Friday, 7 October 2016

Believing evidence

I made the quote box above extra large because it is extra true.  I will quite literally believe anything no matter how ludicrous it may seem if there is actual, real, true, and verifiable evidence to support it.   I don't care how crazy it seems as long as there is not just evidence, but solid evidence.

There is now a video purportedly showing that Jahi McMath is breathing on her own.  Evidence?  Yes.

Solid evidence?  Not so much.

On his blog, Professor Thaddeus Pope reposted a video that had been posted to the "Keep Jahi McMath On Life Support" page on Facebook.  I feel I must quibble with Professor Pope just a bit, as he states she "breathes on her own" and puts the word "death" in quotation marks, much like the anti-brain death faction.  Regardless, the majority of the 5+ minute video focuses on the lights on the ventilator that is breathing for Jahi.  For a good portion of it, Jahi appears to be breathing faster than the 12 breaths-per-minute to which the machine is set, and the Patient Effort light occasionally blinks, indicating that Jahi is breathing on her own.

Or does it?

The "Jahi is alive" crowd seemed to think that Jahi starting menstruating indicated that her brain was alive, but there have been other documented cases of brain dead patients starting puberty.  Similarly there are also documented cases of brain dead patients showing supposed respiratory effort.  Unfortunately for Jahi (and even more so for her her mother), it does not indicate that Jahi is not brain dead or will ever "go to the mall" as Nailah says in the video.

In this case report from Poland, a patient who had failed two brain death examinations was noted to have multiple triggered assisted breaths.  The clinicians were baffled, so more brain death confirmation studies were ordered.  There was no blood flow to the brain on ultrasound, and a cerebral angiogram confirmed no cerebral blood flow.  They concluded that "Cardiogenic oscillations associated with incorrect low ventilator trigger settings may falsely suggest persistence of breathing efforts in a brain-dead patient".  In other words, the airway pressures changed during heart beats, and this falsely indicated to the ventilator that the patient was trying to take a breath.

Another case report documents a very similar phenomenon, where a brainstem dead patient was shown to have triggered breaths on the ventilator.  The authors' conclusion sound eerily similar: "'Triggering' was probably caused by a decrease in airway pressure in time with cardiac contraction. The trigger flow rate is crucial as factors other than the patient's inspiratory effort can initiate flow from the ventilator with very sensitive settings."

And a very well-described case series from China tells of two more patients with similar presentations, both documented brain dead using a combination of clinical examination, apnoea testing, and EEG silence, and both with triggered breaths on the ventilator.  In both cases, brain death testing was repeated, and it remained consistent with brain death.  At the risk of sounding like a broken record, they concluded, "Minimal changes in circuit flow unrelated to the respiratory effort can trigger a ventilator breath and may mislead caregivers in recognizing BD."

In other words, it very well may not be Jahi breathing at all, but rather other factors making it seem like Jahi is breathing.

The saddest part of this latest episode in the saga is at the end of the video, the camera pans over to Jahi, flaccid and motionless, eyes still closed, exactly as she was when she died 3 years ago.  In her continued deluded state, Nailah thinks of this as an improvement.

It would be painfully easy for anyone to verify the veracity of this video.  It would take a pulmonologist less than five seconds to say either Yes or No.  If an intensive care doctor examined her and said "She's breathing.  Nope, not brain dead", I would have no choice but to believe it no matter how ludicrous.

Imagine the media frenzy surrounding the first documented case in human history of even partial recovery from brain death, whether miracle or marvel of modern science.  We all know that Jahi's parents enjoy a show.  They revel in publicity.  They enjoy the attention.  I have no doubt whatsoever that they absolutely know how easy proving this video would be.

But that hasn't happened.  Ask yourself why.  I think we all know the reason.

So until it does happen, I cannot believe it, and I remain utterly and completely sceptical.

142 comments:

  1. If she was going to come back from death, it should only take three days.

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    1. I got banned from their FB page when i pointed out that god was leaving it a bit late after 200+ days when the expected was three days :)

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  2. The sensitivity setting was set at 2 cmH20 so I don't believe that the triggered breaths were due to the alteration of airway pressures. However, I suspect that someone is pressing the manually cycled button to give the appearance that Jahi is triggering the vent. cardiogenic oscillation usually occur at 0.5 cmH20 sensitivity setting.

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  3. Her face is so puffy. She's filled with fluid. I wish her mother would stop bilking people and the state of NJ and let her go. How long can this go on?

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    1. Well, people last sent money to the GFM campaign six months ago. So she continues to bilk NJ residents and the rest of us (via Medicaid - I recollect seeing some documentation long ago that indicated Jahi was a Medicaid patient).

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    2. Far as I know, the state of NJ has no administrative or legal authority to terminate Medicaid benefits for Jahi as long as there is a doctor authorizing the treatment. From the documents we saw, she is currently coded as severely disabled by anoxic brain damage, but still a live patient.

      Remember that Jahi has never been declared legally dead in NJ. But if this ever *were* to happen, her residency in that state is now established, so of course the family could exercise that religious exemption to a DDNC.

