Jahi McMath case in California

[bionicmlle]

I think the maintenance of her body is dependent on a lot of things. I think the only way they could actually utilize nutrients would be via TPN (nutrition given thru blood, not gut) so I don't understand the g tube. Her lung and gut tissue are likely to be damaged and not functioning properly but I think electrolyte imbalance will be the final "culprit" either due to renal failure or over-ambitious "re-feeding."

[Ralar]

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.

And according to the doctor whose affidavit was a part of the proceedings re: inserting trach and GI tube, Jahi is shitting out her intestinal lining and medical personnel were suctioning all kinds of disgusting foul smelling decomp excretions from her airway. The doctor said her exterior looks okay -- her hair is done, her nails are manicured, etc. -- but beneath her skin it is a different story: she is decomposing from the inside out.

[mags]

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)

Yeah, I'm not sure how much actual decomposition is going on here vs. skin breakdown and pressure sores/ulcers at various points. Her skin may be getting loose because of weight loss.

The integrity of the lining of the gut is dependent upon regular use. In a non-brain-dead patient who might be on the ventilator for a while we usually try to use the gut as soon a possible with tube feeds. It sounds like Jahi has been getting nutrition via her IV and not her intestine. Why? I don't know. Doctors probably resisted it because she is brain-dead but compromised with IV nutrition since the courts kept extending the use of the ventilator. They could have put down an NG tube (through her nose, down esophagus to her stomach -- nurses usually do this procedure at bedside, no anesthesia needed) as a temporary measure but it seems they didn't. NG tubes get dislodged and IV nutrition is prone to causing more infections so the long term solution is a G-tube inserted through the abdomen into the stomach and is a little more stable. Placing a G-tube is usually performed by a GI doc with the help of a scope and under mild anesthesia. Anyway, if not used the lining of the gut will slough off and leave the gut with very little protection from infection. Refeeding her after all this time will be...delicate.

[Coconut Flan]

Does the lawyer really believe this? He says she's "improving" and now getting the care she should have been getting all along.

How can a corpse improve?

http://www.cnn.com/2014/01/08/health/ja ... th-update/

[anjulibai]

I'm sure the heart will stop very soon, but I bet they won't say so for months.

[bucherwurm]

Even though I have read the articles saying she is dead, and I have no connection with the family, I have a hard time thinking she is actually dead when her heart is still beating. I know her brain has no activity, and it never will, therefore it cannot tell the body how to work (heart beating, breathing reflexes, other organs working, etc). But the fact that her heart hasn't stopped is hard to wrap my head around. Logically I know, but something just isn't connecting in this noggin' of mine.

[anjulibai]

Your brain is where your mind is, not your heart. If your brain dies, you die, that's all there is to it.

[PurpleSheepleEater]

Isn't her heart beating because of the ventilator? They said she went into cardiac arrest, meaning her heart did stop. They restarted it and are keeping it beating artificially. It's not beating on it's own and it can't because the brain is dead. I'm assuming she would flat line within seconds of removing the ventilator.

[sableduck]

Isn't her heart beating because of the ventilator? They said she went into cardiac arrest, meaning her heart did stop. They restarted it and are keeping it beating artificially. It's not beating on it's own and it can't because the brain is dead. I'm assuming she would flat line within seconds of removing the ventilator.

No. Her heart is pumping under its own power on the impulse of its pacemaker cells. When she went into cardiac arrest, her heart stopped and presumably she was without oxygen long enough to cause brain death. The medical professionals were able to restart her heart, but due to the brain death she won't breathe. The ventilator is only breathing for her, giving her blood the oxygen. That oxygenated blood is being circulated throughout her body by the beating heart. Brain death does not cause the heart to stop beating, as the cardiac muscle will beat on its own as it is directed by its own pacemaker cells. It is not controlled by the brain stem. What happens is that when someone stops breathing, the cells die quickly from lack of oxygen. Once those pacemaker cells have died from lack of oxygen, the heart will cease beating.

