Saturday, 18 January 2014

Jahi McMath Misconceptions and Twitter

Up until a few weeks ago, I thought Twitter was the stupidest idea ever.  Microblogging?  Really??  Think about it, what can you really say in 140 characters or less?  As it is, you can barely get one idea through.  Then if you start responding to multiple people, your ability to communicate is even more limited.  And if you dare use hashtags, your character count dwindles to near zero, and you have resort to things like saying "u" or "ppl".  I'd rather stick hot pokers in my genitals than say "u". 

Regardless, having engaged in several Twitter brawls (a few still ongoing), I can definitively say that Twitter is, in fact, the stupidest idea ever.  Yet I find myself continuing to try to argue with (and educate) several ignorant individuals who, for reasons known only to them, seem hell-bent not only on ignoring facts and ethics but also on denying science.  But arguing on Twitter is next-to-impossible, partly because of the character limit.  But the main reason is that anyone can get a Twitter account, especially people whose sole intent is to malign, abuse, and insult.  And as I've seen firsthand, 140 characters is plenty when your goal is either to foment mischief, spread malinformation, or both. 

Having said that, I'd like to use this opportunity to expound some of what I've said while trying (in 140 characters or less) to battle the nonsense I've come across on Twitter and comment threads on the various Jahi McMath stories I've read.  Which is pretty much all of them. 

1) Brain death is not full-body death. The body is still alive. 
This is a very simple mistake to make, but it is no less a mistake than eating potato salad that's been out for several hours on a hot summer day.  The body sure does look alive, it's warm, and the heart is beating.  But the body is just functioning, not alive.  It may seem a fine distinction, but there is a world of difference between a body that is merely functional and a live person.  You can argue that a bacterium is alive despite not having a brain.  I would counterargue that a tree is also alive despite not having a brain.  The fact is humans are different.  We have personalities, our consciousness, our humanity.  That lives in the brain and nowhere else.  
 
2) The brain can recover and heal. 
From an injury, yes.  From death, no.  Dead brain cells remain dead forever.  No amount of prayer, hope, or time ever can change that.

3) It is not illegal to have a brain dead patient on a ventilator, so Jahi's family isn't doing anything wrong.  
It isn't illegal to put a doll on a ventilator either.  For that matter it isn't illegal to stand on your head naked and sing "Wrecking Ball" by Miley Cryus.  But why would you?  All of those things lead to the same thing: no benefit whatsoever, and everyone thinking you're insane.

4) Jahi's family isn't hurting anyone, so what they are doing isn't unethical. 
First, they are hurting themselves by refusing to accept and deal with reality.  The lasting memories they will have of Jahi will not be of the beautiful, vibrant 13-year old girl they once knew, but rather of the brain-dead, unresponsive girl lying in a hospital bed with a machine pumping air in and out of her every few seconds.  The memory of her voice and laughter will be drowned out by the sounds of the ventilator.  

The second (and infinitely more damaging) harm is that this gives other families the idea that what Jahi's family is doing is somehow normal or ok.  The consequentialist theory of normative ethics states that an action is moral if the consequences of that action are more favourable than unfavourable.  For those of you still awake after reading that bit of soporific academic drivel, it's entirely obvious that keeping dead people on ventilators serves no reasonable purpose, other than preventing families from ever having to let go, which is the ultimate act of selfishness. 

5) Jahi's family had to fight to have her removed from CHO, which was trying to block them from leaving, which violates their rights. 
Another very common misconception.  Except for psychiatric patients who are involuntarily held because they present a threat to themselves or others, patients cannot be kept in hospital against their will.  Jahi's family could have taken her from the hospital at any time, but there was no facility willing to take her in her current state.  Her family was trying to compel the hospital to place a tracheostomy and feeding tube, because the hospital correctly felt it was unethical to perform surgical procedures on a dead patient and refused.  The court would not force the hospital to perform the procedures, and ultimately the two sides reached an agreement that the hospital would release Jahi's body to her mother's care. There was never an order from the court forcing the hospital to release her.

6) Jahi's doctors tried to force their opinions and will on her family. 
The doctors only had their patient's and her family's best interest in mind.  After she was declared dead, they allowed several days for the family to congregate and for a second opinion to confirm the diagnosis.  Obviously the family, denying logic and reason, disagreed with what was in their best interest.  It seems obvious that if the doctors had forced their will, Jahi would have been taken off the machines and buried weeks ago.

