Friday, 29 June 2018

Finally over

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

Almost.

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

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

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

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

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

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

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

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

It's finally over.

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

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

Until the next one comes along.

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

465 comments:

  1. You were wrong Doc. You were wrong about the simple piece of biological science which Fisher performed that contradicted his findings on Jahi. Don't pat yourself on the back too much.

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    1. Hi Johnny, I was wondering whne you were going to show up.

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    2. No, Doc wasn't wrong. When the brain goes, what is the point of maintaining the shell? Jahi's been gone since December of 2013. Just because medical technology can keep a body without a brain warm with a beat heart for several years doesn't mean there is anybody home. I think it's grotesque.

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    3. keep in mind it has been repeatedly demonstrated that you can keep a disembodied heart beating as long as you keep it filled with oxygenated blood.

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    4. That's true, Ken. I just don't see what the point is. Just because you can do a thing, doesn't mean you should. That heart isn't going to keep beating without constant technological intervention. Is that life? I don't think so.

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    5. Not only can you keep a heart beating you can keep a dogs head responsive. Im serious look up the clip on youtube its rather disturbing

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    6. Can you please elaborate on that? What did Fischer get wrong?

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    7. No he can't elaborate on it, because there is nothing to elaborate on.

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    8. and because he's an idiot.

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  2. Okay, so here's what I don't get: how did the family manage to get doctors and nurses to care for (let alone DO SURGERY) on someone who was clearly dead? It seems like such a waste of skilled time and resources.

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    1. I think this is a huge ethical dilemma. Why do we do CPR when someone's heart stops? Is that different than surgery on bodies who do have a pulse? So many questions we need to think about.

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    2. The reason why she was able to still get care is because in Jersey there's a law where you don't have to accept a brain death diagnosis for religious reasons. Thus, in the state of New Jersey, Jahi was not legally dead.

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    3. Jaymie, off topic. Jahi received CPR for nearly 2 hours after she coded. What does this have to do with brain-death. Jahi's yet again.

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    4. Yet dead again.

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    5. we do CPR, because occasionally, the heart just gets BSOD, and if you can reboot it quickly enough, the patient will recover.

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    6. Ken Brown, let's be a bit more precise... "we do CPR, because on RARE occasions, the heart just gets BSOD... and even more rarely, the patient will recover *intact*."

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    7. true. improvements in CPR technique are improving the odds for people with a correctable issue, but it is still true that a lot of cardiac arrests are because of problems we can't fix. also, CPR, alone, is unlikely to lead to spontaneous recovery. (yes TV and movies get that wrong)

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  3. Wait, what?? Surgeries? How is that even possible legally and morally? I'm genuinely curious. I thought she was just in this perfect stasis this whole time, like a coma patient.

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    1. Yes, surgeries. Jahi's body was hospitalized at the end of April, so it has been over a month and a half. ICU? I'm not sure. What a waste of medical resources.

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  4. Dr. B:
    Respectfully disagree.
    This isn't over -it's just begun.
    Jahi McMath's death, or confirmation or whatever we call it, probably renders it moot on her count.
    And my guess is the majority of the medical community will retreat from asking any medical questions for a while. If so, they haven't learned very much from this case.
    But now the question of brain death will shift from primarily medical to primarily legal. There has been a lot of commentary on the "fiction of brain death". I refer specifically to an article by Shah in 2015 which was quoted extensively.The courts have a problem if they recognize this as a fiction, which some of them are obviously doing.
    Simply put this is the way I see it is this.
    If we recognize that brain death is distinct from "they can be buried right away dead", which it is obviously, then what do the courts call "death" for someone who doesn't fit the traditional cessation of heartbeat criterion?
    Will they even have a category of death that does not fit that criterion?
    When can the courts say stop the machines over a third-party objection?
    I mean if a family or interested party can summon a brace of lawyers and say no, and the courts allow that to go on for a long time, then obviously the law is having a problem with brain death.
    There could very well be different criteria for death in different states -dead in New York, alive in New Jersey. For my part, the law has to come to grips with that. That's one of the take aways from this case.
    From a legal standpoint, Is brain death simply another type of irreversible coma where the patient retains rights until his or her heart stops, or is it a special category where the patient no longer has rights and the ventilator must be stopped.
    I don't know if the legal community will take this on in McMath or any near future cases but it is quite important.
    Cory Franklin

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    1. the good news is that the one thing Grillo did that was assertive was signed a court order that when she did finally become all the way dead, the body was to be turned over for an autopsy. since she apparently did die in a medical facility, there is no way I can see for the family to withhold the body. hopefully, CHO will adopt a "the truth must be known" position instead of letting the family continue to write the narrative.

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    2. Dr. Franklin, did you see the video Professor Pope posted from the brain death conference in April? They talked at length about Jahi's case and the topics you bring up. If we maintain these patients as a matter of course what level of continuing medical interventions do we provide? Jahi had multiple surgeries. Would we continue to attempt restarting their hearts if they coded? What about dialysis in the case of kidney failure? And who would pay for all these interventions?

      Bioethics professor Arthur Caplan suggested a thought experiment. Why not extend this to people who suffered cardiac arrest and couldn't be revived? If a body can be maintained biologically and that is considered life then why not keep the cardiac patient's body going too. There are heart bypass machines that can do that right?

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    3. "What about dialysis in the case of kidney failure? And who would pay for all these interventions?"

      What about organ transplants?

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    4. I haven't seen Prof. Pope's video. Can you publish the link?
      I'm not sure Dr. Caplan's cases are analogous for several reasons.
      And the idea that we can keep anybody alive with the right intervention is certainly not what my experience was. I lost a lot of patients where we went full-bore.
      Mother Nature always gets last bats.
      Cory Franklin, M.D.

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    5. Here's the link:

      https://www.youtube.com/watch?v=tHD0OUUfiR0&feature=youtu.be

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    6. Thanks.
      Will watch
      Cory Franklin, M.D>

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    7. Thank Dr. Pope! Let us know what you think.

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    8. Don't know if my earlier entry made it.
      Interesting two hours. More heat than light.
      No answers some questions.
      Dr. Truog: Nice, simple explanation of brain death being a spectrum condition. Doesn't really address the question of whether someone could cross the line -from dead to alive.
      Dr. Shewmon: I don't know about any of you but that was some pretty compelling video. Look, I don't know if those were responses, maybe not, but it sure didn't look like spinal reflexes. He posits the theory that these are intermittent responses which would mean when you do the tests might be important. I can't say he is wrong (even if I hesitate to say he is right).
      Ms. Goodwin: Didn't add much. There is a racial component to this case and to brain death, but I don't see it as a major element. Henrietta Lacks as someone asked? I don't see it. This wasn't primarily a racial thing. Also I disagree with her interpretation of the Tuskegee Experiment -yes racial, but more complicated than that and I don't believe the primary motive was simply to obtain autopsies. She also expressed surprise at the notion that Chinese prisoners had been executed and their organs harvested. I think there is some good evidence for that,
      Dr. Caplan: Also not much contribution. His concern was primarily economic. Personally I think we need much more research into the imaging of brain death. Those costs should be subsumed by the medical centers (I have never understood how fixed costs items like CT and MRI, where the major costs are personal, upkeep and depreciation are used sparingly to keep prices high. But that's also another day's work).
      Basically, the McMath case leaves us with two major questions:
      With what we are learning about clinical and imaging tests, are the 50 year-old diagnostic criteria still valid?
      And does the law need to revisit this concept of death considering patient rights, organ donation, and termination of treatment.
      these questions are worthy of discussion.
      Cory Franklin, M.D.

