by Dr. Paul Fisher who DID examine her, and that's good enough.  He did an extremely comprehensive neurological exam.  All of her brainstem reflexes have disappeared, her pupils are fixed and dilated, and she failed an apnea test.  She was taken off the ventilator for nearly 10 minutes, and she had no respiratory effort whatsoever.  If her brainstem were alive, she would have tried to breathe as her carbon dioxide levels rose.  She didn't.  Therefore her brainstem is dead.

Q: Well what if you're wrong?  Aren't doctors wrong all the time?
A: All the time?  No.  Occasionally?  Yes.

Q: Well doesn't that prove that you could be wrong here?
A: No.  At least 6 physicians have done a thorough examination, all of which were conclusive for brain death.

Q: But you just said doctors make mistakes!  What if they all made one?
A: She's also had two electroencephalograms (EEGs) which have shown no electrical activity in the brain.  Live brains have electrical activity.  She also had a radionuclide brain scan which showed no blood flow to her brain.  Brain tissue is extraordinarily sensitive to lack of oxygen, so no blood flow means a dead brain.  A computer could read a flat EEG and a blank brain flow scan.  Then again, so could a 5-year old.

Q: But couldn't you still be wrong?
A: No.

Q: But there are all those stories about brain-dead people waking up!  What about Zach Dunlap and Colleen Burns and Sam Schmid and Suzanne Chin and...?
A: I don't have access to their medical records, but clearly none of them were ever actually brain dead.  Perhaps their families were told they were brain dead by mistake.  Perhaps the families were told they had a "severe brain injury" and their families heard "brain dead" instead.  Perhaps the doctors made a mistake in their examination and subsequent diagnosis.  Regardless, because of all the reasons I stated above, it is 100% impossible for someone who is brain dead to wake up.

Q: But what about miracles?
A: You may believe in miracles all you want, but I will NOT get dragged into a theological debate.  Beliefs are funny things.  Personally I believe that all of you will eventually come to your senses and finally understand the science here, but that doesn't mean you will.

Q: What harm could all this really be doing?  Why are you so opposed to giving her a chance?
A: Quite simply, this is setting a dangerous precedent that will make some people think it's ok to keep a dead body on machines.  I also fear that it will prevent some people from deciding to become organ donors, which is the most noble sacrifice anyone could possibly make.

Q: But her heart is still beating!  Her body is warm!  And her kidneys are making urine!  Are you telling me that dead people have beating hearts?  Should we make caskets waterproof to protect the ground from all the urine the dead people make?
A: Clearly you don't understand basic human anatomy and physiology.  The heart, kidneys, and lungs do not require a brain to function.  If I hooked a human kidney up to an oxygenated blood flow, it would produce urine, no brain (or batteries) required.  Same thing goes for the lungs, heart, and all the other cellular mechanisms.  Because Jahi's body is hooked up to a ventilator, it pumps oxygenated air into her lungs.  Her lungs, also requiring no brain input to exchange gases, continue to exchange oxygen for carbon dioxide, and her cells which are receiving blood flow (remember, her brain is NOT getting blood flow) will continue to function.  So her body will stay warm, her heart will still beat, and her kidneys will still make urine.

Q: So doesn't that mean she's alive?  Isn't brain death not true death?
A: No.  There are two definitions of death - cardiac death (heart stops, all other cells then die) and brain death (brain dies).  Both mean the same thing - the patient is dead.  One is not "more dead" than the other.  Jahi is no less dead just because she has a beating heart.  She has no functional brain.  Just like anyone who thinks brain dead people can wake up.

Q: Well aren't you an arrogant ass.
A: Yes.  Any other questions?

Q: No.
A: Good.

81 comments:

  1. "She has no functional brain. Just like anyone who thinks brain dead people can wake up". That has to be the best line from the entire post! :D

    ReplyDelete
  2. I haven't met this story before and haven't checked in on DocB' since before he started posting on this.

    I can really understand how the family don't want to accept that their child is dead. I have some related personal experience and accepting that someone is beyond help is incredibly difficult and painful.

    However, my thoughts on this come from the opposite angle:

    Medicine is now so advanced that you could have a heart beating in a box (with a few tubes etc). This would not be a living person. It would be a pumping machine.

    You could add lungs to your box and they could probably also be made to work. Still not a person, however. Just a breathing, pumping machine.

    In practice you could carry on adding quite a few organs, and in theory you could construct a whole body this way. You could pretty much construct Frankenstein's monster one organ at a time. With electrical stimulation etc it could be made to breathe, circulate, even move a bit under computer control but without a functioning brain, it would still just be a machine.

    The body is the machine and the brain is the driver. Sad as it is, that is what Jahi's body now is - a driverless machine. The car is still running but the driver stepped out weeks ago.

