Family wants to keep life support for girl brain dead after tonsil surgery #8

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  • #581
Once this poor child is removed from the ventilator, she will simply cease to breathe. No gasp, no agonal respirations. IF she is on a heart monitor, her heart rate will slow. After a couple of minutes, her pulse will stop. Often, there will be what is termed PEA (pulseless electrical activity) on the monitor. No blood is being pumped, and the QRS complexes (the sharp up-and-down EKG spikes) will be come widened and blunted. Eventually (and it sometimes takes 10-15 minutes) even the PEA will stop.

If Jahi's heart stops while she is on the ventilator, it depends on "how closely" she is being monitored, how quickly this is detected, and whether or not they have decided to try to do anything about it.

It is "possible" that her heart and other functions (like pulse oximetry) are not being monitored continuously, if she is in a long term care facility. We have no idea what they are monitoring, and the capabilities of the staff and the facility. Particularly if Mrs. Winkfield had decided not to try to do anything medically if her heart enters an abnormal rhythm-- for instance, if she is on palliative care, she may not be on typical ICU monitoring, but just have the ventilator cycling.

If she is receiving heart monitoring and pulse oximetry, and if appropriate alarm limits are enabled and audible, then if her heart enters an abnormal rate or rhythm, the alarms will sound as the limits are violated. Then the staff would have to decide if they are going to attempt to treat whatever is going on (with drugs, and intravenous fluids, and/ or electricity), or "let her go", or call 911, etc. I have no idea what they have decided to do.

If, for example, they have decided to "let her go", hopefully they will silence alarms, allow family to sit quietly with her body, hold her hands, etc, and at some point an appropriate staff member will quietly turn off the ventilator.

Very seldom does a heart go from a normal rhythm to complete stand still (asystole) abruptly-- it's more likely her heart would experience rate and rhythm abnormalities as a prelude to the final pings of electricity that precede asystole (standstill). That could be minutes, or hours. Often, the final bits of electricity can kick out for 15-20 min or more, once a rhythm has ceased. The other situation, as MMJ explained above, is that the heart continues to put out electricity, but there is no "squeeze" to produce a pulse that can be felt. That is a common ending, too, with that rhythm deteriorating to remnants of electricity that eventually stop.

There is no suffering for someone with brain death. Their color will become pale (most noticeable in the lips and inner mouth, and the palms, in someone with darker complexion), and the skin takes on an ashy, pale color as circulation ceases.

She wouldn't gasp or convulse, if that is what you're asking.

In fact, if she is not on a heart monitor or a pulse oximeter, the staff might not notice that her heart isn't beating well for some time. The vent will continue to cycle, even if her heart isn't beating well enough to circulate blood effectively, or if her blood pressure is very, very low.

I want to add that if she is in a home care, or long term care facility, that the monitors themselves are not as sophisticated as an ICU setting. They may not have any central telemetry monitoring-, but may have a type of transport bedside monitor- meaning, only when someone is in the room looking at her monitor would they be evaluating what is going on. We cannot assume what kind of monitoring her body is receiving, or not receiving, since there is really no "standard of care" for the level of care her body is receiving. Basically, they are free to do whatever monitoring they want, or are capable of doing. I doubt she has continuous arterial blood pressure monitoring, for example-- so may be on intermittent blood pressure cycling using an external cuff (such as a dynamap). They might set that to go off every one minute, or set it to go off every 15 min, or longer, etc. Or just manually cycle the automatic BP when they are in the room.I doubt they have noninvasive cardiac output capability (which uses the ventilator circuit to calculate cardiac output). All of this monitoring is dependent on having staff who understand how to do it, and how to interpret it. We just have no idea what the capabilities are where she is.

Thank you both very much for your professional insight. That makes me feel so much better knowing there wouldn't be signs of a visible "struggle" when Jahi is finally allowed to rest in peace.

Like I said, I have never witnessed death so I have no idea the series of events that takes place while those final moments pass.

I just had this vision of multiple alarms going off, her body convulsing, etc. and her family creating a situation of complete chaos as her body demonstrated all of these "reflexes" that they were told would NOT happen because she's brain dead - and them misconstruing them as "oh my gosh, this is IT...she's coming BACK!!!"

And then possibly finding blame with the doctors at the new facility for not taking extreme measures to keep her alive during her "awakening" - but in reality - it was the FINAL moments of death, not her body miraculously recovering.

I am SO relieved to hear that this will be a very peaceful, calm passing, because although I don't agree with anything this family has done to this point, I wouldn't wish for ANYONE to see their child's last moments to be described as stressful, painful, etc. as they passed through their final moments.

