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OAKLAND, Calif. (AP) — After her daughter underwent a supposedly routine tonsillectomy and was moved to a recovery room, Nailah Winkfield began to fear something was going horribly wrong.

Her 13-year-old, Jahi McMath, was sitting up in bed, her hospital gown bloody, and holding a pink cup full of blood.

"Is this normal?" Winkfield repeatedly asked nurses.

With her family and hospital staff trying to help and comfort her, Jahi kept bleeding profusely for the next few hours then went into cardiac arrest, her mother said. The girl was declared brain dead on Dec. 12.

Now, the hospital wants to disconnect her life support, the family says, but their lawyer Christopher Dolan has refused permission and is trying to keep Jahi on a ventilator through the holidays while the family obtains another opinion on her condition and reviews medical records. A court hearing was set for Friday.

Hospital officials said they couldn't discuss the case because the family hasn't given them permission to do so.

In a statement late Thursday, Dr. David Durand, the hospital's pediatrics chief, wrote of Jahi's case: "We are unable — without the family's permission — to talk about the medical procedure, background or any of the details that are a part of this tragedy.

"We implore the family to allow the hospital to openly discuss what has occurred and to give us the necessary legal permission — which it has been withholding — that would bring clarity, and we believe, some measure of closure and deeper understanding of this medical case," the doctor added.
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In an interview at Children's Hospital Oakland on Thursday night, Winkfield described the nightmarish turn of events after her daughter underwent tonsil removal surgery to help with her sleep apnea.

She said that even before the surgery, her daughter had expressed fears that she wouldn't wake up after the operation. To everyone's relief, she appeared alert, was talking and even ate a Popsicle afterward.

But about a half-hour later, shortly after the girl was taken to the intensive care unit, she began bleeding from her mouth and nose despite efforts by hospital staff and her family.

While the bleeding continued, Jahi wrote her mother notes. In one, the girl asked to have her nose wiped because she felt it running. Her mother said she didn't want to scare her daughter by saying it was blood.

Family members said there were containers of Jahi's blood in the room, and hospital staff members were providing transfusions to counteract the blood loss.

"I don't know what a tonsillectomy is supposed to look like after you have it, but that blood was un-normal for anything," Winkfield said.

The family said hospital officials told them in a meeting Thursday that they want to take the girl off life support quickly.

"I just looked at the doctor to his face and I told him you better not touch her," Winkfield recalled.

Hospitals do a barrage of sophisticated tests to determine brain death, said Dr. Cristobal Barrios, an associate professor and a trauma and critical care surgeon at the University of California, Irvine. He is not involved in Jahi's care and spoke about general hospital protocols.

The tests include touching a patient's cornea to elicit a blink, moving a breathing tube to stimulate a gag reflex, tickling the back of the throat to bring on a cough, and applying pressure or pain.

If the patient fails to respond to all of those tests, doctors remove the breathing tube for a few minutes. If there is any brain activity, the patient should begin breathing within a few minutes, he said.

In some cases, doctors will also draw a blood sample, add radioactive tags and re-inject it into the body to track where it flows. If the blood doesn't flow to the brain, Barrios said, there is no brain activity.

Generally, two teams of specialists must run the tests and determine independently that the patient is brain dead, he said. At UC Irvine, those evaluations must take place 12 hours apart if the patient is a child.

Barrios said it's not unusual for family members to resist a diagnosis of brain death.

While the hospital is not obligated to keep life support going after that diagnosis, Barrios has left brain dead patients hooked up for up to five days while family members move toward acceptance, he said.

"I understand why sometimes for families it's devastating and confusing," he said.

For more photos and a link to the article, click here.
 
