Terri's Starvation Commences: Terri's "Exit Protocol" Begins

Thrown Back ^ | March 18, 2005 | Fr. Rob Johansen

[sionnsar]

After a roller-coaster night and day, in which Congress first appeared to have abandoned Terri, then in which some Congressmen intervened in a last-ditch effort to prevent the feeding tube removal, and Judge Greer again demonstrated his singleminded intent to have Terri die, it comes to this.

According to reports at Blogs For Terri and from the Schindlers, Terri's feeding tube was removed at about 2:00 PM this afternoon.

Congress may intervene next week, but may not. What is certain is that from this moment on, unless someone can unsuccessfully undo the work of Michael Schiavo, George Felos, and Judge Greer, Terri begins dying.

Michael and Felos went on national television a few nights ago, and told viewers that Terri wasn't going to be starved to death, but that she was going to be "allowed to die". I suppose in some Orwellian alternate universe that might be true, but now, in regards to Terri, it is a monstrous, flat out lie. Michael Schiavo said that Terri would peacefully slip away. That too is false. Terri will die a horrible, prolonged death. The document I reproduce below demonstrates that.

The document I reproduce below was prepared by the hospice at which she resides, by their own doctors and nurses. It was produced in anticipation of the first time Terri's feeding tube was removed, in 2001. Anyone reading it with a rudmimentary knowledge of medicine will recognize that in Terri's case, and the cases of many others in similar situations, the so-called "treatment" that is given is in fact not treatment at all. It is a regimen of medication intended to perpetrate an illusion: the illusion that someone is peacefully "slipping away", when in fact they are dying in a painful and brutal way.

The document was given a name by those who wrote it. They called it Terri's "Exit Protocol".

I first published this document last September, when it first came to light. I republish it here so that all can see the truth of what is being done to her.

As I mention below, the document is not yet available on line. However, I will remedy that soon. I will try to have it available online in it's original form within the next few hours. As soon as it is, I will let you know where to get it.




Terri's "Exit Protocol" Discovered In Hospice Documents

Cheryl Ford, RN, a nurse from Tampa who has been very active in the efforts to save Terri's life, recently undertook, on behalf of the Schindlers, a review of medical records from when Terri was first admitted to Woodside Hospice. Woodside Hospice is run by Hospice of the Florida Suncoast. It is of interest to note that Michael Schiavo's attorney, George Felos, was a member of the Board of Directors of Hospice of the Florida Suncoast until the Terri Schiavo case began to attract widespread public attention a few years ago.

In her research, Ms. Ford found a document titled "Exit Protocol" in Terri's file. The document is on Hospice of the Florida Suncoast

"Patient Care Notes" stationery, and is dated April 19, 2001. This document lays out, in clinical detail, the procedures to be followed in bringing about Terri's death by starvation and dehydration.

I reproduce here, in entirety and verbatim, the contents of this document. It was sent to me in the form of an Adobe PDF document. It is not yet available on the web, but as soon as it becomes available I will post a link to it.

The text of the document is in black type, my comments and explanations will be presented in red type

Exit Protocolxxxxxxxxxxxx00038

Patient Care Notesxxxxxxxxxxxxx The Hospice
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxOf The Florida Suncoast

Date

4/19/01xxxxxxxxxxxxxClinical Pharmacy
xxxxxxxxxxxxxxRe: Medication review and symptom management


Pt. is a 37 yo woman in a vegetative state with no apparent signs of distress. Enteral tube-feeding to be discontinued on 4/20/01.

Current Medications:

1. antacid suspension 1-2 tablespoons prn [prn = "as needed"]

2. Naproxen suspension 375 mg Q8* prn menstrual cramps. [Q8* prn = "every 8 hours as needed". Naproxen is a pain-relieving and anti-inflamatory drug. ]

3. Vitamin liquid daily.

Upon discontinuation of enteral feeding the following signs/symptoms may or may not occur. The following is a brief list of symptoms for which to monitor and recommended interventions.

1. d/c ["discontinue"] antacid. d/c Naproxen suspension.

2. d/c Vitamin liquid

3. Monitor symptoms of pain/discomfort. If noted, medicate with Naproxen rectal suppository 375 mg Q8* prn.

Wait a minute! George Felos, Michael Schiavo, and all the other advocates of feeding-tube removal have been saying repeatedly that dying by denial of nutrition & hydration is "peaceful" and "painless". They've both said so in interviews and press conferences, such as on Larry King Live. So if dying by denial of nutrition and hydration is, as Michael said, "painless and probably the most natural way to die", then why is medication needed for pain and discomfort?

4. Signs of compromised skin integrity — continue vigilant skin care, provide moistener to lips, consult wound-care specialist if needed.

As the body dehydrates, the skin loses its tone and dries out. Left untreated, this will lead to cracking and bleeding. The lips are even more sensitive in this respect. "Vigilant skin care" is the liberal use of lotions and moisteners to mask these symptoms. The lips must be continually swabbed with special moisteners, and have lip balm applied to them. In the last stages, though, in spite of such measures, skin breakdown often occurs. Because of the body's debilitated state, normal healing mechanisms do not function. Hence the need to consult wound-care specialists to deal with ulcers and open sores.

