Jahi McMath: Family says brain-dead teen's body may be too deteriorated to save

[alp227]

Source: San Jose Mercury News

A day after winning the three-week battle to take their brain-dead daughter from Children's Hospital Oakland, the family of Jahi McMath conceded Monday they are losing the ghastly war against nature.

Her body, checked in at an undisclosed care facility Monday morning, has deteriorated so badly, that "Right now, we don't know if she's going to make it," said attorney Christopher Dolan.

"She's in very bad shape," he said. "What I can tell you is that those examinations show that her medical condition, separate from the brain issue, is not good."

Dolan's frank and sober assessment echoes a Friday legal declaration by Children's Hospital Oakland critical care pediatrician Dr. Heidi R. Flori, who opposed surgical insertion of a feeding tube because the girl's body was deteriorating.

Read more: http://www.mercurynews.com/science/ci_24857783/jahi-mcmath-brain-dead-teens-body-may-be

[MADem]

1. They need to let that poor beautiful child go. It is a sad and awful thing to lose a child, but

she is gone and she's just not coming back.

[DallasNE]

6. Not Just That

But it has actually extended the agony of the family. Amazing how a simple tonsillectomy could have gone so wrong. I had that done some 65 years ago when it was performed in a doctors office using ether -- boy did that upset the stomach -- but it was uneventful otherwise.

[AtheistCrusader]

7. This wasn't a simple tonsilectomy.

This was her third operation for the same, to try and correct apnea issues.

[LeftyMom]

11. And apparently the family mismanaged her aftercare,

by encouraging her to talk and laugh when she was supposed to be quiet and let her throat heal, and by trying to suction her themselves when she started bleeding, which almost certainly caused more damage.

[anasv]

20. I still have not read a clear writeup of what happened to her.

[avebury]

28. If what you are saying is correct I doubt

that they would have a valid malpractice case against the hospital. It is a hard pill to swallow to realize that they might have contributed to her death.

[FarPoint]

30. Oh boy.....

This may be the source of the families inability to let her go....guilt.

[Nine]

33. I don't think that's based on anything more than Internet gossip, is it?

It might have happened but also might not have.

[LeftyMom]

73. It's based on the court filing by the hospital.

Obviously it's their side, but the family are loons, so I would personally trust the hospital over them.

[Nine]

74. ok

I saw some blog or something where allegations were being made based on reports by supposed other patients there at the same time.

[BeliQueen]

36. Her family didn't mismanage her after care

She was bleeding in post-operative. Her mother asked for something to be done. They did nothing until her heart stopped.

I hate how people always blame the victims.

You should be ashamed to spread such vile lies against this mother.

[Daemonaquila]

71. It's appalling that you're blaming the family for that.

Information on how she died showed lack of care by the hospital, and family members trying to save her from choking when they couldn't get help from the hospital staff.

Here's a very personal story that is VERY pertinent. My mother suffered a hypertensive crisis that caused severe encephalopathy. After she was discharged from ICU, her function was quite poor, but improving with correct treatment - which she was not getting. Because her doctor was a complete ass, keeping her restrained (which was causing hallucinations and delusions over time) for over a week, she was not getting the chance to clear her head, start PT, restart normal eating and drinking, etc. She should have been given a bed sitter and slowly returned to a normal routine. Instead, the bimbo refused to do anything, and thought she was calling my bluff when she said that the only way she would do that was if a family member would stay with her 24/7 for 2 days in the hospital to tend to all of her hallucinations, keep her in bed, etc. So instead, I called HER bluff.

That first night showed just how badly hospitals practice medicine, and how irresponsible they are in monitoring patients and responding to emergencies. They woke her around 1 AM for ORAL meds in pill form (this despite the orders that she supposedly wasn't to have anything solid by mouth, and the availability of patch and liquid versions of her meds), dispensed by a hurried nursing aide who was more interested in just getting the pills down the throat of a still mentally addled, just woken woman who was disoriented and half asleep. She didn't stick around 15 seconds afterward, which was how long it took for my mother to start choking and coughing because the pill had gone down the wrong tube. I called her back, and she tried to follow protocol (which she didn't know) to use suction. Equipment for suction wasn't even in the room, and she didn't know where it all was. She ran down the hall to a supply closet and brought back what she realized were the wrong tubing and attachments, couldn't figure out how to make it work (it wasn't going to!), and just kept uselessly fiddling as my mother choked and I was the one working on her to get it out. (She still had some airway and her O2 was in lower acceptable range, so I was avoiding doing a full Heimlich in hope that they'd get the vac working. She is a really tiny, frail woman.)

I hit the nursing station call button, and got a grumpy reply, basically "What are you bothering me for?" I told them to get a real RN's butt to the room because the patient is choking and the aide has no idea what equipment to use and is just dithering around. They knew I'm a lawyer and had already punked the doc, so suddenly they had 3 people rushing in, 1 of whom had the RIGHT equipment in hand, 1 to yank out the aide and dress her down (how about training her right in the first place?), and 1 supervisor to observe in case things went badly and they needed a witness. The RN with the correct gear took care of business in about 10 seconds after connecting the equipment, without my having to create more trauma for my mom, thankfully. However, I have to ask what would've happened if (a) I hadn't been there, and (b) had left the half-trained dope fiddling about with equipment that would never have connected rather than being willing to call in the attitudiunal but competent nursing staff.

