Family wants to keep life support for girl brain dead after tonsil surgery #7

[Elley Mae]

Diagnosing a brain as “dead” is a matter of determining the function of its most primitive area, the brain stem. The brain stem, the plug of neural tissue at the base where the spinal cord enters the skull, is the body’s plant manager, sustaining systems like muscle tone, metabolic equilibrium and ventilation.

http://www.nytimes.com/2014/01/10/health/the-science-behind-brain-death.html?hp&_r=0

The last step is called an apnea test.
To perform this, doctors allow the carbon dioxide level to slowly increase in the patient’s blood; once the concentration reaches a certain threshold, anyone with a partly functional brain stem will wheeze for breath. This is the true litmus test for brain death, and it can take about 20 minutes, during which doctors must not leave the room even for a moment, said Dr. Panayiotis N. Varelas, director of the neuroscience intensive care unit at Henry Ford Hospital in Detroit.

“If the patient tries to breathe, you abort the test immediately and say the patient is not brain-dead,” Dr. Varelas said.

 

[IrishMom]

Oh, OK, I mis-understood what you wanted to know.
Ambien is kicking in.. as two other people said last night. Now's it my turn LOL.

When reviewing ALL the surgery that the child had just been through, I think it would be next to impossible for her to SWALLOW a bite of solid food without immediately having a strong pain response and regurgitating the food piece.

I cannot say with any degree of certainty that this did occur, though.

It is very possible that she was in the " Twilight Zone" for a while.. Kids are prone to this.. This still does not mean that she did or did not eat anything. We do not know exactly how she reacted from anesthesia or what happened or when. I wish we all had a definitive answer, but my best nurse-guess is that it would have been too painful to swallow, she would have gagged or spit it out.

Thank you! That is more along the lines of what I was thinking. That if she was given food, she would gag or perhaps thrown up. Another thing I find curious is that, in such a setting where several patients are in one "open area" with family present, no one besides this one person (IF he was indeed a witness) has spoken out. With all of the media coverage, I would have thought you'd have at least one or two people who would be chiming in with what they saw. If a patient was in distress and a family was shouting for doctors and there was copious amounts of blood involved, people would have been watching. IF the family was loud and disruptive (as this man claimed, even before the emergency), people would have noticed. Yet no one, not one single person has spoken out either in support of the family OR the hospital staff. Obviously, these people would not be bound by law to say nothing public as CHO is, so why the silence? Would the hospital or a lawyer representing the hospital have urged them to say nothing until a trial? I suspect if the McMath family had an independent witness from the ICU we'd have already heard about it. :dunno:

 

[AnaTeresa]

Jahi is not decomposing, only her brain and brain stem are. As long as there is circulation, any parts that are receiving circulation are not decomposing. She is not a corpse. A corpse has no organ function and Jahi does have organ function. This doesn't mean there is a chance she will recover. I just cannot stand to read articles that speak of Jahi as a corpse. I find this distasteful, degrading and highly disrespectful.

Yes, I'm really struggling with people calling Jahi a corpse as well, for the same reasons. To me, she's not a corpse until her heart stops beating. Perhaps I'm oversensitive, but it seems so disrespectful and degrading to Jahi and her family.

I hope, behind the scenes, Jahi's family has been meeting with their pastor and are seeing the inevitable. I hope that these measures taken at the new facility are helping them process the inevitable and are easing their grief. I hope that Jahi's inevitable decline will help them come to terms with this sad situation. I hope that they feel they have done everything they could for her, and can now let her go.

I hope that they've found some calm in the eye of this sometimes nasty storm. I also hope that the staff at the hospital are doing well. Like many have said, it's a good hospital. Even if there was some negligence on the part of the hospital, Jahi's family has praised many of its staff. I'm sure this situation has been hard on them as well. I'm praying for peace for all, at this point. It's such a sad, sad situation.

 

[popsicle]

Just a friendly fyi but we aren't allowed to discuss comments in msm as they are considered rumor.

 

[nursebeeme]

Just a friendly fyi but we aren't allowed to discuss comments in msm as they are considered rumor.

this is correct

 

[SugarQueen]

Just a friendly fyi but we aren't allowed to discuss comments in msm as they are considered rumor.

Oops! I thought we could as long as we stated it was rumor. My bad.

Sorry Nurse!

 

[meanmaryjean]

BBM

What about what Dr. Flori said in her report?