5. Signs of dehydration
(A) dry lips, mouth. Swab saliva substitute inside mouth prn. (see next page)

After a few days without water, the body stops producing saliva, necessitating the use of a "saliva substitute" to avoid ulceration in the mouth, and a characteristic foul odor on the patient's breath. The cessation of salivation also leads to other complications which appear in the "pulmonary" section.



xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx00039

Patient Care Notesxxxxxxxxxxxxx The Hospice
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxOf The Florida Suncoast

Date

4/19/01xxxxxxxxxClinical Pharmacy Note — continued

xxxxxxxxxxxxxSigns of dehydration — continued

(B) decreased urinary output - no change in care plan.

While there may be "no change in care plan", one of the effects of dehydration is incontinence. The patient's diapers or "chux" pads will need to be changed more frequently, until such output ceases entirely.

6. Pulmonary
(A) Inability to clear secretions - reposition and swab mouth, consider scopolamine patch behind ear every 3 days.

Dehydration causes the natural mucus secretions of the mouth, nose, and throat to thicken, as the body struggles to protect these delicate membranes. The lack of saliva exacerbates this problem, preventing the normal swallowing of these secretions. These thick deposits can interfere with breathing. The use of the scopolamine patch promotes drying of these secretions, which prevents their build-up, but hastens the breakdown of the tissues.

(B) dyspnea ["difficulty in breathing"] — nebulize low dose 2-5 mg morphine sulfate Q4* prn.

In the last stages of dehydration/starvation, the patient's breathing will become difficult and labored. He or she may even begin gasping for breath, as even the lungs' ability to effect transfer of gases is compromised. Morphine nebulized into a fine spray relaxes bronchial passages and relieves these symptoms. However, because of the resultant decrease in respiratory efficiency, this may hasten death.

7. Multifocal myoclonus or terminal agitation (sometimes caused by electrolyte imbalance). Consider diazepam rectal administration 5-10 mg. May repeat in 4 hours if not resolved then daily - twice daily as needed.

Myoclonus is twitching or spasm of the muscles. Multifocal means "occurring in many different parts of the body". This is usually the result of imbalance in electrolytes, the chemicals, such as salt, potassium, and calcium, which make your bodies internal electrical "batteries" work. Nerve impulses and muscle contractions are governed by electro-chemical reactions utilizing these chemicals. Dehydration causes these chemicals to be out of balance, interfering with normal nerve and muscle function. This can result in nerves and muscles "firing off" uncontrollably, causing spasm. The patient will writhe and become extremely agitated. If you have ever had muscle cramps resulting from strenuous exercise (especially when you have sweat profusely), you have some idea what this feels like. Imagine having this happen all over your body, repeatedly. Diazepam (more commonly known as Valium) is a muscle relaxant

8. Grand Mal seizure, which is highly unlikely given current conditions and lack of contributing factors (meds). Recommend diazepam 15 mg rectally as indicated in seizure management orders.

In the final stages of starvation and dehydration, the same electrolyte imbalances which can cause muscle spasm can also lead to uncontrolled firing of neurons in the brain, according to a similar mechanism. This results in seizures.

Thank you for the opportunity to collaborate regarding this patient's care.

I would observe, in conclusion, that most of the "treatments" described in this Exit Protocol are in fact not directed at easing the patient's true condition, but in masking the symptoms of dying by starvation and dehydration. These treatments are designed to create the appearance of a peaceful "slipping away", when nothing of the sort is happening. The medications hide the fact that the patient undergoes a lengthy and painful deterioration, in which his/her body wastes away cruelly. Remember this the next time you hear or read someone say that Terri should be "allowed" to die.

[bvw]

Every hour minute counts. The President of the US and the Govenenor of Florida must act now with stong and armed police actioon to take Terri into protective custody -- in anticipation of legislative and court action -- otherwise it may be preseumed that Terri's death will be hastened by foul play.

[supercat]

Curiously, feeding tubes are removed everyday but for some reason this case has generated interest where there was none before.......at least not of this magnitude.

Generally, when a feeding tube is removed, it is (or at least is supposed to be) because the body is no longer capable of processing any digested nutrients that enter the bloodstream. Feeding someone in such a case would do no more good than shoving food down the throat of someone whose stomach had a huge unclosed hole in (e.g. from a gunshot or stab wound).

Terri, however, is perfectly capable of digesting and processing any nutrition she receives, and would also likely capable of much improvement if she were given therapy (she's been allowed none for about a decade). Her husband's statements claim that she's PVS, but his actions speak otherwise. Terri is aware of what's going on, but her husband is doing everything possible to stifle her cries for help.

[NautiNurse]

Do oyou know what the purpose of the vinegar soaked rag was?

Is oyou a word? I will defer to your spelling expertise.

[thinkingman129]

Thanks back at you.

Should I now go and check all of your posts, too?

Certainly, you'll find more errors in mine than I would in yours, correct?!

[NautiNurse]

Do whatever you think is best. After your original post, I slipped into a musing about that old glass house, throw stones proverb. :o)

[thinkingman129]

Glass Houses: Reflections are better when your glass is clean and you can see out, as well as within. The view is better when the glass is clean and unobstructed, too.

All too happy to have my errors exposed. Doesn't bother me. Does it bother you?

Or did it make you angry and did you want to retaliate?

[thinkingman129]

One other thought: some of the best puns I've ever seen have been the result of errors.

Errors are not necessarily bad, they're just that, errors.


Sort of like the problems we encounter in life. Our reactions are far more important than the circumstance.