So, blaming the family for trying to help a girl in a crisis because the staff is conspicuously unavailable and/or not acting on a call for help? Not flying with me. Beyond this example, I do a lot of disability work, and most of my clients are disabled NOT because of their conditions, but because of what has been done to them by the medical system. Hospitals are run by greedy bastards who skimp on staff and training, and staff is both overstressed and in many cases insufficiently skilled or simply punching the clock. The family has unfortunately gone a bit mad in their grief, and is making horrible decisions right now, but it is NOT in any way their fault.

[shrike]

72. Been there, done that, Daemonquila

I don't even want to go into the particulars as to what happened to myself AND my husband during the unfortunate times we had to be hospitalized. But suffice it to say I know exactly what you're talking about.

[Carolina]

77. As a doctor

myself, I totally agree with you. The hospital is the worst place to be today UNLESS the patient has a 24/7 advocate at the bedside.

When my elderly Dad, now deceased, was hospitalized for a urinary tract infection (on top of other problems including dementia), the ER doc was great. But Dad required admission for IV antibiotics and fluids and once admitted to the floor (finally ~1:00AM), the hospitalist and a nurse nearly killed him. Without going into details, had I not been there and actually threatened the MD (hospitalist), I dread to think of what would have happened.

The current system with its patient centered platitudes and electronic medical record is still disjointed, and there can be an appalling, potentially life-threatening lack of continuity of care and communication among professionals. Without an advocate who knows the patient, and better still knows something about medicine (or has common sense), people suffer worse outcomes including death.

After that episode, my Dad required 3 other hospitalizations before he died and I insisted he be taken to the hospital where I knew the MDs and the housestaff (residents) instead of to the nearest facility. There my Dad received great care and watchfulness, even when I wasn't around. But how many people have doctors as relatives?! And how many people can be at hand 24/7 or at least in the evenings which when things typically go south?!

In this sad 13 year old's case, we do not know exactly what happened and may never know. MOST MDs practice honestly but protectively and strive to do their best; and I say that after a lifetime (34+ years) of being in medicine. But the human body is not an amalgamation of fixable parts and sometimes through no apparent fault of the surgeon or case management, things go wrong. In any such case, the hospital has surely circled its wagons; and much of what we, the public, hear comes from a naturally distraught family and a media that loves to sensationalize.

As a pathologist, I know Dr. Flori's assessment in her sworn statement is correct given the autopsies I have done on those maintained on life support. We can artificially maintain functions up to a point, but organ systems are inter-related and with the brain completely gone (including, and especially, the brainstem), all other systems will deteriorate: multi-organ system failure. So we never know exactly what transpired in what appears to be a tragic and complex case.

[REP]

69. General anesthesia on an apnea patient is always risky

And doing a tonsillectomy to correct apnea has been shown to be next to useless.

[MADem]

17. Exactly...and the family has suffered enough.

Ironic that the old ways, with the ether and a pair of tin snips (well, not quite, but ya know, pretty close) would probably have been a safer situation.

[kestrel91316]

82. It was NOT a "simple tonsillectomy". It was extremely complex, invasive, and

dangerous surgery to modify the entire inside of her upper airway to deal with her obesity-related sleep apnea and airway obstruction.

It was a HIGH-RISK procedure that could have been completely avoided by a proper diet and eight loss plan.

[FreedRadical]

9. They need... is a poor way to start a sentence.

When it comes to talking about the trauma of the struggle of a loss of a child. I don't mean that to sound like a shot a you. However, unless the trauma is yours... No, please never say that to someone you know who is dealing with the loss of a child. I hope above hope you will never know what this can feel like. In my unwanted experience.

It is sad though

Peace

[MADem]

16. The body is "deteriorating." They do NEED to let that child go.

She's brain dead. She has been for awhile and she's not coming back. It's like a Frankenstein situation right now--it's horrific.

It's a terrible thing. Delaying at this stage isn't going to make anything better or assuage that grief--it's just going to leave them with memories that will get more terrible, not less. Their memories of their child will be overtaken by images of a dead husk on breathing tubes, not their vibrant and beautiful little girl.

[FreedRadical]

18. I know. Yours was a reasoned response.

Mine emotional.

[MADem]

19. I can understand--you see pictures of her; she was beautiful and she had a smile that could light up

a room. Her family must be beyond grief, but they just have to pull it together and do this difficult thing.

[azurnoir]

2. They really need to let this poor girl's body rest

more on her condition here it's the testimony of a Children's Hospital MD, her condition is very different from that of Terri Schiavo as her brain stem is no longer intact or functioning-meaning that despite being on a 'vent' her body is decomposing

http://media.nbcbayarea.com/documents/HeidiFlori.pdf

[avebury]

29. It is hard to imagine, after reading

that document, why on earth the judge allowed this situation to continue past Christmas. That is one judge that needs to be removed from the bench.

[LeftyMom]

3. She's dead. She's rotting. She's going to start to really stink if she doesn't already.

Some seriously gross shit is already going on (her intestinal lining is sloughing off and exiting her body) and some nastier stuff is soon to follow (her brain is liquefying, and as the tissues in her head deteriorate around it it's going to start to flow where gravity takes it) and as unfortunate as that is, it might be the only thing that gets it through their heads that she's D-E-A-D.

[FarPoint]

31. I mentioned a few days in a thread

about the body odor....decomposing in-spite of the ventilator. It is extremely difficult to attend to such a clinical condition as a caregiver.

