Doctors defend life for Schiavo

St. Petersburg Times ^ | October 25, 2003 | WILLIAM R. LEVESQUE

[NYer]

PINELLAS PARK - She smiles and cries. She recognizes her mom and dad. She is shy around strangers. She likes music and once smiled broadly when her brother told her he met Bruce Springsteen.

This is Terri Schiavo in the eyes of her family.

Mrs. Schiavo's family, doctors for the family and former caregivers held a news conference Friday to counter assertions by the husband, Michael Schiavo, that Terri is in a vegetative state and has no consciousness.

"It doesn't take a doctor to know that my sister reacts to me," said Mrs. Schiavo's brother, Bobby Schindler Jr.

"She listens to me," said Mrs. Schiavo's mother, Mary Schindler.

As the family pleaded its case, the American Civil Liberties Union announced it would join in the representation of Michael Schiavo to help overturn "Terri's Law," the measure passed by lawmakers Tuesday that allowed Gov. Jeb Bush to intervene in Mrs. Schiavo's case.

Bush ordered Mrs. Schiavo's feeding tube reinserted after she went six days without food and water.

"Once the governor thinks it is the proper role of the Legislature and he set aside the judgment of the courts, that requires us to get the courts to declare that is just unconstitutional," said Howard Simon, executive director of the ACLU of Florida.

Michael Schiavo has said that his wife, 39, would not want to be kept alive by artificial means.

Court-appointed doctors and physicians hired by Michael Schiavo's attorneys have testified that Mrs. Schiavo has no consciousness. They describe her groans, the opening and closing of her eyes and her smiles as involuntary reflexes.

That testimony led a Pinellas-Pasco circuit judge to order her feeding tube removed on Oct. 15 before lawmakers empowered Bush to intervene.

Felos said family members often project meaning from random movements and sounds.

"That's a common phenomenon," he said.

Felos said his doctors and others appointed by the court have watched the family interact with Mrs. Schiavo and have not seen evidence of cognition.

"If you look at the hours of video there are many instances where the mother says "Hi, it's mom' to Terri," Felos said. "There's no reaction. Absolutely nothing."

Mary Schindler doesn't believe it and sees a daughter's love for her family every day.

"My daughter is not in a persistent vegetative state," she said. "She is not a plastic plant like Mr. Felos says she is. She is extremely brain-damaged, and she's a human being."

Bobby Schindler said his sister likes John Denver music and smiles when it plays. Before her brain was severely damaged in 1990, Mrs. Schiavo knew her brother loved Bruce Springsteen music. She bought him a Springsteen album in 1978.

After he told her he met the rock musician a year ago, Schindler said, "There was a smile on her face to light up the room. ... She showed elation."

Three doctors who have examined Mrs. Schiavo for the family said they are convinced that she retains some level of consciousness.

Dr. William Hammesfahr, a Clearwater neurologist, said Mrs. Schiavo's eyes fixate on her family and she tries to follow simple commands, such as when doctors ask her to pull against their arm.

"This is a case about a judicial system making an error," Hammesfahr said.

But Felos said doctors used by the Schindlers, especially Hammesfahr, don't have the credentials of physicians on the other side.

In a 2002 order by Pinellas-Pasco Circuit Judge George Greer ruling that Mrs. Schiavo could not recover, Greer labeled Hammesfahr a "self-promoter."

The judge noted that Hammesfahr testified that he had treated patients worse off than Mrs. Schiavo yet "offered no names, no case studies, no videos and no test results to support his claim."

"There is no doubt the judge looked at the credibility of the doctors," Felos said.

Mrs. Schiavo's sister, Suzanne Carr, said she believes her eyes.

Carr said: "It's not my imagination."

[Polybius]

Any thoughts from legal Freepers on this??

Another legal question:

If the so-called "husband" already has a second common-law marriage complete with one kid and another one on the way, wouldn't Terri's parents have a strong case for petitioning to annul Terri's marriage?

The conflict of interest is obvious. Imagine if Terri were to regain some of her faculties with therapy. What would Hubby say to Terri?

"Terri, I'd like you to meet my common-law wife and our two kids.....Well, not our kids as in "you and I" ours......They're our kids as in "her and I" ours ......And....uhhh....We have a nice house....Well, not "you and I" have a house but "we", which has not included you, have a house and.....uhhhhh.......Terri, I'm divorcing you.