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    9. I can't help thinking that this question is often looked at from the wrong direction: Brain death is actually the fundamental type of death while cessation of heartbeat is used for historical reasons.

      The fundamental definition of "death" for a multi-cellular organism is difficult to find but some notion of irreversible inability to sustain itself must be near the mark. From that point of view, cardiac arrest only becomes death when the function of the heart cannot be restored. Historically, the heartbeat was easy to measure and once a heart stopped, that was pretty much it. However, we all know that it's not so final any more - hearts can be re-started, replaced or substituted (at least for limited periods) with machines. This technology will doubtless continue to improve.

      Providing no other damage has occurred, the organism can recover from heart-related issues. Cardiac death only becomes final when other damage has occurred - particularly to the brain-stem with its essential reflexes or perhaps some very widely distributed failures. Even multi-organ damage can theoretically be corrected and might one day possible in practice.

      Declaring death due to an inability to restart the heart appears to simply be a proxy for death due to much more fundamental damage which has either occurred or must inevitably occur due to the loss of heart function. However, it appears that definitions of death are diverging, rather than approaching this fundamental point. Is that the difficulty in measuring this more fundamental death, I wonder, or am I just missing something here?

      Ugi

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    10. Dr. Franklin, You didn't find Caplan's talk compelling but he did bring up the point about using fMRI to see if movements are associated with neuronal function. He isn't wrong regarding the expense and the fact that not every hospital has one. He did ask if that is something we need to start adding to the brain death examination. Isn't that the most sensitive technology we have at this point to detect brain function?

      The again what do you do with that information? Say we establish that x number of brain dead patients' brains light up when they twitch a finger. Are we then morally compelled to keep those people on support until they suffer cardiac death? And if they are considered living persons do we continue to offer the full gamut of medical interventions to keep them biologically alive?

      Most adults wouldn't choose to be supported for such an existence for themselves but should society bear the costs for the minority who choose such an outcome for their loved ones?

      If things continue as they are in the US we will soon see Medicaid and Medicare as we know it end. If states just get a block grant for Medicaid as proposed there will be a finite amount of money available. I can't see how some kind of rationing wouldn't be inevitable at some point.

      Isn't there a better use of limited funds-disabled children and adults who are actually conscious, children and people with diseases and conditions that require more money than the current caps on private insurance. Medicaid also supports the elderly who have exhausted their private funds but need 24/7 skilled nursing care. As technology advances NICU costs will accelerate because more extreme premature babies will be salvageable, etc.

      I'm kind of surprised that you see using the organs of executed people as morally acceptable. That would only be acceptable if they were willing organ donors. Don't they deserve the same element of consent as everyone else?

      Legislatures under the sway of Federalism are going in the opposite direction. It's everyone for themselves. The more money you can amass and leave to your heirs the better. If you can't save enough to fund your own retirement then you're on the street. If you can't afford to pay for your own healthcare then too bad. If you work full time but can't afford to feed your kids then go hungry.

      They claim to be pro life but that encompasses more than saving fetuses from abortion or forcing hospitals to keep brain dead people on life support and providing extreme interventions to prolong lives even in the absence of quality. There has to be a willingness to address poverty and fund social programs and pay for those interventions.







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    11. Real quick clarification:
      1. I think we need more research in imaging in brain death.
      That should be obvious. As Dr. B will attest, CT scans have revolutionized the diagnosis of appendicitis and abdominal trauma. I can't tell you what we will do with the information without knowing what the information is.
      2. Finances are an important question, but I am of the opinion that they should be discussed separately from the scientific aspects of brain death (and ICU). Dr. Caplan tends to commingle those discussions - and that leaves both the science and the economics lacking.
      3. I am completely opposed to organ donations form prisoners - with or without their consent. In my opinion, prisoners can not give uncoerced consent by definition (possibly before execution - but even then I am opposed because of the conflict of interests the state has). My point was that it seemed Ms. Goodwin was surprised by the occurrence (perhaps I read her words wrong).
      4. I believe that discussions of poverty and social problems are separate from the problems we are discussing here. I know a lot of people don't agree with that. But again I fell both discussions suffer when we pit one group against another. Whether to fund abortion has no place in this discussion of brain death.
      Cory Franklin, M.D.

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    12. I'm not talking about funding abortion I'm talking about the legality of it. You can't separate abortion and brain death as legal issues because it is the right to life groups that are behind this push to eliminate the legality of both. They want personhood and all the rights that entails to include fertilized eggs and biologically maintained bodies. You can't separate the two issues.

      Sorry about the misconception regarding the executed prisoners. When you said there's some good evidence for that I see you were referring to the fact that China uses them for organs not that there's good evidence to emulate that practice.

      Eventually technology will lead us to many grey areas with respect to what is moral or ethical. Science by necessity must be agnostic to such issues but we have to decide whether just because something can be done should we do it.

      What do you think about the Bioquark project to reanimate people after death? Their research includes regenerating tissue and organs and reversing the aging process. Some people will see value in all of those approaches but what if we could halt aging or even conquer death? Should we? Unless we extend our habitat to include other planets I don't see how that would be a sustainable practice.

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    13. first; I will state that the underlying rule of science is that what we knew for sure, yesterday, may be known to be wrong today.
      for this reason, we should be willing to revisit brain death at any time a person shows reason to do so. that said, I don't believe that "I don't believe in brain death" is a valid reason.

      I believe that as much as I can call a patient dead by obvious signs, being cold, stiff, and dead, with lividity; or being missing important bits. cardiac death counts as an obvious sign for paramedics and above.
      confirming brain death requires even more training and equipment than determining cardiac death does. the fact the heart can continue without having a brain connected to it indicates that having a heartbeat is not proof of life.

      as far as organ donation from prisoners - I feel that they should not be denied the right to donate organs, but there must be safeguards to preserve their right to refuse. of course, I have also looked in some depth at a case in which a condemned man was fighting to be executed against the opposition of a group of people who opposed capital punishment; so I am aware that there are all kinds of people in the world.

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    14. Bioquark sound a lot like hucksters to me.
      But this is America and everyone is entitled to their scam, er enterprise.
      Cory Franklin, M.D.

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    15. Dr. Calixto Machado is a special advisor at Bioquark and their ReAnima project. He offered a declaration to the court in support of Jahi's family and can be heard offering a statement at the beginning of the Q & A session after the brain death conference. Might he have had a wee bit of a conflict of interest regarding his involvement in the McMath case?

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    16. That's possible but I wouldn't necessarily dismiss his findings out of hand.
      Cory Franklin, M.D.

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  5. now we're waiting for the autopsy results.

    but yes, johnny, she followed exactly the course predicted - the family was just able to stave it off a little bit longer than average.

    and doc: if we didn't like stories that aren't framed in a completely unique way every time, TV would have died years ago.

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    1. The family was able to stave it off with round the clock medical care provided and paid for by the taxpayers of New Jersey.