I nearly bled to death two weeks after my tonsillectomy, well past what is normally considered the danger zone for complications after surgery. Fortunately for me, I was working a shift in labour and delivery at the time of my sudden haemorrhage, and the nurses quickly bundled me into the elevator down to the trauma bay, where anaesthesia quickly intubated me to protect my airway while an ENT surgeon and the blood bank were called. In under 3 minutes, I'd lost the better part of two litres of blood. I was scared, but I had the medical knowledge to know what was happening and that I was in the best possible hands by the time the anaesthesia meds caused me to lose consciousness and I was rushed to the OR.

I can't imagine how that little girl would have felt; I honestly think it's a blessing that her tragedy occurred before she was ever aware that anything was wrong. Pre-op is always a bit frightening, and most patients have at least some fear that something will go badly. I'm sorry that she's gone, but sometimes things happen despite the best care being taken, and her legal guardian did sign a consent form acknowledging that they knew that there was a possibility of something going catastrophically wrong. I hope that a thorough investigation is performed, and any malpractice is discovered and punished, but I also hope that if none is found the family can find peace without anyone being to blame. Sometimes shit happens.
 
How does the hospital have ANY say in whether or not the child is left on life support? Isn't it the decision of the next of kin?

Did I miss something in there were the girl was in state custody prior to the surgery?
 
"I just looked at the doctor to his face and I told him you better not touch her," Winkfield recalled.
I bet that doc isn't gonna touch her.

There might have been nothing anyone could have done differently but the mom needs to accept it and they need to give her reasonable time to be able to do that.

I can't imagine the pain and anguish she is going through.
 
I hope that a thorough investigation is performed, and any malpractice is discovered and punished

I feel that statistically, this surgery is so common, that malpractice should be the case. In light of the fact that this happened to you, do you feel that there should be more of a risk assessment involved with the surgery, or is it luck of the draw with body stamina? You vs 13 year old girl...
 
How does the hospital have ANY say in whether or not the child is left on life support? Isn't it the decision of the next of kin?

I believe it is more of an assessment of eventual probability. The poor child is brain dead at 13, and there is really nothing more that our technology can help with. A lot of people are in need, and as harsh as it seems, they could be working on another child in that room. They can't legally turn her life support off without consent, but their job as doctors is to assess logically and objectively, and this may be the best thing for everyone.
 
I feel that statistically, this surgery is so common, that malpractice should be the case. In light of the fact that this happened to you, do you feel that there should be more of a risk assessment involved with the surgery, or is it luck of the draw with body stamina? You vs 13 year old girl...
Everyone is different in how they handle anestheia, how their individual body heals.

For me any type of anesthesia, even a spinal block for the c sec makes me vomit uncontrolably afterwards. They are ready with meds when i've had to have a procedure done.

My 5 yr old will have to be life and death to ever have anything done, as I don't think anesthesia works on him. At the dentist they gave him the laughing gas, 3 shots of novocaine and it still didn't numb him, they pulled his broken tooth like that. It took 3 seconds but he felt everything.
 
How does the hospital have ANY say in whether or not the child is left on life support? Isn't it the decision of the next of kin?
The girl is brain dead. She's not in a coma or some vegetative state. It is an irreversible condition at this point. There is no miracle going to happen to revive a dead person. The hospital did all it could and is not legally obligated to treat what is essentially a corpse. The family does not accept the opinion of the doctors and sought an injunction to prevent them from pulling the plug.

A judge on Friday ordered a California hospital to keep a girl declared brain dead on life support following what was supposed to be a routine tonsillectomy.

The ruling by Superior Court Judge Evelio Grillo came as both sides in the case agreed to get together and chose a neurologist to further examine 13-year-old Jahi McMath and determine her condition. The judge scheduled a hearing Monday to appoint a physician.

The girl's family sought the court order to keep Jahi on a ventilator while another opinion is sought.
[...]

The family says doctors at Children's Hospital Oakland wanted to disconnect life support after Jahi was declared brain dead on Dec. 12.
[...]

Despite the family's description of the surgery as routine, the hospital said in a memorandum presented to the court Friday that the procedure was a "complicated" one.

