13 year old girl is brain dead after tonsilectomy (Jahi McMath). Mom wants life support continued.

Have any of you been following this story? A girl in Oakland had a tonsilectomy. She made it through the surgery and started bleeding a couple of days later, went into cardiac arrest and now there is no brain activity.

Article here

The mother has since lawyered up and got an injunction to keep the girl on life support. Sometimes in these cases the family is/are nutjobs, but in many of these cases the hospital or doctor was simply callous or uncaring or negligent and that's what riled the family up.

Other articles have quoted the mother saying nurses gave her a cup and told her to catch the clots so they could see how big they were, and they didn't react quickly enough or call a doctor soon enough when things started going downhill. That's believable, however, sometimes things in routine procedures go horribly wrong.

Count on HuffPo to post a sensational story.

Anyway, this case made me think about the lung transplant case. Here is an article where a professor of bioethics, who happens to be a Catholic priest, weighed in with this refreshing analysis:

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"There's no moral or legal or medical justification for providing ventilatory continuation in a corpse, other than organ transplant," Father Paris writes in an e-mail. "it's not life support; the child is dead. They're not keeping her alive; they are oxygenating her organs.

The family's position is understandable on an emotional level, he adds. They cannot bring themselves to admit their daughter has died,says Paris, who has consulted on the President's Commission for the Study of Ethics in Medicine and who frequently serves as an expert witness in cases involving termination of medical services. But if you allow a system to say, If the family screams loud enough, we will do what we believe is incorrect, we'll do what we believe is not medically appropriate, we'll do what we believe is wrong, we'll continue to do what doesn't work. If you continue to go this route it's a colossal social disaster.

As an aside, Salon got the opinion of this guy during the Terry Shiavo fiasco. He said among other things:

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The court said, Remove the feeding tube and the family protested. Of course, the family has the radical, antiabortion, right-to-life Christian right, with its apparently unlimited resources and political muscle, behind them.

California law requires two doctors to examine a patient three hours apart to make this determination. The family asked for, and got, a third doctor to make another determination.

There is also the issue of money. According to other things I've read, now that she's brain dead, insurance companies and other sources of funds won't pay to prolong life.

Bottom line: it's sad and unexpected, but she's brain dead. It's possible the hospital f*cked up but it's sad to see everyone with their own agenda jumping on this bandwagon: religious "right-to-life" nutters***, Obama-care Death Squad mongers, OHMIGAWD SHE'S JUST A CHYYYLD, etc.

**because keeping a brain dead person on life support is SO COMPASSIONATE. eyes2

It does suck when hospitals fuck up big time...however, if the person's pretty much gone, let them go. When my mom was in the hospital, my brothers and I got together and decided to put in a DNR order should things go south (well, they did months later). We were prepared to let her go...no need keeping someone plugged in if said person has no chance in hell of recovering anyway.

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"She, and all other rabid breeders, are like crabs in a bucket headed to Red Lobster. When they see a smarter crab escaping, they try to pull it back in." - Miss Hannigan

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The moo in this case is probably like Terri Schaivo's...thinking there is anything in there. I remember seeing the scan on that woman's brain....she was bean dip.

It may hurt but the most humane option is to let them go.

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From a bottle cap message on a Magic Hat #9 beer: Condoms Prevent Minivans
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I want to pick up a bus full of unruly kids and feed them gummi bears and crack, then turn them loose in Hobby Lobby to ransack the place. They will all be wearing T shirts that say "You Could Have Prevented This."

Of course Moo wanted life support continued. After all, if she does the humane thing and lets the girl die in peace, Mommy might have to cry! Well we can't have that!

It sucks things went so badly for a routine surgery, it really does. But that's how it went and there's no hope of this child ever having any semblance of a real life. She is gone in every sense of the word, being kept alive by machines like a failed science fair experiment.

This part I don't believe:

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Sealey said McMath didn't want to undergo the tonsil-removal procedure and told her mother, Nailah Winkfield, before she went under that “something bad is going to happen to me.”

That sounds like something that the famblee threw in to make it seem even more tragic and make the hospital/surgeon seem like bigger assholes. Also, I've never heard of a child developing sleep apnea. I know it can be more common in obese people, leaving me to wonder if the girl was fat and if that contributed to the risk of complications. Generally, the fatter a patient is, the greater their overall risk for problems during and after any surgery. This is not to say that someone who is 250 pounds is guaranteed to die on the table, but I think they have a higher risk of shit going wrong compared to someone who is 100 pounds lighter.