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    3. I asked Professor Pope if an independent exam concluded that Jahi still fulfilled the criteria for brain death could Nailah then invoke the NJ religious exemption. He said if she did it would have no bearing on the court case since CA issued the death certificate and the dispute is being heard in a CA court.

      Under such a scenario things would remain as they are. If plaintiffs fail to get the death certificate revoked they could just remain in NJ and continue to receive full benefits there.

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    4. That's my understanding too. I was just speculating that if there ever *was* a situation that resulted in Jahi's medical status being questioned in NJ (which hasn't yet happened, and may never come to pass) the religious exemption could be claimed *there* (New Jersey). So, the current situation would be maintained.

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  4. I won't believe until a respiratory therapist and a doctor are there in the room with her to exam her. And not the doctors the mom chooses.
    The camera pans her face and like doc B said, she still is just laying there flaccid, lips still the same.
    Mary

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    1. Ventilator triggers: http://gejl.info/articles/eng/Mechanical_ventilator

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    2. "Family members say they've seen reason for hope
      Jahi's family members maintain that they're hoping for a miracle.
      Her mother told CNN last month that she'd seen improvements, including indications from a hospital monitor that she said suggest her daughter was trying to breathe on her own." CNN 01/9/2014

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  5. At the end of the video Nailah mentions that she had been told Jahi had a lesion on her brain stem that would never heal. Now she believes that they were wrong and this video is proof. I know that dead brain cells can't regenerate but what about lesions on the brain stem? Is that even possible?

    Nailah also remarks that Jahi's nurse is laughing at something she said in the background. I wonder why she didn't just let the nurse say something to corroborate what is happening with the vent. Of course she is preaching to the choir on the Keep page but if she really wants to convince skeptics surely she realizes that a nurse's word would carry more weight.

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  6. do we have any proof the video was taken this year?

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    1. One persistent problem with this case is that NONE of the videos or still shots ever has reliable dating, and often pictures which are supposed to be "recent" or "new" prove to be months or years old.

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    2. Ken, I am just as skeptical. Mostly due to the most recent photo taken by a lady who braided Jahi's hair about a year ago. Jahi was notably smaller, necrosis on her mouth etc. we have all seen that photo. I think she is posting an old video for a reason. It was recently publicized that they could once again prove that Jahi is alive. I remember reading that in Dr. Pope's blog, that the defendants would be allowed to have their own doctors examine Jahi. I really think that Nailah has gone to posting more than normal videos and pics lately thinking that will be enough to convince a judge. She is thinking if she shoves enough material into the media, that no exam will be needed. That is why I think these are old videos. She went from having necrosis on her mouth area to looking plump again with lips that look like they did on day 1?

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    3. Ma is notorious for posting old photos and videos and saying they're brand new. I agree that this one is from early on.

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    4. Another reason I don't put much credence in the videos is that they never show a *full* view of what's going on in the room. The many earlier videos that were intended to prove Jahi's responsiveness to her mother's voice commands showed us various movements of selected body parts, with Nailah's voice in the background. But we haven't seen one (far as I recall) that showed a full-body view of Jahi in bed, with her mother at bedside, speaking *as* the movements happened. So, I always wondered if these were just videos taken when random spinal reflex movements were happening, with the voice added in later, to *coincide* with the observed movement.

      This recent one isn't much different. We see something happening with the vent, which may or may not be auto-triggering, as Nailah "motivates" Jahi to keep breathing, by reminding her of a favorite activity (trips to the mall) that could be accomplished much easier without being connected to a ventilator. We don't know if there was just a video taken of the vent display, when someone noticed an apparent irregularity, then the voice was added later...just as we don't know if Jahi was *really* reaching for the Taki Fuego chips when her hand moved.

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    5. I think the earliest video clips posted had the voiceovers done live - which is why mama had to "encourage" Jahi so many times before the desired twitch would occur. it is kind of like training a cat to sit on command. the secret is figuring out how to predict when the cat plans to sit down.
      videos posted later may have had the voiceover added after the fact.

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  7. I've messaged Nailah to let the RT in charge to briefly change the settings to CPAP with zero pressure support, zero PEEP, and ventilator sensitivity to 5 cmH20. Just put her on flow by with a little bit of oxygen and observe the monitor. If the vent monitor is registering spontaneous respiration and spontaneous tidal volume while on CPAP, it means Jahi is breathing on her own without the ventilator's help.

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    1. I was performing a brain death exam a few years ago. The exam was consistent except the patient kept triggering the vent while on CPAP. I spoke with one of my senior colleagues who said to take the patient off completely and watch the chest wall. The patient was brain dead. The vent was being triggered by the patient's cardiac activity.

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    2. The vent will not be delivering any volume of breaths while on CPAP. Not unless the apnea back up settings are triggered.

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  8. Ma won't get the chance to prove Jahi is alive any time soon in state court. The next case management conference is April of next year. This case is going to drag out for a long time. The judge in the federal case has not yet ruled on the issue of overturning the death certificate. Meanwhile, Jahi's 16th birthday is coming up on October 24.