    Let's imagine, for a minute, that we are aliens and we watch Earth and conclude that cars are life-forms. It's not that unlikely - they move, they eat (petrol), they breathe and they die. Normally they die because they grow old or because they crash. When they do they stop running around and fall apart - either suddenly as they hit a bridge pillar or slowly as they rust and their components pack up.

    We know, however, that what makes a car run is the driver and just sometimes an unfortunate driver pulls their car over onto the shoulder because they are having a heart-attack. Our aliens will see the car still running, it's warm and breathing and producing exhaust gasses and appears outwardly to be alive. Just wait, they will think, and the car will start moving again. But it never will because the driver is gone.

    RIP Jahi - and may your car be allowed to rest soon too.

    ReplyDelete
    Replies
    1. This is probably the best explanation of her state I've read so far. Could not have worded it better. I just wish the family would finally understand it that way..

      Delete
    2. I agree....a wonderful explanation : )

      Delete
  3. I have a question....I read the report on the link you provided. When the Dr turned off the vent for those 9 minutes or so did the heart stop also? Did they have to re-start it?

    ReplyDelete
    Replies
    1. No, but if they had left the vent off for longer, it would have. Remember, the heart functions independently of the brain. The increased carbon dioxide level in her arterial blood (greater than 70, if memory serves) would have stimulated her brainstem to initiate a breath if it weren't dead. This alone is diagnostic of brain death, even without the other supporting studies I mentioned.

      Delete
    2. Thank you for all the info provided. I have one question: If blood is flowing all over her body keeping other organs alive...why is it not flowing to her brain? Sorry if you explained this previously, I am really curious about what is possibly happening to this poor girl.

      Delete
    3. It stopped flowing to her brain around the time of her cardiac arrest due to cerebral edema (swelling of the brain). Once the blood flow stops, the vessels typically clot off.

      Delete
  4. This is a very informative and persuasive post. But I know that some folks are still not going to believe it. Sad.

    ReplyDelete
  5. Lawyer Dolan: She's in very bad shape.

    Yes, I would assume she is. She's been dead for over three weeks now. Gawd, my head is going to explode.

    ReplyDelete
    Replies
    1. I forgot to include a link to the story:
      http://www.insidebayarea.com/news/ci_24853880/jahi-mcmath-brain-dead-girl-moved-undisclosed-care

      The story adds that the trach and feeding tube procedures haven't been done because there were other undisclosed "medical issues" that unidentified "independent" doctors have identified.

      Delete
    2. SO MANY QUESTIONS!!!! I'm wondering exactly how much care the hospital had to provide besides keeping the ventilator on. Did they have turn her every 2 hours, bathe her, have her covered in Bair Hugger to keep her temp up, respiratory care? I would assume that weeks of inadequate tissue perfusion everywhere on the body has her in a very bad shape.....but the family thinks it's from no nutrition and poor care from the hospital. Can't wait to see how well she does in the family's home or this facility she is supposedly going to run by a hairdresser.

      Delete
    3. OMG just read that article. Says she deteriorated badly at the hospital. Well yes - of course she did - she's been dead for three weeks. And what happened to the family's claims that she was doing better the past few days??

      Delete
    4. Call me crazy, but I think this sad-excuse-for-a-lawyer's minuscule conscience/voice of reason is realizing he has backed himself and the family into a corner and it trying to add the spin of "further" hospital misconduct/poor care as the reason for Jahi's body's imminent and inevitable decompensation once removed from the PICU (can't say death, that is already confirmed).

      Delete
    5. @doctorem922 Same thought I had. Initially. If, while at CHO, she was only given minimal support then some of the claims could be true. Physiologically speaking that is. Having done some reading as to how the pregnant women that have been declared brain dead have been maintained it seems there were IV medications and nutrition as well as various hormones, etc., were being given to maintain physiologic "health". The question arises after the declaration of brain death for Jahi, just how much support was given aside from the respirator and the warming blanket? I believe she was given drugs to stabilize her BP and heart rate. I just question what else was being done in that time frame between declaration and transfer.

      Delete
    6. I just wanted to clarify: In no way do I agree with what is being done with Jahi. No matter what they do for her she is still just as dead. I was simply thinking out loud, as it were, about the lawyer's claims that they didn't provide adequate care for Jahi at CHO after the incident, which is now causing deterioration of her body. Yes, I actually said that with a straight face. However, Jahi having been declared dead (brain or otherwise) would dictate the course of care given the law(s) in place in California regarding brain death. Do you see where I'm going with this? I sure hope so because I'm confusing myself. ;-)

      Delete
  6. Just morbid curiosity, how long will a heart continue to beat without a functioning brain? If (God forbid) they kept her hooked up to that ventillator would it go on into infinity?

