I'm simply stunned.
As you can probably imagine, considering everything I see in my trauma bay, it takes a lot to stun me. The most recent judge in the Jahi McMath case managed to do it.
If you aren't familiar with Jahi, you can read more about her sad case here (there are links to other updates in that post). In short, at age 13 she underwent a complicated nasopharyngeal surgery back in December of 2013. The surgery reportedly went well, but postoperatively she bled to the point of cardiac arrest and eventual brain death (which was verified by 6 separate physicians). Her mother fought the diagnosis, and she moved Jahi to New Jersey where she still resides, on a ventilator and unresponsive.
Or is she?
The family has released several videos showing Jahi supposedly moving to verbal cues and another showing her overbreathing her ventilator (if you aren't familiar with that term, just google it). They claim this proves she is not brain dead, and they found a well-known brain death critic named Alan Shewmon, a paediatric neurologist, to supposedly corroborate their hypothesis.
In response to this, judge Stephen Pulido this past week declared that there is a possibility that Jahi is not in fact brain dead, so he has decided to send the case to a jury to decide if Jahi is still dead or if she no longer satisfies the requirement for brain death.
There are several glaring problems, all of which have combined to flabbergast me.
The first and biggest problem I have here is that Alan Shewmon HAS NOT EXAMINED HER. He solely relied on the 49 unsubstantiated videos supplied by Jahi's family to formulate his opinion that Jahi does not meet the criteria for brain death. I've seen several of the videos, and I can definitively tell you that they mean exactly jack shit. For example, one of them shows only Jahi's foot moving in response to her mother's voice. That's it, just her foot. There is no indication how long they were taking video, if she was moving her foot prior to the commands being given, etc. It's absolutely meaningless.
Let me reiterate this in no uncertain terms: Alan Shewmon has averred in a sworn statement given to the court that Jahi no longer meets criteria for brain death based solely on these videos. The only instance when he examined her was in December of 2014, at which time he stated that she was not in any way responsive (see paragraph 9). He has NOT re-examined her since. Not to mention the fact that nothing in the videos is acceptable in either diagnosing or ruling out brain death.
And Judge Pulido not only accepted Shewmon's ridiculous statement, he has kicked this to a jury to decide in response to it.
Since when does a jury get to decide who is living or dead? I thought that was the job of doctors. Has medicine advanced to the point where a group of twelve people can make medical diagnoses? And who the fuck decided it was a good idea to do that based on the testimony of a doctor who hasn't even examined the damned patient?
Consider this - if I were to make a diagnosis on a patient I had not examined, what would you call me? At best, you should call me unethical. At worst, a quack. And even worse, consider this: Judge Pulido is asking a jury, presumably without any medical training whatsoever, to synthesise and assess information that even experts would have difficulty with? Are you fucking kidding me?
This case has officially become a farce. It was sad and risible before, but this latest development is absolutely ludicrously preposterous. I don't know how else to put it.
As I have said many times before, if new evidence comes to light showing that Jahi is in fact not brain dead, I will recant everything I have said and state without question that I was wrong. Until then, this is fucking ridiculous.
The pray for jahi Facebook page is already praising the lord. They hope all the jurors will be " believers" there is a picture posted there and she still looks the same.ReplyDelete
I do not understand why they don't do another brain death test or an MRI or EEG , anything. From what I have read all the last tests were performed in 2014.
I also don't understand that if she was "alive" how come her eyes have never been open. Even people in a PVS have their eyes open.
Well, exactly. If she was really alive, there'd be things beyond videos her mom is putting out. You would think her mom would be all about getting doctors to come and examine her daughter, wouldn't you? To show this miracle to the world and get people to believe it? No. That never happens.Delete
This is so ridiculous. I've read a few statements by people who support this madness and they say, well, shouldn't we be excited about these advances in brain science? Shouldn't we be thrilled at what we're learning?ReplyDelete
Um, no. Because what we're learning is that a family can manipulate the heartstrings of a lot of people and depend on the state of hundreds of thousands of dollars of care for someone who is dead. And notice that no one ever examines her? There's never any impartial video that shows these things? No.
Or, and my favorite, people say they've "visited her" and they know she's still alive. Um, OK. Whatever.
Thanks, Doc, for providing sanity.
Is there a chance that the mother will be forced to allow an additional brain death exam? Of course, she would not accept the results, but, surely, the court would? It's clear that this is about the money, and always has been. I fear they will settle with the family, and the general public will be left with the impression that brain death is not valid, Jahi rose, and we are henceforth screwed when explaining brain death to families.ReplyDelete
Yup, agree Jennaba, on all counts.Delete
Judge Pulido is not an expert on brain death so that's the reason why he sent this case to the jury. He can only apply the law on BD. It's part of America's system of checks and balances. Both parties or litigants will have the opportunity to present their case/experts in court according to the definition of brain death or the UDDA.ReplyDelete
he's obviously not an expert in having enough backbone to rule according to the law, either. because the law says six real doctors examined her, administered the approved tests, found her dead, and wrote out a death certificate. the only way to overturn that is to have real doctors doctors examine her, administer the approved tests, and find a different result than the six had three years ago.Delete
Thank you Doc for putting the fact succinctly, eloquently and with hardly any swearing.ReplyDelete
I seriously hope that the family are forced to allow independent full and complete medical examinations by qualified doctors and specialists with provable and verifiable qualifications relating to neurology, brain injury, brain death and anything relevant, not some quack (my apologies to ducks) God help us if this goes to a jury since they will likely buy into emotion, quackery and religion as opposed to provable facts.
Even if the verdict comes back that Jahi is still dead, her family will continue to keep her in NJ on death support until her body breaks down into smoosh and even they (and their supporters have to admit she isn't going to wake up and walk any time soon.
This travesty should have ended the day she died.
I can't believe a jury gets to decide whether Jahi is dead when multiple DOCTORS have already said she is. It's so sad this has been dragged on for so long. This girl is dead. Let her go and stop wasting resources trying to keep her "alive."ReplyDelete
The only bright spot is, I would think/hope that the judge/other lawyers (as in, opposing the family) will require that Jahi's lawyers submit RECENT documentation of her as discovery and evidence, including recent pictures, videos, and tests done. Undoctored pictures of Jahi that show her whole body, rather than what her mother chooses to show. The fact that her mother uses smoothing effects on Jahi's skin in pictures and only chooses to show certain parts of her body and will take some really zoomed in close ups suggests to me that she doesn't look nearly as good as her mom portrays and pretends. I can't see a judge or opposing counsel allowing any old, doctored photos or those that only show select parts of her fly in court. The jury will need to know the truth to find the truth.
I would love to see the "defense" attorney dismiss every candidate, for cause, who is not qualified to declare death.Delete
Whole brain death or brain stem death?Delete
absence of brain function. you know, like you.Delete
Will the mother allow an impartial 3rd party to examine her? See if she breathes over the vent? See if she moves independently? If she doesn't they should throw the case out.ReplyDelete
if she doesn't allow the exam?Delete
Then the case should be dismissed. How can a jury make a decision on brain death if the proper tests have not been run? Not on her mother's video evidence, not on Shewmon's 3 year old determinations, but a current filmed impartial examination. Tickle her toes, tickle her ears. Does she smile? Take the vent off and see if she spontaneously breathes. The vent is the engine fueling the heart and lungs.Delete
Momma wants her designer shoes and bags, Jahi is the conveyance to get the donations.
As said other wise, let the girl go.
no, I was suggesting if she doesn't allow the exam to throw the case out.Delete
personally, I think since she has been told to go ahead and prove her claim for every hearing so far, she should be held in contempt of court.
Well, let me try and advance a minority opinion here.ReplyDelete
Jahi McMath fulfilled the criteria for brain death three years ago. She should have been declared legally dead and mechanical support stopped.
But for reasons which are now irrelevant, her support was not stopped.
From a medical view, there is no point in ranting about the family.
The patient's heart didn't stop and it should have by now according to th odds.
And she did not suffer somatic death. In fact, she has remained stable from a cardiovascular standpoint. That has happened in brain death but not too many times. I venture to say that not many doctors have seen this (and everyone who is saying "well, the patient can have these involuntary spinal movements" is correct - but I bet they haven't seen these over three years out, so that in itself is interesting. It bears exploring.
Now a judge is faced with this fact and at least one expert says the diagnosis is wrong (regardless of how valid his evidence is- he is certainly qualified even if he is wrong). The judge could have ruled against the family but what he did was not unreasonable. Remember - he is dealing with a legal diagnosis not a medical one. The experts will get to weigh in and one hopes tests will be repeated (I for one would like to see a PET scan).
There are two possible outcomes to this:
1. The diagnosis will remain the same after the judicial proceeding. This means the experts were right three years ago, and they are right now.
2. The diagnosis will change because of new information. That could mean the experts were wrong then, or they are wrong now, or there is a problem with the diagnosis of brain death.
That last one is the one that's really important. We are talking about a diagnosis that's essentially not changed for 50 years. I for one would like to see some new information here.
Why not repeat the imaging?
Why not repeat the PET scan?
Why not analyze the CNS hormones?
Sorry, but the I see an outlier like this, and Jahi McMAth by virtue of circumstances is an outlier, I want to revisit the issue. Especially one that has not been revisited for a long time.
