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

[K_Z]

So, I have to share this story with all of you, because I know most of you will appreciate it.

Someone (Beginner’s Luck?) had an excellent post about the general public having a short attention span, and not actually reading articles, just relying on sound bites and headlines. This is a perfect example.

I was at my daughter’s sport practice this evening, waiting to pick her up. There was a group of parents there, on the wifi, chatting about the top news stories and scrolling around on iPads and phones. This is the conversation I overheard between 2 moms. I happen to know both of these moms are college educated at the bachelor's degree level.

Mom 1: OMG—can you believe that the girl in California, the one with brain damage from the tonsillectomy—now her ventilator is broken! It says the experts say her ventilator won’t work indefinitely! Why can’t she get another ventilator? Won’t her insurance pay for it? OMG—the hospital is so cruel! First they cause brain damage—and now they can’t get her a new ventilator.

Mom 2: I know—I saw that, too. Maybe she is on medicare (KZ note--medicare? LOL!), and she can’t qualify for a new ventilator. Does she really need it? Maybe they can just give her more oxygen, or something?

Mom 1: I don’t know, but it sounds really bad. Maybe some charity can donate a new ventilator.

I cross my heart that I DID NOT make this up. I pinky swear. And I did not say one single word to either Mom1 or Mom2. This, fellow posters, is a random slice of America. This is the tide we are trying to hold back with our brooms. IMO, JMO, and all that.

 

[janx]

I just learned of this case today and have to say that I don't find too many reliable narrators in the mix, including the media.

The medical and legal reports seem credible, but there's a lot of missing information--and even more unqualified assumptions being made.

Does anyone else have this impression?

 

[momrids6]

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 ..)

Name: HAMMONS, DAVID DOUGLAS
License Type: Physician and Surgeon C
License Status: License Renewed & Current
Fee Exemption: Voluntary Service
Expiration Date: 03/31/2014

 

[SeekingJana]

Does this mean she will soon be septic ?


Sent from my iPhone using Tapatalk

From what K_Z posted:
Originally Posted by K_Z
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.

Ischemia means inadequate blood flow to the intestines. Necrosis means dead tissue areas forming in the intestinal wall.

Perforation means that the intestinal wall is eroded so that there are holes in the protective wall, allowing intestinal bacteria to escape from the bowel and enter the peritoneal cavity and the bloodstream.

It is a series of steps which lead to frank extravasation of the myriad of intestinal bacteria seeping out, but K_Z is saying that the process is underway. I don't think anyone can say with certainty where Jahi's intestines are currently on the continuum of perfusion and integrity to degradation and sepsis without examining her, knowing her labs, etc.

I hope this helps. It's sad and it's pretty gruesome, and I apologize for this, but it is factual. Also, if she was given steroids to control the cerebral edema, they also hasten the lack of GI integrity, as does antibiotic therapy as it destroys normal GI flora and allows " bad" bacteria to proliferate.

 

[janx]

So, I have to share this story with all of you, because I know most of you will appreciate it.

Someone (Beginner’s Luck?) had an excellent post about the general public having a short attention span, and not actually reading articles, just relying on sound bites and headlines. This is a perfect example.

I was at my daughter’s sport practice this evening, waiting to pick her up. There was a group of parents there, on the wifi, chatting about the top news stories and scrolling around on iPads and phones. This is the conversation I overheard between 2 moms. I happen to know both of these moms are college educated at the bachelor's degree level.

Mom 1: OMG—can you believe that the girl in California, the one with brain damage from the tonsillectomy—now her ventilator is broken! It says the experts say her ventilator won’t work indefinitely! Why can’t she get another ventilator? Won’t her insurance pay for it? OMG—the hospital is so cruel! First they cause brain damage—and now they can’t get her a new ventilator.

Mom 2: I know—I saw that, too. Maybe she is on medicare (KZ note--medicare? LOL!), and she can’t qualify for a new ventilator. Does she really need it? Maybe they can just give her more oxygen, or something?

Mom 1: I don’t know, but it sounds really bad. Maybe some charity can donate a new ventilator.

I cross my heart that I DID NOT make this up. I pinky swear. And I did not say one single word to either Mom1 or Mom2. This, fellow posters, is a random slice of America. This is the tide we are trying to hold back with our brooms. IMO, JMO, and all that.

I wrote my last post before I read yours. :floorlaugh: It's laziness, to be sure, on the part of media *and* audience. :facepalm:

 

[SophieRose]

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

Currently volunteers providing medical care to the homeless. A practicing Catholic, he seems to take his religion seriously.

Article from Dec 2013
http://www.gardnerfamilyhealth.org/_blog/news/post/volunteering-at-gardner-health-services/

 

[jjenny]

So, I have to share this story with all of you, because I know most of you will appreciate it.

