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

[Isabelle]

I would imagine her stomach is a massive ulcerated crater from initial stress of cardiac arrest and prolonged ventilator use. Wouldn't surprise me if stomach and intestines ruptured/perforated. Wonder how long it would take for her airway to decompose to the point to not be able to tolerate the endotracheal tube. Would think she will suffer massive pneumothoraces before that happens. Certainly she is requiring higher and higher vent pressures. Very sad.

 

[Herat]

Isn't it possible that this delay of autopsy actually HELP the hospital?

.

It's certainly possible that the month-long delay in investigating the anatomic reason for the bleeding will mean very little definitive information is available one way or another. This may benefit CHO or it may benefit the family. I think it would probably benefit CHO, but I don't know for sure.

The autopsy will just list all the findings found at the time of autopsy. There may be some comment about the age of injuries, but I think the coroner will let the medical experts determine the significance of the findings.

 

[Morag]

Maybe insurance. But, then I have heard she didn't have any insurance. Just a thought.

It occurred to me that there might be insurance implications. But, then, I couldn't imagine that any doctor would do a more dangerous procedure just because of insurance. And surely the extensive nature of this surgery was more dangerous than each of the procedures done separately over a period of time. More incisions = more bleeding.

I rather think that the hospital's insurance carrier will settle with the family rather than go to trial, so we may never know what really happened. Unlike some, I don't believe that the family force-fed her or suctioned her to the point that she hemmorhaged.

 

[kaki]

Omg...just heard that JVM Is asking if its too early to "pull the plug". She will be discussing this tonight with a "one in a million chance survivor"! Tune in tonight....ugh!

 

[Karmady]

Heheheh

Can I just say this warms the cockles of my black evil heart!

Herat, I confirmed with an experienced trial attorney who handles death cases all the time that the uncle cannot recover absent some special relationship. If her parents were deceased and he was her guardian, for example.

Doesn't mean the mom can't throw him a mill or two, though. I'm sure he's counting on it. jmo

 

[Donjeta]

The term "brain dead" can be misleading, said Cynda Hylton Rushton, professor of clinical ethics at Johns Hopkins University, because it sounds like a person really isn't dead. If someone dies of a heart attack, doctors don't say they're "cardiovascular dead," for example.
Doctors should be more transparent about the finality of brain death, said Arthur Caplan, director of the Division of Medical Ethics at NYU Langone Medical Center.
Terms such as "mechanical support" or "artificial machine support" should be used to refer to sustaining the functioning of a brain dead person, he said. "No one wants to take away 'life support.'"
"Dead is dead," agreed neurologist Dr. Richard Senelick in The Atlantic. "Brain death isn't a different type of death, and patients who meet the criteria of brain death are legally dead."
The American Academy of Neurology updated its brain death guidelines for adults in 2010, asking doctors to follow a step-by-step checklist of some 25 tests.

All criteria in the guidelines must be met before a person can be considered brain dead; however, the legal definition of brain death can vary from state to state.
The American Academy of Pediatrics added to those guidelines for children. These childrens' guidelines advise there should be two attending physicians involved in the care of the child, and they should make separate examinations separated by an observation period.
Both must determine the child is brain dead. In making that ruling, the doctors use the currently established criteria; there must not be a conflict of interest.
"No one who has met the criteria for brain death has ever survived," Senelick said. "No one."

http://edition.cnn.com/2014/01/06/health/brain-dead-basics/index.html

To experts, the case has raised no novel legal issues, but it has created a painful spectacle.

Arthur Caplan, director of the division of medical ethics at New York University Langone Medical Center, said the Jahi case could compel other families to "ultimately say, 'I'd like to take this body home and wait for a miracle.' That would be a public policy of disrespect for dead bodies."

"The ability to get clear about brain death has been a real obstacle," he said. "This hasn't helped at all."

http://www.latimes.com/local/lanow/la-me-ln-jahi-mcmath-time-limited-20140107,0,5429201.story

There are two major ways that Jahi's brain death -- likely caused by catastrophic bleeding, brain swelling and heart attack, based on family reports -- damages the organs, according to Slatkin and other physicians.

One is the trauma of the initial injury, called a "sympathetic storm," which triggers a massive stress response -- flooding the bloodstream with chemicals and likely damaging the hypothalamus, a small area at the top of the brain stem that regulates body temperature, appetite and the release of many important hormones.

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.

Even heroic efforts to sustain her, such as a ventilator, can backfire, said Slatkin.

"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."