Thank you so much for your insight...I truly appreciate it.
 
  • #582
While Jahi isn't capable, thankfully, of feeling any distress when her heart stops, the living people around her certainly are capable of feeling distress. Whether or not Jahi's family has a peaceful experience when Jahi's heart stops (which it most assuredly will, at some point), depends on the decisions they have made/ are making about what they want to do when that time comes. From what they have demonstrated over the past 6+ weeks, they are in denial about her brain death, and continue to use social media to proclaim her improvement and that she will fully recover. Perhaps they are saying and feeling differently in their private, family moments together. I'm sure we will never know, nor should we.

I think it is probable that Jahi's heart will stop while she is still on the ventilator. I don't see them taking her of the vent, and letting her heart stop. Mrs. Winkfield has said many times that she will not remove the ventilator until her heart stops. And it is definitely possible to have cardiac arrest, and also have a ventilator still cycling and blowing air into her lungs.

If Mrs. Winkfield has decided that Jahi's heart is not a "DNR" (do not resuscitate), they she may have made arrangements with the staff and facility to do whatever they are capable of doing to keep her heart going. That means it could be a very emotional, chaotic situation, as well, if they decided to jump on her chest and do CPR, and attempt ACLS manuvers. As it has been told that she is in a long term care facility, and given that she is legally dead with a death certificate, it is extremely doubtful 911 would transport to any ER. The capabilities of a nursing home, even one with ventilator and IV capability, are extremely limited, when it comes to providing ongoing "ICU" type support during and following cardiac arrest. They might get her heart back for a few minutes, or a few hours more, but there is a limit to how much you can "flog" a dying heart in a brain dead body.

And keep in mind that if Jahi is in a long term care facility, the capability of the nurses (and physicians) is definitely not the same skill level and knowledge level as that of ICU nurses and pediatric intensivists. IOW, most LTC LPN's and RN's nurses are very good at what they do, but they are not ICU trained and skilled. They would have a very limited ability to know how to run vasoactive IV drips and monitor them, if they even had access to vasoactive drugs in their facility, etc. Long term care facilities don't have the kind of pharmacy support that acute care hospitals do. There is probably no physician in house 24/7 to tell the nurses what to do (if the doc even knows what to do), beyond BLS, and possibly some ACLS interventions.

What I am getting at is that the stopping of Jahi's heart could indeed be a very chaotic event, and it is also possible that Mrs. Winkfield might "blame" them for not being able to resuscitate Jahi's heart when it happens.

I genuinely hope that the staff "there" is preparing the family for the inevitable, and talking about how to make Jahi's cardiac arrest be as peaceful as possible for the family. I hope this, but I also strongly doubt that anyone is willing to do the intervention with the family that is necessary to get them to the point where they will face reality. Anyone who doesn't speak their party line that Jahi will recover, is summarily dismissed as being "negative", and a "hater", and not trusting God to resurrect her.

All that means is that when cardiac arrest does happen, the family's emotional coping will be hampered even more, and for much, much longer. I wouldn't want to be one of the staff caring for Jahi's body-- I wouldn't trust this family's reactions, based on their conduct over the last 6 weeks.
 
  • #583
MMJ, could you make any kind of an estimate about what Jahi's pulse ox numbers would be? thanks

After (IF) the vent were removed, they would gradually drop. But, a pulse oximeter does not register once there is no pulse OR when the circulation to the periphery of the body is compromised. They are a very limited device in which a lot of people put a lot of stock.
 
  • #584
I thought I read something either in MSM or a court document, stating that while Jahi was still at CHO, there was a scare where her heart became unstable and they had to rush and take measures to get the heart stabilized again. This I believe happened closer to the time that she was moved out of CHO.

I think that Jahi is somewhere where they are able to closely monitor her vitals and provide the care that they were capable of in a ICU setting. At least as far as the monitoring and adjustment of medications. IMO, all efforts available are being done to maintain Jahi's heart to continue beating.

I know some may think this is not possible, what facility would do this? What medical providers will do this? How would this be accomplished financially? But, with all that came forward to help enable this to happen and all the connections that they have, whether politically or financially, IMO they have found such a place or set one up.

Although it may be a small minority, this case has shown that there are those that don't believe in the brain death criteria. There are those that feel that a family should be able to decide when death occurs. There are those that believe in miracles and god will heal her. There are those that don't believe she is brain dead.