I agree with PET Scan for glucose metabolism. If Jahi's brain is metabolizing glucose then she is not technically dead based on the definition of brain death.Delete
first: no, nothing about this is inconsistent with other long term brain dead cases.Delete
second: Shewmon is NOT an expert - he is a brain death denier. therefore he is a biased opinion.
what the judge did is TOTALLY out of line. Jahi's condition is a medical condition, not a legal condition. if she does not pass the tests in accordance to UDDA, she is dead. full stop.
the only thing that makes Jahi's case an outlier is that the judges have shown a total lack of spinal structure.
Without wanting to get into a spitting match, let me say
1. Exactly how many brain death cases can you document with somatic survival for almost four years? And I'm guessing that even if you can give me a number, because they are out there, the very fact the number is small says yes this is an outlier.
2. If you check Alan Shewmon's credentials he is clearly qualified to enter an opinion. You may not agree with it, and you may even right, but by any standard he is indeed an expert.
3. You might believe what the judge did is totally out of line. Again you might be right. But you are clearly mistaken when you say there is not a legal element to the definition of death. when you say if Jahi does not pass the tests in accordance with UDDA she is dead, that' begging the question. There are two parts to this legal question -first does she still meet the UDDA criteria having somatic survival for so long. Second what do the UDDA criteria mean in 2017 with new tests and new information?
1: the number is small because most people in this situation allow nature to take its course.Delete
the percentage of people who have set out to keep a brain dead patient alive for an extended period of time, have exceeded a year, and as I recall, without wasting the time for a google search is 20. after which an autopsy showed there was no longer a brain at all.
2: I checked Shewmon's credentials three years ago. he is not qualified, because his opinion is there is no such thing as brain death. he is not qualified to testify in this case, because he hasn't been in the same state with the patient in three years, and stated that he is basing his opinion on the family's home videos.
3: there is a legal component to death? sweet. some good friends of mine lost their granddaughter to cancer some years back. do you think I can appeal that to the state supreme court and have her brought back to life?
Maybe this miraculous new treatment can be extended to cure cancer. just take the cancer to court, and if the jury finds you cancer free, you are cured.
read this very carefully: DEAD IS A MEDICAL CONDITION. the courts have no jurisdiction over medical conditions.
first: being undead does not miss any of the UDDA criteria.
second: the UDDA criteria still mean there is no brain function. the new "tests" people keep throwing out are nothing but a distraction.
So, should we have two different death certificate? One for the death of the brain and the other for cardiac death?Delete
your question is exactly why there has to be a legal definition of death.
And indeed there is -it usually reverts to medical standards - and despite the acrimony that's exactly what is at stake in this case. That's why the case is so important.
Careful, Ken. You're talking to Dr. Franklin who probably knows more about brain death than all of us combined. His opinion, like Shewmon's, is valid. I vehemently disagree with Shewmon, but he is not the only one who holds that opinion.Delete
I'll address Dr. Franklin's other points in a bit when I have more time.
then he should understand why letting 12 people who are too dumb to get out of jury duty decide whether a person is alive or not is a very bad precedent.Delete
Ken, jury duty is not just for dummies. As a Black woman who is sick of seeing the criminal justice system fail to even indict cops for killing unarmed civilians, I make it my business to show up whenever I'm called for jury duty. And so does everyone else I know. IMO, that & voting are the fundamental responsibilities of citizenship in a democracy.Delete
Maybe our justice system would function better if more of our citizens didn't think they were too good to serve on a jury.
as do I, but the fact remains that I am only qualified to determine death in the presence of obvious signs of death; and THAT is a higher level of training than the average juror has.Delete
Ken, you don't have the credentials to determine death.Delete
Ken always carry a portable pocket-sized EKG machine with him all the time. Flat line you're dead! Thank God for Duracell batteries.Delete
What part of "Keep it civil" do you not understand?Delete
Knock off the childish bullshit. Now.
Dr. Cory, I had to go back to DocB's April post about Jahi to make sure but you never really addressed the statements made by the two expert witnesses on behalf of the defendants. I'm especially interested in your opinion regarding the results of the auditory evoked potentials test done in Sept. 2014. There was no response to maximum aural stimulation so defendant's witness stated that meant it was a medical impossibility that Jahi was hearing sound much less responding to it.Delete
Shewmon stated that he could offer no medical explanation for his belief that Jahi was responding on the family's videos but the fact that she appeared to be must mean current testing isn't sensitive enough. The only alternative, in his opinion, was that the family was lying regarding the veracity of the videos which was something he couldn't accept.
I'm inclined to think Occam's Razor applies in this instance but I'm no medical professional. Shewmon adamantly stated that the videos were the only way to ascertain whether Jahi was responsive since the movements couldn't be reliably duplicated.
If you read the day nurse's statement which documents her observations from roughly February through August of 2016 the movements are indeed quite rare, happening maybe a couple or few times a month with at weeks between them sometimes.
Her statement was entered into evidence on June 29, 2017. It's interesting to me that the last documented movement, whether volitional or not, happened over a year ago.
I'm not inclined to comment on the specifics of the exam, without everything in front of us. I don't know that I would have done what Shewmon did in terms of making his decision based on video evidence, but that will come up again. Shewmon does have impeccable credentials - Posner cites him extensively in his writings, and Posner wrote the book as it were. It's fair to ask whether Shewmon has an agenda since he is a believer in a state outside brain death, but his opinions cannot be dismissed out of hand.Delete
There are three issues here:
First- what is Jahi McMath's current neurologic exam, and does it conform to the current UDDA standards? That's where everybody submits their findings in a neutral forum and we can see. That's when I would personally opine on whether I think she is brain dead (right now I'd say about 75-25 she is- but that's a pretty large error margin for such a serious question).
Second: What test should specifically be done in this particular case. Does she require a new round of imaging? Again I am in favor of a PET scan, if I was advising her team, I would ask for that. ButI don't know how it will go in terms of what tests she receives. I'm fairly confident no one has ever received an MRI four years out from a diagnosis of brain death, so that would be interesting.
Third: Why are the courts involved. Even some of my sophisticated colleagues take umbrage here. Of course judges and juries are not qualified to diagnose brain death but that is not what they are here for. They are neutral parties to a dispute. This is how we should solve this particular problem -let everyone present their case to neutral parties (yes I know everyone will have biases). Maybe there is no evidence other than Shewmon using old videos -the judge and jury will probably understand that is not sufficient evidence to overturn the diagnosis. They may be baffled by bullshit, but there is no other way to mediate disputes of this nature fairly.
Let me make tow other points:
1. For centuries we have had difficulty ascertaining when people are actually dead. Yes, in most cases it is easy but centuries ago they weren't sure when to bury someone or when to call them dead when they were fished out of the Thames or the Seine. And mistakes were made occasionally. People were sometimes buried alive. So we naturally assigned this to the medical profession. We trust them. But we do not trust them absolutely, nor should we. in certain situations we want to review what they do and how they do it. I know doctors don't like that; I sat with a couple of experienced docs this weekend who railed on it. But this is for the best. Instruct the public responsibly on what you are doing when you diagnose brain death. The public needs it, more today than ever. This is a chance for them to do that. I've dealt extensively with the public and lawyers and the last thing they want to hear is "we're doctors, just leave everything to us."
Second: There is going to be some comment on my comments.
I invite them. Consider this -for those of you who really believe Jahi McMath is dead, and have complete confidence in the UDDA criteria, then this trial is the best thing you can hope for. This is what you want. It will demonstrate exactly what you are saying. That's what I would think.
That's what I've been saying all along. Ischemic Penumbra per Dr. Shewmon. Where the blood flow in the brain is low but not absent. That might explain why Jahi lasted this long. Why are we not using PET vs SPECT in Jahi's case?Delete
As a reminder John (since I assume that's who you are), her brain flow scan was negative. Not low flow, not trickle flow, NO FLOW.Delete
And as another reminder (both to you and Dr. Franklin), PET has not been validated in brain death.
I don't think SPECT is sensitive enough to detect low blood flow. That's all I'm saying.Delete
How are you going to validate PET in brain death if no one ever gets the test?
This is a great case to see what it shows.
Then how do you explain T.K. who lasted 20 years on somatic support and whose brain was totally calcified when his organs finally failed? Shewmon probably knows more about these long term outliers than anyone since it seems to be his passion to study them. He even coined the term "chronic brain death" to describe their condition.Delete
The most compelling medical record thus far is from Jahi's time at St. Peter's in NJ. She spent 8 months in their ICU and her records reflected that at no time was her condition anything other than consistent with brain death. It's worth mentioning that they were the only US hospital willing to accept her transfer and perform the tracheostomy and gastrostomy. Being a Catholic facility they certainly err on the side of life yet still discharged her to her mother's apartment with a brain death diagnosis. No long term care facility in NJ would take her.
The family claims that they noticed a change in Jahi's neurological status in the spring of 2014. From January to late August 2014 Jahi was in St. Peter's ICU and their records documented no such change.
More than two weeks after Jahi's cardiac arrest she had a radionuclide cerebral blood flow study. 40 minutes of imaging time demonstrated a complete absence of any intracerebral activity, only some activity in the scalp and face.
