Skip to comments.Hospital won't aid transfer of girl on ventilator
Posted on 01/02/2014 1:08:18 PM PST by Anton.Rutter
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I and several others have explained why you are wrong several times over on this thread and others. If you refuse to educate yourself on the topic and spout off based on your feelings then you cannot be helped. Good day.
Remember a bad outcome is not necessarily a mistake. The practice of medicine is still an art. Not every body reacts the same way, and it is not predictable. The frustrating thing about being a physician is that you can do everything perfectly and still have a bad outcome — the act of God. I weep that the lawyers have won (see tagline) in equating every bad outcome as a result of a mistake, or worse, malpractice. Very few physicians are guilty of malpractice — namely the intentional ignoring of a standard of care. On the other hand, there is always someone willing to blame a physician or a nurse for a bad outcome. The brutal truth in this case? Airway surgery in morbidly obese (and the child was morbidly obese) for obstructive sleep apnea is indeed a high risk procedure. Is it possible that the parents were seeking the quick fix (surgery) versus the disciplined? I cannot answer, but in my experience, many people turn to high risk surgery to solve years and years of poor discipline, and when you roll the dice, sometimes a bad result happens. Tragic? Yes. Mistake? We cannot know, at least not yet.
Don’t bother. I asked for his credentials, and all I got was how I was wrong and that I had transitioned from lying to deliberately lying. The writer walks about colorful rhetoric. Ever notice how some people accuse you at that which they are most proficient and blind to what, in fact, they are doing? I stand by my statement — if and when he decides to fess up as to his learned opinion — I will listen and debate on grounds of equality — until then, he (or she) is merely what the Macbeth soliloquy so profoundly and aptly called “a poor player who struts and fret his hour upon the stage — a tale told by an idiot — full of sound and fury, but signifying nothing.”
Thank you for answering my question. I’m now a little more sure that she is in fact dead. There is still a little room in my mind for doubt. Either way, it’s a tragic situation, and my heart goes out to Jahi and her family.
aka--A troll by any other name is still a troll.
THis is beyond tragic. Unlike some on this thread who cannot see the truth, please do not confuse the analysis of what physicians are faced with every day as an abdication of the emotion that this is horrifying. I can tell you stories of great tragedy and heart wrenching issues that physicians and nurses face everyday, and few people care to understand. Thank you for at least listening to all the arguments and coming to a conclusion based on the issues, not the emotions. God bless you and may you enjoy a peaceful 2014.
Well played — I love your style.
Thank you for this post it is what I was searching for when clicking on this thread.
How sad for her mother. It is as I feared: it seems she is in denial.
We should all keep her and her daughter in our prayers.
I agree, it is so sad. I am sure there is both denial and guilt in this, and I know that she is grasping at straws. But enabling this is the wrong thing to do.
He was nothing more than a shell. It is still haunting to think of his eyes. All we had to do was look at his eyes. Nothing. He was truly someone who could be described as the living dead. Alzheimer’s had destroyed his brain and robbed his body. His soul, his awareness, his humanity had long since been pushed out by this awful disease process.
He is who I think of when I read someone is clinically dead. His heart was beating and his lungs functioned. PERIOD. Letting nature take its course, it was only a matter if time before his body passed.
Granted, the circumstances are not the same as Jahi’s. He had a disease process; Jahi had post operative complications. But the end point is the same. Jahi’s soul has passed. It will never return. She is in God's care now. It's time to let her body pass as well.
I understand her mothers agony. If I was in her place, I would cling to every last measure of hope. I would see signs of life that were not there. I would see what my heart wanted me to see.
Gas_dr has given an excellent medical perspective and insight. I'd be willing to bet Jahi’s nurse's would give an assessment which fit hand & glove with what gas_dr explained.
Whoops! Nurse’s = Nurses
It's a moot point as the family has not been able to find a physician willing to perform this surgery.
"The family has pleaded on Facebook and Twitter for help to find a physician willing to perform both surgeries for Jahi, but so far no one has stepped forward..."
And FWIW, this New York facility, New Beginnings, is an outpatient care center operated by a former hairdresser who offers a "holistic approach" to treating traumatic brain injuries. There isn't a single MD on their Board of Directors. Their website is currently soliciting $5000 in donations to install an electrically-operated door to the entrance of their office.
Argument by authority, eh?
I have discussed physiology, you law and rhetoric - hardly have you made medical or scientific arguments, by your own admission.
