Jahi McMath case in California

[Buzzard]

Giving antibiotics to a corpse has reached a new realm of delusion. Shame on the people encouraging this mother.

Thats awesome. Lets give antibiotics to someone who is dead, therefore containing bacteria that goes along with decomposition. Lets kill off a whole bunch of those bacteria and, because she has no immune system, allow the resistant bacteria to take over IN A HOSPITAL. Do these people have absolutely no idea about the danger they're exposing the other people in the hospital to?

[mags]

I've been following this discussion and just wanted to add some additional info. Disclaimer: I am a doctor but I've never taken care of a brain dead patient as far out as Jahi is. Every case I've been a part of has ended with withdrawal of care after a couple of days, basically giving family time to process the news, get out-of-town family to the hospital for one last visit, and decide on a time to withdraw care (which means to shut down the ventilator in the case of brain death) I have taken care of very sick patients who needed extended ventilator support and so I know the common problems that come up with vents.

First of all, she still has respiration at the cellular level (b/c the ventilator is providing oxygen and the heart is pumping it) so her muscles will probably not go through rigor mortis until her heart stops. Rigor mortis only lasts for about 24 hours anyway so, even if it did happen as soon as she was brain dead, her body would have relaxed again by now.

A lot of the discussion is concentrating on how long her heart can keep beating. The intrinsic pacemaker of the heart has several "back ups" that get slower and slower so, if the main pacemaker cells give up, the backups will take over at a slower pace. It could be a while before the heart stops if nothing else went wrong with her body. This link is wikipedia but it expains it well: http://en.wikipedia.org/wiki/Cardiac_pacemaker

The two most common problems with vent dependent patients that leads to the heart stopping is pneumonia and/or kidney failure. A pneumonia can lead to a widespread infection and blood pressure so low (aka, sepsis) that the heart muscle itself doesn't get the oxygen it needs to keep going. In this case the heart muscle won't respond to any pacemaker stimulation because the muscle fibers don't have oxygen. Certain medications can improve blood pressure but she will only have access to these in a hospital. Sepsis can cause kidney failure but several other things can so it too, especially not getting enough fluid and adverse effects of some medications (antibiotics commonly do this). If she goes into kidney failure and needs dialysis, she probably won't get it. She would need another procedure to place the catheter AND a nephrologist would have to order dialysis. I have never seen a nephrologist order dialysis when medically futile. NEVER. I'm not saying it has never happened though but I will be very hard to find a doctor and a hospital to agree to do it. Untreated kidney failure will lead to increasing potassium levels. Elevated potassium will essentially 'short circuit' the electrical system of the heart and cause it to stop.

She reported to be on antibiotics already so she probably has an infection (though the source of infection hasn't been reported.) I'm sure she has skin breakdown (another possible source of infection) and maybe even a urinary catheter (possible infection source). Given the reports that she is in pretty bad condition, I don't think it will be much longer -- probably days, maybe a couple of weeks -- before her heart stops. I honestly hope it is sooner rather than later.

Hopefully this isn't too confusing and maybe a little bit helpful.

[Coconut Flan]

Hopefully this isn't too confusing and maybe a little bit helpful.

Very straight forward. Thanks!

[Stephanie66]

But WHY would one prescribe antibiotics to a deceased person?

[sparkles]

But WHY would one prescribe antibiotics to a deceased person?

Why would anyone do one tenth of the things they're doing to this poor girl? Delusion heaped upon delusion. Honestly, I try to never, ever make a joke of someone else's tragedy (there but for the grace of the FSM go I) but this is just such an unreal situation that my mind can't help but go there, if only because it's so difficult to comprehend. Princess Bride, Monty Python, Psycho (in more ways than one), Weekend at Bernie's...the Zombie apocalypse maybe?

[Alice_Fraggle]

Thats awesome. Lets give antibiotics to someone who is dead, therefore containing bacteria that goes along with decomposition. Lets kill off a whole bunch of those bacteria and, because she has no immune system, allow the resistant bacteria to take over IN A HOSPITAL. Do these people have absolutely no idea about the danger they're exposing the other people in the hospital to?

Is she in a hospital? I thought she was moved to a nursing home type place.

[gardenvarietycitizen]

That was helpful, mags. Thanks.

Reading a bit more about this today I read that there have been some cases of maintaining a brain dead person's body with all available heroic measures (to keep the blood flowing/heart pumping/temperature and hormones right/etc) for a month - considered a very long time - for a REASON, namely that there was a live fetus inside essentially using the mom's body now as an incubator to develop as far as possible. And yet still it was a tradeoff, only possible because the babies were far enough along to be survivable (even while premature) with only that small amount of time left in the body.

Everything I read including the informative comments here makes me think the end is not far, this problem (unlike the Schiavo case, which was a living person with a live brainstem) is going to solve itself fairly soon.

I'm certain the right to life people are still going to trumpet to the skies how great it was that this kid was "allowed to live out her life naturally in spite of the heartless doctors" or similar, because that's what certain groups are always looking for illustrations for.