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  9. Why is it that every time Ma mentions the mall, I keep seeing that scene from Dawn of the Dead?

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  10. I wonder how long Judge Gilliam has to issue a ruling. Isn't there usually some kind of timeframe in which a ruling should be made? In an answer to a post on his blog Professor Pope said that it wasn't yet time to present evidence in either case but on what basis is the federal judge expected to rule? Wouldn't he need to review some sort of evidence first?

    Dolan claimed they had many recent videos that were never publically released before. I wonder if this is one of them.

    Like Cleo said, there isn't another CMC until next April and both sides said that the case wouldn't be ready for trial until sometime next year at the earliest.

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    1. and meanwhile the grifting continues. it looked for a day or so like the child who was shot in Townville was going to join the ranks of the undead, because his family matched the religious profile, and it's pretty likely the primary perpetrators were trying to groom them, but they did let him go in peace.

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    2. I don't know if there's a deadline by which Gilliam must rule. He did cancel the hearing for oral arguments in the case because he said he had enough to go on in the briefs submitted by plaintiffs and defendants. So, I imagine no actual evidence will be presented in federal court and no experts will testify. If Gilliam rules that the death certificate is valid, the state court matter will become a $250K case based on alleged malpractice alone. I fully expect Dolan to take the death cert issue to the SCOTUS if Gilliam rules against him.

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    3. Of course it could also go the other way. If Gilliam said he had enough to go on he might just accept all of Dolan's declarations at face value. I just reread Dolan's objection to the motion to dismiss and he claimed that because of procedural rules this court must accept plaintiff's allegations as fact.

      As for timelines, after asking about it I did some research and it appears that judges can take all the time they desire. The question was asked on an attorney forum and one guy waited nine months for a ruling.

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    4. It could certainly go the other way, but I was at the initial federal hearing and saw that Gilliam was annoyed with Dolan's popping up and interjecting at various times. That doesn't really mean anything, other than Dolan was annoying and I don't claim to be in the know, but my 26 years as a medical litigation paralegal makes me believe that Gilliam will let the death cert stand. I'm not going to bet any money on that, though. Judges make surprising rulings all the time, as we've all seen.

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    5. and on this case they have pretty consistently pandered to the family.

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    6. Hard to say. If Judge Gilliam said he had "enough to go on," this could mean that he's figured out that there hasn't really been any medically-relevant, meaningful, or even current "evidence" presented by the plaintiffs that would justify rescinding the death certificate.

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  11. This is the miracle of God. Only in God's hand can this sort of thing happen. And only God can judge not you slimy human faeces who walk on this earth. If they want millions then they should get millions. For it is the law of God that states "an eye for an eye." "Hear ye, hear ye!" You narrow-minded, pusillanimous, pompous cowards!

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    1. that's a lot of judging I hear coming from you.

      "for the love of money is the root of all evil."
      "Thou shalt not bear false witness"
      "do not pray on the street corners as the hypocrites do"
      "I am the Lord, your God, Thou shalt have no other gods before me."

      this is not a miracle of God, this is a family of grifters and their enablers defying the will of God.

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    2. God has the final say as to when we leave this earth - not a doctor & not any man made law. Jahi can lead the way in giving Christians the right to stand behind their belief that "All things are possible with God" & not be "forced" to accept when doctors say there is "no hope". Doctors lie all the time. They lie to save money for hospitals and insurance industries!

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    3. Can you prove to me that the doctors lied? I'd like to know where you get your information. I think Nailah and her family lies. They drink, they swear.

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    4. I work for the Chief Financial Officer in the biggest hospital and Trauma Center in the city and doctors have an incentive to discharge patients early, even if they're not 100% fully recovered. Every month, our office issues checks to doctors who would abide with this policy. The public doesn't even know that this is happening.

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    5. Doctors are encouraged to discharge patients when they are ready to be discharged. It is a common misconception that one must be 100% recovered to be discharged. That is not remotely the case. Nearly every single patient can complete their recovery at home.

      I categorically disbelieve that doctors are paid to discharge patients early.

      And to the person spreading the gospel above, Doctors don't decide when patients die, nor does god. Patients do that when they die.

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    6. Somehow "I work for the Chief Financial Officer in the biggest hospital and Trauma Center in the city..." sounds just like John Benton.

      Softship

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    7. If the laws of God were in force, then she would have been buried by now. It is the machines of man that is breathing and keeping organs functional, but sadly not her brain. Kindly step away from your pulpit of fire and brimstone.

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    8. Yeah discharging patients saves money. Money they then spend on caring for those who cant be discharged!
      Connor

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    9. They are welcome to let God have the final say on whether Jahi is alive or not. the hospital has been trying to give God the final word for three years, now. the scamfam keeps demanding that New Jersey's citizens pay to keep her in artificial undeath so they can keep grifting off other people's tax money.

      but yeah, God could hit her with a blizzard, or a lightning bolt, or a hurricane, or something if he really wanted to end this stupidity. of course, that would cause a lot of collateral damage.