Some may be having second thoughts about offering to provide care and finances. If they committed for the long term in the beginning, I don't see how they can back out. I've kind of wondered how they would approach the McMaths if finances ran out, care providers became burt out and quit, supplies that were necessary to treat her became difficult to obtain.

I've wondered if there was any inner conflict with providers and organizations that maybe had to turn away other's that have living family members that need care and resources.

Just how long does one provide endless, extraordinary resources, to one family in denial that isn't willing to let go?

Then, there is always the possibility that the extraordinary measures are being encouraged for political or financial reasons, on top of the family denial.

Poor Jahi! Even though she is deceased I feel like she is being used and disrespected.
 
  • #585
My father had cancer and I put him in hospice. He was a big and stubborn man and there was no way I could properly care for him at home by myself. I was the only family member. My main concern was that he was kept comfortable and pain free. I watched my mom die in excruciating pain as a child. Medicine has come a long way since then and I thank god that there have been advances in providing comfort care to the dying.

Medicine has advanced to a point where extraordinary measures "can" be taken to keep those alive that should be let go. Those that have no chance to recover and all the measures that are utilized are only prolonging the inevitable.

These advances in medicine are a good thing, because it can give medical providers extra time to see if lives can be saved for some individuals. For others,
in time and with many tests, it also becomes very obvious that nothing medicine can do will save, reverse or allow for improvement of the person.

There is no reversal from either brain or heart failure. The only difference is a machine, due to modern medicine can be used to keep the heart beating. This machine is a wonderful invention because it has allowed lives to be saved. The machine was not invented to indefinitely prolong the heart beat for deceased people. Because it can keep organs alive after death, medicine realized that those organs could be used to save other people. What a wonderful thing it is to be able to give children and others life because of this machine. A small, very vocal, minority are against organ donation though. This small minority wants to twist things around to make it look like there is a conspiracy behind organ donation. This small minority wants others to be against organ donation so they mislead or lie. Society has the responsibility to see that people are educated so they can make their own well informed decisions.

On one side of the coin, families have rights to say what they want done with loved ones that can't make decisions for themselves. From the other side of the coin, when may family members choices become cruel by prolonging pain and suffering or disrespectful to the deceased by desecrating their body?

I think their are times when courts have to step in and take over for the patient, just like when a child or adult is being abused. This is why we have child and adult protective services, because there are times when caregivers are not capable of making the best decisions and the decisions they do make cause harm.

My father held on for a long time in hospice without a vent or anything other than comfort measures. He was able to communicate if he was in pain or not and treated accordingly. I could never imagine putting my dying father on a vent and prolonging his pain and suffering or prolonging the inevitable. That IMO, would have been cruel and selfish. I cannot comprehend the thought of my family indefinitely keeping a vent on my body after I have died, cutting on my body and pumping my body with drugs, while it slowly decays. Would any human being want that?

I would hope in that event someone would step in and take over and put me to rest. I would hope that they would provide counseling to my family to help them work though their grief in a healthy manner.
 
  • #586
I viewed the video several times watching the primitive spinal reflexes react to the ice on the feet. I kept looking at the toes. I don't know whether it was the lighting or what, but several of the toes looked quite a bit darker than the others, mainly the pinkie and 4th toes.

Did anyone else notice this or is it my poor eyesight/imagination? The pallor of her exposed leg? TIA
 
  • #587
I viewed the video several times watching the primitive spinal reflexes react to the ice on the feet. I kept looking at the toes. I don't know whether it was the lighting or what, but several of the toes looked quite a bit darker than the others, mainly the pinkie and 4th toes.

Did anyone else notice this or is it my poor eyesight/imagination? The pallor of her exposed leg? TIA

Yes I saw it as well. Her right foot the toes are much darker.
 
  • #588
While Jahi isn't capable, thankfully, of feeling any distress when her heart stops, the living people around her certainly are capable of feeling distress. Whether or not Jahi's family has a peaceful experience when Jahi's heart stops (which it most assuredly will, at some point), depends on the decisions they have made/ are making about what they want to do when that time comes. From what they have demonstrated over the past 6+ weeks, they are in denial about her brain death, and continue to use social media to proclaim her improvement and that she will fully recover. Perhaps they are saying and feeling differently in their private, family moments together. I'm sure we will never know, nor should we.

I think it is probable that Jahi's heart will stop while she is still on the ventilator. I don't see them taking her of the vent, and letting her heart stop. Mrs. Winkfield has said many times that she will not remove the ventilator until her heart stops. And it is definitely possible to have cardiac arrest, and also have a ventilator still cycling and blowing air into her lungs.