    ReplyDelete
    Replies
    1. This depends on the caliber of care she receives and what complications her other organs suffer (things that are not mutually exclusive either). Modern medicine, in the ICU setting, can provide medications and other support indefinitely, until an inevitable complication ensues. Fortunately, this young lady is brain dead, so her suffering has mercifully ended and it will be her loved ones who will witness and suffer as her body is riddled with failure. Complicated answer to a simple question, sorry!

      Delete
    2. Lisa: Without providing the necessary hormones certainly not, (although in very limited amount of cases is the hypophysis actually partially preserved, due to it's location).

      Delete
    3. http://www.youtube.com/watch?feature=player_embedded&v=rZAxbAVcKR0

      A heart beating independently.

      Very informative blog, I am writing my own article on this case and will be linking to this. If this does go to court, I am pretty sure that scumbag lawyer is going to fall flat on his arse. He doesn't have a leg to stand on

      Delete
  7. I share your sentiments, and though I have been a passive observer thus far, I feel as though reading the majority of peoples' comments are killing off my own brain cells one by one. I too fear the precedent this case will set - how it will change what we do every day in medicine. Every time I think if this girl, I am reminded of an interaction I had with a mother in our PICU about this time last year:

    As a knealt next to the mother who hours before had witnessed her 8y old son collapse while playing from a brain aneurysm, discussing the gravity if his situation, she grabbed my leg and stopped me, saying "thank you for the way you are talking to me. I appreciate your care, compassion and how you are explaining everything to me...I love my baby so very much, but if I cannot bring my son home with me, I want someone else to be able to." She proceeded to choke back tears while asking me about the process if organ donation. I was humbled to be in her presence (and glad I was already on my knees) She does not love her son any less than Ms. Winkfield loves her daughter, that I can say with unwavering certainty. And I did not learn how to determine THAT in medical school.

    This case has illustrated the gross malininformation that exists regarding modern Western Medicine - the facts surrounding diagnoses and organ donation, our motives and capacity for empathy, and our unending pursuit of "first do no harm." (And yes, it's HIPPpcrates, not HYPocrates as I have seen so many commenters compare us to hypocrites - illiterate, stupid, or both? I'll let you decide)

    ReplyDelete
    Replies
    1. Thank you for sharing that story. I've had a few interactions like that myself, but they are few and far between the other familys that choose to live in Denialsville or IDontGetItLand.

      And thanks for using "malinformation" too! I hope it catches on.

      Delete
    2. I think that denial is the problem. And I know how strong and pervasive it can be. I had cancer 10 years ago and it took me reading the pathology reports and surgical reports hundreds of times over 9 years to finally grasp the gravity of my situation at the time. I did not choose to be in denial, but I was so extremely.

      This is such a god awful situation. I feel bad for everyone in it. Except maybe the lawyers and the people who are decieving the family.

      Delete
  8. The way this whole thing has unfolded, it's pretty clear to me that very few people hae a decent, adequate understanding of biology. You don't have to be a doctor or a nurse to get it. All you have to understand is no circulation=no blood flow/oxygenation=death. Yet millions don't come close to being able to grasp those simple facts.

    ReplyDelete
    Replies
    1. You don't have to be a scholar either. I never finished high school (though I did get a GED), but I know that no blood flow to the brain means brain death. The person is dead. As someone earlier said, the driver has left the vehicle.

      Delete
  9. DB don't know if you've seen this, I guess it was or is to be filed tomorrow? If ANYONE is on the fence about Whether the family is doing the "right" thing by Jahi you MUST read this: Warning Graphic: PDF will open a separate windowhttp://media.nbcbayarea.com/documents/HeidiFlori.pdf
    It really is a medical "crime" to keep her hooked up.
    The lawyer the judge should be disbarred.

    ReplyDelete
    Replies
    1. I did see that. It's very telling. I hope everyone who is hoping for a miracle and yelling about not feeding her for 3 weeks reads this, especially the part about her GI system not working.

      Delete
    2. So many comments are moderated on regular sites that you can't say things like (or get comments published that say) liquefaction and now sloughing. To make people understand what has and is happening, from the inside out. I am glad she is in no pain, but little dignity has been spared her. And I feel for HoodRat (assuming all checks out). Thanks for writing informatively and sarcastically. Sometimes you gotta punch them in the face with a little snark to get a point across. With a smile, of course.

      Delete
    3. Wow! This answers most of the questions I asked in another reply. It seems almost criminal now that they have been allowed to do this to her body. I wish the term "beating heart cadaver" could be used more when discussing this story. Maybe that would help those out there that still think she has a chance. I go back and forth between thinking the family is just in complete denial and for lack of a more politically correct term, just stupid vs. sinister motivations. I read the grandmother is in the medical field. One story said she is an LVN with 30+ years experience, whereas another story said she is a surgical assistant. I can't help thinking that at some point after she woke up and said she wanted a popsicle, that the family (maybe grandmother) did something to cause her bleeding and this is their way to prevent the autopsy being done. Now this is just me thinking....I am in no way saying this is what happened, but I'm just trying to figure out why this is still going on almost a month after she died.

