Family wants to keep life support for girl brain dead after tonsil surgery #5

[J1981]

I was curious as to whether 9 minutes off of ventilatory assist is the norm. If a person was not brain dead, but did not have spontaneous respiration, the lack of oxygen for 9 minutes would ensure brain death. If I remember my biology correctly, the brain cannot live beyond 6 minutes without oxygen.

ETA: did a look up on procedure to determine brain death and patients are left off respiratory support for 8 to 10 minutes or until the CO2 level rises to a cutoff point.

^^i was thinking the same thing. Pretend she wasn't brain dead, wouldn't she be after being tested for it? That would horrify me of that were my daughter, but I do realize this was the 3rd test.

Eta: I see others' responses to this same question and understand now! I do also completely trust Dr. Fisher.

 

[K_Z]

I hope the reports are wrong, then, that he examined her and unplugged her for nine minutes. If he did, then... :no:

Dr. Fisher did the apnea test in accordance with every single neuro and pediatric standard. He removed her for 8+ min. He observed AND MEASURED by arterial blood gas her CO2 rise from the low 40's to the mid 70's. (You cannot use end tidal CO2 measurements for apnea testing, for obvious reasons.)

Human bodies breathe not so much on the hypoxic drive (low oxygen), as they do on the hypercarbic physiologic drive (high CO2). This hypercarbic drive to breathe is mediated in the brain.

When the brain dies, the hypercarbic physiologic drive to breathe is gone, producing no agonal or gasping respirations of any kind, and no weak or "low effort" breaths (hypopnea). In short, there is no physiologic respiratory drive at all if the the patient fails the apnea test. This test must be done in the complete absence of any medications that could depress respiratory drive.

I posted before that the terminology can be confusing-- a patient who "fails" the apnea test may be interpreted by lay people as "breathing a lot without pauses", but the true meaning is that the patient had no response to the physiologic challenge of apnea.

 

[Leilei]

1. If such a facility existed with an intensive care unit who would treat a brain dead patient with a death certificate, wouldn't that facility have contacted CHO and proceeded with the transfer as CHO requested nearly 3 weeks ago?

2. I don't for one minute believe she is going to NB in Medford, NY. Dolan wants to keep that heart beating for as long as possible - years if he could!!!
The lack of medical expertise and questionable personnel and equipment puts him at risk of losing her heartbeat by completely inept care.

Think of it- Dolan would want to keep her heart beating for years, if possible, while her skin breaks open and oozes, while she has fecal impactions, while stool leaks out through and infects her broken skin, while her lungs become infected with poor trach hygiene and overly aggressive tube feedings. At some point it might become abuse of human remains (corpse). And Uncle Omari seems like he'll be going along for the ride, too.

BBM. They state that she will be treated with dignity. There is NOTHING dignified about this. That is hell on earth, in my opinion. Putting a child's body, anyone's body, through that is just nightmarish.

Good morning, everyone. Trying to catch up on everything, and trying to stay warm.

 

[Karmady]

^^i was thinking the same thing. Pretend she wasn't brain dead, wouldn't she be after being tested for it? That would horrify me of that were my daughter, but I do realize this was the 3rd test.

jmo, but this is how nasty rumors get started. Look at the report. She was 100% oxygenated and her levels were closely monitoried t/o the test. Do you (general you) really think the court appointed expert pediatric neurologist from Stanford is going to cause brain damage while testing for it for submission to the court. No way. It was all per protocol. I'm 1000% sure. Don't you think someone besides a poster at WS would have noticed this grave error before now were it otherwise. jmo

 

[jjenny]

I hope the reports are wrong, then, that he examined her and unplugged her for nine minutes. If he did, then... :no:

Dr. Fisher was appointed by the court to examine her. He is an expert in the field. He is a pediatric neurologist.
I have no doubt whatseover all the tests were done according to established protocol. Also she was already brain dead for a while by the time he examined her. She was first diagnosed brain dead on December 11. Dr. Fisher examined her on December 23.

