Monday, 12 March 2018


I tried my best, I really did.  I've seen the article, I read it, and I tried to ignore it.  I had fully intended to leave it alone until I had some more actual information, and just like anything else, my resolve was firm until it wasn't.

Many of you know exactly what I mean, but for those of you shaking your head and wondering exactly what the hell I'm talking about, you obviously missed the title.  Yes, I'm talking about the article about Jahi McMath in The New Yorker magazine titled "What Does it Mean to Die".  In case you haven't read it, click the link, read it, and then come back.

No seriously, go read it.  Yeah yeah yeah, I know it's long!  JUST READ IT.

Done?  Good.

If you're anything like me, the first thing you noticed was the pictures.  There aren't many, but there is one very-obviously-posed picture of Jahi looking quite bloated though peaceful in her bed covered by an "I believe in Miracles" blanket, her mother leaning in talking to her, her step-father looking on and smiling, and her little sister peering in through the doorway.

Give me a break.

Much more striking than how Jahi looks is the overriding racial overtones that are pervasive throughout.  The article starts with this little tidbit from Jahi's mother Nailah in the fourth paragraph:
Just two paragraphs later we get this quote from Nailah's mother Sandra:
Is any of this true?  I wasn't there, so I can neither prove nor disprove these allegations.  However, the procedure was performed at a world-class children's hospital (in a city that has a larger black population than white), not a run-of-the-mill facility or some rural clinic.  I obviously can't disprove it, but I find it all but impossible to believe.  And of course the doctors and hospital in question cannot defend themselves due to privacy laws.

The article goes on to explain how Nailah failed to understand how Jahi could be pronounced dead even though "her skin was still warm and soft and she occasionally moved her arms, ankles, and hips".  This was doubtless explained to the family dozens of times both in the immediate aftermath and in the ensuing four years.  I've written about it here multiple times, though I have a strong suspicion they haven't read it.  Maybe they should.

Anyway, the article then delves back into thinly veiled racism with this passage:
And then:
Probably not surprisingly, Dr. Williams remembers the conversation differently (though her contradiction is not further explained in the article).  Unfortunately it gets even worse in the very next paragraph:
Sigh.  I nearly put the article down and stopped reading at this point, because the slant was plainly obvious.  However, Jahi's story was not about race, it was about a little girl who suffered a horrible post-operative complication and died.  It was never about race until they made it about race.

The next portion of the article is a retelling of the legal struggles Nailah went through and how she eventually got Jahi out of California to New Jersey, where she remains to this day.  It isn't until over 3000 words later that we finally get into the heart of the issue - what it means to die (you know, the title of the damned article).  The author goes into the history of how brain death criteria came into being, and she unfortunately delves into the seemingly true (yet demonstrably false) assumption that brain death was somehow invented in order to facilitate organ transplantation.

It would have taken the author 0.211 seconds (I timed it) to find an article from the Journal of Medical Ethics written by Dr. Calixto Machado (a name that should sound strikingly familiar to anyone who knows Jahi's case and who is mentioned later in the article) in 2007 that directly refutes this point.  The title is rather unambiguous: "The concept of brain death did not evolve to benefit organ transplants", and the main point is summarised quite concisely in the introduction:
It is commonly believed that the concept of brain death (BD) evolved to benefit organ transplantation.  Nonetheless, a historical approach to this issue will demonstrate that both had an entirely separate origin.  Organ transplantation was developed thanks to technical advances in surgery and immunosuppressive treatment. Meanwhile, the BD concept was developed thanks to the development of intensive care techniques.
Later the article explains how Jahi has supposedly developed the ability to move her hand and foot in response to verbal commands.  This claim is based on a series of videos that have been corroborated by exactly no one, yet they somehow have convinced neurologist Alan Shewmon to declare that she no longer meets brain death criteria.  What the article fails to mention is that Jahi had brainstem auditory evoked potentials performed back in September of 2014, which revealed that there was no auditory pathway, making it therefore an anatomic impossibility for her to hear anything.  She simply has no neural pathways that can allow her to hear the commands to which she is supposedly responding.  This hearkens back to the Terry Shiavo case, where her parents insisted that she could see them and respond to them, but an autopsy later revealed that her visual cortex had been destroyed, rendering her completely blind.

Just like with Jahi, Terri's parents had "video evidence".  Just like with Jahi, Terri's parents believed that Terri was interacting with them.  And just like with Jahi, Terri's parents were wrong.  What you can't see in Jahi's video clips (but can with Terri's) is the presumably hours and hours of footage it took for Nailah to get these cherry-picked video clips.  I have no doubt that Nailah saw Jahi twitching her hand and foot and recorded as much footage as she needed to get exactly what she wanted.  There is an excellent explanation here about why we have no reason to believe these videos.

