Family wants to keep life support for girl brain dead after tonsil surgery #6

DNA Solves
DNA Solves
DNA Solves

New Posts

Status
Not open for further replies.
Herding Cats said:
I have to say the following...

In the beginning, I had a lot of sympathy for NH and the family. No one should have to bury their child, especially after a surgery that was to improve her daughter's life. I saw how horribly she was suffering - the guilt, the shock, the loss...all so much, so much.

But, after a time, I started to feel manipulated by her. What sealed it for me was not the lawyering up. Rather, what got me was two things: Gramma NOT correcting anyone's misperception that she was an RN - making sure that her true licensing level was accurately portrayed. Gramma didn't see the need for that, and allowed us to believe she was an RN rather than an LVN. Why does that matter? It speaks to truth, honesty, integrity, and intent. Families have cultures, and if this is the oldest female member, then she set the tone...and the tone she set was dishonest, misleading, and lacking in integrity.

Second, and more importantly, is the family NOT releasing the hospital to speak of Jahi and the surgery, and what went wrong. Again, we go to the issues of honesty, intent, integrity, and truth. We, the public, were told their side, heard their descriptions of the horror they experienced...but were not allowed to hear the other side.
Why is that? Why, if there was nothing to hide, did the family refuse to allow the hospital to discuss things, to educate the public...but insist that the public hear their side, often loudly and vociferously?

Had the family NOT brought the public into it, I could easily see their call for privacy as an honest one. But to bring the public into this fight, and then to not let the other side explain their understanding of the situation...and educate the very same public that the family has been raising money from, and gathering sympathy from...well, to me, that speaks of a bullying culture.

So between the two issues - Gramma's setting the tone of dishonesty and the family refusing to let the hospital talk...I no longer have the ability to feel as much sympathy for the family as a whole.

That said, I cannot shake the thought of the diagnosis "dysfunctional grieving", which is a NANDA diagnosis. I am not sure, but I do know a lot of therapists counsel folks who have had trouble letting go of their loved ones...I don't know that diagnosis, though.

I believe that at this point, the mother is not in touch with reality; I'm not ready to say she's psychotic, but there are a lot of indications that she's broken with reality in some ways. She is not doing this as a faith-based step, as much as she may say so. She's doing it to avoid burying her daughter. Ad that, to me, is the saddest part of things...

If we ever need an example in the future of how strong denial can be, all I will ever need to do is look at this case.

And I must say, I'm personally angry at the family, and at her faith community. Her pastor does not seem to understand what having faith is...and as I posted a few days ago, it's not that God promises that nothing bad will happen to His followers; rather, He promises that He will help us through it. Her faith community has failed her badly, for not helping her understand this important aspect of faith...and have been encouraging serious delusions.

And I'm left wondering - when NW doesn't get her miracle, and instead has to bury Jahi...what will her faith be then? That she didn't "deserve" a miracle? That God doesn't exist, because He didn't raise Jahi from the dead? And how will that affect her, and her other children?

No, I can't say that I have overriding sympathy for the family. I feel horrible for Jahi...and at how her body has been treated by those who loved her most in life, now that she's passed. Allowing her to decompose while they watch and say "she might recover"...no, I'm angry for Jahi.

Just thought I'd add my thoughts on this aspect of things. It's been bugging me, a lot. Prayers for Jahi, always.

Best-
Herding Cats
Click to expand...

re the bbm

If they had not put out the most private details of her condition themselves, I would even agree with that decision. But they have.
 
Herding Cats, that was the best post I've read in a while. I agree 100%. Thank you.
 
SeekingJana said:
Upon reading Dr. Fiori's thorough medical assessment dated 1/3, the lack of temperature regulation jumped out at me. I had wondered when basal hypothermia would set in. I've only seen one other prolonged case of it, in a microcephalic infant who lived to the age of 9 months, and died in our Peds. unit as the family was not comfortable with a home hospice death. I referenced her very early on in this case, as her parents were extremely gracious and thankful for the care we gave her. They dressed her up every single day of her life like a tiny princess.. It was extremely sad but there was dignity and grace because of the positive staff- family interaction.