“She has not had evidence of bowel functioning (sounds) for weeks. Yesterday (January 2), she passed some stool that was clinically consistent with defecation of the tissues lining the bowel (i.e., her body is sloughing her gut).“

Is the "sloughing of the gut" not considered decomposing? Please explain.

The lack of bowel sounds can be attributed to the fact that she had not been fed in several weeks. And the sloughing of the lining is fairly common in people who do not eat for long periods of time. Forgive the following: We get children with what it termed 'short gut syndrome. Usually, they have had a majority of their intestines removed because of a catastrophic overwhelming infection or loss of blood supply in the neonatal period. They live the remainder of their lives with only a special type of IV nutrition called hyperalimnetation. (hyperal)

Hyperal supplies water, carbs, protein, fat, minerals and vitamins - and one can subsist on it for years.

Anyhow, these kiddos will, every now and again, slough off the mucus layer of their inactive bowel. It's nasty, but harmless and normal.

 

[Herat]

It doesnt I suppose but I wondered why Jahi was put back on the vent after they took her off to see if she was breathing. So I found the purpose of this in searching.

After reseaching I found life support is put back on people declared brain dead for the purpose of donating the organs. She was brian dead and she was not breathing.

Why did the hospital put Jahi on life support?

Because the parent's wouldn't take her off by themselves and filed a suit in court to stop them from taking her off of the ventilator.

 

[Herat]

When I was 15 (many moons ago) I had major spinal surgery. After recovery, I was moved to a private room. I was awake, chatting nonsense and absolutely starving. I had had no food in two days at that time and although I couldn't walk and my back was stitched from neck to bottom all I could think of was food. I felt NO pain. Actually, I was high as a kite. It was another 2 days before I was allowed to actually eat, of course, but that didn't stop me from wanting to crawl into the hall and hijack a food cart.

I noticed on one of CNN's articles http://0-edition.cnn.com.library.ccbcmd.edu/2014/01/08/health/jahi-mcmath-update/index.html
<modsnip>

My question is this, for those of you who may have experience with the type of surgery Jahi had... following such a surgery, hypothetically, would a patient still be "numb" enough in the throat area an hour or two later, (or medicated with pain meds) to be ABLE to eat small bites of a burger? I can believe she was hungry. I can believe she may have wanted to eat. But COULD she? Would she actually be able to swallow even small "chunks" of food?

Her post-operative orders would have been very specific about NPO with the exception of ice chips or some other clear, cool liquid-like material for comfort.

Any bits of real food would have been prohibited. She would be able to swallow, to control secretions, but the idea would be to absolutely minimize it. Hence, no talking, no drinking, no food, no chewing.

However, this story is hearsay and we cannot be sure unless it is in sworn testimony in a deposition or in court. MOO

 

[Harmony 2]

Good morning!!!

Please stick to the facts as rumor is not allowed!!!

 

[Herat]

Jahi is not decomposing, only her brain and brain stem are. As long as there is circulation, any parts that are receiving circulation are not decomposing. She is not a corpse. A corpse has no organ function and Jahi does have organ function. This doesn't mean there is a chance she will recover. I just cannot stand to read articles that speak of Jahi as a corpse. I find this distasteful, degrading and highly disrespectful.

Organ degeneration is probably a better term.

I prefer physical remains as a term.

 

[IrishMom]

Her post-operative orders would have been very specific about NPO with the exception of ice chips or some other clear, cool liquid-like material for comfort.

Any bits of real food would have been prohibited.

However, this story is hearsay and we cannot be sure unless it is in sworn testimony in a deposition or in court.

Oh absolutely! I agree without question that it would have been prohibited for her to eat. What I was wondering was if it were even possible with that type of surgery for a patient to be so numb or medicated that if someone did give her food, would she have been physically ABLE to swallow it. I have no experience with "throat" surgery, so I was curious if the possibility existed. You're absolutely right. It is a rumor until verified in court. :seeya:

 

[Herat]

