Skip to comments.Terri’s ‘Exit Protocol’
Posted on 01/14/2005 1:09:55 AM PST by amdgmary
On Oct. 27, 2003, Michael Schiavo, the husband of the cognitively disabled Florida woman, Terri Schindler-Schiavo, appeared on Larry King Live to explain why he was fighting so hard to remove his wifes feeding tube. His appearance was only days after the Florida legislature intervened to have Terris feeding tube reinserted for the second time in two years.
Michael Schiavo insisted that he wanted to help his wife die with dignity. He told King: Its painless, and probably the most natural way to die. It is a very easy way to die probably the second best way to die, the first being an aneurysm.
At the same time he was speaking on national television, Terris medical file contained a document prescribing for her a slow and painful death by starvation and dehydration.
Called an Exit Protocol, the document contains explicit instructions for how Terri will be treated during the grisly series of events that will occur should the courts decide to withdraw her feeding tube. Terris fate remains an active issue in both the Florida state and U.S. federal courts.
The nurse who discovered the Exit Protocol, Cheryl Ford, R.N., a Tampa nurse, was reviewing Terris medical file at the request of the Schindler family when she found the document. For the benefit of our readers, Ford agreed to explain this document in detail. [Editors note: The protocol, in bold print, is followed by Fords comments.]
Patient Care Notes The Hospice of Florida Suncoast 4/19/01 Clinical Pharmacy Re: Medication review and symptom management. The patient is a 37-year-old woman in a vegetative state with no apparent signs of distress. Enteral tube-feeding to be discontinued on 4/20/01.
This is a very critical piece of information from a nurses point of view, Ford said. We have a patient with no apparent signs of distress, yet enteral tube feeding is going to be discontinued on 4/20/01. This is murder. And its premeditated murder, because look at the dates notes were prepared the day before the tube was supposed to be withdrawn.
What would make the death more difficult is that Terri is a healthy woman, weighing approximately 138.5 pounds, which means she will endure longer than other patients who are in the midst of a natural-death process.
I was an oncology (cancer) nurse, Ford said. These people are very weak and gaunt. Their bodies are already shutting down, and their tube feedings are withdrawn when their body systems can no longer handle it. But Terri is not a cancer patient thats what bothers me. Shes a healthy young woman.
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.
Monitor symptoms of pain/discomfort. If noted, medicate with Naproxen rectal suppository 375 mg. Q8 prn [Q8 prn means eight times a day as needed].
If someone in a persistent vegetative state cannot feel pain, as Michael Schiavo and his attorney, George Felos, have consistently told the world, why do Terris charts tell nurses how to treat her for pain?
According to Ford, that is because Terri can and will feel pain during this process and a lot of it.
Think about what hunger pains are like if you havent eaten in a while, Ford said. You start to get that gnawing feeling, almost a burning in your stomach. Most people dont extend themselves into the depths of hunger. They grab a cracker or bread if theyre out shopping for a while just to make themselves feel better.
Terri would not have this option, however. Within several hours, shell start to feel this kind of hunger pain, Ford said.
Dehydration would only add to the discomfort: When she starts going into the dehydration stage, her metabolism will start to change. Her electrolytes will get imbalanced. Shes going to get uncomfortable and will start to writhe.
Advance a couple days without food or water. Now her mouth is parched, her lips, her gums, her tongue will start to crack and bleed. The nasal cavities will start to dry, crack and bleed. The stomach will get dry and shrink, causing vomiting and heaving, Ford said.
Pulmonary (a) Inability to clear secretions reposition and swab mouth, consider scopolamine patch behind ear every 3 days.
When you first go into dehydration, your body will automatically compensate by making saliva. But when she gets into the stage where the stomach shrinks and nausea begins, theyre going to stick a patch behind her ear for the nausea. What the patch also does is dehydrate you by taking away this fluid.
(b) Dyspnea nebulize low dose 2-5 mg. Morphine sulfate Q4 prn [four times a day as needed]. Dyspnea is when you have difficulty breathing. What theyre going to do is use a nebulizer the way you might use for asthmatics only instead of giving a histamine to help her breathe, theyre going to give Terri morphine sulfate, which only suppresses respiration more. In the later phases shell start gasping for air.
In seven to nine days, as most of her body fluids are lost, her blood pressure will go down and her heart rate will rise. The blood will be shunted to the central part of the body from the periphery of the body, so that usually two to three days prior to death, the hands and feet become extremely cold. They become mottled and have a bluish appearance. The eyes will become so dry the patient cant move them anymore because there will be fluid in them.
