I just talked to Dr. Zuri to get a better idea of what might have happened from a medical perspective. This is speculation but makes medical sense. I was wrong in what I had posted about bleeding factors not being screened. A bleeding time is typically done to determine whether a patient's ability to clot is in a timely fashion. If the bleeding time is prolonged, a hematologist is usually consulted to figure out what blood factors may be present. If a bleeding time was not done, that could be a problem for the ENT doc.
Ok. Dr. Zuri said IHO not having read anything about this case, that the morbid obesity and neck size were likely key contributors. During a tonsillectomy, the patient is intubated nasally. Because of neck size, the intubation may have been "traumatic" meaning very difficult sometimes causing laryngeal tissues to swell. Due to her size, during surgery, more air has to be forced into the lungs, which sometimes causes alveoli to burst, resulting in decreased respiratory function once extubated. She was extubated and seemingly alert in the recovery room. Then the perfect storm. She bled which may have been a result of surgery, blood dyscrasia, intubation, extubation. The swelling of laryngeal tissue combined with the bleeding compromised her airway, thus not allowing oxygen circulation.
For brain death to occur, the brain is starved of oxygen for 4 minutes (or less in MO patients). The heart, being starved for oxygen does not pump enough circulating oxygenated blood. Blood pressure falls. The heart stops. IV fluids are given at a rapid rate to increase volume. In MO patients, there is usually a degree of heart enlargement. The increased IV volume being delivered overwhelms the heart and with lake of oxygen and cardiac compromise, the heart stops. CPR begins. The anesthesia docs are trying to get an airway either via intubation or tracheostomy while patient is being bagged. Since the airway is occluded, this is usually very difficult. Bagging the patient with airway occlusion with an ambu bag is unbelievably difficult. The chest doesn't rise like it is supposed to. While someone is trying to intubate the nose, someone else may be trying to do a trach. Mind you, having been in this scenario, everything is happening so fast, and if one person is unsuccessful, another doc moves in to try. Yes, there is a very high level of anxiety, almost panicky. Oxygenated Blood is not being circulated. The brain is not getting oxygen and upper neuron function is being lost causing the brain to die.
Once an airway is established and heart function restored ( through defibrillation, cardiac drugs, volume), efforts are made to stabilize the patient. However, oxygen deprivation has not just starved the brain, causing it to die, it has starved every major organ system. Dr. Zuri said it is unlikely that Jahi responds to mother's touch. The Brain Death EEGs are done to determine brain wave activity, usually a series of three. If all are the same, the patient is declared brain dead.
I asked Dr. Zuri about the feeding tube if placed and then life support is withdrawn, does the feeding tube matter. He said no because the patient is brain dead and not in any other brain state. I asked him about the coroner's request and comments. He said that the COD determination could be complicated by the intervening treatments such as massive amounts of steroids, drugs, healing of tissues. In a malpractice suit, it has to be proven that there was negligence and harm. Delaying things could work against the family IHO.
Another factor is cost. Once a patient has been declared brain dead, the insurance company will cease to pay the hospital for costs incurred. I would imagine that her care is probably between 2-4K a day. The hospital will eat that unless if a lawsuit is taken to court, and found not negligent, the family will be held liable for those costs. UGH.
Dr. Zuri felt that there would be an out of court settlement by the hospital to the family. He also thought that the one sided negative press was harmful to the hospital which is why they are asking the family for permission to speak and clarify some of the misinformation that has been disseminated by the family and their attorney.
Sorry for the long post. I just wanted to share with you what a doctor thought. He may be totally off base, but he just explained things to me as I understood the facts to be. There truly are no winners here. JMO