Jahi's heart is beating on it's own power, which I'm sure is what is giving her mother hope, however delusional it is. If the ventilator was removed, Jahi's heart would stop beating within minutes.

[PurpleSheepleEater]

Ok, well that's kind of what my understanding was. Without the ventilator the pacemaker cells would suffer lack of oxygen and would not be able to function so her heart would stop. The ventilator is keeping her alive and allowing the heart to function.

Poor girl, she's dead and gone. What a violation to have her body being messed with like this.

[mags]

Even though I have read the articles saying she is dead, and I have no connection with the family, I have a hard time thinking she is actually dead when her heart is still beating. I know her brain has no activity, and it never will, therefore it cannot tell the body how to work (heart beating, breathing reflexes, other organs working, etc). But the fact that her heart hasn't stopped is hard to wrap my head around. Logically I know, but something just isn't connecting in this noggin' of mine.

The brain doesn't actually tell most major organs how to function. The heart is a muscle with embedded cells that stimulate the electrical impulse that causes the heart to contract which pumps blood. (Read more: http://en.wikipedia.org/wiki/Cardiac_pacemaker). With each contraction, blood is pumped to the lungs to pick up oxygen and get rid of carbon dioxide and the oxygen rich blood is sent back to the heart. The oxygen rich blood is then sent to the rest of the body to provide necessary oxygen to all cells. A small part is diverted to the heart muscle itself because, as a muscle, it needs oxygen to keep contracting. All of this happens without input from the brain.

There is no intrinsic system in the lungs that controls breathing. Control of breathing is involuntary but comes from the brainstem. With brain death, the brainstem is dead also. The ventilator forces air/oxygen into the lungs, which stretches the chest wall/ribcage. The ventilator then pauses and the ribcage recoils to it's normal position causing the body to exhale. The vent pushes air in again, etc. Patients with normal brainstems who are on vents for other reasons often "breath over the vent" which means they take extra breaths above what is being provided by the vent. Brain dead patients do not do this. In fact, one of the criteria for diagnosing brain death is an "apnea test" where the vent is turned off and the patient and monitors are observed for signs of breathing. It's been a while, but I think there is a time limit with no breaths and/or dropping to a certain oxygen saturation to meet that particular criteria. So, without the ventilator, she won't take a breath and no new oxygen is provided to the blood. The lungs have a reserve of oxygen that lasts for a few minutes (this is why you can hold your breath underwater and not die right away) but when it is gone the oxygen in your blood starts dropping FAST! If the heart muscle can't get oxygen it stops contracting and the pacemaker cells die. When the vent is removed she probably won't flatline right away. It's different for everyone, but it usually happens within a couple of minutes.

Other organs can function without the brain as long as there is oxygen to keep the cells going. The intestine has it's own nervous system, independent of the brain, that moves food through. The kidneys and liver only need blood flow to filter the blood. The brain doesn't tell these organs HOW to filter the blood.

The brain is the seat of consciousness, personality, communication, senses, memories, motor function, control of hormones, and regulation of temp/sleep/wake etc. People can still lead productive lives if any one of these areas is lost but to lose ALL of it PLUS your ability to breathe without a machine is brain death (loss of brain plus brainstem) and you don't come back from that.

[mags]

Looks like I cross posted with a couple of others who said the same thing as I did but with fewer words...

[ILoveJellybeans]

Oh God, I wonder what happens when you feed a corpse. The results are going to be horrifying

[gustava]

How long does the brain have to be deprived of oxygen for it to be dead? The related question is why, when she went into cardiac arrest, did it take so long to get her heart going that her brain died?

Do my questions make sense? I'm an English teacher whose knowledge of science is pathetic.

[apple1]

How long does the brain have to be deprived of oxygen for it to be dead? The related question is why, when she went into cardiac arrest, did it take so long to get her heart going that her brain died?

Do my questions make sense? I'm an English teacher whose knowledge of science is pathetic.

(I am a healthcare professional/ not a physician).

Generally, the heart must be restarted within 6 minutes to prevent brain death.

However - it's not that simple.

