Tuesday, 12 February 2019

Recognition

Though I live in a relatively small enclave of a much larger city, there are still occasions where I will see someone I recognise. It could be hospital staff, another physician, a nurse, or a patient or their family member. One of my patients several years ago (whom I did not recognise as first) turned out to be a woman who lived just a few houses down from me. It is usually difficult for me to identify a familiar face, because while I am good at recognising the face, I am terrible at coupling a name or place to it. But there are some faces that just stand out for whatever reason, and these faces tend to belong to people who, for one reason or another, have made an impact on my brain.

Yes, that's foreshadowing.

It was right around lunch time, which my stomach kept reminding me by attempting to digest itself (or so it felt and sounded), when Paolo (not his real name™) was brought to me in a heap of mud and vodka. According to the ambulance crew, Paolo had thought it would be a really fantastic idea to drink heavily during his lunch break at work and then drive his van off the road, causing it (and him) to roll over several times. I have to assume his right foot tumbled partially out of the window as the vehicle rolled, which caused it to get crushed between the van and the road and mangled both the foot and the van nearly beyond recognition. It's difficult to describe the carnage I found around what-used-to-be his ankle, but let's just say that there were very few structures I could actually identify as belonging to a human foot. And for the first time in my career, I removed a piece of a pencil from a traumatic wound.

Seriously.

Yet despite his grisly injury, he had surprisingly very little pain as we examined him and found no other injuries (other than a few lacerations on his scrotum. No, I have no idea how that happened). I suppose there is a reason the phrase "feeling no pain" exists.

Anyway, I'll just give you the short-short version: I sutured his scrotum and Paolo lost his leg, but he lived.

Wait wait wait, that's it? 'He lost his leg'? And you sutured his scrotum and aren't going to tell us anything more about that? That's the end of the story? What the hell is this, Doc?

What this is, is not a story about Paolo.

Uh . . . what?

Haha, the old bait and switch! I teased you with what you thought was an interesting story, but I'm swapping it for (what I think is) an even-more-interesting story, which will probably fall flat and be interesting to no one but me.

Alas, woe is me.

Aaaaaanyway yes indeed, this story is not about Paolo but rather about the guy who was taking Paolo's blood pressure, getting him a warm blanket, and reporting his findings back to the trauma nurse. I had no idea who he was. He wasn't one of the trauma nurses, because there were already two of them there and he was dressed in street clothes. He was a young guy in his mid 20's, handsome, tall, long hair, and he had a hospital badge, so clearly he wasn't just some guy who walked in off the street offering to help.

I know this kid, I thought. Who is he? Is he the son of a family friend? A neighbour No wait, is he the guy who replaced my refrigerator motor last year? I just couldn't place him, but he definitely looked familiar. Very familiar.

If anyone had been watching me from across the room, it must have looked as if I were ogling this kid, which I, uh, I guess I was in a way.

This bizarre leering continued for at least five minutes as he continued bustling around helping the nurses and I continued racking my brain for some inkling as to just who the hell he was. Finally, still at a loss, I decided that I had imagined the whole thing and that I didn't actually know him and that he wasn't the guy I saw buying 10 packs of Velcro at the hardware store last week (my mind goes to some rather strange places sometimes). I started berating myself for wasting so much time in this futile endeavor, and right around then the kid finally caught my eye, cocked his head, and smiled knowingly. As he walked up to me holding his hand out for a handshake with a big grin on his face, it instantly hit me, and I smiled back, extended my hand, and said,

"Oh, hello again Theo."

His grin brought it all back to me. I had seen Theo (not his real name™) in my trauma bay almost exactly four years ago to the day. He had been working as a volunteer medic, standing on the side of the road helping the victim of a minor car crash in the middle of the night, when a drunk driver plowed into him and another volunteer at high velocity. Both of them had been brought to me, but Theo was in much worse shape. While the other young lady had a minor fracture of her thoracic spine and a few abrasions, Theo had a horrific open skull fracture and a large subdural haematoma. He underwent surgery to remove a portion of his skull and evacuation of the blood clot and then spent several weeks in hospital before going to a brain injury rehabilitation facility. I remember him as being extremely polite, always willing to participate, always thankful, and always smiling.