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    10. @softship: I remember, years ago, my car was hit by a guy who worked for a major limousine company.

      turned out when my insurance company hunted him down that the biggest thing he drove for them was a broom. took them two years to get the blood out of THAT turnip.

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    11. Hurricane Matthew is coming. Maybe this stupidity will end.

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    12. "This is the miracle of God. Only in God's hand can this sort of thing happen. And only God can judge not you slimy human faeces who walk on this earth. If they want millions then they should get millions. For it is the law of God that states "an eye for an eye." "Hear ye, hear ye!" You narrow-minded, pusillanimous, pompous cowards!"

      This is hilarious! It can't be Benton, for he has no sense of humor.

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    14. @ Cleopatra - The references to specific allegations of medical negligence in the post directly above this one are familiar... :)

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    15. So how exactly does millions of dollars in exchange for a loved one's untimely death constitute an eye for an eye, hmmm? They only want it so Nailah can have her fancy dinners and designer clothes/acessories.

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    16. God had his say with Jahi nearly 3 years ago. It's only the courts, Jahi's family and medical technology that have kept poor Jahi's body going.

      Looks like John Benton has yet another job. He is certainly versatile!

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    17. Religious anon of 8 Oct 19:07

      If only God can make things possible, then why have all the thousands and millions of people who pray to God to fix their disabilities been denied? Does this guy have some sort of kink in causing people terrible pain, poverty, loneliness?

      The only thing that changed their disability was their doctors. The medication or procedures are what made the situations better, if they could be improved upon.

      My friend out west, also disabled, runs disability services for a county of over a million people. Because of stupid changes by people who don't think things through, he's having clients die because they are killing themselves. They can't get pain control anymore, their medications have been reduced and they don't let them live a life anymore. For some their doctors simply closed up shop and made it extraordinarily hard for existing patients and the other available doctors, of which there aren't any. I guess your God wanted to take his "miracle of medicine" away from these people to...punish them? for living productive lives?

      Or maybe this God really does believe in reincarnation, and we're all Ugandan presidents who believed American Evangelicals and decreed that LGBT people deserve to be dead because of behavior that affects no straight person in any way.

      Wow, that sounds kind of overboard when it's all written down, eh? Almost like evidence is being ignored for faith.

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  12. I hope that means the next time I'm told at 9 a.m. That I'll be discharged I won't still be perched on the side of the bed with my bag packed and all pissed off at 2:00 p.m. I can fully recover at home.

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  14. Doc, you made a very valid point in stating that if Jahi was *really* breathing on her own, the family would have gotten the supporting statements from a qualified respiratory therapist and doctor, called a press conference (hey, maybe even the Guinness Book of World Records team!) and basked in the media attention.

    But think of all the *other* issues they could resolve with this "proof." Jahi's CA death certificate could be immediately rescinded, without a court battle. This would allow Jahi's mother to "take her home," knowing that she'd be entitled to Medicaid there too. And, it would resolve the direction of the medical malpractice case. They wouldn't need to worry about accepting the "chump change" maximum settlement of $250K for
    wrongful death, but could pursue the personal injury claim, which has no maximum limit for compensation.

    If there was indeed "proof," attorneys Dolan and Brusavitch would be celebrating right now too.

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    1. One could also look at it the other way - the $250K cap on lawsuit for dead patients works to the benefit of the doctors who botched her surgery and her after-care and then sued to have her declared dead. I don't blame them for not trusting the medical establishment.

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    2. One could certainly believe that if one were fabricating things. The doctors did not "sue" to have her declared brain dead. They did their jobs and declared her brain dead.

      As for the "botched" surgery and postoperative care, unless you have access to her records, you are again inventing "facts". That is not allowed here.

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    3. Sure, I understand that a determination of wrongful death would limit the financial exposure of the doctors and hospital. My point was that being able to offer conclusive proof of Jahi's actually being able to breathe on her own would provide a *major* benefit to her family...not just financially, but by restoring Jahi's eligibility for continued medical services in CA. I don't see why the family, and their attorneys, wouldn't take advantage of this opportunity to *immediately* resolve these issues, if they *could.*

      In a situation like this, it wouldn't matter what specific opinions the judges, medical defendants and their attorneys,or any one of us might have about the concept of brain death. It wouldn't matter whether typical hospital testing standards fully conform with the UDDA, or even if the UDDA itself should be reviewed. It wouldn't matter if anyone had specific religious convictions, or not, about brain death. If it's a proven, supportable *fact* that a patient actually has some breathing capacity, death, by anyone's standards, didn't happen.

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    4. and, of course, since we've SEEN what the post-op instructions were, and what Mama Nails tweeted they were doing, instead, we know hat even if he DOES have the records, he is inventing "facts"

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  15. What would really put the cherry on top of this travesty would be if the staff at the current facility had a mishap of some kind which disabled the respirator for long enough that the mother decided Jahi was actually dead. And then sued for wrongful death.

