Family wants to keep life support for girl brain dead after tonsil surgery #6

[CHERIE.T]

I continue to be puzzled why the concept of "no blood flow to the brain" is so very difficult for so many people to grasp and understand-- not just here, but in general society.

Dr. Fisher's report clearly says a rasdionuclide SPECT blood flow diagnostic test was done, with no flow. There is nothing more definitive than that, save doing an autopsy to SEE the dead brain.

When intracranial pressure exceeds blood pressure for long enough, brain tissue dies. The flow scan will show the tracer in the carotids, and not penetrating any tissue inside the skull. The tissue is not just "not perfused"-- it is not in suspended animation, waiting for blood flow-- the brain tissue is dead.

Back in another thread, a very insightful poster (I can't remember who :blushing:-- Donjeta or Beginner's Luck? ) made the analogy that if it was a finger or limb that did not have any blood flow to it for a month, it would be plainly obvious to anyone with eyes what the state of deterioration of the limb is. You can cut off a dead limb, and the person might live. But without a brain, there is no life. No possibility of recovery. At all. Ever. Functional decapitation.

There is also a rather persistent idea in a large swath of the public that when circulation stops to the brain, it goes into a state of "suspended animation". I have read many comments about waiting for "the brain swelling" to go down, and circulation will be restored, the person will wake up, etc.

It is just so puzzling to me how so many people don't have the most basic grasp of what "cell death" means. Is it because we are so urbanized as a society that a lot of people are removed from the realities of anatomy, birth, death, etc? Not to be too blunt, but why don't otherwise rational people realize that human beings will deteriorate and decompose, just like any other living organism? Have most people really never seen any kind of decomposition of a living organism? Just baffling to me.

But then, some first time moms who watch too many labor and delivery reality shows think labor happens in about half an hour! It's like we humans have urbanized and compartmentalized ourselves so much we think we are immortal, and not subject to the same laws of nature and science as any other living thing! Baffling.

You knocked it outta the park!
From the bottom of my heart.......thank you.

 

[Peliman]

Good thing you're not with a red neck fishing from a creek. They constantly spit. :floorlaugh:

Gotta chum up the water somehow, fish bite better.

BTW: There's a fine line between fishing and standing still.

 

[Isabelle]

Would want to know when the surgeon was notified of a problem and what the response was. If it was anything like the response I got, well, I would not be surprised. It took a call from our PICU Intensivist to the ENT surgeon telling her to get her a&& back to the hospital. There are good and bad everywhere. Don't let me get started on the charge nurse who would not call the neonatologist about a major frank bloody stool from an NICU step down baby (hospital policy was that only the charge nurse could call). That baby almost died. I should have told the parents what happened. I am sorry I was such a coward. BTW the doc freaked and progress notes reflected charge nurse wouldn't call him.

 

[Leilei]

This is the most recent photo, but I don't have the link anymore. I used snagit so I could have a better look at what is going on with the skin. It's on a twitter account that was linked upthread ... if anyone has the link handy? I don't remember the date, but I understand that it is a photo of the sister holding the patient's hand.

http://i160.photobucket.com/albums/t189/zed0101/death3_zpsff65d01f.jpg

I'd like to see the earlier photo. That must be from when she was smiling at the time she was admitted?
I wonder, if she is deceased, would her index finger bend back like that? It looks like a strange bend/angle to me. When I first looked at the photo, I wondered that happened to the rest of the finger.

I can only find the earlier photo on the Facebook page, and I don't think I'm allowed to link it here. It was posted New Year's day, her mother is holding her hand, pink nail polish.

 

[Herat]

I wonder, if she is deceased, would her index finger bend back like that? It looks like a strange bend/angle to me. When I first looked at the photo, I wondered that happened to the rest of the finger.

Looks to me like it has the pulse oximeter on it and is just bent back.

 

[ArianeEmory]

In addition to the above, we've absorbed the fictional trope where the soap opera character emerges from their coma at the most dramatic moment. So we think "coma, he could wake up, maybe the brain will reboot itself or something."

We're just wrong,

 

[MaybeNotToday]

I really cannot bear to see her pictures. Is there a way to prevent the automatic upload from being seen by a poster? I know it's just me being too sensitive - I'm not offended and hope I'm not offending. Just really really sensitive to visuals.

 

[J1981]

Looks to me like it has the pulse oximeter on it and is just bent back.

That's what I assumed too but was too embarrassed to say "plastic monitor thingy" in place of "pulse oximeter".