He had had another operation several months later to replace his portion of skull followed by many more months of rehab. And now here he was, four years later, completely recovered.

And on his way to nursing school.

Instead of being turned off to the medical field, Theo told me that his experience only strengthened his will to continue his pursuit of helping. Today he was shadowing the trauma nurses and gaining experience for the future. As Theo put it, "As stupid as it sounds Doc, after seeing firsthand what paramedics, nurses, and doctors can do, I just want to give back. Pretty corny, right?"

I didn't think it sounded corny at all. I actually thought it sounded rather wonderful.

Wednesday, 9 January 2019

Falling down

Of all the trauma alerts I get, the most frustrating has to be "FALL". These are usually elderly patients who fight gravity and lose, and their cases are seldom (if ever) satisfying. They typically are uninjured beyond bumps, bruises, and lacerations, though due to their age their recovery from such minor injuries can take several days or even longer. But if they do sustain serious injuries, they tend to be isolated to hip fractures, which I don't treat. The other types of falls (off a ladder, off a roof, off a bar stool etc) usually are from heights of 3-4 metres and are thus mostly uninjured (zzzzzzzz) or have broken ankles, which I still don't treat. All of this adds up to a very sullen me as I trot down to the trauma bay for yet another fall.

So when my pager alerted me to a fall recently (my third one of the day by 10 AM already), I got not a bit excited and tried my best to avoid the trauma bay entirely. I had only had one coffee by then, so I figured maybe the caffeine would elevate my heart rate even if the complexity of the trauma didn't. My Inner Pessimist, however, forced me to walk down to the trauma bay despite my efforts to ignore him.

The bustle when I got to the trauma bay confused me. Normally for low-level traumas the nurses and other staff sort of mill around chatting prior to the patient arriving, but in this case everyone was rushing around getting equipment. For a fall? What the hell is going on?

And about 30 seconds later, Xavier (not his real name™) arrived, and that question was quickly answered.

"Hey there Doc, this is Xavier. He fell off a cliff and . . ."

Wait, wait, wait. He fell off a what? Where the fuck is there a cliff around here??

"Yeah, you know the {Redacted} Cliffs."

Uh . . . no I really don't. I had no idea there were any cliffs in this area.

"Anyway, Xavier fell off a cliff about 30-40 metres. He woke up at the bottom and doesn't remember anything. 

No but seriously, where the hell is there a cliff?

"Ahem. Vitals have been stable though he's breathing a bit fast. He's complaining of pain all over his body."

Yeah, after falling 40 metres down a goddamned cliff I would be stunned if he weren't.

Normally the first thing I do is a full assessment, but my Inner Pessimist was insisting that I google where the fuck this cliff was. I resisted that urge and instead decided to, you know, examine my patient, an idea which seemed only slightly more important at the time. Xavier looked completely miserable. His blood pressure was fine but his heart rate was in the 140's. The most common reason for a high heart rate in trauma is bleeding, the second most common cause is bleeding, and third most common cause is fucking bleeding.  It could also be due to pain or heart injury or drugs, but bleeding is always my first concern. My concern was somewhat higher because his oxygen saturation was in the 80's (normal is 95-100%). 

On my initial head-to-toe assessment he was tender in his head cervical spine, thoracic spine, lumbar spine, chest, left hip, and left arm, though other than some rather crunchy ribs he had no obviously broken bones. His breath sounds were diminished on the left side, indicating that he likely had a pneumothorax (collapsed lung) under those fractured ribs. That concern was confirmed about 60 seconds later when I saw his chest X-ray.