The article says this was a great hospital and the surgeon was the best in his field, and while that doesn't guarantee that EVERY surgery will be problem-free, it makes me wonder if the girl might also have had some undiagnosed condition. I don't know what would cause cardiac arrest in such a young and otherwise healthy patient on the heels of surgery - trying to find out about that specifically just yields more coverage of this story. I'll be curious to see if anyone finds out more about what possibly went wrong or if it was just one of those freak flukes that no one could foresee, prevent or treat. The fact that she started to bleed and went into cardiac arrest a couple days after the surgery is very intriguing. You'd think if it was, say, a reaction to medication/anesthesia/whatever, it would have occurred immediately.

The family is just attention whoring because they lost their free CNA for 30 years in the future.

But, I believe that the girl did express apprehension about not waking up. She was 13--she was no small child. When I was 6, I had surgery and up to the day of surgery, worried that either I would not wake up or I would be paralyzed but awake and they would be carving on me!

I feel sorry for the child. But what 13 year old has sleep apnea? I am guessing it was either the result of shitty genes or the result of moo feeding her too much that allowed her to get so overweight. Or perhaps a combo of both.

I feel sorry for the girl. However, it is really difficult to feel sympathy for a breeder. Her parents knew she was going to die the moment they dragged her here. They were just hoping that they would be gone first so they would not have to see it. They probably also wanted her to get a good job and take care of them in her adulthood. eyes2

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"I have found little that is 'good' about human beings on the whole. In my experience most of them are trash, no matter whether they publicly subscribe to this or that ethical doctrine or to none at all."
~Sigmund Freud

Update: Judge has declared the girl brain dead

However, there is no immediate mandate to remove life support. I guess there's the hope that allowing the family to have Christmas with the corpse (sorry, but that's the reality ) will give them some closure so they'll let the poor thing go.

Well, from what I've read, it supposedly wasn't just a simple tonsillectomy, but that it was considered a complicated case. However, we can't really get the full story on the situation, because the famblee refuses to allow the hospital/doctors to talk about it.

The famblee also wants to bring in their own "expert" apparently; someone who is called a pediatric professor. The hospital opposes it because the professor has no neurological expertise, and he apparently feels that lack of brain activity is no reason to declare someone dead. I read that he believes that because the person "exhales" it means they are alive.

To me, it's stupid for someone who is a professor to say that exhaling -- even with no brain activity at all -- doesn't mean a person is dead. If they truly believed she was alive or would come back -- and let's face it, deep down they don't -- then they would unplug the machines and see what happens. We all know what will happen though. All functions will cease.

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peace-n-quiet
But, I believe that the girl did express apprehension about not waking up. She was 13--she was no small child. When I was 6, I had surgery and up to the day of surgery, worried that either I would not wake up or I would be paralyzed but awake and they would be carving on me!

Oh I believe that the girl was most certainly scared, but the whole "something bad is going to happen to me" just doesn't sit right with me, for some reason. Like the girl was scared, but that quote sounds like something Mommy and Uncle concocted for the media. But that might just be me and my crazies.

And I didn't know it was considered a complicated case. I wonder why that is. Obesity? Another health condition, like maybe a heart defect that the family is conveniently not letting the media hear about because they'd be painted as douchebags if the news found out they made the girl get surgery in spite of another illness that made surgery much more dangerous? (phew run-on) I also wonder if the girl had actual diagnosed sleep apnea or if she just snored a lot and kept the whole house awake, so they decided to get her tonsils out to see if it helped?

The cardiac episode strikes me as odd when the surgery had nothing at all to do with her heart. I don't know how common it is for someone to go into cardiac arrest within days of non-cardiac surgery. Maybe folks who are more knowledgeable in health and medicine can shed light on this?

I really hope that they are just going to keep the life support going through X-mas in order to say their final goodbyes and they're not hoping for a "Christmas miracle" where she magically wakes up and is all better.

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Cambion
The cardiac episode strikes me as odd when the surgery had nothing at all to do with her heart. I don't know how common it is for someone to go into cardiac arrest within days of non-cardiac surgery.

From what I've read of the case, the cardiac arrest happened directly because of massive bleeding. The bleeding was considered a complication of the surgery (which I'd imagine could happen with even the most minor ones) because it started in the recovery room.

What makes me very uncomfortable with the hospital's comment is that the kid was bleeding for hours. The mother was even given a container and asked to assess the size of the clots.

