Family wants to keep life support for girl brain dead after tonsil surgery #1

[time4coffee]

I find this case fascinating in its ethics and science. It also haunts me as a mother, I just can not imagine the grief mom must be feeling. I had a couple of technical questions for those with more medical knowledge than me. I've seen the images showing no blood flow to brain dead brains. What causes this lack of flow? With a beating heart and adequate blood pressure, shouldn't blood be pushed into the brain as it is being pumped through the whole body? Are the vessels damaged beyond repair during brain swelling preceding death? What is the pathophysiology that causes no more perfusion in the brain while other organs are still perfused? My other question is when is a time of death declared? For record keeping and death certificate purposes. Is it after the first flat EEG? The second? Has an official time of death been declared? Or would the doctors "call it" after removing the ventilator and the heart ceases? If they declare death after the heart ceases, this could lead to some of the confusion with the family. I would imagine it would confirm their belief that the hospital "killed" jahi if her death certificate ends up reading time of death 5:00pm 12/30. Does anyone with critical care experience have knowledge of a time of death being recorded after brain death but prior to removal of a ventilator? What a tragic and thought provoking case.



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[Isabelle]

I find this case fascinating in its ethics and science. It also haunts me as a mother, I just can not imagine the grief mom must be feeling. I had a couple of technical questions for those with more medical knowledge than me. I've seen the images showing no blood flow to brain dead brains. What causes this lack of flow? With a beating heart and adequate blood pressure, shouldn't blood be pushed into the brain as it is being pumped through the whole body? Are the vessels damaged beyond repair during brain swelling preceding death? What is the pathophysiology that causes no more perfusion in the brain while other organs are still perfused? My other question is when is a time of death declared? For record keeping and death certificate purposes. Is it after the first flat EEG? The second? Has an official time of death been declared? Or would the doctors "call it" after removing the ventilator and the heart ceases? If they declare death after the heart ceases, this could lead to some of the confusion with the family. I would imagine it would confirm their belief that the hospital "killed" jahi if her death certificate ends up reading time of death 5:00pm 12/30. Does anyone with critical care experience have knowledge of a time of death being recorded after brain death but prior to removal of a ventilator? What a tragic and thought provoking case.



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When a person bleeds out, as in this case, there is not enough blood flow to major organs and brain and heart. The heart fails. In this case it seems enough blood and fluids couldn't be given fast enough to overcome the damage done. Children crash much faster than adults, leaving little time for decision making. My main question would be, why was she not returned to the OR and in ICU she could have been sedated and treated just as in the OR, so she wouldn't even have had to be transported out of the unit! Certain surgeries are performed in the NICU, the OR is not necessary!

 

[CHERIE.T]

Such good info on this thread. It certainly makes it easier for me to grasp the meaning of brain death.

Has anyone heard if this child has been over weight for a long time as in months or years? I wonder if her sleep apnea caused her to gain a lot of weight.... imo

 

[scmom]

This article is about bleeding after a tonsillectomy and/or adenoidectomy.
Snipped from article:
Although a number of complications related to this surgery have been well characterized in the literature, the most common and potentially life threatening is post-tonsillectomy and adenoidectomy hemorrhage (PTAH). We present two pediatric cases of severe PTAH refractory to cauterization and surgical ligation in which bleeding was ultimately controlled through endovascular techniques.
http://www.ajnr.org/content/22/4/713.long

 

[Linda7NJ]

Such good info on this thread. It certainly makes it easier for me to grasp the meaning of brain death.

Has anyone heard if this child has been over weight for a long time as in months or years? I wonder if her sleep apnea caused her to gain a lot of weight.... imo

In my opinion, food intake is what caused weight gain.
IMO the medical treatment was as simple as eat less & move more. if that meant counseling, a nutritionist, removing her from her parents home and into foster care.
Children do not have the means to purchase food. It was provided. In abundance.
All IMO


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[Softail]

Time Short to Find New Facility for Jahi McMath
OAKLAND, Calif. December 29, 2013 (AP)

The family of a California girl declared brain dead after complications from tonsil surgery was running out of time Sunday to find a new facility to take her in and keep her on a ventilator.

Chris Dolan, the family's attorney, said he was waiting to hear from the New York hospital after its facility director and medical director speak. He wouldn't provide the hospital's name, saying the media attention could hurt Jahi's chance of being transferred there.

On Sunday, the hospital said it had not heard from the New York, or any other, facility about a transfer.

"We need to be able to talk to the other facility to understand what it is they are capable of doing," Cynthia Chiarappa, a hospital spokeswoman, said Sunday.