"Dec. 23: Grillo extends an order keeping Jahi on a ventilator through the evening of Dec. 30. A court-appointed pediatric neurologist, Dr. Paul Fisher of Lucile Packard Children's Hospital, examines Jahi, looking for any signs of electrical activity or blood flow in the brain."

http://www.mercurynews.com/nation-w...cmath-timeline-events-case-brain-dead-oakland

 

[BeginnersLuck]

In the press conference last night, Dolan stated that the laws applied to brain death arose from cases of gunshot victims. (not his exact words)

There have been so many things that have been stated that are not true, throughout this situation. These misconceptions or lies are very concerning to me due to how it may affect societies view toward the medical community. Also, as Dolan stated, he would be talking to those that he personally knows in government to address these laws for change.

There are special interest groups that wish to overturn these laws that have been enacted, for many different reasons. These special interest groups are large in number and want to change what our laws have defined as "life" to what their personal or what they state, their religious beliefs are. Usually these arguments are seen in cases concerning conception of life, but due to this case, it is now become apparent that they are also applying these arguments in cases of what defines death.

I feel it is important to address the myths that have circulated because of the high media attention this case has received.

First, I want to ask anyone if they have run across anything in literature that has suggested that the laws concerning "brain death" have anything to do with gunshot wound victims?

Second, when I began to research this morning, I ran across this lengthy document on "Protecting Human Subjects". It is a document that considered as part of the UDDA.
http://bioethics.georgetown.edu/pcbe/reports/past_commissions/Protecting_Human_Subjects.pdf

I'm posting a link before I go off to research this while I get some coffee in me.

http://bioethics.georgetown.edu/pcbe/reports/past_commissions/Protecting_Human_Subjects.pdf

More good links are here:

President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research - Wikipedia, the free encyclopedia

Links here as well

Uniform Determination of Death Act - Wikipedia, the free encyclopedia

The Uniform Determination of Death Act (UDDA) is a draft state law that was approved for the United States in 1981 by the National Conference of Commissioners on Uniform State Laws, in cooperation with the American Medical Association, the American Bar Association, and the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. The act has since been adopted by most US states and is intended "to provide a comprehensive and medically sound basis for determining death in all situations".[1]

I don't know if there is any pertinent information as it would apply to Jahi's case in any of the documents included at the links. If someone has researched these already or has knowledge, I was kind of hoping that if I posted the links, before reading everything myself, they could chime in on the subject.

 

[Isabelle]

I wondered about that myself. Ten minutes is the standard but the test is aborted and the patient is connected back to the ventilator if the saturation levels drop too bad.
The patient is pre-oxygenated for a while before the test to make it safer and according to this http://www.surgicalcriticalcare.net/Guidelines/brain_death_determination_2009.pdf
the patient is not kept completely without oxygen during the test.




But there are complications so it is not something that most physicians would do lightly I think.
See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824942/


http://www.ems1.com/airway-manage b...eic-oxygenation-Everything-you-know-is-wrong/
(Not a scientific article and not about the apnea test but explains what apneic diffusion oxygenation means and how long it takes to desaturate after preoxygenation)

The article re: complications of the apnea test originates from Havana, Cuba. My mom's birthplace!

 

[mck16]

BBM. They state that she will be treated with dignity. There is NOTHING dignified about this. That is hell on earth, in my opinion. Putting a child's body, anyone's body, through that is just nightmarish.

Good morning, everyone. Trying to catch up on everything, and trying to stay warm.

OT-- I am too. No moisture here, but temps in the teens. My feet are frozen. And I saw my dog this a.m. eating a RAT. Kind of goes along with the bizarre nature of the day. If you know what I mean.

 

[Elley Mae]

At a news conference Sunday night, Omari Sealey, the girl's uncle, and family attorney Christopher Dolan declined to say where the girl was being taken, citing privacy and security concerns.

http://www.sfgate.com/health/article/Brain-dead-Jahi-McMath-released-to-her-family-5116262.php

 

[Karmady]

In the press conference last night, Dolan stated that the laws applied to brain death arose from cases of gunshot victims. (not his exact words)

There have been so many things that have been stated that are not true, throughout this situation. These misconceptions or lies are very concerning to me due to how it may affect societies view toward the medical community. Also, as Dolan stated, he would be talking to those that he personally knows in government to address these laws for change.

There are special interest groups that wish to overturn these laws that have been enacted, for many different reasons. These special interest groups are large in number and want to change what our laws have defined as "life" to what their personal or what they state, their religious beliefs are. Usually these arguments are seen in cases concerning conception of life, but due to this case, it is now become apparent that they are also applying these arguments in cases of what defines death.