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  6. will it really be done though? I'd imagine post mortem finding will be released and further discussion will ensue. like you though, I'm happy her siblings can finally have some closure, even if they will never truly heal from what's been done to them. those kids have been the true victims the past 4.5 years

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    1. I'm sure the kids being neglected in favor of jahi isn't done, either.

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    2. Ken, according to one report I read the family is donating her brain for further scientific study. If they follow through there might at least be something positive to come from this tragedy.

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    3. @ Anonymous 29 June 2018 at 18:12— that depends on who they donate it to. If it ends up going to some group associated with Byrne or the Schaivo Foundation or the IBRF you can kiss the scientific part goodbye.

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    4. Also, I'm not a doctor or scientist but am I right in thinking there's little scientific value in studying the brain of a deceased brain death patient whose cause of death is already known and understood by the medical profession?

      I mean, I get that a lot of medical science is about advancing our current understanding of things we already know, but as far as I know the causes of Jahi's brain death are no mystery.

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    5. I'm sure their hope is that there's still enough brain structure remaining to debunk brain death as a legal criteria. Supposedly brain death leads to total necrosis and Jahi still had some structure in September of 2014. Of course structure doesn't necessarily mean function but who knows? It would be interesting to see what her brain looks like now after almost 5 years.

      In the video Prof Pope linked to regarding the April brain death conference Dr. Shewmon showed MRIs of several brain dead patients after various time periods since diagnosis. His intent was to compare the rampant necrosis to Jahi's MRI which showed remaining brain structure.

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    6. when liar dolan first showed the MRI, I showed it to a friend, and he said "that ain't right."

      pretty much covers it.

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    7. Anon - I think it will be very interesting to see what her brain looks like. In the case of the young Japanese boy who was kept on somatic support for nearly 20 years after brain death, there was essentially no identifiable neural tissue. I hope we get to see what Jahi's looks like. For science.

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    8. At the brain death conference I linked to in another comment the MRI of the Japanese boy's brain was one Shewmon showed as well as another patient at 4 years and one at 10 months. He mentioned that research shows congenitally decorticate children can still display consciousness.

      The video is very interesting if you have a couple hours to watch it. The speakers were Robert Truog,MD, Alan Shewmon,MD, Arthur Caplan,PhD and Michelle Goodwin,JD.

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    9. I don't know why he thought bringing up the decorticate children was relevant to Jahi's case because those children have functioning brain stems. He seemed to be implying that consciousness doesn't require a cortex or that it originates in the brain stem. He didn't really elaborate.

      I wish I could remember the question someone asked him at the end of the session. After saying he was glad someone asked that he said he couldn't answer to some laughter. It had to do with how he accounted for one of his assertions that was contrary to what JahI test results showed. I'll have to go back and listen again

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    10. Im suprised he doesnt just use himself as an example of someone functioning without a brain

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    11. that would require admitting he is an imbecile.

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  7. If I recall, there was going to be a jury trial to determine if Jahi somehow came back to life. Yes, a jury trial. Does that fact that her body finally failed moot that case?

    I'm also going to predict that Mama will sue the New Jersey hospital for malpractice, allowing Jahi to be all the way dead.

    I, too, am appalled that physicians would perform surgeries on someone in possession of a death certificate. That takes resources away from living people who could actually benefit and be helped.

    Rest in Peace, finally, Jahi.

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  8. I do agree she is a child who can now finally rest in peace. Thank you for the Jahi update.

    We understand. I will wait.

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  9. Professor Pope provided a link to a video from the April Brain Death Conference in which the Jahi case was a major topic. I highly recommend watching it. Some very interesting commentary from doctors Robert Truog and Alan Shewmon. Arthur Caplan, professor of Bioethics at NYU, imagined the consequences if death by neurological criteria was no longer a legal diagnosis. What level of continuing medical interventions would be ethical to provide? Surgery, dialysis? Jahi did end up having multiple surgeries.

    Doctors Shewmon and Byrne were involved in the McKitty case in Canada. She was declared brain dead last year and issued a death certificate. Her family is in a long legal battle with the hospital regarding her continued care.

    Professor Pope linked to the most recent court decision in that case. It's 111 pages long but well worth the read. Although the judge ultimately sided with the hospital he issued yet another stay pending appeal.

    What I found most interesting was Dr.Shewmon's differing attitude regarding McKitty's alleged responsiveness and Jahi's. The family provided cell phone videos which he found persuasive because they showed what he thought were movements inconsistent with spinal reflexes.

    In McKitty's case he ultimately decided that because she lacked cerebral blood flow they must originate in the spine. In Jahi's case he was still insisting as of the April conference that cerebral blood flow studies aren't sensitive enough to differentiate between no flow and low flow.

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    1. McKitty from Toronto was declared dead by the courts this week. The judge came back and she is to be taken off of any life support. I can not remember the time frame, I apologize.

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    2. There's a stay pending appeal so even though the judge ruled in the hospital's favor she will remain on support for the foreseeable future.

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    3. http://thaddeuspope.com/images/382645541-McKitty-v-Hayani-Reasons-for-Decisionx.pdf

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    4. On P. 11, article vii: "...assessment of...values, wishes and beliefs of the individual patient."

      The patient was found unconscious and not breathing, having suffered brain damage from a DRUG OVERDOSE. Though she may have affiliation with christian religion, she demonstrated a lack of care for her own well being at that point.
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      P. 22, article 59 "...a lack of capacity for consciousness, brain stem reflexes, and capacity to breathe."

      So...if the patient has already suffered massive cerebral damage, and is not able to regain consciousness, reflexively react to various stimuli, or trying to breathe on their own, then brain death is indicated. So...if they need a respirator to be "alive" alongside the other indicators, they're dead!
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      P. 45, article 131: "...the medical determination of death cannot be subject to an individual's values and beliefs. Death, as in the diagnosis of any medical condition, is a finding of fact. To import subjectivity to the definition of death would result in a lack of objectivity, certainty and clarity."

      The court wisely chose to state that an objective, verified diagnosis of death by multiple doctors using current medical knowledge to make the determination should stand above the beliefs of a few individuals.
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      So what we have here is a complete determination that the procedures to determine brain death (including brain stem) are valid, tested, and not a violation of religious views. It should be noted that the New Jersey law was referenced, but considered a legislative issue rather than a judicial one.

      Yes, she's going to be on support until they file another appeal (that is valid), or the deadline to do so expires. But it doesn't look like this is going to change the Ontario opinion on cause of death.

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  10. I heard the news that Jahi’s heart had finally stopped beating last night with relief. What was done to her body after her brain died was horrendous. The abuse of her corpse and the treatment of her siblings filled me with pity and anger.

    I also looked with dismay at the way this event was treated in the news. “Jahi has finally died” when she has been dead for more than 4.5 years and the persistence of the media to repeat the fiction that she had a simple tonsillectomy and not the infinitely more complicated procedures that were actually performed. The fact that she was in the pediatric ICU after her surgery should have been a major clue that this wasn’t a routine outpatient procedure from the start.

    Now I hear that multiple procedures were performed on her corpse over the years. Who authorized the expenditure of resources on a dead body? How was it even legal or ethical?

    I hope this will close the chapter on this case but I am sure the legal battle will rage on.

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    1. I heard the news report this morning that she was in a "vegetative state."

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    2. I have contacted CBS regarding their misrepresentations. I hope you don't mind Doc, but I sent them a link to this article (as it has sublinks to the whole saga) for reference.