I've had the misfortune of spending some time in hospitals with one relative or another post-surgery, I am really dismayed that the kid didn't have a surgeon/surgery resident assess her in the recovery room for the bleeding. That's why it's called a recovery room. Bleeding happens. But profuse bleeding post-surgery usually means going back to the operating room to cauterize/deal with the source. That's emergent management. Then, the medical management would try to find out why she was bleeding so much.

There is just something so fucking weird about the turn of events. With hope, more information will come out. It's not unusual for a string of bad or incompetent decisions post surgery to let a complication lead to a grave outcome.

The famblee members, though, are fucking idiots for letting the kid stay on the machine. She's dead. Bury her and have a service, as sad as you may be. She's not coming back.

That's pro-life alright. Doesn't matter if you're brain dead, suffering with sword through your brain, on life support, whatever. You have the right to live.
Well, that's not living.
I hope they let her go soon.

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"Don't you know how to deal with children?!"
"I don't like animals who act on instinct."
I think you're on to something Akihiko.

She appears overweight in some pictures and obese in others. Not sure what the state of her health was but...

Jahi underwent three surgeries at once on Dec. 9: An adenotonsillectomy; a uvulopalatopharyngloplasty, or UPPP, which is tissue removal in the throat; and submucous resection of bilateral inferior turbinates, which is nasal obstruction.

Contrary to the moo and the lawyer representing the famblee, this is NOT a routine tonsillectomy. That is a lot of fuckin' surgery at one time.

I hate to say it but losing weight may have helped her sleep apnea enormously.

About 30 minutes after the surgery, Jahi started coughing up blood and suffered a heart attack.

Honestly, this does not sound like the dragged out recovery the moo and the grubbing lawyer describes to the media. She was in the ICU. These patients are never alone, and certainly would not be not looked at for 3 hours.

At the end....six doctors all came to the same conclusion. This girl is dead. Three of them were brought in by moo and family. Now they want to doctor shop because they want to find one who may tell them she is actually alive in there.

The judge denied any further motion to keep her on the ventilator, and has ordered her removed by 5 pm December 30. It is sad that one has to be evicted from life support, but she is not there anymore.

May she rest in peace once she is allowed to do so.

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From a bottle cap message on a Magic Hat #9 beer: Condoms Prevent Minivans
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I want to pick up a bus full of unruly kids and feed them gummi bears and crack, then turn them loose in Hobby Lobby to ransack the place. They will all be wearing T shirts that say "You Could Have Prevented This."

Wow, yeah that is pretty vastly different than what was said in initial coverage. No, that was not a routine tonsil removal and shit didn't go downhill days after the surgery. Why the fuck did she need all that done at once? I mean I get the thought of "Well let's get it all over with while we're in there," but this seems like a LOT of surgical intervention for a non-emergency case (like someone who was in a car accident and comes in alive, but in pieces).

I think it's normal to get the adenoids and tonsils out at once, but then the tissue removal from the throat and correction of a nasal obstruction on top of that? Unless that tissue was seriously damaged, why was it fucked with? I bet it was all too easy for stitches to rupture just from breathing and swallowing saliva.

And I also now wonder if Dr. Best In The World wanted to do all this at once or if the family insisted on doing three fucking surgeries on the girl in one fell swoop (thinking they'd save money is my guess). No, it wouldn't have been fun to have more than one surgery, but I wonder if the girl would have lived if she had the surgeries all done separately so each part of her throat/sinuses/whatever had time to heal. Was her alleged sleep apnea really that severe that she needed all that done at once? I only saw one photo of the girl and she looked a little chubby, but OMG land mass huge. I think she could have safely had the surgeries all done separately.

The nasal obstruction was probably the most urgent issue, so why could that not have been done first, and then the adenotonsillectomy and then the tissue removal when everything had time to heal? I'm not saying it would have been very fun or comfortable, but I have never heard of someone undergoing this many full-blown surgeries at one time when it wasn't a matter of immediate life and death.

The family has found a long term care facility that will take her to "give her a chance to wake up." Idiot ambulance chaser claims she is showing signs of breathing on her own and movement. I guess the six doctors that disconnected her to prove she is not breathing on her own and declared her dead don't know what they are talking about.

These morons have to realize that "her blood pressure stabilized" is a machine doing it for her. There is a fly in the ointment...this "care facility" requires the hospital to put in breathing and feeding tubes. The hospital refuses to because she is dead.