"This is not transferring an individual in a vegetative state, but a dead body."

"At a certain point, they have to be able to look themselves in the eye and realize that this young lady is dead and is not coming back under any circumstances."

http://abcnews.go.com/Health/wireStory/facility-york-hope-jahi-mcmath-21359632

 

[MyBelle]

I don't think you are being insensitive at all. I happen to agree with you - It is insane. I also find it almost criminal, or borderline fraud that the family continues to solicit donations. Granted, people give of their own free will, but come on. The money will end up in their pockets. I seriously don't see any transfer. People donating seem as nutty as the family. :nuts: :twocents:

ETA: They are up to 16K. http://www.gofundme.com/Jahi-Mcmath

People are compassionate and give money. This family has suffered a terrible, emotional loss. They will have funeral expenses when all of this is over.

 

[Softail]

People are compassionate and give money. This family has suffered a terrible, emotional loss. They will have funeral expenses when all of this is over.

I don't doubt for one minute that people are compassionate. Yes, they will have funeral expenses, yes it has been a terrible time for them.

The problem I have is the way then went about it. Under a pretense to have her transferred to another facility because she is still alive. It appears that will not happen. I think it is/was wrong to solicit donations for THAT purpose. If people are compassionate and want to donate then have at it! :twocents:

 

[BeginnersLuck]

I find this case fascinating in its ethics and science. It also haunts me as a mother, I just can not imagine the grief mom must be feeling. I had a couple of technical questions for those with more medical knowledge than me. I've seen the images showing no blood flow to brain dead brains. What causes this lack of flow? With a beating heart and adequate blood pressure, shouldn't blood be pushed into the brain as it is being pumped through the whole body? Are the vessels damaged beyond repair during brain swelling preceding death? What is the pathophysiology that causes no more perfusion in the brain while other organs are still perfused? My other question is when is a time of death declared? For record keeping and death certificate purposes. Is it after the first flat EEG? The second? Has an official time of death been declared? Or would the doctors "call it" after removing the ventilator and the heart ceases? If they declare death after the heart ceases, this could lead to some of the confusion with the family. I would imagine it would confirm their belief that the hospital "killed" jahi if her death certificate ends up reading time of death 5:00pm 12/30. Does anyone with critical care experience have knowledge of a time of death being recorded after brain death but prior to removal of a ventilator? What a tragic and thought provoking case.



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Just answering your last question about declaration of death. Two sets of tests have to be administered hours apart. These were done and she was declared dead after the second test, I believe on the 12th of Dec. One of the many videos out there, states that the coroner was set to arrive the following day (the following day of which the video was recorded) Then the family got the court order to keep her on the ventilator over the holidays. The judge recognized she was deceased but gave the family more time and ordered an additional outside neurologist to do another test for confirmation. In between all of this there were a few more different neurologists that also did the testing. So I believe there were at least 5 or 6, maybe even 7 different professionals that confirmed she was brain dead.

 

[MyBelle]

She is not, her heart is still beating, she is not a corpse. I don't think a Death Certificate has been issued.

I don't believe it has been issued either. Her body is suspended in a legal limbo. Doctors have proclaimed her brain dead and laws have been changed to accommodate that diagnosis as the basis for clinical death. I think the only place this will be resolved is in the courts. I will be surprised if she is moved anywhere.

 

[Veidt]

I'm sorry but the fact that we don't have the hospital's side and that the family is suddenly asking for so much money seems off to me. I'm not saying their horrible, corrupt people but they're not being fair. If the hospital messed up then IMO anything the staff could say would be taken apart and analysed to see if it was just generic PR info with no real answers. Especially in the course of an investigation. As it is it just sounds like the family has their version and that this is the only possible factual version. They're asking people to believe them and give them money but they won't allow people to be informed about why this money is necessary and for what, or to listen to all sides before deciding whom to believe. It's not fair to anyone.

We just don't know if the hospital really was rude or incompetent, sometimes people get desperate when a loved one dies and need someone to blame even though accidents and simply chance happens because it's easier to make sense of that. Sometimes breaks in communication happen. We don't and can't know. My heart goes out to their family but the way they're acting just doesn't seem right to me.

The risks ARE glossed over.

I'm sorry but I have to disagree. Of course that it depends on the doctor and the hospital.

Patients have the right to be informed of risks and to ask questions. This is why, where I live at least, doctors, medicine labs and so on are required to prove information about risks so a patient can consent to a treatment knowing what they're getting into.

However, IMO part of that is also being realistic. If a medicine has a 1 in one million chance of death, then the patient should know but the patient should also know how low it is. It shouldn't be blown out of proportion.