By all means perform a new MRI with contrast. Even if it revealed no remaining brain tissue Dr. Shewmon would still be saying, "But there must be something, we just can't see it because our technology isn't sensitive enough."
One of the unanswered questions here is what is the limit of neuroplasticity.Delete
Brain death doesn't require every neuron to be dead, simply a lack of function that will support life. Neuroendocrine function can continue, blood pressure can stabilize as this case demonstrates, but these do not preclude brain death.
But can some of those functioning neurons reorganize if given time and support?
Who knows? Again, great case to examine this. Unfortunately it takes a court case to do it.
Can't answer for PET scan but here's your study for MRI (they put a dead salmon in a MRI scanner and it lit up):
I doubt the study I present here will serve as valid medical evidence of the need for proper control for brain death but it does stress the need for proper control of statistical techniques as used in the scientific world.
I'm not sure I understand your point.
Yes, the salmon gave them false positive evidence of activity.
That's not a reason to do the test in this case.
Jahi McMath might give them false positive activity. That will be important information, about the patient and the test.
It's not a statistical issue - it's a single patient.
Like any test, we would have to have good interpretation and clinical correlation.
I would think we want as good a profile as possible.
No, I;m not saying every brain death case needs an MRI or PET scan. I'm saying we have a very special case here.
This is a diagnosis that's 50 years old - and we have tests we didn't have then. Think how CT scans changed the diagnosis of appendicitis that we made in 1968.
It would be good to have as much information going in as possible.
don't forget they also got a false positive on an MRI with a green jell-oDelete
the problem with using Jahi as a study is that you have to deal with her family.
the problem with believing in Shewmon's impeccability is that his bias against brain death being death renders his opinion in matters of UDDA quite peccable.
Like any test, we would have to have good interpretation and clinical correlation.Delete
This is indeed what I was thinking but I was framing that issue as a scientist (thus, the statistical issue) and not as a clinician for which, I have absolutely no training (my knowledge in that domain is limited to having worked with a clinical scientist psychiatrist).
Think how CT scans changed the diagnosis of appendicitis that we made in 1968.
CT is how they diagnosed mine back in 2013 (age 37 bordering on 38); they tried first with echography but they couldn't conclude anything as my appendix exploded 24 hours before and was a mess (I don't feel pain but I suspect the appendix wanted to go south by 10 days ago before I showed up at the hospital and the reason is explained by this piece: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0005289 and maybe a few others).
My point is, medicine has always been a lot more complicated than science is (despite science being difficult enough) because of patient care and some issues that I can't think about now (It is currently Sunday 9pm where I am and I am woken up since Saturday morning 9am) but I was providing a limited bit of evidence in that domain.
For context, I have been influenced by the principles of science based medicine (see https://sciencebasedmedicine.org/about-science-based-medicine/ for a precise definition wrt SBM versus EBM) and I'll be studying a bachelor of statistics soon to better evaluate scientific and medical evidence.
In the meantime, I'll set on studying brain death diagnostics to get better acquainted with it.
Medicine is applied science and that's what they teach in med school. We will crucify you if you question my applied science.Delete
If that were true, doctors wouldn't do research and advance both the science and art of medicine.Delete
But thank you for demonstrating your complete ignorance of medicine.
I disagree. The vast majority of physicians do not do scientific investigation or contribute to scientific knowledge. Do you?Delete
All doctors are required to keep up with new research to maintain credentials. The "applied science" argument is bullshit, because the science is constantly changing.Delete
And yes, I have several publications. And no, I won't give the citations, and no, I don't give a fuck if you believe me or not.
Anon, you can keep you crucifix; one of my previous employer was a medical scientist (MD/PhD/DEA) running a research group, my current medical doctor is also a scientist running his research group when he's not taking care of patient and finally, I am regularly in contact (phone contact with invitation for visit) by medical doctors, medical scientists et al.Delete
Maybe DocBastard doesn't want to give you his list of publications but I can:
I can == I can give the one I worked on, obviously, I am not aware of any publications done by DocBastard.Delete
CEUs are not research. Sorry.Delete
Dr. Cory you mentioned that Ms. McMath was maintaining her blood pressure but wouldn't the severe edema revealed in the latest picture suggest otherwise?Delete
You also stated that brain death doesn't require every neuron to be dead but a lack of function to support life. In this instance did you mean life in the biological
sense, as in a functioning body or life for the purposes of making a life or death diagnosis?
I think we can all agree with Dr. Shewmon that Jahi is by virtue of continued somatic support, alive in the biological sense, or as the recent headlines state "technically alive". But that's where the disagreement arises, is life without sentience enough to do away with the concept of brain death?
Well the short answer to your last question is indisputably no.
Life without sentience, what ever your opinion of it, cannot in any sense be equated with brain death. To use the old high school logic course - all patients with brain death are not sentient, but many, in fact most, patients without sentience are not brain dead.
Brain death is a very specific diagnosis - "technically alive" is a terrible term because it sort of undermines the concept of brain death. Brain death is supposed to be an absolute line between life and death. Think about it the same way you would pregnancy - you either are or you are not (altho in that case the question is not when life ends but when it begins). These are conceptual questions- by definition cannot be completely answered by technical means. Technical means help clarify - but do not answer conceptual questions.
But death must have a medical definition - brain death is our effort to make it equate to cardiac death (which if you think about it is relative as well in certain cases - does every doctor stop CPR at the same point?)
Likewise it requires a legal definition - the law needs a point at which to take away someone's personhood in terms of rights, responsibilities etc.
Think of the McMath case not about Jahi McMath but as about the concept of brain death, which is really what is at stake here. It's very important that the law and the medical community are on the same page.
as for the edema I have no idea what that is. Could be many things from loss of cellular integrity to a trach harness being tied too tight. Don't want to comment without more info.
I will tell you another thing- lots of people here don't like the McMath family. I understand that. But geez, whatever you think of them, you have to give them credit for how well they have taken care of her for four years. whether she is brain dead or not that's really hard to do. Think of it if you will like (CAUTION GEEZER REFERENCE) Captain Bligh in Mutiny Over The Bounty. Yeah he was a real asshole to the men and caused them to mutiny - but the guy managed to sail a dinghy 3000 miles across the South Pacific to survive and make it back to England after they took him off the boat. Come on - not too many people could do that.
You may dislike or despise their motives, understandable, but you cannot help but admire the dedication of the McMath family.
I agree with Dr. Franklin, the McMath family have been taking good care of Jahi for almost 4 years. I am a home health LVN . I take care of a disabled child 40 hours a week. I get exhausted at times, physically and mentally. I get to go home after my shift but the parents have to take care of him then. I doubt though if this child was in Jahis condition that they would be able to handle it. I couldn't either.Delete
Thank you for your thoughtful answers. I always enjoy reading your opinions.Delete
I don't dislike Jahi's family but I think her condition speaks more to the excellent 24/7 nursing care she receives. In the many photos and videos of Nailah online and social media she always has an impeccable manicure with nails that are at least two inches long. As Mary can attest, as a home health LVN, she could never perform the duties of her job with nails like that and neither would she be allowed to sport them on the job. I also have a job that requires nails that are kept quite short. It's a health issue as well as awkward to say the least.
I know what a constant struggle it must be to keep the skin intact in such patients. My sister, in the later stages of metastatic cancer, got decubitus ulcers and she was fairly mobile until the end.
Jahi also has minor siblings that are being raised by relatives in CA while her mom stays in NJ with a daughter who doesn't even know she's there. Her mom is dedicated to overturning Jahi's death certificate so the family can reunite in CA. It's a noble undertaking but it is highly possible that she may succeed simply because a jury was swayed by emotion. It's just a tragic situation all the way around.
The ruling in this case can certainly impact the availability of organs for donation, already in short supply. I had a family member who died recently waiting for a heart transplant.
As for your Mutiny on the Bounty reference, TCM recently had a showing of the 1935 film version starring Charles Laughton as Bligh. I remember the courtroom scene where the judge basically offered an opinion on Bligh very similar to your yours. Although I wasn't around yet back in 1935 I also qualify as a geezer.
I also agree that I have trouble believing the family is doing a significant portion of the work involved in Jahi's long term care. that may be bias on my part.Delete
and as far as organ donation, I am now officially a donor. and maybe eventually I'll get around to the document that specifies that if I become brain dead, or another unrecoverable loss of brain function; the only further care I want is that which facilitates donation.
I think the nurses do most of the work. I know I do with the Child I take care of. I have work nursing agency for a good many years and if a nurse cancels a shift most times there isn't a back up nurse so parents have to do it.Delete
This is such a sad case, and Jahi does not look good. Her face is so swollen.
Mary, you may remember the story about the little boy in Montana who nearly drowned in July 2016. His family wouldn't allow an apnea test so there was never an official diagnosis of brain death. He is home with his family now and his mother is his main caregiver.Delete
They recently raised enough money to buy a specially equipped wheelchair and a wheelchair accessible hyperbaric oxygen chamber. The doctor, Paul Harch, who reversed brain damage in a 2 year old drowning victim with hyperbaric oxygen therapy had offered to treat the boy but didn't have a wheelchair accessible unit.