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    3. Thank you, Scott. It's appalling how wrong the news gets things. I also keep hearing she had a "simple tonsillectomy."

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    4. All on purpose by the family attorneys to frame the events in hoping to taint a potential jury pool

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  11. Doc B, thank you for your factual information and commentary over the past few years. I learned many things from you and the commentaors here I appreciate that you waited until the family formally disclosed her death. We knew she died 4 1/2 years ago, her family now has to accept that and grieve. I agree that the CHO will offer a settlement and we will never get to hear CHO and the doctors' testimony. While I don't approve of the family's actions over the years, I wish them peace.

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  12. Anything can be kept "alive" with the proper combination of medical devices and money. Like the russian dog that was decapitated and the brain kept alive via a bypass machine, to a point where it could lick its nose when a chemical was put on it. Theres no way anyone can say the dog was still alive, it was just a head, but yet it moved and licked. Jahi was a shell, and this case infuriated me from the get go, for a family citing religious beliefs, why couldn't they accept the fact that according to their main belief system, "God does everything for a reason, and it's been predetermined by his Devine will that whatever happens to us happens because he made it so". Stop being selfish, instead of praying for a miraculous recovery that wasn't going to happen, they should of prayed for a quick and merciful end that was painless. These clowns dragged this poor girl through the media circus to feed their own selfish natures and made a ton of money doing so! I am glad this is finally over and done with, and as you said doc, it's just a matter of time until the next one.

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  13. There are several ongoing cases. Remember Israel Stinson? Another American family just sent their brain dead son to Guatemala for a tracheostomy and feeding tube. There's an open court case in Canada right now in which both doctors Shewmon and Byrne are involved. Jahi's case just set a precedent. The right to life groups are behind this movement to redefine death to exclude bodies that can be maintained biologically. Where does it end? Bypass machines can keep a body going without a functioning heart so why not eliminate cardiac criteria as a means to declare death too?

    ReplyDelete
    Replies
    1. Yeah but i thought they werent able to gather the funds to go to guatamala and he died a week later didnt he?

      Delete
    2. There were two boys, one has since been declared dead by cardiac criteria but the other one is in Guatemala. I tried linking to the Medical Futility Blog and Professor Pope's Twitter feed but neither will load for me.

      Delete
    3. http://www.philly.com/philly/health/brain-dead-life-support-childrens-hospital-philadelphia-guatemala-20180625.html?__vfz=medium%3Dsharebar

      Delete
  14. Well, I'm sorry for her mother and her siblings. One of the hardest things that I have ever had to do was to decide to remove life support from my sister. It is an incredibly difficult thing to do. I'm sure that her mother's denial came from that and is making the death even more painful.

    ReplyDelete
    Replies
    1. While I do have sympathy for the family please don’t think this was all about love and denial. Money is a factor here as well. If she was legally alive until her second death in NJ the family could potentially get millions more in a lawsuit. One of the first things Ma did was petition to get the date of death changed on the Cali death certificate. As a nurse I found it shocking how many people see dead/dying loved ones as a source of income. I had two sisters stand in the hallway and say we had to “keep doing everything” to keep their mother alive because if she died one of them would have to get a job.

      Delete
  15. Doc its good go have you back.
    Dont worry if you get repetitive. Long as theres a story well be here to read it.
    Otherwise well all be in the comments wondering wheres doc. Again.

    And its good the tale of jahi has (mostly) come to a close.
    5 years in the...dying.

    ReplyDelete
  16. Some of the news reports said that the second death was the result of excessive bleeding following surgery to treat an intestinal issue. Dolan said that this time Jahi's mother gave her daughter permission to die because she felt Jahi was struggling. Isn't that like saying she refused to give her daughter that permission the first time? Most families don't go down this road. When there's no hope we say goodbye and turn the machines off.

    ReplyDelete
  17. Likewise here. Thank whatever deity you follow she's finally at the clearing. Much like many other things going on in the medical field (PCP Chiro, what?), the legal and legislative ramifications have barely begun to play out. Where it goes, and how much logic is involved remains to be seen.

    I'm with Ken and Connor, tho. You may think your presentation is getting stale; I think your style has evolved to a plateau. Your articles are ALWAYS well written, timed, and phrased. I eagerly look forward to seeing the next entry (I check near-daily). Since I have discovered this blog, I've learned SO much (alas, a lot of it is in the realm of stupidity), and can only pray you're the Trauma Surgeon on call if I end up in need of one. Even if I never knew it was you.

    ReplyDelete
  18. I hope that family can find peace, even with the mother being the way she is. She set an awful precedent for future cases which will cause undo burden.

    ReplyDelete
  19. What a horrible situation. I hope the family can finally find peace. Forgive me if this has been asked already but can her organs be donated to other children or is her body too far gone? Thank you for all the blog posts and answers about this case.

    ReplyDelete
    Replies
    1. Considering she was bleeding from multiple organs, had been sedintary for nearly 5 years, and had probably a huge number of other issues...im no doctor but i highly doubt it

      Delete
    2. I think they were considered too far gone early in the first year of undeath.

      Delete
    3. That’s what I thought. Thanks.

      Delete
  20. I find it interesting that excessive bleeding caused her death “both” times. Do you suppose she had an underlying blood/bleeding disorder?

    ReplyDelete
    Replies
    1. I don't think they would have done the surgery the first time if they knew she had a bleeding disorder/clotting problems - if they did know about one, they would have corrected it first, waited until she was stable for surgery, and then proceed. I'm guessing the excessive bleeding the first time, was due to clot disruption...

      The excessive bleeding the second time around was likely due to the liver failure - the liver makes a lot of the proteins involved in the clotting cascade....So if your liver isn't working, you won't clot well, and you'll have bleeding problems...

      just the thoughts of an icu nurse =D

      Delete
    2. Putin my money on acute upper airway obstruction.

      Delete
    3. Actually, one doesn't need to have a bleeding/clotting disorder for a condition called DIC to develop (Disseminated Intravascular Coagulation). It can happen to anyone in the "right" circumstances.

      Delete
  21. Irrational mother in me screamed fight for your baby.. Counselor in me screamed eeeh gads wtf are you doing.. And then I read more and found docs blog, and read more..
    My grandmother and grandfather chose to remove my uncle from life support when he was 22.. The devastation, the heartbreak, I always wondered what would have happened if they would have taken Jahi's mother's stance.. my answer is simple, nothing- he would have been brain dead living on life support with family holding on to hope because there was nothing else, his body would have eventually deteriorated and died because he would have been a slab of rotting meat connected to wires to give the family hope..

    ReplyDelete
  22. As a result of this case I've had some very pointed conversations about my adult son about how I would want my corpse to be handled in the event of brain death. He has assured me he will make sure any remaining plugs are pulled post haste, regardless of what my other (religious) relatives want.

    ReplyDelete
  23. Casi G since she had multiple organ failure including liver, kidney and heart. If anything she needed some new organs.

    ReplyDelete
  24. Dolan told some media outlets that he wants to still pursue damages against CHO because the NJ death certificate listed anoxic brain injury as a contributing factor. He claims the fact NJ even issued a death certificate proves that Jahi wasn't dead yet so the one from CA is invalid.