"Ms. McMath is dead and cannot be brought back to life," the hospital said in the memo, adding: "Children's is under no legal obligation to provide medical or other intervention for a deceased person."
[...]

At the hearing later, the hospital's attorney, Doug Straus, said two doctors unaffiliated with the hospital examined Jahi and concluded that she was brain dead. But he said, "We're happy to cooperate with the judge's suggestion that an independent expert be provided to confirm yet again that brain death is the outcome that has occurred here."

The family's attorney, Christopher Dolan, said the family wanted independent tests of their own because they do not believe the hospital's physicians are sufficiently independent.

"There is mistrust and there is a conflict of interest," he said.

Judge Grillo said he would grant the restraining order in hopes that a resolution could be reached by Christmas to give the family peace of mind.
http://www.fresnobee.com/2013/12/20/3677155/california-girl-had-fears-before.html
 
I feel that statistically, this surgery is so common, that malpractice should be the case. In light of the fact that this happened to you, do you feel that there should be more of a risk assessment involved with the surgery, or is it luck of the draw with body stamina? You vs 13 year old girl...
I would need to know a lot more about the girl, the doctor(s), and the equipment used to be willing to guess whether it was a medical error or a freak occurrence that lead to her death. The family's decision to keep her on life support, however, is slowly ruining the chances that the true cause of the haemorrhage can be determined.

Honestly, I feel that risk assessment is where it should be; every once in a while, even with everything done to the highest medical standards, something unanticipated and catastrophic happens. My bleed was such a freak occurrence. I have a clotting disorder, which definitely exacerbated the blood loss, but even so it was beyond any reason to anticipate the possibility that fourteen days after surgery I'd nearly bleed out.
 
I know I'm going to sound like a total bitch here, but I some what blame the parents. Look at her pictures..she's 13 years old and obese, it's little wonder she had sleep apnea and other problems. The parents first route to fixing it should have been a diet rather then surgery, especially when she's over weight. A few pounds over weight dramatically increases the odds you will have bad stuff happen, never mind she's a child and you can never be sure how they will tolerate surgery. That being said I'm sure they never in their wildest dreams thought this would happen but as with any surgery there is a risk of death.

Doctors had recommended the tonsillectomy to treat Jahi's sleep apnea, weight gain, inability to concentrate, short attention span and uncontrolled urination, her uncle Omari Sealey told CNN on Monday in a telephone interview.

"They said that she would have more energy, focus more, lose weight, and the urinating would stop," he said.

[...]

Dr. Lisa Thebner, a pediatrician in private practice in New York who was not involved in the case, said excessive bleeding -- though rare -- is not unheard of in such operations, given that the tonsils are removed from the back of the throat, an area rich in blood vessels.

Still, she said, "This was a highly unusual complication."

http://edition.cnn.com/2013/12/17/health/california-girl-brain-dead/
 
Sounds to me the parents were encouraged to do surgery. I don't feel this way now, but I can understand listening to a doctor and totally going with it. After all, it's reasonable to think the doc knows best and trust completely in what they said should be done.
 
Sounds to me the parents were encouraged to do surgery. I don't feel this way now, but I can understand listening to a doctor and totally going with it. After all, it's reasonable to think the doc knows best and trust completely in what they said should be done.
To be fair I maybe should have posted this along with what I quoted, it's in the article I linked.

CNN could not independently confirm Sealey's account.

When asked about the case, hospital spokeswoman Melinda Krigel cited privacy laws.

A statement from the hospital's chief of pediatrics, Dr. David Durand, read: "Our hearts go out to this patient and her family. Unfortunately, we have not been authorized by the family to share information with the public about this matter. Consequently, we are not able to correct misperceptions created about this sad situation.

We only know what her family is saying. The hospital can't comment to correct anything till the family gives the OK. The mother seems to be thinking pretty irrational right now, so who knows what she's told the rest of the family.