The boy's stepfather posts updates regularly on his Facebook Page. Unlike Jahi's parents, they have never posted pictures of their son online except for one recently showing the boy in his new wheelchair on the porch of the family's home. He was facing away from the camera so his face wasn't visible.
Yes I follow that case. I believe he can open his eyes now.Delete
People can take those pictures people post of their disabled child and repost them using a different name. Saying like how many likes or prayers. Somebody did that with that boy Alex pierce and the mom was upset.
Anonymous, the problem was not a wheelchair accessible unit. He told them he had to be able to be taken off the vent for at least two hours at a time.Delete
Yes I had construed the two things: Dr. Harch's unit not being big enough to accommodate Allen's ventilator and the family buying a wheelchair accessible hyperbaric oxygen chamber.Delete
I saw the father mentioned that they were having problems with their son's trach change today and couldn't get his tidal volumes where they needed to be. Just another example of how they are their son's main caregivers. I wonder why they can't get 24/7 nursing care through Medicaid like Jahi when their son was never even diagnosed as brain dead. If he is also opening his eyes that is proof right there that he isn't.Delete
The defense will appeal Pulido's ruling. Stay tuned, folks.ReplyDelete
I certainly hope they do. Had Judge Grill made better rulings in the beginning, this poor child would have been put to rest years ago.Delete
I certainly hope they do. Had Judge Grill made better rulings in the beginning, this poor child would have been put to rest years ago.Delete
you can say that, again.Delete
This is getting so far out of hand, that hands are irrelevant and out of the question.ReplyDelete
Cmon, let the poor child pass already! It's been, what, how many years now? 5 or something?
"Tune in next time for the (not so) thrilling conclusion!" Is what's basically happening now.
What is happening to this society? (-_-)
you mean tune in next time for more of the same.Delete
Its so out of hand weve moved onto feet.Delete
Wow this is astounding! I guess all my future medical needs will be taken care of by a judge and jury. All those years of medical school and nursing school apparently were just a waste of time cause law school taught those legal eagles medicine so much better than doctors and nurses!ReplyDelete
This is abuse. The mother needs to be forcibly removed and Jahi's body allowed to finally be at peace.ReplyDelete
Doc Bastard, have you read what Dr. Shewmon submitted to the court - the entire declaration? I read it last night (it is available online). He does NOT base his claims only on the video evidence. Furthermore, he makes a very good case for why the video evidence is necessary in such cases. If you have not read his entire declaration, I think you would find it quite interestingReplyDelete
Yes I have. The video "evidence" has not been substantiated, nor does it replace an actual physical examination of a patient. It is ludicrous.Delete
For anyone interested in reading Alan Shwmon's Declaration, here it is:ReplyDelete
I wonder whether he has ever considered that the videos might have gotten a voice-over after the hand and foot movements.
He stated that he takes the family at their word. It is apparently inconceivable to him that they would fudge the videos.Delete
Or not even fudge, but only show selective bits. That to me is a big thing--that we're only getting these bits of video from the family, never from an unbiased source.Delete
Dr. Shewmon's declaration states that "Every video file has been subjected to expert forensic video analysis and certified to contain no evidence of post-recording alteration."Delete
The attorney for the defense contests that assertion.Delete
If anything, this case has proven that people can continue to function when brain dead, and they walk among us -- just look at all the brain dead people accepting this farce!ReplyDelete
It's like the Scarecrow in the Wizard of Oz: "But some people without brains do an awful lot of talking, don't they?"Delete
"Yes, I guess you're right."
Picture of Jahi on this page.http://www.newser.com/story/248321/judge-girl-declared-dead-may-legally-be-alive.htmlReplyDelete
There are two pictures on this site.
I think before it goes before a jury all tests should be redone and doctors exam in her.
I went back to this page and now see only one picture, the side view.Delete
I don't understand, if offered enough money won't she let doctors study/examine her daughter to better understand why her body has been sustained on life support.. I would try to prove my child isn't brain dead, and better understand why the body isn't breaking down..Delete
But the pictures look horrible from above Mary gave a link to..
With full brain death, how long does "life support" last typically when a person refuses to remove their loved one? The body usually quits within a year?
Newser did indeed remove the full on face and upper body picture. I noticed it was gone yesterday. Now they just repeat the picture that just shows the side of Jahi's face next to her mother's. The caption under the pictures said they were provided by Christopher Dolan. I guess he realized the first one wasn't a good representation. The one taken down also revealed what appeared to be a large bruise on her left elbow as well as the extreme fluid retention.Delete
It is back up, maybe something wrong with the web page. Last night after I posted the link I went back to the page and it was gone. But this morning it's there again. So very sad. Even if courts say she is alive she will still be like this. Very sad for this poor girl.Delete
Cali; 20 years is the current record.Delete
to compare her from other photos. She looks really swollen which is probably why the photo is taken from the weird angle where the subject is actually her mom and not Jahi.
Cali, people asked why she wasn't physically dying after a few months in. The consensus is that she was young and otherwise healthy when this happened. Her heart was strong and beating well and it continues to do so. If this happened to me today, I would probably have only made it a couple weeks on a ventilator. My 13 year old self could make it for many years.Delete
I seen it where 4 year olds don't last this long, babies and infants that don't last this long on somatic support..Delete
I would assume her weight would be a factor against her sustainability.. Her body was physically breaking down a few months later, when there was reports of her brain liquifying and being expelled from her ears..
This is why Doc Cory wants more research to be done, something is different with these cases that last longer on somatic support..
I have an off the wall intrigue/conundrum.. Sleep apnea can cause numerous health problems, weight gain or difficulty with losing weight.
Why didn't they wait to do the surgery til she lost some weight so there was better odds for her recovery, did they do the surgery in hopes she would be able to lose weight, was the surgery that direr that she couldn't wait and use an apnea mask for the time being..
Ty anon for the response..
Oh gosh! Those pics are bad. Why is the side view of her earlobe turning up? That's weird. And she looks even more bloated than she was in the last photo. And the darkening around her lips are more pronounced. Poor girl doesn't have a nose anymore due to the swelling. Did they glue her eyes shut?ReplyDelete
I dont know. If I were her Mom I'd be letting anyone that could possibly 'prove' she wasn't brain dead do anything they could to prove she wasn't, even at the risk that it proved she was brain dead. What would she lose? Nothing. She still has this legal case.
Is that a screenshot you saved? I don't know how to do that with my new browser.Delete
Yes I screen shot and saved it.Delete
I did it from my phone. I would upload the pic if I could but I can't. I figured just like most pics of Jahi, if you don't get them fast they'll be taken down.Delete
Not your average housewife, I don't think her eyes are glued shut. Rather she probably has ointment in her eyes because they probably don't stay shut all the time and dry out since she obviously isn't blinking.Delete
Bottom line, why does this bother so many of you who (1) aren't Jahi's family, (2) are not paying for her "care" and most likely (3) never knew her before this incident? Get worked up about something you can control, get a hobby, find Jesus, just do something more constructive with your lives. We only get one shot, don't spend a lot on something that doesn't affect you.ReplyDelete
Why? Because it has grave implications for all of us.Delete
a) Should courts/juries start making medical decisions? Should a court/jury be able to decide whether or not you have cancer, whether or not you have appendicitis?
b) Should all brain-dead bodies remain ventilated and in otherwise very extensive intensive care? Do we need to create “brain-dead farms” where such cases are kept indefinitely?
c) Should brain dead bodies be resuscitated?
d) Should brain dead bodies receive Social Security, Medicare, Medicaid?
e) Should medical resources be spent on brain-dead bodies that would be better spent on people who can be healed?
e) Should all heart and lung transplantations become impossible?
f) Who should decide which body is kept on a vent, and which body get buried/cremated?
Excellent summary Softship. Some people are just incapable of seeing the big picture. Like you said, the outcome of this case can potentially affect all of us.Delete
Anon - I'm sorry, I was under the impression that this was my blog and that I could write about whatever I wished. I had no idea that I had to run the topics by you prior to publishing them. Please send along your contact information so that you may verify each topic's relevance.Delete
That said, if I wanted to "find Jesus", I'd be out looking for him. And if I didn't find this topic relevant, I wouldn't be writing about it.
Got it? Good. I'm glad we were able to clear this up.
Anon, we ARE paying for her care.Delete
Do you think the money for her care is coming from her mother?
because I know people who are being financially affected by this.Delete
Anon, you're right. We're not Jahi's family. But she is a child. And she is actively being abused. Every day. All day. As well as her corpse is abused. Every day all day. Because some effing mother has chosen that Jahi is her ticket out of the hood. That's what pisses me off. This has nothing to do with Jahi. It has everything to do with how rich momma can get off of her life/death. She saw this opportunity and ran with it. And being an opportunist is sickening to me.Delete
And my next point, I've held my dead daughter in my arms well before the medical examiner verified that she was indeed dead. Mothers know when their children are dead and no one, will tell me otherwise. It's instinctual and something I cannot explain. But I know and Jahis mother knows deep down in her cold, lifeless, bitter, selfish, hollow, money hungry, black heart of hers. She knows.
And I am in the U.S.A. I am paying for her care (through taxes) of a dead teenager who's Mom won't let her go.
Which brings me to my final point. The Mom needs to let go. She is not better than any other mother out there that has had to let go. She doesn't get to play God. Wrong is still wrong.