[rocktivity]

4. First Candidate for this year's "You Call This NEWS?" Award"

Psst -- newsflash -- in case you didn't know, she HASN'T made it -- SHE'S ALREADY DEAD!!!

P.S. And while you're at it, counselor, you can kiss your malpractice suit payday goodbye.


rocktivity

[jmowreader]

5. Something else they really need to consider

The longer they put this off, the harder it's going to be for an autopsy to determine the cause of death. Which means if they plan to sue the hospital for malpractice, which they almost certainly will, the case will get rejected.

[SCVDem]

8. So much for the gift of life!

Organ donation.

She could have made many families happy, but in their desire to achieve only self satisfaction, that is also gone.

Pay the cashier on the way out.

[davidpdx]

23. I know, I was saying that on a thread about her the other day

If the family had let her go there when she was pronounced dead, there is a possibility that some other child waiting for a vital organ (heart, kidney, etc.) could have had the gift of life.

[Myrina]

35. +1 Brazillion

Yes indeed. So very sad that they couldn't see past themselves.

[TwilightGardener]

40. These poor people don't owe anybody anything. You don't owe organs. It's a gift.

"In their desire to achieve only self-satisfaction"--sometimes people don't grieve as properly as you wish, or rise to the occasion the way you feel they ought, but I for one am not going to judge and condemn. They are in anguish.

[tblue]

49. They don't need our judgment on top of this terrible, tragic, unnecessary loss.

They have been in crisis mode and were not giving up their beloved child until they absolutely had to. Forgive them if they effed this up. I wouldn't dare criticize them. There but for the grace of God....ya know?

[TwilightGardener]

53. Yup. The hospital needs to review the entire way this was handled, in fact.

The family was already reeling from a very unexpected occurrence--they may have felt pressured to end her life, maybe the doctors a little too callous or not understanding enough of the family's education level or religious beliefs--these are all factors that need to be taken into account. Every family I've dealt with in the ICU whose loved one was facing similar doomed circumstances seemed to accept the fate awaiting their family member (at least at the bedside), though not always in the dignified, heroic ways we hope for. This case is unusual, and the hospital needs to reflect upon why that is, WITHOUT blaming the family.

[Gormy Cuss]

60. +1 n/t

[Nine]

64. I strongly suspect a better demeanor from the hospital could have prevented all this.

I don't know, of course, what was said to this family, either by doctors or by nurses and other personnel, but it's hard to imagine a family being in this level of denial if they had been treated with compassion and respect while the circumstances were thoroughly explained to them. I suspect there was conflict between the family and the hospital from the start and that's what laid the groundwork for all this.

[lumpy]

75. Your first sentence says a lot. My impression was that her overall health might not have been

fully determined before the operation.. I guess there might be a problem considering she apparently had a breathing problem with apnea and how that would affect using an ether of some sort to put her 'under'.

[freshwest]

76. It had to have been shocking to lose her for a 'simple' operation. I think it as you say.

They resisted because of disbelief over begin told to turn off life support by the same people who messed up. It was something that should have never happened. It was just wrong somehow. I don't judge them, it's pretty easy to make all kind of judgements online without being there and living it.

My best friend's niece from a broken home was living with her to get her high school diploma and hopefully more. She called me when she found her missing, then the girl called to say she was 'in love' and would be living with a boyfriend and his family.

He'd been seeing her at school and he talked her into sneaking out and moving in with his family, instead of going to college and all the things the family had planned for her.

She had just turned 18, was a very lovely and kind girl, but emotionally vulnerable because of her early familyl life and the family falling apart. He made her feel, and his family also, that he was her future. After a few months, she saw it wasn't good for her as he'd gotten abusive with her, and his family supported him in that.

She wanted to go home and called and met my friend over a meal. On her last day, but my friend didn't know that, she had had a long talk with her. It was her dccision to come home and get on with her life,. My friend was happy. She went to her boyfriend's home to get her things, saying she wanted a ride home.

He took her out for a long, high speed drive instead, trying to talk her into staying, yelling at her. She felt so scared that at a stop light, she tried to get out of the car and he hit the gas to stop her from leaving.

But she fell and hit the back of her head on the curb of the street, fatally hurt. He took her to the hospital and his family showed up and left as they could not the bill. My friend went to the hospital and stayed for a week. Then she called me at 4 in the monring, crying. They'd done all they could to reduce the swelling and waiting to see if her brain would work again. It didn't and they ordered the machine keeping her breathing off and she passed away within minutes. She'd been dead, in truth, since her head hit the curb..

My friend and her family had great insurance and doctorss that she trusted. It was hard to believe she was talking to them a few hours before she was dead. She was gone, just like that, but they'd done their best.

This young lady's family may not have trusted the doctors after the routine operation ended so badly. I don't blame them at all for not believing. Mocking them and trying to make a personal tragedy political doesn't change a thing. Not by us here, or by the ones who were associated with Schaivo.

JMHO.

[SCVDem]

57. Let me put it another way

The family could have eased the tragic passing of their daughter through the joy of the many families who would have been helped, many in a life saving way.

Perhaps self satisfaction was the wrong phrase, but the knowledge that their daughter helped so many in her passing should have made this a little easier to cope with. Read some of the stories from donors families. Hell, they even had a Rose Parade float honoring them and the riders were the grateful recepients.

I believe they were given bad advice and may have been manipulated by a greedy lawyer who only saw profit in misfortune.

