Family wants to keep life support for girl brain dead after tonsil surgery #3

[BeginnersLuck]

No problem. I think that my original question was misunderstood in that I know that Jahi is not breathing on her own and that she would not breathe or have a heartbeat without the respirator. I'm interested in other bodily functions since Jahi has no brain activity. I hope that one of our verified medical professionals will weigh in on this.

KZ, Herat and others ??? have weighed in on this upthread or in the previous thread. I was just trying to remember who exactly has commented on it from a professional standpoint, so you could review their previous post.

 

[MaybeNotToday]

"Religion" is just another tactic that the attorney is trying to use to fight this is court.

The mother has stated she wants CHO to "fix" her. She has stated that she believes she can recover and has given the courts examples of others, that were not brain dead. The examples that have been provided to the courts are not comparable to Jahi's condition.

They are stalling the court system as much as possible to keep her in ICU at CHO. They have no other viable options, so they are trying to publicly defame CHO to do something that is not only unethical but also illegal and won't happen. The family attorney is very well aware of this. The "right to life" group has jumped on board, again trying to force action against already established laws.

Is any of this in the best interest of Jahi? All these other outsiders, have different interests in hand. Jahi's mother is not mentally capable at this point of making these decisions. She believes Jahi will have a miraculous recovery and she doesn't want to take her home and care for her, she wants her to go to another place, apparently anywhere is ok, where these experimental treatments can be performed on Jahi's body.

My mind equates this to not being able to say goodbye and bury a loved one. Instead, wanting their body to be taken elsewhere and hope that they will miraculously rise from death.

This to me, is a mental health issue. A mental health issue where all these other people, with other "agendas" have climbed on board to further their "own" agenda.

We can't allow those that need mental health treatment and those that have "alternate agendas" to force issues and actions, that break laws that are established.

"This to me, is a mental health issue. A mental health issue where all these other people, with other "agendas" have climbed on board to further their "own" agenda. "

BAM nail on head (IMO)

 

[CCmakes3]

These are my questions too! Why not just allow the 2 procedures they are requesting (both I am told can be performed bedside) .

Really? This surprises me. I mean, I know a trache can be performed in the field with a pocket knife if necessary, but I think these procedures are routinely performed in an OR. I know that a Trache or PEG tube can be replaced or changed bedside, but I think the initial insertion must be done in an OR. Perhaps someone with more medical knowledge can weigh in!

 

[Elley Mae]

No problem. I think that my original question was misunderstood in that I know that Jahi is not breathing on her own and that she would not breathe or have a heartbeat without the respirator. I'm interested in other bodily functions since Jahi has no brain activity. I hope that one of our verified medical professionals will weigh in on this.

Oh I hope so too. 25 days no nutrition. It would seem that organs would some functioning. When my husband's kidney starting failing with out knowing what was happening to his body as the process was happening we could see the changes to his body as it was happening. To the point of a waxy substance coming out of his back that you could feel like small bumps. It was the toxins coming out of his body that the failed kidneys couldn't do. He now has a new (transplant) kidney, thanks to his sister being a match. So yes I am interested in how her other organs can not be failing.


o/t I watched bette davis's dick cavett (1971)interview just yesterday.

 

[jjenny]

The other organs haven't failed yet because ventillator is oxygenating them. Brain dead persons can last for some time on ventillators. One brain dead patient lasted 20 years. Usually it's a lot less though. She is getting sugary water for her nutrition, so she is hydrated.

 

[jjenny]

Really? This surprises me. I mean, I know a trache can be performed in the field with a pocket knife if necessary, but I think these procedures are routinely performed in an OR. I know that a Trache or PEG tube can be replaced or changed bedside, but I think the initial insertion must be done in an OR. Perhaps someone with more medical knowledge can weigh in!

From what is in court documents, court ordered to keep her as she is, not carry out any new procedures on her. Mother's lawyer tried to get courts to order the hospital to do these procedures, all courts refused.

 

[BeginnersLuck]

This document illustrates the basic overall criteria that is used in determining brain death and how it is handled with the family.

http://www.lacusc.org/aso/docs/Priv...th/4. Declaration of Brain Death Syllabus.pdf

Brain Death Documentation Form
Use of the brain death determination form is the preferred method for documenting the results of
examinations for brain death. Each item on the checklist form adopted by the Brain Death
Committee must be addressed. The time and date of the second independent confirmatory test or
examination will configure the official pronouncement of death in the medical record.

Family Notification and Period of Accommodation
It is often difficult for family members to fully understand the diagnosis of brain death and it is very
important for medical providers to use language that clearly communicates the fact that a loved
one, if declared dead by neurologic criteria, is truly dead. Avoiding terms like removal of “life
support” when mechanical ventilation is to be removed is essential to avoid further familial
confusion.