7) Her family does not agree with the legal definition of death, so they have the right to challenge it. 
I've seen this argument several times, and on the surface it may seem to make sense. However, if I say I disagree with the legal definition of stealing, does that allow me to take a Bugatti Veyron?  At least 6 physicians confirmed the diagnosis, and simply disagreeing that Jahi is dead does not bring her back to life.   

8) People who are legally blind have some sight, so legally dead people have some life. 
Before you say anything, yes someone actually said this.  Of all the arguments I've seen, this is by far the most preposterous (and funniest).  There is no such thing as "legally dead".  You are either dead or you are alive.  Death by neurological criteria is the same as death by cardiac criteria.  And Jahi, unfortunately, is dead.

On another note, Paul Byrne wrote another piece on renewamerica.com, where he states that Jahi has regained the ability to regulate her core body temperature, a function of the hypothalamus (which is part of the "primitive brain" and controls thermoregulation, hunger, thirst, and the circadian rhythm).  This "fact" has been corroborated by exactly no one, and I can do nothing but question its validity based on the source.  This will firmly remain in the "Unsubstantiated Rumours" category until it is verified. 

One final note: this will probably be my last post pertaining to the tragic story of Miss McMath.  I've taken enough time (both yours and mine) trying to educate, inform, and correct misconceptions.   After this I plan on returning to my stupid stories, stupidly starting with a stupid story about stupid me.  For those of you who found me via Jahi, I hope you'll follow along with me and continue to share my tiny corner of the Internet.  If you choose not to, then FINE!  I DIDN'T WANT YOU TO ANYWAY!

46 comments:

  1. Some of the arguments these people have made would have one believing THEY were brain dead. Geeze... the stupidity must burn them.

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    1. Holly, YES! I guess why they think braindead lives b/c they are living breathing examples of it!<---snark! :( Teh stupid it does burn... Doc "two sides reached an agreement that the hospital would release Jahi's body to her mother's care. " Via the coroner! The coroner had had to sign the DC but he could not put COD until she has a autopsy...
      I'm very surprised that she is still above ground.... but I shudder to think what condition her body is in. Very sad. The family has gone completely silent which is weird since they were blabbing all over the place. Maybe the judge put a gag order on them?

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    2. I think you both forgot- if they were brain dead, they couldn't write it anyways. More like they have large amounts of brain damage impairing function. Or, just to quote proffessor farnsworth from futurama, they have suffered "sublibibal blain dablage"

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  2. Add me to the people who have found you via Jahi. But, I've read a ton of your other blogs now, and enjoy what your write. Thanks! It is a refreshing dose of science and reality in a world seemingly hellbent on denying both.

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  3. i found your blog via twitter and the jahi mcmath saga. i have enjoyed your posts. and i agree, the endless loop of ignorance is frustrating. closed minded people are dangerous and frightening. thank you for being a breath of fresh air in that craziness!

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  4. This is totally unrelated, but legal death, in actuality, is a HUGE problem in India. Due to the increasing population and finite amount of land, some areas have become divided amongst families that it is impossible to scrape out a living. Some people fix this problem by bribing officials to declare relatives dead. Some guy won an Ig Nobel (Google it, some are hilarious) award for "living a fufulling life after death".

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    1. Sorry for the typos/overall lack of clarity. Commenting on mobile sort of sucks.

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  5. Thank you for your informatuve and well written posts.
    I know that Ms. cMath has passed away, but I was hoping you could help me understand a few things
    1. I read the article anout her Hypothalamus. Since we know she is brain dead, is this just a blatant lie? Is there any way that this is possible in a brain dead patient?
    2. If Jahi is being treated with medical technology that provides the illusion of life, is it possible that the condition of her corpse appears to be improving? I don't know if I'm conveying what I mean properly.For example, by providing the body with nutrition, hormone therapy, etc could it make her vital stats APPEAR to be stabalizing, or her physical appearance improve (skin cooring, elasticity, etc)
    I would think that since the family is asking for donations, they have to be mindful of what they say. If people are making donations because the family and their lawyer are saying she is improving, and they are lying, couldn't they be accused of fraud? Or is the term "improving" open for interpretation?
    Sorry in advance for typos. I am using my toddlers tablet whichnis hard to type on

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    1. Her body cant improve, she is dead....they maintain her hody temp by applying blankets as stated in count docs by one of the attending drs at CHO.....Also in drs.report it wasbstated she was sloughing her intestines.....