I have the dot on my drivers license as a donor. Do you?

[TwilightGardener]

59. Yeah, I'm an organ donor. My opinions were informed by 5 years at the bedside

of critically ill, and sometimes dying, patients. Not everyone manages to act according to the heroic script. Sometimes things don't happen in the best manner possible. That is too bad. That's the way it goes. They loved their daughter and didn't give up when they were told to give up, for whatever reason or reasons, but that can't be helped now, and to try to shame them in their grief is just sick.

[SCVDem]

61. The shame goes to the media

for constantly reporting on this morbid, macabre story.

This is none of anyones business.

[OrwellwasRight]

108. I agree. No one "owes" anyone else an organ.

I hate that some people feel entitled to the body parts of another person.

[Arugula Latte]

78. Yep. What a waste.

[liberalhistorian]

113. That is one of the most mean-spirited, cruel,

thoughtless, nasty, insensitive comments I've read on here in a long time, and that's saying a lot. It has nothing to do with any "desire to achieve self-satisfaction" or any such horseshit nonsense. It has to do with mind-numbing disbelief and grief so overwhelming as to be unbearable, understandable grief at the loss of a young, vibrant, child who was likely lost due to medical mistakes by the same entity that told them they needed to pull the plug. As a parent myself, I'd likely feel the same way and anything else at all, including organ donation, would be so far from my mind as to be on Mars. And you know what? That is NOT selfish or a "desire to achieve self-satisfaction" or any other such ridiculous nonsense. Your thoughtless, insensitive cruelty to the family in their loss is, quite simply, unbelievable.

And how typical of so many organ donation promoters I've known-only caring about the donation and the donee, thinking and caring little about the donor and his or her family and what they are going through. No one is "owed" the organs of anyone else. It is a gift and NOT required and no one is being selfish for dealing with their own grief and loss or for not wanting to do it. It is, otoh, selfish for demanding it of people with little regard for their own feelings.

[FreedRadical]

10. wow you guys.

[lisby]

21. Double wow, you guys. n/t

[blkmusclmachine]

12. Religion versus Science. Science Wins EVERY TIME.

[The CCC]

15. Religion versus Science. Science Wins EVERY TIME.

I'm about as pro science as they come, but have the utmost sympathy for those grieving parents.

[warrant46]

118. Religion versus Science

Where they went wrong here is they didn't have a Man hovering over her burning one of these

[SoapBox]

13. This whole thing is just sick...

And that damned freak attorney should have his ass kicked, over the crap he keeps pushing.

[Warpy]

14. You can't keep a non breathing corpse alive for long

Without the brain stem guiding the autonomic nervous system, things start to shut down.

[Mortos]

22. "We're not going to play God,"

Relieved that she is now "safely where she needs to be," Jahi's family believes she is still alive, uncle Omari Sealey said Monday.

"We're not going to play God," he said. "If her heart stops beating while she's hooked to the ventilator, we can accept that."

Jesus H. Christ! Do they not see the hypocrisy?

[3catwoman3]

79. Many people have already...

...played God.

If I chose to, I could say I am playing God every time I write a prescription for otitis media or strep throat. I do not look at it that way, but I very firmly believe that if it is OK for us to step in and change the direction of a patient's situation for the good, it is also OK to step out when no more good can be done.

[davidpdx]

24. It is amazing that it has taken weeks for the family to finally admit that she is dead

Moving her dead body was abuse of a corpse.

[LisaL]

39. Oh they aren't admitting that she is dead.

Far from it.

[tomp]

25. the judge's decision was terrible.

setting a precedent that the family's belief can supersede a doctor's determination of death (multiple doctors, for that matter). that body should have been released for one reason only, disposal.

[Demo_Chris]

27. Yes. nt

[Delphinus]

34. Wow,

that is so true.

[TwilightGardener]

58. No. The family gets to retain some control over the process, AS LONG AS

the patient is not suffering. Doctors are not gods.

[JNinWB]

86. Actually, the family has no say when the determination is brain death.

The hospital is only expected to offer a brief accommodation to family members to pay their last respects and then remove the vent.

A families wishes, beliefs or religious convictions about the deceased person are not relevant.

The Court's intervention is what allowed this macabre travesty

[TwilightGardener]

89. They got a second opinion from a physician outside the facility.

Considering the circumstances of the case, including the possible culpability/malpractice at the hospital, I think it was proper for the judge to allow extra time in this case.

[JNinWB]

90. This outside doctor did not personally examine her.

His opinion could not super cede six specialists who independently declared her dead using brain scans and other tests that have been designed by both state and federal law to determine death of the brain.

[TwilightGardener]

92. He agreed with the results--it was brain death, from what I've read. This was the

physician that was allowed by the court to review the case and gave his opinion on Christmas eve.

[OrwellwasRight]

107. Really?

Is the family going to pay for all this treatment for a corpse? Because surely no insurance company will approve treating a corpse, so that leaves it to the family to pay in cash, and unless they are the Rockefellers, they won't pay, and the taxpayers of California will be stuck with paying for this family's "belief" that the child is not dead.

I'm sorry, but it is this kind of "treatment at all costs" bogosity that is part of the American "rugged individualist" culture. Everyone believes the odds don't apply to him or her (due to a basic failure to understand statistics), and the community suffers so the individual can go with his "beliefs."