And thank you, but I've found Jesus. And he is my hobby.
Your spot on about knowing your child is dead. We have walked that awful journey ourselves. It was the worst day of our life. But denial was not going to bring her back, it was just going to prolong the acute pain of loss and delay our recovery.Delete
To not your average housewife, first I am deeply sorry that you had to suffer the loss of a child. As far as paying for Jahi through your taxes, what is the dollar amount that you would be saving yearly if she was "let go"? Do you think it would be, several dollars, a fraction of a penny, how much? I doubt there is a line item on your paycheck withholding statement that denotes what you "are paying for her care". As far as abusing a child, you claim she's dead, so that's technically not abuse correct? If she's brain dead, there is nothing to abuse or to make feel abused whether her mother keeps her on a vent for 30 years or unplugs her is there?Delete
Pretty sure desecration of a corpse is still wrong. Not illegal but wrong.Delete
You also fail to understand the precedent it sets, just like terry schivo(she had told her husband that should the day come pull the plug. He did. Grandparents said no. The foundation made by those grandparents supports jahis case last i checked). There could be a day where your the brain dead patient and your so called loved ones refuse to pull the plug- EVEN if it was in your will that they do so.
in Oregon, abuse of a corpse is illegal.Delete
*not neccessarily illegalDelete
Technically a corpse is your property if it's your next of kin. If you're not happy with the funeral home handling your families case, you can take the body. Not sure I want to go weekend at Bernie's with my loved ones.Delete
I requested a viking funeral.. Build me a raft, throw me in the center, catch my ass on fire and push me out to see, almost forgot- I want to be taken by an old suburban to the ocean..
I want cremation and to be thrown into my favorite toilet.Delete
Dont worry. Its a septic tank.
Yes, the Viking funeral! My daughter, an only child, has decided to remain childless so I worry who will make end of life decisions for her? She prefers the Viking send off or in lieu of that she said maybe she'll just wander into the woods to die if she becomes terminal.Delete
Apparently they have a term for such folks, the unbefriended. Sounds so sad.
Personally, I don't want any heroic measures. DNR for sure. I don't particularly care what happens to my remains as long as embalming and entombment in a hermetically sealed coffin isn't involved. Salvage any remaining usable parts and either direct cremation or natural burial in just a biodegradable shroud would be the top choices.Delete
my running joke is that I want them to remove all identifying marks and then throw me off the golden gate bridge in the middle of the night.Delete
but really, as I said above, donate everything that is useful and then dispose of the rest in whatever manner suits them. it's not like I'm using it any more.
I am single and have no kids. I have a living will so that if i am in a terminal stae there is a DNR in effect. i want a cremation with no religious service and funny bad taste songs going in and coming out Another one bites the dust going in, a reading from The Bible according to Spike Milligan and ( dare i get the attendees to sing the ying tong song?)and Ding Dong The Witch Is Dead! especially since our family in joke is all the women are witches (mom had a witches hat and broomstick on her coffin and her sister had a floral witches hat on hers ) and smoke gets in your eyes going out.Delete
In honor of the spectacular demise of the Cassini spacecraft I'd like my remains to be vaporized upon entering the atmosphere of some distant star thus returning from whence I came.Delete
I respect all your wishes!! Sorry DocB kinda off topic but matches the topic..Delete
Connor, that reminds me of a funeral in a movie we were talking about at work this last Thursday..
Anon, take what you want from this body, and I don't want to be embalmed either or trapped in a coffin in the ground.. I want them to talk to the ocean *sea* (can't believe autocorrect got me there) and believe they are talking to me.. Your daughter is my type of friend, have her look up the good death or ask a mortician on YouTube, the YouTuber wrote a book called smoke gets in your eyes, she will love me later for it..
Ken- this is why we are friends online, I get your sense of humor, respect your profession and enjoy your opinions and discussions. I went to Beverly State park weekend before last and finished the weekend off eating cheese at another well known place, thought about you and wondering if you were on a call with all that fog.
Tania, I have what my family would think were odd requests in my will.. Love, love your plans, and your aunt and mom's tradition!!
Anon- :) I hope you can one day..
My true funeral arrangements were viking, but doubt we can get permits.. I asked for my body to be taken to the funeral home in a suburban.. I want to be laid out in a refrigerator box, I want everyone to be given markers to write goodbyes and messages of love. I want to be cremated in the box, no embalming, no casket.. Once packaged, each kid gets some ashes, but the rest needs to be pulled out of the plastic bag and put in a biodegradable box, put on a mini viking raft, box caught on fire with some slow starting device, and sent out with the tide, so my raft and box burn and unleash me.. I get my viking burial and and I get to be at the ocean..
Cali, they have legally allowed boxes for cremation that are apparently free of chemicals that are going to vaporize and kill people. They also can't have metal, and fridge boxes often have staples. They might not fit into the cremation oven without being crushed down. They sell boxes for cremation with "head" at the head area or you could go for something from a green casket company http://greenburialcouncil.org/home/plan-for-your-green-burial/certified-products/Delete
I don't plan to have a casket at all, but the one from Aldergrove is particularly pretty. the outside is bark, it has rope instead of handles and a solid top. Some say green but I don't believe they really are. One says "molded from sugarcane" but it's really a plastic that uses ethanol from sugarcane, something like that, so while it's better than dead dinosaurs, it's still plastic. It says it biodegrades, but it needs a high temp industrial composting facility to do that. So cremating works but using a green burial location/cemetery won't.
I plan to do a mini viking funeral for my spouse. Once he's cremated, he has this little wooden boat his father made. I'm going to put his ashes in it, douse it with everclear or some other liquor, put it in the lake, light it, give it a shove and say our goodbyes.
Listen doc: Why do you care so much about this? There is a segment of the population who have always been like this and there will be in the future. You can't eradicate ignorance even shouting. You and everyone on the side of medicine know that she's dead. Why argue with these people. It's like arguing with Trump supporters. Just keep doing your good medical work.ReplyDelete
I can't answer for Doc Bastard, but only for myself.Delete
a) I'm sick and tired of medical malpractice suits filed where no medical malpractice occurred.
b) I'm sick and tired of medical resources being wasted on futile care while not being available for people who could benefit from it.
c) I'm sick and tired of people always trying to fault others for their own problems, and in this case, even for their own errors.
d) I'm sick and tired of people equating opinions with facts.
Perhaps you can’t eradicate ignorance with shouting. But is being silent better? Is complacency better? Should we thinking people all sit back and let all this happen until it does impact us? It might be too late then.
you can't eradicate willful ignorance, but you can educate the uneducated.Delete
"I love the uneducated!" - Donald TrumpDelete
he loves the gullible.Delete
He loves the paranoid (gonna take er guns), he loves the fearful (Mexican is going to rape my daughters), he likes the racists..Delete
It was stupid for him to internet in the Charlie Gard case but hasn't said a damn word about Jahi's case, why is that?
*Interject*, for the love of everything evil I need to learn to proof read..Delete
Just a guess but its likely its just flown under the radar for him as it has for just about everyone else. It did happen what 3 years ago? Typically these sorts of things after 3 years the general public forgets these sort of stories.Delete
Heck the general public forgets them in a handful of days is what I often find.
Charlie Gards story was very recent and thus so was the publicity, hence why Trump weighed in on it.
Thank you Mr. Connor, I just think it's hypocritical, ya know.. However I was trying to be a smartass, I was implying it's because Jahi is black and Charlie was white.. But yes, the public has the attention of gnats, we truly are the minority (on DocB's blog) when it comes to this case..Delete
I enjoy the hell out of you and Ken, and many others on here, y'all keep me thinking..
So I googled "Overbreathing the ventilator", and I found this excellent medical journal entry regarding that and stating that it is NOT and indication of not being brain dead.ReplyDelete
"Cardiogenic oscillation and ventilator autotriggering in brain-dead patients: a case series"
"Ventilator autotriggering, however, may potentially occur in a brain-dead patient as a result of interaction between the hyperdynamic cardiovascular system and compliant lung tissue altering airway pressure and flow patterns."
Jesus...Grammar failure here. Sorry, can't go back and edit my original comment.Delete
Ventilator autotriggering occurs when the sensitivity is too low. You can adjust them.Delete
This comment has been removed by a blog administrator.ReplyDelete
it is the responsibility of the family to obey post-op instructions. according to social media posts from the family (since deleted, but captured before they could be deleted) they barged into PICU before they were told Jahi was ready for visitors, had her talking and laughing when she was supposed to be silent, and communicating only by writing, and when the bleed started; took it upon themselves to suction the op site instead of using the basin they were instructed to use to catch the blood.Delete
(rumors of solid food are completely unsubstantiated)
in a code, the best place for the surgeon to be is out of the way.
(addendum: unless the patient is opened up and he can do direct heart massage)Delete
This comment has been removed by a blog administrator.Delete
I'm not buying that suction story as cause of Jahi's cardiac arrest. Clinicians know this.Delete
Bye, John. You don't know the facts of the case.Delete
what clinicians know is that suctioning a bleeding op site can dislodge blood clots and cause worse bleeding.ReplyDelete
I've read some comments where the person said that the jury trial will be a good thing and that for the people that think Jahi is truly deceased that the jury trial is "what we want".ReplyDelete
Ummm. No. Think about OJ Simpson's trial. We will likely see the results of Jahi's trial be the same as OJ's trial. They will find Jahi 'Not Dead' for the same reasons that they found OJ Simpson 'Not Guilty'.