I wish this could have been the case for Jahi's family and her caregivers.
Click to expand...

Okay now this made me cry.
 
Curiosum said:
When we talk about blood transfusions we are usually referring to a packed red cell transfusion (or PRBCs). It is rare to transfuse whole blood. Because we only transfuse the red cell component the volume of each unit of blood can vary in total volume . They are usually somewhere between 250-350mL though.

With infants and young/small children transfusion volume is calculated based on weight and a specific volume (in mL) is ordered. This is usually divided up into two equal aliquots and each is usually given over 2-3 hours. The timeframe of the transfusion can be adjusted based on the clinical situation. If you have active bleeding or significantly compromised perfusion you may need to increase the speed of the transfusion. If you are concerned about volume shifts and the potential for fluid building up in the lungs (pulmonary edema) then you will want to give the transfusion more slowly.

With adults, and adult sized kids, transfusions are usually ordered in terms of units. Two units is a common and standard starting point. Each unit will again be given individually over a few hours. Of course you can, and may need to, give more than 2 units in some clinical situations. Active bleeding would be one clinical situation that this might be needed.
Click to expand...

I'd like to add just a bit to this, focusing more on the intraoperative/ postoperative situation, because we look at bleeding a lot differently in the OR, and immediate postoperative period, than the rest of the hospital.

We have absolutely no way to know the urgency with which these unit of blood were given. For example, were they running units in on a Level One (or similar brand) rapid infuser? Or were the units called for from blood bank consecutively? At what time, relative to the admission time to PICU were the transfusions given-- minutes, or hours? Was crossmatched blood given, or uncrossmatched (indicating how much time elapsed in the decision making process up on the unit-- was it truly life and death hemorrhage, or over more time?) How fast did the nurses run the units-- over minutes, or an hour each unit (more standard amount of time in non-emergent tranfusions).

At this point, we don't have any way of knowing the timeline of when the transfusions were given, because the bits of information come from second and third hand comments. Omari Sealey was not present-- he was out of the country, and the mom, NW, had a vasovagal reaction (passed out) and was removed from the area for treatment. The grandmother apparently was not present the whole time, either.

Clearly a physician (or more than one) was present and giving orders, or Jahi would not have been receiving blood. In a post op case such as this, it is unlikely that there would have been standing orders for transfusion.

The bigger questions I have, is "which" physicians were aware of the bleeding? Was it only the intensivist/s? Was ENT aware? Was ENT present? What else was being done to control the hemorrhage? Was emergent return to OR considered? If so, why was it abandoned? Etc.

Return to the OR is the "gold standard" for post tonsillectomy hemorrhage. It is probably likely that the tonsillar fossa was the bleed site, not necessarily the UPPP suture lines. And while a bleed from the turbinate procedures could be impressive in the face of a bleeding disorder, the most likely source was the tonsillectomy site. The entire area is fed by 5 branches of the carotid, so bleeding can be brisk and impressive.

A few math calculations:

Blood volume is calculated cc per kg of body weight. Jahi appeared to be quite overweight, but not very tall (wedding picture with others next to her). She also appears to me to not be fully into adolescence (meaning as a child she has slightly higher blood volume per cc body wt).

I would calculate her estimated blood volume at 80cc/ kg. If her body weight was 150- 160 lbs (conservative), then her body weight in kg was about 70. That gives her an estimated total blood volume of about 5.6 liters (5600cc). Four units of packed cells is about 1000cc total volume. You don't replace blood loss cc for cc (meaning you don't give 1cc packed cells for every 1cc lost). Rather, we will look at blood pressure, ongoing hemorrhage, emergency coags and hgb levels, etc. 1000cc is approximately 20% of her total blood volume. We can also assume she lost some in surgery, maybe 500cc or so if the docs were pretty dry surgeons-- we don't know what happened in the OR.

The uncle (who was not there in the ICU, and is giving a layperson's interpretation) states they suctioned 2000cc out of either her airway, or stomach, or both. That may, or may not have all been blood-- we don't know. We don't really know what her actual total blood loss was, but we can make an educated guess based on what info has been given to the public.

