Family wants to keep life support for girl brain dead after tonsil surgery #2

[K_Z]

I think the longest they've been able to maintain a fetus in a braindead mother's body is three months or so but apparently it fails more often than it succeeds. (Don't quote me on that as I don't have a link, it's just something from memory in one of the many many articles I've seen recently, here and the other thread on the pregnant braindead woman.)
In some cases they manage to keep the fetus alive until it's viable and some cases they don't.

But from what I gather, being successful in an organ transplant takes even more than being successful in maintaining the organ in the original braindead owner's body as there are many factors that can cause the recipient's body to reject the transplant. K_Z_ posted a link to a very informative e-book somewhere in these threads, about everything that can go wrong in a braindead organ donor's body so that an organ that still worked in the donor won't work in the recipient.

Amazon has everything, right?

The Brain-Dead Organ Donor: Pathophysiology and Management: Dimitri Novitzky, David K. C. Cooper: 9781461443032: Amazon.com: Books

 

[BeginnersLuck]

About half way down in this article there is a video of the mother I hadn't seen yet.

She talks about CHO being a research hospital and she wants them to fix Jahi. She also mentions all the stories she has heard and seen of others that have recovered from this.

It's sad that all these people are feeding her false hope. That is making it even tougher for her to let go and the day will come when she will have to face that.

From a psychological perspective, I do not understand why people continue to participate in this false hope and miracle talk. I am talking about the ones that are well aware of what the outcome will be and the road that lays ahead. This is so unethical.

http://blogs.kqed.org/newsfix/2013/12/31/jahi-mcmath/

 

[Softail]

Dont think she was trying to be disrespectful, just pointing out the absurdity of it all...

Thank you! I'm not at all. Just trying to look out for Jahi.

Yes, the absurdity of it all!

 

[SeekingJana]

I find this Sam Singer person to be abrasive, loud, and rude. If he came at me with ANY kind of papers to sign and I had the power to refuse to sign them. I would. Because he comes off as a bully IMO and I HATE THAT!!!

IF Jahi's family, her mother, her father, and the uncle who has been on camera as a spokesperson, have been treated like I've seen him ham-fistedly speak about Jahi in the past 2 days, I don't blame them for being mad as He11.
I do not think for one moment that this man works for this hospital in CA.
He was " brought in", IMO, and it definitely shows.

Hate on me if you will, but personality definitely does matter when you are approaching a family with a situation such as needing to talk about a little girl's brain death and how to deal with it together. The spokesperson for the hospital should have been a woman, in administration for many years but with a background in patient care. :banghead::banghead:

 

[Donjeta]

"We are hopeful we will be successful so this tragedy can end," Singer said.

http://news.yahoo.com/life-support-extended-girl-declared-brain-dead-004949499.html

This sounded rather insensitively worded to me. There are no winners here, however this turns out in court, Jahi will still be dead and it's a tragedy that will not end. Singer can forget all about it, perhaps, but the people who loved her won't.

 

[Zuri]

I find this Sam Singer person to be abrasive, loud, and rude. If he came at me with ANY kind of papers to sign and I had the power to refuse to sign them. I would. Because he comes off as a bully IMO and I HATE THAT!!!

IF Jahi's family, her mother, her father, and the uncle who has been on camera as a spokesperson, have been treated like I've seen him ham-fistedly speak about Jahi in the past 2 days, I don't blame them for being mad as He11.
I do not think for one moment that this man works for this hospital in CA.
He was " brought in", IMO, and it definitely shows.

Hate on me if you will, but personality definitely does matter when you are approaching a family with a situation such as needing to talk about a little girl's brain death and how to deal with it together. The spokesperson for the hospital should have been a woman, in administration for many years but with a background in patient care. :banghead::banghead:

I have to agree that he was condescending towards the lawyer. However, IIRC, Mr. Dolan said something to the effect that Mr. Singer worked for large corporations within the Chamber of Commerce. I don't know if he was brought in or was on retainer, but he did NOT IMO put a good face on the hospital. I cringed when I heard him speak. I guess I expected Mr. Singer to be polite and smooth, like a PR spokesperson. Wait, is he their PR spokesperson? IMO

 

[BeginnersLuck]

http://www.contracostatimes.com/new...terri-schiavo-group-secretly-leading-transfer

In a letter to Jahi's attorney Christopher Dolan, Scerri told him the facility would accept Jahi into its outpatient center and eventually move her into the Brendan House facility, now under construction, for long-term care.

