Rebecca Nalepa - suicide or murder? #7

[SunnieRN]

There appears to be a couple of tests doctors current use....

Confirming Brain Death
x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

Many physicians request additional, confirmatory tests before pronouncing brain death. The two most common are the electroencephalogram (EEG) and the cerebral blood flow (CBF) study.

Once a patient fulfills this medical criterion, nothing can be done for the patient. The patient can still be maintained physiologically on the ventilator, but there is no hope of any kind of recovery, even to a state of irreversible coma

Families of a brain dead patient must, by federal regulations, be provided the option of organ donation. If the family consents, the regional organ procurement organization is involved. If the family refuses, the mechanical ventilator, medications and fluids are discontinued, after which the heart stops

http://science.howstuffworks.com/environmental/life/human-biology/brain-death5.htm

Hi,

Not so in California - if I read you correctly, you say that once a family has been approached for organs - if they refuse - their family member would no longer be provided with life-giving care...THIS IS JUST NOT TRUE. Healthcare professionals in Cali allow for the fact that some people can recover from devastating brain trauma. We aggressively rehab our head injury patients...It is up to the family to decide if they wish to allow their loved one to pass on...or if they want to have care and rehabilitation considered. Most go for the Rehab, and today, many of these patients recover. They may not function at the level they did pre-injury-but the family and the patient have gone on to lead fulfilling lives. You would be amazed...

My 2C

I wonder if the article was just worded improperly, by the author and they meant, if the family agrees, life support devices can then be turned off and the patients heart will stop. Actually, if the patient was ventilator dependent, they would not breath from the time they are taken off the ventilator, or just take a few gasping breaths.) Often the heart stopping is in a response to the patient not breathing. The lack of oxygen is what allows death, the heart stops beating after that.

In the first or second thread, we discussed brain death and how it is determined. At that time I questioned the speed in which the diagnosis was made. With any severe injury to the brain, there is always swelling that can mask the results of tests. As stated above, the EEG is the best study to truly diagnose brain death. A functional brain is constantly emitting neurons, pulses, lines fluctuating on an EEG. A non functioning, "brain dead" brain is a straight line, with only minor variations, due to the respirator etc.

The reason I talk about this again, is the speed in which it was decided to remove Maxie from the life support equipment and donate his organs. Even a family with a strong medical base of knowledge holds out hope, that there is a mistake, that it is too soon to really know, that their child may be that miracle that proves science wrong.

There is also the fact that the brain is not an entity that is totally understood.
There are so many variables to what happens in a brain. I had a patient with 'locked in syndrome' once, Karen Anne Quinlan was declared brain dead, her husband petitioned and got a court order allowing her to be removed from the ventilator, guess what, she lived a heck of a long time.

There are also the cases where there is no recovery what so ever. That usually takes time to comprehend and process. Especially with a six year old child.

DS and JS made, what I am sure, was a very difficult decision. I am just beyond shocked that it was made so quickly and that it was determined so quickly that the prognosis constituted that decision. Not placing any blame, or saying that the decision shouldn't have been made, just shocked, after 19 years in nursing, that these parents were able to move to that place at that speed.

 

[scorekeeper]

I think both parents had to agree to turn off life support. Otherwise one that didn't agree could have gone to court.

Kinda' like both parties agreeing to a divorce????

 

[scorekeeper]

I wonder if the article was just worded improperly, by the author and they meant, if the family agrees, life support devices can then be turned off and the patients heart will stop. Actually, if the patient was ventilator dependent, they would not breath from the time they are taken off the ventilator, or just take a few gasping breaths.) Often the heart stopping is in a response to the patient not breathing. The lack of oxygen is what allows death, the heart stops beating after that.

In the first or second thread, we discussed brain death and how it is determined. At that time I questioned the speed in which the diagnosis was made. With any severe injury to the brain, there is always swelling that can mask the results of tests. As stated above, the EEG is the best study to truly diagnose brain death. A functional brain is constantly emitting neurons, pulses, lines fluctuating on an EEG. A non functioning, "brain dead" brain is a straight line, with only minor variations, due to the respirator etc.

