TX - pregnant wife unresponsive on life support, husband hopes to fulfill her wishes

[jjenny]

BBM

Just guessing here waiting for the med or path'ist folks to ring in.

IF MM lives until the point where there is a C section, and IIUC, then
after C-section delivery, two things.
1. No private med ins, no fed or st ins/program will pay for further procedures, because MM is dead.
I imagine some OR team members would be willing to do some procedures to staunch bleeding/seeping, and close MM, etc.
But I dont think they may lawfully do so.

BUT more importantly
2. As soon as the baby is delivered, all/virtually all med procedures must stop.
MM was already dead before and her remains must be transferred to the MedExam'r.
As med folks here said, they need to leave tubes, ports, etc. in her, so ME can do proper exam.
MM is a 'coroner case.' Maybe med folks doing anything further would be deemed to be destroying evd?

MM's remains are not the equivalent of dept store merchandise,
which a store employee can generously gift wrap for free, as a favor for a customer.

I may be all wrong and await correction or clarification by the med/path folks or anyone else who knows. :seeya:

She is already dead. What exactly is going to change after a c-section? I don't know of any lawys that would prohibit a surgical team from doing a proper surgery on her. Why exactly must everything stop? They could complete the c-section, and then turn off life support after whatever period of time they deem necessary.

 

[Linda7NJ]

More links.



http://www.slate.com/articles/healt...tion_how_to_save_the_mother_and_the_baby.html



http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516125/



http://www.nytimes.com/2014/01/19/opinion/sunday/bruni-the-cruelest-pregnancy.html?_r=0







BBM

From the second link

All these points should be discussed with the family, particularly the next of kin who has the authority to make decisions about the disposition of the body of the dead woman and the father of the baby who will have to take care of a baby who may be born with a significant neurological impairment. Fully informed consent of the next of kin is required. However, conflicts may arise if the father requests continued somatic support while the woman’s next of kin objects. In the United States, courts usually uphold the father’s request.25


I fully agree with the above. That's the way it should be.


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[hambirg]

Do hospitals abort from a normal (non-brain dead) patient after 22 weeks when a fetus is viable but abnormal?

NO, a disabled person has the same "rights" as anyone else. Of course a mother can choose, within the bounds of the law, to have an abortion if a child is disabled. But no one else can make that choice. The physicians can't say, well this child will be disabled so we are going to abort it. There are some really interesting cases regarding anencephalic babies.

 

[al66pine]

BBM. There is no reason to keep her body functioning, or her heart beating, once the fetus is cut from her body, and the umbilical cord cut.

The nurses will do their best to clean her up before tagging her body, and wrapping it and doing the paperwork before she is moved to the morgue. But she will be a bloody mess that will continue to seep and soak thru any wadding or packing that can be applied. There will be no effort to stop hemorrhage, give Pitocin to clamp down a flaccid uterus, etc. She is dead. She will be even "more dead" when the baby is cut out. Except that in her "second" death, she is now a coroner's/ ME case. So all tubes will be left in place, and I doubt that even the C-section incision will be sutured. They will pack her full of lap sponges to soak up the amniotic fluid and blood.

And, BTW, there won't be a nice "bikini" pfannenstiel incision. It will be a huge midline incision from the bottom of the ribs to the symphysis pubis. Flayed wide as possible. There is no earthly reason to do a pfannenstiel incision to preserve the uterus-- she isn't having any more kids. Rapid exposure will be necessary to get the fetus out as quickly as possible. It will be a bloody mess.

But we will never hear the story of MM's last moments in the OR. All that will be broadcast and covered is the story of the fetus. MM will be invisible as soon as the cord is cut. She is the decanting jar in this brave new world.

jjenny
Per K_Z, ^^^^MM is coroner's case.^^^^

I hope some med /path't folks can ring in here re my question/comment in my post ~ 1 hr ago:

As soon as the baby is delivered, all/virtually all med procedures must stop.
MM was already dead before and her remains must be transferred to the MedExam'r.
As med folks here said, they need to leave tubes, ports, etc. in her, so ME can do proper exam.
MM is a 'coroner case.' Maybe med folks doing anything further would be deemed to be destroying evd?