Furthermore, California law grants that a family may request a period of accommodation to
facilitate personal, cultural or spiritual needs after the diagnosis has been made and prior to the
removal of medical support. They are also entitled to a written statement of hospital policy in this
regard upon request. The period of accommodation should be reasonably brief (generally on the
order of hours, not days) and is determined by both familial needs and the existing circumstances
within the hospital at the time of the request. If providers encounter a difficulty in finding an
agreeable time to remove mechanical support, the case should be referred to the unit director for
resolution.

 

[CCmakes3]

I think another reason brain death criteria were adopted is that previously, people who became brain dead stopped breathing and died very shortly so the distinction was never an issue. With the advances of critical care medicine and artificial life support we can now save the lives of a host of people who would have been doomed in the previous generations, and that is something to be thankful for. But the downside is that it doesn't always lead to functional recovery and there suddenly was a whole new subset of patients whose brain is dead and clearly cannot recover its functions but whose heartbeat and respiration could be sustained on machines indefinitely or at least for quite some time. This leads the way to new ethical problems that the previous generations never had before. Is it really ethical and right to keep these patients with no hope of recovery breathing on the machine forevermore? Are they alive or are they dead who do not appear so because of the machines?

In the previous generations brain death and cardiac death were pretty much one and the same since the brain died shortly after the heartbeat stopped and the heartbeat stopped shortly after the brain died because the person wasn't breathing.

Thank you for this articulate explanation. I have to admit it gave me pause when I learned that the criteria for brain death were developed at almost exactly the same time that organ transplantation became possible, but from what I can tell, modern-day positive-pressure mechanical ventilators were also invented at around the same time (early 1960's), so for the first time brain death without cardiac death became possible.

 

[Donjeta]

Dr Byrne (I know I know...) in the court docs is concerned about diabetes insipidus and thyroid and adrenal deficiency (probably attributable to the lack of pituitary hormones).

 

[Herat]

"Religion" is just another tactic that the attorney is trying to use to fight this is court.


They have no other viable options, so they are trying to publicly defame CHO to do something that is not only unethical but also illegal and won't happen. The family attorney is very well aware of this. The "right to life" group has jumped on board, again trying to force action against already established laws.

This to me, is a mental health issue. A mental health issue where all these other people, with other "agendas" have climbed on board to further their "own" agenda.

We can't allow those that need mental health treatment and those that have "alternate agendas" to force issues and actions, that break laws that are established.

Beginnersluck- you have such an ability to clearly describe the issues at hand. Thanks so much.

I wholeheartedly concurr, and have noted the issues that I think are perpetuating this charade.

Too many "special interests" have now attached themselves to this tragedy, and the first and foremost is the attorney and the potential for $$$millions in a wrongful death or other lawsuit. To me, he seems to be throwing stuff against a wall hoping it will stick. The ADA stuff is ludicrous and won't take long to dismiss.

The other special interests are taking up taxpayers time and money and will tie up the court system for months in an attempt to promote their agenda.

Shame, shame.

 

[meme4]

http://www.nbcnews.com/id/8225637/ns/us_news/t/schiavo-autopsyshows-irreversiblebrain-damage/
People can and do believe in whatever they set there mind to believe and nothing will change it...I have seen Terri Shavio's name mentioned. Her autopsy concluded she had, massive irreversable brain damage, she was also blind..Her brain weighed only 615 grams,roughly half the weight of the human brain,and therapy could not help her...Her family still maintains that she could follow a balloon.....She was not brain dead but their was nothing that could help her, Jahi is gone and nothing can help her....
Hope I did this right and not violated any terms.....

 

[Herat]

KZ, Herat and others ??? have weighed in on this upthread or in the previous thread. I was just trying to remember who exactly has commented on it from a professional standpoint, so you could review their previous post.

If there is blood flow, her kidneys will produce urine and it will collect in her bladder, which is drained by a Foley catheter. However, because of the hypotension and anoxia from the massive bleeding, her kidney function is undoubtedly damaged.

She may have some limited peristalsis in the bowel. Limited peristalsis can occur in the absence of CNS function. The bowel can have peristalsis for a short period of time even when removed from the body, such as in surgery.
However, she won't have full lower bowel function and there is probably a rectal tube collecting whatever waste comes through if she is not just in a diaper that is being changed at intervals.

 

[Herat]

Really? This surprises me. I mean, I know a trache can be performed in the field with a pocket knife if necessary, but I think these procedures are routinely performed in an OR. I know that a Trache or PEG tube can be replaced or changed bedside, but I think the initial insertion must be done in an OR. Perhaps someone with more medical knowledge can weigh in!

To do a permanent tracheostomy or a PEG or G-tube insertion, you must be in an OR with adequate visualization. The G-tube requires an endoscopy to be done to safely guide the skin incision.