So yeah, what Herat said

 

[Leilei]

This is the most recent photo, but I don't have the link anymore. I used snagit so I could have a better look at what is going on with the skin. It's on a twitter account that was linked upthread ... if anyone has the link handy? I don't remember the date, but I understand that it is a photo of the sister holding the patient's hand.

http://i160.photobucket.com/albums/t189/zed0101/death3_zpsff65d01f.jpg

I'd like to see the earlier photo. That must be from when she was smiling at the time she was admitted?
I wonder, if she is deceased, would her index finger bend back like that? It looks like a strange bend/angle to me. When I first looked at the photo, I wondered that happened to the rest of the finger.

Looking at the pic closer, it looks like a sensor on her index fingertip. I've had them used on me before. See how there's a light there?

 

[Karmady]

This is the most recent photo, but I don't have the link anymore. I used snagit so I could have a better look at what is going on with the skin. It's on a twitter account that was linked upthread ... if anyone has the link handy? I don't remember the date, but I understand that it is a photo of the sister holding the patient's hand.

http://i160.photobucket.com/albums/t189/zed0101/death3_zpsff65d01f.jpg

I'd like to see the earlier photo. That must be from when she was smiling at the time she was admitted?
I wonder, if she is deceased, would her index finger bend back like that? It looks like a strange bend/angle to me. When I first looked at the photo, I wondered that happened to the rest of the finger.

No, it (the pink nail photo) was after the whole thing started and she was dead but still in the hospital. I wonder when this one was taken.

 

[K_Z]

This is true. We don't know.

I presume we all hope she was taken back to the OR.

I was just thinking, the reason we don't know if she was taken back to the OR or not is because the family hasn't commented on that. We have heard commentary about blood, spitting, buckets, Popsicles, calling for help, etc. Etc. But nothing about the OR. So some assume she was not taken back there and died in picu. *if this is the (seemingly) ONE piece of information regarding post-op that the family is NOT sharing, that's simply not fair to CHO and the doctors/nurses*.

Hope that makes sense. IMO!

Wow! That is an intense thought-- that maybe she WAS returned to the OR, and the family has not said so. It seems unlikely on the one hand-- it is hard for me to believe the family would "en masse" omit that very critical detail.

Nothing about the OR-- AND nothing about the ENT surgery service. I am actually quite bothered that most of the criticisms of "the hospital" come from the uncle, attorney, and family. Only Dr. Durand, chief of pediatrics, has been named by name as someone they are particularly vexed with. No one else by name. Not a single nurse, doc, or housekeeper. That has always been a red flag for me-- that the "entire" facility has been maligned, but only one person named.

And yet, for all of the supposed vitriol toward "the nurses" who let Jahi bleed to death during "shift change", and "required" the family to clean up Jahi's blood, the NURSES of the PICU have been singled out for praise by the family as compassionate.

So I have a hard time reconciling the image of "evil" PICU nurses, with the "compassionate" PICU nurses. And the docs are not mentioned at all. There WERE doc/s present. They ordered transfusions. And the family has NOT slammed the ENT docs in public-- ONLY Durand and "the hospital".

 

[K_Z]

This is the most recent photo, but I don't have the link anymore. I used snagit so I could have a better look at what is going on with the skin. It's on a twitter account that was linked upthread ... if anyone has the link handy? I don't remember the date, but I understand that it is a photo of the sister holding the patient's hand.

http://i160.photobucket.com/albums/t189/zed0101/death3_zpsff65d01f.jpg

I'd like to see the earlier photo. That must be from when she was smiling at the time she was admitted?
I wonder, if she is deceased, would her index finger bend back like that? It looks like a strange bend/angle to me. When I first looked at the photo, I wondered that happened to the rest of the finger.

I'm no expert on this, but that sure looks like skin slippage to me. And definitely altered turgor. My understanding is that it often happens distally first, and moves proximal. Eyelids are supposed to be one of the first signs of skin slippage.

 

[Leilei]

I really cannot bear to see her pictures. Is there a way to prevent the automatic upload from being seen by a poster? I know it's just me being too sensitive - I'm not offended and hope I'm not offending. Just really really sensitive to visuals.

I'm sorry, sweetie, I quoted it twice. It is a disturbing picture to me, too. If I can figure out a way to edit, I will, or maybe a wonderful mod can do it much faster/easier than I can.

 

[otto]

This is true. We don't know.

I presume we all hope she was taken back to the OR.