MM's remains are not the equivalent of dept store merchandise,
which a store employee can generously gift wrap for free, as a favor for a customer.

Sorry for raising my voice. I'll use my inside voice now. :seeya:

 

[jjenny]

She is coroner's case now.
She is legally dead.
Yet the procedures are being done on her.
I fail to see why all of the suddent something is going to change after a c-section.
I don't follow this logic, sorry.
What evidence is going to be destoryed? At this time she has already been legally dead for weeks.
Why would the concern about destrying evidence arrise immediately after the c-section, but not prior? Using that kind of logic, nothing can be done to her now, and obviously that is not the case here.

 

[alwaysonmymind]

The family will be there for the c-section AND will want to see Marlise when it's done. MOO

JPS will not leave her a bloody mess as is being described in this thread. moo


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[al66pine]

She is coroner's case now.
She is legally dead.
Yet the procedures are being done on her.
I fail to see why all of the suddent something is going to change after a c-section.
I don't follow this logic, sorry.
What evidence is going to be destoryed? At this time she has already been legally dead for weeks.
Why would the concern about destrying evidence arrise immediately after the c-section, but not prior? Using that kind of logic, nothing can be done to her now, and obviously that is not the case here.

BMM

Now things are being done to MM's body to maintain the fetus.

After c-section, there's ro reason for med personnel to
'do things' to MM's body, because there is no fetus to maintain and the remains are transferred to the coroner/ME.

In the meantime, per TX law, med personnel 'do things' to maintain fetus, although it may destroy evd re MM's COD and MOD.

JM2cts and I may be wrong.
Hope the med/path't folks can correct me or clarify for all of us.
Or maybe the legal crowd will.

 

[jjenny]

BMM

Now things are being done to MM's body to maintain the fetus.

After c-section, there's ro reason for med personnel to
'do things' to MM's body, because there is no fetus to maintain and the remains are transferred to the coroner/ME.

In the meantime, per TX law, med personnel 'do things' to maintain fetus, although it may destroy evd re MM's COD and MOD.

JM2cts and I may be wrong.
Hope the med/path't folks can correct me or clarify for all of us.
Or maybe the legal crowd will.

Well if we are going by TX law, it certainly doesn't say that life support must be stopped immediately after a c-section.

 

[hambirg]

The "quality of life it deserves?" What does that mean?

Some babies "deserve" a different quality of life than others?

What makes a baby deserving, or not deserving, of some criteria, or level of care, that defines quality of life?

It's not just the baby who will suffer if the baby is profoundly damaged., and with a life time of pain and suffering. MM's husband, existing son, parents, friends and family, and every health care worker who cares for that child will share in the vicarious suffering the State of Texas will have created, against the will of the mother, and her husband.

The state of Texas will not suffer at all, whether this fetus lives, or dies. Politicians will not suffer. Rabid pro-lifers will not suffer. They will celebrate the delivery of a beating heart, no matter the collateral damage. And go on to stick their noses into the next womb with a public view. And then completely forget about the child and family that remains. They get to walk away and forget. That's a nice privilege, they have given themselves, IMO.

Red and BBM

Everything in red negates what you posted in bold.

I'm not trying to pick on you. But it's an issue I feel VERY strongly about. Working with the severe, profound population is my niche in life. It's what I do. And I find most people don't understand it. "What makes a baby deserving, or not deserving. . ." Exactly! Who is to say "a life time of pain and suffering?" I will tell you from experience, that those I work with, have the same moments of profound joy, sheer happiness and experience love the same as anyone else. Their lives have meaning, if nothing else to teach the rest of us. Yes, sometimes they have pain and suffering, but don't we all? I suffer from a chronic pain condition. Does that make my life somehow less valuable? Does that mean that others should be able to make value judgments about my life? Am I suppose to be pitied and put out of my misery?