Presumably, her fluid hydration status immediately postop, and BP, were OK before the hemorrhage episode, according to reports that she was sitting up, talking, popsicle, etc. So my very rough estimates, from what we can piece together, is that she may have had a 25-30% estimated blood loss in the acute hemorrhage episode, or possibly much more, depending on unknown factors (which are certainly in the medical record).

The other question I have is when did she arrest, relative to the acute hemorrhage, and transfusions. Did it happen so fast they couldn't retrun to the OR? Were there no OR's, or not enough staff available? They are a level one trauma center, so they have a crew and an OR ready all the time-- but was it in use? What time of day was all this going on? Did she have any evidence of bleeding disorder? Etc. So many questions....that I will probably never get an answer to!
 
Herding Cats , excellent post. Hugs and thank you.
 
Tawny said:
To compound that thought, thistle, what health impacts will there be on a baby that is being incubated by a body that has no brain function? Do we really know, scientifically, what a brain dead host body will or will not provide for the fetus growing inside?

It's a little too sci-fi for me and I don't think it's right. JMO.

Back to Jahi, I guess!
Click to expand...

Tawny, that's one scary little hamster! & I can"t even begin to speculate about TX case..between that & Jahi's case, it's hard to rest easy.
 
K_Z said:
I'd like to add just a bit to this, focusing more on the intraoperative/ postoperative situation, because we look at bleeding a lot differently in the OR, and immediate postoperative period, than the rest of the hospital.

We have absolutely no way to know the urgency with which these unit of blood were given. For example, were they running units in on a Level One (or similar brand) rapid infuser? Or were the units called for from blood bank consecutively? At what time, relative to the admission time to PICU were the transfusions given-- minutes, or hours? Was crossmatched blood given, or uncrossmatched (indicating how much time elapsed in the decision making process up on the unit-- was it truly life and death hemorrhage, or over more time?) How fast did the nurses run the units-- over minutes, or an hour each unit (more standard amount of time in non-emergent tranfusions).

At this point, we don't have any way of knowing the timeline of when the transfusions were given, because the bits of information come from second and third hand comments. Omari Sealey was not present-- he was out of the country, and the mom, NW, had a vasovagal reaction (passed out) and was removed from the area for treatment. The grandmother apparently was not present the whole time, either.

Clearly a physician (or more than one) was present and giving orders, or Jahi would not have been receiving blood. In a post op case such as this, it is unlikely that there would have been standing orders for transfusion.

The bigger questions I have, is "which" physicians were aware of the bleeding? Was it only the intensivist/s? Was ENT aware? Was ENT present? What else was being done to control the hemorrhage? Was emergent return to OR considered? If so, why was it abandoned? Etc.

Return to the OR is the "gold standard" for post tonsillectomy hemorrhage. It is probably likely that the tonsillar fossa was the bleed site, not necessarily the UPPP suture lines. And while a bleed from the turbinate procedures could be impressive in the face of a bleeding disorder, the most likely source was the tonsillectomy site. The entire area is fed by 5 branches of the carotid, so bleeding can be brisk and impressive.

A few math calculations:

Blood volume is calculated cc per kg of body weight. Jahi appeared to be quite overweight, but not very tall (wedding picture with others next to her). She also appears to me to not be fully into adolescence (meaning as a child she has slightly higher blood volume per cc body wt).

I would calculate her estimated blood volume at 80cc/ kg. If her body weight was 150- 160 lbs (conservative), then her body weight in kg was about 70. That gives her an estimated total blood volume of about 5.6 liters (5600cc). Four units of packed cells is about 1000cc total volume. You don't replace blood loss cc for cc (meaning you don't give 1cc packed cells for every 1cc lost). Rather, we will look at blood pressure, ongoing hemorrhage, emergency coags and hgb levels, etc. 1000cc is approximately 20% of her total blood volume. We can also assume she lost some in surgery, maybe 500cc or so if the docs were pretty dry surgeons-- we don't know what happened in the OR.