His workup, which included X-rays and/or CT scans of pretty much every single body part (I think I skipped his thymus and right foot), showed that he was fucking broken. Think of a body part - go ahead, just think of one (other than the thymus and right foot, obviously). Yup, you got it, that was broken. He had fractures in his skull neck, upper back, lower back, ribs, hip, arm, and leg, along with his pneumothorax. He would need a chest tube for his lung, surgery for his hip, arm, and leg, and a neck brace and full back brace for his spine, which would not need surgery.

But the main question I had (other than "What cliff?") was, How the fuck do you fall off a cliff? And seriously, what goddamned cliff??

After several rounds of IV narcotics finally successfully controlled Xavier's pain (because of course he had a longstanding history of oral narcotic abuse), I got a chance to ask Xavier what happened. He very groggily told me that he was trying to show his in-laws the {Redacted} Cliffs while they were visiting that morning, and he simply got too close to the edge, lost his footing, and toppled.

This, I thought, is why I will never be out of a job.

As I contemplated the amount of human stupidity that it takes to get that close to the edge of a cliff (which, I learned later, has no guard rail on it), I looked at Xavier's blood work. While there was no major abnormality in either his blood counts or chemistry, his blood alcohol was about 3 times the legal limit to drive, which a quick calculation told me is approximately infinity times the amount of alcohol one should have in one's system while walking near a fucking cliff at 9 in the morning.

Xavier spent about two weeks with me before going home in a wheelchair, but it took me far less time than that to find out where these cliffs were. The moment I got in my car to go home the next morning I whipped out google and discovered that these cliffs are less than an hour's drive from the hospital. I briefly considered checking them out, but instead I decided to drive straight home and give my kids a big hug.

That seemed much more important. The cliffs can wait.

Friday, 14 December 2018

RFO time yet again

WARNING: NSFW PICTURES BELOW

Seriously . . . very NSFW pictures DO NOT read this in the presence of children. 

YOU HAVE BEEN WARNED.

Several people have emailed me over the past two months to ask if I'm ok because my blog has been silent. I thank you good people very kindly for your concern, but I assure you I'm fine. But good lord, you people are right! It's been over two months since I've written anything. Well, that isn't exactly true - I've tried to sit down and write several times, and I now have 10 (!!) posts partially written and sitting abandoned in my "Drafts" folder. And by "partially written" I mean "a paragraph or two". And by "a paragraph or two" I mean "a sentence". Or a title.

Sigh. Writer's block sucks.

It isn't that I don't have material, it's just that lately I don't seem to have the desire to sit and do it for whatever reason. It isn't mentally exhausting to write and it isn't terribly difficult. Hell, I could sit in my car and dictate a blog post if I wanted to. It's just that I didn't want to.

Until now. Because it's rectal foreign object time again!

If I seem excited, it's because I am. Call it macabre or bizarre, call it weird, call it really fucking disgusting if you prefer. But these cases are, well, fun. There's no way around it - they're just fun. And lest you think it's just me, it isn't.

I always worried that it was just me until yesterday, because yesterday I had the opportunity to have an RFO Battle Royale with one of my colleagues, Dr. T (not his real name™).

And I lost.

I lost.

I told Dr. T about my latest RFO, which happened to be a small pill bottle. Wrapped in a condom. Wrapped in yet another condom. Unfortunately the bottle had slipped up way too high and could not be extracted from below. Normally we can reach up (yes, really) either with our fingers or some surgical grasper, grab the . . . thing, and then pull it out the way it went in. But this bottle was so high (like 25 cm high) it could not be reached. So I was forced to enter his abdomen the old fashioned way ("Never let the skin get between you and a diagnosis"), and squeeze the bottle down his colon into his rectum. As I pushed it through, I said to the assistant who was waiting down below to catch it, "Ok, it should be crowning".

If you aren't laughing right now, then you don't have kids, because that's fucking hilarious.

As I related this story (and my infamous Coke bottle story) to Dr. T, he merely stood there impassive with a slight smile on his face, because he knew that he had already won. Apparently those stories didn't even come close to Dr. T's best (worst?). He then told me not his best story, not his two best, but his three best stories, any one of which could beat any one of mine.