As far as the family suffering, it's the same choice anyone makes when they choose to have unprotected sex. Not every baby is born healthy. The fathers are still responsible and they don't have any choice in whether the woman chooses to have an abortion. The responsibility is still theirs. Munoz is not different than any other man who might be the father to a baby with issues. You ever watch Maury ?(yeah, I watch it occasionally :blushing Same thing. Dumb fathers claiming that the child with CP can't possibly be theirs. . .and then the DNA test proves that it is. Are we suppose to believe that because the child isn't perfect that the father just gets to walk away if the mother doesn't choose to abort? That's the argument?

 

[al66pine]

The family will be there for the c-section AND will want to see Marlise when it's done. MOO

JPS will not leave her a bloody mess as is being described in this thread. moo


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Maybe someone like K_Z or ? can tell us if this c-section is likely to be done in hosp location
where family could see her,before she is transported to coroner for ME to conduct exam or autopsy,
which will apparently precede funeral home and final arrangements.

Thx in adv. :seeya:

 

[NevadaMom]

She is coroner's case now.
She is legally dead.
Yet the procedures are being done on her.
I fail to see why all of the suddent something is going to change after a c-section.
I don't follow this logic, sorry.
What evidence is going to be destoryed? At this time she has already been legally dead for weeks.
Why would the concern about destrying evidence arrise immediately after the c-section, but not prior? Using that kind of logic, nothing can be done to her now, and obviously that is not the case here.

Their only concern is that of the fetus. Once the fetus is out then there is nothing to do to the deceased mother, no extraordinary measures to be taken. In the JM case the hospital didn't want to do a vent or g-tube because it goes against ethics to do a procedure on a corpse. I suspect it's sort of the same here. There's also no point in closing the body when the ME will be doing an autopsy.

 

[Karmady]

BMM

Now things are being done to MM's body to maintain the fetus.

After c-section, there's ro reason for med personnel to
'do things' to MM's body, because there is no fetus to maintain and the remains are transferred to the coroner/ME.

In the meantime, per TX law, med personnel 'do things' to maintain fetus, although it may destroy evd re MM's COD and MOD.

JM2cts and I may be wrong.
Hope the med/path't folks can correct me or clarify for all of us.
Or maybe the legal crowd will.

her cod/mod is not suspicious. They don't need evidence of anything.jmo

 

[al66pine]

her cod/mod is not suspicious. They don't need evidence of anything.jmo

Kar,
Basically agreeing w you here on a common sense basis, but -

per K_Z, MM is a 'coroner's case.'
As I understand that, it means MM's death falls into a category for which the hosp must notify coroner/ME re MM's death.

Then the coroner/ME may decide to investigate further, perhaps conduct an autopsy, perhaps not.

I've not searched for TX statutes re specific categories of deaths to be reported to coroner.

 

[K_Z]

The family will be there for the c-section AND will want to see Marlise when it's done. MOO

JPS will not leave her a bloody mess as is being described in this thread. moo


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There isn't some kind of "inalienable right" for a family member to be in the OR even during "regular" C-sections. It is entirely up to the hospital, doc, crew, and circumstances whether or not a family member is "invited" into the OR. I've done plenty of C-sections with, and without family members there.

Because things are so contentious between EM and the hospital, I think it's possible he might be invited to be in the location that the baby is brought to. But I cannot imagine ANY circumstance where he would be invited to be in the room when the fetus is delivered. I may be wrong about this, but it seems inconceivable to me that this could happen. For a large number of reasons.

And I don't want my words about "bloody" to be misinterpreted. OF COURSE MM's body will be cleaned up after the C-section. OF COURSE all of the amniotic fluid and blood that is able to be cleaned up will be. OF COURSE she will be packed with absorbent gauze, and wrapped with plastic barriers to contain the seepage, both abdominally and on the perinuem. The nurses will do everything permissible to make her look her best. But the fact remains that bodily fluids will seep from her for quite a while after the C-section is over, and her heart stops. That is my point. A boggy, gravid uterus with a big cut in it will seep. If they remove the placenta, there will be a big open area where it attached that will seep, even after her heart has stopped. The only thing that makes a post surgical gravid uterus stop seeping are oxytocics to clamp down the uterus and tamponade the bleeding. (Unless they do a gravid hysterectomy, which I can't imagine unless there is a clear reason for it.) That won't happen. Unless there is a VERY remote chance she is still a candidate for organ donation, such as kidneys. Her heart will most likely not be considered due to the circumstances of her death-- prolonged cardiac arrest, and the almost certain use of pressors for weeks postmortem to maintain sufficient uteroplacental perfusion pressure.