The reason I talk about this again, is the speed in which it was decided to remove Maxie from the life support equipment and donate his organs. Even a family with a strong medical base of knowledge holds out hope, that there is a mistake, that it is too soon to really know, that their child may be that miracle that proves science wrong.

There is also the fact that the brain is not an entity that is totally understood.
There are so many variables to what happens in a brain. I had a patient with 'locked in syndrome' once, Karen Anne Quinlan was declared brain dead, her husband petitioned and got a court order allowing her to be removed from the ventilator, guess what, she lived a heck of a long time.

There are also the cases where there is no recovery what so ever. That usually takes time to comprehend and process. Especially with a six year old child.

DS and JS made, what I am sure, was a very difficult decision. I am just beyond shocked that it was made so quickly and that it was determined so quickly that the prognosis constituted that decision. Not placing any blame, or saying that the decision shouldn't have been made, just shocked, after 19 years in nursing, that these parents were able to move to that place at that speed.

BBM

:tyou::tyou: SunnieRN, for having my back, and saying things so well!!

I remember those earlier post.....decision very soon and so quickly....will never understand and we will probably never know the whole reason/story.

 

[SunnieRN]

BBM

I have wondered the same.....why so soon?

Thank you for sharing your story. MIRACLES do happen :innocent:

Here is is some general info.....there are a lot of web sites devoted to TBIs.

I wonder what he scored on the Glasgow...

http://www.tbirecoverycenter.org/treatment.htm

There are problems with the glasgow score. If a patient is on a ventilator, they are kept heavily sedated to not 'buck' the tube, in other words, so they wont fight the tube. Think of something being down your throat right now. The normal reaction is to get it out. Hence there is a real need to keep a patient sedated. This skews all test results.

When they are trying to wean the patient from a ventilator they have to decrease the medication slowly, to see if their body is ready to breath without the device. This is traumatic for the patient and often someone has to be with them to remind them to remain calm and not 'fight' the tube, but to try to breath with it. This is hard on the patient and the family, who are helpless bystanders.

 

[scorekeeper]

Ok, SunnieRN, the stage is yours........I have a social worker background

I am not a nurse or a chemist

:floorlaugh::floorlaugh::floorlaugh::floorlaugh:

 

[SunnieRN]

I think all of our perspectives are skewed by personal experience by some degree or another. I have a brother who had a traumatic brain injury and was in a coma for nearly 3 months. It's been a long time so I don't remember all the details. I know it took us about 15 hours or more to get to where he was. We had NO idea what was going on in the first weeks! He was on a vent and a feeding tube for a long time. When I first spoke with his doctor on behalf of our parents I said "we under no circumstances want life support discontinued" The doctor very kindly indicated it was a Catholic Hospital and as such we didn't have to worry about that. We were told he would be in a permanent vegetative status, while he's permanently disabled, he's very much an active part of our family.

Given our personal history, I have to wonder what was said, and indicated by hospital staff - as well as how hard organ donation was pushed. It's seems awfully fast to me to make the decision to donate organs, and (perhaps) I'm assuming discontinuing life support.

God bless you and your family! It is so scary and difficult to determine a path when our loved ones are hurt, ill, going through so very much. The attitude of the physicians and nursing staff at that time, really helps or hinders the situation.

I have been involved with many families who have had to make decisions they NEVER wanted to face. I have cried with more families than I can count.

Everyone should talk to their loved ones about their medical wishes. You should have a form, an advance directive or a durable power of attorney for medical care, so that YOUR decisions are carried out and so that your family does not have to decide for you.

When there is a crisis, the family is trying to cope with everything involved. If they know your wishes, they don't have to go through the decision process or the guilt of the decisions they make, either way.

 

[coastal]

Please forgive the OT, but Time said (respectfully shortened):

..."I would feel it was awkward and humiliating having my ex take up with a woman so much younger"...

FWIW - it was awkward and humiliating when my ex took up with a woman who is much older than I am (although I'm beyond those small emotions now :floorlaugh.
Sigh.