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    1. There is no current facility. Nailah has jahi's body in an apartment. She was discharged from the NJ hospital in August, 2014.

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    2. I think he was not trying to suggest she was in a hospital - but just that nailah would try to sue whoever she was letting the state pay to babysit the body.

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  16. I do believe we are seeing spliced tapes. I have had 2 family members be on ventilators for extended periods of time. One for 6 weeks and the other for months with a PEG. Both of them lost a considerable amount of weight during this time. Jahi doesn't look like she has lost hardly any weight. How could she maintain that much weight? Both my relatives have recovered and left the medical facilities and regained the weight they lost. I think this is an tape made up of previous tapes spliced together.

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    1. Maybe giving too much formula. The types I have seen are 250 cal per container. My patient who is active was gaining weight and looking puffy. GI doctor and dietitian lowered the amount per day. Jahi has not moved in almost 3years. No way to weigh her at home, and maybe doctor not monitoring her puffiness. With the formula, the company providing it sends the amount per month the doctor orders. So they can only give so much. But they could also be adding other stuff other then formula.
      Mary

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    2. Jahi is in locked-in syndrome. https://www.ncbi.nlm.nih.gov/pubmed/16186044

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    3. People I have seen in locked in syndrome have their eyes open, and can moves eyes back and forth. even use a computer that they use with their eyes.
      Mary

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    4. Not with total locked-in syndrome.

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    5. that was debunked two years ago, John.

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    6. Ha! Haha! No.

      But seriously, no.

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    7. Honestly, John, your crackpot theories are beyond tiresome.

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    8. You can add locked-in syndrome (total or otherwise) to the list of things you know absolutely nothing about, John.

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    9. Mary, you made a good point about the weight gain. Since Jahi isn't in a hospital, we don't know how closely her nutrition is being monitored, in terms of appropriate caloric content for a patient who's immobilized. In recent times, as people are becoming more interested in natural/organic foods, there's been an increase in the use of blenderized foods for enteral nutrition too, as well as some of the "supplement" beverages usually consumed orally (protein shakes, Ensure, and such). If anything is being added to whatever formula the doctor has prescribed, extra calories may be adding up.

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    10. The only problem with that Scarab, is the hairdresser pictures clearly show how thin she has gotten. Its hard to believe she puffed back up that much unless its fluid retention or this is an old video.

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    11. And the necrosis and hair thinning. I really think Ma believes that a series of videos, old or new will stave off examinations by outside doctors and will satisfy a judge.

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    12. Most likely the family is trying to add Big Mac's to her formula - they have form.

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  17. I wonder if we'll see her dressed up for prom, or apply to college (of course, some colleges are so crazed by diversity-fads that taking a dead student might be their ideal.)

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    1. The family made a big deal about her "graduation" from 8th grade.It was covered in the local news.

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  18. Life news has a new article out. It says Jahi is breathing 14-16 breaths a minute on her own. I thought the machine is set for 12 breaths and she *may* be breathing a couple breaths .

    http://www.lifenews.com/2016/10/10/they-said-she-was-brain-dead-now-jahi-mcmath-is-breathing-on-her-own/

    Mary

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    1. This post was referring to Wesley Smith's blog:

      http://www.nationalreview.com/corner/440913/

      Like you said Mary, he fails to mention the 12 breaths per minute the vent delivers. Even if by some miracle Jahi is actually taking 2 or 3 breaths a minute on her own is that enough to sustain life?

      I know someone with severe aortic stenosis and one of the symptoms is shortness of breath. When this happens she ends up in the ICU with life threatening Co2 buildup. I would imagine that 2 or 3 breaths a minute wouldn't be enough to maintain the proper exchange of oxygen and Co2.

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    2. There are no breaths she is taking on her own. Until there is proof, that is the fact.

      Kate J.

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    3. liesitenews and Weasley Smith, of national review.

      combined total of zero credibility.

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    4. There are some breaths that she's taking on her own. You people have some heart you hypocrites!

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    5. 2 or 3 breaths may not be enough to sustain life but it's enough to change the outcome of the apnea test. You take out the apnea test and she no longer fits the criteria for BD. That's what they're trying to do.

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    6. Anon - It has nothing to do with having or not having a heart. It is all about evidence. At this point the video is unsubstantiated and meaningless.

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    7. That would be up to the judge to decide.

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    8. We are realists. I give you 3 glasses of lemonade. "The glass is half full" "the glass is half empty" and finally "i think This is piss!"
      Connor

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    9. This issue has already been addressed in court in the Mcmath case. January 06, 2014 Order denying TRO : "The medical team has seen no indications of Ms. Mcmath's body spontaneously initiating breaths, however, the medical team has reported that ventilator "autocycling" did occur on at least one occasion and the ventilator circuit and filter did need to be changed. This type of ventilator issue is common in the pediatric intensive care unit. A lay observer could mistakenly believe this showed the patient attempting to take a breath when in actuality, it is merely a reflection of excessive humidity or deposit accumulation in ventilator tubing or ventilator filters that then simply need to be exchanged..."

