Analyzing the Jahi McMath case

The recent tragedy of Jahi McMath, the 13-year-old girl who died following complications of tonsillectomy and adenoidectomy, has focused many people on the question of brain death. Although I have no more details about this case than anyone else reading the news, I am quite familiar with the sort of things that happened to this unfortunate child. As many of you know, her family does not believe she is dead, although multiple physicians have documented she is and the county medical examiner’s office (the coroner) has issued a death certificate. She has been transferred from Oakland to a facility in New York.

So what is brain death? It means no function at the level of the brain stem or above. Function stops where the spinal cord joins the base of the brain. How do we know somebody is brain dead? There are a series of standard and relatively low-tech bedside tests to determine that. We first make sure the patient has a normal body temperature and has no sedating drugs in their system. There should be no purposeful response to any stimuli. The muscles are flaccid. Then we test for brain stem reflexes. One of these is response of the pupils to light — there should be none. There needs to be absence of normal movement of the eyes to motion of the head (called doll’s eyes) or no movement when we put cold water on the ear drum (called cold calorics); both of these measure the same reflex. There should be no blink reflex, called the corneal reflex, when a wisp of cotton is brushed on the eyeball. There should be no gag reflex when we stimulate the back of the throat with a wooden tongue depressor. Finally, the last test of brain stem function is the apnea test: we allow the blood carbon dioxide level to rise and look for any effort to take a breath. Rising blood carbon dioxide level is a strong trigger to the normal brain to breathe, and failure to do so means this ability is lost.

What happens after the bedside brain death determination varies a little from hospital to hospital. Many hospitals require 2 tests 24 hours apart; if both show no brainstem function, the patient is legally dead at the conclusion of the second test. As an alternative, we can do the bedside test followed by a simple scan to determine of there is any blood flowing to the brain. These two tests together give us an immediate answer, and many hospitals require the flow study for children. If the bedside examination shows no brainstem function and the flow study shows no blood flow to the brain, the patient is legally dead. I write the time of death on the death certificate as the time of the scan.

When I do these things I always want the family with me and watching what I do as I explain what is happening.

That all seems straightforward. As with this case, sometimes it’s not. For one thing, not all cultural traditions recognize brain death as real if the heart is still beating. I’ve been in that situation. For another, sometimes there are reflexes at the spinal cord level that look as if the patient is alive. That’s a difficult thing to watch.

The upshot is that I have continued support — mechanical ventilation, often medicines to support heart and other organ function — on a brain-dead patient for some time. Usually this is because the family wants some time to cope with things, or else there is a family member traveling to the hospital. I’m always ok with that, up to a point. A key principle here is that a family cannot force me to behave unethically, and continuing organ support of a dead person is disrespectful of the dead– mutilating to the body. Many ethical traditions, including my own, refuse to do that.

The longest I have ever continued organ support on a dead person was 6 weeks. We had a huge court battle similar to this case, with the court ultimately allowing us to withdraw support. A family member then attempted to enter the hospital with a gun. It was ugly.

The bottom line is that, with the exception of the one case above, I have always been able to mediate the situation by listening to families, being frank about my own duties (both legal and ethical), and allowing them time to grieve. I have always regarded caring for dying people and participating in their death as an honor granted me by the family.

I think there is more going on in this case than we know. Why this case became so adversarial is probably a complicated issue, and these complexities do not translate well to the evening news. At the very least, clearly the hospital and doctors failed to establish a relationship of trust with the family.

Regarding the child’s cause of death, I’d lay odds she had sudden bleeding from the tonsilar bed, the tissues under where the tonsils were. This is a well-known complication after tonsillectomy if the clots fall off. After that I think she probably lost her airway, either from obstruction from blood clots or some other reason. She was a large girl undergoing the procedure because of sleep apnea. Such people often have difficult upper airways to access and control with a breathing tube in a hurry, and that was what she probably needed. The back of the throat is also quite inflamed immediately after this kind of surgery and a rebleeding tonsil site can obscure everything with a large quantity of blood. I know this from experience. It’s a difficult situation to manage. I assume she went 4-5 minutes without an adequate airway, leading to brain damage and subsequent brain death. This is a common progression after anoxic brain injury — lack of oxygen — from any cause.