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    2. Since she was moved we have no Drs. reports on her body's "condition" all we have is Family quotes "she's improving" all the while they continue to grift $$ and yes that is fraud.
      As Kay said in the LAST medical report before she was being "FED" she was sloughing her intestines...I hate to think of the situation now...

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    3. Thank you @crystalwolflady. I think my usage of quotaion marks and caps was overlooked by Kay. I don't want anybody to think that I am one of the delusional folks that think Jahi is still alive, or that death can be "improved' upon. I know that her body isn't actually going to improve.
      @crystalwolflady, I know we haven't been updated. I guess I was asking if its even possible for the body to give the appearance of improvment?
      I personally don't see how a dr could be doing thisbfrankensein type stuff legally.its so insane!

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    4. I'm wondering if the family would even notify anyone should the body actually decompose (completely)...
      It would put an end to the fund collections...

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  6. I also found you reading about the Jahi mess and then on twitter. I have enjoyed reading your other posts as well. I will definitely continue to follow your posts.

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  7. I had to make this same decision with my mother 8 years ago and didn't hesitate. The woman lying in the bed was not the woman I knew and loved. I gave the hospital permission to keep her on life support long enough to gather recipients for her organs and no longer. I don't understand people who insist on trying to keep dead people "alive".

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  8. I read the Paul Byrne piece earlier today. He strikes me as the sort who would recast facts in whatever light necessary to prove himself correct. He counts this unsubstantiated core temperature maintenance point a vindication and a direct result of Jahi's excellent care in a setting that isn't a battleground. But the contentious wording is as misplaced as the idea that a battle for life is even occurring.

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  9. Excellent piece, but no mention of the rumour going around now that apparently fish oil can resurrect the dead!

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    1. Fish oil...I haven't seen that one yet.

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    2. Well, Jesus preformed the miracle with the fish and the loaves of bread.

      Maybe fish oil is concentrated Jesus?

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    3. Fish Oil (Omega 3) has been shown in some instances to significantly help in the healing process of a damaged brain.
      But not all, and defiantly not from the "Dead"...

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  10. Good Morning Doc..
    4) Amen. And amen.
    7) Should you procure a Veyron, pick me up. The roads here are fantastic. Great choice.. a Top Gear sort I take it? An aside..'gum is a Mom, lol..

    Hekate..the Omega3 thing has been around for years through Dr. Barry Sears. Several days ago it was highlighted on a CNN Anderson Cooper installment,and again covered on several CNN news shows. There are 2 documented cases of severe brain INJURIES (no one was brain dead) with good outcomes after omega 3 therapy. There is some thought that it may help sustain function as we age. Can't hurt, though it can cause bleeding issues in high doses (the doses in the 2 cases were huge, one in a young WV coal miner, one in a CA teen hit by a car). I saw shortly after the broadcast that Jahi's fb page was filled with fish oil suggestions, as though they knew all along..'please have the family contact me right away..' Heartbreaking and mind bending at once.

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  11. DocBastard, you are a voice of reason in a sea of religious hysterical madness. Other bloggers and media outlets can't even get basic facts straight. They keep repeating, "routine tonsillectomy", even though we know Jahi underwent rather complicated throat surgery. Several people on the #JahiMcMath hashtag are there only to try and confound any rational argument. If the general consensus were to go their way, I have a feeling they'd take the contrary position because it's 'fun'. We can dismiss them as cranks out of hand. The really scary people are the ones who truly believe - due to religious mania - that the dead can come back to life. Dr. Byrne would be in this category. One month on, and still collecting donations, the family look like scammers.

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  12. Twitter is, um, interesting. There are a lot of people tweeting who are not interesting in learning anything that contradicts their preconceived notions. Some of them have agendas and it becomes apparent when you try to reason with them presenting facts. For instance, Shutdown Central, who is a radical anti-corporate, has a clear political agenda, facts be damned. Brian the Cobra character also seems to have some kind of agenda, but I'm thinking he's just someone who enjoys being contrary and also doesn't care much about facts regarding brain structure and function. Brian the Cobra dude is now claiming that the Doc isn't a real Doc. Shutdown Dude (or Dudette, take your pick) has posted a Twitter audit that rates DocBastard as "Borderline Fake."