    ReplyDelete
  25. Doc said she developed DIS, a loss of her clotting factors, that alone is very hard to reverse.....this the excessive bleeding.

    ReplyDelete
  26. And once your unable to clot a minor cut can be horrible. Like the many "tiny cuts" you get furing surgery

    ReplyDelete
  27. Here folks. I wrote this piece on Jahi when I finished my surgical rotation way back in 2014. I'd say that I was pretty close, eh?

    "Let me explain a little better about the issues around feeding, since the rhetoric was that the hospital was "starving" Jahi, and that's simply not the case.

    We know from the medical reports (released to public) that Jahi suffered a lack of oxygen to not only her brain but to her whole body, intestines and digestive tract included. When this happens, the intestinal lining -- the cells that enable you to absorb the nutrients you eat -- dies and begins to slough off, because it is particularly sensitive to lack of oxygen. That happened to Jahi. Any food given to Jahi via a feeding tube at that point would not have been absorbed and would have been wasted (at best) and caused complications at worst.

    In a living, non-brain-dead person, hospitalized with post-ischemic (lack of oxygen) injury to the bowel, the standard procedure is to stop any feeding via the digestive tract and to give nutrients only via IV until the intestines can recover or until it's determined if the damage is so severe that emergency surgery is needed to go in and remove dead portions that are beyond recovery. This is called "bowel rest." So, the fact that Jahi was getting fluids and nutrients only by IV was medically appropriate even in the absence of her fatal brain injury.

    However, given that Jahi had been examined and declared dead by two CHO doctors and a 3rd court-appointed specialist, there would be no emergency surgery to remove dead sections of intestine. While the court battle was fought, she would be maintained only on IVs. If the damage was too severe, the intestines would perforate, she'd become septic, and things would go downhill quickly from there. If the damage was mainly to the intestinal linings and wasn't full-thickness of the intestines, the linings would eventually regenerate on their own, given enough time -- which she certainly has had by now -- then feeding via the GI tract could safely resume. But no-way, no-how should Jahi have been getting food via a feeding tube while active intestinal sloughing was still going on. Even the family's own doctor held off doing so for a while after she was removed from CHO. That doctor knew the risks.

    Now that the ischemic colitis has resolved, she should not still be sloughing intestinal lining (unless her blood pressure is too low to perfuse the intestines well enough, and repeated episodes of ischemia have developed), and the intestines should now be able to absorb the nutrients given by a feeding tube. Those nutrients will do nothing to reverse the brain death, since none of them will be going to the brain (brain circulation ceases with brain death), but they will be enough to keep other body tissues going so long as the ventilator continues to run, the heart continues to beat, and blood continues to circulate.

    Hope this explanation helps."

    ReplyDelete
    Replies
    1. This is a good summary, and turns out to be very accurate. Other things we were reading at the time, about how she would surely die completely within weeks, turned out to be inaccurate, and may have fostered the idea that she wasn't "really" brain dead.

      Delete
  28. What keeps coming into my mind: poor baby. I hope her soul is finally at rest.

    ReplyDelete
  29. Ah-ha! Thanks for the clarifications. I just found it very interesting that it happened both times, with both surgeries. I am definitely with everyone else here. I hope her family can move on and heal from this. I also hope that the medical community reveals what they learn through the autopsies as well.

    ReplyDelete
  30. I breathed a sigh of relief for this girl I never knew but read about and was drawn to. At first I felt 'sorrow' for her mother but as time went on I was angry and annoyed at her. She was not putting her child first. It was always herself and her wishes. Her grandmother is a pathological liar.

    People simply became more confused about the case, some really believing Jahi was not brain dead...because of the lies put out.

    In the end, her heart finally stopped and she will be put to rest. I hope the medical community was able to learn something from this. What I learned is how dysfunctional things can get when people lie and people believe the lies.

    Kate Johnson

    ReplyDelete
    Replies
    1. Sigh. You people still don't get it. When will you people realize that this case isn't about Jahi or the family, or Michael Kors, or how much money they have in their GFM account, it's about the UDDA's neurological definition of brain death. That's where people's dysfunction are coming from especially with some nurses whoworks in convalescent hospitals.

      Delete
    2. no, we get it perfectly. it is about people wanting to redefine things to suit their own wants.

      Delete
    3. John Benton: You're still the same dolt you were 5 years ago, bashing Eleanor and Kate. You're also still yammering about upper airway obstruction as if you're an expert in that area. It was BS then, and it's certainly BS now.

      Delete
    4. years from now, anybody who tries to pretend competence where there is none, will be referred to as a "benton"

      Delete
    5. It's Mr. Dolt now. Thank you.

      Delete
    6. That's a good one, Ken!

      Delete
    7. Congratulations John Benton.
      You have single handedly ensured i will never name a child John, or Ben.

      Delete
  31. Now she can rest in peace. I hope that her siblings in particular get grief support. They have been told for years that their sister would recover despite that not being possible. Part of their childhood was sacrificed for this macabre saga, I really hope they will be able to speak with qualified grief counselors. But I have doubts that will happen.

    ReplyDelete
  32. Thanks Doc B for the update, especially appreciate the extra medical details.
    I work in Australia as a palliative care doctor, and things are different here. Doctors cannot be forced to provide a futile or unethical treatment. It's unlikely that this whole disaster would have gotten off the ground here, because the family and hospital would have gone to Court as they did there, and I believe the hospital would have been supported to turn off the life support back in 2013.
    I am glad for her siblings and I hope the family and health practitioners can finally move on.

    ReplyDelete
    Replies
    1. the good news is that for every Jahi McMath story, there are two or three stories about a family who donated their brain dead child's organs, and later got to meet people whose lives were saved or changed by the donation.

      my family knows that if I go brain dead, after confirmation, I want as much as possible to be recycled.

      Delete
  33. Your stories about Jahi McMath and other similar cases are frankly boring and repetitive.

    ReplyDelete
    Replies
    1. You know what's fun- choking on a dick, you should try it..

      Delete
    2. Oh boo hoo.
      So sad that somebody is forcing you to read them.

      Hint: most of us disagree with you

      Cheerio
      Softship

      Delete
    3. anon: you know what's boring and repeitive?

      you.

      Delete
    4. Anon, no one is forcing you to be here, and no one is forcing you to comment. If you find my stories boring then I suggest you find one of the other approximately 644 million websites out there and go fuck right off.

      Delete
    5. Major Props, Cali.
      Ken, you can do better than that.
      And I'm with DocB, don't just fuck right off, fuck all the way off.

      Delete
    6. I love these responses.

      Kate Johnson

      Delete
    7. I myself am concerned about the deity like status Doc is elevated to here, the cult like effect of a blog with one author , and the mob psychology. Is every dissenting opinion from a "hater?" I think you people are adults but you sound like children. Would you say this in real life? I doubt you would tell someone to "choke on a dick" or "fuck right off" even if in your fantasy you would.

      Delete
    8. Oh dont worry im very open about my opinions in public.
      And no, just toxic ones that try to spread misinformation maliciously. Which all come from one person.
      High john. Didnt miss you.
      Now, kindly, fuck off.

      Delete
    9. no, most of the dissenting opinions are from a dumbfuck. and by that, I mean from ONE dumbfuck. a poster child for dunning-krueger, if you will, or , for that matter, even if you won't.

