SO does she move? This whole thing just confuses me.
The first video I was like "okay where's the string?". The second video seems more convincing. Not when she moves her hand, but the way her body moved at the end. I used to be a RN in a Pediatic ICU and she definitely reacted how a child with a anoxic brain would when stimulated. Whether or not that was faux is the question....
The first video I was like "okay where's the string?". The second video seems more convincing. Not when she moves her hand, but the way her body moved at the end. I used to be a RN in a Pediatic ICU and she definitely reacted how a child with a anoxic brain would when stimulated. Whether or not that was faux is the question....
I don't think I can watch the videos, but would anoxic mean brain death? Or just a brain injured due to being deprived of oxygen?
To me the videos aren't bad. But I also dealt with this on a near-daily basis so my view is slued . She's not decaying. She has kid blankets on her. She looks quite comfortable. Anoxic brain injury does not mean brain death- just lack of oxygen. Pts have this spastic movements and can have clonus and such.
You could just turn it on an pause it if it looks to be too much.
I don't think I can watch the videos, but would anoxic mean brain death? Or just a brain injured due to being deprived of oxygen?
To me the videos aren't bad. But I also dealt with this on a near-daily basis so my view is slued . She's not decaying. She has kid blankets on her. She looks quite comfortable. Anoxic brain injury does not mean brain death- just lack of oxygen. Pts have this spastic movements and can have clonus and such.
You could just turn it on an pause it if it looks to be too much.
So did the video change your mind at all? Assuming it is not faked...
My completely non-medical thought: Wouldn't someone in her condition have muscle spasms and twitches? Were they coaxing her to "move" but knew she'd probably twitch within the next 15 seconds or so? For example, when she "moved her hand" at first it was controlled motion and they next time was a relaxation, dropping the cotton roll?
To bolster his claim that Jahi McMath should be declared “alive again,” the attorney for the Oakland teenager’s family displayed video clips Thursday that he says show the girl responding to her mother’s requests to move her feet and hands.
“Jahi suffered a serious brain injury — no doubt about it,’’ attorney Chris Dolan said. “But we question how accurate the brain-dead assessment is.”
Doctors at UCSF Benioff Children’s Hospital Oakland declared the 13-year-old girl brain dead in December after she went into cardiac arrest following routine surgery to deal with sleep apnea. Her family has fought the hospital every step of the way and says she is still alive.
Dolan said the goal was to “get the mantle of death off of her” so that Jahi can return to California from New Jersey, where she is being cared for by her mother, stepfather and sister at a private home.
In one video clip, which the attorney said was shot within the past few days, Jahi’s mother, Nailah Winkfield, is seen coaxing her daughter to move her foot and toes.
“Come on Jahi, you can do it,” Winkfield says, and after several seconds pass, the girl jerks her foot.
In another clip, the mother urges Jahai to move her hand, which is holding a foam padded cup. The girl lifts the cup a few inches, then drops it.
In both videos, Jahai is hooked up to a ventilator and feeding tube.
Dolan also showed still photos of Jahi in a cherubic state with her hair neatly pulled up in a bun and her skin appearing smooth and healthy.
The attorney said he would use the videos to support his filing this week in Alameda County Superior Court seeking to have a judge overturn his finding that there was “clear and convincing evidence” that doctors had properly declared Jahi brain dead.
He showed off the videos to reporters in his Market Street office, in a presentation that featured two large TV screens and a phone hookup with the head of a brain research foundation in New Jersey who took part in tests on Jahi at Rutgers University medical school.
If Dolan can persuade the court to overturn the judge’s death finding — as well as a subsequent ruling from the Alameda County coroner — she could be returned to her home in California, with the costs to care for her shifted to the state and possibly UCSF Benioff Children’s Hospital Oakland.
Jahi can’t get health care in California now because of the declaration of brain death, Dolan said. “We can’t do anything now because under California law she is brain dead.”
If nothing else, the photos and video call into question assertions by hospital representatives last year that Jahi’s body would soon deteriorate.
In a court filing by the hospital in December, a critical care pediatrician at Children’s warned that “dramatic signs of the body’s deterioration will continue to manifest over time.’’