Meanwhile I hope the mom in future years is able to come to terms with all this, including her own delusions (which she'll probably realize were just that, in the end). May they all have happier years.

[Becket70]

As futile as this is, I think the lawyer and her support structure have placed the mother in a position in which she cannot back down and must see this until the awful, gruesome end. Shame on them.

[CallmeChaCha]

In case anyone needed proof that this poor girl is dead, here is a medical analysis of the body's inevitable decaying state:

http://www.insidebayarea.com/bay-area-n ... source=pkg

(link not broken because it's a news site, note that some of the details are a bit grisly)

Jahi's family needs to understand that this girl is dead, give her a respectful funeral, and end this freak show.

I finally read the document linked above. So many questions. When the attorney said Jahi was in bad shape, does that mean the decomp is now noticeable to regular people (ie, people with no medical training)? And if she's being given antibiotics, how did they determine she had an infection, assuming that's why she's being given antibiotics? This is all so sad and sickening.

[Trynn]

Not to mention, someone living could probably have used those antibiotics.

[Ralar]

The case of Jahi McMath, the 13-year-old girl who was declared brain-dead after a tonsillectomy at Children's Hospital Oakland, is now the centerpiece of a political fundraising effort aimed at lifting California's $250,000 cap for pain and suffering awards in medical malpractice cases.

Consumer Watchdog, a Southern California nonprofit that has teamed up with the state's trial lawyers on a proposed November ballot initiative to lift the limit, just sent out a mailer to supporters saying, "Hospitals like Children's actually have an incentive to let children like Jahi die.

On a positive note:

Christopher Dolan supports the proposed initiative but said using the girl's case for fundraising is "a bad thing to do."

"This case is not about raising money for any type of initiative," he said. "It was about getting (Jahi's mother) the right to make choices over the life-and-death decisions concerning her child."

But

Dolan is past president and a current board member of Consumer Attorneys of California, the prime group funding the ballot initiative to lift the limit on pain and suffering awards. Last summer, he co-authored an article for the group's in-house magazine branding the $250,000 cap "draconian, arbitrary and outdated."

http://www.sfgate.com/bayarea/matier-ross/article/Jahi-McMath-case-used-as-Consumer-Watchdog-5123174.php

[Becket70]

Giving families the right to make these life-or-death choices, rather than their acquiescing to sound medical advice has some real serious long-term implications. I've been placed in the situation of having to sign off on allowing the vent to be removed from a loved one so I know what an awful, pain in the pit of your stomach, throat closing feeling and ache in your heart nightmare it is. Perhaps someone who works in this area knows if people always go along with doctor's recommendations (I know it takes a varying amount of time for acceptance to sink in) or has something like this happened in the past where the family refused to sign off on turning off life-support.

[J'ean Skirt]

If the body is decomposing, wouldn't rigor Mortis have set in as well? This whole thing is becoming ghoulish, let the poor girl rest in peace already.

Rigor probably won't set in until her heart stops.

Bit of biology: when the proteins in muscle fibers contract there isn't energy used. Energy is expended to stop the muscle from contracting. Rigor is just the point where the stored energy in muscle fibers is all used up and the muscle fiber can't stop contracting.

At this point, her heart is beating and there is some metabolism going on (even if it's just the automatic stuff). So I wouldn't expect her to fully go into rigor, although she may have some muscle contraction problems given the combination of brain death and lack of food.

[starfish]

Giving families the right to make these life-or-death choices, rather than their acquiescing to sound medical advice has some real serious long-term implications. I've been placed in the situation of having to sign off on allowing the vent to be removed from a loved one so I know what an awful, pain in the pit of your stomach, throat closing feeling and ache in your heart nightmare it is. Perhaps someone who works in this area knows if people always go along with doctor's recommendations (I know it takes a varying amount of time for acceptance to sink in) or has something like this happened in the past where the family refused to sign off on turning off life-support.

That's an interesting point. I had an elderly aunt (in her 90s) who was hospitalized with pneumonia. She slipped into unconsciousness, went on a vent, and we were told they would take her off of it within a few days. It was not really a choice on our part but she was not brain dead either. We took her off the vent and she died within a few minutes.

I remember the doctor saying that different countries have different standards for venting patients and that for instance, in Hong Kong they would never keep a patient on a vent past 48 hours. Don't know if that's true or not.

[Eater of Worlds]

I read in the sprocket trials site that several family members suctioned the blood that Jahi was bleeding before they called the ICU nurse. I wonder if that delay, if true, could be why she ended up dying. Maybe mom feels guilty for not calling the nurse right away and is trying to assuage that guilt.

[Jesus Camp Counselor]

From a comment on the Sprocket blog, someone posted a link to her sister's Instagram account that claims they had the trach and g tube inserted today.

instagram.com/p/i60m6vo0sN/#

Her sister says that they are "praying for a strong recovery." :angry-banghead: And then there are commenters saying that's great news. :pull-hair:

This makes me feel rather ill. I read the affidavit from the doctor that described the deterioration of the body, and that indicated that she was losing the lining of her digestive tract. And now they are giving her food? I'm afraid the results are going to be truly gruesome.