"I don't want her off life support because I really feel like she can wake up," Nailah Winkfield told CNN's Piers Morgan. "I feel like it's just been a rough week for her and, if they just give her some more time, then she'll be able to wake up."
 
I know they say they can't comment without family's permission but now it's all in the courts and the hospital is now stating their facts. I also as a parent wouldn't be trusting of the hospitals doctors making the determination. Actually it would make sense to have a policy in place that in these circumstances their affiliates would never be appointed for these determinations.
 
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It is not up to the family when and if mechanical ventilation is discontinued when the patient has been declared brain dead. The hospital had every right to discontinue "treatment," but was showing compassion to the family so they could have time to accept things. The coroner had every right to demand mechanical ventilation to be discontinued and pick up the body, but they too, were showing compassion towards the family. The hospital and coroner had these rights prior to the injunction. That's why the family got the injunction to keep the kid on mechanical ventilation.

The mother is a nurse. A NURSE. She does not believe her daughter is dead. Even though there was brain death confirmation on Thursday, December 12th, twelve hours a part. The testing has been repeated, at least twice, that I have read and the family still does not believe it. They want a third and fourth opinion done next week. The nurse has no concept of brain death.

I watched an interview with the mom. She stated the machines are not what is providing her daughter with a heartbeat or breathing. So why not extubate her?

Here is a FB page of the family's supporters. They think this girl will be murdered by the hospital if they discontinue the vent. I haven't been on it in a few days because I can't take the people on there. They are giving "examples" of people who were "brain dead" and came back to life. I'm sorry, but that just does not happen. No one has ever come back from the dead. (except Jesus if you believe in that sort of thing)

https://www.facebook.com/keepJahiMcmathonlifesupport

She has also been on the vent for 9 days. A dead person has been on a vent for 9 days. This girl is not in a coma. She is not in a vegetative state. She is dead. On a vent. For 9 days, as of today. It doesn't matter if the vent is discontinued a month from now. That girls date of death is still going to be December 12th.
 
Can anyone explain how a tonsillectomy can stop uncontrolled urination? I've not ever had a tonsillectomy and neither did my kids, but I do know that the tonsils are not connected to the bladder or kidneys.

Doctors had recommended the tonsillectomy to treat Jahi's sleep apnea, weight gain, inability to concentrate, short attention span and uncontrolled urination

Sounds to me like she may have been well on her way to being diabetic.
 
Can anyone explain how a tonsillectomy can stop uncontrolled urination?
I think they are thinking that if they got her sleeping better, she would be more focused, less moody, and able to lose weight. That would probably help with problems in that area. But since it's only info the family has released, who knows if that is even part of it.
 
I understood how a tonsillectomy would help sleep apnea which she then could maybe sleep better and that would help with the concentration, attention span, and weight gain since she would feel more like doing stuff if she slept better. But I don't get the excessive urination part, but like you said that is a quote from Jahi's uncle, so who knows.
 
As a parent she's holding out hope...every last amount possible. I'm sure she's heard stories, maybe even witnessed some as a nurse

They were told there was no chance of their son surviving after he suffered devastating injuries in a car crash.

But Steven Thorpe’s parents refused to give up hope – despite four specialists declaring him brain dead

Convinced they saw a ‘flicker’ of life as Steven lay in a coma, John and Janet Thorpe rejected advice to switch off his life support machine.

They begged for another opinion – and it was a decision that saved him.

A neurosurgeon found faint signs of brain activity and two weeks later, Steven woke from his coma. Within seven weeks, he had left hospital.

And four years on, the trainee accounts clerk says he owes everything to the persistence of his parents.

From his home in Kenilworth, Warwickshire, Steven, 21, said: ‘I feel so lucky that my parents wouldn’t take no for an answer.’

‘Hopefully it can help people see that you should never give up. If you have a gut feeling about something then follow it. My father believed I was alive and he was correct.’