You claim to know a lot about her condition. Perhaps you can tell us how you are privy to such detail You have apparently seen her medical records. That’s probably where you saw the results from the brain analyzing machine that can tell when a brain is liquified vs being jellied or mushy or A-OK.
Thank you so much for your kind words. There is one subtle difference. In the patient you described, you found that his cerebral cortex had vanished...thought, emotion, sense of history. BUT (and here is the difference) you patient still had a functional brain stem — all the reflexes, breathing, heartbeat, endocrine function, was still preserved. He COULD live independently of full support. In the case of Jahi, she has lost not only the advanced brain (biconvex view on imagery), but her midbrain and low brain are also dead. Brain death legally is termed WHOLE BRAIN DEATH, which is an excellent point you bring out in your post. Poor, sweet little girl is dead precisely as a function of WHOLE BRAIN DEATH. There are lots of partial brain deaths — stroke, alzeheimer’s, and voting democratic (which arguably is almost whole brain death — tragedy is that the brain stem can still pull a voting lever.)
"He who knows what he knows not is wise, follow him...He who knows not what he knows not is a fool -- shun him".
It is evident you know not what you know not. All the best of luck, but also remember it is better to be silent and thought a fool than speak up and remove all doubt. I have no doubt when it comes to your statements, and by extension...you. Good day.
We do have brain analyzing machines. These are called reflexes. They do not depend on whether one is awake, sleeping, ill or well. When the brain is functioning “alive” these reflexes are intact. Loss of the reflex reveals no brain function.
In addition there are multiple scans that can be done that prove no blood flow to the crucial areas of the brain, EEGs that can show lack of electrical activity in the brain, etc.
It seems you do not want to hear the truth, just hold to your own opinion. As is famously said, you have the right to be wrong.
Forget about him — he wallows in his or her own ignorance. Much better suited for him or her to be at DU, where how you feel must be the fact.
Why do you need credentials.
I never argue by authority. Persons who do so are invariably incompetent, Doctor.
The issues are 2:
1) The girl is not a corpse.
2) Does the family have the right to decide on further treatment? Sub-issues arise from the answer to this.
The family does have the right, but they have not filed the appropriate paperwork nor found a facility. Have you no reading comprehension skills? Sheesh! Since they can’t find one, why don’t they make arrangements to take her home? Oh, that would mean mama would have to take care of her. Since her mom indulged her to obesity by failing to cook and exercise with her therefore preventing this entire issue anyway, I’m doubting mama wants to take care of her now.
Many people have tried to have a reasonable argument and discussion with this poster. It is a waste of time, as there is no reason or discussion, just unvalidated, incorrect statements he or she masks in the facade of some sort of rationality. Many have seen the transparency of his or her veneer, save your breath and frustration, for one should not respond to a person who violates the fundamentals of good debate, honesty, reason, and good will.
And certainly the family can arrange private transport to the house and private ventilator service and pay for it, but it will be at their own expense as insurance terminates at death, and the girl is dead. If they have a macabre obsession to ventilate a corpse, then I suppose that is their decision, but no one else should have to pay for it. Maybe ifinnegan would like to pay for it? Or defray the million dollar a month cost that this will certainly incur?
I see you use the term corpse again.
This s the crux of the discussion and the reason for your retreat in that there s no way for you defend the use of the term and seem too prideful admit it is not accurate.
You insist on using this term inaccurately to present a distorted representation of brain death and the situation of this grl’s body.
This took place in December 12.
A corpse would have no benefit from a ventilator.
Would have no circulating blood.
Would not be able to be maintained at normal body temperature.
Would not be able to maintain physiological and metabolic function of organs or other systems.
A corpse that died on Dec 12 would not be able to donate organs or tissues.
You are quite remiss in your responsibilities in using such disinformative language.
“Oh, that would mean mama would have to take care of her. Since her mom indulged her to obesity by failing to cook and exercise with her therefore preventing this entire issue anyway, Im doubting mama wants to take care of her now.”
That’s pretty nasty.
There’s no way you can know this.
This spitefulness says a lot about where you’re coming from.
At least the gas doctor portrays crocodile tears.
Gas passers are little gods, in their own minds. They take a patient to death and bring them back ... in their minds.
“And certainly the family can arrange private transport to the house and private ventilator service and pay for it”
We are in full agreement and you have finally addressed the actual issue which I first addressed to you stating your comment describing brain death diagnosis was beside the point.
It took time, but you finally got there. Congrats, Doctor.