In one direction, it is also well-known that hypothermia extends the time before brain death occurs. So - there is the caveat that "they're not dead until they are warm and dead". This has been proven true with, for example, children pulled from cold ponds and resuscitated after much longer times, who turn out to be OK in the long run.

In the other direction - more factors come into play. The brain requires both oxygen and glucose to stay alive. These two substances are carried to the brain by the bloodstream. During cardiac arrest, of course, this is not happening. The heart can be shocked and restarted, but if there is insufficient blood supply (hemoglobin in the red cells is the oxygen carrier), the brain is still not getting adequate oxygen.

Based only upon news stories, it is my understanding that Jahi hemorrhaged severely post-op. In addition to cardiac resuscitation, she may have required sufficient transfused blood infused to carry enough oxygen to keep her alive. Blood can be infused fairly quickly if there is are adequate line(s) in place to infuse it, but it is still not instantaneous.

There are many additional factors. Maybe she didn't have adequate line(s) postop. Starting lines during cardiac arrest (with its circulatory collapse) can take time. Maybe the heart didn't initially respond. Just because paddles are used doesn't mean that every heart starts right back up in normal fashion.

This is extremely complex and we cannot know what actually happened in this case. Much of the "news" in this case has been conjecture.

My comments in this post are based on general info, and I have no knowledge about this specific situation.

[mags]

(I am a healthcare professional/ not a physician).

Generally, the heart must be restarted within 6 minutes to prevent brain death.

However - it's not that simple.

In one direction, it is also well-known that hypothermia extends the time before brain death occurs. So - there is the caveat that "they're not dead until they are warm and dead". This has been proven true with, for example, children pulled from cold ponds and resuscitated after much longer times, who turn out to be OK in the long run.

In the other direction - more factors come into play. The brain requires both oxygen and glucose to stay alive. These two substances are carried to the brain by the bloodstream. During cardiac arrest, of course, this is not happening. The heart can be shocked and restarted, but if there is insufficient blood supply (hemoglobin in the red cells is the oxygen carrier), the brain is still not getting adequate oxygen.

Based only upon news stories, it is my understanding that Jahi hemorrhaged severely post-op. In addition to cardiac resuscitation, she may have required sufficient transfused blood infused to carry enough oxygen to keep her alive. Blood can be infused fairly quickly if there is are adequate line(s) in place to infuse it, but it is still not instantaneous.

There are many additional factors. Maybe she didn't have adequate line(s) postop. Starting lines during cardiac arrest (with its circulatory collapse) can take time. Maybe the heart didn't initially respond. Just because paddles are used doesn't mean that every heart starts right back up in normal fashion.

This is extremely complex and we cannot know what actually happened in this case. Much of the "news" in this case has been conjecture.

My comments in this post are based on general info, and I have no knowledge about this specific situation.

I agree.

I'd like to add that during a cardiac arrest it is also important to place a breathing tube into the airway, usually by going through the mouth. In someone who is bleeding profusely from the airway/throat area, visibility is limited and placing a breathing tube is difficult. So even if everything works perfectly on the circulation front (i.e. the heart starts right back up and she has two or more good lines transfusing blood as fast as possible) getting oxygen to the brain will take longer if the medical personnel has trouble establishing an airway.

[twinmama]

Oh God, I wonder what happens when you feed a corpse. The results are going to be horrifying

I have no idea at all what will happen, but when my kids were in the NICU they had ng tubes for feedings. And before the nurse was allowed to give their next feeding, they were required to check for residuals (meaning food from the previous meal that had not been digested). If there were residuals, it was re-fed and checked again. A dead body is obviously not going to digest anything, so if they checked for residuals it would all be there presumably and I don't think she would ever get past the first "meal."

[gustava]

I agree.

I'd like to add that during a cardiac arrest it is also important to place a breathing tube into the airway, usually by going through the mouth. In someone who is bleeding profusely from the airway/throat area, visibility is limited and placing a breathing tube is difficult. So even if everything works perfectly on the circulation front (i.e. the heart starts right back up and she has two or more good lines transfusing blood as fast as possible) getting oxygen to the brain will take longer if the medical personnel has trouble establishing an airway.