There are some directly antagonistic ethical issues in play here. Patients, and their families, are in charge of medical decision making. But they don’t have the right to demand whatever they want. This can be as simple as requesting a test that is not medically indicated or as complicated as this case. Futile care is unethical, particularly if it causes pain to the patient. Of course in this case the patient is already dead, so one could argue that there is no harm in persisting. But there is ethical harm, I think.

I have been in the situation of requesting, on behalf of a family, transfer of their brain dead child to another facility when we have reached an impasse. That is my obligation to them. But no facility I have ever dealt with would accept transfer of a dead person; I wouldn’t, and I am surprised the family was able to locate one.

One other thing I’m occasionally asked: Has anyone who was declared brain dead ever been found later not to be dead? I am unaware of any cases of this. If you hear of such things you need to understand that a patient in a deep coma, totally unresponsive to the world, is not dead. They still have the reflexes I described above intact. Once in a while such a person awakens.

At any rate, nature has a way of deciding these things no matter what we puny humans do.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must FaceHow to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

email

Comments are moderated before they are published. Please read the comment policy.

  • Alicia Bailey

    My daughter was declared brain dead, and did not have any brain stem reflexes. They were constantly asking if she was an organ donor. I told them to please run the cerebral blood flow test, but they refused. The doctor told me we have to make sure she is truly dead before we run the test. Well, if they didn’t believe she was truly dead yet, but declared her brain dead, that sends a red flag. After three days she started to have corneal reflexes and overriding the ventilator and moved her thumb. They repeated the CT scan and it showed increased swelling to the point there was a midline shift. Undoubtably, the delay on measuring her ICP or treating it, has caused secondary brain injury. She is awake today and can stand and can walk with assistance and eat yogurt. However, she is blind and very disabled. The whole declaring brain death shouldn’t ever be done by exam only. The law needs to be changed!

    • querywoman

      This is probably one of those “exception” cases. You don’t say how you feel about her survival, and it’s probably very difficult to determine. She sounds like she has serious limitations, which you blame on delaying treatment. I can’t comment on that, since I am not a doctor. A lot of doctors can’t evaluate the situation appropriately either, since it’s not their specialty.
      Most people who doctors currently dx as “brain dead” will probably never awaken. I seriously doubt that Jahi will awake again, since six specialists dx’d brain death.
      There will always be a few exceptions, and some families like Jahi’s have their hopes.
      Pregnant Marlise Munoz in Texas definitely appeared to be nonfunctional, and since her husband is a paramedic, like she was, he probably knew by intuition.

  • Maggie

    Zach Dunlap, declared brain dead, gave an interview on the today show 3 months later

  • http://www.chrisjohnsonmd.com/ Chris Johnson

    My own practice is always to do a brain flow study. The bedside exam, although relatively simple, is after all done by humans. It also requires experience, and not all physicians have the necessary experience.

    • maritimer_reborn

      Jahi had the brain flow study, and EEG as well as the standard bedside tests noted above, and the family still refuses to believe. It’s mind-boggling. http://www.scribd.com/doc/198076300/Children-s-Hospital-Oakland-Dr-Paul-Fisher-Report

    • querywoman

      You describe carefully what you do. Of course, there is a chance your judgments may be wrong. But, if four other doctors agree with you, there is only a teeny chance you are all wrong.

  • querywoman

    There is a possibility that the brain death diagnosis was wrong for Jahi. However, six doctors declared her brain dead! The odds are teeny!
    In life, while we have it, there are no absolutes. Doctors attempt to define death. The only true sign of death is decay.
    Supposedly, her body seems to be able to regulate temperature again.

  • http://www.chrisjohnsonmd.com/ Chris Johnson

    Exactly. That’s why it is called a confirmatory test. First you do the physical exam, the bedside test.

  • http://www.chrisjohnsonmd.com/ Chris Johnson

    Yes — body temperature must be normal before any testing is done.

    In the Dunlap case I’m astonished that somebody was ignorant enough of the proper procedure to do a PET scan (what?) on a person who had not first had a bedside exam indicating brain death. That makes no sense.

  • querywoman

    Some laws are truly bizarre, like my local law of no cell phone use in school zones. We assume that applies to car drivers, not car passengers or walkers.