Someone (Beginner’s Luck?) had an excellent post about the general public having a short attention span, and not actually reading articles, just relying on sound bites and headlines. This is a perfect example.

I was at my daughter’s sport practice this evening, waiting to pick her up. There was a group of parents there, on the wifi, chatting about the top news stories and scrolling around on iPads and phones. This is the conversation I overheard between 2 moms. I happen to know both of these moms are college educated at the bachelor's degree level.

Mom 1: OMG—can you believe that the girl in California, the one with brain damage from the tonsillectomy—now her ventilator is broken! It says the experts say her ventilator won’t work indefinitely! Why can’t she get another ventilator? Won’t her insurance pay for it? OMG—the hospital is so cruel! First they cause brain damage—and now they can’t get her a new ventilator.

Mom 2: I know—I saw that, too. Maybe she is on medicare (KZ note--medicare? LOL!), and she can’t qualify for a new ventilator. Does she really need it? Maybe they can just give her more oxygen, or something?

Mom 1: I don’t know, but it sounds really bad. Maybe some charity can donate a new ventilator.

I cross my heart that I DID NOT make this up. I pinky swear. And I did not say one single word to either Mom1 or Mom2. This, fellow posters, is a random slice of America. This is the tide we are trying to hold back with our brooms. IMO, JMO, and all that.

I don't think you can make this up.
:floorlaugh:

 

[momrids6]

Currently volunteers providing medical care to the homeless. A practicing Catholic, he seems to take his religion seriously.

Article from Dec 2013
http://www.gardnerfamilyhealth.org/_blog/news/post/volunteering-at-gardner-health-services/

"I contacted Gardner Health Services and they were willing to provide me with coverage, as well as pharmacy and EKG services for patients."

 

[Peliman]

I'm sure the hospital insurance companies are going to subpoena all of Jahi's medical records to find reasons why things turned out the way they did.

Speaking of transfusions made me wonder if she was sickle cell positive but we may never know.

Just thinking out loud.

 

[janx]

From what K_Z posted:
Originally Posted by K_Z
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.

Ischemia means inadequate blood flow to the intestines. Necrosis means dead tissue areas forming in the intestinal wall.

Perforation means that the intestinal wall is eroded so that there are holes in the protective wall, allowing intestinal bacteria to escape from the bowel and enter the peritoneal cavity and the bloodstream.

It is a series of steps which lead to frank extravasation of the myriad of intestinal bacteria to seep out, but K_Z is saying that the process is underway. I don't think anyone can say with certainty where Jahi's intestines are currently on the continuum of perfusion and integrity to degradation and sepsis without examining her, knowing her labs, etc.

I hope this helps. It's sad and it's pretty gruesome, and I apologize for this, but it is factual. Also, if she was given steroids to control the cerebral edema, they also hasten the lack of GI integrity, as do antibiotic therapy as it destroys normal GI flora and allows " bad" bacteria to proliferate.

But this is decomposition. These are all aspects of decomposition, as I understand it (albeit slowed by the ventilator activity). It's normal. The report re Jahi's body from 1/3 makes this clear. I dunno. The poor girl is dead, and it just seems absurd that Children's Hospital had to pretend to keep her alive, had to preserve the body for such a long time when it was only doing what any natural dead body does.

 

[SeekingJana]

Name: HAMMONS, DAVID DOUGLAS
License Type: Physician and Surgeon C
License Status: License Renewed & Current
Fee Exemption: Voluntary Service
Expiration Date: 03/31/2014

I've never seen a professional license with these notations.. I really do think he did come out of retirement to take care of the end of life needs on a voluntary basis.

Whatever we think about the family's decision to keep life support going, this man is, IMO, very compassionate. It appears that he has NO monetary stake in the eventual outcome due to the notation of " Voluntary Service", and probably little to no professional liability either, which is great.

This is a WIN/ WIN situation for CHO and our concerns for the potentially stressed PICU nurses there. This man pretty much rescued them, y'all. I think it's extremely compassionate for the McMath family as well. JMO. :truce:

 

[SeekingJana]

But this is decomposition. These are all aspects of decomposition, as I understand it (albeit slowed by the ventilator activity). It's normal. The report re Jahi's body from 1/3 makes this clear. I dunno. The poor girl is dead, and it just seems absurd that Children's Hospital had to pretend to keep her alive, had to preserve the body for such a long time when it was only doing what any natural dead body does.

<modsnip> I was answering a question about sepsis, which was asked by another poster. The progression of deterioration/ decomposition happens when bowel doesn't have enough blood supply ( ischemia); no blood supply at all ( necrosis); and the end point ( extravasation of gut bacteria into the peritoneum and bloodstream).

The cause is multi-factorial in her case: Brain death, with resultant lack of tissue perfusion for a period of time as I stated above, as well as hypothermia.

 

[K_Z]

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.

Congratulations on your new baby! I hope all went well for you both.