Every cell in the body is programmed to die, he noted. But the assault of stress hormones, immune dysfunction and massive inflammation accelerates death, he said.

http://www.mercurynews.com/science/ci_24857783/jahi-mcmath-brain-dead-teens-body-may-be?source=pkg

The bodies of brain dead patients kept on ventilators gradually deteriorate, eventually causing blood pressure to plummet and the heart to stop, said Dr. Paul Vespa, director of neurocritical care at the University of California, Los Angeles, who has no role in McMath's care. The process usually takes only days but can sometimes continue for months, medical experts say.
"The bodies are really in an artificial state. It requires a great deal of manipulation in order to keep the circulation going," Vespa said.
Brain-dead people may look like they're sleeping, he added, but it's "an illusion based on advanced medical techniques."

http://www.ktvu.com/news/news/local/experts-clock-ticking-ca-brain-dead-teen/ncdzh/

http://www.washingtonpost.com/blogs...overnment-hospital-or-family-decide-her-fate/

We’ve become complacent about medical procedures, but none is without risk. The most common postoperative complication from a tonsillectomy is bleeding, and an August 2013 study found that one patient in anywhere from 1,732 to 170,000 will die as a result.
Pretty rare.
For the mother who’s lost her child, it’s devastating.
And that leads to the “mom guilt” issue, which I suspected might be driving Winkfield’s determination. ”Before the surgery she said, ‘I am scared Mommy,’” Winkfield wrote in her letter. “‘ I said, ‘Why Jahi?’ She said, ‘I am afraid I won’t wake up.’ I told her it was going to be fine, it was a simple procedure. I should have listened to her.”

...

To say it’s a tough decision to remove life support measures like a ventilator for patients like Schiavo or Quinlan who have some brainstem activity but are not brain dead is an understatement. People should discuss with family members what they would want done in such a situation. Too often, it ends up played out in the courts.
But someone who’s been declared brain dead — like Jahi was almost three weeks ago — is medically and legally dead. Physician Heidi Flori graphically described the condition of Jahi’s body in a court document.
Yet the government is getting blamed. A press release from the Schiavo Network refers to Jahi as “only the latest example of government and hospital boards taking private medical decisions away from families.” Bobby Schindler, the network’s executive director and the brother of the late Terri Schiavo, says, “Given our current medical environment, with more and more emphasis on government, we all have reason to worry.”

 

[otto]

AC did a pretty decent job of reporting on this.

For some reason Allyson Scerri really annoys me. She's never seen Jahi, how does she know what Jahi is like? And I think that people might mistakenly take her statements for the opinions of a medical professiona because she gets introduced as the head of a rehab facility. For her information, Jahi's heart is not beating strong, the doctor at the ICU who actually knows about this stuff said that she can't keep up her blood pressure.

The fact that she's saying that a person with a death certificate is a true survivor makes me think that some of these people think brain death is no big deal because they don't actually use their brain before they open their mouths.

Nice play with emotions there, from the atty. If you're against us it could be the doctors killing off your child one day.

Dr. Fiori wrote she has an increase in muscle contractions as a result of lacking nervous regulation.

When this has to be said on national TV, you know something went wrong somewhere.

"DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, you know, her prognosis is she has been declared brain dead and, you know, that's an irreversible condition."

 

[gitana1]

http://www.nbcbayarea.com/news/loca...ul-For-Transfer-Critics-Abound-238866771.html

I'm pretty shocked where we are as a nation. People "lashing out" at a grieving family for refusing to accept their little girl's death? The lack of compassion, the virulent rage against such sad people, rage so intense that some cannot restrain themselves from spending hours, even days of their own lives monitoring and branding and questioning and hating these sad people.

It astounds me.

Jahi's body has left the hospital. The hospital and it's staff are no longer part of the "drama". I hope everyone can leave this poor family alone to spend the last moments her heart has to beat, giving her their love and saying goodbye.

Instead of venting such simmering rage by insisting on surveilling this "awful" family, hungrily hoping reporters will camp out to follow them around, calling for their attorney to be disciplined by the state bar and their surviving children to be monitored by the government, perhaps this family can now be left in peace?

That is my prayer to God today.

 

[Donjeta]

Nancy Grace ‏@NancyGraceHLN 17 h
I guess this hospital never heard about Lazarus coming back from the dead #JahiMcMath

Idiot. Lazarus came back after four days in the grave. God needed no ventilator for that miracle.

What is she suggesting? Should all hospitals keep all the dead on machines on the off chance that they might come back from the dead?

 

[Shecky]

Nancy Grace ‏@NancyGraceHLN 17 h
I guess this hospital never heard about Lazarus coming back from the dead #JahiMcMath

Idiot. Lazarus came back after four days in the grave. God needed no ventilator for that miracle.

What is she suggesting? Should all hospitals keep all the dead on machines on the off chance that they might come back from the dead?

Honestly though, where do we draw the line? Could a skeleton regrow all its organs and tissue and come back to life via a real God given miracle? Who's to say what is possible if we're entertaining the idea of the supernatural and miraculous.