    Twitter is not a place where you'd go to learn anything, nor to educate anyone. In fact, I don't know why I've bothered. It can be fun if you just want to poke at people like that, but it gets pretty old after awhile, at least for me it does. It can really feed into people's particular obsessions with endless back and forth that doesn't advance anyone's cause or beliefs.

    I enjoy this blog, and have read quite a few of the previous stories that are completely unrelated to the current McMath debacle. That story isn't finished, there are no doubt lawsuits to follow, but the judicial system moves glacially. I'll be reading this blog in the future. Thanks, Doc!

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    1. I decided not to name names on the various misconceptions I refuted, and I've seen the stupid claims that I'm not a real doctor. I have no interest in nor desire to prove myself to fools. They are nothing but desperate ramblings by people with no real evidence to back up their bogus statements, so all they can do is try to tear down the people who refute them. It's quite sad to witness, to be honest. It's no wonder neither of them has many followers.

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    2. I probably shouldn't have named any names, either. I'd edit them out if I could. There are plenty of fools there, that's for sure. I've noticed that a couple of them are posting the same things for the past day or day, but very few people are bothering to tweet to them anymore. It's really an exercise in futility.

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    3. They popped up suddenly when Terri Shavio family got involved, coinkydink? I think not all these sock accts, shutdown, brian the snake frankie something all fake accts. All with a RTL agenda which is religiously fueled. Problem is the Catholic church has already come out and said braindead is dead, so Who are these people? These are the teabagging fake xtians that the Pope called a "cult" of "ideologues" right before Christmas. We have a huge cult of fakers that hide under "Right to life" that even the pope calls them out! In Texas they are keeping a braindead EMT alive b/c she is pregnant! Lawyers have said they are misinterpreting the law but this is TEXAS where a fetus is kept alive so what if its braindead too! Deluded and with a agenda for sure. You can't reason. They have their talking points and they stick to that no matter how deluded. After all they are paid TROLLS!

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    4. I left their names off out of respect, as I have no interest in shaming people publicly. Unfortunately they clearly have no such moral integrity, which is evidenced by their unfounded claims that I'm not a real doctor. They are welcome to their opinions, even if they are completely wrong. I obviously can do nothing to change their minds about anything, so I will not try.

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    5. The usual suspects are still at it, but almost no one is bothering to argue with them any more. I stopped a few days ago, it's pointless to reply with anything resembling the truth and I won't stoop to personal attacks. I cannot respect anyone who will not have an honest discussion (yeah, I know, it's Twitter) but twists words of others and shifts the discussion when it's convenient to the agenda, whatever that agenda is. Resorting to personal attacks (like claiming that Doc isn't a real Doc) and yelling Nazis! is a sure sign you're losing the argument. Pretty pathetic.

      Oh, and I did my own Twitter audit on my own self, and I'm 92% authentic!

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  13. Thanks DocBastard...love your name too! Funny.
    You broke it down perfectly here. I am sad you won't be commenting on the McMath stuff anymore...guess I'll have to check out your other 'stupid stuff'.

    Peace!

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  14. Count me among those who landed here as a result of Jahi McMath with every intent of checking in on your words of wisdom from here on out. As a side note, I wish to thank for your dedication as a ER physician. Just about a year ago my life was saved by ER staff - arrived due to one issue and found I was in CHF (BNP greater than 700) though I had no CHF symptoms. If it weren't for the ER physician on call that day I might not be here now. Happy to say after mitral valve replacement I feel great. I think of the ER physician quite often - he was both compassionate and hysterically funny at the same time. He and my ER nurse should have come with a 2 drink minimum. They kept me laughing and distracted for more than 5 hours while a room was located. Your blog reminds me of that time (in a good way). Mazel Tov!

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  15. Thanks Doc , I hope Jahi's family finds peace in the fact that their baby girl has passed on and do the right thing. She should not be remembered this way .

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  16. Let me add my thanks, too, for what you and others do in ERs. I'll have to check out your other writing.