  • http://www.chrisjohnsonmd.com/ Chris Johnson

    Alicia:

    I do the brain flow study as soon as possible after I’ve done the bedside brain death exam. Since it’s such a simple test, usually the radiology department can accommodate me quickly, even in the middle of the night. Until the patient is declared brain dead, I continue all support measures because, well, they’re not dead.

    Overall I’m actually pretty flexible about family requests. For example, I’ve had patients I’ve kept supporting for a day or so afterwards and then repeated the bedside examination even though it wasn’t required by hospital policy. But there does come a time when we have to stop. I’m just reluctant, after doing this for over 30 years, to be completely dogmatic and rigid in my practice.

    Again, I think the issue in the Jahi McMath case is that there appears to be no trust between the hospital and family. I don’t know why that is, but it would be a huge problem in discussing what to do next.

    I’m a big supporter of organ donation, but I really don’t allow that issue to enter into the calculation at this point.

  • querywoman

    Thank you for explaining more. Fortunately, I have never been at the bedside of a person in this condition.
    I am very critical of the organ donation industry, including the coercion of loved ones at a a bedside like your daughter’s.
    I have no problem with organ donation. I had a close friend from high school who lived many years with a kidney transplant.
    I have a problem with coercion and looking at other people as possible organ donors.

  • Kathleen Glaser

    I hadn’t heard about Jahi gaining weight after the feeding tube was placed. Where did you see that?

    • Pak31

      Only her family is saying this. Of course they are only going to say positive things about her. We see no pictures though and have no updates from any medical professional. Amazing.

  • querywoman

    I am researching now to see if a C-pap machine was even tried before her complex surgery.

  • http://www.chrisjohnsonmd.com/ Chris Johnson

    See the above comment by Jason Simpson.

  • katerinahurd

    The cornerstone ethical principle of medical ethics; first do no harm, clearly shows that there is no ethical or unethical harm. In your article you describe a 13-year old as a big girl. Do you think that an elevated BMI might have contributed to hypertrophic tonsills or adenoids or influenced the duration of anesthesia administered? Since the chief physician of the CA hospital was ademant in his statements about the transfer of the brain dead girl to another facility, do you suspect that an under the table agreement was reached between the parents of Jahi McMath and the chief physician to spare the CA hospital from any negative publicity?

    • http://www.chrisjohnsonmd.com/ Chris Johnson

      I think that there are many key details we don’t know, so I wouldn’t want to speculate about her particular management. As a general statement, though, I don’t think this child’s size had anything to do with the anesthetic administered. Also as a general statement, larger people tend to have more trouble with sleep apnea.

  • carolyn mann

    “Why the Medical Industry and Society will ultimately benefit from the Jahi McMath Case”

    The medical field, organ donor advocates, and many angry individuals are implying that the decision the McMaths family made to keep their 13 yr old daughter who was declared brain dead (medically and legally dead)on life-support was ultimately selfish, violated Jahi’s ethical rights and will cause false hope and denial to families in the same situation–thereby hurting the entire medical field, organ donor campaign–and societies financial and emotional welfare.

    Well, I feel quite the contrary–and strongly believe that medicine, organ donor programs and society will greatly benefit from this experience– emotionally, ethically, scientifically and financially.

    I feel it is extremely important that the rights of an individual, guardian or family member be upheld, especially under circumstances like these–and especially in the medical field. I believe the medical sciences need to be challenged–that is how it advances and improves. Einstein was often deemed crazy, and was famous for challenging and testing the limits and laws of science, and it greatly evolved because of it.

    Brilliant scientist are always challenging the rules and boundaries of science everyday– but so are caring parents. Through the love and questioning of concerned parents there has been a tremendous amount of valuable input contributed to medical studies and evaluations. Many were also written off as hysterical parents in deep denial just like the McMaths are now. And many parents requests and inquiries were often considered ridiculous–only to be later proven extremely valuable and groundbreaking.

    If I had a dime for every time a parent told me they were sent home from the hospital with a sick child and incorrectly diagnosed, and they said they “just knew” their child was seriously ill–and ran back to the hospital only to find out that the hospital did indeed miss a very serious diagnosis the first time around.

    It is quite unfortunate the medical industry didn’t take too kindly to this challenge, to say the least. And instead, became quite defensive–and a bit cruel. Speaking from more of a psychological perspective, when a person, panel or institution is on the extreme defense–there is usually some tinge of insecurity or even culpability there.