      Delete
    10. Not 100% sure this anon is John. If not, I have to go with Doc here. If all the stories are "boring and repetitive" then please relocate yourself and your unneeded comments to another website.

      This is not a cult; nor do I (can't speak for anyone else) consider Doc a diety. What I DO however, is consider Doc a highly intelligent, well read and knowledgeable medical professional who is willing to share the highs, lows and insights of his profession honestly. Unlike some Blogs I've read, he will also show up in the comments to clarify things for his readership.

      So yeah, Sod off.

      Delete
    11. Yeah, John is highly educated now. He can change his speech and mannerism just to play with your mind. Johnny is so brilliant, he makes women drop their panties immediately.

      Delete
    12. only if they are carrying laundry and throw up a little in their mouth.

      Delete
  34. Thank you for the update on this tragic case. As an ICU nurse it has been difficult to hear so much misinformation about this case. It started early when the press kept saying she had complications from a simple tonsillectomy. I felt compassion for the poor doctors and nurses who were forced to do corpse care when all have the "first do no harm" as their mission. So much sadness to go around.

    ReplyDelete
  35. I had to send $150K from my Trust Fund to the Winkfield family in care of the Dolan Law Firm in San Francisco. What will you miserable cheapskates do, eh?

    ReplyDelete
    Replies
    1. Nothing.
      Because brain dead patients need a plug pulled not more money to keep their corpse from rotting.
      You can all me callus, i prefer realist. Or logical. Or sensible. Or having an iota of intelligence

      Delete
    2. As Doc B said,John, you can go fuck right off.

      Delete
    3. why would we do something so stupid? mom was capable of working. Medicaid was paying the medical bills. suckers like you paid for the nails and shopping sprees. millions of better uses for trust fund money. most of us, medical or otherwise, do things every day to make the word a better place. perpetuating this travesty is not one of those things.

      Delete
    4. As promised when this whole thing started from the very beginning when Dolan took this case. Dolan is also a personal friend of ours. It's too bad we weren't able to bring in the big guns during trial. We would have shredded them.

      Delete
    5. Time to stop feeding the troll. It only encourages him to get more and more outrageous.

      Delete
    6. If I knew Dolan, I sure as hell wouldn't amit it.

      and I help people who didn't kill their child through their own unwillingness to follow doctors' diections and then try to grift off the system for the next 4 and a half years.

      Delete
    7. Had to huh Johnny? Smdh.

      Delete
  36. Sure you did Benton, like you have a trust fund

    ReplyDelete
  37. JMHO, but poor Jahi has been resting in peace since 12/2013; for me, the continuing macabre abuse of her corpse has been disturbing & distressing, so I'm glad that particular horror is over. It's also been infuriating to me those with a "pro-life"/anti-choice/anti-organ donation agenda used the tragedy for their own sick purposes, which resulted in the real-life abuse/neglect of Jahi's LIVING siblings and other loved ones in the process. Deplorable! And, when I think of the taxpayer $$$ spent to keep a corpse above ground that meant LIVING people didn't get the care they needed, it's heartbreaking and enraging. Think I'm wrong? Talk to the parents of children in NJ LIVING with chronic medical conditions including mental illnesses about the scarcity of publicly funded resources to improve their kids' lives. The limited resources spent on a CORPSE while there's so much need in LIVING children is obscene & unconscionable. WWJD? Not what was done to Jahi's corpse, that's for sure!

    ReplyDelete
    Replies
    1. exactly. i would worry that suicide would be in the kids' future. maybe if I'm dead, mama will love me too kind of thing

      Delete
    2. Somwhat ironically to those who were against organ donations (including her own family) the family donated her brain for scientific research

      Delete
    3. Wow, Anon. You bring up a scary and cryptic point. I absolutely hope that is never the case.

      Delete
    4. they claim to have donated her brain for scientific research. that presumes she still has a brain, and that the people they would have donated it to practice science.

      Delete
    5. As i understand it anyone can donate any body part to science. Theyll accept them. Doesnt mean they wont throw them in the trash

      Delete
    6. She received help from some brain foundation. Perhaps in order to receive the treatments/ medication she had to agree to allowing them to study her brain. I hope you all know Ma would not do anything chritable on her own.

      Kate Johnson

      Delete
    7. A lot of people needs help from the brain foundation on this site as well my awesome nurse.

      Delete
    8. yeah, like John Benton. maybe he should go see the wizard, and get a bran new brain.

      and connor, you missed my point, entirely.

      Delete
    9. No dont worry ken. I got it completely. Just decided to make my own joke

      Delete
  38. At least Jahi's body will finally be left to rest in peace. While I'm sure this story isn't fully over yet, it's out of the doctors' hands.

    Call me cold if you want, but I find it ridiculous that it took this much time and money and effort to keep a dead body, a corpse, 'alive' for the grieving parent to make a media spectacle about it. Time that could have been better spent helping patients, better spent on court cases that mattered, better spent on raising the living children she had. Money wasted from taxpayers, scammed from donators, thrown at lawyers in vain hopes of overturning a natural cause of death. Effort wasted at hospitals that could have potentially been used for saving lives instead of caring for a body that needed a casket, the time of private care nurses wasted caring for a corpse instead of for the elderly who need someone to help them.

    I fear that the surviving children will be scarred by this event, in more ways than one. First, they're part of this big media scandal, and everyone in the US and likely in other places around the globe knows who Jahi was. They'll be known by many names, none polite, in the school-yard because their mother kept a dead girl in the house. On top of that, they were robbed of the time for their natural grieving process, in the vain hope that one day, Jahi would open her eyes and spring out of the bed, good as new.

    I've lost a parent. That grieving process takes a long time. I know it, and I know that losing close family can really screw you up inside.

    Then there's the other problem. Now those children will fear going to the hospital for routine things, things that should be done for their health. It's not, perhaps, a certainty, but I wouldn't be surprised if the mother uses this as a scare-factor to her surviving children, that hospitals are just out to kill you.

    Why do I feel there's a potential fear in the future for her children? Because of mine. I was 6 when my mother passed (Lung cancer, for the curious), and even 20-ish years later, I still can't stand that 'medical' smell. You know the ones, the strong disinfectants and everything else common in a hospital. Hell, I can barely go into a doctor's office without having my heart rate go way up. It's something I'll likely never get over, just like my fear of bees and wasps. (I'm not allergic, just I don't want to be around things that have wings and can sting.)

    The optimist in me hopes that the surviving children turn out okay, and that they get through the grieving process quickly. The realist in me knows that they're going to need help. The pessimist in me believes that their mother won't get them the help they need, dooming the surviving children to a messed up life.

    Somehow I doubt this story will have a happy ending, even though Jahi can finally be laid to rest.

    ReplyDelete
    Replies
    1. Dakala, I am so sorry for your loss of your mother at such a tender age. You make some very good points.

      Delete
    2. yes, my thoughts exactly. my heart breaks for those kids. and I don't think mom is capable of recognizing how much she's damaged them or the help they'll need.

      Delete
  39. I'm expecting a GFM to be started any second now to pay for flying the body to CA and the funeral. It will be a big splashy media affair and the family have to look their best.

    I hope the other three children and one grandchild will finally get the time and attention they deserve. Particularly her little sister. Poor girl.