You have claimed victory in ignorance to the issue. You have not addressed the macabre nor legal ramifications of continue to ventilate a dead person. In America you have the freedom to make irrational decisions. It does not change that the child is dead, nor does it change any of the science. I do not agree with you in any way shape or form. You fail to address the queries around accepting the child is dead. I would support your freedom to go dig up a family member in the cemetery dead for two weeks and place them on a ventilator at your own expense, but that does not mean that that person IS ANY LESS DEAD. Please understand the difference between the freedom to make a foolish choice rooted on science (again something which you never address) and agreement. I need neither the congrats nor the accolades of the wrong or foolish. Claiming victory in your case only increases the delusional quality of your logic.
I do not take a patient anywhere near to death. For your education, an anesthesiologist “renders a patient insensible and free from pain” during a surgical procedure. I am a Christian schooled in science and practice my art. Please understand the difference between spewing vitriol and inaccurate statements. If you wish to cast accusations as to my mindset, I welcome you to have surgery without one of my colleagues in attendance. Might I suggest you familiarize yourself with the statements of the American Board of Anesthesiologists and American Society of Anesthesiologists. In none of their statements is that we take a patient near death. However, when seconds count, physician anesthesiologists save lives.
“You have not addressed the macabre nor legal ramifications of continue to ventilate a dead person.”
That’s right. I never argued about that one way or the other.
“I would support your freedom to go dig up a family member in the cemetery dead for two weeks and place them on a ventilator at your own expense, but that does not mean that that person IS ANY LESS DEAD.”
I would not support anyone’s right to do that. But, oddly, your example here is exactly the point I have been making about brain dead vs dead.
A ventilator will do nothing to support function of non-brain tissues in a corpse.
Yet in the brain dead, a ventilator keeps these tissues functioning to such a level that they are able to be harvested, even three weeks after legal death, and used in transplants.
You don’t seem to be want to allow for the distinction. Whereas we can agree that they are both states of death, they are not the same physiologically.
I am sure you understand it, but don’t seem to want to be objective and clear about it because you seem to think it would be detrimental to your argument that it is a waste to continue support.
I do not necessarily disagree with the position that she is brain dead and should be removed from support.
But I cannot distort physiological reality nor do I think such obfuscation as you have attempted is necessary.
I feel people can understand that the brain is dead but the body is being kept alive by machines. There is no reason to say she is a corpse or a cadaver when that is not the case, except to sway emotion in those who may not be familiar with situations as these.
My comments and argument have been solely based on science regarding your insistence that she is a corpse.
On the other hand your argument for her being a corpse was not scientific but was legal.
Again, in no way is her condition physiologically equivalent to a 21 day old corpse.
You're a loony. You're as messed up as they are. Good day sir or madame. Get help.
Before Xmas this happened and I was in the Bay Area where Children’s is located. I saw a news report of this which had a picture of her.
My first comment here at FR on this was about her obesity and underlying health problems that must be associated with it. That post is here.
You were a bit too obtuse to realize that my comment was that you can not know how the family fed her or exercised her etc... Not that you could not know she was obese.
In fact, the photo I initially saw on local news before Xmas was quite shocking. She was clearly obese and looked much older than 13. Photos shown more recently seem to be earlier photos that show her obesity but do not reflect what she looked like when she had this procedure that went wrong.
My initial comment to some degree was meant to say that there should not be an assumption that this horrible outcome was due to medical negligence.
Stop listening to the parents when they continue to call this a 'simple tonsillectomy.' That's being said for public sympathy while the family is using HIPAA to prevent the hospital from speaking publicly on the details.
This morbidly obese girl had sleep apnea.
She underwent uvulopalatopharyngoplasty, which is far more extensive and risky than a tonsillectomy.
For those who don't know what this surgery is, excess tissue is removed to help wide the airway. Included in this tissue is the uvula (thing that hangs down in the back of your throat), a large part of the soft palate, tonsils, adenoids & pharynx.
The bleeding issue is a known risk of the surgery and could have occurred without any negligence on the part of the surgeons, nurses, or hospital.
Like too many arrogant ‘doctors’ you presume to tell me what I may think. I have zero respect for you. You presume so much that you are incapable of rational perspective. I expect next you will order me to think of you as a scientist. When I refer to the gas passers, that is not referring to competent, diligent anesthesiologists. But your arrogance prevents you from realizing that. Not one of my twelve surgeries in life has been done without attendance by a competent anesthesiologist, usually overseeing a nurse anesthetist. I have been blessed to avoid the gas passers ...
Thank you for the info!
Yes, we heard thru the grapevine anyway that the surgery was more involved than just tonsils, but the mass media keeps referring to it that way...so anyway....what a tragedy!