    I am also quite surprised that the medical society, in general, didn’t see this experience and media attention as a positive thing–unless they had something to hide, of course. But somehow I believe many in the medical field secretly do know this will benefit them in the end. But instead, the medical representatives are taking this “woe is me” attitude and are taking more of the “look how unappreciated and disrespected we all are treated in the Medical field ” tone. Which seems a bit suspicious to me–and still confuses me.

    In fact, one of the Medical representatives got all choked up on TV–and well, all I have to say to that is: these Medical representatives–and all those in the medical field– need to get a thicker skin, and be more amenable to the controversies that may bestow them, because ultimately it is in these exact challenges that propel advances in medicine and help it continue to grow–or else it can remain stuck.

    Then, on the other side–some of these Medical experts have taken on a more elitist tone–refusing to listen or take into consideration anything the McMaths feel or say–and basically writing them off as crazy. This is terribly unfair to the family–and the medical field of science as well.

    These types of controversies expose the hidden flaws in the medical system–but they also promote the positives attributes medicine provides as well. The medical profession should not be so much on the defense and inflexible–it is in no way helping the fields of sciences advance.

    I certainly believe no one enters the medical profession to hurt people–but indeed to help them. However, they are human and do make mistakes and must understand because of these mistakes they will be questioned and challenged–as they should be–no true offense to them.

    It is precisely because of heated emotions of a person or family members that many practices, ethics and medicines have changed, evolved– and yes, greatly improved because of it. The medical sciences NEED to have people test and challenge these boundaries–and they should’ve welcomed this families challenge–and actually assisted them into it. I personally feel that this hospital, in particular, owed it to this family–yes, I do. And even though California’s laws are clearly spelled out on this, there are exceptions to every rule–and the circumstance here definitely qualify for an exception.

    Let’s face it, the medical field does make mistakes–as the Mcmaths family felt this hospital did with their daughter’s routine surgery that went terribly wrong. You cannot turn the channel on TV without an attorney advertising for suing over a particular harmful medicine or malpractice of some kind.

    Stephen Thorpe, a teenager from England was misdiagnosed by 5 Doctors as Brain dead after a tragic car accident–his father swore he “just knew” he wasn’t dead–and Stephen did awaken 5 weeks later from life support–being incorrectly diagnosed. The McMaths could’ve heard of such cases that may have helped influenced their decision as well. They could also be very religious and believe the prayer of God will grant them a miracle–and if you are a person who believes in miracles–why not believe that God may have one in store for your child?

    And how dare people say the McMath family is in it for the money. I can assure you there is not enough money on this planet that can help a parent heal from the loss or illness of a child–only time, hope, faith and love can ever do that. But losing a loved one, especially a child, is not something a person ever gets over. They only learn to live with it –with true fortitude, perseverance and brute strength–not millions of dollars.

    And regarding the ethics of desecrating Jahi’s body over a certain time period in her condition can be argued as well. As far as Jahi’s body is concerned–it is being well cared for in what I would understand to be a licensed and state regulated Healthcare facility that runs by licensed doctors, under certain codes and rules of ethics. And also must abide by their states very strict Health and Osha codes– so her body is not being desecrated, but in fact, well cared for. No, Jahi’s body is not being held in their back bedroom for God’s sake.

    And to use the medical field’s argument against themselves–if she is the so called dead “Corpse” they refer her to (they really need to change that terminology to something more easier to handle, something like “brain compromised” or the like, for family members especially) — then technically Jahi should not be suffering in any way. In many religious faiths, they argue that removing organs from a deceased body of any kind is a form of desecration.

    And to put the ethical blame on the parents for being selfish for not allowing the harvesting of Jahi’s organs–well that is simple– why would the parents ever think of giving up Jahi’s organs if they think she may indeed still need them– if she is given that chance–however slim–of recovering?

    As a mother–I not only can truly sympathize with their decision–but I also can understand exhausting every possible option to give my child a chance. Organ donation is an extremely noble thing to do–however a family, person or loved one who decides against it should not be deemed not noble or selfish because of this very personal decision.

    And who is to say, under different circumstances, that Jahi’s parents wouldn’t have considered organ donation for her body. I heard they were spoken to very callously by this hospital staff by using technical, medical and curt terms that came across as completely unsympathetic, which greatly offended the family. This flaw needs to be explored –and fixed in the medical field.