If you don't want to take any chance at all then you're not obligated to do so. You can just opt out of treatment and try to cope with your health problem the best you can.

However, for most people the risk is so minor that it's worth it. I've had non-major surgery before and I knew the risks but I also knew that if I didn't do it there was a 100% chance that I'd keep being in pain and uncomfortable and that my health would suffer even more in the long run.

Some of us just don't believe in blowing things out of proportion... technically just going about my daily routine there's a chance that I'll die... but I'm not going to lock myself in the house forever just because I might go outside and get killed by thieves or hit by a car or hit by lightning.

And I agree with K_Z, medical professionals are humans so even when they're doing their best they still can't control what goes on in their patients heads when they explain things.

Have him looked at. Sleep apnea is a HUGE precursor for dementia in later years (because of the chronic low oxygen saturation).

Thank you for this, I have a relative with sleep apnea and I'll get them to see a doctor for it ASAP! Thank you so much!

 

[Donjeta]

Such good info on this thread. It certainly makes it easier for me to grasp the meaning of brain death.

Has anyone heard if this child has been over weight for a long time as in months or years? I wonder if her sleep apnea caused her to gain a lot of weight.... imo

It's a two way street. Overweight children are more at risk for developing sleep apnea but the tiredness and the hormonal changes associated with sleep apnea can cause weight gain.

http://thechart.blogs.cnn.com/2012/02/17/vicious-cycle-of-sleep-apnea-and-obesity-in-kids/

 

[MyBelle]

I don't doubt for one minute that people are compassionate. Yes, they will have funeral expenses, yes it has been a terrible time for them.

The problem I have is the way then went about it. Under a pretense to have her transferred to another facility. It appears that will not happen. I think it is/was wrong to solicit donations for THAT purpose. If people are compassionate and want to donate then have at it! :twocents:

It isn't a scam. I don't believe the mother was aware the facilities would require procedures that the hospital is refusing to do prior to transport.

 

[MyBelle]

Just answering your last question about declaration of death. Two sets of tests have to be administered hours apart. These were done and she was declared dead after the second test, I believe on the 12th of Dec. One of the many videos out there, states that the coroner was set to arrive the following day (the following day of which the video was recorded) Then the family got the court order to keep her on the ventilator over the holidays. The judge recognized she was deceased but gave the family more time and ordered an additional outside neurologist to do another test for confirmation. In between all of this there were a few more different neurologists that also did the testing. So I believe there were at least 5 or 6, maybe even 7 different professionals that confirmed she was brain dead.

But did the additional physicians perform their own tests or did they rely only on the tests performed by the hospital and didn't perform tests on her themselves?

 

[BeginnersLuck]

Hey, Christmas Eve I accidentally OD'd on a new pain med I'd never taken before- took it 4 hours apart rather than 6 because I was confused. When I picked up the prescription I asked the pharmacist about the side effects- she never mentioned nausea and dizziness. I vomited for about 4 hours- so much for the dinner we went out for- it all immediately came back up. I was told I could function- even drive on this medication!!!

I'm glad your ok!

I'm on more medication now than I have ever been. If I am prescribed something I always get online to the website that you can list your meds and see if any interact. I do this before I take anything, even over the counter now. I also research for myself the side effects. I research doctor recommendations. Doctors do have differing opinions and not everyone is informed on everything. It's my body and I want to know what I am putting into it. Also, I am the one that knows my body best.

I encourage everyone to do this for themselves as well.

 

[Wyle_E_Coyote]

But did the additional physicians perform their own tests or did they rely only on the tests performed by the hospital and didn't perform tests on her themselves?

The court appointed one did do his own tests. It was reported that the tests took several hours. Not sure about the other non-CHO doctors... safe to say that there were at least three separate sets of tests, and possibly several more.



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[LyndyLoo]

I find this case fascinating in its ethics and science. It also haunts me as a mother, I just can not imagine the grief mom must be feeling. I had a couple of technical questions for those with more medical knowledge than me. I've seen the images showing no blood flow to brain dead brains. What causes this lack of flow? With a beating heart and adequate blood pressure, shouldn't blood be pushed into the brain as it is being pumped through the whole body? Are the vessels damaged beyond repair during brain swelling preceding death? What is the pathophysiology that causes no more perfusion in the brain while other organs are still perfused? My other question is when is a time of death declared? For record keeping and death certificate purposes. Is it after the first flat EEG? The second? Has an official time of death been declared? Or would the doctors "call it" after removing the ventilator and the heart ceases? If they declare death after the heart ceases, this could lead to some of the confusion with the family. I would imagine it would confirm their belief that the hospital "killed" jahi if her death certificate ends up reading time of death 5:00pm 12/30. Does anyone with critical care experience have knowledge of a time of death being recorded after brain death but prior to removal of a ventilator? What a tragic and thought provoking case.