[tomp]

115. I don't know specific CA public health law, but....

...it has GOT to include some point at which there is a legal obligation to dispose of a dead body. I assume that point is some time shortly after the person is declared dead BY A DOCTOR. Only a doctor can determine death. And this was done several times by several doctors. "Brain death" EQUALS death. The judge allowed a TRANSFER of a dead body for purposes other than disposal. That, as far as I can tell, MUST violate some aspect of the CA public health laws. Also, "Suffering" is presumed not to occur in dead people.

[TwilightGardener]

116. Brain death is impending death, legal definitions aside.

Let's say they couldn't, or didn't, scan and measure the brain waves and electrical activity-- they'd have a harder time determining brain death. It's technology-driven, in addition to neuro exams of reflexes, pupils, respiratory drive, etc. The legal definition is important because it allows the process of recovering organs in an effective manner, and directs possibly needed (and expensive) resources away from the patient. Public awareness has caught up, and most families accept the inevitable, once it's confirmed. Which I generally agree with. But, she's still in a stage of dying. She is not yet a dead body, until her failed organs create a toxicity that overwhelms her heart. She's actually still a person, and a patient, and not a corpse. I have never treated a person with a heartbeat as a corpse, no matter how hopeless the diagnosis or how imminent the death. All patients are entitled to dignity, no matter what legal battle rages around them, and all families should be entitled to request a judge to delay extubation, for at least a short period of time, if they feel that something is truly wrong with the diagnosis or the medical process.

I honestly can't imagine not having SOME input over the decision of when to extubate, in regard to my own children and family. The insane "what ifs" and guilt would haunt you for life if you didn't truly understand the diagnosis, didn't trust the doctor or facility, or had some religious beliefs that ran counter to reality.

[tomp]

117. death is not a diagnosis

it is a determination. and the law should not accede to religious beliefs that run counter to reality.

i feel certain that the hospital staff has been as considerate as possible to the family. it is virtually impossible to fully accommodate people who just won't or can't understand. at this point they need grief counseling or psychiatric intervention.

[Demo_Chris]

26. I feel sad for them and cannot imagine their pain...

If nothing else, hopefully now they can let go.

[bucolic_frolic]

32. Time for Cryogenics

Deep freezers will be revived someday.

Don't you think so?

[Kelvin Mace]

47. Sadly, no

The part of her that is HER is gone, completely destroyed. Even if they were ever able to regrow the dead tissue in her brain, the unique bio-electrical "essence" that was a person is gone. Kind of like restarting a computer with no operating system software and no user files.

Imagine that you wrote the greatest novel ever, and stored it on your computer. Then a massive power surge fried the computer and destroyed the hard drive utterly. You can replace the hard drive and reload the OS, but the novel is GONE forever

And even if she were "backed up" somehow and restored, would it be the same person? Deep metaphysical/philosophical waters here.

[LisaL]

37. Did this lawyer really think she could have been saved?

She is brain dead. Even on a ventillator, brain dead patients don't last forever.

[cosmicone]

41. That lawyer should be disbarred n/t

[bucolic_frolic]

63. The lawyer is a hired gun

They are paid to represent the interests of their clients
in this case the parents

[TwilightGardener]

38. Truly brain-dead people don't live long. It's not a Terry Schiavo type case.

Their most basic functions are just gone--temperature regulation, heart rate, hormonal activity. Organ failure follows.

[LisaL]

42. Yes, her body is already in poor shape.

Her body can not regulate temperature well. They have to keep her body covered in blankets. Her body also can not regulate her blood pressure well. The new facility couldn't insert the feeding tube into her body due to some physical problems with the body.
Why the courts allowed all these efforts to keep the deteriorating body alive is beyond my understanding. Per CA law the girl is legally dead.

[TwilightGardener]

43. Her heart will soon stop beating, and the family will accept that, and they'll

lay her to rest. In the end, an extra couple weeks on a ventilator (I'm surprised she even lasted THAT long, after the second-opinion confirmation of brain death, but then she was 13) isn't going to matter that much. She felt no pain or discomfort. The parents will know in their hearts that she is gone.

[magical thyme]

46. it mattered to the people who were forced to attend to that body

and it mattered to whomever could have been helped by that ventilator.

Aside from the obvious problems with caring for a deteriorating corpse (the stench of carrion is horrific) is that it is quite unsanitary for those forced to deal with it. The process includes bacterial and fungal growth. There is a reason why bodies are buried or cremated versus left to just lie around and rot.

And then the emotional trauma for the doctors, nurses and technicians forced to attend to her body.

There were more than 2 opinions. The hospital initially had 2 irreversible brain-death diagnoses. The parents then brought in 3 of their own doctors, all of whom diagnosed irreversible brain-death. The court didn't bring in a 2nd opinion. They brought in a 6th opinion.

[TwilightGardener]

50. Please. I've cared for those patients who were declared brain dead and were going

to have organs recovered and donated--I've kept them going until their final surgery, I've given them their last baths, their last oral care. You're lecturing the wrong person. And no, she's not a corpse, her heart is still beating--what she is, is called "dying". And I doubt any other patients who needed ventilators actually died because this girl was on one.

[magical thyme]

51. you've cared for them for a month after they were declared completely brain dead?

I expect organs are harvested very quickly. This body has been on the ventilator for a month now, with the brain stem not functioning. The girl is dead. The body is disintigrating.

I don't think they are the same thing at all.