    I can personally attest to first hearing the news of a deceased loved one by a medical doctor in very nonchalant, casual–and very cold manner. And I was then handed a list of the local funeral homes within minutes of the devastating news. Yes, the bioethics committees can use some work there–and this should spur some new research, laws and rules to give more detailed information as to when, in fact, a body definitively and seriously starts decline.

    Just like the ethics and medical committee had to do research when abortion became legal– after careful research they found that abortions can not be performed after 22 weeks–well, they should now conduct more research and studies to developed more clear cut laws about brain dead individuals. However, regardless of all the rules– there will always be exceptions to every rule–or else we wouldn’t have our courts filled with cases–as it should be.

    The funny thing here is that , for myself, I requested my family take me off of life support within a reasonable (short) time if I was ever brain dead–but I trust in my families decisions when that time is–but I am also an adult that made this decision. This child was under the care of her parents–and therefore were entrusted to them –as she should be.

    I also believe in the Death with Dignity act enacted in Oregon–whereas it is legal there for a terminally ill person to end their life from a pill prescribed by their physician. But, regardless of my own personal beliefs or choices– I would never, ever attempt to know how these parents felt in this particular situation, because I had never experienced it, and hope to God that I never, ever will.

    But unfortunately, my best friend did– by losing her young son in a car accident. After supporting my friend through that horrible process I can unequivocally say, this experienced topped one of the hardest things I had ever experienced and changed my life forever–and I could only imagine the pain of my dear fiend and Jahi’s parents.

    Back to legal ethics, the only time children become entrusted to the state is when they are in some kind of harm. So if Jahi is legally dead both medically and legally, she can no longer be harmed –right?? And considering she is in a licensed, state regulated facility–she is not being desecrated–right??

    In true actuality, it is really a win win situation for the medical field–and society. Because this family made the ultimate sacrifice putting their dear daughter’s body and heartbroken emotions on the line to challenge these rules and boundaries of science. Out of desperation to save their child–the McMaths have now provided the medical field and society invaluable lessons to learn and prosper from. All on the McMaths tab with private donations–with no more cost to either the Medical association or our society.

    How is this so? Well, if Jahi comes out of this in any way it will change the entire course of evaluating brain dead individuals, provide hope and save millions of lives–whereas everyone will benefit. But if this case plays out as medical field has predicated–medicine will get it’s validation, and whether medicine wants to admit it or not, they will still learn valuable lessons from this experience–both biologically and ethically.

    They should start perhaps with changing some of the dehumanizing, technical terms and keep them locked behind Medical staff doors. And work on better ways that the hard working, perhaps overtired, and well meaning medical team can properly learn how to address and communicate to shocked, stunned and depressed family members in more humane and compassionate ways and terminology.

    And to develop better rules and regulations from this experience–to force the Medical profession to review the ways they handle and deal with situations they clearly overlooked. We are not dealing with experiments here–but human beings.

    And again, if this medical teams prediction of Jahi’s condition comes to be — than this families long, agonizing walk to save their daughter’s life will still give society and others the information to help them make quicker decisions if they are ever in the same scenario, and thus, rid them of any guilt in making the decision to take their loved one off of life support at the appropriate time period.

    It will surely be a boon, not a detriment, to the organ donor program. Since more people may decide quicker to take their family off of life support because of Jahi’s case– and thus, be more prone to consider donating organs.

    Living loved ones could possibly be given more clear cut, precise guidelines and time periods to when exactly body parts start to decline after being declared brain dead. Perhaps they should also allow outside doctors for second opinions, and options like these to further assist families in these extremely difficult decisions.

    And now–even if all of the McMath’s choices fail –it will not be in vain. It will only increase the potential for organ donation–perhaps even doubling it. Because families will use them as a reference to say –look , it was tried and thoroughly explored through the Mcmath’s family ordeal–and from that realization and information learned, they may be less likely to venture down that long , hard road that McMath family already travelled for them.

    Taxes and insurances plans will also go down (although I wouldn’t count on it) because of less less hospital stays and medical treatments. And again, society will benefit from this knowledge the Mcmaths have provided us all.