Yeah, I lost badly.

3) The third best story starts with "He was bored". Normally when I get bored I read a book or something, but not this guy. Nooooooo. This guy (yes, it's always a guy) put an enormous dildo in his rectum and then lost it. It could be felt from below, but it could also be felt from above. WAY above. Like at his umbilicus (navel (belly button)). Because this wasn't just a normal dildo, it was one of these:
I warned you there were NSFW pictures. I fucking warned you.

Anyway, Dr. T took him to the operating theatre, put him to sleep, and grabbed it from below with a surgical clamp like we always do. There was one problem - if you look at the bottom of that, uh, device, you'll see a little dial. Dr. T, unfortunately, couldn't, because he didn't yet know it was there. I'm sure by now you see where this is going. Dr. T grabbed the dial, twisted to try to extract the object, and turned the damned thing on. Apparently this one didn't just vibrate, it also rotated. After the initial shock and panic, the rotation actually helped free it from its environment and it slid back out to freedom.

One loss.

2) The objects we remove are mostly phallic, for obvious reasons. Mostly. The second best story Dr. T told me involved a bone cutter.

What?

You heard me. Indeed, this man had inserted a pair of metal cooking tongs. I'm sure you've seen them before. You know, one of these:
If you're wondering, he inserted the small end first, "small" of course being a relative term. If you look carefully at the grasping end you'll see a very small gap between the end of the metal and the body of the tongs. As they were being removed, that little gap had been able to trap a tiny ridge of rectal mucosa and was unable to let go, so Dr. T had to use a bone cutters to snip off the tip of the tongs, being careful not to snip anything else by mistake.

Loss #2.

1) Dr. T was almost in tears as he told me this last story, his best. It was another guy who was "just bored". But when he got to the hospital he refused to tell anyone what it was, just that "it" had been there for several hours. An X-ray showed . . . something round. A CT scan also showed something. Round. I looked at a picture of the scan and could not figure out what the hell it could be. It looked to me like the head of a toilet brush:

Dr. T just laughed harder and had to stop to wipe his eyes. No, not a toilet brush. Not even close.

He took the patient to theatre, and once he was under anaesthesia he was able to feel the object. It felt rough though somehow also smooth and supple. Organic, one could say. He couldn't get his fingers around it, and regular graspers kept slipping off. So he tried a larger grasper and was able to gain purchase on it, but then the thing tore.

Shit.

He grabbed it again and tore it again. And again. Finally after several attempts he managed to spear the object, and was able to extract it in its entirety:
If you're wondering, this wasn't a little clementine or tangerine. No, this was a big orange. A really big orange. According to Dr. T, the only thing that allowed him to remove it was the fact that the patient was "a professional".

And with that, tears streaming down his face, Dr. T defeated me soundly.

But I will have other opportunities.

Until next time, Dr. T. Until next time.

Monday, 1 October 2018

No good deed

I'm sure you've all heard the phrase "No good deed goes unpunished". If you haven't, you really need to get out and/or read more. Seriously. Anyway, it is typically said in a sarcastic way after something bad happens after you've done something nice ("I raked my neighbourss leaves and then watched as they were strewn all over the yard by their obnoxious children"). Sometimes, however, the phrase can be taken literally.

Like with Ted (not his real name™).

Ted is an auto mechanic and the nice guy of the neighbourhood. Though he had a large beard and unkempt hair and generally looked like my usual Friday night assault victim, Ted was quiet, kind, and respectful, proving once again that you shouldn't judge a book by its cover (read: I shouldn't be an idiot and prejudge people based on their looks because I'm too often wrong).

Ted is the guy who would fix your blender if it stopped working, clean your gutters when they got clogged with leaves, and change your tyre while you were at work. You know, just because. He is a true Nice Guy, that one-in-a-million fellow that you hope to find next door when you move to a new house.