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. Multifocal myoclonus means seizures taking place in various parts of the body. Because of the electrolyte imbalance, Terri will begin to have seizures, Ford said. Shell start to twitch. You dont see this in an oncology patient because theyre already dehydrated. Even the elderly, who are going into the natural process of death, their bodies are doing what God created them to do slow down.
Our job as health-care professionals at this point is to understand the death process and to oblige the process God has given these people to help them in comfort measures palliative care not to enhance death. But Terris not terminal, Ford said. What theyre doing here is starving a healthy person to death. This is the only reason why shell go into multifocal myoclonus.
Grand Mal seizure, which is highly unlikely given current conditions and lack of contributing factors (meds) [medication]. Recommend diazepam 15 mg. rectally as indicated in seizure management orders.
If she happens to make it into a grand mal seizure, they will give her 15 mg. of valium. The valium wont make this easier, it will just help to bring her to death faster, because she wont have the ability to fight her way out of it, Ford said. Her body will not be in good shape at this point. You wouldnt look at her and say she was comfortable. Shes been without food and water for a long time. Shes pretty much withered, her skin is broken down, her metabolism is broken down, her kidneys havent received anything. Her body is reacting to the lack of food.
At this point, death is imminent.
During the Oct. 2003 tube withdrawal, Ford saw Terri before the process began.
They started off by dressing her in wool sweaters and long pants, then wrapped her in a wool blanket to sweat her out to make her deyhdrate faster, Ford said. She was horrified, especially because it was only October and its still hot in Florida in October. This is not a painless or dignified way to die, Ford said. Its against the law to dehydrate and starve to death a prisoner on death row. Why should we allow it to be done to a disabled woman or anybody?
The cruelty Ford has seen Terri endure is not even believable, she said. In this case, Dr. Kevorkian would be more humane than what they intend to do to Terri.
Contact Susan Brinkmann at firstname.lastname@example.org or (215) 965-4615.
I have suspect some of those who troll the Terri threads are selfish bastards who don't know when to 'let go', suffer survivor's guilt, are inexperienced or refuse to recognize the point when treatment sucking away every last ounce of dignity, making the patient unrecognizable to friend or family and they to him or her.
My view is Terri's "dead" but her body hasn't caught up with this reality. There's no viable ethical argument, however, to starve a patient to death. So long as food, rather than artificial respiration or similar means, is all that keeps her from dying she should be fed.
She'd have been better off if she'd been killed by her original illness. Her parents are just as sick as her husband.
This isn't death with dignity. It's murderous.
My father died this way 3 years ago, but he made the conscious decision to do so after discussing it with the family. He had PSP, a rare form of Parkinson's and had been sick for years. His body was rejecting the feeding tube and the doctors said that they could put him on IVs, but it would only prolong his death. It was a nightmare...I have never recovered from spending his last 10 days with him, watching him slowly starve to death, but it was his wish.
I feel for your loss of your father. The distinguishing characteristic in this case is that Terri doesn't have the ability to make the same choice as your father. It is an estranged husband with a monetary incentive who is trying to make the choice for her.
Terri's the HOSTAGE OF THE SUNCOAST. (at hospice of the suncoast).
Why so Hateful! Terri is not unrecognizable to friend & family (only to the eyes of those who love death and her adulterous husband.)
Who are you to say someone else is better off dead!
It is your kind who will destroy the culture!
I understand that fully, I was just responding to her husband's comments that this was a good way to die...when, from my experience, it is most definitely not.
But once she's dead, that lovely life insurance policy will kick in. Michael should sign the benefits over to her parents and go on with his miserable life.
Have you seen the Videos of Terri obeying the commands of her doctor? How can the "dead" do what their doctor tells them to do?
Please go to her Web Site and watch her Videos! Go to www.terrisfight.org
it doesn't make sense to me either.
The woman who was supposed to WATCH OVER this process is dead now herself, right?
The woman who watched Terri being starved in Oct 2003 was Jodi Centonzi's mother, Eleanor Centonzi. Eleanor died of ovarian cancer Sept 5, 2004 in Jodi and Michael's house. Also, the priest who testified against Terri in the 2000 trial, Fr. Gerard Murphy, was run over by a car in Tampa last year.
I just read this again and it amazes me that so many will believe Felos and MS that this is a painless way to die. Freepers especially are known IMO to dig to the bottom, but many have failed to do that with Terri's situation. They call us fanatics or emotional when the opposite is actually true and it seems that more often than not they won't even take the time to educate themselves about Terri. I think that is must be a fear of becoming disabled that has paralyzed some from diving in and learning.
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