      Delete
  10. Y'all guess wut, she my cousin and I see first hand how fucked up she look before she left CHD, her skin got a gray kinda look but she still warm, she sticky as fuck, I could smell her bad breath kinda smell like old chicken, and her nose leaking shit. What's the shit coming out her nose? I'm her cousin, no bullshit I think Tasha goin too far but whateva. Who want the tea? I'll keep y'all posted if u want me to

    ReplyDelete
    Replies
    1. I'm not sure how you found me, but if you are indeed her cousin, updates would be greatly appreciated. However, I would ask that you email them to me directly (docbastard1@gmail.com) rather than post them here. That way I can read your update first before posting it just to make sure that your family's privacy isn't threatened. If you'd rather just say "fuck it" and post it here anyway, that's up to you, and I certainly won't stop you.

      I take great pride in privacy (my patients' and my own), and I don't want anything to compromise YOUR family's privacy either.

      What has happened to Jahi is tragic, but I'd hate for anything to make the situation worse than it already is.

      Delete
    2. My heart hurts for you and your family, HoodRat. I do hope once this is over—and it will be—that eventually you will remember your cousin as the vivacious 13-year old with the engaging smile and dimples, and not as she is now. What made Jahi Jahi is gone, and I wonder what she is thinking, watching the horrors unfold.

      Delete
    3. That "hoodrat" person is probably a racist troll. Their username and the way they type is telling.

      Delete
    4. I think it was the reference to 'chicken' that made me suspect this in the first place too

      Delete
    5. you ratchet liar

      Delete
  11. I'm sure they did not disconnect her from her ventilator for ten minutes. That would be long enough to kill her if she wasn't already dead. It was probably a minute or less.

    ReplyDelete
    Replies
    1. Well, I may be wrong but it seems to me that the test lasted 3 minutes, according to the report.

      Delete
    2. Sorry Patrick, but that's not how an apnea test works. She was off the ventilator for 9 minutes (started at 1538, ended at 1547). As I said, it was nearly 10 minutes with no respiratory effort.

      Delete
    3. ...I see I suck so much at reading the DocFont...

      Delete
    4. Ten minutes would cause brain damage. Three minutes would cause brain damage. It cannot be ethical for the test to run much longer than a minute or so. Even so, this test would kill people with paralysis or polio, so it doesn't seem like much of a test to me.

      Delete
    5. No Pepper, you are mistaken. Reader Scott (his real name) tried posting this comment but it failed (DAMN YOU, CAPTCHA!), so I'm doing it for him. His explanation is spot on:

      "Pepper: The root source of your confusion involves the distinction between hypoxia (low oxygen) and hypercapnia (high carbon dioxide). The act of taking a breath in and out provides two simultaneous functions, getting O2 in and getting CO2 out. Getting the CO2 out is actually the more time-restrained function and when you try to hold your breath as long as possible e.g. while diving underwater, the increase in CO2 is actually what makes it physically impossible to keep going. Rarely does a diver run out of oxygen. Rather, he becomes acidotic from high CO2 and this "CO2 drive" causes the unsuppressible need to surface for another breath of air and release the CO2 buildup. When an apnea test is performed, the lungs are filled with 100% O2 and a pulse oximeter measures O2 in the blood. The patient never suffers hypoxia. If they do, the test is aborted. What they do experience is a very high CO2 level,. So high that a living brainstem, even if profoundly damaged, will automatically try to breath (ventilate off) some of the CO2 to correct the resultant acidosis. This "CO2 drive" is the fundamental, and extremely accurate, basis for the apnea test, not the "hypoxic drive". Again, pulse oximetry is used to assure that oxygen levels stay in the safe range, which is easy to do when being given 100% O2, as compared to the room air O2 content of 21%."

      Delete
  12. It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way – A Tale of Two Cities by Charles Dickens.

    ReplyDelete
  13. I realize this is an unprecedented case, but can you speculate what could happen once her heart does stop beating and according to the family finally "dies"? Since they released the body to the family, would the coroner's office wherever she is have jurisdiction to come in and take her and then finally complete the autopsy? If this family is already in a malpractice suit with the hospital, wouldn't they need the death certificate to be completed, especially when the death is listed as undetermined at this time?

    ReplyDelete
    Replies
    1. I was discussing this with Mrs. Bastard just a few hours ago. Once her heart stops (which I suspect will be quite soon), will they take her to a funeral home? The coroner's office? Cemetery?

      I haven't a clue.

      Delete
    2. I'll try to find it again, but I read a very recent statement that the body must be returned to the Coroner's Office once the heart stops beating, per the court order releasing her to mom's care. The statement was made by the county sheriff during an interview on Jahi's whereabouts.