However, the part of the article that caused me to groan the most was this:
Really?  REALLY?  She just so happened to have that conversation with her kids the previous year?  And Jahi just so happened to say "Keep me on one of those"?  Apparently we, the readers of this article, are expected to be too stupid to see right through this.  We're supposed to believe that Jahi asked for what her family is doing to her.  That she wanted this existence. 


Of all the things that have never ever happened, this never happened the most.

Monday, 5 March 2018

Four B's

NOTE: I realise I have not posted anything in three weeks.  I'm sure most people don't give a rat's ass, but there may be one or two of you who have been wondering if I'm ok.  Yes.  Real life, you know.

I may have mentioned it before, but there are four B's that I just don't do in trauma: bones, brains, burns, and babies.  Bones I leave to the orthopaedic surgeons, because while I thoroughly enjoy working with saws, hammers, and chisels, I much prefer wood to bone.  Bone is just too brittle, and wood doesn't heal.  Or bleed.  Brains are a different animal altogether - no one understands how the brain works or heals, so how the hell could I try to operate on an organ that I don't understand.  Burn patients require way too much personalised care and attention, and I just don't have the attention span for that.

And then there are babies.  I don't like working with children.  Don't get me wrong, I love children.  I love my own more than anything else in this world (with the possible exception of Mrs. Bastard), but that probably explains exactly why I don't enjoy paediatric trauma.

Ok, reading that last sentence back I probably could have worded that better.  No one enjoys seeing children get hurt, but goddammit you know what I mean.

No matter how much I dislike and try to avoid paediatric trauma, and in spite of the fact that there is a paediatric trauma center less than 30 minutes from mine, every now and then I still get one.  Some parents (and some ambulance drivers) bring their children directly to me because it is the nearest hospital.  And that is exactly what Cyrus' father did.

Even the overhead page of "Level 1 trauma now" sounded somewhat harried and panicked.  Nah, that's probably just your imagination I thought as I walked down.  My Inner Pessimist reminded me that most "Level 1 traumas now" are gunshot or stabbing victims that have been unceremoniously dumped, close to death, on our doorstep.  But not this one.  This was a fall, which was unusual.

Unfortunately all of our trauma bays were occupied by other patients when Cyrus (not his real name™) was brought in by his father.  Dad was in tears as he laid Cyrus carefully on our gurney in the hallway.  He was seven years old, just a few months older (though much, much larger) than my own Little Bastard.  His eyes were closed, and he wasn't moving.  While that sounds ominous, it usually isn't.  But it could be.  And the last several decades of working in trauma have taught me that making assumptions in my line of work is generally a Very Bad Idea.

I asked Cyrus' father what happened, and he explained that he had been running away from a neighbour's dog when he tripped and fell, hitting the back of his head on the ground.  He had initially been a bit dazed, but he promptly vomited and passed out.  And he hadn't said a word since.

Whenever I hear any sort of "trip and fall" story with a child, my brain immediately snaps to potential child abuse, but not this time.  I have a very good feeling about this sort of thing, and it was entirely evident that this was simply an accident.  I did a detailed physical exam (as best I could in the hallway), and my first finding was a contusion on the back of Cyrus' head.  This isn't necessarily a big deal.  But just as I was about to explain to his father that this was probably a simple concussion, I looked at his pupils, which were unequal.

Oh, shit.

I very calmly explained to Cyrus' father that while this may be just a concussion, I was worried that something much more serious had happened in his brain.  We brought him straight to the CT scanner, and less than 5 minutes later I saw exactly what I did not want to see:


Cyrus had a significant subdural haematoma on the right side of his brain exactly opposite his scalp contusion, something called a contrecoup injury.  As if that weren't bad enough, there was enough swelling in his brain already to cause the right cerebral hemisphere to start pushing towards the opposite side.  This is a sign of severe oedema and an indication for surgery to relieve the pressure.

I took one deep breath, knowing I was about to give a man the worst news he's probably ever gotten in his life.  I carefully and thoughtfully tried to explain as best I could what was going on, but I think as soon as he heard "severe brain injury with bleeding", he tuned out everything else.  While I was explaining the situation, my brain thought of only two things:

  1. This could have been my son, and
  2. I need to get this child to the paediatric trauma center NOW.
Our neurosurgeon was about 30 minutes away, and it would take less time to airlift Cyrus to the paediatric trauma center while they readied their operating theatre and got their neurosurgeon to the hospital.  

An hour later Cyrus was out of our hospital.  And that's the last I heard of him.

Thankfully I had no new patients come in for several hours afterwards, because my brain was stuck thinking about Cyrus and my own children.  This was a simple freak accident, but this adorable little boy could potentially die from it.  There is no reason for me to think the same couldn't happen to one of my children, and it made me consider ensconcing them both in bubble wrap permanently.  I know, I know.  Accidents happen, they are unavoidable, they could happen to anyone, that's why they are called "accidents", etc etc.  I know these things.  I KNOW them.  But my brain won't allow me to rationalise it.

This is why I don't do kids and why I respect the hell out of anyone who can.  Because I can't.