"We will be providing Jahi McMath 24-hour licensed nursing staff and licensed respiratory therapists," she wrote. "We are also hiring a pediatrician who will accept her as his patient."

The family still must get Jahi to the facility. A letter from Medway Air Ambulance quotes a price of $31,910 to transport Jahi from Oakland to Long Island.

Medway flight coordinator Terry Hoard confirmed his company quoted the family a price and would have no problem transporting a brain-dead patient across country.

 

[SeekingJana]

I have to agree that he was condescending towards the lawyer. However, IIRC, Mr. Dolan said something to the effect that Mr. Singer worked for large corporations within the Chamber of Commerce. I don't know if he was brought in or was on retainer, but he did NOT IMO put a good face on the hospital. I cringed when I heard him speak. I guess I expected Mr. Singer to be polite and smooth, like a PR spokesperson. Wait, is he their PR spokesperson? IMO

YES, Singer is the PR person for CHO. I read that he was brought in. By whom and why, I have no idea. I'd say he's from the other side of the country, and has no permanent affiliation with the hospital. All is JMO based upon my life experience with loud men. Can't deal, not for one minute.

 

[Herat]

I mean no disrespect to Jahi at all. I'm on her side completely. She has been lost in this mess. So, I think it is an honest question. What exactly do dead people eat? She has been declared dead.

Everyone who wants to feed a dead person is disrespectful in my opinion. :twocents:

The issue is placing a feeding gastrostomy tube into her stomach by doing a surgical procedure to incise the skin and with the use of an endoscope in the stomach, guide the tube through the skin and secure it into the stomach.

This is a surgical procedure. It needs to be done by physicians (usually gastroenterologists) and it is normally done with anesthesia in an operating room.

Just like with a tracheostomy tube, I do not believe any physicians on that staff will want to participate in this with a person declared legally dead.

There is also the issue of how one manipulates a feeding gastrostomy in a person who has no muscle tone and markedly reduced peristalsis. This is just a nightmare scenario for infection, aspiration, perforation, or any other recognized complication. Then, do you "treat" a complication in a body whose brain is now the texture of custard and has no voluntary respirations or cardiac activity?

Huge slippery slope here and the hospital cannot acceed to the maudlin show coached by the attorney and put on by the family for full media play.

This is an abomination and needs to stop.

 

[meme4]

What exactly is an outpatient center, they dont have a building ready for patients.....:banghead:

 

[SeekingJana]

I HOPE the Schiavo Foundation does help the family get Jahi to where they want her to be, and I hope they get everything all settled in and happier and I hope CHO has nothing more to say or do with the case/ event/ matter.

However we want to look at it, the family will persist and IMO, it's better to take help offered by the Schiavo family and their foundation right now than to keep this going in the public arena.

Let Jahi have some dignity. Her family feels wronged, and I am beginning to see why. CHO is using a very abrasive man to get their message across to a grieving mother, IMO.

 

[MLO]

The issue is placing a feeding gastrostomy tube into her stomach by doing a surgical procedure to incise the skin and with the use of an endoscope in the stomach, guide the tube through the skin and secure it into the stomach.

This is a surgical procedure. It needs to be done by physicians (usually gastroenterologists) and it is normally done with anesthesia in an operating room.

Just like with a tracheostomy tube, I do not believe any physicians on that staff will want to participate in this with a person declared legally dead.

There is also the issue of how one manipulates a feeding gastrostomy in a person who has no muscle tone and markedly reduced peristalsis. This is just a nightmare scenario for infection, aspiration, perforation, or any other recognized complication. Then, do you "treat" a complication in a body whose brain is now the texture of custard and has no voluntary respirations or cardiac activity?

Huge slippery slope here and the hospital cannot acceed to the maudlin show coached by the attorney and put on by the family for full media play.