Thanks. That helps me better grasp the complexity of the situation.

[Buzzard]

Does the lawyer really believe this? He says she's "improving" and now getting the care she should have been getting all along.

How can a corpse improve?

http://www.cnn.com/2014/01/08/health/ja ... th-update/

"She is doing very well and getting the treatment she should have gotten 28 days ago," Dolan said, referring to what happened to Jahi after a December operation.

"Doctors are optimistic that her condition has stabilized and that her health is improving from when she was taken from (the Oakland hospital)."

Pictures or it didnt happen.

This whole thing really illustrates how amazing our bodies are. The heart functioning independent of the brain etc. The biology/anatomy I'm learning is fascinating.

I'm assuming the weight loss is due to her cells using the stored energy in fat to "run the powerhouse" so to speak. Does anyone know if the length of time she can maintain correlates to fat stores? Would she have run out of energy sooner if she had weighed less? At some point the body will cannibalize muscle, right?

[ILoveJellybeans]

How can they say she is doing well and improving. Cause living people who are just in comas are supposed to smell like death, right?

[Becket70]

I have been peppering Mr. Becket70 with questions, since he is in the medical field. I, too, was confused as to how she can have her heart keep beating in this situation. His answer was that, while she is brain dead, she is not clinically dead. He feels the brain stem must still be functioning, though he says it is functioning on a primitive level. Hence, her heart continues to beat and her reactions are reflexive. He said they can keep her going for a while but her brain will never recover. I don't know if there have been any PROVEN (not anecdotal) cases of a person recovering from brain death. Anybody ever heard of such a thing?

[twinmama]

People who wake up from brain death were not brain dead to begin with. Everything I have read says she has no activity in her brain stem either.

This explains exactly what is happening to her body and why she will never wake up. http://media.nbcbayarea.com/documents/HeidiFlori.pdf

[salex]

People who wake up from brain death were not brain dead to begin with. Everything I have read says she has no activity in her brain stem either.

This explains exactly what is happening to her body and why she will never wake up. http://media.nbcbayarea.com/documents/HeidiFlori.pdf

I thought this was a thoughtful and serious view of the facts of life/death.

I warn against reading it if graphic medical descriptions of what the body does after death would be disturbing to you.

sprocket-trials.blogspot.com/2014/01/jahi-mcmath-merely-dead-or-really-most.html

[twinmama]

I thought this was a thoughtful and serious view of the facts of life/death.

I warn against reading it if graphic medical descriptions of what the body does after death would be disturbing to you.

sprocket-trials.blogspot.com/2014/01/jahi-mcmath-merely-dead-or-really-most.html

Yes, this is what I had read would be happening to her brain. I didn't want to say it without a link to back it up as it's very disturbing. Thank you.

Reading that information again makes me think that the mother really needs someone to stand up to her, for her own good and the good and dignity of Jahi's body, and tell her she cannot continue this. Horrifically painful as it would be, she needs to be stopped. Why everyone around her is insisting on indulging her delusions I don't understand. She believes something that is not true, not something that requires faith or something that might become true, something that is flat out false. Its almost cruel to not disabuse her of that, or if that's not possible take the actions that she cannot.

Speaking of that, what is the law here? Can only Jahi's mother turn off her ventilator at this point? If another relative did it, would Jahi's mother be able to sue them?

[Coconut Flan]

Reading that information again makes me think that the mother really needs someone to stand up to her, for her own good and the good and dignity of Jahi's body, and tell her she cannot continue this. Horrifically painful as it would be, she needs to be stopped. Why everyone around her is insisting on indulging her delusions I don't understand. She believes something that is not true, not something that requires faith or something that might become true, something that is flat out false. Its almost cruel to not disabuse her of that, or if that's not possible take the actions that she cannot.

This. That anyone would encourage her in the delusion is horrible. The hospital was trying to bring her to reality and that should have been encouraged rather than vilified. Anyone who has participated in what has basically been desecrating a corpse should be ashamed.