So when one of his neighbour's needed a new engine for his car, of course Ted volunteered not only to buy him a new engine at his cost, but also to install it for him at no charge. All he asked was for his neighbour to reimburse him the cost of the engine.

Apparently that wasn't good enough.

After the job was finished, Ted presented his neighbour with his now-functional car and asked him to pay him for the engine. Not for labour and not for his time (which would normally be approximately an arm and a leg), just for the engine. The neighbour bafflingly said no.

Ted was confused, as I think anyone in his right mind would be. Still being a Nice Guy, Ted asked again, nicely. The neighbour refused again (somewhat less-than-nicely) and stormed off.

Ted was still confused. Obviously.

The neighbour returned a short while later with several friends in tow. I have no idea what the neighbour could have possibly told them ("This fucking guy actually wants me to PAY for my new engine that he bought and then installed for me for free! What an asshole!"), but I suspect Ted was expecting him to be bringing payment.

Ha. No. The group of men proceeded to beat Ted half to death resulting in:

  • fractured mandible
  • seven fractured ribs
  • two punctured lungs
  • fractured nose
  • forehead laceration
  • knee laceration
  • ear laceration
Ted needed surgery for his mandible and bilateral chest tubes to reinflate his lungs, and he spent nearly two weeks in hospital recovering. But no matter how much pain he was in, regardless of the fact that he couldn't open his mouth after his jaw was wired shut, he always took the time to say "Thank you, Doc" and tell me how a great a job the nurses were doing.

Yes, Ted truly was a Nice Guy.

I saw him in my office a week or so later for follow up. The first thing he did was give me a bear hug (again, despite his broken ribs) to thank me for saving his life, which I didn't really do and tried to explain to him. He was never in a whole lot of danger of dying, though I suppose if I hadn't put in the chest tubes that was possible. Regardless, Ted looked great and was feeling great (relatively speaking), and though I didn't ask, that's when he told me the whole story of how he got hurt.

The neighbour is behind bars. The friends are behind bars. And Ted is back to being Ted, fixing refrigerators and painting fences. And just before leaving (and after giving me another bone-crushing hug), he said he would invite me to his house next time he brews up a batch of beer. And I absolutely believe he will.

And I believe I will take him up on that offer.

Sunday, 23 September 2018

Really REALLY over?

I am not a lawyer, nor do I claim any specific expertise in any field having to do with law. But I do know what the word "dismissed" means, and I do know what the phrase "with prejudice" means, so when I saw these words in a Request for Dismissal, written by Bruce Brusavich (who happens to be the lawyer representing Jahi McMath's mother Nailah Winkfield), and submitted to Alameda County Superior Court on September 7, 2018, my eyes got a bit wide.

In case you aren't quite following, it appears that the Jahi McMath saga may finally finally FINALLY be over. Professor Thaddeus Pope posted this document to his website:
Again, I claim no expertise in law, but this certainly appears to me to be a request by Nailah Winkfield to dismiss all complaints against Dr. Rosen with prejudice. This means case closed, never to be reopened, etc.

If that is in fact true, I have no doubt that the two sides reached a settlement, which I (and everyone else) have predicted from the very beginning. I am also not surprised that there has been no media coverage of this whatsoever. I am also not the least bit surprised that no autopsy results have been produced, as I highly suspect Ms. Winkfield would never have let an autopsy happen. As the world learned with Terry Shiavo, autopsy results can refute family members' claims better and more soundly than any expert.

If any lawyers happen to come around, I would appreciate some verification on this. But to my untrained and extremely amateur eyes, it appears the Jahi ordeal is finally, actually, really, and in all other ways over.

Until the next one happens.

Tuesday, 4 September 2018

A tale of two patients

It's been over two months since I wrote anything, which is by far the longest interregnum I've ever taken.  And by "interregnum" I mean "I've been too goddamned lazy and/or distracted to sit down at my computer and get some writing done".  Sure, I've seen many blog-worthy patients in the past 8 weeks, but I've just had some trouble framing them into what I thought would be an interesting story.