This is another Terri Schiavo all over again. Her brain was mush, but at least she was conscious. This one does not even have a functioning brain stem, confirmed by docs hired by the family.

But at the end of the day we know the real reason...Mommy does not want to cry.

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From a bottle cap message on a Magic Hat #9 beer: Condoms Prevent Minivans
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I want to pick up a bus full of unruly kids and feed them gummi bears and crack, then turn them loose in Hobby Lobby to ransack the place. They will all be wearing T shirts that say "You Could Have Prevented This."

What a shame that some facility and a bunch of right-to-lifers are giving this family false hope. She is not in a coma. She is DEAD. Hopefully the family will come to their senses soon and let her go.

Ugh, some place is volunteering to keep this thing going. Sad. The girl and family did get a raw deal, it's a shocking thing for this to happen. This surgery wasn't an emergency, it seems it was advised for apnea and momma was all for it. Maybe momma feels responsible, it was a lot of surgery, still it was just ENT surgery which shouldn't be a great risk even if it is complicated. Some ENT surgeries take hours and yes it can be really bloody. I've had sinus surgery and septoplasty, and know of people having UPPP, which is really painful and should only be done if really necessary but should NOT be dangerous. Even combined the surgeries were pretty minor, bleeding from the nose is normal and often looks worse than it is, lots of blood gets swallowed too. If the girl had cups of it, that's a bad deal and she should have been taken back in to stop it.

Hopefully the family accepts this and lets the girl go and moo doesn't feel guilty because she was going on medical advice to solve a problem. One thing I know about apnea, weight loss can often times be the solution that cures it. A person doesn't even have to be that overweight to get it, just a little extra fat in the neck can do it, and there are so many fat and obese kids who may get this and be at risk for cardiac issues even if they are otherwise healthy.

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Cambion
Also, I've never heard of a child developing sleep apnea.

I did, but mine was a really unusual case. I had so many bouts of tonsilitis as a kid that my tonsils became permantly swollen. Because of that, the small amount of muscle relaxation that's normal when asleep would cut my air off. We had to have a ENT specialist certify everything for my insurance company to approve the surgery. I was an overweight child, but I wasn't anywhere near obese when I finally had them yanked.

I still snore now, and rarely have bouts of apnea where I wake myself up gasping for air, but that's mostly because I could stand to lose a lot of weight. And I'm working on it.

I can't really say anything about this particular case. When I thought it was a simple tonsilectomy it seemed tragic. Now it just seems like they rolled the dice with a complex surgery, and came up short. What's tragic is the inability to let go. I'm dealing with that IRL right now. (Someone in hospice care and a dysfunctional family - always fun).

"Selfishness is not living as one wishes to live, it is asking others to live as one wishes to live." - Oscar Wilde

Who is going to pay for all this?

I'm sure that the famblee will sue the hospital at some point, but they surely don't have the money to do this stuff now, do they? Long-term care is not going to take this girl for free.

I was reading that they even looked at a facility as far away as New York. And how was that going to happen? Not only would they have to pay the bills, but they would've had to relocate at least temporarily, based on how long they let this go on.

Someone else mentioned Terry Schiavo. Didn't she languish in care for something like 20 years? I know her famblee had lawsuit money to keep that going, but, 20 years and they still weren't going to give up until the courts intervened. These folks could do the same thing.

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cfchevygirl
Someone else mentioned Terry Schiavo. Didn't she languish in care for something like 20 years? I know her famblee had lawsuit money to keep that going, but, 20 years and they still weren't going to give up until the courts intervened. These folks could do the same thing.

At least Terri Schiavo still had a functioning brainstem (as horribly brain-damaged as she was), and could breathe on her own. This girl DOESN'T.

I agree that it was ill-advised to perform three different surgical procedures at once, under non-emergent circumstances -- but the fact that Jahi's family misrepresented this as a "routine tonsillectomy" makes me wonder about their credibility regarding other details of the case.

Since they've got a bunch of "supporters" flying on pure emotion rather than logic, I'm thinking they'll have to have a phalanx of armed guards outside the room when the time comes to turn off the life support machines as per court order.

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cfchevygirl
Who is going to pay for all this?

I'm sure that the famblee will sue the hospital at some point, but they surely don't have the money to do this stuff now, do they? Long-term care is not going to take this girl for free.

I was reading that they even looked at a facility as far away as New York. And how was that going to happen? Not only would they have to pay the bills, but they would've had to relocate at least temporarily, based on how long they let this go on.

