Friday 7 October 2016
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.
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