[honeygrl]

From what I have read, he's brought the little mistress to meet his wife. Kinda heartless isn't it?

[amom]

"...But Felos said doctors used by the Schindlers, especially Hammesfahr, don't have the credentials of physicians on the other side..."

I thought I'd check into this a bit and see for myself. FWIW

Hammesfahr's Bio
http://www.medforum.com/jobline-srch/lifeline/cv/hammeswm.htm

Image of Hammersahr's Nobel nomination
http://www.floridaneurologicalinstitute.com/images/nobel_nomination8.gif

list of articles written by Hammersahr.
http://www.floridaneurologicalinstitute.com/articles.htm

A couple of favorable stories about patients of Hammersahr using Hammersahr's approach.
http://www.unmc.edu/healthwatch/docs/scripts/reverse.htm

In Oct 2002, he was under investigation for his advertising methods (thanks to MS's atty it seems) "...Identical complaints about his advertising filed in previous years have been found to be without merit by the Board of Medicine..."
http://www.sptimes.com/2002/10/22/TampaBay/Schiavo_case_doctor_t.shtml

[amom]

my apologizes if my post above has already been covered.

[eleni121]

Michael Schiavo has a lot of explaining to do - if what this doctor says is true.

Hopefuly the angle of culpability on the part of this scum's role in Terri's condition will be investigated thoroughly.

What other reason could there be for his relentless fixation to see her dead and cremated?

[MHGinTN]

Michael Schiavo enjoys tormenting his ward. She is the perfect victim for him to play with. Read m. Scott Peck's, People Of The Lie to get a clear picture of the type of monster Michael Schiavo is. Peck's book is quite revealing! You will see the demonic Michael Schiavo in those pages.

[aristeides]

The SCOTUS had no objection to the Connecticut legislature's exercising a judicial function and ordering a new trial in a will contest, setting aside a judicial decree, in CALDER v. BULL, 3 U.S. 386 (1798) .

[aloysius89]

Impressive research on Hammesfahr. What about Felos' doctors?

Important to remember in evaluating truth claims. Focus on the issues that are verifiable and inarguable.

1. Has any rehab been done?
2. Has the husband demonstrated in his actions the regard for his wife's wishes and other promises he may have made?
3. Where experts have expressed opinions is that opinion always the same, i.e. if pro-life then knee-jerk pro-life or if pro-death likewise?
4. Is there demonstrated in the actions of those responsible for her care a respect and regard for the comfort and health of Mrs. Schiavo?

Having ascertained to the best of our ability the plain facts of the case perhaps we should propose Solomon's solution. As both Mr. Schiavo and Mrs. Schiavo's parents have declared an interest in controlling Terri's future a wise judge could offer to cut her in half so that both sides might have her. The one who loves her enough to give her up gets to keep her.

[KosmicKitty]

In Terri Schiavo's case, her personality is gone. All that is left is an empty automaton. It hardly seems a dignified way to live.

Actually, that may not be the case. Below is a link to an article I posted several days ago. It's a study of brain scans of people in a PVS. Very interesting. Basically, even the "learned" doctors don't really know what's going on in there.

http://www.freerepublic.com/focus/f-news/1005899/posts Please click on this link to get to the link to the rest of the article

"Daniel Rios is 24 years old, with wavy black hair, a thick mustache and a glassy stare that seems to look both at you and through you. One day almost four years ago, while he was taking a shower, a blood vessel ruptured in his brain, and he collapsed on the bathroom floor. After emergency surgery, he lay in a coma for three weeks. When he finally opened his eyes, he could not speak or move his body; his head simply lolled. In the months that followed, the doctors monitoring him at the Center for Head Injuries at the J.F.K. Johnson Rehabilitation Institute in Edison, N.J., saw few signs that he had any meaningful mental life. Sometimes he looked as if he were crying. Other times his eyes would follow a mirror passed before his face. On his best days he was able to close his eyes on command. But those days were rare. For the most part he lay unresponsive, adrift in a neurological twilight. "