Once these have been surgically inserted, they can be changed in an ICU setting with proper support.

The pocket knife stuff is only for a life-threatening emergency and is not ever adequate for a permanent tracheostomy for a ventilator-dependent patient.

 

[MaybeNotToday]

I think it's time their pastor makes another statement. It's still my opinion he holds the key to the little girl's peace. I believe the mother is not competent to make these decisions on her own. It may be due to either a personal mental issue pre-existing or as a result of this trauma.

Regardless it's my opinion that her belief system is a result of a deeply ingrained cultural belief. That is why I fear ONLY her pastor can help her overcome these beliefs. It would make the community as a whole to take another look at how they view death, life after death, organ donation etc. This is probably a daunting task to imagine for the pastor. But, IMO could make this tragedy mean something.

 

[Zuri]

Very interesting read:

http://sprocket-trials.blogspot.com/2014/01/jahis-legacy.html

This was a very good read. The only point I was stuck on was the history of possible diabetes and clotting issues. Even if the family was not forthcoming with an accurate medical history, a pre-operative work up is done through lab work. Dr. Zuri said that in patients going for surgery, the lab work he sees includes a CBC, Chem7 and a bleeding time. The Chem 7 includes a blood glucose. The bleeding time determines how long it takes for blood to clot.

My daughter had a tonsillectomy twice because they grew back. The above referenced blood work was done. With Jahi, If there were any abnormal lab values, their indications/implications should have been addressed pre-op. That responsibility would fall on the pediatrician and the surgeon. JMO,JMPO,JMV, MOO

 

[CCmakes3]

From what is in court documents, court ordered to keep her as she is, not carry out any new procedures on her. Mother's lawyer tried to get courts to order the hospital to do these procedures, all courts refused.

Thanks. I do understand and agree with why the courts won't allow it and the hospital won't do it, I'm just questioning the assertion that these procedures can be performed bedside as asserted by the original poster. It would surprise me if that were true.

 

[Elley Mae]

If there is blood flow, her kidneys will produce urine and it will collect in her bladder, which is drained by a Foley catheter. However, because of the hypotension and anoxia from the massive bleeding, her kidney function is undoubtedly damaged.

She may have some limited peristalsis in the bowel. Limited peristalsis can occur in the absence of CNS function. The bowel can have peristalsis for a short period of time even when removed from the body, such as in surgery.
However, she won't have full lower bowel function and there is probably a rectal tube collecting whatever waste comes through if she is not just in a diaper that is being changed at intervals.

bbm, I admit I had to look this up. I am ignorant to alot (a lot) of things but I have witnessed things that I don't know or didn't know the word for. That I have witnessed and it was mind boggling to say the least.

 

[Zuri]

I think it's time their pastor makes another statement. It's still my opinion he holds the key to the little girl's peace. I believe the mother is not competent to make these decisions on her own. It may be due to either a personal mental issue pre-existing or as a result of this trauma.

Regardless it's my opinion that her belief system is a result of a deeply ingrained cultural belief. That is why I fear ONLY her pastor can help her overcome these beliefs. It would make the community as a whole to take another look at how they view death, life after death, organ donation etc. This is probably a daunting task to imagine for the pastor. But, IMO could make this tragedy mean something.

ITA. Someone she trusts that has a firm grip on reality needs to advise her. I am not sure her pastor is going to be the one to do it unfortunately. I think it is going to be the judge. This just seems wrong on so many levels. JMV, JMO

 

[BeginnersLuck]

If there is blood flow, her kidneys will produce urine and it will collect in her bladder, which is drained by a Foley catheter. However, because of the hypotension and anoxia from the massive bleeding, her kidney function is undoubtedly damaged.

She may have some limited peristalsis in the bowel. Limited peristalsis can occur in the absence of CNS function. The bowel can have peristalsis for a short period of time even when removed from the body, such as in surgery.
However, she won't have full lower bowel function and there is probably a rectal tube collecting whatever waste comes through if she is not just in a diaper that is being changed at intervals.

Thank you so much for correcting me by adding the information on blood flow!

Your contributions have been very valuable in assisting to help educate me, on some of these issues surrounding this complex situation.

The legal, ethical and medical aspects of this situation have kept me gripped to this case.

I am so glad to have such great, knowledgeable posters and one place where all this information can be compiled for analysis.

 

[Zuri]

Insertion of a feeding tube and a trach can be defined as "life saving measures". Ethically, morally, medically, legally, I doubt any physician would perform these on a brain dead patient with no chance of recovery. A court cannot force a physician to perform these operations. According to Mr. Dolan's own blog, Jahi has experienced fluctuations in BP and heart rate. Despite court wranglings and a war of words, Jahi may have the final word after all. JMV