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I will attempt to explain some of this for you....Brain Death is assessed by at least 2 doctors..and must be repeated in order to assess and label it...BUT unlike what Im reading here...It does not mean the brain is decomposing and rotting as time goes by....Brain death conclusions is based on assessment of the Brain Stem..which is that portion of the brain the governs autonomic nervouse systems..aka..Cardiovascular and Respiratory....This can happen due to trauma..or in this young girls case..massive blood lose suddenly that couldnt be replaced fast enough.....The brain Stem is the direct connection to the Spinal Cord...which then enables the higher portions of the brain to send messages to move a limb...cough etc......So...then many here are assuming her higher brain is not functioning at all..It's being perfused by her young heart that still functioning...but she's underable to breath on her own due to disrupted neuropathways @ Brain Stem....

Here's a link that explains Brain Stem Death....and just why its such a contaversial subject...

http://www.nursingtimes.net/nursing...tem-death-and-its-implications/203314.article

snippet~~



The legal and ethical perspective
Although clinical guidelines have been developed to define brainstem death, they have not been incorporated into legislation, which means the diagnosis is not a legal definition of death. However, Dimond (2004) points out that it has been recognised in a number of court cases. The first was the case of a 19-month-old child who had been diagnosed as brainstem-dead. The doctors felt that to continue with this child’s care would be futile as there was no chance of recovery, and an appeal was made to a court to have the child removed from the ventilator. The judge recognised that the child was dead and furthermore decided that the time of death was when the doctors had first performed the brainstem death tests. This established the validity of the medical Royal Colleges’ guidelines for the tests of brainstem death in law. It also established the principle that removing patients with the diagnosis from ventilation would not be killing them as they were already dead.





There has been some concern about the ethical reasons for diagnosing a patient as brainstem-dead. Sundin-Huard and Fahy (2004) suggest that the only reason for testing a patient for brainstem death is to provide a source of donor organs. It is not until the patient has been diagnosed as brainstem-dead that the issue of organ donation can be considered. They suggest that ventilator and cardiovascular support can be withdrawn from a patient if doctors are convinced that to continue with treatment would be futile. This, they suggest, is ethically questionable and may be deceiving relatives who believe the diagnosis of brainstem death will be for the benefit of the patient. However, the previously mentioned legal cases do suggest there is a role for the diagnosis of brainstem death in deciding on the withdrawal of treatment.

 

[Kaliste]

Almost at their goal. Wondering what the family and donors expect to happen when it's reached?
http://www.gofundme.com/Jahi-Mcmath
$19,675

 

[Wyle_E_Coyote]

Have you had any sort of non emergency surgery? I have. The risks ARE glossed over. People are brought up to trust and defer to doctors. so while risks are explained they are poo poo'd by the very doctors suggesting the surgery. At least that's been my experience.

While this outcome may be rare, it's an all too real possibility. I'd bet my last dollar it was never detailed to the parents. Risks were glossed over., as they always are!


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Given that she was *scheduled* to be sent to the ICU after the surgery, which is not typical nor routine, I find it hard to believe that the risks were glossed over.

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[Donjeta]

I will attempt to explain some of this for you....Brain Death is assessed by at least 2 doctors..and must be repeated in order to assess and label it...BUT unlike what Im reading here...It does not mean the brain is decomposing and rotting as time goes by....Brain death conclusions is based on assessment of the Brain Stem..which is that portion of the brain the governs autonomic nervouse systems..aka..Cardiovascular and Respiratory....This can happen due to trauma..or in this young girls case..massive blood lose suddenly that couldnt be replaced fast enough.....The brain Stem is the direct connection to the Spinal Cord...which then enables the higher portions of the brain to send messages to move a limb...cough etc......So...then many here are assuming her higher brain is not functioning at all..It's being perfused by her young heart that still functioning...but she's underable to breath on her own due to disrupted neuropathways @ Brain Stem....

Respectfully snipped for space.

The reason so many are assuming that her higher brain is not functioning at all is that the doctors who examined her testified so.

...the results of that examination indicated that Ms McMath had sustained an irreversible cessation of all functions in the entire brain, including her brainstem....

...reports of all these EEGs confirm that Ms McMath has no cerebral activity.

http://media.nbcbayarea.com/documents/CHO+-+Physician+Decls.pdf