Dolan, on a speaker phone with Philip DeFina, chairman and CEO of the International Brain Research Foundation in New Jersey, said researchers had conducted brain imaging and other tests on Jahi at Rutgers University with the assistance of medical school neurologist Charles Prestigiacomo and found she had measurable brain activity.
“If the brain is dead, there is no electrical activity,” DeFina said.
Stanford bioethics Professor David Magnus, who has not seen the video showing Jahi’s movements or DeFina’s findings, disputed the validity of any test that wasn’t an independent clinical exam conducted by a qualified neurologist.
“I haven’t seen any signs or evidence that they have had such an evaluation,” he said. “The rest is smoke and mirrors.”
Magnus added, “Patients (found brain dead) don’t recover — it’s irreversible. That would be groundbreaking, and a dramatic finding that would be problematic for the entire neurological community.’’
DeFina said he wasn’t questioning the findings of Children’s examining doctors, but rather the adequacy of the test for brain death that was developed in the 1960s and is still the standard.
San Francisco Chronicle columnists Phillip Matier and Andrew Ross typically appear Sundays, Mondays and Wednesdays. Matier can be seen on the KPIX-TV morning and evening news. He can also be heard on KCBS radio Monday through Friday at 7:50 a.m. and 5:50 p.m. Got a tip? Call (415) 777-8815, or e-mail matierandross@sfchronicle.com Twitter: @matierandross
To me the videos aren't bad. But I also dealt with this on a near-daily basis so my view is slued . She's not decaying. She has kid blankets on her. She looks quite comfortable. Anoxic brain injury does not mean brain death- just lack of oxygen. Pts have this spastic movements and can have clonus and such.
You could just turn it on an pause it if it looks to be too much.
So did the video change your mind at all? Assuming it is not faked...
Absolutely. I used to be pro- brain dead. But if I was her nurse, that would be enough for me.
Interesting thing is that the hospital she's in, is about 25 mins away from me. It stuck a "wtf" in me when I heard the hospital was accepting a "dead body" because it's a really good hospital and I couldn't think why they would do that. Maybe She really wasnt brain dead...
What I fear is the effects of this case on Organ Donation and the already great public fear that we "kill people to take their organs"....
My completely non-medical thought: Wouldn't someone in her condition have muscle spasms and twitches? Were they coaxing her to "move" but knew she'd probably twitch within the next 15 seconds or so? For example, when she "moved her hand" at first it was controlled motion and they next time was a relaxation, dropping the cotton roll?
No. To move, you have to send some impulses to your brain. Humans don't act act like snakes or alligators that can keep moving after theyre killed. Even if we did, snakes/alligators stop moving 11 months after being killed. If you're brain dead, nothing will happen- on command or not.
My completely non-medical thought: Wouldn't someone in her condition have muscle spasms and twitches? Were they coaxing her to "move" but knew she'd probably twitch within the next 15 seconds or so? For example, when she "moved her hand" at first it was controlled motion and they next time was a relaxation, dropping the cotton roll?
No. To move, you have to send some impulses to your brain. Humans don't act act like snakes or alligators that can keep moving after theyre killed. Even if we did, snakes/alligators stop moving 11 months after being killed. If you're brain dead, nothing will happen- on command or not.
Okay, that helps me understand the situation a bit more. Thanks.
So did the video change your mind at all? Assuming it is not faked...
Absolutely. I used to be pro- brain dead. But if I was her nurse, that would be enough for me.
Interesting thing is that the hospital she's in, is about 25 mins away from me. It stuck a "wtf" in me when I heard the hospital was accepting a "dead body" because it's a really good hospital and I couldn't think why they would do that. Maybe She really wasnt brain dead...
What I fear is the effects of this case on Organ Donation and the already great public fear that we "kill people to take their organs"....
Interesting. It just seems like something that shouldn't be debatable you know? Like an MRI of the brain should show one way or the other right? I guess I don't get why there would be controversy over that.
This is very confusing. I'm not watching the video, just based on descriptions here. How long can she remain however she is? On the ventilator?