If Mrs. Winkfield has decided that Jahi's heart is not a "DNR" (do not resuscitate), they she may have made arrangements with the staff and facility to do whatever they are capable of doing to keep her heart going. That means it could be a very emotional, chaotic situation, as well, if they decided to jump on her chest and do CPR, and attempt ACLS manuvers. As it has been told that she is in a long term care facility, and given that she is legally dead with a death certificate, it is extremely doubtful 911 would transport to any ER. The capabilities of a nursing home, even one with ventilator and IV capability, are extremely limited, when it comes to providing ongoing "ICU" type support during and following cardiac arrest. They might get her heart back for a few minutes, or a few hours more, but there is a limit to how much you can "flog" a dying heart in a brain dead body.

And keep in mind that if Jahi is in a long term care facility, the capability of the nurses (and physicians) is definitely not the same skill level and knowledge level as that of ICU nurses and pediatric intensivists. IOW, most LTC LPN's and RN's nurses are very good at what they do, but they are not ICU trained and skilled. They would have a very limited ability to know how to run vasoactive IV drips and monitor them, if they even had access to vasoactive drugs in their facility, etc. Long term care facilities don't have the kind of pharmacy support that acute care hospitals do. There is probably no physician in house 24/7 to tell the nurses what to do (if the doc even knows what to do), beyond BLS, and possibly some ACLS interventions.

What I am getting at is that the stopping of Jahi's heart could indeed be a very chaotic event, and it is also possible that Mrs. Winkfield might "blame" them for not being able to resuscitate Jahi's heart when it happens.

I genuinely hope that the staff "there" is preparing the family for the inevitable, and talking about how to make Jahi's cardiac arrest be as peaceful as possible for the family. I hope this, but I also strongly doubt that anyone is willing to do the intervention with the family that is necessary to get them to the point where they will face reality. Anyone who doesn't speak their party line that Jahi will recover, is summarily dismissed as being "negative", and a "hater", and not trusting God to resurrect her.

All that means is that when cardiac arrest does happen, the family's emotional coping will be hampered even more, and for much, much longer. I wouldn't want to be one of the staff caring for Jahi's body-- I wouldn't trust this family's reactions, based on their conduct over the last 6 weeks.

:sigh: This is EXACTLY what I was hoping wouldn't/couldn't happen. I keep picturing the family screaming and shouting for someone to "DO SOMETHING!!" Added to that, envisioning themselves (or demanding the staff) continue chest compressions for a ridiculous amount of time, or dozens of electric shocks to her heart because they simply can't accept that the end is there.

I guess all I can do is hope that once her heart does stop, that the family lets her go peacefully and doesn't create another scenario in an attempt to find fault with this new facility and it's caregivers. :(
 
  • #589
I viewed the video several times watching the primitive spinal reflexes react to the ice on the feet. I kept looking at the toes. I don't know whether it was the lighting or what, but several of the toes looked quite a bit darker than the others, mainly the pinkie and 4th toes.

Did anyone else notice this or is it my poor eyesight/imagination? The pallor of her exposed leg? TIA

I saw darkness of the toes and it didn't look normal to me but I'm not experienced in these matters to feel comfortable saying anything.

My family and I are all pasty white so thinking of some that I know that have lost circulation, it has been more bluish in color from what I can remember. I visited a friend in a nursing home once that had been on dialysis for years. Some of his fingers were black and you could see the bone. He had all his wits about him and it was horrific to see him experience and go through this.
 
  • #590
Someone posted this on one of the FB pages and I thought it would be good to include here since there has been so much misconception about brain death.

I don't know if it was previously posted here on the thread.

The concept of brain death did not evolve to benefit organ transplants

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652772/
 
  • #591
Thank you both very much for your professional insight. That makes me feel so much better knowing there wouldn't be signs of a visible "struggle" when Jahi is finally allowed to rest in peace.

Like I said, I have never witnessed death so I have no idea the series of events that takes place while those final moments pass.

I just had this vision of multiple alarms going off, her body convulsing, etc. and her family creating a situation of complete chaos as her body demonstrated all of these "reflexes" that they were told would NOT happen because she's brain dead - and them misconstruing them as "oh my gosh, this is IT...she's coming BACK!!!"

And then possibly finding blame with the doctors at the new facility for not taking extreme measures to keep her alive during her "awakening" - but in reality - it was the FINAL moments of death, not her body miraculously recovering.

I am SO relieved to hear that this will be a very peaceful, calm passing, because although I don't agree with anything this family has done to this point, I wouldn't wish for ANYONE to see their child's last moments to be described as stressful, painful, etc. as they passed through their final moments.