    The medical field, society and myself should all be thanking them. People should not be casting horrible insults, accusations and aspersions on this family. The medical field and society are missing the big picture here–the Macmaths fight against the system and medical rules actually did us all a favor in the invaluable lessons we were gifted from their very sad experience– all free of charge to us.

    I feel the medical community put a lot of this on themselves–they cannot always expect that inventions like the heart/ lung machine–and life support can only fit into their nice, little rule book to be used only when they were meant for temporary use, as in organ transplant or surgery–no, sorry!! The Medical industry should’ve really thought out this situation. And be prepared, and even open when situations–or challenges like this one may, in fact, arise. And guess what? It did arise–in the Jahi case!

    And perhaps it was Jahi’s and her families true destiny to revisit this aspect of science to actually help others –not to hurt them.

    Should a loving family member challenge a situation like this ever again? Absolutely! Science, society and the well-being of my own family needs them to. I want to personally send out my deepest thoughts, regards and support to the McMath family for their courage for daring to break the rules–rules that do sometimes need to be broken–especially to help advance medicine and our society. And Hopefully medicine and society will see it the same way as me one day– and thank the McMaths too.

    • disqus_qJEMXTKtR1

      Beautifully written! Thank you.

      Gene Uzawa Dorio, M.D.

    • querywoman

      The doctors and hospital might have been callous to the family, or maybe not.
      Should parents have the right to waste medical resources on a child who has no hope? I don’t think they do.
      So fare as I can tell, an unnamed Catholic rehab center took Jahi.
      Surely the Catholic church realizes that sometimes letting go is the best thing.

  • http://www.chrisjohnsonmd.com/ Chris Johnson

    There is no standard rule. Most practitioners I know try to do the flow study soon after the clinical exam because most families want to know the findings.

    That being said, hospitals set their own rules for brain death determination. Some require 2 bedside tests separated by a certain time lapse, others require 1 test with a confirmatory flow study, or some combination of those. Many require the flow study for children, for example. Many hospitals also restrict the physicians who can perform these tests — neurologists, neurosurgeons, and intensive care specialists, for example.

  • Wadine Toliaferro

    I want to congratulate Carolyn Mann for her extraordinary post. Loved it!
    I have wondered for sometime, now, about race being a part of this case. First, statistics show that health care for African Americans is poorer than for caucasians. Was this a factor in Jahi’s care before, during, and after surgery? If the state of Florida is unable to charge two men with murder of 17 year olds how can we trust the system to care about the well-being of African American children and families?

    • Ashrock

      this is the crux of why we tend to see a preponderance of African American families insist on futile care…because of the mistrust of the medical profession and longstanding history in the past and present of minorities being shafted in the current health care system…which..I might add is not being ameliorated by the ACA.

    • querywoman

      I think African Americans are more likely to experience a diabetes-related amputation.

  • jaydeebee

    The reason the term “dead” was used is because the precisely describes her condition. For some reason, we use euphemisms for death as if it softens the blow. We say someone has “passed”, I assume, because it seems less final than death. I disagree that we need to change terms. It just muddies the waters. Already we have women declaring “We’re pregnant!” as if the father of the child is carrying a fetus, too. Does this mean that the husband of a pregnant must disclose this on his medical records? Should he avoid x-rays, alcohol, and certain medications? No. Women are pregnant and dead is dead–no matter how we misuse the terms.

  • CarolO

    This was a great article. I, too, am surprised any medical facility would accept this “body”. She might be in a private nursing home short on ethics and eagerly accepting of the money they are receiving. Money, I might add, the parents do not have!! Donations from others is admirable but money should be used to help those who can be helped, not to allow a dead person to lay and rot away. I believe these parents should be sued for failure to dispose of a dead body in the proper manner. Not to be mean but simply to be factual, if these parents cared so much for this child, they would not have allowed her to become so obese that she developed sleep apnea at the age of 12! Apparently, DENIAL is common with them way before this child died.

  • CarolO

    The problem here is not the doctors nor the tests. Five doctors have testified this child is dead including the medical examiner and probably several more times since this went to court. The problem is the parents who refuse to see the obvious and also refused to see this child was obese at the age of 12 which is what caused all this to start with!

  • Pak31

    First of all, the comments about her eating and gaining weight are stated by her family and their lawyer. BUT we have no physical proof that any of that is true. Secondly, there is a court document online that you can read from a doctor of the hospital I believe that lists the condition of Jahi’s body prior to her release from the hospital. It states that her body was showing signs of decomposition. Her intestines were sloughing among other things.