I feel it is important to address the myths that have circulated because of the high media attention this case has received.

First, I want to ask anyone if they have run across anything in literature that has suggested that the laws concerning "brain death" have anything to do with gunshot wound victims?

Second, when I began to research this morning, I ran across this lengthy document on "Protecting Human Subjects". It is a document that considered as part of the UDDA.
http://bioethics.georgetown.edu/pcbe/reports/past_commissions/Protecting_Human_Subjects.pdf

I'm posting a link before I go off to research this while I get some coffee in me.

http://bioethics.georgetown.edu/pcbe/reports/past_commissions/Protecting_Human_Subjects.pdf

More good links are here:

President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research - Wikipedia, the free encyclopedia

Links here as well

Uniform Determination of Death Act - Wikipedia, the free encyclopedia



I don't know if there is any pertinent information as it would apply to Jahi's case in any of the documents included at the links. If someone has researched these already or has knowledge, I was kind of hoping that if I posted the links, before reading everything myself, they could chime in on the subject.

It wasn't so much that he related it to gun shot wounds, per se. Instead, it was related to determinations of death for purposes of bringing charges for murder. One would expect that a large number of such cases would arise in the context of brain death ensuing from a homicidal gun shot wound to the head. jmo

 

[Donjeta]

In the press conference last night, Dolan stated that the laws applied to brain death arose from cases of gunshot victims. (not his exact words)

In one of these pressers (please don't ask me to look for a link) I heard him say something to the effect that the brain death laws were created so that the police could start homicide investigations before the victims were actually dead. It didn't make much sense to me as the police are able to start attempted homicide investigations if the victim is still alive and charge the perp for homicide later if they die.

I didn't look at any of the links yet but maybe Dolan had read that gunshot victims are often good donors from an organ transplant perspective as many of them are young and healthy, apart from being brain dead.

 

[K_Z]

I'd like to share one way it is possible to "adjust" the interpretation of what the family of Jahi McMath is doing with their efforts at sustaining her physical body in the presence of absolute brain death. This is what I think the mediation agreement is.

The coroner always has the authority and leeway to allow families to perform various cultural and religious/ personal rituals with the bodies of their loved ones, as long as not prohibited by law or the situation. The coroner also is the authority to allow transport of dead bodies by family members, under certain circumstances, and in accordance with laws.

It helps me a lot to "frame" what the family is doing in this manner-- as "personal religious and cultural rituals".

In that manner, the coroner has perhaps decided to view the potential trach and feeding tube as "religious rituals" performed on the dead for the benefit of the family, rather than desecrating a corpse. I think the coroner has magnanimously bestowed the gift of patience and time on this family, to perform whatever rituals and transportation they discussed. To be sure, none of the "things" done to Jahi Mc Math's body at this point will be considered medical care.

I believe that if any licensed health care providers are involved with inserting tubes and whatnot, they will claim that they performed these as "religious rituals" that were discussed with the coroner, and approved. I don't believe any health care providers will be charged with anything. They are too smart for that. Presumably any HC providers involved have considered the impact on their reputation, insurance, and career future, and still wish to participate in these "religious and cultural rituals" on Jahi Mc Math's body.

It would help a lot, IMO, if the NB place in NY would also consider and market themselves a cultural and religious "institution", instead of pretending that they are some kind of licensed authentic health care facility (instead of the truth that they are a nonprofit that rents physical space to consolidate services). They are offering to provide a temporary place for the family to move and store the body, while they continue to carry out their version of personal, religious, and cultural rituals on the body of their loved one.

It maybe sounds a bit blunt to put it this way, but it really fits with state laws, and helps to reframe some of the astonishment and other extreme emotions some of us are feeling about what the family is doing.

 

[jjenny]

It wasn't so much that he related it to gun shot wounds, per se. Instead, it was related to determinations of death for purposes of bringing charges for murder. One would expect that a large number of such cases would arise in the context of brain death ensuing from a homicidal gun shot wound to the head. jmo

I can easily envision that an accused killer would argue that his victim is alive and not dead, even if the victim is brain dead.

 

[missy_g]

Since she is being pumped full of oxygen is she going to decompose?

Also isn't the lack of brain activity damaging her brain?