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    10. I'd love to have a heart. I could have given it to the friend who died saturday for lack of one.

      the apnea test will prove if she is taking breaths on her own. that's what it does.

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    11. Betsy Gilbert, if there is water collecting in the tubing, the ventilator wouldn't be "autocycling," it would be "high pressure" limiting - meaning if the ventilator pressure reaches the set limit, an audible or visual alarm activates. The vent will then temporarily stop the inspiration, then allow the patient to exhale immediately. Ventilator autocycling occurs when a the sensitivity set too low or if a gas leak exists in the airway which creates a negative change in the airway pressure.

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    12. @ Betsy - And, the possibility of auto-triggering of the vent would have to be considered *now*, just as it was during those January 2014 court deliberations, if this video, or any other reference to Jahi "taking breaths on her own," were to be introduced as evidence of "proof of life."

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    13. I don't think you understand the meaning of auto-triggering or autocycling. Ventilator autocycling is the continues cycling of the ventilator from the inspiratory phase into the expiratory phase. It's continuous and you'll notice it right away. I didn't see it on the video.

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  19. Just a question from a lay person. If you are breathing on your own, why does someone have to coach you to take a breath? Doesn't the body automatically do it by itself because the Co2 level is too high?

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    1. Yes, but I think Nailah is also trying to demonstrate that she is responding to voice.

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    2. If Nailah really wanted to convince the world Jahi is responding to voice commands she should have her open her eyes.Doing something that is automatic is not convincing. But that is not possible when your brain dead is it.

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  20. I found this interesting article about these people here in California in sub acute hospitals. Very sad to end up like this.
    Mary

    http://impossiblechoice.org/deciding-when-a-life-is-no-longer-worth-living/

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    1. This is why you MUST have a living will.

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    2. Thanks for the link Mary. It was an excellent article and more than any other I've read makes you realize the horror and despair that results from futile care.

      It baffles me that most people would never choose to exist in these states yet they force it upon their loved ones.

      There is indeed a fate worse than death and this article describes it perfectly.

      Delete
    3. my wife and I have an agreement that if we are presumed to be brain dead, then after the recommended tests and intervals, (assuming the tests confirm brain death) we will let go and donate what can be salvaged.

      Delete
    4. Persistent vegetative state with the ventilator breathing for you is worst than brain dead. At least in my opinion.

      Delete
    5. I think the people in these places are pvs and unresponsive. I don't know if any are brain dead, then the state wouldn't pay. Think it said at this hospital only 8 out of 62 patients are responsive. I think all or most on ventilators. If that was me I wouldn't want the G Tube, just let me starve to death. There are thousands like this in California, makes big money for these hospitals. I don't know family members don't let them go. Unless they are all waiting for *miracles* to happen.
      Mary

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    6. yeah, but I hesitate to say if I unresponsive and totally dependent on a machine, to pull the plug. last time I said that my wife shut off the TV.

      more seriously, if there is no hope of recovery, then why drag it out. give God the opportunity to cast his vote, and then donate what can be salvaged.

      greater love hath no man, etc.

      Delete
    7. My friend was in a bad car accident and he ended up in a sub acute hooked up to the ventilator. He was unconscious but we all knew that he didn't want to exist in that state. So when we visited him we thought we could help by pulling the ventilator plug out of its socket and that's exactly what we did when the nurse walked away. But "lo and behold", the damn vent still works and it started alarming! We couldn't figure out how to shut it off so we just ran out of the room into the parking lot. We heard later on that the nurse called the cops.

      Delete
    8. @ Mary - I think you're right about some families waiting for a "miracle" to happen. As the doctor stated in the article you shared:

      "Google has also complicated things, with people rejecting medical opinions and instead believing what they find on the Internet, said Dr. Warm."

      “What’s changed is the broad availability of information. But the information doesn’t come with an indicator of how accurate it is.”

      I remember reading something in one of the court filings in the Israel Stinson case that actually *said* something like, "Ms. Fonseca has personal knowledge of patients who have made a complete recovery from brain death." Obviously, she hadn't achieved some major scientific breakthrough in the field of neurology. This young mom, desperately trying to figure out what had happened to her son, and desperately looking for some hope of his recovery, had probably read about some of these "miracles," in which a person who'd suffered *some* degree of consciousness impairment had "awakened."

      The case mentioned in the article you shared is one of those...

      "Families read the stories about Wallis — “Coma man wakes after 19 years” — and believe if they just wait long enough, the same could happen to their husband, wife, brother or sister."

      Problem is, no one really knows if these cases are even *comparable* to their family member's situation, since every situation is unique.

      Delete
    9. and such wildly exaggerated and unscientifically based stories are very easy to find in places like liesitenews.

      Delete
  21. Doc, when you say "parents" you really mean "parent". The dad hasn't been seen in a long time AFAIK, probably ran far as he could get from this crazy train.