"One morning just over a year after his accident, Rios was taken to the Sloan Kettering Institute on Manhattan's East Side. There, in a dim room, a group of researchers placed a mask over his eyes, fixed headphones over his ears and guided his head into the bore of an M.R.I. machine. A 40-second loop of a recording made by Rios's sister Maria played through the headphones: she told him that she was there with him, that she loved him. As the sound entered his ears, the M.R.I. machine scanned his brain, mapping changes in activity. Several hours afterward, two researchers, Nicholas D. Schiff and Joy Hirsch, took a look at the images from the scan. They hadn't been sure what to expect -- Rios was among the first people in his condition to have his brain activity measured in this way -- but they certainly weren't expecting what they saw. ''We just stared at these images,'' recalls Schiff, an expert in consciousness disorders at Weill Medical College of Cornell University. ''There didn't seem to be anything missing.'' "

"As the tape of his sister's voice played, several distinct clusters of neurons in Rios's brain had fired in a manner virtually identical to that of a healthy subject. Some clusters that became active were those known to help process spoken language, others to recall memories. Was Rios recognizing his sister's voice, remembering her? ''You couldn't tell the difference between these parts of his brain and the brain of one of my graduate students,'' says Hirsch, an expert in brain imaging at Columbia University. Even the visual centers of Rios's brain had come alive, despite the fact that his eyes were covered. It was as if his sister's words awakened his mind's eye."

[Annie03]

Yes-I just reread that book, what a great point. Definitely a worthwhile read and very eye-opening.

[Moonman62]

Oh yes JUDICIAL activism is ok but never should a legislature legislate.

Why do we even need a legislature?

/sarcasm

[First_Salute]

Affidavit of Carla Iyer, nurse who cared for Terri Schiavo from April 1995 to July 1996
FR page about Terri Schiavo. It includes affidavits by some of the nurses who cared for her, as well as excerpts from the parents' lawsuits on her behalf:

The pages start with nurse Carla Iyer's affidavit. Carla Iyer's license indicates that she is still practicing --- see Reply 53.

Michael Schiavo's sworn testimony that he would spend the rest of his life taking care of Terri --- see Reply 105, item 23 therein.

Nurse Carolyn Johnson's affidavit --- see Reply 78.

Nurse Heidi Law's affidavit --- see Reply 86.

The first time in court, that Michael Schiavo recollects that Terri allegedly had expressed some wish that she would not want to live, was in the year 2000, ten years after her initial medical emergency --- see Reply 124, item 20 therein.

A bone scan ordered by a doctor, and performed on March 5, 1991, just over a year after her initial medical emergency in February 1990, concluded that she suffered from a history of bone trauma --- see Reply 221.

 

[TaxRelief]

The NYTimes has pulled the article. Do you have the full text in cache?

MAGAZINE DESK | September 28, 2003, Sunday
What if There Is Something Going On in There

By Carl Zimmer (NYT) 3905 words
Late Edition - Final , Section 6 , Page 52 , Column 1

DISPLAYING FIRST 50 OF 3905 WORDS - ... Rios is 24 years old, with wavy black hair, a thick mustache and a glassy stare that seems to look both at you and through you. One day almost four years ago, while he was taking a shower, a blood vessel ruptured in his brain, and he collapsed on...

Correction: October 19, 2003, Sunday

An article on Sept. 28 about people with brain injuries or impaired consciousness referred imprecisely to the condition of Daniel Rios, one patient studied, a year after a blood vessel ruptured in his brain. He was minimally conscious, or had some level of awareness -- not vegetative, or showing no signs of consciousness.

[First_Salute]

Recent lawsuit, August 30, 2003 ---

UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF FLORIDA
TAMPA DIVISION
Civil Action No.: 8:03-CV-1860-T-26-TGW

ROBERT SCHINDLER and MARY
SCHINDLER, as parents
and next friends of Theresa Marie
Schindler Schiavo, an
incompetent ward ...

[snip]

VERIFIED AMENDED COMPLAINT

[snip]

FACTS COMMON TO ALL COUNTS

[snip]

23. At the trial of the medical malpractice suit, defendant Schiavo swore that he
would use any recovery of pecuniary damages to take care of Terri for the remainder of
her life. He testified that he was going to become a nurse and devote his whole life to
taking care of her. He presented a detailed rehabilitation plan to the jury, a plan devised
by a rehabilitation specialist.

 

Previous lawsuit of September 22, 2002 :

UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF FLORIDA
TAMPA DIVISION
Civil Action No.: 8:03-CV-1860-T-26-TGW



THERESA MARIE SCHINDLER
SCHIAVO, Incapacitated, by her
Parents and Next Friends, ROBERT
and MARY SCHINDLER,

[snip]

20. In January, 2000, the Petition was tried to Hon. George W. Greer. No
attorney, no guardian ad litem, or any other independent voice represented
Terri at this trial. At this trial, Schiavo remembered, for the first time, that
Terri had told him sometime during the 1980s that she would not want to
survive on "anything artificial."

