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TopazLover 38,305 Views

Joined: Jun 7, '08; Posts: 7,997 (86% Liked) ; Likes: 23,035
retired; from US

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  • Jan 22 '14

    I regard anyone who does to another human being what this man did more akin to a two-legged globule of phlegm with a pulse than a fellow human being. His actions were despicable beyond what words can describe and the mind can comprehend.

    That said I believe that how society reacts to this crime is an entirely different question.
    I personally strongly oppose the death penalty. I don’t believe that the death penalty has a place in a civilized society.

    In this case the legal punishment decided on was death. It was not death with a wee bit of torture and suffering thrown in for good measure. Therefore the method of carrying out the punishment in my opinion should be quick and painless. Not because the murderer deserves it but because it cheapens us as a society to stoop to his degenerate level.

    I think that the right we as a society have to call the actions of others immoral is dependent on how we ourselves act. You cannot say that we will punish others for large evils if we allow ourselves small evils. How much suffering can you impose on another before your own actions are so deplorable that you are no longer distinguishable from the one you are casting judgment on? For how long can you claim that you are on the side of the good/right/moral? To me this is a very slippery slope. I believe that causing other human beings pain and suffering is wrong, regardless of our reasons and motivation.
    (The obvious exception to me is self-defense).

  • Jan 22 '14

    My first job out of nursing school was at a long term care facility. It wasn't my ideal situation, in fact the ten-years-ago I would have never saw it coming. While I knew some of my classmates were holding out for that perfect job in labor and delivery, gracefully bringing new life into the world, here I was on the opposite end of the spectrum. I saw people at their hardest points in life, I watched people take their last breath, I spent Christmas night with people who'd otherwise be completely alone. It was hard, but as a new grad I needed experience, any experience because it wasn't easy to come by.

    In that first year of employment, some days were smooth and other days were filled with unpredictable chaos, but one thing was always predictable reliable, and that was Bill and Sandy. Every day around 2pm as I entered the facility, mentally preparing for the shift ahead of me, I could always count on seeing the two wheelchairs, linked by hands. Sometimes you could stand by and hear the flirtation and giggles. It would remind you of your first love.

    "You're pretty." He would say.
    "Oh shut up" she always retorted with sass.

    In the new employee orientation, we even had a special segment by the social worker dedicated to the two intermingling.
    "Both of them have real spouses at home, and so you must keep an eye on them. If any family is coming to visit please separate them, and we don't let it ever go beyond hand holding."

    Sometimes their flirtation got a little hot and heavy, causing me to blush and carry on. How awful I thought, to know that he is being unfaithful and had a wife at home. Though as the 50+ hour work weeks would come and pass I would see that his wife wasn't much in the picture. It seemed that she had a busy life that didn't involve Bill. Maybe it was because she knew about Sandy and that put her off, the reason remained a mystery but the one obvious fact was that Bill and Sandy were very much in love.

    Maybe it was wrong, but when your life is in a facility, you would never be against two people bringing joy into each other's lives daily. So as the sun rose and the moon fell, Bill would be next to Sandy unless sleeping hours had struck. It was an everyday occurence to see them together at meals. But one day, I only saw Sandy sitting alone in the cafeteria.

    "Where's Bill?" I asked my aide.
    "Bill didn't wanna get up today, he seems really tired."

    Hmm that's unusual, I thought. I popped into his room and he drowsily greeted me. His vital signs were normal, and so I carried out the rest of my hefty medication pass, sending the aide in to feed him dinner in his room.

    A couple hours had passed as I made my evening rounds. I always hated night time meds, it meant waking up 20-30 elderly patients out of their beauty sleep to talk them into swallowing pills, usually always unpleasant and unwelcomed as you can imagine.

    I was about halfway through the pass when Bill's aide came running down the hall towards me and I knew something was wrong.

    "I got him up for the restroom and he collapsed, he's really out of breath and dizzy, his blood pressure is 180/100. His words are jumbled-"

    With what felt like only seconds of an assessment I knew something wasn't right. It was so uncharacteristic of him to pass up a dinner date with Sandy.

    "Send him out immediately" the doctor said via returned page. Sending out is nursing home terms for call the ambulance and have them handle it because this is serious. As I stapled together all necessary paperwork to hand off to the EMT, I checked on Bill who had his aide nearby for support.

    "Bill, the ambulance is on it's way okay?" And usually defiant to any sort of fuss he replied "ok" shakily with obvious fear in his voice.

    His roommate, an amputee sat up out of his sleep confused by the commotion, their beds only divided by a thin blue curtain.

    As my heart felt its usual raciness in times of stress I couldn't help but think about Sandy. They always mentioned in school the "nurse's instinct". It was something, though new to me, that I was starting to develop. My nurse's instinct was proving itself right more often and I something inside told me that Bill would not be coming back. I thought about Sandy rushing out of bed the next morning, putting on too much rouge to meet Bill for breakfast and him not being there and us having to explain something and though she was old as hell she was sharp as a tack. That's when I made a split decision.