EM may or may not be allowed to see her after he heart stops. Most families in the case of organ donation (which is the closest situation to MM's) say their good byes before the body of their loved one goes to the OR.

And to address the comments about MM being a potential organ donor, this is what I found. (Also, the coroner would have to sign off on this plan in advance. That is customary. MM is a coroner case due to the particular medical circumstances, not because anyone suspects foul play at this point.)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002294/

Organ procurement and transplant outcome

In three reported cases after successful delivery, organ donation from the brain-dead mother was carried out. In two cases, organ procurement was accomplished after the intrauterine death of the fetus. In yet another five cases, organ donation was performed, but no report about the status of the fetus was provided. In six patients, consent was given by the patient's family to donate heart, lung, liver, pancreas and kidneys. In four donors, no information was given concerning donated organs. The 1-year graft survival in the reported cases was excellent. Only one liver and one pancreas were lost in two patients owing to their primary nonfunction. Finally, in all cases, maternal somatic support was ended either after delivery or after organ donation.

Also, the number of reported cases is too small to define the rate at which intensive care support of the brain-dead mother can result in a healthy infant. The percentage of successful cases cannot be determined, because there are no reports describing failure of intensive maternal support from all medical centers. Finally, it cannot be established whether a relative infrequency of cases such as those that we found in the published literature reflects the rarity of the event, perfect success in all prior situations, reluctance to initiate intensive efforts required to support the brain-dead patient or simply publication bias.

Organ donation and transplant outcome

After the delivery of the fetus, a brain-dead mother should be considered as a potential organ donor. Multiorgan instabilities and extensive critical care therapy lasting for weeks may have endangered the organs and caused complications in the recipients. Nevertheless, if one or more organs are still functioning at the time of delivery, the feasibility of organ donation in such catastrophic cases should not be ignored. As reported by Suddaby et al. [2] in a retrospective review of 252 brain-dead potential donors from 1990 to 1996, five of seven pregnant women functioned as organ donors for 20 transplant recipients. For all of those patients, excellent patient and graft outcomes were reported.

Here is a story from Nov 2013-- the same time as MM's cardiac arrest incident. Only MSM articles-- no journal articles as yet.

http://bigstory.ap.org/article/hungary-baby-delivered-brain-dead-mother

A university hospital in Hungary says a premature but healthy baby was delivered after doctors kept the child's brain-dead mother on life support for three months.

The University of Debrecen said Wednesday that some of the mother's organs — her heart, liver, kidneys and pancreas — were donated to four recipients two days after the delivery.

The mother suffered a stroke when she was 15 weeks pregnant.

BBM. So in this case, the mother's body was maintained another 2 days after delivery of her fetus. This is the only case I can find similar to MM's situation. And the only info on this Hungarian case is very brief MSM articles, not scientific literature.

 

[K_Z]

Maybe someone like K_Z or ? can tell us if this c-section is likely to be done in hosp location
where family could see her,before she is transported to coroner for ME to conduct exam or autopsy,
which will apparently precede funeral home and final arrangements.

Thx in adv. :seeya:

The C/S will be done in the main OR, unless her heart stops suddenly. Then the standard of "care" is to perform an urgent perimortem C/S in less than 4 minutes from the cardiac arrest. Which means that if she arrests in the ICU, they would do a bedside C/S.

I linked articles further up about perimortem urgent C/S.

Here is an article from Slate-- a resident's POV.

http://www.slate.com/articles/healt...tion_how_to_save_the_mother_and_the_baby.html

 

[Linda7NJ]

Thank you K_Z !
I really appreciate all the work you do and information you provide the button wasn't enough!


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[jjenny]

I found multiple articles where brain dead persons on prolonged life support were used as organ donors. Given that Marlise was a paramedic, she could very well be an organ donor.
I am not sure why it's a remote possibility at all.