 

[TaxRelief]

Annulment is brilliant, but the Catholic Church down there is corrupted.

[First_Salute]

Editorials
by Dave Andrusko

"Awakening His Mind's Eye"

"Their evidence suggests that even after an injury that leaves a brain badly damaged, even after months or years with little sign of consciousness, people may still be capable of complex mental activity."
New York Times Magazine, September 28

Professor William Brennan is a pro-life scholar whose academic life's work it's been to illuminate the dark power of destructive language. Dehumanizing the Vulnerable: When Word Games Take Lives helps us understand how a witch's brew of derogatory words mingled with degrading labels and stirred with a demeaning stamp of disapproval works to poison our attitude toward the medically vulnerable.

We see this at work in the case of Terri Schindler-Schiavo. Her husband wishes to have the feeding tube through which his brain-injured wife is fed removed, according to the Associated Press (AP). Various "experts" called by the husband insist Terri is in "persistent vegetative state (PVS)," even though her parents and more than a dozen experts brought in by her parents insist she is not, the AP reports.

This is no mere quibble over words. It's crucial. Under Florida law, if she is said to be in a PVS, there need not be "clear and convincing evidence" Terri would want her feeding tube removed. Terri is, in fact, severely brain-damaged, but that is NOT the same as being in a PVS. (To be clear, pro-lifers would adamantly oppose robbing her of nourishment by removing the tube even if she were in a PVS.)

A local judge has ruled that Terri's feeding tube should be removed at 2:00 p.m. October 15. Unless the rag-tag army of family, friends, and volunteers who have stood by Terri for years find some last-minute legal reinforcements, Terri may have died by the time you read this editorial.

But the PVS label is not the only diagnostic label that opens the door to taking food and fluids away from severely brain-injured patients. Of more recent coinage is the "minimally conscious state." But this is "an inaccurate name for an invalid concept,'' according to Dr. Alan D. Shewmon, chief of pediatric neurology at the Olive View-UCLA Medical Center in Los Angeles.

As reported in the September 28 edition of the New York Times Magazine, Shewmon told Carl Zimmer that "there is no scientific way to draw a line between full consciousness and minimal consciousness, and says he worries that the definition is so broad that it easily encompasses people who are conscious but suffer from other neurological disorders that impair their ability to communicate."

In practice "PVS" and "minimally conscious" are code words for "lives not worth living." It's only a few syllables from there to the ultimate dehumanizing label: "vegetables." And who could be expected to care for "vegetables"?

So the trap we must not fall into is to accept these vaguely defined labels as accurately describing anything. Alas, many physicians, "bioethicists," and ordinary people do give them credence. How to get out of this box? By showing that there is far more reason for hope than they ever imagined for patients so labeled. And that is what Zimmer's article - - "What If There Is Something Going On in There?" - - is all about.

Early on Zimmer alludes to an article that appeared last year in the journal Neurology, titled, "The Minimally Conscious State: Definition and Diagnostic Criteria." Written by neuropsychologist Joseph T. Giacino and 10 co-authors, it fashioned this "new category of consciousness." It is as dangerous to the vulnerable as it is slippery. But, fortunately, ongoing work is revealing that "a vast number of people who might once have been considered vegetative actually have hidden reserves of mental activity." This is also true for people diagnosed in a minimally conscious state as well, Zimmer writes. (Sometimes "impaired consciousness" is used as an all-purpose designation, which is even more open to abuse.)

Thanks to highly sophisticated MRI machines the brains of these injured patients are scanned and then mapped for changes in activity. Let me quote from what researchers found after 24-year-old Daniel Rios (thought to lack "any meaningful mental life") listened to a 40-second loop of his sister's voice telling Daniel that "she was there with him, that she loved him."

"Several hours afterward, two researchers, Nicholas D. Schiff and Joy Hirsch, took a look at the images from the scan. They hadn't been sure what to expect - - Rios was among the first people in his condition to have his brain activity measured in this way - - but they certainly weren't expecting what they saw. 'We just stared at these images,' recalls Schiff, an expert in consciousness disorders at Weill Medical College of Cornell University. 'There didn't seem to be anything missing.'"