    ReplyDelete
  22. I saw the article headlines that "Jahi is breathing on her own" but when I clicked on the article it seems that is really not true. Has she been taken of the ventilator? Nope! There was a video of her on the vent and towards the end the showed her body. How can anyone look at her and not know that she is not alive - much less that she will not be taking any trips to the mall? Of course, Life site news ,or whatever it is doesn't allow comments. Unless you agree with their viewpoint, that is.
    There was also another article written by someone with the title " JD, PHD" on medicalfutility.blogspot.com. (Thaddeus Mason Pope, JD, PhD).
    Evidently they don't allow comments on there without approval. I made the comment that I noticed his title didn't include "Medical Doctor" but apparently it wasn't approved.

    ReplyDelete
    Replies
    1. Dr. Pope is a law professor, not an MD. He's an expert on the legal ramifications of brain death and on end-of-life issues. We respect his expertise. He's been commenting on Jahi's case for nearly three years and obtains the court documents for that case and other similar cases. It sometimes takes several days for comments to be approved. He's a busy man.

      Delete
    2. This comment has been removed by a blog administrator.

      Delete
    3. Thanks, Doc, for removing the moronic comment above in response to mine. I read it in my email notification.

      Delete
    4. You are welcome. People may complain about censorship and free speech and blah blah blah...

      Tough shit. There's no such thing as free speech in Bastardia.

      Delete
    5. We now have a name for our virtual kingdom! Personally, the lack of civil rights here doesn't bother me, since we are visitors, not citizens :)

      I post from the USA, where each of our 50 states has not just its own flag, but its own state tree, state flower, and state bird. So, in honor of our virtual community, I humbly submit this entry for your consideration as its official plant:

      http://www.backyardnature.net/yucatan/bastardi.htm

      Delete
  23. I watched the video and I have so many question. 1. How do we know if her heart is still beating? I don't see any cardiac monitor. How often are they doing vitals? 2. What is Jahi's code status? Is she full code or DNR? 3. Is she already embalmed? Embalming fluid will increase the body mass after embalming.

    ReplyDelete
    Replies
    1. I don't think anyone reading here actually "knows" anything (actual, provable facts) about the *true* condition of Jahi's body at this time. So, I will share a few of my *speculations,* as a non-medical professional. (Doctors and nurses, please jump in with clarifications and corrections, as you see fit).

      Heart still beating? I'll guess "yes," since it's the heart that effects the blood circulation that allows body tissue to survive. The purpose of the vent is to *keep* the heart performing that function as long as possible. As we saw in the case of Aden Hailu, when her heart finally failed after more than 7 months on vent support, full body death occurred.

      How often are vitals checked? I'll guess fairly often, since there is full 24/7/365 nursing care in the home. And, we have already been told, by family's attorney, that a variety of hormone supplement medications are administered to control body functions like blood pressure, metabolism, body temperature control, appropriate fluid balance, etc.

      Code? I'll guess no DNR, since the family's current legal actions are focused on proving that Jahi is "alive" so they can move back to California and restore her eligibility for medical care. That can't happen if full cardiopulmonary death occurs.

      Embalmed? No, same reasons as above.

      Delete
    2. Carl Tanzler did it: http://www.the-line-up.com/carl-tanzler-mummy-dream-girl/

      Delete
    3. Quite a story; I hadn't heard of this before! We can only imagine that if this scenario had happened in present time instead of 1931, Tanzler would have tried to convince Elena's family to allow him to pursue indefinite somatic support...

      Delete
    4. That is one weird story! Only thing different in this case then Jahi's is that poor woman had full body death and was buried. Then brought out of the grave.
      Mary

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    5. alternately, jahis body is in a freezer in the back room, and all photographs are over a year old.

      we have seen nothing that proves any of the media posted is recent.

      Delete
    6. I finally clicked the following button on Doc B blog, so I don't have type my name (Mary) at the end of my posts like I've been doing.
      Anyway if Jahi's mom wants these pictures more reliable, why doesn't she have a newspaper with the date showing next to Jahi, so she can prove the picture was taken on that day and not a couple years ago?

      Delete
    7. because that would prove when the picture was taken, and in Mama's case, that would be a bad thing.

      Delete
  24. It's actually cheaper for the hospital and Rosen to settle if you do the math. Let's say 10 million. 2.5 million for Brusavich. Another 2.5 million for Dolan. 5 million for Nailah, Omari, and grandma. Solved!

    ReplyDelete
    Replies
    1. EvErybODaYyyyyyy Gott MillioNss!

      Delete
    2. it is if you re only thinking in the short term, which sadly, many people do in that situation. in the long term, the next person will also want 20 million, and the next, and the next, and so on.

      Delete
  25. What did the death panel activist say to Trump?

    ReplyDelete
    Replies
    1. Doc - clean up on aisle 23:28!

      Delete
    2. I was waiting for the punchline.

      Delete
    3. I'm guessing she asked him to name her as his vice presidential candidate.

      Delete
    4. Tic Tac, Tic Tac, Tic Tac, Tic Tac, Tic Tac...