For as long as you can. Most of the time vent peds patients (and adults) pass from complications like pneumonia, sepsis. Theoretically, if no complications occurred- she could stay like that until natural death.
Absolutely. I used to be pro- brain dead. But if I was her nurse, that would be enough for me.
Interesting thing is that the hospital she's in, is about 25 mins away from me. It stuck a "wtf" in me when I heard the hospital was accepting a "dead body" because it's a really good hospital and I couldn't think why they would do that. Maybe She really wasnt brain dead...
What I fear is the effects of this case on Organ Donation and the already great public fear that we "kill people to take their organs"....
Interesting. It just seems like something that shouldn't be debatable you know? Like an MRI of the brain should show one way or the other right? I guess I don't get why there would be controversy over that.
Yeah but medicine isn't an exact science. There really isn't much evidence on Pediatic Bain death criteria. The latest update was 1987, I believe. When determining brain death there are a few different tests to make sure. Thats why ik extemelt intrested in the medical reports. The gold standard is a Cerebral Perfusion Scan. But it's not a must have.
Interesting. It just seems like something that shouldn't be debatable you know? Like an MRI of the brain should show one way or the other right? I guess I don't get why there would be controversy over that.
Yeah but medicine isn't an exact science. There really isn't much evidence on Pediatic Bain death criteria. The latest update was 1987, I believe. When determining brain death there are a few different tests to make sure. Thats why ik extemelt intrested in the medical reports. The gold standard is a Cerebral Perfusion Scan. But it's not a must have.
Interesting. Although the likelihood (assuming she is not brain dead) that she could recover from such an injury is pretty minimal correct?
Why can she move her body on command but she can't breathe?
Think of the vent in 2 different ways. 1) is she initiating breathing but it's not compatible with life in long term (eg breaths too shallow. After a while your CO2 will get high l/t coma l/t death). 2) is there a lack of any respiratory drive. Sonif we turned off the vent she wouldnt take a single breath.
After your brain lacking oxygen, there's swelling that occurs after. Sometimes the area can recover after. I tried looking at her vent in the video to see. It does not look like she was assisting with any breaths (initiating or helping). But if the vent is breathing enough for her, her head could be telling her she doesn't have to/the vent is set at a higher breath per minute than her drive.
Yeah but medicine isn't an exact science. There really isn't much evidence on Pediatic Bain death criteria. The latest update was 1987, I believe. When determining brain death there are a few different tests to make sure. Thats why ik extemelt intrested in the medical reports. The gold standard is a Cerebral Perfusion Scan. But it's not a must have.
Interesting. Although the likelihood (assuming she is not brain dead) that she could recover from such an injury is pretty minimal correct?
Yes. She would probably stay like that for the rest of her life. Maybe open her eyes spontaneously. But never walk or have any kind of quality of life.
so if she were brain dead, there wouldnt be seizure like activity, correct? the second video with the cup just looks like spasms to me. look at the way her hand forms a claw
Correct. Nothing. No seizures. No jerking. No movement. I have also never seen a brain dead person who develops contractions either. They are flaccid.
Post by karinothing on Oct 3, 2014 21:08:40 GMT -5
Well, now I have no idea what to think. It does somewhat scare me that one could be declared brain dead when they aren't. But then I think that if there is zero change of recovery...does it matter for me? I guess it does for some obviously. Sad all around.
These videos have me completely freaked out. They certainly look real, but if the body is really moving independently, then that means some pretty scary things about the way the medical community determines brain death.
My DH is a neurologist and I asked him about this.
He said: 1) Even a brain dead body can have movement from the spinal cord that's independent of the brain. Whether that movement can occur even a year later is sort of uncharted territory but theoretically possible.
2) Our tools for determining brain death are rather crude. It is possible, for instance, that she still has brain activity at the base of the brain stem; it's really hard to reach the lowest part with current technology.
3) She's not going to recover further; this is it. From a medical ethics standpoint, we're spending millions of dollars to take care of someone who may be, at best, "slightly not dead," as he put it.
4) Given point 2, there may be neurologists willing to say, OK, maybe she's not brain dead in the strictest sense. But given point 3, an overwhelming number of doctors would say this is futile and, frankly, abuse.