Read more: http://www.dailymail.co.uk/health/a...ors-makes-miracle-recovery.html#ixzz2oA42igej
 
Their lives were rudely interrupted in dramatically different ways, from a lightning bolt to a heart attack to an ATV accident. One was declared brain dead; another was disconnected from life support to allow her to die; the third was in the deepest coma recognized by medical science.

Taken first to a local hospital, he was then airlifted 50 miles away to United Regional Healthcare System in Wichita Falls, Texas, where there was a trauma unit better able to treat the severe damage he had done to his brain. But 36 hours after the accident, doctors performed a PET scan and informed his parents, along with other family members who had gathered to keep vigil at the hospital, that there was no blood flowing to Zack’s brain; he was brain dead. A second scan confirmed the results of the first.

His family agreed to allow surgeons to harvest his organs to give life to others. Calls went out to organ-donor networks, and surgeons began planning the organ harvest while Dunlap’s family gathered around the young man’s bedside to say goodbye.

Some four hours after doctors declared Zack dead, a nurse began to remove tubes from Dunlap. His cousins, Dan and Christy Coffin, both of whom are nurses, were also in the room. Something about Zack’s appearance made them think that he wasn’t as dead as the doctors said. On a hunch, Dan pulled out his bone-handled pocket knife and ran the blade up the sole of one of Zack’s feet.

‘Our son is still alive!’
The foot yanked away, but the other nurse said it was only a reflex action. So Dan Coffin then dug a fingernail under one of Zack’s nails. Zack yanked his arm away and across his body.

That, the other nurse agreed, wasn’t a reflex action. It was a sign of life.

http://www.today.com/id/27924674/#.UrY8HNJDua8
 
Sounds to me the parents were encouraged to do surgery. I don't feel this way now, but I can understand listening to a doctor and totally going with it. After all, it's reasonable to think the doc knows best and trust completely in what they said should be done.

I also do the scheduling for my docs (anesthesiologists) for 2 hospitals and a day surgery center and you know, after all my life i have worked for docs and I really am more disgusted by all this. There are 3 doctors that perform most of the surgeries at these hospitals, one is a podiatrist another is an ENT and the other is an Ortho. We have many many of those specialists in town and they have 5 surgeries to every 1 the other docs have.

I know it isn't coincidence cause I used to work for the podiatrist and we have a girl that used to work for the ortho, she said that he would be pissed if he wasn't triple booked every 15 min, the podiatrist is under investigation from medicare for over billing shit and the ENT does a lot of ear tubes on kids.

I just have to wonder if this doc wasn't surgery happy before really seeing if she was a good candidate for surgery.
 
I understood how a tonsillectomy would help sleep apnea which she then could maybe sleep better and that would help with the concentration, attention span, and weight gain since she would feel more like doing stuff if she slept better. But I don't get the excessive urination part, but like you said that is a quote from Jahi's uncle, so who knows.


I have no idea why a tonsillectomy would help urination. Everything else makes sense, but I dunno. Maybe we have a pee button in our nasopharynx that we don't know about. :p Maybe near the gag button.




As far as the stories of people coming back from brain death. I really don't put any stock into them when they are second hand stories. Just last night I watched Undercover Boss and a girl was talking about her dad being in a coma. She said, "he's basically brain dead" living in a nursing home in a coma. He is not "basically brain dead" if he is in a coma.

Time and time again I have heard people talk about brain death and coma interchangeably and they are two very different distinct terms.

IF someone was declared brain dead, I want to know what type of doctor. Was it a Podiatrist? The article said "specialist" but didn't list what type of "specialist" or even the name of the "specialist." I just really have a hard time believing these stories when they are from family or friends who don't understand what terminology they are talking about.

I'm not even being facetious.