    Wednesday

    ReplyDelete
  40. Finally, an end to the ongoing saga of Jahi McMath alive or not alive depending on which state you live in.

    What i am interested in would be the autopsy results especially concerning the brain.
    Since we have not seen scans or the results of any tests done by independent doctors since 2014 after which the parents refused to allow them, the results showing the condition of Jahi's brain will be fascinating.
    How much of the brain is left?
    What condition is the brain in?
    Could she have heard anything?

    If her brain is in such a poor condition, she could not have heard anything thus could not have responded to her mom's voice commands, if it was calcified or liquified to the extent that it could not have been functional full stop how would her parents and her supporters explain away their claims that she was not dead?

    How would they have explained away the twitches in her hands and feet if her brain was liquified or calcified?

    Could it be that her 'doctors' knew this which is why they refused independent scans and tests?
    Where her 'doctors' being paid and if so by whom?
    Could they face investigation and possibly charges if they knew Jahi was brain dead/dead dead and yet claimed she wasn't in order to claim payments from the parents or medicaid or whoever, would that be fraud?

    I feel for the surgeons who had to operate on her, would they have been tempted to open her up have a look and declare her dead and that she died on the table?
    When she coded after the 2nd operation, did they perform CPR to try and bring a corpse back?
    If so why, given they knew she was legally brain dead in California complete with death certificate and at a minimum in a PVS and had been for 5 odd years.

    Finally in early June she was taken to surgery, where they apparently found nothing grossly wrong.
    In relation to what?
    A normal healthy child or someone who was in a PVS and had been for years or a corpse?

    I hope that after all this and the results of the autopsy that changes are made regarding brain death and that the same rules apply everywhere regardless of religious beliefs. If you are brain dead you are brain dead, end of story.

    I also hope that given how long they managed to keep her body going after brain death that much will be learned regarding treatment and care of vegetative patients, life support and how long various organs can go on for before giving up the ghost.
    It may be the only thing good to come from this debacle.
    I also hope Jahi's siblings get a lot of counseling given how long they had to live with a corpse who died officially twice.

    My condolences go to her family and friends, they have lost a daughter, a sister, a friend officially for the 2nd and final time.
    This time there was no coming back, no hope of continuance, no chance of a miracle.
    Their whole lives this last few years has revolved around Jahi, they now have to return to what passes for a normal life.
    I hope they don't try and drag it out in the courts, prolonging the pain, especially if the autopsy proves that no matter what they saw and believed, Jahi was not responding to their commands, Jahi was brain dead, dead dead and it was all simply the Lazarus effect.
    Not a miracle or deliberate action.
    Whatever happens they will need a lot of support.

    I also wonder if they will decide to sue the quack doctors who said she was not brain dead, she was alive and could recover, albeit profoundly disabled?

    PS Doc, you could never bore us.
    No two patients are the same, no two cases are the same and me personally, i love the way you write.
    Please don't leave us unattended, some of the others scribble on the walls, leave coffee stains on the table and dirty dishes in the sink (not me of course cos i am good)

    Thanks Doc and keep up the good work.

    ReplyDelete
  41. Raises hand** I am one of the heathens that scribble on the walls. I make no excuses. I am a bad girl.

    However, with that said...

    I am dying..uh, no pun intended, to see her autopsy results on her brain.

    ReplyDelete
    Replies
    1. So it's you that pilfers and purloins my crayons, you bad girl.
      Makes note to tell Santa.

      Delete
    2. I also stick them up my nose when you're not looking.

      Delete
    3. Still better than where I stick them before you get a hold of them Canaan....

      Delete
    4. Ewwww! That's why I got pink eye! Gross Connor!

      Delete
  42. What about that little girl from the Philippines who woke up at her funeral? She's in 6th grade now.

    ReplyDelete
    Replies
    1. got documentation? I'll bet you are afraid to give it because it won't be a case of a properly diagnosed case of brain death recovering from it.

      Delete
    2. http://www.nydailynews.com/life-style/health/girl-wakes-funeral-article-1.1866241

      Delete
    3. And mention of brain death is GASP NOT MENTIONED?

      Delete
    4. That's after embalming!!!

      Delete
    5. Anon, Did you read what I read because before your whole post a link debacle? I did my own quick Google search on "dead Philippino toddler awakes at funeral" and read about 4 stories, much like yours that mention 1) no brain death. 2) that she is, at this moment still dead. And 3) made no mention of embalming practices.

      Idk what you're trying to accomplish. But, try again.

      Delete
    6. Benton's law: in any forum, there will be one person who pretends to be competent, but isn't.

      Delete
    7. This comment has been removed by the author.

      Delete
    8. Clickbait. For all of three vague paragraphs, and two (really blurry) videos, there are ads for more clickbait everywhere (wow, Dolly Parton showed too much as a teenager? That's on page 65).

      Unless you send me a cease-and-desist order for using your IP, I'm totally stealing Benton's Law. This is meant not as plagiarism, but as the highest compliment I can pay. Thank you Ken!

      Delete
    9. my goal it to have it quoted at him everywhere he goes.

      so yes, use it frequently.

      Delete
  43. Thank you DocBastard, I feel your great relief!
    And don't worry about becoming boring.
    Greetings from Central Europa

    ReplyDelete
  44. Professor Pope just posted some new court documents. There was another hearing on June 25 to clarify that only the issue of Jahi's standing as a living person or if she was legally dead was to be decided during next February's jury trial. Looks like the media wasn't the only entity left in the dark regarding Jahi's status. They didn't bother to notify the court either.

    ReplyDelete
    Replies
    1. I wonder how that squares with Grillo's January 2014 order that Jahi's body must be returned to the Alameda County Coroner upon cardiac death.

      Delete
    2. I've been going over the court documents on The Medical Futility Blog and can find nothing stating that Grillo ordered Jahi's body returned to the Alameda County Coroner. The only stipulation regarding the Coroner upon her transfer from CHO stated that:

      The Coroner has to sign something accepting the body from the Hospital-whether it is the Release or some other document.

      If you know of the particular document containing such an order could you link to it please?

      Delete
  45. As of June 29 they still hadn't notified the court but Brusavich said he was going to ask that the Feb. jury trial go forward when he notifies the judge. If a jury finds that Jahi was alive since her release from CHO the family can ask for damages to cover all of their medical expenses up until June 22. Of course they didn't have any because NJ taxpayers covered them.

    Ironically they have a better chance of having Jahi declared alive now that she's finally been taken off of life support because the jurors will be more sympathetic.

    What a strange case.

    ReplyDelete
    Replies
    1. if I was CHO I would ask for a postponement until after the autopsy

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    2. The hearing is scheduled for February. I'm pretty sure the autopsy will be done by then.

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  46. interestingly your website was the first place i went to after the news broke that the dead...um...died. because i wanted to read what you had to say about it! so your post was actually anticipated and welcomed. because it is nice to read indications of rational thought from time to time.

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  47. I just tripped over this and realized it features Shewmon (who I regard as a quack but other disagree). It's from 2007. Others may find it interesting.

    https://bioethicsarchive.georgetown.edu/pcbe/transcripts/nov07/session5.html

    Wednesday

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  48. I have never posted here, but, have read most of the stories, especially this case. I have a medical question. Is her organ failure a direct result of her brain death and something that was going to happen at some point? Or did something else happen, secondary or unrelated to her brain death, like an infection or something (I don't know what this different thing could be as I am not a medical professional)?