  • querywoman

    I read a report from a doctor who examined her before she was released from the hospital that said she was apparently passing bits and pieces or her bowels, not having bowel movements.
    Though I lack medical training, it was convincing to me.

  • querywoman

    It’s very hard to get the truth since where she is being held is hush-hush. I don’t trust the Schiavo people on her.

  • querywoman

    Yuck!

  • querywoman

    It’s very possible her family fed her much too solid food and suctioned her. Were they not being watched by a nurse?

  • jill

    why did news of this story suddenly just…stop? It was everywhere but as soon as she was transferred to NY there’s now nothing out there or updates…

  • jaydeebee

    Most of what’s being said is hearsay. However, the family did say that Jahi was talking and laughing. I believe both of those are contraindicated during recovery from this surgery. She was given a white board to use to communicate. There really was no reason for her to be vocal.

  • querywoman

    This case is so high profile, that I am sure the doctors were very careful.

  • querywoman

    And how would the nurses know this family should be really watched?

  • querywoman

    Some special dental mouthpiece might have helped, also playing a special musical instrument.

  • querywoman

    I believe in a loving God and an afterlife, but that same God lets us all die an earthly happens.
    Death happens! And it happens during or after some surgeries!

  • Ken M

    I just find it all hugely ironic that the supporters of this girl remaining on life support keep touting the whole “It’s God’s will to let her survive. The Doctors are trying to play God by removing her from life support, so help us prevent them from doing that.” It seems all too hypocritical to me, since if they’re basing this on “God’s” will, they shouldn’t have let her go on life support to begin with. Is that not human intervention? It seems as though the Doctors were playing “God” when they put her ON life support. Removing her from that would allow the natural thing to occur, which at this point is more than evident. Unfortunately, I don’t think the family is sane, nor insightful enough to realize the aforementioned.

    • Pak31

      Ken, I think it’s a tough situation. You could have people say that if it’s God’s will then she shouldn’t have even had the surgery in the first place. Or we shouldn’t go see doctors for anything. I believe it’s all different beliefs for different people. BUT, that being said, there has to come a time where you realize that enough is enough. I am not disagreeing with you, I totally agree with you. I guess I can see how people don’t want to part with a loved one. I have never had a relative in a situation like this. There is something going on here. How can they be THAT delusional to feel she’s recovering? If they want what is best for her, and she is decomposing then they should let her go. IF they ARE religious then they should realize that the soul departs the body upon death.

  • carolyn mann

    From my posting, I obviously do not think it is a waste of Medical Staff resources. Or a “waste” of anything when we speak of a human life either dead or alive. I believe much will be learned from this that will change these types of difficult scenarios. There are obvious ethical flaws that were carried out here that should be explored much, much further. I think it is important to understand that there are no “guilty”parties here–everyone is certainly well meaning but caught up in an extremely difficult and emotional situation. The Mcmaths were in essence broadsided by this shock–as we’re this Hospital–much angst (understandably) towards each other that things were said and done in the midst of it. So there should be no blame, but simply lessons learned. Thank you for your response posting,

  • querywoman

    Will she perspire?

  • Pak31

    Agreed.

  • querywoman

    I had a tonsillectomy, probably a much simpler one, inflicted on me as a child. I woke crying for my mother, whom I did not get soon enough for me. One of the OR nurses, however, was our neighbor.
    I didn’t want the promised treats like ice cream or popsicles for a few weeks. I do think popsicles, the watery stuff, was more tolerable to me immediately after the surgery.
    Did the family really give this girl solid food after the more complicated surgery and did she want it and eat it? Everybody’s different, but I can see that would cause a bad problem. Instructions are often just a list of things to ignore.
    Dr. Christopher Johnson gave us a good idea of how complex this surgery was for a plump girl.
    Just horrid!

  • querywoman

    One of the biggest mysteries here is who is paying for the aftercare.
    What’s cost? Is it totally charity? The bed costs money, the supplies, the personnel, the rent and utilities.+Talk about medical rationing is always valid.
    We shall see.

  • querywoman

    In Christianity, mortal death brings the ultimate victory: eternal life.
    In human life, all priests and other ministers spend lots of times with the dying and their families, trying to get them to let go peacefully.