      Delete
    3. This whole thing, from a legal standpoint, seems pretty bizarre. I'm no lawyer, and I am clueless about the laws regarding a death, especially one like this. How often does someone pass away, then have family members insisting she's still alive, then cart her body off to another state, incomplete death certificate in hand? I'm glad I'm not the one who will have to sort this out when her heart finally does give out.

      Delete
    4. I read that article too right after posting that. I believe it's from a CA news site. Once the initial autopsy is done, then the family/lawyer will want 5 more opinions.

      Delete
  14. Love your Q&A. Exactly the way I've wanted to answer those questions.

    ReplyDelete
  15. This comment has been removed by the author.

    ReplyDelete
    Replies
    1. ** Not sure what happened with my first post.

      The 'mal-information' on social media sites regarding Jahi McMath's case is astounding and appalling in it's absence of common sense.
      However it has led the pathway to your blog which is a breath of fresh air and a voice of reason, and for that I am thankful.

      Delete
  16. Dear Dr Bastard, do you have any idea on how long Jahi would have been bleeding before arresting? Assuming her mothers recollection of events is correct (unlikely during such trauma) why would a doctor not arrive until the arrest? Would the ICU nurses be responsible, and wouldn't they know the difference between normal bleeding and hemorrhage? (That's fucking stupid. Of course they would.) if the bleeding was so heavy, as it clearly was, why would they not perform emergency recauterization? If hemorrhage is a known threat, why wouldn't the staff be all over her, rather than letting everyone else do the suctioning, etc.
    I assume there is more to the events but since I don't know for sure I figured I ask. I read somewhere that she had 4 transfusions, how long would each take? Thank you- dh

    ReplyDelete
    Replies
    1. I can't speculate on any of that really. Bleeding can be torrential after surgery, and she may have swallowed quite a bit in addition to what she was spitting and suctioning.

      I also can't guess what the staff was doing and where the doctors were. All we have are the family accounts, and we all know how reliable those are.

      A transfusion can drop in at an hour per unit, or a unit can be pounded in in about a minute. It all depends on the situation.

      Delete
    2. Doc, if you care to do some math (because I do know know the nominal volumes involved) my particular story can give an idea... you can use my details as a starting point. I had my tonsils and adenoids removed and two days after the procedure (but still in the hospital, yay 1970's) my scabs released. The staff assumed that as long as I was past the worst risk already. The nurse checked on my 10 minutes before I was discovered in peril as part of her rounds and was returning to the nursing station. She heard me "gurgling," as the blood was flowing into my lungs. I was a completely average 6 year old boy in terms of statics except for weight due to chronic allergy related illness, part of what the procedure was supposed to treat. She found me minimally coherent (semi respondent by visual clues and eye tracking) and I don't know exactly exactly what she said into the intercom but it appeared that everyone in the hospital was in the room (including the janitor as by no my lungs had seen enough of my blood via this method and were attempting to expel it all over the place). I remember a ER doctor (so he said) and another doctor talking to me about the tube they were putting down my throat and right about this point I crashed (strangely I remember most of this from discovery to the moment I crashed.) Years later my parents showed me the copy of the nights reports (they got the call to come to the hospital immediately at 3am because "Your son probably will not be alive at 3:30"). The records clearly say that both doctors believed that while they were not able to measure the amount of blood suctioned from my due the frantic efforts and confusion, they had drawn enough blood to fill both lungs nearly half way and there was a considerable additional volume on the bed, my pj's and the floor. They also say that I took 3 units before I stabilized and that "I'm delighted to say I have no idea how this little boy lived or how he is so lightly effected 7 days later" I take that as meaning it was a very near thing. Instead of going home in two days, I spent an additional week in the hospital for the problems I now had with my lungs for a while. I do not know what the full meaning of "crashing" meant in my case as much of the chart notes are lacking details and I suspect my parents removed the most troubling from them before I was shown them.

      The doctors noted that they "Stopped the bleeding 13 minutes after the last recorded rounds" Now my surgery was the "normal" version, not super deluxe roto-rooter version done for sleep apnea. I do know that I have sleep apnea and when the options for treatment were described, I quickly went with the "Apap machine please!" route.

      Delete
    3. arghh ---I DON'T know the nominal amount.

      Delete
    4. In 2002 I had sleep apnea and was scheduled for the same type of surgery that Jahi had. I had tried Cpap, and because of the structure of my internal nose, the Cpap didn't work. About a week before the surgery my husband passed away and the surgery was postponed. I moved then to a different area to be closer to family and therefore saw a different doctor. My new doc told me I didn't need the surgery as a full face mask would do the job and the obstruction in my nose that prevented the air flow would not matter. I've been using a Bi-pap ever since and now I'm especially grateful, after hearing what happened to Jahi, that I never had the surgery!