Just because the heart has been kept beating by the ventilator does not mean the rest of the body isn't disintegrating. Her mother cites her body's warmth as a sign that she is alive. In fact, it is heated blankets that are keeping her warm...the optimum temperature for growth of many bacteria.

http://www.mercurynews.com/science/ci_24857783/jahi-mcmath-brain-dead-teens-body-may-be
The insult" of brain death "evokes profound physiological and structural derangements in the peripheral organs," concluded Dr. Martin Gasser and his team in an Annals of Transplantation paper. Blood and other infections are likely, they wrote.

...The other is the cascade of later complications, like when a computer crashes. Cellular metabolism goes haywire. So do cardiac and lung function. There is often severe hypertension and imbalances of important regulatory hormones.


..."You're applying abnormal pressure to keep the lungs open and functioning, which creates small tears in the lining of the air sacs and bronchial tree, opening up the possibility of infection."

[TwilightGardener]

55. A day or two, usually. By the time they get a confirmation of brain death, their

systems have already gone fucking haywire, and I'm running around with bags of insulin and D50 trying to control glucose levels, have them on blood pressure drips, cooling mats, blankets, etc. in an effort to keep them viable for recovery--all directed by the organ recovery team. In the end, she's been dying, all this time. It's just taking longer than if her heart stopped first. But no, she's not a corpse. She's not "rotting". She's just dying. I'm not sure why people are so macabre and ghoulish about this case.

[JNinWB]

88. Jahi is not dying, she is dead.

A still-beating heart does not determine that a dead person is not dead.

Six specialists determined that Jahi is brain dead; in CA 2 separate examinations are all that is required. That's the law.

Her body is decomposing.

[TwilightGardener]

91. No, she's dying. Her electrolytes and acid base balance will soon go screwy enough to

the point where her heart goes into arrhythmia and stops. Her organs are failing, her guts are leaking bacteria into the bloodstream, it's a matter of time.

[JNinWB]

93. I don't think that the word "dying" means what you think it means

There is a difference between an evidence-based, legal determination of death and personal or religious beliefs.

When a person is dead, the dying part is over.

[TwilightGardener]

94. I'm quite sure I know what it means, thanks.

[JNinWB]

95. "What you believe is true for you"

[Boudica the Lyoness]

119. Imagine if these morans started a trend

and lots of people wanted to keep their dead loved ones on vents, complete with IV fluids, feedings and antibiotics. That is what this girl's body is being treated with, weeks after a death certificate was issued!

Imagine the public health issues involved. What about necrophiliacs coming out of the woodwork?

This is abuse of a corpse.

The coroner has declared her dead yet you and thousands of religious nut cases think gods going to have her up, walking and talking.

Since you don't understand what death is, read this;

http://www.scribd.com/doc/196756012/Children-s-Hospital-Oakland-Supplemental-Declaration-of-Dr-Heidi-Flori

[TwilightGardener]

120. I fully understand what death is. Thank you for your helpful concern.

But no, until her heart stops, she's not a corpse.

[JNinWB]

121. Is there a religious belief that informs your comments?

Can you explain the difference between dead and a corpse?

I assume some believers find passages in the OT that claim that death can only be determined when the heart stops beating This seems to be the religious argument put forth by the family.

[TwilightGardener]

122. No--I'm not a very religious person. But actual death, meaning that cells in the body

cease their function and are irreversibly dead, happens when your heart stops. I think the family should have accepted reality long ago--they're prolonging the inevitable, but as far as I'm concerned that's not a tragedy in and of itself, because nature will take its course despite artificial support, at least in this case. The cases that I think are really wrenching are the Terri Schiavo's of the world--not brain-dead, can be extubated, can maintain an airway, but...no meaningful life.

[JNinWB]

123. Thank you for taking time to comment.

I cannot understand continuing any form of life support for those in a PVS. Or, even long term comas or advanced Alzheimer's. I have instructed my daughters (if I ever enter the adv. Alzh. stage) to just give me a "cocktail" and say their good buys. ; )

Like Sharon--in a coma since 2006! If you ask any adult, who understands these conditions, no one would want to be kept alive in such a state of shadow existence.

[Mr.Bill]

114. Alameda county issued a death certificate on her

a week ago. She is legally dead.

[magical thyme]

104. she is medically and legally dead. The person is gone and not coming back.

People are not being ghoulish and macabre. The situation -- maintaining a deteriorating and decomposing body mechanically, without a living person and to no purpose -- is ghoulish and macabre.

There has been enormous discussion and re-discussion on the medical ethics and the definition of death for legal and medical purposes. Whole brain death does not require the heart to stop to be legal death or medical death. Prolonging the dying process will not bring back life; it only keeps an inanimate body without a person minimally functional, while provide a fertile environment for bacteria and fungus to thrive.

You run around like crazy maintaining bodies is sufficiently good condition to keep organs viable for re-use elsewhere. Kudos to you for doing that very important job; it has to be enormously stressful. I don't need to tell you that the organs are harvested as quickly as they are because best case they will deteriorate to where they aren't functional or worth transplanting pretty quickly.

Her family did not retain a high powered lawyer to buy them time to get past denial and come to terms with her death. They refuse to believe even the 3 neurologists that they hired to examine her. They retained the attorney because they believe that God "may spark her brain to wake up." Neither God nor Dr. Frankenstein are going to wake her brain because it is not asleep. It died of ischemia a month ago.