The uncle (who was not there in the ICU, and is giving a layperson's interpretation) states they suctioned 2000cc out of either her airway, or stomach, or both. That may, or may not have all been blood-- we don't know. We don't really know what her actual total blood loss was, but we can make an educated guess based on what info has been given to the public.

Presumably, her fluid hydration status immediately postop, and BP, were OK before the hemorrhage episode, according to reports that she was sitting up, talking, popsicle, etc. So my very rough estimates, from what we can piece together, is that she may have had a 25-30% estimated blood loss in the acute hemorrhage episode, or possibly much more, depending on unknown factors (which are certainly in the medical record).

The other question I have is when did she arrest, relative to the acute hemorrhage, and transfusions. Did it happen so fast they couldn't retrun to the OR? Were there no OR's, or not enough staff available? They are a level one trauma center, so they have a crew and an OR ready all the time-- but was it in use? What time of day was all this going on? Did she have any evidence of bleeding disorder? Etc. So many questions....that I will probably never get an answer to!
Click to expand...

Another excellent post, imo, KZ. Really bringing home how it is impossible for anyone to lay blame or draw ANY conclusions based on the limited information and understanding the general public will ever have of the actual situation and why it's so important not to rush to judgment. Thanks!
 
nursebeeme said:
Has anyone talked about why they cannot put in the peg tube? Also vitamins are most likely a banana bag (mvi in d5 our 10)
Click to expand...

We don't know how long her arrest was, or what happened subsequently to that. She may have infarcted her gut. Ishemic necrosis. Etc. She hasn't had bowel sounds for weeks, per Dr. Fiori's report, so I'm thinking completely nonfunctional gut. And she has been on pressors for weeks, and still pretty hypotensive. That doesn't equal good perfusion to the gut.

Herat is right-- tissue paper thin areas, compromised areas of circulation with necrosis, (even if she doesn't have ischemic necrosis from the arrest), ready to perforate. Proliferation of gut flora. Etc.

Really, really, really not a candidate for a PEG. IMO.
 
mck16 said:
Okay now this made me cry.
Click to expand...

I didn't recount the baby's life and death to make anyone cry. I'm so sorry. The point was that her little tiny life had an impact on at least one of her nurses which has persisted many years after she left this earth, because of the love her parents showed her, and which we as a staff were able to show to all three of them.

We had so many very sad suspected or confirmed abused children to care for at about the same time ( one child came in after her parents let her fall out the open door of a moving car and then ran over her- the Pampers she had been wearing still had tire tracks on it and was taken as evidence of a crime- I can't ever forget that little baby) while this one child was especially so utterly wanted and loved by her parents.

The baby never seemed to be in any pain at all, and her parents had actually been told to expect her to pass away months before she did. They were thankful for the extra time with her, so it was an amazing room to step into. They had a marvelous church and community support system in place..

I remember the days of her living and of loving her, and bonding with her parents and them with us, not the moments of her very quiet and peaceful passing from a world that was not conducive to her survival.

As Dale Evans once wrote about her deceased baby, this child and others are definitely " Angels, Unaware".
God bless the children, all of them.
 
It took me FOREVER to catch up to you people.

I am overweight and I recently had a c-section. Because of my weight, post surgical dvt was a concern, so they gave me prophylactic heparin.

That would explain how she bled out so fast.... jmo.
 
truecrimejunkie said:
So horrified by this story! I haven't been able to get it out of my thoughts. I apologize if this link has already been posted but I came across a similar situation 10 yrs ago.
http://www.ksl.com/?nid=148&sid=82028
Click to expand...

Looks like the parents were told the ventilator would be disconnected in 24 hours after two doctors independently determined Jesse was brain-dead, then parents went for restraining order. His heart stopped beating two months later. The social security death index records Jesse's death date as when his heart stopped beating. Same with the teenage girl in Florida whose parents brought her home in 1994 after she was declared brain dead, and her heart stopped four months later. SS death index is not the same though, as a death certificate.
 
Tulessa said:
I'm just praying that the family can accept the reality. It sucks to be in their position. My heart goes out to them. The lawyers? Not so much. :( Like Git said..........walk in their shoes. :(
Click to expand...