      Delete
  17. How much public misconception can directly be linked to inaccuracies in news stories they've read in these last three weeks? Terminology is everything in reporting - be it health, crime, business or education. I see reputable agencies like the Associated Press and institutions like The Washington Post using phrases like "life support" and want to shake reporters and editors alike.

    ReplyDelete
    Replies
    1. I've been noticing inaccuracies in all the news media since the late 60's. Sometimes it's deliberate to fit certain agendas, sometimes it is not deliberate.

      Delete
    2. My career was in journalism, and I can promise you that newspapers have always had inaccuracies. In 18 years of full-time work and with many of my friends still in the business, I can't ever remember anyone deliberately injecting inaccuracies into their copy, except for those who have been caught making up stuff to make a story better. Suggesting that is akin to suggesting that doctors are conspiring to harvest organs.

      But I can explain how a lot of inaccuracies occur. 1. Newspaper reporters and editors have to decide what information to include and what to leave out. It's even worse for TV, which has so little time to tell a story. A person's bias can creep in, even if they think they are being fair. Does a reporter have so much sympathy for the family that he doesn't want to be blunt about what's going on? Is a reporter distrustful of hospitals and doctors? Is she a Christian who believes that praying may bring Jahi back?

      2. The media wants as many clicks as possible, but they don't want to be attacked or lose subscribers. That's why we're getting harder-hitting stories from the LA Times than the SF area media. Race & religion complicates this story. Liberal, white journalists may fear asking hard questions, lest they be seen as racist. Ones who work for conservative media outlets don't want to anger religious readers who might share the beliefs of Jahi's family.

      The story would be reported differently if the family was poor, white, rural Texans. Sites like Gawker and Wonkette would be making great fun of them.

      I haven't seen any interviews by the family's priest or pastor. That makes me wonder if the scumbag lawyer suggested they use religious reasons, which might work in court much better than simply saying we believe she's still alive and believe in miracles.

      Another obvious question is whether the family tried to get Jahi on a diet in hopes of reducing the sleep apnea and diabetes. I realize this sounds like I'm blaming the family and dead girl, but our society needs to do a better job of keeping kids in shape.

      We have the scumbag lawyer talking about how intelligent the family is, and it sounds like the kids are doing quite well in school, but no one dares to ask how educated the parents are. In fact, we know next to nothing about them.

      Where are the questions on whether the PICU was full while Jahi's body was there and whether that kept some kids from being treated in the PICU? Did Jahi have health insurance? Did it continue to pay after doctors said she was dead? If not, does the hospital have to absorb those expenses and will that mean someone else gets less care? Was it traumatic for hospital personnel to be forced to care for a dead child? Dolan talks as if Jahi is still alive. Does that mean he believes she's alive? If he believes that brain death is real death, isn't he lying? Wouldn't that be unethical? (A lawyer can't say his client didn't rob a bank if he knows for certain that the client did.)

      Bottom line: Reporters are skating around the hard questions in this case, which may be why some of us are so obsessed.

      Delete
    3. 3. When stories are very sensitive and reporters lack expertise, they often do a he said/she said story in an attempt to appear fair. They quote the hospital spokesman and they quote the lawyer, as if both sides were making legitimate points.

      4. Editors may dictate the angle of a story. For example, they may have thought the family would be more sympathetic than an institution. That doesn't mean they would instruct reporters to be inaccurate, but the reporter may feel pressure to see the story through the eyes of the family.

      5. Newspapers have been cutting back since the '90s, and reporters often have very little time to report a story. So, they may fall back on the he said/she said model.

      6. "Burning sources" is risky in a story like this. If a reporter angers the family, or Dolan thinks a media outlet is going against his case, he can stop talking to them and give breaking news to another source. The hospital is much less likely to do that.

      Delete
    4. Thank you Suzie! More than the medical angle of this case, the way the media has seemingly adopted the fantasy that the family and their lawyer is selling has troubled me. I still see them reporting "routine tonsillectomy" when anyone who has followed this case, no matter how peripherally, KNOWS this was no routine surgery. That is the most glaring example but there are many, many more including failing to mention that while the family has been free to discuss their version of events the medical and nursing staffs at CHO are not free to do so. In fact, the family has denied their request to do so. You'd think that would be at least mentioned in the seemingly non-stop coverage.

      Frankly, this reminds me of the coverage of the OJ Simpson case where both sides were treated as if the explanations of events were equally plausible when any unbiased look at facts would have made the defense contention of a vast conspiracy pretty unbelievable.

      It seems if the same things is happening here: magical thinking vrs science and the media is not stepping up and doing their job by presenting things accurately

      Delete
  18. Apparently, there has been a trach and feeding tube placed in Jahi''s body. Saw it on Twitter, there was a link to an Instagram post from someone who claims to be Jahi''s sister. http://instagram.com/p/i60m6vo0sN/

    It just strikes me as ghoulish that some think it's helpful to feed a dead person.