A day or so ago I read about this kid who died in an auto accident. I was going to post it but DD was farting and gave up. He was declared brain dead on a Sunday and was an organ donor. Because of his blood type and organ procurement teams coming to him the procurement didn't start until Tuesday night. The family said the heart team got his heart at 11:30 Tuesday night and he was finally pronounced dead on Wed. at 1am. Tell me how he was pronounced brain dead on Sunday, his heart was removed at 11:30pm Tuesday, but he wasn't pronounced dead until Wed at 1am? I even looked up his obituary to see what they listed in it. Sure enough, it said he was in an accident on Sunday and died Wed at 1am. Why do they think this? Because they do not understand brain death. They are going to have a huge surprise when they receive his death certificate and it has his death listed as Sunday.

Sometimes brain stem reflex testing is done to see how many brain stem reflexes are left. This helps the docs in thinking of diagnosis and prognosis. The docs may be relaying this info to the family and saying things like, "your loved one only has 3 brain stem reflexes left. This does not look good. They may become brain dead in the near future," and the family taking that as a declaration.

I've heard people tell the stories and I've asked them, "did they really pronounce them brain dead?" and I get, "Well, no, they said he was in a medicine coma, but it's the same thing." A medicinal coma is not the same thing as brain death and brain death testing cannot be performed while in a medically induced coma because medicines like phenobarbital (which is a common drug used for medicinal comas) slow brain activity (that's why they use it for comas) and may skew the testing. Someone may appear to not have any brain activity or minimal activity.

Also, when family is given a prognosis regarding a loved one they may not understand the terminology because most of the time it's a doctor who has to use big words to make themselves appear to be a God.

Many health care professionals don't even understand brain death. I used to give in-services at hospitals for health care professionals (lab techs, social workers, x ray techs, and nurses) whose licenses accepted the CEU's. I understood non clinicians not understanding brain death, but there are PLENTY of clinicians who do not understand it. There are physicians who don't understand it.


Who knows. I wasn't with those families to hear the exact words that were used. However, I know that I 100% believe in brain death and the confirmatory processes used to determine it. There is nothing anyone can say or do to prove it to people who do not understand it or don't want to understand it.


Did I mention I saw an interview with the mother and she said the machine is not what is providing her daughter with a heart beat? If she truly believes this then there should be no problem turning the vent off. It is the vent that is providing the heart beat. The heart doesn't need the brain to pump. It needs oxygen and that's what the vent is providing.

I need to step away. My BP shoots through the roof on cases like this. :(

I do feel horrible for this family and the little girl, though. I probably sound like a dick, but I'm really not meaning to come across that way.


ETA: I just saw China's post regarding the Podiatrist! HAHAHAHA! Me mentioning a Podiatrist was completely coincidental. I was typing while you were posting. lol

Also, sorry for the novel.
 
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I believe what I posted was pretty credible with links. I'm just saying any chance at all her child could come back, I can't blame her for believing it's possible.
 
The links were stories from people. The articles didn't include any statements from the treating facilities. I have a hard time believing the "lay person" telling a medical story because of the reasons I stated above.

Three of the four stories described comas. One claimed brain death. I'm not trying to disrespect the kid from the story, I just have a hard time believing he was pronounced. It would take showing me the pronouncement from the chart. And, if I were pronounced and woke up, I would want the pronouncement so I can say I came back from the dead.


This is from the other article you posted.

Doctors agreed to try to bring Steven out of his chemically-induced coma to see if he could survive. Two weeks later, he woke up.
A spokesman for University Hospitals Coventry and Warwickshire NHS Trust said: ‘The injury to Steven’s brain was extremely critical and several CT scans of the head showed almost irreversible damage.

‘It is extremely rare that a patient with such extensive trauma to the brain should survive. We were delighted to see Steven recover.’

This is why the kid was pronounced. They tested him while in a medically induced coma. That's why they don't (shouldn't anyway, that's protocol) do that in the U.S.

And the bold part. Definitely a fuck up the docs tested him while in a medically induced coma, but the CT scan did not show irreversible damage. It showed almost irreversible damage.