I was just thinking, the reason we don't know if she was taken back to the OR or not is because the family hasn't commented on that. We have heard commentary about blood, spitting, buckets, Popsicles, calling for help, etc. Etc. But nothing about the OR. So some assume she was not taken back there and died in picu. *if this is the (seemingly) ONE piece of information regarding post-op that the family is NOT sharing, that's simply not fair to CHO and the doctors/nurses*.

Hope that makes sense. IMO!

Was she hooked up for transfusion before the popsicle incident? If not, would that happen in ICU? She received four liters of blood. I just read that the average adult has a blood volume of roughly 5 liters. What is the standard unit for a blood transfusion bag? I guess the most important question is whether everything was ready for a potential transfusion. I'm guessing it was, but in the middle of it all, mom fainted. Apparently the grandmother, who was the second person to use the suction tube, was also at the bed when nurses were trying to look after the patient. I can't imagine the chaos at the time!

 

[otto]

I'm sorry, sweetie, I quoted it twice. It is a disturbing picture to me, too. If I can figure out a way to edit, I will, or maybe a wonderful mod can do it much faster/easier than I can.

Sorry, let me change it to a thumbnail ... bare with me for a minute ... apologies.

I have resized the original, but I can't do anything about the quoted larger image.

 

[Harmony 2]

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[K_Z]

Looks to me like it has the pulse oximeter on it and is just bent back.

With purple polish (sensors don't read thru purple, blue, and red very well) , and the altered turgor, I wonder why a different pulse ox isn't being used? Earlobe? Forehead? etc. That does not look like a very accurate place for the sensor. (IMO) And if her body is clamped down distally, it won't read well, either. (vasopressin or hypotension and altered circulation)

 

[Linda7NJ]

Would want to know when the surgeon was notified of a problem and what the response was. If it was anything like the response I got, well, I would not be surprised. It took a call from our PICU Intensivist to the ENT surgeon telling her to get her a&& back to the hospital. There are good and bad everywhere. Don't let me get started on the charge nurse who would not call the neonatologist about a major frank bloody stool from an NICU step down baby (hospital policy was that only the charge nurse could call). That baby almost died. I should have told the parents what happened. I am sorry I was such a coward. BTW the doc freaked and progress notes reflected charge nurse wouldn't call him.

People are people. There ARE Good and bad in all professions, all races, all walks of life, all income brackets, etc....

Reminds me of the old joke....what do you call a a doctor that graduated last in his class...answer: doctor.

 

[Peliman]

I've been asking myself this question since I have a 34 yr old daughter and 6 yr old granddaughter. What would I advise my daughter if my granddaughter was in the same position as Jahi? It's difficult even typing brain dead, stem dead, no peristalsis.

How many second opinions before I advise my daughter to unplug the vent if I felt my opinion would make it easier for her. I do feel total brain death is dead. It would be difficult to share that opinion with her but based on what I've learned here I would have to.

I want to thank all the professionals here for sharing their knowledge and it helps me understand the issues more clearly, which would be important.

I'm also wondering if there's a lack of clear communication with the general public not knowing exactly what's going on in this case.

I also feel the major networks are more interested in the controversy for ratings and selling ad space. JMO

 

[otto]

Wow! That is an intense thought-- that maybe she WAS returned to the OR, and the family has not said so. It seems unlikely on the one hand-- it is hard for me to believe the family would "en masse" omit that very critical detail.

Nothing about the OR-- AND nothing about the ENT surgery service. I am actually quite bothered that most of the criticisms of "the hospital" come from the uncle, attorney, and family. Only Dr. Durand, chief of pediatrics, has been named by name as someone they are particularly vexed with. No one else by name. Not a single nurse, doc, or housekeeper. That has always been a red flag for me-- that the "entire" facility has been maligned, but only one person named.

And yet, for all of the supposed vitriol toward "the nurses" who let Jahi bleed to death during "shift change", and "required" the family to clean up Jahi's blood, the NURSES of the PICU have been singled out for praise by the family as compassionate.

So I have a hard time reconciling the image of "evil" PICU nurses, with the "compassionate" PICU nurses. And the docs are not mentioned at all. There WERE doc/s present. They ordered transfusions. And the family has NOT slammed the ENT docs in public-- ONLY Durand and "the hospital".

Don't nurses wear name tags? When my son went to ICU, the first thing that happened was I was introduced to the two RNs that were looking after him. One would be seated at the end of the bed, the other one would be at the nursing station in the center of the room. I was told that I could sit quietly beside him. At some time later they explained what I could do ... watch levels. At the very least, do they not know the names of the nurse assigned to the patient?