Respectfully, the type and dosage of heparin that is given for postop DVT prophylaxis does not "fully anticoagulate" the patient, in the therapeutic sense. It acts at a different point in the clotting cascade.

Rather, this type of dosage (most likely subcutaneously, in your case) is minimal, and subtherapeutic, enough to prevent (well, try to!) errant blood clots from forming.

We have no evidence that Jahi received any kind of heparin, for any reason, at this point. It is extremely, extremely unlikely that she bled to death as a complication from DVT heparin prophylaxis.

I wanted to clear that up.

 

[K_Z]

From what K_Z posted:
Originally Posted by K_Z
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.

Ischemia means inadequate blood flow to the intestines. Necrosis means dead tissue areas forming in the intestinal wall.

Perforation means that the intestinal wall is eroded so that there are holes in the protective wall, allowing intestinal bacteria to escape from the bowel and enter the peritoneal cavity and the bloodstream.

It is a series of steps which lead to frank extravasation of the myriad of intestinal bacteria to seep out, but K_Z is saying that the process is underway. I don't think anyone can say with certainty where Jahi's intestines are currently on the continuum of perfusion and integrity to degradation and sepsis without examining her, knowing her labs, etc.

I hope this helps. It's sad and it's pretty gruesome, and I apologize for this, but it is factual. Also, if she was given steroids to control the cerebral edema, they also hasten the lack of GI integrity, as do antibiotic therapy as it destroys normal GI flora and allows " bad" bacteria to proliferate.

Thank you, Seeking Jana, for rescuing my mangled explanation. I should have done a much better job with that, but I'm really glad you did! Caught in the throes of "flight of ideas", I guess!

 

[janx]

What's your point? It doesn't matter what the factors- I was answering a question about sepsis, which was asked by another poster. The progression of deterioration/ decomposition happens when bowel doesn't have enough blood supply ( ischemia); no blood supply at all ( necrosis); and the end point ( extravasation of gut bacteria into the peritoneum and bloodstream).

The cause is multi-factorial in her case: Brain death, with resultant lack of tissue perfusion for a period of time as I stated above, as well as hypothermia.

While I appreciate these diagnoses, it just seems rather bizarre (or ultimately pointless) to me since she is dead.Her body is breaking down the way any body would, except that the decomp is retarded a bit due to the ventilator.

But I appreciate that you are answering someone's question (I guess?) :seeya:

 

[Karmady]

I've never seen a professional license with these notations.. I really do think he did come out of retirement to take care of the end of life needs on a voluntary basis.

Whatever we think about the family's decision to keep life support going, this man is, IMO, very compassionate. It appears that he has NO monetary stake in the eventual outcome due to the notation of " Voluntary Service", and probably little to no professional liability either, which is great.

This is a WIN/ WIN situation for CHO and our concerns for the potentially stressed PICU nurses there. This man pretty much rescued them, y'all. I think it's extremely compassionate for the McMath family as well. JMO. :truce:

Except there are no end of life needs. Her life is over and has been for a month. If he's come out of retirement, he's done it to facilitate a mentally unstable mother/family watch their loved one's body decay. That's creepy, not compassionate, imo. I do agree, though, that anything to get her out of Children's is a good thing. effing bizarre, imo.

 

[Donjeta]

I just want to know if he's made it clear to the family that he's just stalling the inevitable or if he claims that he can raise the dead.

 

[SeekingJana]

Thank you, Seeking Jana, for rescuing my mangled explanation. I should have done a much better job with that, but I'm really glad you did! Caught in the throes of "flight of ideas", I guess!

No, you were the pilot.. I was just flying wingman with you.
Thank you for all you have contributed to this forum discussion from the beginning. :loveyou:

 

[SeekingJana]

Except there are no end of life needs. Her life is over and has been for a month. If he's come out of retirement, he's done it to facilitate a mentally unstable mother/family watch their loved one's body decay. That's creepy, not compassionate, imo. I do agree, though, that anything to get her out of Children's is a good thing. effing bizarre, imo.

I tried to be very careful in my wording. Notice that I didn't say her end of life needs. IMO, the people being treated and needing care are the living, talking, family members at the bedside, not the shell of a sweet little girl not allowed to go.

I think a mature E.R. doc knows the stages of grief. I believe he can guide them to acceptance if they trust him, which I think they do.
And, since it all started with her, remembrances to Dr. Elisabeth Kubler- Ross for teaching health care professionals what the stages of grief are and how grief is processed ( usually).

 

[K_Z]

Except there are no end of life needs. Her life is over and has been for a month. If he's come out of retirement, he's done it to facilitate a mentally unstable mother/family watch their loved one's body decay. That's creepy, not compassionate, imo. I do agree, though, that anything to get her out of Children's is a good thing. effing bizarre, imo.

Hmmmm....I wonder if he still has prescriptive authority?