Until now.

I'd like to present a pair of patients whom I admitted on the same date just a few hours apart.  Both were seriously injured and both spent considerable time with me recovering.  But I found the differences between the two rather startling.  So for this post I've decided to do something a little bit different and see who can spot the differences.

Ready?

Let's begin.

Patient 1: Ivan (not his real name™) was the victim of a hit-and-run pedestrian accident.  He was walking home from work when a car struck him at high velocity.  He suffered a complex fracture of his left tibial plateau, a right humerus fracture, an open right ankle fracture, several broken ribs, and a ruptured urinary bladder.  I performed an exploratory laparotomy and repair of his bladder laceration, and an orthopædic surgeon performed a surgery for his humerus, two surgeries for his right ankle, and 3 surgeries for his left knee (so far).  He had an external fixator on his left knee for several weeks while his œdema improved before his final two surgeries, he had an uncomfortable urinary catheter in his penis for several weeks while his bladder healed, and he was unable to bear any weight on his right (dominant) arm and both legs for 2 months.  In short: he was broken.

Patient 2: Tera (not her real name™) was driving her car down a dark road at night with a blood alcohol level over twice the legal limit when she went off the road and struck a tree.  In the process she fractured her left acetabulum (the socket of the hip) and a bone in her right hand.  She required one surgery on her left hip and was unable to bear weight on her left leg for 6 weeks (no surgery was required for the right hand).  In short: she was mostly fine.

Every day that I went to see Ivan, he was kind, respectful, and polite despite his multiple injuries and significant pain.  "Thank you, doctor" was his closing statement each morning as I walked out of his room.  Even though I had cut him open and inserted a large, uncomfortable tube into his penis, he thanked me.

On the other hand, every day that I went to see Tera, she had nothing but complaints.  The nurse took too long to get my medicine (20 minutes), the nurse took too long cleaning me up (15 minutes), it's too hot (it wasn't), my leg is swollen (it's broken, of course it is), my splint on my hand is too tight (it wasn't), it took too long getting back from getting X-rays (30 minutes), no one is telling me what's going on (yes I was), I want to be transferred to another hospital.

Anyone see the difference yet?

I sure did.  As I walked from one room to the other day after day, the difference in their attitudes astounded me.

Tera (who you will remember caused her own injuries by driving drunk) did nothing but complain.  She even refused physical therapy on multiple successive days because of pain despite the fact that it was the only thing keeping her in hospital.  I wanted to suggest to her nicely (read: scream in her face) that she had a team of people whose entire job was to take care of her so she could try showing some basic gratitude, but I didn't.  No, I just listened.  Standing there and listening to her many grievances was a far, far better thing that I did than I had ever done.  And yet she never once said "Thank you".  She showed no appreciation or gratitude at any time before I finally was able to send her to rehab.

Ivan, on the other hand, who was much more severely injured through no fault of his own, who was completely unable to walk, who had a catheter hanging out of his penis, who had three broken limbs, and who had a huge incision on his abdomen, was still able to smile and cooperate and participate with his own care.  No matter what was asked of him, no matter how much pain he was in, Ivan simply gave a weak smile, said "Ok", and then did it (or at least tried).

Look, I understand that no one wants to be in the hospital.  My patients are in pain and I'm asking them to get out of bed and walk.  I get that.  But all I ask for is a little civility and a little gratitude.  Trust me, I don't want to be seeing your obnoxious drunk ass in the trauma bay at 2 AM either or repairing your bladder at midnight, but here we both are.  So let's try our damnedest to make the worst of times into the best of times.

Friday, 29 June 2018

Finally over

It's over.  After nearly 5 years, the Jahi McMath saga is finally over.

Almost.