Post by Velar Fricative on Oct 4, 2014 9:19:45 GMT -5
I'm not going to watch the video but we can't know that the video is from very recently versus shortly after she was declared brain dead, correct? Or do they do anything showing proof the video is from recently (speaking about current events, holding up a recent newspaper, etc.)? Sounds silly but I can't help but wonder.
My DH is a neurologist and I asked him about this.
4) Given point 2, there may be neurologists willing to say, OK, maybe she's not brain dead in the strictest sense. But given point 3, an overwhelming number of doctors would say this is futile and, frankly, abuse.
This is my understanding. Even if she isn't completely brain dead, she is not going to recover. She is not going to walk or be wheeled out of that hospital. She will not be able to function without machines doing it all for her. This poor child needs to be let go. The parents are torturing her and her family, and they need serious mental help.
This is very confusing. I'm not watching the video, just based on descriptions here. How long can she remain however she is? On the ventilator?
For as long as you can. Most of the time vent peds patients (and adults) pass from complications like pneumonia, sepsis. Theoretically, if no complications occurred- she could stay like that until natural death.
Like, 70 years? I mean, if she's 13, "natural death" could be that far off? I'm just saddened for the family, and very confused still. Thanks for your input, you sound very knowledgable. (Not sarcasm in case tone doesn't come across correctly in text).
My DH is a neurologist and I asked him about this.
4) Given point 2, there may be neurologists willing to say, OK, maybe she's not brain dead in the strictest sense. But given point 3, an overwhelming number of doctors would say this is futile and, frankly, abuse.
This is my understanding. Even if she isn't completely brain dead, she is not going to recover. She is not going to walk or be wheeled out of that hospital. She will not be able to function without machines doing it all for her. This poor child needs to be let go. The parents are torturing her and her family, and they need serious mental help.
Exactly. I even asked him, "So does this case highlight that there's still a lot we don't know about the brain or is it just a freak show?"
So, I really do think this girl is brain dead, but IF she did have some lower brain stem activity, was capable of slight twitches or maybe opening her eyes, does that mean she can think? Is this girl laying there having thoughts and trying to respond to stimulus? Because if so, that is so fucked up on her parents end. The poor thing is not going to get better and she's just trapped.
So, I really do think this girl is brain dead, but IF she did have some lower brain stem activity, was capable of slight twitches or maybe opening her eyes, does that mean she can think? Is this girl laying there having thoughts and trying to respond to stimulus? Because if so, that is so fucked up on her parents end. The poor thing is not going to get better and she's just trapped.
This. I think that the latest information makes this all even worse. Even if she isn't totally and completely brain dead, it sounds like there would be the most minimal activity going on. So, I sure hope there isn't any awareness at all.
So, I really do think this girl is brain dead, but IF she did have some lower brain stem activity, was capable of slight twitches or maybe opening her eyes, does that mean she can think? Is this girl laying there having thoughts and trying to respond to stimulus? Because if so, that is so fucked up on her parents end. The poor thing is not going to get better and she's just trapped.
This. I think that the latest information makes this all even worse. Even if she isn't totally and completely brain dead, it sounds like there would be the most minimal activity going on. So, I sure hope there isn't any awareness at all.
It's unlikely she has any activity in her cerebral cortex. DH said he wouldn't be surprised if it had liquified by now. We're literally talking about the tiniest bit of brain activity, if there's any at all.
But most likely these questions won't be answered until they take her off the ventilator and do an autopsy. I mean, this is all anyone's armchair analysis at this point.
I'm not going to watch the video but we can't know that the video is from very recently versus shortly after she was declared brain dead, correct? Or do they do anything showing proof the video is from recently (speaking about current events, holding up a recent newspaper, etc.)? Sounds silly but I can't help but wonder.
I have been thinking along the same lines. I know the Terry Schiavo people had videos showing that she was "responsive", but they were a couple isolated clips taken from hours and hours of footage where they just kept saying her name or asking her to blink and there was no response. Very a broken clock is right twice a day kind of thing. Videos can lie.