Their lawyer has said he didn't know anything about this when he took on their case. He has no background in either medicine or biology or biochemistry or healthcare, period. But he personally believes, based on his pro-life religion, that parents alone should be able to decide when to turn off ventilators and he intends to fight for that based on his "pro-life" religious beliefs.

He brags that he has taken their case pro bono because he's already earned his money and is happy to spend it on (ramming) his personal beliefs down our collective throats. He doesn't appear to have taken into consideration the financial situation of Jahi's parents. With a death certificate dated December 12, I doubt insurance will pay for her room and care after that date. They had raised about $40-50K when I last looked. The transport alone was bumped from a little under $30K to $32K+ when they actually moved her.

Personally, I find it ironic that people who purport to believe that the body and soul/spirit are 2 separate things would recognize when that soul/spirit has left the body, it has already gone back to God or to heaven or wherever they believe it is going. Either that, or it is still stuck with a nonfunctional body and waiting to be released so it can go to wherever.

[bhikkhu]

44. Jeez - I'm getting a DNR order myself

nobody's going to even think of pulling that crap on me.

[PasadenaTrudy]

56. I have one

as part of my Will. Also a DNI, Do Not Intubate.

[Botany]

45. I hope she is "unplugged" ASAP

Last edited Tue Jan 7, 2014, 08:11 PM - Edit history (1)

No doubt without a functioning brain her organs are also shutting down too. Her
kidneys have to be failing right now and then what are they going to do? Put
her on kidney dialysis?

[magical thyme]

48. I expect that whoever accepted her body is going to be having second thoughts very soon

and maybe some serious heart-to-hearts with her family.

Tending to a slowly necrotizing body strikes me as very unsafe as well as extremely unpleasant.

[Beacool]

52. The kindest and most sensible thing for the parents to do is to let her die in peace.

What's the point of making the girl go through all that when the end result will still be the same?

It is now defying common sense. It is also selfish, they need to let their child go.

I'm not even going to go into the expense of transporting and keeping her artificially "alive". That's a separate issue.

[Nonhlanhla]

54. Quite macabre - this and the Texas case

Last edited Tue Jan 7, 2014, 01:27 PM - Edit history (1)

This sad story has made me realize even more how macabre the case in Texas is with the brain dead pregnant woman. Since that woman is also brain-dead (as opposed to in a coma - if reports are to be believed), it means they are growing that fetus inside a slowly decomposing body. The fetus was already cut off from oxygen for who-knows-how-long when the mother collapsed, and is now developing inside what can only be a toxic environment. I cannot for the life of me see how that can be acceptable to anyone. Even one of the most ardently "pro-life" Catholics I know said that they should shut down the machines in that case, since it goes against Catholic teaching to grow a fetus inside an artificial environment, and a dead body on machines is just that. Her view intrigued me. But for me the bigger issue is that the body is decomposing, and this is not a healthy environment in which to grow a human being.

As for Jahi, the family does need to start facing reality, painful as it is.

[kestrel91316]

83. As long as she is on a ventilator and her heart is beating to keep blood circulating, she

IS NOT DECOMPOSING. Her body is, however, very sick and not a good environment for healthy fetal development.

Decomposition occurs when blood supply is compromised. It's called gangrene.

And yes, I do know a great deal about these things, as is my professional responsibility.

[Nonhlanhla]

84. From what I've read

From what I've read about Jahi's case, even though the blood is circulating, the fact that her brain is no longer controlling her organs (excepting the heart, of course, since that is separate from the brain anyway) makes them slowly disintegrate. So decomposition is happening, just at a slower rate. Which is also why Jahi's organs are no longer viable for transplant.

Please correct me if that is incorrect. But I was NOT saying she is decomposing at the same rate as a non-ventilated corpse. Obviously the ventilator will slow the process down.

[XemaSab]

98. She's pooping out her intestinal lining

That's pretty funktified from where I am sitting.

[Arkansas Granny]

62. I hope this is over soon so the family can complete the grieving process and start healing.

There is nothing worse than losing a child and their loss has been going on for weeks now. I wish peace for them all.

[Myrina]

70. I don't think they've even begun the grieving process ...

.... by all appearances, they're in complete denial of reality.

[QuestForSense]

85. Sounds like it's drawing to a close.

Mercifully.

[LisaL]

111. Not quite. The new facility actually managed to put a feeding tube into her.

[SCVDem]

65. The real sad reality will hit

when the funeral is over and the bills start coming.

Even with insurance, the hospital and doctors are not working for free.

THAT is the final indignity, financial ruin.

On second thought, that would be when they get the lawyers bill.

[Thirties Child]

66. Sometimes you bleed and no one knows why.

If Internet reports about talking and eating hamburgers are correct, the mother is at least partly to blame - she allowed both. She couldn't have understood how serious the surgery was, and must not understand now what brain dead means. I feel two ways about this - horrified by her ignorance and sympathetic because she lost her child. If Jahi didn't bleed after the earlier surgeries, then she probably doesn't have a bleeding condition; either the surgery was botched or the hamburger - if there was one - did enough damage to cause a hemorrhage.