If the more extensive surgery was necessary, then it had to be done even if risky. Sometimes we need these things, but the result was still tragic.
(What i find amusing, and this is a total aside and has nothing to do with this girl or the hospital...........is that uvulopalatopharyngoplasty leaves a person unable to speak, pronounce French. HA! I didn’t need an uvulopalatopharyngoplasty to almost flunk out of French class due to difficulty pronouncing it, ha! ha!)
Who peed in your bran flakes this morning? Try frosted flakes. The sugar might sweeten your nasty disposition.
The uvulopalatopharyngoplasty was a quick, but risky, fix.
I have no idea whether the physician(s) recommended it, but I feel certain there's a signed informed consent floating out there that mentions excessive bleeding and risk of death.
Try to keep up ...
Perhaps if you were attended to by an anesthesiologist instead of a nurse overseen by an anesthesiologist you would have enough brain cells to see the fallacy of your statements commanding that I not presume to tell you what to think, yet presuming to paint such sweeping perspective as to my ability. I can back up my statements with nine years of post doctoral training and four board certifications including neurocritical care. So yes, I do know something about the brain and anesthesia at large. The fact is that arrogance is often presumed by the ignorant in the light of the truth. Finally, a man is judged not by his friends, but by his detractors. In this case that you have no respect for me, i am comforted, for if the willfully ignorant have no respect for me, then I must be doing something correct.
gee, well if the surgery does turn out to have been unnecessary then the result is even more tragic...
what an awful thing to happen....
(I guess the only alternative is more big brother state-ism, but..... sometimes I wonder if we are doing the best we can to let any parent have surgery done on their kids... without some sort of review or ??? Again, I trust the govt far less than I do even the worst of parents.......so I do not have a better answer for this question........and don’t claim I do......................but the kids can sure end up the losers sometimes, can’t they?)
Thatta boy, stay in character.
One of the problems with the brain death/organ donation issue is the definition of brain dead that varies by location. If there were agreement among various countries and states in the criteria used I think there might be more acceptance. In some locations the committee that decides not he criteria to be used is also the committee that handles organ transplants. It’s a slippery slope from there.
There is a very rigid definition of brain death. In fact whole brain death is probably the best in terms of organ procurement as a result that the patient is dead, but it is still possible to oxygenate the tissues for harvest and subsequent transplant. On the flip side, non-beating heart donation requires speed, and usually by the time the heart stops many of the most delicate tissues are destroyed. There is a very rigid wall of separation between declaring and procurement for this exact reason.
Hospitals do it all the time when they pilfer organs from "brain dead" but living persons without anesthesia.
On Friday, the Alameda County Coroner issued a death certificate stating that Jahi died on Dec. 12, three days after doctors at Children's performed a tonsillectomy that led to complications.
She's DEAD in California. More info in article, including...Hospital agrees to let Jahi McMath family take girl
Title:Tonsillectomy and Uvulopalatopharyngoplasty (UPPP)
This is a common surgical procedure done under general anesthesia. On the day of surgery, the anesthesiologist, operating room nurse, and doctor will see you at the pre-operation holding area. An I.V. will be placed. You are then taken to the operating room. Once under anesthesia a breathing tube is placed. The surgery is performed through the mouth and the breathing tube is removed before you are aware of it. The surgery takes about one hour. There are no outside incisions. There are dissolvable stitches in the back of the throat.
Yes, complications can occur following any surgery. The hospital staff is supposed to keep check on a patient and handle those complications. Like many other surgeries, UPPP has a mortality rate of less than one percent. Most of the patients with serious complications following UPPP do not die. So, we have to ask what happened in this case. If the child's weight was an issue, then the surgeon had the option to refuse to perform the surgery until she lost weight.
I was responding to your comment about the parents “milking” the situation. When I used the term “hospital staff,” I was referring mostly to the people (nurses, assistants, etc.) who care for a patient following surgery. Did the staff alert the surgeon or a doctor to the complications right away? Or did they brush off the mother’s concerns? There are serious questions to be asked in this case.
I misstated the risk of the operation, but 1% mortality is still 1%.
He or she is a flipping idiot.
It varies by location.
Doctor, your posts are not coming across as very Christian.
I’ve had to deal with many different doctors, surgeons, nurses, etc. Some (who are considered top-notch in their field) are down-to-earth, sympathetic, and will take on a whole hospital and other doctors to fight for their patients.
But, there are others who sneer at their patients and patients’ families. Your posts are coming across as sneers.
The rate of mortality is actually less than 1%, like many other surgeries.