The idea that a jury will decide if Jahi is alive or not instead of impartial medical doctors is ridiculous! It sets a bad (horrible?) precedent. It will result in the courts being even more clogged up with people trying to declare their family members 'not dead' for financial gain, and the hospitals will be even more clogged up with more Jahi's on life support.
Without knowing what will happen in the trial let's examine your theses:
"The idea that a jury will decide if Jahi is alive or not instead of impartial medical doctors is ridiculous!"
Medical doctors determine medical death. The law determines legal death. If all of a sudden medical doctors determined that PVS patients were dead, this might not set too well with the public and hence the law.
And the doctors appear to be impartial by your account if they believe the same way you do. Perhaps Alan Shewmon is as impartial as any of the doctors who are declaring her dead. What makes him less impartial?
"It sets a bad (horrible?) precedent."
The case is only a precedent in the sense of it being about brain death. Issues of discontinuing life support or feeding have been determined in courts in the past.
"It will result in the courts being even more clogged up with people trying to declare their family members 'not dead' for financial gain, and the hospitals will be even more clogged up with more Jahi's on life support."
Well, put simply, doesn't that depend on the outcome of the trial? Yes, it is certainly possible that will be an outcome if Jahi is found not to be brain dead. But of course if she is, then it is far more likely that no, there won't be a bunch of these cases clogging up the courts.
The case is as much about an important diagnosis that has implications for society as it as about one patient.
but what if you had to submit your findings of PVS to a court, and a jury decided if the patient was really in PVS?Delete
the trial is not over whether brain dead is dead. the trial is over whether Jahi is brain dead.
It's really simple. Get rid of the whole brain death criteria and just stick with the death of the brainstem. People are confused. We have an old imperfect brain death criteria and it was written based on outdated knowledge and understanding of the phenomenon of human death. Time to reevaluate!ReplyDelete
Of course! It's so simple! That must be why we're all arguing about it! But you've figured it out!Delete
"All functions of the entire brain including the brainstem" equals death. That's what we have in the US. You are confusing your readers by shoving your brainstem death criteria down people's throat and they believe you. I agree with brainstem death but I've noticed that your readers don't even know the difference.Delete
You will now show me exactly where I have been confusing brainstem death criteria with brain death, and how I am shoving anything down anyone's throat. Because I don't seem to recall ever having done that, even once.Delete
If you can't find even a single instance, then I expect an apology from you. I'll wait.
I wouldn't recommend holding your breath while you wait.Delete
Doc, I don't recall you posting anything about the difference between your brain death criteria vs the ones we have here in the US.Delete
I don't recall doc posting anything about allowing people to use some kind of back door effort to try to figure out his location.Delete
You replied to one of my comments where I didn't have the forethought to sign it so that people could direct their replies to the particular comment.
You said ""The idea that a jury will decide if Jahi is alive or not instead of impartial medical doctors is ridiculous!"
Nope. No, it is NOT ridiculous because that is the whole point and reason for the trial. The judge could care less what the doctors say, the judge says the doctors can't determine it and it will be up to a jury.
I don't know if you paid attention to the OJ Simpson trial but the jurors decided the actual guilt or innocence didn't matter. It's likely that the will do the same in the Jahi case. It doesn't matter what the facts are when they have a chance to strike out against the evil doctors that discriminate and give substandard care to black folks. Their "Not Dead" verdict will be their means to strike back.
I would think that any reasonable person would understand why this doesn't need to go to jury trial where people with no medical knowledge will determine if she is live or dead instead of doctors. That doesn't even consider the "OJ effect" as jurors evaluating medical patients and diagnosing them can never be good.
As Ken Brown replied to your response to me: "The trial is not over whether brain dead is dead. the trial is over whether Jahi is brain dead."
I'm glad he got my point. Perhaps you just didn't understand me (as I do tend to go off on tangents) but I don't think that is the case.
As to the "OJ effect" on the jurors, it is already starting. I read an article just today on The Root. Apparently that website is geared to black folks addressing racism from what I gathered by looking at the other articles.
The article was about the judge declaring it would go to trial and that Jahi was probably alive. The article had a nice picture of Jahi at the very top of the article and the photo was captioned "Jahi now at 15" in very large font. Beneath that was a note that the photo was from december, 2015 which is nearly 2 years ago.
Nowadays Jahi is extremely bloated and it grated on me that the article was purposely misleading people to think that Jahi looks healthy and well by showing a photo a couple of years old instead of the recent picture posted just 5 days ago on The Verge ( I think that was the name of the article with the pictures that was linked earlier). I commented in the comment section that the author was hiding the truth and misleading people with an old photo because the current photos don't fit her story line. While I was respectful I did make the above comment and it was immediately deleted. That surprised me because there are several links to this docbastard.net blog about Jahi that they allowed to remain yet they deleted my comment.
At any rate, I can tell that the "OJ Effect" will be the deciding factor in any juror trial to determine if Jahi is alive or not. I don't see how any reasonable person could say otherwise or dispute that being very likely.
Signed Andy W
The only way this trial will end in jahi being declared dead is if its a jury of doctors and only doctors.Delete
I forget if it was here or on another forum I suggested the state's lawyers insist on just that.Delete
Not on this post at least perhaps another oneDelete
In the above I referenced The Verge as the source of Jahi's recent pictures when I should have said newser.com.ReplyDelete
Well Andy, I must say I have to hand it to you.
You know what will happen before the trial.
In that case, you're right. Doesn't seem to be much point in actually having a trial.
Time out all of you, y'all are getting rough..Delete
What I gather from Dr. Cory's writing is this will be considered a landmark case, it will set the stage for how people can legally battle for loved ones in the future..
From a completely legal stand point this is a good thing, it forces the medical research to look at and study brain death criteria, it also opens jahi up to being relooked at and restudied.. It can open funding to better study and help understand why do some people last longer, is there a grey area of brain death..
From all accounts I have read the body doesn't typically last this long on life support, it usually gives up and "completely dies" (for lack of better words). Why do some bodies last 20 years when diagnosed with brain death, why do some shut down faster, is it care the body received. why hasn't she shut down? Can studying her give us some insight to maybe help someone in the future, or give doctor's stronger tools or give patient's loved ones better understanding and help them.make better decisions for their loved one..
Now I am going to go out on the other limb with my favorite quote, "emotion is always the enemy of true justice." Whether your emotionally charged against this going to court or vice versa, opinions come from beliefs.. We need facts, the courts won't allow beliefs and opinions, if they do it goes to the supreme Court and gets thrown out and forced back to the lower courts.
I agree with others here, juries are made from our peers, but, doctor's are the peers at this time, Jahi's lawyers will never allow a doctor on that jury, they prefer laymen with no knowledge so there is no bias.. I have tried to get on juries but because I hold a criminal justice degree and psychology degree they automatically exclude me.. Lawyers want people who will be impacted emotionally.. I have heard lawyers call DNA evidence junk science, so I can see the concern from some posters here..
This will be an interesting case to watch, this will be a landmark case.. Essentially death is on trial..
Sorry if I don't make much sense.. Back in the 90s I had a client, she went in to labor at 25 weeks, the state stepped in and took the child away from the mother at birth because Mom and baby tested positive for weed, mom was also 15.. Baby had to have a trach, baby coded several times, state had resuscitation orders in place, baby coded three times in one day while I was having a meeting with the mom in the hospital, baby left that hospital with severe brain damage, wheel chair bound, can't talk, feeding tube, breathing tube, but she is some what alert.. When I became pregnant a few years later this case made me paranoid, I talked with my obgyn about it through out my pregnancy..
The problem is that the family really doesn't want Jahi looked at or studied. I may not be stating this exactly right, but some months ago the Judge agreed to one of their motions and said that a third impartial party needed to do tests to determine if she did or did not meet the criteria for brain dead. Guess what? They dropped the motion! They didn't want an apnea test as according to them "it might cause further harm". The family doesn't want to know if she does or does not meet brain death requirements. It's likely that they suspect that she is really dead as far as what determines brain death.
It looks like this time they will have to put up or shut up and allow a full battery of tests by an impartial third party if they want this trial to go forward.
I'm not so sure if test results will mean anything to a jury of average Joe's on the street as they may want to make a statement similar to other trials where race played a part in the verdict. I can certainly see your point about how it would be a good thing to understand why Jahi's body has not shut down completely. I don't think her family is inclined to contribute medical knowledge or studies on her body though. From what I have read, the patients age, body weight and health determines how long they can remain ventilated. She is young and had a high body weight and I think she will be another "T.K." and will stay on that vent for decades.
On a different topic, I really can't believe this whole thing has proceeded they way it has. Namely, Youtube videos supposedly showing purposeful movement and now the claims that Jahi is writing and drawing. Can the family actually really believe that she is alive? I puzzle over that. It is grotesque what they are doing with her by playing dress up and having hair and nail day. I do notice that they have pretty much stopped making any facebook posts or sharing any new photos. Jahi is starting to look really bad, so bad that pretty much anyone can look and tell that she is in increasingly worse shape. It's hard to claim improvement with the way she is starting to look.