I understand that there can be bleeding after surgery, and that it can be fatal. Been there, almost done that. Because of rheumatic fever, Mr. Thirties had a tonsillectomy in 1945, when he was seven. He had delayed bleeding, had to have a blood transfusion. He bled after dental work and, after surgery on his thyroid, was only saved by an emergency trach - two days after surgery his bleeding was so extensive his trachea was closing up. Extensive testing then couldn't figure out why. When he bled after a total knee replacement - bruised from his waist to his ankles - he was tested again and this time diagnosed with Platelet Disorder NOS (Not Otherwise Specified). Meaning there is a problem but they don't know what it is. He'll never recover completely from the knee replacement - too much dried blood in there. We told the surgeon he's a bleeder, but he said tests show his blood clots fine, no problem. It clots fine but it doesn't stay clotted. The surgeon should have listened to us, maybe said in that case he wouldn't do the surgery until we had seen a hematologist. And we should have consulted a hematologist beforehand. The fault is ultimately ours.

[uppityperson]

67. I hope the family is able to find peace some day. eom

[rocktivity]

68. Too "deteriorated"? No, it's too DECOMPOSED

on account of her BEING DEAD! Decomposing is what dead bodies are SUPPOSED to do!!!


rocktivity

[Lint Head]

80. I feel so bad for the mother but this just seems to be more about the feelings of the family

than respect for the child that has been injured in this horrible situation. Allowing a body to linger and deteriorate seems macabre. Holding on to an obviously dead relatives body as long as possible can border on a selfish act as opposed to a selfless act.

[kestrel91316]

81. Corpses do get like that after death, people.

[herding cats]

87. I really feel for her family, but it's time to let her go.

I have the deepest empathy for what they're going through and the pain they're suffering. I can only hope there's someone in their life to help them accept that she's gone and help them to find peace.

[Sunlei]

96. the hospital did nothing for 3 weeks to support the other organs, they were so wrong.

all that hospital wanted to do was pull the vent plug. Who knows what would have happened over the past 3 weeks if the hospital had started support right away.

[TwilightGardener]

97. Well, they would have had to. She would have been on IV drips and fluids to keep

her blood pressure up and her organs perfusing, she would have had to receive glucose, electrolytes, possibly insulin, antibiotics. What they didn't do was feed her gut, from what I understand, which will lead to big problems in her stomach and intestines--but they may not have been legally or ethically able to, given her diagnosis.

[Sunlei]

99. the new place said they could not place a feeding tube.

Her stomach and intestines went to long without support. Her gut has probably shut down and that will be the death of her. The hospital didn't even care to try, to me, that is the worse part of everything. Sure a feeding tube and a tiny bit of food may have failed. But they would have tried and I bet the family would be more at peace.

[LisaL]

100. The "death of her" already happened on December 12th when she was declared brain dead.

She was legally dead ever since.

[Sunlei]

106. not to her family. The hospital and Doctors should have 'tried', her family had asked for weeks to

feed her. There would have been no harm to give her a feeding tube and try. The child is not suffering. They didn't even have to do surgery, just pass a cath. with a couple cc of mush. To not even try is heartbreaking! Some Doctors have no compassion at all.

[LisaL]

110. Why should they have tried?

She is legally dead. Why exactly should the hospital try to feed a legally dead person?

[colinmom71]

112. The type of feeding tube that a comatose patient would require would need to be surgically inserted.

It sounds like you're thinking that they could use a simple NG (nasogastric) tube to feed liquid to her stomach. But for a patient who has little to no ability to move or sit up, that would leave the patient at very high risk of reflux of the feeds into the lungs. NG tubes are not usually used as a feeding method for this reason.

This is why patients with conditions that do not allow for regular feeding (kids with severe cerebral palsy, for example) must have a surgically inserted G-tube (gastrostomy tube). A G-tube is designed to by-pass the stomach and lead the feed directly into the upper portion of the small intestine. This keeps feeds from "pooling" in the stomach and becoming a reflux risk. For a patient who is supine and immobile (like Jahi), an NG tube feed would be too likely to cause asphyxiation from the feed seeping up the esophagus and into the lungs (reflux).

There have already been reports that Jahi may have had a blood clotting problem, so even not accounting for the brain death diagnosis, another surgery so soon after a bleeding complication from previous surgery would be unnecessarily risky if the aim is to keep her alive on assisted ventilation. It's not about compassion, it's about not undertaking an excessive medical risk...

[rocktivity]

124. "Try" feeding a corpse? Why? She's DEAD!

America's health care system ranks 37th in the world. We shouldn't be wasting personnel and treatments and resources on corpses!


rocktivity

[LisaL]

101. It's the law in CA that the hospital pulls a plug on a brain dead person.

You want the hospital to break the law? Is that it?

[JNinWB]

102. What do you think would have happened over the last 3 weekd?

Do you believe that Jahi would be measurably less dead if the hospital had supplied more mechanical support?

It should be noted that the judge granting the initial restraining order required that hospital maintain the existing status quo---they could neither add nor remove any mechanical assistance.

[LisaL]

103. And per law hospital didn't need permission from relatives to pull the plug.

So why would the hospital even be inserting feeding tubes into the legally dead person?

[JNinWB]

105. I understand that hospitals maintain a brain dead person on a vent

for a short time as an accomodation to the family. No feeding tubes. The family can gather and pay their last respects to the deceased.

Apparently, CHO extended the vent time to satisfy the family's demands, inadvertantly giving them time to obtain a lawyer and go to court for the TRO.

[LisaL]

109. That's exactly right.

Hospital was trying to follow the law. It gave family more time than usual to spend with the legally deceased. Family used that time to obtain a lawyer and go to court.