This is an abomination and needs to stop.

While I agree, you really should have used a less appealing food than custard. Now I want custard, but I'm not quite sure I'll be able to get that image out of my head.

 

[Herat]

What exactly is an outpatient center, they dont have a building ready for patients.....:banghead:

An outpatient center does not meet state or federal regulations for the overnight stay of patients. It would need to have to meet all sorts of design, size, construction, and permit requirements, as well as provide all sorts of medical equipment, specific bed requirements, medical supplies, etc.

The requirements are very specific- the size of the doors and their fire rating, the type of material that can and cannot be used on the flooring, etc.

The list of regulations runs into hundreds of pages and there is not way in hello that what has been described can possibly take care of any incapacitated person.

It is a huge tell on the lack of options availble that the attorney or family would even mention this as it is not at all a serious consideration, and it emphasizes the devious intent of the attorney and family in trying to play the hospital.

Children's Hospital would like nothing more than to have the body of Jahi leave. However, they are not going to be goaded into participating into such a charade as this "transfer" proposes.

 

[meme4]

I find it highly absurd they want to place her in a facility run by a hair dresser, isnt even finished being built or renovated, I hope the hospital stands by it stance of not operating on a deceased person,shows them the door ...I think they will regret the decisions that making, they have no idea of whats ahead.....And as for the picture they keep showing claiming she holding their hands, its an illusion...My fathers hands were like that. My sympathies run out for them, when they made this little girl a circus side show.......
.

 

[K_Z]

BBM Iam glad you commented on this! I was hoping you would.
I had lots of questions too.
•what is the length of the flight from California to New York?

Well, a commercial flight is about 4-5 hours. In a small jet, I suspect they would have to stop for gas at least once, maybe twice, depending on the route, the altitude, and the particular jet. (I am not a pilot.) And assuming they didn't have to follow a convoluted flight plan due to weather or other administrative reasons.

• How much duplicate machinery/back up supplies would be required for the flight?

Hard to answer. I don't know what their capabilities are, and what they use for an oxygen source. For example, if you are "hand bagging" a vent patient during transport on or off, or during time on the ground, you use much more oxygen than the vent uses. Most vents are pretty efficient. But you have to plan for emergencies, delays, etc.

An air ambulance will have their own cardiac monitors, pulse ox, ETCO2, IV pumps, suction, and bags of fluids and other supplies. Transport ventilator, too. They will have back up ETT's and laryngoscopes.

A big risk in transport for Jahi's body would be dislodging the ETT. Who knows if the crew and the doc in attendance are skilled at placing another ETT in a reasonably complex situation, in a patient with an ETT sitting there with the cuff eroding her trachea for the past 3 weeks?

• How many people would need to be on board in the event of an emergency with Jahi?

I don't know how big their plane is. Probably at least 2 individuals to care for the patient.

• what if the doctor had a health emergency who would back him up?
The flight nurses. We almost never had a doc fly with us when I was doing military airevac. And if we did, they were pretty out of their element, and generally not a lot of help.

•what if for some unforeseen reason she had to be manually ventilated? How long could one person do it alone?

Until they collapsed of exhaustion, I suppose. If the oxygen ran out, they can bag someone with room air. I had to do that once for about 2 hours till we landed. (I had help and med techs to squeeze the bag-- these were military aircraft.) I had a couple missions where the vents weren't working well and we switched to hand bagging for a period of time.

•What effect would the ascent/descent and altitude have on her brain pressure, blood pressure and /or other bodily functions?

From what I know of her situation, I can't see any reason for an altitude restriction. The cabin of most aircraft is pressurized at about 8000ft. The most serious affects on physiology happen in the first 5000 feet ascending. When someone has something like a pneumothorax (an air pocket in the space between the pleura and the lung), it's important to have a chest tube in it, because as the aircraft ascends, the air will expand, and collapse the lung. (Think of potato chip bags inflating on commercial flights-- any gas pockets in the body will expand, such as the colon.) The cuffs of ETT's can be filled with saline, instead of air, to reduce the potential for the cuff bursting or causing more tracheal trauma. I don't know if she has a ventriculostomy, but her brain is already dead, so air expansion intracranially is kind of a non-issue.