 

[SunnieRN]

Ok, SunnieRN, the stage is yours........I have a social worker background

I am not a nurse or a chemist

:floorlaugh::floorlaugh::floorlaugh::floorlaugh:

You are a wealth of knowledge and I love your posts. This subject is near and dear to my heart for many reasons. I remember a child we had on a vent, when I was in nursing school. The child had fallen in a pool and not been found for at least 10 minutes. This was in CA, where the weather at the time was around 97 degrees, so the water in the pool was very warm. There was no hypothermic reactions involved, that can slow the respirations naturally, etc.

This child was determined to be brain dead, over a long period of time. This was a catholic hospital. This little girl was 2 1/2 and had been on life support for almost a year. Her parents had both been home at the time of her fall into the pool. Both felt a tremendous amount of guilt. They didn't want their child to die, but after a year, they had distanced themselves.

They rarely visited, did not take active rolls in her care or the decisions made. This baby was only held by the nurses, who loved and cared for her. She was only changed and bathed by the nurses who cared for her.

She was on a ventilator a feeding pump, heavy sedatives. She had a central line, due to continual infections, so she could receive constant antibiotics.

That was my first experience looking at quality of life, vs quantity of life. There was one nurse, who worked with her, that approached the family about giving up custody of this sweet baby. She wanted to foster this baby and bring her to her own home. Se wanted to get her out of a hospital environment, full of germs and illness and give her a bedroom with mobiles and toys. Give her love. The parents in their guilt, refused.

That is but one experience I have had. Hence my very strong opinions, so I will now again drop the subject. As I said earlier, no judgements in Maxies case. Just shock and surprise. Of course I wasn't there and don't know the reasons for the decisions, but it 'feels wrong' to me.

 

[Lawgirl]

And Rebecca's has not been ruled a suicide. From the articles I have read LE had not planned on even investigating Max's death until Rebecca died. It had been viewed as an accident. Speaking of accidents, what happens if a child darts out in the road in traffic and gets killed by a car? Should the parent or whoever is watching the child at that time be blamed? Is it not just an accident? Accidents do happen, unfortunately.

Yes, charges may be brought upon that parent.

http://www.cbsnews.com/stories/2011/07/26/national/main20083609.shtml

 

[arielilane]

SunnieRN, thank you for your informative, professional and insightful posts.

I have a question, that I hope you can answer. If a child falls from a flight of stairs as Max did, does one have to hit his head on something with such force to cause a brain injury or simply by the fall itself cause a brain injury?

 

[Lawgirl]

But it's a complete speculation that RN would know that there was no hope at the time of the supposed suicide. The child was taken to the hospital, his mother and father were there. Did RN ever got to visit? Like was already pointed out, for organ donation, the sooner the support systems are turned off, the better for organ harvesting. But the system was not turned off at the time of this supposed suicide.

Under the circumstances, I'm not sure someone would sit down and explain to RN that true condition of the child. First, they are in shock, there is still a disbelief going on, second she was taking care of him and she allowed this to happen. I wonder if she was purposesly kept out of the loop because they were so angry with her...that she actually thought there might be hope...just as his sister thought there was hope and she was asking everyone to pray for Maxxie...she also thought there was hope.

If RN thought there was hope, why would she kill herself so quickly?

 

[believe09]

Personally, I am on the fence about quarterbacking letting the child go and allowing organ donation to move forward-if both parents agreed then it was a shared decision. Clearly they felt it was the right time.

I have a harder time reaching a conclusion where either or both parent would force RN to strip, tie her up and then fling her over the balcony to be found by father's brother. Or that anyone would.

 

[Quester]

As I recall it, it was "injured" and asking for prayers. I don't recall anything about "brain dead."

http://www.wittyprofiles.com/q/3262032

 

[arielilane]

I believe it was determined that is DS's boyfriend's daughter that remitted that post. I don't have a facebook account to read if there is additional information posted.

 

[SunnieRN]

SunnieRN, thank you for your informative, professional and insightful posts.

I have a question, that I hope you can answer. If a child falls from a flight of stairs as Max did, does one have to hit his head on something with such force to cause a brain injury or simply by the fall itself cause a brain injury?