 

[newmrsc]

I'm pretty shocked where we are as a nation. People "lashing out" at a grieving family for refusing to accept their little girl's death? The lack of compassion, the virulent rage against such sad people, rage so intense that some cannot restrain themselves from spending hours, even days of their own lives monitoring and branding and questioning and hating these sad people.

It astounds me.

Jahi's body has left the hospital. The hospital and it's staff are no longer paiftar the "drama". I hope everyone can leave this poor family alone to spend the last moments her heart has to beat, giving her their love and saying goodbye.

Instead of venting such simmering rage by insisting on surveilling this "awful" family, hungrily hoping reporters will camp out to follow them around, calling for their attorney to be disciplined by the state bar and their surviving children to be monitored by the government, perhaps this family can now be left in peace?

That is my prayer to God today.

I am very sad for this family. Their loss is one that no one wants to go through, one that few of us can imagine. Their pain is real and I have all the compassion in the world for their loss. However, they have invited public scrutiny by calling for donations - the support of the public - and by inviting the justice system into their lives. They have asked for the government to intervene, and that is something that we all have an interest in. As a California resident, I am particularly interested in this case and the possible ramifications if enough public support is gathered based on misinformation that is being perpetuated by an attorney. And for me personally, as a member of the California Bar, I have an interest in what other professionals do. In fact, we have a duty to report others for misconduct.

We shouldn't be hateful, and I know there are lots of examples of that out there. But honestly, read any news story - there are hateful responses to anything, no matter how innocuous. Such is the nature of internet anonymity. But I just think we also need to remember here that misinformation is being spread and they are asking the public to do something - to support an unheard of precedent in law, to make decisions that scare many of us in terms of the future of medico-legal issues, and to donate money to their cause. There are many who have encountered these situations with grace and acceptance and have quietly mourned their loss, but this family decided to make it a public battle, and in doing so have also invited scorn upon CHO, whose actions cannot yet be judged. Standing up for a hospital aimed at doing children's work and who is not yet legally responsible is, IMO, an important task.

Everyone is invited to feel differently, this is MOO, my :twocents:

 

[Elley Mae]

Time is limited for brain-dead teen, experts say

http://www.latimes.com/local/lanow/...imited-20140107,0,5429201.story#axzz2phME3MMQ

 

[nomoresorrow]

Thank you!

I'm pretty shocked where we are as a nation. People "lashing out" at a grieving family for refusing to accept their little girl's death? The lack of compassion, the virulent rage against such sad people, rage so intense that some cannot restrain themselves from spending hours, even days of their own lives monitoring and branding and questioning and hating these sad people.

It astounds me.

Jahi's body has left the hospital. The hospital and it's staff are no longer paiftar the "drama". I hope everyone can leave this poor family alone to spend the last moments her heart has to beat, giving her their love and saying goodbye.

Instead of venting such simmering rage by insisting on surveilling this "awful" family, hungrily hoping reporters will camp out to follow them around, calling for their attorney to be disciplined by the state bar and their surviving children to be monitored by the government, perhaps this family can now be left in peace?

That is my prayer to God today.

Thank you Gitana for wording so eloquently what I could not find the words to say. I have been in sheer disbelief at the reactions from those who disagree with this family's choice(s) regarding Jahi and I cannot imagine, for one moment, how anyone even thinks this is any of thier business. It's not their child and/or their loved one. Do what you (people in general) want when/if, god forbid, you're ever in this situation, but stay the he$$ out of other people's business when it comes to them making a different decision for their own loved one. I have seen a lot but the reaction/response from posters and others regarding Jahi's family just sickens me. JMO ~

 

[Elley Mae]

Jahi McMath arrives at long-term care facility, says family

http://www.cbsnews.com/news/jahi-mcmath-arrives-at-long-term-care-facility/

"There is no evidence to anyone that suggests Jahi McMath has any chance of recovering any brain function,” Douglas Straus, an attorney for Children’s Hospital, told CBS News. “That is a sad, but undisputed fact."

 

[otto]

Isn't it possible that this delay of autopsy actually HELP the hospital? If it's true that the longer she is on a ventilator the harder it will be to determine COD, that could favor the hospital and not the family.

How can the family determine that the hospital was the "cause" of her death if an autopsy results show something that happened AFTER she left the facility?

They likely will say that the coroner and the hospital are all part of some conspiracy if that autopsy doesn't show the COD as being something directly related to that surgery.

:facepalm:

With that said...when would the autopsy "death" time equal? And would the COD be based on her Dec 12th death? Or her date of "death" after her parents "approve"?

What a damn nightmre. The more the family can muddy the waters with the legaleze of it all, the better off they believe they will be.