      Delete
  26. New post on the Keep page for Jahi:

    We are celebrating Jahis SWEET 16th birthday tomorrow, thanking God for all He has done. Showing the world that our lovely angel is ALIVE and proving all the doubters wrong, still showering Jahi with blessings. Turning a sad situation caused by those who gave her less than three months to survive, into a learning experience of what HOPE, FAITH and LOVE can do. Yes, Jahi will keep fighting with her mum until she claims her victory of full recovery and her life back.

    Still believing that a "full recovery" is just a matter of time. Will none of the current medical professionals involved in her care explain to the family why this is not possible?

    ReplyDelete
    Replies
    1. There isn't a new picture. I read a lot of the comments. People saying she isn't dead, moves and breathes on command, just waiting for her to "wake up". So if she isn't awake yet how can she move on command? For me to believe anything I would have to see her with her eyes open moving her fingers when mom tells her to.

      Delete
    2. That's what confuses me too Mary. How can she respond to commands when she can't even open her eyes. To be capable of responding she would have to be at the very least in a minimally conscious state. That she has never opened her eyes in almost 3 years makes that highly unlikely. It's also suspect that there isn't even a picture alleged to be "new".

      Professor Pope also marked the occasion with a new post:

      http://medicalfutility.blogspot.com/#!/2016/10/jahi-mcmath-happy-birthday-16.html

      Delete
    3. There is a picture posted of Jahi with a crown on her head. Doesn't look good to me.

      Delete
    4. I agree. How can you call that "life". It's sad. Compared to the hairdresser's pictures from last October she must be full of fluid now. That can't be a good sign.

      Delete
    5. "Will none of the current medical professionals involved in her care explain to the family why this is not possible?"

      I expect the family has been told why recovery isn't possible. I can only speculate about the McMath family's motivations for keeping Jahi's body warm, but there are definitely people who fervently believe that as long as the heart is beating and the lungs and inflating and deflating, even though that's being done with a machine, then there is life. I've seen posts referring to the cells of the body continuing to metabolize, therefore the person is "alive." I am appalled at the money it is takes to keep bodies warm and blood circulating, when that money (and ICU beds) could be used to help people who CAN be helped. This is indeed futile care - with that much brain damage there will never be any recovery. SMH

      My oldest sister was in ICY for a couple of days last week - if she hadn't been found by my other sister when she was, and transported and placed in ICU, she would have died. Her blood pressure was bottoming out, and it took a couple of days to stabilize her pressure enough to move her to a step down unit. She is home now and recovering. But what if there hadn't been an ICU bed available?

      Delete
    6. @Samantha, I am glad your sister is better and that there had been an ICU bed for her.

      On Jahi's new picture, which is new since they put a picture of baby Israel next to her, her right eye looks like something on it. I tried too zoom in on picture but gets blurry on my tablet.
      Sad how they are all celebrating her "sweet 16".
      I can't get that picture off my mind now. Looks like a person would look like in a casket.

      Delete
    7. Mary, is that a picture of Israel Stinson or is Nailah's grandchild also named Israel?

      Regarding her eyelids, I think they are just shiny from all of the Vaseline on them. Same with her lips, there's so much gloss on them it's reflecting the light. I imagine they must use tons of Vaseline to keep her eyes and lips from drying out since she can't blink and her mouth is always open.

      Those two facts make it impossible that she is in a vegetative state or minimally conscious. If she were in a PVS she'd have sleep/wake cycles and minimally conscious people can also open their eyes. Jahi can do neither.

      Once discovery takes place in the state and federal actions the family will have to allow independent medical experts to examine her. I'm confident that Nailah will once again reject their findings so nothing will change.

      Delete
    8. I am sure that's a picture of Israel Stinson with Jahi. Maybe a way to show the picture is not an old picture Jahi.

      Delete
    9. Mary, that's what I was thinking too. Or, maybe it's their way of claiming a "victory" over "the system" (legal and medical mainstream professionals) that allowed baby Israel to be "killed," while they've been successful in avoiding that outcome for nearly three years now.

      Delete
  27. This comment has been removed by a blog administrator.

    ReplyDelete
    Replies
    1. Dream on, John. You're as delusional as ever.

      Delete
  28. Professor Pope gave a presentation recently regarding brain death and brain death disputes. After mentioning the Mirranda Grace Lawson case he said that the toddler had recently suffered cardio pulmonary arrest. Her family had been using the courts to delay the administration of the apnea test to forestall a brain death diagnosis. Apparently that case is now moot.

    ReplyDelete
    Replies
    1. I had been wondering whatever happened to Mirranda.

      Delete
  29. I wonder if her parents will recoup the $30,000 bond they put up to stall the test back in September after the court ruled in the hospital's favor. She was in the ICU for 7 months at a cost of $10,000 per month. I wonder who ate that bill.

    At least the poor child is at peace now.

    ReplyDelete
    Replies
    1. I misspoke, according to court documents the cost is closer to $10,000 a day.

      Delete

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