I have no idea what effects acsent would have on her body's blood pressure, since I don't know how her body is behaving now. I have transported dead bodies, but we weren't trying to keep them alive anymore. I had one pt die past the j-point on the way to Hickam (too far to turn around or divert), who was a DNR, but wasn't on a vent. Family was trying to get him back to the US before he died. We covered him with a blanket, and he was "officially" pronounced dead on the ground in HI. You can't call an inflight emergency for a DNR who dies. Interestingly, you can be born in flight-- birth cert shows longitude and latitude. But you cannot "die" in mid air. But I digress...sorry.

• What about autonomic dysreflexia. I know she is brain dead but can she have problems like quadriplegics do?

Yes. Those reactions are mediated by the spinal cord independently of brain function.

• Will ventilator settings need to be tweaked during takeoff and landing?
Probably. Depends on what the goals for therapy are. Are we going for a certain set of vital signs, O2 sat, ETCO2? How aggressively are we going to treat anything? BP, heart rhythms, etc. Do we do CPR if her heart arrests? Use electricity? Drugs?

*I just don't see this plane ever leaving the ground.

I agree.

• Who would be held responsible if her heart stops beating on its own during the flight?

God? IDK. I really have no idea of the legal ramifications of caring for and transporting a person declared dead.

Moo
Sent from my SGH-T679 using Tapatalk 2

My comments in blue.

 

[Zuri]

http://www.contracostatimes.com/new...terri-schiavo-group-secretly-leading-transfer

The new facility is going to need more than a pediatrician on staff. This is a facility dealing with TBI, not brain death. IMO, The facility is going to have to be inspected, have protocols in place, meet OSHA guidelines, etc. Every single staff person will be required to know CPR down to knowledge of medical waste and infection control. Who is qualified enough to supervise all this? If Jahi codes, they call 911 and she is transported to the ER where the treating physicians will face resuscitating a brain dead person? OMG.

JMO, JMV, IMO

 

[Zuri]

My comments in blue.

OT: I just wanted to thank you for your service to our country. Being a flight nurse is not for the feint of heart. Thank you...

 

[Softail]

I find it highly absurd they want to place her in a facility run by a hair dresser, isnt even finished being built or renovated, I hope the hospital stands by it stance of not operating on a deceased person,shows them the door ...I think they will regret the decisions that making, they have no idea of whats ahead.....And as for the picture they keep showing claiming she holding their hands, its an illusion...My fathers hands were like that. My sympathies run out for them, when they made this little girl a circus side show.......
.

Ahh.. Meme. I have to say I like your avatar much better now!

I don't think Jahi will be going anywhere. The family and attorney have been playing games for days... and it continues. It is pathetic and sad on so many levels.

My continued hope is for Jahi. That this circus stops and she can rest in the peace she so deserves. :rose:

 

[Karmady]

The new facility is going to need more than a pediatrician on staff. This is a facility dealing with TBI, not brain death. IMO, The facility is going to have to be inspected, have protocols in place, meet OSHA guidelines, etc. Every single staff person will be required to know CPR down to knowledge of medical waste and infection control. Who is qualified enough to supervise all this? If Jahi codes, they call 911 and she is transported to the ER where the treating physicians will face resuscitating a brain dead person? OMG.

JMO, JMV, IMO

Anyone venture a guess as to who the pediatrician they're hiring might be. :facepalm:

 

[Karmady]

I find it highly absurd they want to place her in a facility run by a hair dresser, isnt even finished being built or renovated, I hope the hospital stands by it stance of not operating on a deceased person,shows them the door ...I think they will regret the decisions that making, they have no idea of whats ahead.....And as for the picture they keep showing claiming she holding their hands, its an illusion...My fathers hands were like that. My sympathies run out for them, when they made this little girl a circus side show.......
.

No kidding, huh? Absurd and ghoulish. I literally almost can't believe these events are happening. I agree with whomever has said I think it's time that the mother gets some serious personal counseling or treatment. I'm not being sarcastic or disrespectful. I mean it 1000% jmo