I really wonder what the true motives of the parents are. Even if she would happen to "wake up" she would probably have no quality of life and now, she has no quality of life.

I haven't looked into this because it bothers me so much. I went as far as asking my mom what she would do if we were in the same situation. She said she would have let me go when the doctor officially pronounced me brain dead.

This has become a fiasco. I don't think Jahi would want to be seen like this. IMO her parents have dragged it out WAY too long. They should have taken her into their custody a long time ago. I also wonder what kind of lawsuits are going to come from this?

JMO...

 

[K_Z]

OT-- I am too. No moisture here, but temps in the teens. My feet are frozen. And I saw my dog this a.m. eating a RAT. Kind of goes along with the bizarre nature of the day. If you know what I mean.

Off topic.

Minus 29 here this morning, with 10 mph winds. That's a -50+ wind chill. Gonna crank up the thermostat and pour more hot coffee!

Gonna do the banana test later-- kids put a banana out to freeze last night. We do it every year at least once. You can drive a nail into a board with the frozen banana as a hammer!

 

[jjenny]

The brain is already damaged beyond repair. If the heart still beats the body shouldn't be decomposing.

 

[BetteDavisEyes]

How sick for the mother to subject this to her other children.

I can imagine the other siblings would be questioning why their sister is not waking up.

I can't imagine living in that two bedroom apartment and seeing a dead corpse being hooked up to a ventilator.

it's extremely morbid and grotesque.

IMo

It's positively ghoulish. :moo:

 

[K_Z]

Since she is being pumped full of oxygen is she going to decompose?

Also isn't the lack of brain activity damaging her brain?I really wonder what the true motives of the parents are. Even if she would happen to "wake up" she would probably have no quality of life and now, she has no quality of life.

I haven't looked into this because it bothers me so much. I went as far as asking my mom what she would do if we were in the same situation. She said she would have let me go when the doctor officially pronounced me brain dead.

This has become a fiasco. I don't think Jahi would want to be seen like this. IMO her parents have dragged it out WAY too long. They should have taken her into their custody a long time ago. I also wonder what kind of lawsuits are going to come from this?

JMO...

BBM.

I'm sorry to be so blunt, but Jahi has been brain dead 24 days, at least. The brain begins to autolyse (soften, liquefy, and coagulate) in the first couple days. She has, in effect, no brain.

While normal brain tissue is firm, a brain that has been dead shows progressive autolysis, a form of biological self-destruction. “It will almost be like soup,” Dr. Harry Vinters, chief of neuropathology at UCLA, recently explained to me. He is the co-author of a major textbook on the pathology of the brain and has performed almost a hundred autopsies on the brain-dead. “It really depends on how long they have been on the ventilator. If they have been on the ventilator for two days, then the brain is grey and softened. But if, for example, a family has had difficulty deciding what they want to do and the patient has been kept on the ventilator for two to three weeks, then there’s tremendous autolysis. The brain gets very swollen, soft, and mushy.” The nerve tissue can become so friable that fragments of brain from the head will break off and float down the spinal column. “Sometimes I’ll be looking at a slide of the spinal cord,” says Vinters, “and I’ll see fragments of cerebellum floating around in the specimen.”

http://www.vqronline.org/articles/2005/fall/chen-dead-enough/

 

[BeginnersLuck]

If moved anywhere, IMO, the best place for Jahi is home. I'm not buying the MSM reporting as of yet though. I'm wondering if it was a reporting error.

They have been very specific that they want a feeding tube and other care for her to be kept on the vent for as long as possible.

I also want to point out, because the subject has come up, that the entire Jewish religion does not believe that brain death is not death. It is noted in the article linked below, along with the court findings. I also have been unable to find any other religion that does not consider brain death, death.

http://www.freerepublic.com/focus/f-news/2128098/posts

IMO, the religious exclusion that Dolan is arguing has no bearing whatsoever with the family as far as the courts are concerned. At least it shouldn't. IMO

 

[popsicle]

Natalie Neysa Alund ‏@nataliealund 2m
"She's in very bad shape," family attorney @cbdlaw says of #JahiMcMath's condition today http://www.insidebayarea.com/news/ci_24853880/jahi-mcmath-brain-dead-girl-moved-undisclosed-care … @insidebayarea @3rdERH