    ReplyDelete
    Replies
    1. my understanding is if her brain was working, she wouldn't have had this issue.

      Delete
    2. Thanks. Regardless I am glad that she is finally being buried as I feel really bad for her siblings. Although sadly I am sure the mom is still going to devote her time energy and money fighting these futile lawsuits. I hope NJ changes it laws so there is no exemption, religious or other, when a person is declared dead (neurological criteria and when the heart stops).

      Delete
  49. That autopsy is going to be gold.

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  50. CHO, the medical examiner of whatever county, NJ (she died her final time in) a family chosen medical examiner AND a non-biased non-related to the case or outcome to the case in addition to one lawyer from each side and a video tape should have been included in that autopsy. I know that is a bunch of people, but a bunch is at stake.

    ReplyDelete
    Replies
    1. Judge Grillo's original ruling prior to her release from CHO stipulated that her body had to be returned to the Alameda County Coroner for autopsy when the heart stopped. We'll see if that bears out.

      Delete
  51. The real question thats yet to be adressed: will mama nails try to go full weekend at bernies?

    ReplyDelete
    Replies
    1. I thought that was what we have been addressing for the last 4½ years.

      Delete
    2. That was more like half weekend at bernies. I mean dragging her into the courtroom and holding her up from behind to make her walk

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  52. WTF? Ten steps backward. The local Oakland area paper just published a follow-up article implying that Harvard Medical School says Jahi 'improved' before she re-died.

    Distilling presentations about the McMath case from a conference on brain death into a misleading article like this, painting it as fact, is fifty shades of wrong. It pours kerosine on the fires of every public misconception.

    "Jahi McMath improved after she was declared brain-dead, doctors say"
    https://www.eastbaytimes.com/2018/07/02/jahi-mcmath-when-dead-isnt-dead/

    ReplyDelete
    Replies
    1. I read it. The "doctors" boil down mostly to Doctor Shewmon, whose judgment in this case is questionable, to put it nicely.

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    2. The spin put on the article and headline smells of Dolan.

      Delete
    3. IDK. I think most media outlets think first, middle, and last about clicks. That's how they make their money. Not so many clicks for an article that says, in essence, "dead child remained dead over four years and finally expired." "Dead child wasn't really completely dead!" will get more clicks I imagine.

      Delete
    4. Also there is the money, though I imagine the family has not yet thought this all the way through. If she was dead to start with, their damage award is limited to $250,000. If she wasn't "really" dead until recently, they could claim for expenses in the meantime.

      The catch, though, is that the State of New Jersey's Medicaid, which has been paying the lion's share of the expenses, will immediately slap a lien on any recovery for medical costs, leaving the family relatively little. The family's only hope for personal reimbursement would be a claim for "emotional distress." Hard to estimate the amount that would be awarded on this basis.

      Delete
    5. He is getting it out in the main stream media as fast as he can, far and wide as loud as he can for only one reason, to sway the potential jury. You cannot unring a bell.

      Delete
    6. *** I will add that it does not need to be factual, it just needs to saturate the media and his potential jury selection. Its dirty, and its playing games.

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    7. From day one - Dolan and Company have been all about tainting the jury pool -

      Delete
  53. which is why I have been all about pointing out his lies.

    ReplyDelete
  54. But Ken, we have far less reach than he has.

    ReplyDelete
  55. Chris Dolan just conducted a live press conference with Jahi's mother, stepfather and uncle. Nailah answered questions at the end and someone asked if Jahi coded in NJ and was there an attempt to resuscitate her. Nailah said that after she gave Jahi permission to go she coded and the doctors at Robert Wood Johnson tried really hard to resuscitate her. She said at no time was Jahi removed from the ventilator until after those attempts failed. There was an autopsy performed in NJ and right now they are fighting with Alameda County to bury Jahi on Friday. The CA coroner initially wanted to take possession of her body on their arrival in CA but the family didn't allow it. CA wanted to conduct their own autopsy but Dolan said she was embalmed and since they have the report from NJ there's no need. The hold up to bury her has to do with the confusion over her official date of death which is needed for the burial permit.

    Dolan said that a hospital which he refused to name has possession of Jahi's brain. After it is studied, scanned, etc. the resulting tests will go to Alan Shewmon and his team. It's unclear if any of those results will be made public. Maybe Shewmon will write a paper or something.

    Dolan was going to give any reporter who asked a copy of her NJ death certificate. He's supposed to post it on his legal website at some point. There were 4 or 5 contributing causes of death but I can't remember all of them. Nowhere on that form did it mention brain death. It said that she was suffering from an anoxic brain injury since Dec. 2013.

    Dolan told Nailah to explain who was paying for Jahi's medical care in NJ and she said she NJ provided insurance. It seemed neither her nor Dolan wanted to call it Medicaid. Answering a reporter Dolan explained that it was NJ's version of CA's Medi-Cal. They said that it didn't cover all her expenses and many things they had to pay for out of pocket. When asked to specify Nailah mentioned vitamins, lotion, body wash etc. in other words nothing that any insurance is going to cover.

    They did say that Jahi had nursing care for only 16 hours a day and Nailah provided the other 8.

    Dolan said there is no money involved in the lawsuit to have the death certificate overturned. He said the personal injury part of the malpractice suit will be dropped and it will go forward as a wrongful death.

    ReplyDelete
    Replies
    1. So basically they are stonewalling real examine of her body and brain and/or a second opinion autopsy and a cherry picking the people who are going to confirm their made up fairytail they have lived with for almost 5 years. I find that disappointing (I was interested in unbiased research of whatever left of Jahi brain) and maddening as the family and lawyers are spinning everything to give themselves the best outcome at the pointless trials, like fight over the death certificate,

      Delete
    2. The family has a case v. Rosen, CHO, et al regarding primary PTH, s/p adenoidectomy, s/p UPPP. Primary bleeding is always attributed to surgical technique:

      1. http://www2.pedsanesthesia.org/meetings/2015annual/guide/protected/syllabus/lectures/2015-CA-1444098715-195.pdf

      2. OTO Crisis
      A GUIDE FOR THE ON-CALL OTOLARYNGOLOGIST
      Jodi Zuckerman M.D.
      G. Aaron Rogers M.D.


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    3. From a legal standpoint, is there any value in having the first death certificate overturned? Seems that would be a moot point now.

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    4. Anyone can amend a death certificate as long as the changes are approved by the informant who originally approved the death certificate, and IF defendants present evidence to support their claims.

      Delete
    5. plaintiff*

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  56. It said primary bleeding is often attributed to surgical technique not always.

    ReplyDelete
  57. And the beat goes on. Article on the web, an interview with Jahi's mom. She sang the same tune, that Jahi was alive, etc.

    So, the story could pan out with the Winkfield/McMath family fading into obscurity, or disgracefully milking their experience for all it's worth.

    I have to wonder what her mom is going to do with her life now. She may have to get a job and support herself like so many of us. (Wait. Was that bitchy?) IMO, she also has some serious amends to make to her living children.

    No winners here.

    ReplyDelete
  58. I may go to the funeral on Friday, as I live 25 minutes away. I want to pay my respects to this poor girl, the victim of 4.5 years of exploitation.

    ReplyDelete

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