    ReplyDelete
    Replies
    1. Samantha..I would have thought it easier to give her nutrition through IV (TPN), esp since it appears her digestive system is not functioning normally. Though being dead, there is no need for nutrition. I wonder if there is a focus on 'feeding the child', in a way the family can feel she is being satiated and not hungry. Makes me wonder about the 'feeding her in the icu story'.

      Delete
    2. I'm also confused about this claim; and honestly wonder if it's true. As a former Med Professional, the trach? Maybe. But basically doing a minor surgical procedure on the digestive system of a decomposing body?? Someone who's reported to be "sloughing" intestines?
      As weird as this case has gotten, these last reports REALLY floored me!

      Delete
  19. DocB..thank you for your posts I was initially heartbroken and sympathetic, then upset and angry, now horrified and disgusted by all the goings on with this case. Where is a compassionate rep from the CA Brain Injury Association, and social workers (neither connected to the hospital) to assist this family in understand what is happening? Her uncle recently stated they'd let her go if her heart stops while on the vent..because then it will be God's will. There is no understanding of how her body functions, the role of the equipment, and medications she is being given. I am a CBIS, and the caregiver for my youngest son, who sustained a severe TBI in 2006. He lives at home, with the help of nurses, needs 24hr care No vent, great cough!! After many complications, we landed in this place..unable to speak, to move, to eat. Sam communicates through blinks and thumbs ups..and "Mom" when he really needs me. He is very much a part of our large, extended rural family..and he will never be left to live among strangers in a facility. One look at Jahi's mother's nails says she has never cared for her daughter in this condition, she is looking for someplace, and others, to do so. This family needs help to understand Jahi is already gone...and the att'y needs to know this case will not put his name in lights. Thank you for all you do!

    ReplyDelete
    Replies
    1. Dadgum, In the court filings there was a document entered by CHO detailing the extraordinary accommodations this family has received. They included daily visits by a social worker, chaplain (nearly daily) and they also arranged for "child life professionals" to work with Jahi's siblings. That does not include all rules they relaxed to allow 8 family members to stay overnight, special mail handling, rooms secured for the family both in the hospital so they could meet and a room at the family center where they could eat.

      Having been though a tragedy yourself, I imagine you would have appreciated that kind of accommodation for your family when your son was hospitalized. I read a comment by another dad whose son was in the PICU at children's over the holidays while all this was going on and he was very angry at the family. He said that it was disruptive to all the other families and their kids. He also appreciated how difficult is was for the staff in the PICU to stay focused on the other kids while this circus was in town.

      Delete
  20. I have been a PICU nurse for26 years and have been involved in this scenario many times. Thankfully the few times a family tried to get the courts involved they declined. As one judge put it " There is no child's welfare to consider". We did have one that went three weeks, but DI came to the rescue and we did not treat with DDAVP, so eventually we had cardiac failure. Someone asked how long the heart can beat without the ventilator, well, in the cases I have been involved with, about 15-20 minutes for a young, strong, heart. I have also had cases that only lasted a few minutes. While the heart and organs can go merrily along for some time, there are many subtle hormones and chemicals that will start going out of whack, because they do have some regulation that the brain would usually handle. I did hear of a case in Japan where they kept a body going for 165 days after declaration of brain death, but by extraordinary means. They used frequent bronchoscopy and bronch washings for infections, hormone replacement, and daily labs to determine at what rate to run K, Ca, Na etc.

    ReplyDelete
  21. I've got your dumb question of the day...

    If you cut off a person's oxygen supply for just 4-6 minutes, brain damage occurs. So why is it an ethical 'test' to turn off the vent for ten straight minutes to see if they breathe on their own? If there's trauma and impedes respiratory function, aren't you increasing the trauma with the test? Is it unreasonable that a 'test' shouldn't cause more harm to the patient? Shouldn't the test be limited to 3-4 minutes?

    ReplyDelete
    Replies
    1. See this earlier comment for your answer:

      DocBastardJanuary 10, 2014 at 6:24 PM

      Delete
  22. I am obsessed with this issue. My family walks away if I start talking about it. My question to the Doc, is this. I read ...Session 5: Response to the Council's White Paper, "Controversies in the Determination of Death" by Dr. Alan Shewmon. It is too lengthy to go into details. Dr. Shewmon speaks about 3 individuals that are "brain dead" yet being kept warm. ( I was going to write "alive" ) One that stands out is this boy, T.K.. When he was 4 1/2 he developed some type of meningitis. Lost brain functions. From what I understand because of age and I think it was before 1981, life support was kept on. This child "lived" (stayed warm is probably a better term) for 20 1/2 years. He grew, went threw puberty ect. How is this possible? It even stated that the corpse was able to be put into a sitting position..This is macabre but amazing. Supposedly, the family of this boy sent a picture of him floating on a raft in a swimming pool. This picture was published in Neurology Journal in 1998. Any thoughts on this one. This does not change my mind, brain death is death, this article just intrigues me. I can not find a direct link for the article, but if anyone is interested in reading it...google.Presidents Council on Bioethics-Georgetown University, then transcripts, then, transcripts by date, November 9 2007 session 5

    ReplyDelete
    Replies
    1. Here's the link :)
      http://jcn.sagepub.com/content/21/7/591.long

      Delete
    2. Thank you, if you don't want to pay or download you have to go to the Georgetown University website.