I am not a medical person. I have no courage for what they do. A million years ago when I was 16 yrs old, my grandpa had a massive stroke and was taken to the hospital. We had hopes of recovery. After 3-4 days, the hospital pronounced him brain dead. The family had a conference and told me they would be taking him off of support. I turned into a ball of rage, & disbelief that they could be so cavalier about MY grandpa! I needed to be C.O.N.V.I.N.C.E.D. that this was in fact, the truth of the matter. I was a child - it wasn't my call, but they let me blast out my feelings. My loving and older and more-hurt-than-I family members came to me and with sadness and empathy convinced me that there was no hope for him. I was ignorant of medical science in those years. My loving family talked me out of my fantasy that it would turn out positive. I just never could accept it if it wasn't for their wisdom and kindness in explaining.
Flash forward - I lost my beloved grandma (in her sleep, so they told me, while I was at a hotel catching up on sleep). Then my estranged father (they called me about the funeral, and I missed the funeral because I got lost in Denver Airport and missed the flight).
THEN my mom fell broke her arm and was admitted to the hospital and needed x-rays. She was diagnosed with cancer (from the mri's, etc), and was dead in 6 days (from the cancer). That TIME I SAW AND FELT her leave her "shell" in person. I was in the room with her and had just talked to her 10 minutes before I went to sleep in a recliner next to her bed. It is all terrible. It is all a shock. I never talk about any of this stuff to anyone. I just want to say ws is kind, honest, thoughtful, and caring - and again HONEST about this topic. I can read here and not (really) trigger. You are all so full of wisdom and smart in your different fields. Thank you, each and every one of you......I cant believe it took me so long to get to the truths of these deaths in my life.

You can share it here. As you can see, many of us deal with the mysteries of life and death, and don't have the answers. You're in good company.

 

[momrids6]

Post op: Turbinate reduction:

Bleeding: It is normal to have some bloody discharge for the first 3-5 days after sinus surgery, especially after you irrigate your sinuses. If steady bleeding occurs after surgery, tilt your head back slightly and breathe through your nose gently. You may dab your nose with tissue but avoid any nose blowing. If this does not stop the bleeding you may use Afrin spray. Several sprays will usually stop any bleeding.

http://www.hopkinsmedicine.org/sinus/patient_information/post_procedure_directions.html

 

[Herat]

Post op: Turbinate reduction:

Bleeding: It is normal to have some bloody discharge for the first 3-5 days after sinus surgery, especially after you irrigate your sinuses. If steady bleeding occurs after surgery, tilt your head back slightly and breathe through your nose gently. You may dab your nose with tissue but avoid any nose blowing. If this does not stop the bleeding you may use Afrin spray. Several sprays will usually stop any bleeding.

http://www.hopkinsmedicine.org/sinus/patient_information/post_procedure_directions.html

Her surgery was much more extensive, and these post-op instructions are for a purely outpatient surgery.

They are apples and oranges.

 

[Herat]

Sadly, a month+ after the surgery and no one will likely ever know with a high degree of certainty where the bleeding came from: The tonsillar beds, the palate resection, the tubinate beds......

Objectively, it's the kind of information that would have been helpful to know for future surgeries of this type.

 

[momrids6]

In children, palatal surgery is usually necessary only in cases of extreme obesity.

Palatal surgery
UPPP is the most common procedure for the treatment of OSA syndrome. This
procedure, introduced by Fujita in 1981, consists of tonsillectomy, reorientation of the
anterior and posterior tonsillar pillars, and excision of the uvula and posterior rim of the soft palate.

http://www.uvm.edu/medicine/surgery/documents/Snoring_and_OSA2.pdf

 

[momrids6]

Her surgery was much more extensive, and these post-op instructions are for a purely outpatient surgery.

They are apples and oranges.

I understand that. They sprayed something in her nose according to family.

Post op instructions for patients are usually far easier to understand for an average person without medical training.
Trying to break it down for easier comprehension

 

[ArianeEmory]

They were out in droves today (in front of CVS, Vons, Walgreens) alll wanting me to sigh the petition to raise the cap. They never mentioned Jahi, but the timing is suspect. And, no, I didn't sign it. When asked why, I said if hospitals end up paying millions of dollars on each case, guess who is going to pay for it? You and me via health insurance premiums. No matter how much liability insurance a doctor/hospital has, the trickle down effect could be disastrous.

MOO

Mel

The timing is beyond suspect, didn't someone say last night here that the family lawyer is also on the board of whatever organization is lobbying to get the cap removed?

I know it's coarse to have to say 'follow the money' in a case like this, but...

 

[ItsJustaName]

Sadly, a month+ after the surgery and no one will likely ever know with a high degree of certainty where the bleeding came from: The tonsillar beds, the palate resection, the tubinate beds......

Objectively, it's the kind of information that would have been helpful to know for future surgeries of this type.

I'm not in a health care profession, but wouldn't they have been able to determine the source of the bleeding before she was declared brain dead? If they were able to stop it, they must have been able to determine the source.