I found this sad website where mothers have had to chose to terminate a pregnancy where there is something wrong with the fetus. I want to quote what one mother's grandmother told her.

http://www.circleofmoms.com/motherh...ate-a-pregnancy-or-remove-life-support-219994

When I called my Grandma she told me something that was very helpful to me.

"In order for there to be good in the world there is also evil. God is not responsible for all the pain and suffering in our lives. Sometimes his gift to us is the strength to make the awful choice to send our child to be forever in his care."
Click to expand...
 
K_Z said:
We don't know how long her arrest was, or what happened subsequently to that. She may have infarcted her gut. Ishemic necrosis. Etc. She hasn't had bowel sounds for weeks, per Dr. Fiori's report, so I'm thinking completely nonfunctional gut. And she has been on pressors for weeks, and still pretty hypotensive. That doesn't equal good perfusion to the gut.



Herat is right-- tissue paper thin areas, compromised areas of circulation with necrosis, (even if she doesn't have ischemic necrosis from the arrest), ready to perforate. Proliferation of gut flora. Etc.



Really, really, really not a candidate for a PEG. IMO.
Click to expand...


Does this mean she will soon be septic ?


Sent from my iPhone using Tapatalk
 
Also, that press release where CHO asked the family to allow them to share more details, plus the ICU admit leads me to believe it was an incredibly risky surgery with many complicating factors, and that the family knew the outcome could be pretty bad. I mean, I still have all the sympathy in the world for them, but I think it's patently unfair to consider malpractice on the part of CHO.
 
duchessofdork said:
It took me FOREVER to catch up to you people.

I am overweight and I recently had a c-section. Because of my weight, post surgical dvt was a concern, so they gave me prophylactic heparin.

That would explain how she bled out so fast.... jmo.
Click to expand...

Congrats on your new baby, :). I hope you are both doing well !!!

I have questioned whether she might have been given ASA ( Aspirin) containing pain meds. or plain Aspirin for her throat discomfort at home for a period of time prior to surgery.

Often, when a pre-surgical assessment form is filled out, the patient ( or parent) remembers prescription meds., but forgets to list OTC meds.

Aspirin could anti-coag. her big time. I wish they had checked for the presence of it in a serum tox. screen, but I am doubtful it was done... I would have thought of it because nurses know from asking about OTCs that parents give teens Aspirin, or let them take their own.. but doctors don't usually think about this in a crisis situation like frank hemorrhage.... IMO...
 
momrids6 said:
Angela Clemente found a retired Emergency Med doc from San Jose to "take the case," Dr David Hammons of Kaiser Hospital

http://media.nbcbayarea.com/documents/JahiDeclaration.pdf
Click to expand...

I tried to read all of the PDF forms.. He can be retired but still retains a current CA Medical License, correct?
Just wanting clarification for those who might think otherwise...

I wonder if the grandmother knows this doctor? It was stated earlier that she worked as an LVN for Kaiser. ( I know there are or were Kaiser facilities all over CA, but still, they could have crossed paths at some point ..)
 
duchessofdork said:
Also, that press release where CHO asked the family to allow them to share more details, plus the ICU admit leads me to believe it was an incredibly risky surgery with many complicating factors, and that the family knew the outcome could be pretty bad. I mean, I still have all the sympathy in the world for them, but I think it's patently unfair to consider malpractice on the part of CHO.
Click to expand...


Unfair to even consider?

I'm going to have to disagree since we really have very limited facts. Except a child bled to death in an ICU the same day she had surgery.

I also believe... despite her one night allegedly previously scheduled, ICU stay, her surgery was not inordinately complicated or risky. IMO.






Sent from my iPhone using Tapatalk
 
Status
Not open for further replies.

DNASolves

Who is Escambia County John Doe (1989)?

Members online

... and 130 more.
Total: 2,112 (members: 131, guests: 1,981)

Online statistics

Members online
131
Guests online
1,981
Total visitors
2,112
Totals may include hidden visitors.

Forum statistics

Threads
599,447
Messages
18,095,546
Members
230,861
Latest member
jusslikeme
Back
Top