If you aren't aware of the Jahi McMath story, then you obviously have not been reading this blog very carefully, because I have written about her rather extensively, first here, then here, here, here, here, here, here, and most recently here.  The short version is that Jahi was a 13-year-old girl who underwent a series of upper airway procedures for sleep apnoea in December 2013 which was complicated by bleeding, cardiac arrest, anoxic brain injury, and brain death.  Jahi's family refused to accept the diagnosis, and thus began a battle between Jahi's mother, Nailah Winkfield, and Children's Hospital Oakland over whether Jahi was really brain dead (she was) and what should have been done with her (nothing).

Eventually Nailah and CHO came to an agreement that Jahi would be released from the hospital to her mother's care, and after moving from California to New Jersey (one of only two states where brain death can be refused on religious grounds), Jahi has remained on a ventilator, completely unresponsive, still brain dead, at a private apartment.

Over the ensuing years there was a report that she had started menstruating, despite evidence to the contrary that she had already had her first period prior to surgery.  There was a video supposedly showing her breathing over her ventilator, despite the fact that in April while she was in hospital she never did.  There were videos released by the family purportedly showing Jahi moving her finger or a foot to voice commands despite radiologic evidence that her cerebral audio pathways were completely destroyed and she had no anatomic mechanism by which that could be possible.  A neurologist rather ludicrously claimed, based solely on these videos, that Jahi was not brain dead, but rather severely disabled.  Despite these claims, Jahi never woke up, never opened her eyes, never showed any sign of life other than a beating heart.

Ever since this adventure began, I've been rather adamantly averring that Jahi was dead and that delaying her burial was unethical and nothing short of cruel to her and her siblings.  There have been a multitude of deniers, people full of hope and wishes and thoughts and prayers, that claimed Jahi would wake up.  Through it all I have continued to maintain that brain dead is dead, that Jahi would never wake up, that no one in human history who was properly diagnosed as brain dead had ever recovered from it, even a little bit.  While that may on the surface seem callous and uncaring, it is in fact quite the opposite.

And though sometimes I don't want to be right, I was right.

On June 22, 2018, over 4 1/2 years after she lost her life, Jahi finished passing on.  For the sake of simplicity, I will refer to this event as her death, even though she actually died on December 9, 2013 and was declared dead on December 12, 2013.  I have known about her final death since it happened, but I decided not to write about it until it was reported in the news out of respect for her family and what they are going through. 

Jahi had been hospitalised several times for various issues, including January and April of this year for some kind of undisclosed "intestinal issue".  I suspect it was intestinal ischaemia (decreased blood flow to the gut), though I cannot confirm this.  She was treated with antibiotics both of those times, and the surgeons seemed unwilling to operate on her.  Finally in early June she was taken to surgery, where they apparently found nothing grossly wrong.  Nailah and her supporters of course declared this as some kind of miracle.  I, on the other hand, knew that it was simply the beginning of the end. 

Jahi started a slow but steady decline since then, including renal failure and lactic acidosis, culminating in disseminated intravascular coagulation, multi-system organ failure, and fulminant liver failure causing uncontrollable bleeding.  She was apparently brought back to the operating theatre for "one last look" on June 22, got back to the intensive care unit, promptly coded, and died.  Again.

It's finally over.

I suspect Nialah will continue her legal battle against CHO, though I would be shocked if CHO doesn't immediately settle the wrongful death lawsuit out of court just to get it over and done.  But Nailah plans to pursue a federal civil rights lawsuit to get the date of death on the death certificate changed from December 12, 2013 to June 22, 2018.  I haven't a clue what she thinks that would accomplish nor how much time and effort this would take away from her caring for her three other children.

I don't know details of Jahi's various illnesses or operations, nor can I divulge how I know this information, nor is that in any way important.  What is important is that Jahi can finally be laid to rest after being abused for so many years.  And her siblings can finally move on with their lives.  And I can finally stop writing about this case. 

Until the next one comes along.

NOTE: I realise it has been over a month since I have written anything here, and for that I apologise.  It isn't that I haven't had any interesting cases, because I have.  However, it has become increasingly difficult to frame my stories in a way that I have not before, and I don't want to risk becoming boring and/or repetitive.