Her face is so shiny in one of those photos. I'm assuming it's fancy glitter face stuff her mother uses. If it's not and it's fluid because her skin can't expand anymore, it's my understanding that is not a good sign and death is around the corner because her tissues are starting to break down.Delete
Don't forget that her brain was starting to break down three years ago. An image from then: http://wnarchive.cbslocal.com.edgesuite.net/555df65d20e36
This is a description of the abnormalities "it's markedly abnormal. There's significant loss of gray-white differentiation in the cerebral cortex; the straight sinus in the tentorium cerebellus is widely dilated, as are the lateral ventricles; the cerebellum itself appears amorphous, with no visible sulci; the sella turcica appears to be obliterated as has the pons; there's an increased amount of CSF in the fourth ventricle; there is one large and four smaller infarcted areas near the corpus callosum (actually, I don't even see a corpus callosum) and within the lateral ventricles. All the extra fluid represents areas of necrosis where tissue has been lysed and resorbed." taken from the response section of this very good site from the early days when Jahi was still in CA http://sprocket-trials.blogspot.com/2014/10/jahi-mcmath-alive-again.html
Im reminded of an old docbastard post with a name along the lines of "too much" about how while trying to stop the bleeding around the chest of the patient very suddenly fluid spilled out his ears as his brain hemoraghing or whatever it was did him in(in no doctor and it was a while ago).Delete
Andy, my apologies for taking so long to respond..Delete
Any court worth their salt won't allow the antics, they will force mama'nails hand to show scientific proof.. The hospital lawyers will provide all medical documents that will become available to the public that we haven't been able to see before or be told about because of Hippa (sp?).. So we will find out about the talking and laughing after surgery and whether the hospital suspected they were feeding her, but I think the feeding rumor was an out right gross lie because of her weight.. My bets are they pull back before an medical information is given back because of the lawyer discovery, family won't want things to come out for the general public to read.. and I don't think they will have a dog's fight to have this case fought with a gag order because of the high demand of knowledge and the fact it could be a landmark case..
The hospital lawyers will throw challenges to have scans, those scans will show if her brain has liquified or calcified.. If her brain has done either I doubt they will need to do an apnea test..
The family refuses to allow independent doctors with nothing to gain from this case to look at her daughter.. I'm all for DocCory being allowed because he is truly on the fence from what I have read..
I am totally in the grey area, I have had one family member (1981) that was removed from life support because he was brain dead from being shot in the head.. I wish I still had him and get angry at my family for not taking more than three days to make the decision to remove him from life support..
There will be challenge, discovery, evidence, disputing evidence and expert witnesses, subpoenas, documented testimony.. I'm very interested to see all the court information.. And will give DocB and DocCory better insight to educate us on..
The thing about brain death is even though the body can be maintained for how ever long, depends on the age etc., but they will still never regain consciousness once the brain stem is gone. I really don't see the point in ventilating bodies just because we can but there are others, mainly for religious reasons, who want to keep their family members around regardless.ReplyDelete
Sure it would be a novelty to study these outliers, as Dr. Cory calls them, but what do you do with that information? We could probably maintain most brain dead patients with trachs and feeding tubes for however long their particular body lasts but to what end?
If we make this the new standard of care who pays? Hell, we can't even get politicians to agree that basic healthcare should be a right much less get funding to warehouse people who are dead for all intents and purposes.
Get rid of the UDDA's whole brain death criteria then.Delete
And exactly how does that answer the question of who pays for the futile care? If you want to ventilate your brain dead loved ones until their heart stops you should have to pay for their care or do it yourself. The we can get rid of the UDDA. Just realize that major organ donation goes along with it.Delete
I'd wager good money that the same folks who want to keep their brain dead loved ones around forever would also expect them to be first in line for a heart or lung transplant if that was their problem instead.
No. If we adopt brain stem death instead of the whole brain death, I guarrantee problemyou won't have problems with futile care.Delete
"We could probably maintain most brain dead patients with trachs and feeding tubes"
There are some who could be maintained for days to weeks but not the majority. Certainly few as long as Jahi McMath. That's one of the reasons this is a case.
It will present a problem if Jahi McaAth is found to be brain dead and the judge does not order life-support terminated (what should have happened the last time around, but we are not there yet, nor are we close.
The question we have now is whether Jahi McMath is brain dead according to UDDA criteria, and whether there is extenuating information, thus calling into question UDDA criteria. Suppose Shewman is correct and the movements she shows are in direct response to stimulus. Suppose her MRI is different from the one done four years ago. Suppose a PET scan shows metabolic activity. Right now, can anyone say for certain that none of those is true? I know I can't. There are all sorts of implicatications if any one of them is true.
I know some people here think the judge will never rule she can be taken off life support no matter what, but I prefer to let this play out before we are faced with that question.
And as an ICU doc who also did a clinic, i never liked the "see how much money we could save to spend on primary care" argument Nobody has ever showed me that ICU money is fungible enough to go to primary care- and I did both.When you can guarantee me that the money I spend in ICU would actually go to primary care, get back to me,
suppose anybody did any objective tests in the last 3 years, despite the courts repeatedly telling them to, if they wanted to prove Jahi was alive...Delete
Dr. Cory, What do you mean by your statement regarding ICU dollars going to primary care? I know what fungible means but in this case are you talking about private insurance dollars, medicaid funds or unreimbursed expenses that public hospitals have to absorb due to uninsured patients.Delete
I have heard for years about how much money ICU wastes.
And this money should go to primary care.
It's a simple utilitarian argument.
Doesn't that mean we should get rid of the fire department and give the funds to better fire prevention? Or the trauma unit for funds to combat violence? (Dr. B- weigh in?)
But I have never seen a concrete plan in a public or private hospital that actually outlines how funds are distributed to benefit patients and maximize benefit. Have you?
When I did primary care, it was interesting that it was far easier for me to actually document how many people I helped and lives may have been saved in the ICU than in my clinic.
I had a certain budget in the ICU, knew how many patients we took care of, how many people lived and died each year. i never saw comparable figures for the outpatient clinics.
The iCU is an easy target for waste and a badly run ICU will waste a lot of money, but so will a badly run primary care clinic.
ICU and out patient are complementary services, they should not compete for the same funds without a well documented analysis that includes other centers in the hospital. and that means looking at a lot of salaries of vice presidents and administrators
It benefits the insurance companies.Delete
Cory: it is true that patients in ICU cost more to treat than they might have if they had gone to primary care in a timely manner. it's not a matter of diverting ICU funding to primary care, however, any more than, as you say, selling the fire trucks and spending the money on fire prevention. - but we budget more money for prevention, and because we do so, the fire trucks roll less often. similarly, if we change the healthcare dynamic so people go to primary care as soon as the problem starts, then less of them will end up in ICU.Delete
That's probably true -but not in any first order sense.
The effects are far removed from the intervention.
And remember the case of unintended consequences - more primary care might conceivably mean fewer deaths, more sustained chronic illness and more ICU care. Not saying that's true - saying it might be.
The point is we can't directly trace prevention and less ICU care. It sounds good, it might be true - but no one really knows, despite all the opinions.
Before I start rationing ICU care, I'd like to see some cost-benefit and cost-effective analyses, and some hard data.
it msy be that some who will end up in ICU despite primary care would die before they make it to ICU, but overall, the ounce of prevention/pound of cure equation still applies.Delete
@ Ken BrownDelete
Yes. I completely agree. I just don't know whether that applies to health care economics and hospital funding.
if you really want to stop wasting money, the best strategy is to not have three layers of for-profit between the patient and the care. but then it gets political.Delete
Sorry, thought you were John. I agree, once your brain stem is dead so are you.ReplyDelete
The family is pursuing the above because they are limited to (iirc) only $250,000 in damages if she's legally dead, but unlimited damages if they can convince a jury she is alive & needs those funds for her ongoing care.
Of course, after any award/settlement is collected the family could then petition life support to be ended which would allow the beneficiaries of her estate (usually the parents) to retain any unspent funds.
So there is unfortunately a significant financial incentive to have Jahi declared alive...at least until the funds are paid.
How can they petition the court to turn off Jahi's vent if the court ruled in their favor?Delete
After all of the other unprecedented ridiculousness that has occurred, I am concerned that a jury will rule that Jahi is alive based on videos they do not understand and this farce will continue until Jahi's body gives out via infection, etc. as was the case with the young boy with Meningitis.ReplyDelete
The only comfort is that at least Jahi is not aware of what is being done to her. Jahi passed long ago.
I honestly believe we are going to see a jury make a terrible mistake and set a ridiculous precedent. There is nothing normal about the way this case has panned out and no judge seems to have the balls to demand the family provide actual tests and not rubbish testimony from a brain death denier.
I used to follow you until 2015 on your blog, found you from FML and now just decided to look you up again. I'm pleased to see that I haven't missed anything. Back then you were also writing about Jahi. All the best. I'll check in another few years :)
He's still writing about it because, unbelievably, it's still an ongoing story. Whenever there are new developments he gives an update with commentary. Those of us who follow him regularly appreciate and look forward to those updates and opinions.ReplyDelete
Please know, in the ensuing years prior to your "checking in" again, your absence won't be missed either.