 

[K_Z]

Kar,
Basically agreeing w you here on a common sense basis, but -

per K_Z, MM is a 'coroner's case.'
As I understand that, it means MM's death falls into a category for which the hosp must notify coroner/ME re MM's death.

Then the coroner/ME may decide to investigate further, perhaps conduct an autopsy, perhaps not.

I've not searched for TX statutes re specific categories of deaths to be reported to coroner.

Cases to be referred to coroner, OCME/ ME.

http://www.coroners.ie/en/CS/Pages/Deaths Which must be Reported to the Coroner

Tarrant County Texas:

http://www.tarrantcounty.com/eMedicalExaminer/site/default.asp

CDC handbook
http://www.cdc.gov/nchs/data/misc/hb_me.pdf

JCAHO Sentinel Event reporting

http://www.jointcommission.org/assets/1/18/SEA_4.pdf

 

[K_Z]

Red and BBM

Everything in red negates what you posted in bold.

I'm not trying to pick on you. But it's an issue I feel VERY strongly about. Working with the severe, profound population is my niche in life. It's what I do. And I find most people don't understand it. "What makes a baby deserving, or not deserving. . ." Exactly! Who is to say "a life time of pain and suffering?" I will tell you from experience, that those I work with, have the same moments of profound joy, sheer happiness and experience love the same as anyone else. Their lives have meaning, if nothing else to teach the rest of us. Yes, sometimes they have pain and suffering, but don't we all? I suffer from a chronic pain condition. Does that make my life somehow less valuable? Does that mean that others should be able to make value judgments about my life? Am I suppose to be pitied and put out of my misery?

As far as the family suffering, it's the same choice anyone makes when they choose to have unprotected sex. Not every baby is born healthy. The fathers are still responsible and they don't have any choice in whether the woman chooses to have an abortion. The responsibility is still theirs. Munoz is not different than any other man who might be the father to a baby with issues. You ever watch Maury ?(yeah, I watch it occasionally :blushing Same thing. Dumb fathers claiming that the child with CP can't possibly be theirs. . .and then the DNA test proves that it is. Are we suppose to believe that because the child isn't perfect that the father just gets to walk away if the mother doesn't choose to abort? That's the argument?

Hambirg, I admire and celebrate the tender loving care you provide to these souls who are among the most vulnerable on earth. Maybe you would not believe it, but I have done my share of caring for the most vulnerable among us, too. Of course they deserve the best that is available. Once they are here, we all have an obligation to care for these souls, and protect them from harm, and suffering as best we can. No one is arguing that point.

My point is that we don't have to intentionally create and produce human beings who will have a lifetime (however long or brief) of pain, suffering, confusion, and discomfort. That is vastly different than providing comforting care to those who are here.

IMO, what the State of Texas has done to MM's body has created an unethical and immoral situation for her, and her fetus, who is now a potential child. She and her husband have the right to choose, IMO. And the State of Texas removed all choice from both of them, and is experimenting with their fetus. Poor MM didn't have the "right" to even be just dead on her kitchen floor. Privately dead, and privately mourned by her loved ones. The state of Texas made her into an object, a public spectacle, a uterus host, and a science experiment, against her will and the will of her husband and family. That is simply, utterly awful, to me.

We may never come to any agreement on this, and that is ok. Really.

 

[LaborDayRN]

While I am holding out hope for the baby. I understand that it's most likely not gonna be a happy ending.


But why would they just leave her body after the c section? Why not clean her up. Even if she isn't leaving the Or alive. Why won't the give her the same treatment as everyone else. That's really awful what you described. I hope that's not how it all happens.

I can only speak from my personal experience. Most nurses I know treat the dying and dead as they would want their own loved ones to be treated. I have cared for many babies who have passed, unfortunately. I've washed them, dressed them and photographed them for their parents. I've clipped locks of hair, and done hand and foot prints. The parents hold them and love them, sometimes for hours and hours. Some of these little ones have been gone from us for some time. We try our best.................

My coworkers who work with adults do the same. It's why we became nurses. We care for our patients.