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    1. Ironically, 5 days after I wrote this, I was in an ER with what turned out to be some viral crud. DB, I know you're a trauma surgeon, not an ER doc, still I couldn't resist adding this. Also, I had to wait four hours to get taken back because of all the people coming in by ambulance and helicopter. It sucks to get sick on a Saturday afternoon.

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  17. I say you write what you want to write about, when you want to write about it. This whole Jahi train wreck is a lesson for everyone in the medical community, and it's not finished wrecking. If something comes up that needs clarification, and you want to write about it, I will happily read it.

    I will also happily read about the amazingly stupid things people do to land in your ER's trauma bay, and the fantastic things you and your team do to save those individuals. I feel at home here...

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  19. Thank you for that the hypothalamus argument has started to pop up in different articles and it's driving me crazy as it is clearly untrue.

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  20. You'd think people would get it after the 4 or so times doc has explained that brain dead is dead... apparently not though.

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    1. I think there are a lot of people who have no understanding of the brain's physiology, structure and function and won't do any research for themselves. They see news reports about people who were apparently misdiagnosed and woke up, more or less. Others seem to have an extreme pro-life viewpoint, and if the heart is beating, then there is "life" there, no matter that the brain is completely fried, and it must be preserved at all costs.

      But, I could be completely off the mark.

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  21. The amount of people who are brain dead and still alive is astonishing. Side note, great post as always.

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  22. You've got some great stories that you've told on your blog already Doc, and I'm sure tons more to come. Keep sharing your life. It's interesting reading.

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  23. Yesterday, Jahi's uncle uploaded a video on instagram sent to him by his sister. In the video, Jahi's mother insists "Jahi responds to cold stuff". She then proceeds to rub an ice cube across Jahi's feet to which "Jahi" moves her feet. To which Jahi's mother insists "A brain dead person can't do that"

    I pick faults with the entire video. The biggest one is that a brain dead person CAN "do that". These movements were not in a voluntary fashion, they were more of a muscle spasm fashion.

    The second was the appearance of the feet. The toes were tight together, not loose and free like those who actually have a living pulse and not an artificial one by way of ventilator. Her complexion was also of that of a corpse. She doesn't have that lively hue a living person has. Jahi's feet were also very bloated. Hmmm, bloating, that's consistent with decomposing.

    The video has since been removed but I still found it very interesting. Hopefully they stop the charade soon but something tells me Jahi isn't the only "brain dead" participant in this tragedy.

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    1. This comment has been removed by the author.

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    2. Facebook posts indicate this was a video presented as evidence in court - true or not I cant verify that - The blogger at Trials and Tribulations (Sproket) probably could. I hope the DocBastard will come back to the topis of Jahi in the future and offer some explanation to this nonsense that this shows proof. There appears to be some atrophy(?) in the feet but what I know I have learned from House and Greys Anatomy what do I know.

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    3. There's a very simple explanation - it's called the undulating toe flexion sign, and it is entirely consistent with brain death. It's a similar concept as the Lazarus sign. They are both spinal cord-mediated reflexes, no brain or brainstem required. There's no miracle recovery, I assure you. Otherwise, I'm sure Uncle Omari wouldn't have deleted it. You can learn more here: http://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1031&context=neurol_bull

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  24. Uncle omari removed a comment on their FB page asking him how the 6 different tests for the medical determination of brain death, and her being without oxygen for at least another 36 minutes (combined) minimum made them think she was ever going to BE again. i am banned from their page. can't ask them a reasonable question.

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  25. I certainly did find you by searching for information regarding Miss McMath. I have since read many of your other posts and find them insightful, clever, and very entertaining. Thanks for posting stories that are at a much higher caliber than the every day drivel posted by people who are seemingly as ignorant and moronic as Mr.Bieber and his band of mindless drones (a.k.a. fans).

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  26. I understand that it is not illegal to keep a brain dead person on a ventilator, BUT....what about doing it for a prolonged period of time? Jahi's mother has shown photos of Jahi with necrosis on her eye and hands before taking them quickly off the internet after people bashed her for it. Isn't it a health hazard to living people to have a dead body slowly decompose above ground? How long will the authorities allow this gruesome thing to continue? This entire thing is getting and has gotten way out of hand now.

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