  • querywoman

    I have always found the description of her as a “corpse” offensive, while there is still some life in her.

  • carolyn mann

    Thank you for explaining this very personal decision–you really didn’t have to–and I feel that is brave of you–and I believe because you did what you believed–or felt what right–you must ALWAYS trust it was the right decision. God bless you and your child–stay strong and love your child with all your might–she needs you to–and nothing was ever the wrong decision–especially when it comes from a loving and dedicated mother, father or loved one. I admire you–and you are great.

  • querywoman

    Nice long response, Carolyn. I only mentioned religion to point out that, if they are getting Catholic assistance, the Christian Church will eventually celebrate her passing. The Church has a reputation for prolonging life at all cost, but, in reality, the Church has comforted more of the dying and their families.+
    Time will tell.
    I wonder if we will ever find out where she is?

    • carolyn mann

      I don’t know if we will ever find out where she is. But I hope we learn a lot more either way–so everyone can at least learn something from this tragic event. I think we should all be mindful and sensitive to the McMath family at this time–its really easy making judgments from the outside–so we must be careful of that. Thanks for your response.
      think any church will sanction whatever she chooses if they are truly kind and compassionate towards people in need. Or, at least they should be–God, what a horrible thing to deal with a loss of a child–but indeed a strong faith is what helps many get through–but it can be confusing at times for true believers in what to do–I have faith in God and the McMaths–I really do–and I trust they are doing what they feel is right. I would certainly want the same respect granted to myself and family.
      So much better to have an open mind and less judgment here–spending time in judgment can be wasteful–and who was to blame. Although, I think it is important the event and practices be investigated for the family and for medicine, if mistakes were made. Not saying they there was–or wasn’t. But there is certainly something that can be learned and changed from this. My heart goes out to both opposing parties–nobody truly wins when a life is lost–BUT the rest of us who could learn something and benefit from others distress.
      Thanks again for your reply–it’s good to keep a healthy discussion going…

      • querywoman

        Al I say here is that her mother says she is getting better. We shall see.

        • carolyn mann

          It is really interesting what will ever come of it–It would be nice if they did get their miracle…
          Only time will tell…..

  • Patti1968

    It can be confusing because some people, especially journalists, throw the term “brain dead” around when it is not warranted. Some cultures and religions ascribe to the belief that death does not occur until the heart stops beating and that is when the person is “truly dead”.
    If someone has “some activity” in their brain found on testing, then they are not brain dead. Brain death is death of the whole brain, including the brain stem. People with some brain activity are in a deep coma or persistent vegetative state (PVS). A person dies when either their cardiac system ceases functioning or their brain dies. A brain dead person is truly dead; it just describes that the brain died before their heart stopped.
    When someone is in a PVS, a family may be approached to decide whether or not to disconnect the artificial ventilation. But in cases of brain death, ventilation is stopped because we don’t continue to treat the dead. Our culture defines acceptable ways of disposing of the body. (Late answer I know, but I didn’t see where anyone answered your question. :-)

  • Fiona1933

    Yes, but you only saw what the family said, their interpretation. the hospital has not been allowed, by the family, to respond. And what seemed to make Nailah Winkfield angry was the doctor’s denial of what she demanded: ‘I want Jahi home with me”. The first thing she demanded was that although Jahi had died on December 12, that she should be allowed to occupy a room, a vent and nurse attention for nearly 2 more weeks for Christmas and Nailah expressed absolute outrage at the refusal. She was also angered that the doctor had called Jahi ‘dead’. What did she want from him? “She’s dead, but don’t give up hope”? “Alls he could say…was daid” she said. A doctor must be driven beyond endurance to say “What dont you understand? She is dead, dead, dead”. Seriously, what did they want? They wanted her not to be dead and when they didnt get what they wanted, they did not respond like adults. It was disgraceful to have a press conference outside a working hospital, and a march and to encourage hatred like that…calling the hospital ‘murderers”

  • Fiona1933

    http://www.ncbi.nlm.nih.gov/pubmed/16970850 Reports have repeatedly stated that the body won’t last long, vent or not, but here is a case of a child surviving twenty years! This is seriously gruesome. His mother took him, brain-dead, from the hospital, and kept him two decades in the basement.

    ewwww