This didn't occur in the U.S.


http://www.dailymail.co.uk/health/a...ors-makes-miracle-recovery.html#ixzz2oA42igej


I'm not picking on you, just so you know. I'm just responding to your posts with the stories.
 
A comment from the MailOnline article. Looks like the U.S. and the UK actually have the same protocol.

SH,
Sheffield, UK, 1 year ago

As an ICU nurse I have to say there's a lot of information missing or not quite right in this story. It says that the patient was declared brain dead but then woken from an artificial coma - well part of the criteria for brain stem death testing is that the patient is not in an induced come ie not on any drugs that can affect the concious level. I think this is more a case of the patients family misunderstanding the information they've been given. It's a real shame, because brain stem death is so difficult for patients families to comprehend and come to terms with - misleading stories like this make it so much harder.


Read more: http://www.dailymail.co.uk/health/a...ors-makes-miracle-recovery.html#ixzz2oAabDemG
 
Sorry for back to back posts, but I wanted to say that if it's true that kid was pronounced dead and he came back, HE IS A ZOMBIE!
 
Everyone is different in how they handle anestheia, how their individual body heals.

For me any type of anesthesia, even a spinal block for the c sec makes me vomit uncontrolably afterwards. They are ready with meds when i've had to have a procedure done.

My 5 yr old will have to be life and death to ever have anything done, as I don't think anesthesia works on him. At the dentist they gave him the laughing gas, 3 shots of novocaine and it still didn't numb him, they pulled his broken tooth like that. It took 3 seconds but he felt everything.
My son is the same way and he's been put under anesthesia as well and he didn't wake up to well
 
In the not-too-distant-past, death was simple: You stopped breathing, your heart stopped, and you died.

But, like many things in the technological era, death can be more complicated now - as evidenced by the plight of a 13-year-old who lies motionless at Children's Hospital Oakland.
[...]

Jahi's family and doctors disagree over whether she's dead, but on one topic everyone is united: She is a very special case. Almost all deaths are because of heart and lung failure. Less than 1 percent fall into the category of brain death, a condition officially incorporated into the definition of death by a 1981 presidential panel of doctors, lawyers, researchers, psychologists and ethicists charged with defining death at a time when rapidly advancing technology was blurring the lines between life and nonlife.

According to the panel's report, death occurs when "an individual has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem."

The report was the basis of the Uniform Determination of Death Act, a draft law later adopted by many states, including California, that provides medical and legal guidelines for determining death in cases when the brain has stopped functioning.

The guidelines were intended to help doctors and families navigate the nuanced and difficult decisions about ventilators, feeding tubes and other life-sustaining measures. But they remain silent on time of death, stating that the actual declaration of death is to be determined on a case-by-case basis.

In most cases, experts said, when a person has zero brain activity and zero chance of recovery, families choose to disconnect life support.

But it's never an easy decision, said Dr. S. Andrew Josephson, director of inpatient neurology at UCSF. "That your loved one can die but still be breathing with the help of a ventilator - this is not a concept very many people are familiar with," he said. "It can be a very difficult task for physicians to explain to families."

Ordinarily, brain death occurs after a severe head trauma, such as a car accident or gunshot, damages the brain but leaves the heart and lungs intact. But sometimes, it can occur when oxygen and blood temporarily cease flowing to the brain, such as when an aneurysm ruptures or someone is revived after cardiac arrest.

Such was the case with Jahi.
[...]

The complications resulted in brain death, according to the hospital, and she was declared dead, although she was still on a ventilator.

Jahi's family has asked that doctors provide antibiotics, blood-pressure medication and a feeding tube directly into her stomach, in addition to the ventilator and dextrose IV drip she's receiving, Dolan said.