Thank you so much for your insight...I truly appreciate it.

-------
I did... but my husbands was very peaceful.
 
  • #592
:sigh: This is EXACTLY what I was hoping wouldn't/couldn't happen. I keep picturing the family screaming and shouting for someone to "DO SOMETHING!!" Added to that, envisioning themselves (or demanding the staff) continue chest compressions for a ridiculous amount of time, or dozens of electric shocks to her heart because they simply can't accept that the end is there.

I guess all I can do is hope that once her heart does stop, that the family lets her go peacefully and doesn't create another scenario in an attempt to find fault with this new facility and it's caregivers. :(

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I honestly think the courts should be able to have authority over cases like this.
I think the Judge tried. This family is out of left field and authorities were fed up. I feel they put everyone including this child through the mill. They are finished with family til they let go! I still think they have her at home. Anywhere else someone would know by secrecy. this would leak out one way or another. This is cruel.IMO
 
  • #593
:sigh: This is EXACTLY what I was hoping wouldn't/couldn't happen. I keep picturing the family screaming and shouting for someone to "DO SOMETHING!!" Added to that, envisioning themselves (or demanding the staff) continue chest compressions for a ridiculous amount of time, or dozens of electric shocks to her heart because they simply can't accept that the end is there.

I guess all I can do is hope that once her heart does stop, that the family lets her go peacefully and doesn't create another scenario in an attempt to find fault with this new facility and it's caregivers. :(

--------
That is exactly what I yelled. I looked at the Nurse and just said you knew, thats why you moved slowly. Then I shut up and sat with him.
 
  • #594
OT. But, I hope everyone affected by the ice storm that hit Atlanta is OK, and that your families are home and safe. Stay warm!!!
 
  • #595
GREAT? she is great? :banghead:

Well, it is possible, I suppose, that each of us defines "great" a little differently. FWIW. :twocents:
 
  • #596
It's all relative I think. Compared to a healthy thirteen year old she is not that great but compared to most other people who have been deceased for six weeks she is looking perky.
 
  • #597
The video of Jahi's feet is at this link.

http://www.mercurynews.com/bay-area-news/ci_25001625/video-claims-show-jahi-mcmaths-feet-move

" Dr. Neal E. Slatkin said,.... spontaneous movements aren't rare in brain-dead patients and can be seen in 50 percent or more of such patients.

The movement, according to Slatkin, could be spinally mediated reflexes or due to irritable nerves or muscle membranes reacting to the application of cold.

The movements are not an indication that she is alive, he said.

"She's brain-dead. She has no thought. She has no ability to control or interact with anything in her environment," Slatkin said. "She's completely dependent on machines and forever will be."


In the video a woman (Jahi's mom?) says "I don't understand how a brain-dead person can do this". Sadly, she does not WANT to understand this because she refuses to listen to those who try to educate her. People explain it to her but she thinks they are just being mean, are lying to her, have a reason to want Jahi dead, etc. But just because she refuses to acknowledge it or be educated on it does not change the facts. Perhaps it will sink in as she watches her "thick" girl transform into a emaciated shell of her former self. But even then, I am sure mom will say this just shows her girl is "growing up", maturing and losing baby fat.
 
  • #598
  • #599
It reminds me of a science experiment, except in this case the question is: how long can a dead body be artificially preserved. I think daily photos should be released so the world can see what a remarkable recovery is possible.

Hi Otto,

I think if Jahi was making any progress, we would have certainly have heard about it by now. My goodness, if she was really recovering, I might even throw a few dollars their way. I don't believe that's the case. I believe she is decomposing just like Marlise Munoz.

In the recent brain death case in Texas (keeping the heart beating to try to salvage the fetus):

Munoz described in a signed affidavit Thursday what it was like to see his wife on life support: her glassy, "soulless" eyes; and the smell of her perfume replaced by what he knows to be the smell of death. He said he tried to hold her hand but can't.

"Her limbs have become so stiff and rigid due to her deteriorating condition that now, when I move her hands, her bones crack, and her legs are nothing more than dead weight," Munoz said.

Read more: http://www.nydailynews.com/news/nat...-life-support-article-1.1591802#ixzz2rsro14Vl

MOO

Mel
 
  • #600
This is not just a denial of brain death, it's a total denial of death. Until or unless there is decomposition or some kind of decay that is obvious, I don't expect the family to concede Jahi is deceased, no matter what any health professionals around them say.

If they're quoting bible passages and expecting Johi to arise then they will not accept scientific reality. It's going to take a facility to eventually say "enough is enough."
 
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