The child was declared dead on Dec 12. If the child had a brain injury, but was still alive, there could have been a large financial settlement. I think another case was linked where a child suffered brain damage due to post-surgical complications. The award was something like $4.2 million, which would of course be for the lifetime care of that child. In this case, the child is deceased and the date that the child died will not be changed. We can't die twice. I think the maximum amount of award is $250,000, but the uncle called that "chump change" and has his eye on the $30 million option. It's possible that dragging this out is related to trying to establish grounds for getting access to the millions. I'm sure that the lawyer will attempt to change the day that the child died as that may open the door for a larger award, but it's pretty much impossible to argue with medical science regarding brain death. The family might want to use prolonged pain and suffering in relation to the death of the child as a basis for financial compensation, but it is the family that has prolonged this. Religion has been mentioned by the lawyer, but there is nothing in the Baptist religion that conflicts with accepting death and burying the dead.

Regarding the cause of death, I think we already know that she died as a result of the known, post-surgery complication of bleeding. After excessive blood loss, she suffered a heart attack. That resulted in a lack of oxygen to the brain, and ultimately brain death. The question is what happened when the family was using the suction tube, because that seems to be the moment that the excessive blood loss occurred and the situation became critical.

 

[PoirotryInMotion]

Ran across this post by commenter "Ugi" yesterday, explaining the concept of brain death. While I'm sure the analogy breaks down at some point (esp. in medical minds), I think it might help lay persons understand:

https://www.dropbox.com/s/azfz50q6lpxcm05/driverless car quote.png

"The car is still running, but the driver stepped out weeks ago."

 

[gitana1]

I am very sad for this family. Their loss is one that no one wants to go through, one that few of us can imagine. Their pain is real and I have all the compassion in the world for their loss. However, they have invited public scrutiny by calling for donations - the support of the public - and by inviting the justice system into their lives. They have asked for the government to intervene, and that is something that we all have an interest in. As a California resident, I am particularly interested in this case and the possible ramifications if enough public support is gathered based on misinformation that is being perpetuated by an attorney. And for me personally, as a member of the California Bar, I have an interest in what other professionals do. In fact, we have a duty to report others for misconduct.

We shouldn't be hateful, and I know there are lots of examples of that out there. But honestly, read any news story - there are hateful responses to anything, no matter how innocuous. Such is the nature of internet anonymity. But I just think we also need to remember here that misinformation is being spread and they are asking the public to do something - to support an unheard of precedent in law, to make decisions that scare many of us in terms of the future of medico-legal issues, and to donate money to their cause. There are many who have encountered these situations with grace and acceptance and have quietly mourned their loss, but this family decided to make it a public battle, and in doing so have also invited scorn upon CHO, whose actions cannot yet be judged. Standing up for a hospital aimed at doing children's work and who is not yet legally responsible is, IMO, an important task.

Everyone is invited to feel differently, this is MOO, my :twocents:

No. They didn't. They took measures to put pressure on the hospital and to garner support so that the plug would not be pulled. They did what they felt was necessary to prevent that and guess what? It worked.

Did publicity invite a national conversation about death, religion, malpractice, belief, end of life decisions, cost of care, legalities surrounding the definition of death, etc.? Absolutely. But it did not give free license to rip these people to shreds or bash them publicly.

That's kind of like saying celebrities invited the stalking by the paparazzi because they are celebrities. I disagree.

 

[SwampMama]

Nancy Grace ‏@NancyGraceHLN 18h

I guess this hospital never heard about Lazarus coming back from the dead #JahiMcMath

Unbelievable. Does Nancy have any idea how stupid she sounds when she says things like this?

 

[Donjeta]

No doubt the family and the attorney will stop giving daily press updates and it will help them acquire privacy during the last times that Jahi's heart will beat.

Grieving families cannot be expected to think straight as they are in an emotional crisis but I think there are many people on the fringes of this sad case, looking for publicity, who need to be called out every time they appear for spreading misinformation and outright lies. Journalists who don't bother to check any facts, medical professionals who promote pseudoscience and give false hope to grieving families, lawyers who know very well that their client is dead but tell her family and the world that she can wake up so they can bash a hospital and accuse them of trying to murder a girl who already died weeks ago.

 

[otto]

I'm bumping this. Referring to the purple part. How is it okay to accuse this family of being motivated by wanting to cash in? Come in, guys. I know Websleuths is much better than this.

In terms of understanding what is going on, it is difficult to overlook the statements from the family regarding cash awards, and the lawyer's posturing in terms of pretending that a deceased person is alive. Something is going on here beyond keeping a deceased body plugged into a machine while the internal organs fail. It's not related to religion, because there is no religion that has this belief. It's not because the family cannot understand that the child has died, as there is ample information available all over the media about the fact that no one comes back from the dead, and a miracle has never happened.

What could be the reason for what is happening with this child's body? Why is the uncle openly stating that this is about money?