I have said from the beginning, that something sounded 'fishy' to me. This is not 'typical' of an injury down a flight of carpeted stairs. Now, if Maxie had suffered a 'broken neck', where the high cervical bones protecting the spine were fractured, it can cause injury to the spinal cord and affect the functioning of Maxies brain, including the part of the brain that control automatic responses, such as breathing and movement. This is a definite possibility, but again, would a simple fall on a carpeted staircase cause this injury?

http://www.wittyprofiles.com/q/3262032

This reads:

My Dad's girlfriend's son is in a coma.
He fell off a balcony at his dads house this morning. He might not live. He's basically my little brother and I love him so much. They don't know if he'll live. He hasn't woken up since the fall. He doesn't have any brain activity going on. I'm worried sick. I can't stop crying. I can't go see him, my dad won't let me go. He's six. That's too ******ing young to die.
I'll I'm asking for is for you to pray. Pray for Maxfield Shacknai. Please.
I love you Max.


If this is true, what balcony did he fall from? This may explain where Rebecca was found and why. Also, could lead me to believe the reason for foul play in her death, as if he actually fell from a balcony, though it may not be her 'fault', the parent(s) may have felt she was negligent.

Didn't know DS had a boyfriend. Was he who answered her door when LE couldn't find her?

 

[elementry]

The retired detective, author, and self proclaimed expert on suicides, was 'interviewed' very early on in the case. Since he runs some kind of police museum, I have a feeling they told him to shut up. He did not seem to have any inside information nor any expert information from what I heard.

Wouldn't a plain vanilla suicide (if there's such a thing, in any case, this one has some odd circumstancial wrinkles) be announced within a six week window if not sooner? Almost seems like LE, lacking other fruitful avenues, is busy striking down all other scenarios element by element, thus delivering a kind of negative proof of suicide - and incidentally hoping the long elapse of time induces a general apathy in the public by the time they finally issue a finding. They may have to deal with a few unhappy Zahau's, but besides that will anybody really care that much 2 months after the fact? Of course if the fact is true and verifiable regarding suicide, that would help put this one to bed.

 

[Lawgirl]

You are a wealth of knowledge and I love your posts. This subject is near and dear to my heart for many reasons. I remember a child we had on a vent, when I was in nursing school. The child had fallen in a pool and not been found for at least 10 minutes. This was in CA, where the weather at the time was around 97 degrees, so the water in the pool was very warm. There was no hypothermic reactions involved, that can slow the respirations naturally, etc.

This child was determined to be brain dead, over a long period of time. This was a catholic hospital. This little girl was 2 1/2 and had been on life support for almost a year. Her parents had both been home at the time of her fall into the pool. Both felt a tremendous amount of guilt. They didn't want their child to die, but after a year, they had distanced themselves.

They rarely visited, did not take active rolls in her care or the decisions made. This baby was only held by the nurses, who loved and cared for her. She was only changed and bathed by the nurses who cared for her.

She was on a ventilator a feeding pump, heavy sedatives. She had a central line, due to continual infections, so she could receive constant antibiotics.

That was my first experience looking at quality of life, vs quantity of life. There was one nurse, who worked with her, that approached the family about giving up custody of this sweet baby. She wanted to foster this baby and bring her to her own home. Se wanted to get her out of a hospital environment, full of germs and illness and give her a bedroom with mobiles and toys. Give her love. The parents in their guilt, refused.

That is but one experience I have had. Hence my very strong opinions, so I will now again drop the subject. As I said earlier, no judgements in Maxies case. Just shock and surprise. Of course I wasn't there and don't know the reasons for the decisions, but it 'feels wrong' to me.

This is the most heart breaking story I have ever heard in my life.

 

[SunnieRN]

Oh yes, and now I am doubly curious as to who's bedroom that is/was.

 

[SunnieRN]

This is the most heart breaking story I have ever heard in my life.

I am sorry, it wasn't my intention to make you or anyone feel sad, but to refer to parents and their reactions. I could state other cases as well, some with children, some with teens and young adults. The reactions are usually the same. Devastation, grief, anger and denial. Acceptance and any steps forward are much more difficult.

 

[Lawgirl]

I am sorry, it wasn't my intention to make you or anyone feel sad, but to refer to parents and their reactions. I could state other cases as well, some with children, some with teens and young adults. The reactions are usually the same. Devastation, grief, anger and denial. Acceptance and any steps forward are much more difficult.

I have always said it takes a special kind of person to be in the nursing field, a certain kind of strength.