Someone else mentioned Terry Schiavo. Didn't she languish in care for something like 20 years? I know her famblee had lawsuit money to keep that going, but, 20 years and they still weren't going to give up until the courts intervened. These folks could do the same thing.

I believe I read that insurance will pay for it. But I (and people with much worse depression than mine, I'm sure) have to pay $100 a pop so the psychiatrist will give me my Zoloft.

This is sick. They're basically turning her into a puppet and pretending she's alive. I know turning off life support can be a hard choice when the person has some brain activity, but when they're gone for good?

If there's an afterlife, I hope that poor girl is happy, and can't see what's happening here on earth.

I'm not sure insurance could cover it since she's technically dead.

I guess they found a nursing home that will take the brain dead girl, which means that there is a bed that could've been taken by someone who is qualified, all because people cater to this family who is in fantasyland that their kid will wake up and be normal

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cfdavep
I guess they found a nursing home that will take the brain dead girl, which means that there is a bed that could've been taken by someone who is qualified, all because people cater to this family who is in fantasyland that their kid will wake up and be normal

The facility is in New York. The kid is in California. That means fixed wing air ambulance at critical cast costs. It also means Jet as opposed to cheeper turbo prop due to time and distance.

All this cost is conjecture based on working in the field and fee schedules I've seen.

For a Lear 35 operator an approximate cost for just rolling up the hangar door is in the neighborhood of $15,000. Add in per mile charges rangeing in the ball park of $150 per mile. Then add in medical charges for oxygen, ventilator, medications, IV pumps, cardiac monitoring, RN and either RRT or paramedic.

Then add in ground ambulance charges to the airport and from the airport. That gets charged at critical care rates so that's $2000.

Now planning a flight direct - which it won't be due to the fact it will be flown IFR FAA part 135 - comes out to be approx 2,300 NM and 6 hours (ground speed 400 knots) in the air from Oakland to Albany NY (not sure where in NY so Albany being somewhat center and the State Capitol becomes default)

Per mile $345,000
Basic 15,000
Crit care air 1200
Ground 2000
total approx ______
$363,200

Considering that this is not emergent insurance can deny the claim.

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“There are three things all wise men fear: the sea in storm, a night with no moon, and the anger of a gentle man.”

I've been reading the various news articles about this saga, and their comments. One commenter brought up an interesting point that explains it better than I ever could.

Ok, as we've all been informed, the nursing homes that would have taken her (corpse), would have required a gastric feeding tube and a tracheostomy to be installed beforehand (and of course, the hospital won't do either one.)

Short answer: Jahi McMath is already dead, and they're just oxygenating her organs. The packaging is there, but Jahi has moved on.

Complicated answer: What this famblee doesn't understand is that brain stem death isn't the same as a persistent vegetative/minimally conscious state -- as I mentioned before, even Terri Schiavo had a functioning brain stem. In the absence of the brain stem, autonomic functions (including the digestive system) will not work. A person in a PVS can "live" for years and years on a feeding tube (provided the brain stem still works), but if they dump nutrition into Jahi's gut via a feeding tube, all that swill is just going to sit there until her stomach ruptures, because the necessary nerve impulses from the brain just aren't there to move stuff through the digestive tract.

They also have people donating to their cause -- so far, they've raised $5,000. The people who gave them money are undoubtedly just as stupid. I hope the government taxes the fuck out of them on it.

Maybe they should bring in a witch doctor for Jahi -- now THAT would be interesting to watch...

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drlove0378

Complicated answer: What this famblee doesn't understand is that brain stem death isn't the same as a persistent vegetative/minimally conscious state -- as I mentioned before, even Terri Schiavo had a functioning brain stem. In the absence of the brain stem, autonomic functions (including the digestive system) will not work. A person in a PVS can "live" for years and years on a feeding tube (provided the brain stem still works), but if they dump nutrition into Jahi's gut via a feeding tube, all that swill is just going to sit there until her stomach ruptures, because the necessary nerve impulses from the brain just aren't there to move stuff through the digestive tract.

Doesn't the brain- if it isn't receiving any blood flow- just pretty much starts to liquify and come out of the person's nose and ears? That's not going to be pleasant for them to see...

No, not until the rest of the soft tissue containing the brain rots and gives way too...
But it won't be too long, since she has no brain stem, her assorted systems usually governed by the brain stem will gradually deregulate further and further. There's only so much medicine can do.