      Delete
    3. Strange, it allowed me to view to pdf at first. This link is safely free to view :)

      https://hods.org/pdf/Long%20Survival%20Following%20Baterial%20Meningits-Associated%20Brain%20Destruction1.pdf

      Delete
    4. That body did not go through puberty in that article. He stated two other bodies did, but we do not have the clinical evidence on which two bodies he is referring to. For the BP reasons, I wonder what the albumin level and osmolality were? Was Erythropoietin or some other g tube drug given for hypotension? I find it pretty scary that they would put a vent near a pool. The entire story was science going too far. (although, I did enjoy reading about it) Can you imagine when the day comes that we can keep people alive forever by artificial means and people will want us to because we can...does that mean we should ethically, morally, and legally? More or less in the Jahi case that is what is occurring except modern medicine can not keep the organs going forever. Morally, ethically, and legally the line was drawn years ago with "brain death". What worries me in the Jahi case, is that now all these excessive measures are all being done to keep organs perfusing artificially until a family decides she is dead and people think that is ok without thinking of the financial and moral impacts??. Now, think about the time when we have the capability of keeping a body functioning forever and some family wants this to happen because they think they have every right to abuse modern medicine for whatever reason they believe, how many people on earth would we have since people would not be dying?, where would we store them all if they can't not move and we need machines?, where would all the financial funds and medical personal be to help the actual natural living?

      I am pretty scared about the future. Hopefully, I will dead.

      Delete
  23. I really appreciate you trying to educate people, I worked in Neurosurgery back in the UK for a few years and you know what makes me dizzy? The size of the universe and beyond, the infinity and how bloody stupid people are in this country. I swear there is nothing like it in the rest of the western world. Voodoo and magical thinking are rife in the US, it is truly frightening.

    ReplyDelete
  24. Because my son was being treated by an ENT at CHO at the same time as this occur ance I became very interested in this case. I was curious why the surgeon was not named in the media. They named the other dr.s. I appreciate finding a blog with so much good information and not all the bs.

    ReplyDelete
  25. Is there any way you could transcribe Dr. Fisher's report? Doctors need to take penmanship lessons. o_o *ducks and runs*

    ReplyDelete
  26. If you read this post about Dunlap from Steven Novella's blog, it's clear he was simply misdiagnosed: http://theness.com/neurologicablog/index.php/brain-dead/

    ReplyDelete
  27. Actually, Lazarus was raised from the dead. Nothing is impossible with God.

    Now, with that having been said...I believe God already answered Jahi's family, and the answer is NO. They just won't take that answer.

    They seriously need to bury that girl. And people need to stop funding the GoFundMe account, it basically amounts to Internet panhandling in this case.

    ReplyDelete
  28. I have to say that even if some people take offense to this writing it's completely true. I'm glad that someone has written this. I also want to make comment on the fact that the body of Jahi McMath is clearly grieving and should never have been given the option to keep her child's body on a ventilator for any longer than necessary. In my opinion somebody who has some intelligence and is able to make these hard to make decisions should have the mother court ordered to be committed to mental health facility where professionals can aide her in grieving process and the body should be dealt with manner everyone's body is handled in when death occurs. It's awful when a child passes. If every parent that loses a child to death could prolong the inevitable burial process our hospitals and long tern care facilities would never have the space to care for living patients. Also, why in the world was the body released to the mother? If that were possible for other parents there would surely be a disgusting mess where ever they wound up taking the body to. I'm not try to sound harsh, I have lost a child to SIDS. I'm glad that the doctors tried as hard as they could to save my son and I was able to hold his body for several hours after their efforts. I was simply told that it was time to say goodbye to his physical body and it was time for me to leave the hospital so they could do what was needed to be done with his remains.

    ReplyDelete
  29. Docbastard: Don't be so quick to rule out acute upper airway obstruction as the reason for her cardiac arrest. I don't think Jahi bled to death. This sounds more like acute upper airway obstruction. According grandma's HLN video interview, Jahi was desaturating from 92 down to 79 so I suspect she developed laryngospasm, or POPE/NPPE, and then cardiac arrest.

    How do we know for sure?

    - check post-intubation note (code blue notes)

    - check post-intubation CXR.

    - interviews

    ReplyDelete

If you post spam or advertisements, I will hunt you down and eliminate you.