"They want all life-support measures taken," he said. "They do not want to give up."
http://www.sfgate.com/health/article/Alive-or-dead-Brain-death-a-complicated-issue-5083320.php

Uniform Determination of Death Act: http://bit.ly/1fsN3oR (pdf)
 
Declaring death used to be simple: The deceased turned blue and stiff. The heart became inaudible, the pulse faded and the chest stilled.

That's not Jahi McMath's story. The 13-year-old Oakland girl's skin is still soft and warm. Her pulse still strong. And her lungs fill with air.

Advances in modern medicine are complicating her final chapter, sustaining her heart but unable to revive her brain.
[...]

For a society that invests the beating heart with such symbolic importance, it can be difficult to accept medicine's now-universal definition of death: loss of all brain function.
[...]

Her stunned family is challenging Children's Hospital's determination of death -- based on an evaluation of five doctors, two hospital-based and three independent -- and is demanding the hospital continue sustaining their child's body. The final search for any sign of brain activity will be made on Monday by a court-approved doctor, selected from a list of neurologists at UC San Francisco. The findings will be presented in court on Tuesday.

The advent of artificial respirators, specialized medical teams and intensive care units can seemingly keep "alive" patients who have lost all brain function and who, without artificial support, would have no breath, pulse or circulation.
[...]

There are times that hospitals do decide to keep dead people on machines. For instance, they may seek to sustain organ donors or pregnant women until birth.

And California law allows "reasonable accommodations," usually just several days, to be made to allow families to travel long distances to gather in a hospital room. "It is a better place than the morgue," said Arthur Caplan, head of the Division of Medical Ethics at NYU Langone Medical Center.

But hospitals seek time limits. High-tech intensive care units are designed for those with a chance of recovering. Prolonged care of the dead is traumatizing for health care workers too, experts said.

It is also expensive. Hospitals can't discharge the deceased, because nursing homes won't accept them. And because private and government insurers only cover the costs of the living, not the dead, hospitals must cover the expense.
[...]

"Brain death is death," Caplan said. "It sounds like it's not really death, but it is. ... The term creates false hope and expectations," he said. "It would be far better to say: "The patient has died, and the reason is brain death.' "

Forty-three states -- including California -- now recognize "brain death" through laws or court decisions. Brain death laws also have the backing of the American Medical Association and the American Bar Association.

People who are "brain-dead" offer no response to any stimulus: pinprick to the skin, light in the eyes. Their pupils are fixed and dilated, their eyes don't move when their head is turned, and they cannot breathe without a ventilator. A brain scan detects no sign of activity. (They are not patients like Terri Schiavo, whose brain damage was not complete before she was removed from life support in 2005.)
[...]

Yet, while families have the right to insist on treatment of living patients, there is no legal or ethical duty for hospitals to to treat the dead, ethicists say.

"We don't revive people by judges," said Caplan.
[...]

Tuesday's verdict, if it supports previous evaluations, will end a tragedy that is no longer just medical, but emotional and judicial.
http://www.mercurynews.com/science/...icines-ability-keep-heart-beating-complicates
 

From the article you posted. This IS a huge problem, not only with the public, but with clinicians. I've said it a couple of times already. It's difficult for clinicians to explain brain death when they themselves don't understand it.

Another issue is many doctors don't want to be the one to tell a family their loved one is dead. They don't want to accept they have lost a patient. God complex at it's best. Although, some just don't want to be the bearer of bad news.

I don't know how many times I have been called to the hospital to discuss organ donation with a family and as I'm talking, I realize they have no idea their loved one is dead. The doctor did not explain brain death and many times I have been told, "he/she just said the prognosis is very poor and we have decisions to make." ugh

The OPO (Organ Procurement Organization) is not supposed to have any contact with the family until the family knows their loved one is dead. We would ask the staff and be told the family has been told. It would be in the damn chart! Very frustrating, not only for us, but for the families as well.

The problem is education and training and probably communication. When I spoke to families, I would ask them what the doc said and what it meant to them. That way I could see if they understood their loved one was dead and they understood brain death.
 
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