[Stephanie66]

Not to mention, someone living could probably have used those antibiotics.

In all honesty, there's no shortage of antibiotics. Until recently, up to 80% of the US antibiotic supply went to livestock.

Of course she has nastiness in her body. It is decomposing. I can completely feel for the mother, as it was such a sudden, shocking loss. But other mothers and fathers have had sudden, shocking losses every day and they don't act like this.

I IM'ed a friend of my brother's (Best man at each other's weddings friend) who practices law in Orange County. He wasn't well versed on this case, but said that California is not really good about disciplining members of the bar. He added that there aren't a lot of medical malpractice attorneys because of MICRA, which capped non-economic damages to $250K, and attorneys can only get 30% of that. So the attorney isn't in it for the money.

[twinmama]

I wonder if at some point, her family will realize what is happening to her body and be completely horrified at what they're witnessing/doing. I can see explaining away a lot of decomposition/deterioration as normal bodily functions, but once they realize what it actually is... how horrific to be watching your child decompose. Talk about scarred for life.

[Stephanie66]

I wonder if at some point, her family will realize what is happening to her body and be completely horrified at what they're witnessing/doing. I can see explaining away a lot of decomposition/deterioration as normal bodily functions, but once they realize what it actually is... how horrific to be watching your child decompose. Talk about scarred for life.

I can't remember what movie it was, but the guy was talking to a corpse the entire time that we (the viewers) believed he was interacting and talking to his girlfriend. Or maybe it was "Criminal Minds". But as the police talked to him and told him she was dead, she fell away in front of him, just turned into this mummified thing.

Although I don't think it will get quite that far with Jahi, I do wonder who in the HELL is putting in IV lines and GI tubes? Does this person have a medical license? Her bowels are not able to obtain nourishment, so it is only going to slough off the Ensure along with the linings of her bowels. Her IVs will collapse. HEALTHY veins collapse after a few days of IVs. (My husband had to have his changed out after four days) This is just a dog and pony show and for what?

[Coconut Flan]

The family seems to still be firmly rooted in denial. They can't seem to grasp that there is no recovery possible at all at this point. I agree who would insert the g-tube at this point? Maybe if they keep messing with the body it will completely fail faster and end the sideshow they've made of her body.

[twinmama]

Although I don't think it will get quite that far with Jahi, I do wonder who in the HELL is putting in IV lines and GI tubes? Does this person have a medical license?

I read that the medical professional caring for her now is a retired doctor doing it on a volunteer basis. I can't recall where I read that, so obviously take with a grain of salt. But I imagine it can't be someone who is actively practicing because they could lose their licence over treating a dead body, right? I'm just very glad she has left the hospital, I can't imagine what that fuss could do to other very seriously ill patients being treated nearby. And how horrible for a bunch of doctors and nurses to KNOW that she is dead and still have to "treat" her. Traumatizing and unethical.

[sparkles]

Would it have to be a person with a medical license though? After all, they're not treating a living person, they're working on a corpse to humor a mother who's in denial. It seems to me that anyone with a passing knowledge of medical procedures would be able to accomplish what's being done here.

ETA because damn you autocorrect!

[sableduck]

Is her body actually decomposing though? She meets the criteria for brain death--there is no electrical activity in her brain. However her heart is still pumping and circulating oxygenated blood due to the ventilator breathing for her, so the cells are still getting oxygen and, apparently, nourishment through the G-tube. She, clearly, is dead; but her heart is still beating, so I would assume her body is not decomposing the way we might think.

I believe though that there would be skin breakdown, as there is with any bedridden/immobile patient, and she is probably close to multiple organ failure. Very few people stay ventilator-dependent long without multiple and often deadly complications.

Any medical people able to weigh in on this? (I am a paramedic, not a doctor, but I have seen several cases of brain-death where the bodies were kept alive on a vent for quite a while, usually waiting for family or other things. Not this long though)

[Eater of Worlds]

As far as decomposing, I read that her brain is essentially liquifying right now, and if you took a sample of her spinal cord fluid you'd probably find brain cells or even chunks of brain in it.

[salex]

In all honesty, there's no shortage of antibiotics. Until recently, up to 80% of the US antibiotic supply went to livestock.

Of course she has nastiness in her body. It is decomposing. I can completely feel for the mother, as it was such a sudden, shocking loss. But other mothers and fathers have had sudden, shocking losses every day and they don't act like this.

I IM'ed a friend of my brother's (Best man at each other's weddings friend) who practices law in Orange County. He wasn't well versed on this case, but said that California is not really good about disciplining members of the bar. He added that there aren't a lot of medical malpractice attorneys because of MICRA, which capped non-economic damages to $250K, and attorneys can only get 30% of that. So the attorney isn't in it for the money.

I have read the attorney is working to get the cap removed, and this may a case used to leverage that. Her uncle was tossing the 30 million term around... but I'm pretty sure that will never happen.