As Zimmer eloquently describes it, "Even the visual centers of Rios's brain had come alive, despite the fact that his eyes were covered. It was as if his sister's words awakened his mind's eye." Zimmer likens these scans to "eavesdropping" on the patients' inner worlds. ''It's free speech for people who have no speech,'' Hirsch says.

Theories to explain these "enigmatic hints of awareness" are too complex and too lengthy to go into in any depth. Suffice it to say that higher-level thought (such as language and memory) is believed to occur in networks of neurons located at the surface of the brain in the cortex. According to Zimmer, these neurons "form loops which dip deep within the brain where they converge and then return to the surface."

One theory is that the activity of the loops is "synchronized" by a special set of neurons deep in the brain. When the synchronizers are damaged, "harmony" is disrupted and the brain "slips into a vegetative state." But even after extensive brain damage, Schiff and his colleagues believe, "some of the loops may still

function, though in isolation - - like fragments of mind."

According to Zimmer, in looking for more subjects for his study, "Schiff discovered the Center for Head Injuries in Edison, where Rios is treated. Neuropsychologists there have specialized in tracking how patients recover from brain injuries, moving from comas toward consciousness. Joseph Giacino, the lead author of the Neurology paper that defined the minimally conscious state, is the center's associate director of neuropsychology. He is one of the few doctors who focus on both the study and the long-term treatment of patients with impaired consciousness. 'You come in in a coma, and you can get your treatment all the way to when you're back at work and you still need some follow-up.'"

Given what is at stake, it is almost eerie what one skilled man can do. In some cases, just by working his fingers deep into muscles and stimulating nerve endings, Giacino "can actually coax patients into consciousness." Some diagnosed as being in a minimally conscious state can speak. "Some tell him their names, others tell him to leave them alone. As soon as he removes his hands, they slip away again," Zimmer writes.

The potential implications are staggering. Typically, without outward signs of recovery (often times the wait is no more than a few weeks), such patients are dumped off in ill-suited nursing homes "and they rarely see a neurologist again."

Joseph Fins, who has been exploring the ethical dimension of Schiff's new research, provides Zimmer with one of the great understatements: "It certainly raises the question that there's more 'there' there than we've been giving them credit for,'' he says, adding, 'It's very suggestive that there's consciousness.'''

Near the very end of the story, we learn that, based on his responses to questioning, Rios is said to have "officially emerged from the minimally conscious state." But then there's Fins' very sobering closing observation: "If he ended up in a nursing home and started doing things like this, no one would have noticed.''

When it comes to the debate over those who are brain-injured, we can hope that the work of Schiff, Hirsch, and others is changing the evidentiary ledger.

Where before, only the debit side had entries, now there is an important entry on the credit side. How ironic that it should come from the New York Times!

Dave Andrusko can be reached at daveandrusko@hotmail.com.

 

[TaxRelief]

Political Pawn? No, Terri has become God's pawn in a moral war.

[Deo volente]

"20. In January, 2000, the Petition was tried to Hon. George W. Greer. No
attorney, no guardian ad litem, or any other independent voice represented
Terri at this trial. At this trial, Schiavo remembered, for the first time, that
Terri had told him sometime during the 1980s that she would not want to
survive on "anything artificial.""


Something's been bothering me about this and I need an answer.

WHEN was the feeding tube first inserted, and HOW did Terri survive before it was inserted?

I assume she survived by EATING, being fed by the staff.

If so, then it follows she CAN swallow, and must be given the chance to eat again on her own.

Michael says that Terri said, "Nothing artificial, no tubes for me."

She didn't say "NO SPOON FOR ME!!!"

[Mad_Tom_Rackham]

[She smiles and cries. She recognizes her mom and dad. She is shy around strangers. She likes music and once smiled broadly when her brother told her he met Bruce Springsteen.]

There you have it. She perfectly fits the ACLU's definition of "a persistent, vegetative, comotose state".

The flagship of the amoral death-worshiping left never met a fetus, baby, infirm, or elderly that they didn't want to see murdered.

[Polybius]

Annulment is brilliant, but the Catholic Church down there is corrupted.

Maybe I'm using the wrong legal term.

The validity of the marriage within the Catholic Church would not affect the legality of the marriage in Florida state law.

I'm looking for the civil law term that means, "Gee, if this guy has already moved on in life and has another woman as a common-law wife with kids, then, unless bigamy is legal in Florida, the first marriage is no longer legally valid".