Wesley J. Smith visited Jahi with Bobby Schindler recently. He says he witnessed her touching her thumb and forefinger together several minutes after her mother told her to. Apparently it impressed the hell out of him.ReplyDelete
I just read Wesley Smith's account.
I'll tell you what the most striking thing to me was. Not his evaluation of he neurologic response. That could be anything.
It was his point that there is an almost absolute lack of curiosity about the case in the medical community.
I have to tell you he is 100% right.
You can bring up the kid who "lived" 20 years with meningitis (and I don't even know what testing they did on him but there sure aren't a hell of a lot of cases like this, whatever the outcome.
This is an unusual case.
He's right -where are the doctors?
They are being kept away from her. Wouldn't you think the family would try everything to have any neurologist examine her if she were actually not brain dead?Delete
They should be begging doctors to examine her to prove their point. They aren't. What does that tell you?
It must be pointed out that Weasley and the truth were introduced once, on a train in Barcelona, and haven't been seen together, since.Delete
You may be right about the family keeping doctors away, but you certainly don't see the medical community writing too much about the case anyway. Or the legal community for that matter. this blog is one of the only forums about this case.
You see all sorts of stupid cases engender a lot more commentary than this one.
In addition the Chinese just admitted they were getting organs from prisoners, which had been suspected for a long time. IF anything that should raise more commentary about brain death, organ donation in the lay press form professionals but it doesn't.
The idiosyncrasies of the McMath family notwithstanding, this case should be generation much more medical commentary.
Thaddeus Mason Pope has been downloading the court documents on his Medical Futility Blog from the beginning, not only this case but many other brain death and medical futility cases. Without his indispensable blog we wouldn't know any of the actual details. You don't get the facts from news articles.Delete
McMath's case has generated tons of interest with folks like Shewmon, Paul Byrne, Calixto Machado and the International Brain Research Foundation. Shewmon has been researching "chronic brain death" for years, Byrne is aligned with the Religious Right to Life groups, Machado is on the board of Bioquark the outfit trying to reverse brain death with their ReAnima project, and Philip DeFina's IBRF charges enormous sums of money to the desperate families of traumatic brain injury patients for its experimental therapies.
I agree with DocB. I don't think the family would welcome the involvement of a panel of independent experts with no dog in this fight. I also agree with Dr. Cory that this is exactly what needs to be done.
I see Philip DeFina, who calls himself a neuroscientist, has a new venture, CIIT-the Center for Integrative and Innovative Therapies. Although he is not a medical doctor, according to their website:Delete
Dr. DeFina diagnoses and treats individuals based on their unique brain "fingerprint" (chemical-electrical-magnetic signature map), which can be applied to all areas of the human brain. He has created proprietary processes and protocol for assessing neurological functions electrically, magnetically and chemically to determine the pattern, strengths and weaknesses of the brain.
Apparently there's some controversy regarding DeFina's alleged curriculum vitae:Delete
If she were alive then it would be in her interests for her parents to allow independent doctors to perform the tests in an appropriate environment where interference from outside sources could not impact on the results.ReplyDelete
As was pointed out in an earlier post, i knever thought of the financial element of the parents getting compensation (if Jahi was declared 'alive') and then once it was in their sticky little mitts, petitioning the courts to have her 'life' support turned off and thus getting a shit load of money as they would inherit.
It paints a whole different picture as to why they want her declared alive.
Not because they want her kept on support at the taxpayers expense as they would probably return to their native state and have it pay all her support, but because having her declared still dead limits the amount of money they would get and it would not be enough for the lifestyle they want to become accustomed to.
I do wonder if the courts would place restrictions on the money, such as limiting it to being used to pay only for her support and preventing them from from promptly petitioning for her support to be turned off as soon as they got it.
I also wonder if it ever got to court whether witnesses would be called who said they witnessed them making her talk and laugh against doctors orders, allegedly giving her food and then suctioning her (grandmother) without authorization?
If so and it was shown they dis some or all of the above could that lead to charges, negligent homicide perhaps?
Their actions caused her death as if they had followed the orders and she was not talking, laughing, eating food then it is likely she would not have started bleeding and if she had then not been allegedly suctioned by the grandmother then clots would have formed and the bleeding slowed or stopped or she would have been taken back to theater for treatment.
If they refuse the tests or place conditions on them or who does them then the case should be thrown out, Jahi declared still dead and then whatever else happens ( i would so love criminal charges to be laid if they played a part in her death)
I doubt seriously they'll petition the court to turn off support, instead, I'm putting my money on a middle of the night vent 'accidental' disconnection or something of the like.
Hi Not Your Average Housewife, You bring up an interesting point. If they tried such a thing could they then face homicide charges?Delete
It would be suspicious that they had managed to keep her 'alive' for x amount of years, successfully petition to have her declared alive again, win a bucket load of compensation and then oops,something went wrong with the machinery and she died again, this time permanently.
First thing would be the police would investigate given that money is a well known motive to murder, the timing would be just too unlikely.
Second, their language and behavior would give them away.
If they faced murder charges, it would be fascinating to here their excuses as if they denied murder but perhaps used an already dead defense they could and should then face charges for fraud etc and not only have to repay any money won plus interest, they should also have to pay all legal costs and then also return all monies paid by their supporters who gave believing the family claims Jahi is still alive.
It could get very interesting.
Id like to point out on this very blog we talked about the money motivation in year 1 of this case back when lawyer Dolan was still involved (or is he still involved Ive not heard word) who was petitioning a bill that would increase the amount He would get off death by malpractice to unlimited at the time.Delete
Don't quote me on this, because I am not sure. But I think that if Medicaid is used, Medicaid is paid off first and foremost before any monies are handed out to anyone.Delete
Call me heartless or soulless if you want, but I think the best thing that could happen for Jahi and her family would be a power outage.ReplyDelete
Jahi gets laid to rest at last, rather than carrying on this farce about her being 'alive.' Her family gets to start the grieving process properly, rather than clinging desperately to false hope.
If they believe in God, let the power outage happen during a thunderstorm. Then they'll take it as a sign.
Dakala, not heartless or soulless. I agree with you. That's the only truly fair outcome to the whole ordeal. Then everyone involved can put this thing to bed. Sigh. Until next time.Delete
Uhm, they have back up generators plus those portable vents have back up batteries that can last for 6 hours. Or manual ventilation.Delete
I realize this. (Sigh)Delete
A reeeeeeaaaallllllyyyyy long power outage in the first hour after everyone falls asleep in the house and no one hears the alarms and wakes up 8 hours later and BAM! Just like that.
That's a stretch huh? Damn
And what are the odds people from California, that now live in NJ are going to have a generator on hand to just go hook up and turn on?
In all seriousness, poor Jahi is looking bad in the latest pic. I cannot imagine that she's not breaking down somewhere under all those blankets, her lips, the elbow markings, she's so bloated... I think Jahi will have the final say in this.Delete
The family already has a back up generator. It was mentioned in an old news article that Nailah was worried about the NJ snowstorms knocking out power so she purchased one years ago. I'm thinking the majority of people who have vent dependent patients in their homes would have one.Delete
Hi Dakala, i agree, however as things are currently i would not be surprised if they were to call 911 and try and get her admitted (with the EMS being yelled at to do CPR and everything else remotely feasible by her parents) If i recall another commentator in an earlier Jahi post posited such a scenario.ReplyDelete
It was funny as heck but given what we know of her litigious and in denial(at least publicly) family i would not be surprised if such scenario came about.
"How long has she not been breathing?"
"About 4 years, She's been on a ventilator"
"Why has she been on a ventilator?"
"She's been dead"
"Umm, How long has she been dead?"
"Since dec 2013, although we have been disputing this even though we accepted a death certificate from the coroner in order to get her moved from California to here because if we believe she is alive, the state will let us maintain her on life support"
Time of death could be interesting, dec 2013 and then again at current time and date.
Tania, you raise an interesting point. Nailah has said that she believes only cardiac death is valid but would she accept it if Jahi's heart stopped or would she expect the 24/7 nurses to administer CPR until paramedics arrived?Delete
One of the defendants, Patrick Howard, MD, has filed his case management statement (hearing is October 10) wherein he states he intends to file a motion for determination re whether Jahi is legally dead, which is the "primary driving issue in the case." He will request an independent medical examination of Jahi and plans to conduct an extensive examination of the "videos" (his quotation marks) in question. The statement is only a half-page preview on the court's site, so can't see all of the details, but discovery is requested to begin next year. I plan to attend the case management conference and will report on that here.ReplyDelete
Dr. Shewmon and vagus nerve stimulation. http://newsroom.ucla.edu/releases/UCLA-Develops-Unique-Nerve-stimulation-7163ReplyDelete
Man responds to stimulation after 15 yrs. of vegetative state. http://www.cnn.com/2017/09/25/health/vegetative-state-vagus-nerve-study/index.html
I'm betting Shewmon would like to try this on Jahi.
Cleo, the family dropped their motion to bifurcate the issues of liability and Jahi's legal status but according to the court site that hearing is still on the calendar. Is that just an oversight?ReplyDelete