    "Sandy. Wake up." I helped transfer her into her chair.
    "What is this about! ?" She said with her always present attitude. I pulled her silk nighty over her legs. "You need to say goodbye"

    And no further questions were asked as the staff far down the hall looked at me puzzled. I squeezed Sandy in her wheelchair to his bedside and went against all patient fraternization rules, nurse professionalism rules and scantily dressed patients being in the opposite sex room rules. Maybe this was too much, and highly inappropriate, I thought, but it felt like the right thing to do. So I rolled her to his bedside, and gave enough privacy to still be near enough to hear:

    "I love you Sandy"
    "Oh shut up" she said and gave him a single kiss on the hand.

    I tried to keep it together. This reminded me of a scene from the Notebook or some equally heart wrenching romance flick. Only this love was real. I gave them a few more minutes together and before the paramedics arrived I had Sandy back comfortably in bed.

    The "nurses instinct" proved right once more, and Bill didn't come back. He died the following morning of multiple organ failure. It was fast and unsettling, but I felt that I did my job in having his nursing home mistress there to see him off.

    It took a while to get used to not seeing them together. She never once mentioned him to me, and I never brought him up to her. I was never mandated for what I did that night. I'm pretty sure no one of authority knows about it. Eventually his bed was filled with another elderly gentleman and we moved on with our lives. The nursing home was cold in that way. One trauma to another all fading into a distant memory.

    So often in nursing we are bombarded with rules and beaurocracy and paperwork. So much that even the sweetest of souls becomes tired and desensitized. We need to take ourselves back, mentally to the initial drive and purpose of what our jobs are. The compassion part. We must follow the strict guidelines but every so often our heart makes an exception to the rules.

  • Jan 22 '14

    During the second week of January 2014, there was a small Internet storm regarding blog posts written by Emma and Bill Keller for The Guardian and The New York Times, respectively. The Kellers wrote about Lisa Bonchek Adams, a very well-known breast cancer blogger who last year was diagnosed with Stage IV disease after having been in remission for over five years.

    Ms. Adams tweets and blogs frequently about her day-to-day experience as a forty-something mother of three young children who also has metastatic breast cancer. The Kellers' posts came across to most people as very negative, as labeling Adams' social media activity as poor taste, TMI (too much information, over-sharing) and undignified, and as comparing her readers to gawkers at a car accident. Emma Keller wrote: "Should there be boundaries in this kind of experience? Is there such a thing as TMI? Are [Lisa Adams'] tweets a grim equivalent of deathbed selfies, one step further than funeral selfies? Why am I so obsessed?"

    In addition to being a health care professional, I am also a Stage IV breast cancer patient, and I publish a blog about my experience, so I followed the developments closely. I tried to understand why such strong negative feelings had been aroused and why I was reacting to them so strongly.

    Then it came to me. Those of us who use social media to talk about our life with terminal illness are defying categories. Social media is supposed to be for active people who eat in restaurants and play with their pets and attend sporting events and go to professional conferences, right? People with terminal illness are supposed to rest quietly in darkened rooms or lie sighing on a chaise longue on the porch or smile bravely as they murmur a few words to their nearest and dearest, right?

    Perhaps the discomfort expressed in the Kellers' posts is a reflection of society's discomfort with death and dying? People like Lisa, people like me, cause discomfort to some because we bring our experience out of the sickroom and into the full light of day. We cause discomfort to some because we are living, living with full knowledge of our impending death, living in pain and with disability, but living as fully as we can while we are dying.

    People like me write because we are writers. Should we stop writing just because we are nearing the end of life? Should we forego the social interaction that is made so difficult by our physical condition but is facilitated through the new media? Should we lock ourselves away in a figurative darkened room so as not to chance disturbing the hale and hearty with thoughts of death? This is a social issue and an eschatological question (in the larger sense). Our writing is an expression of our humanness, of our being as a social animal.

    Nurses support and encourage physical, mental, emotional and spiritual wellness. The phenomenon of some people living for several years with metastatic cancer is relatively new, and it brings with it new challenges. Advocating for our patients in terms of pain control, ADL support, cognitive support and spiritual needs is part of our training and our traditional role. Perhaps we need to look at new and creative ways to advocate for our patients' social needs, as well.

  • Jan 17 '14

    Well, everyone here is going to hate me, but I don't care: I am foursquare opposed to capital punishment. If it were up to me, it would be abolished. I mourn with the families of the victims, too.

    I oppose the death penalty, but that doesn't mean I'm a bad person.

    I should probably refrain from coming back to this thread. I'm afraid of the blowback that will await me.

  • Jan 14 '14

    I enjoy being professional. To be a person of character. To be weeping and carrying on at bedside perhaps is not the best choice--I have a tremendous amount of coping skills--however, ya gotta keep that professional level of communication. Empathy. But when I am done for the shift, I am all set. I have other fish to fry.

    Otherwise, I wish I had a sugar daddy, shopping and lunching and mani-pedi-hairdo kind of days. One foot in the grave the other on a banana peel--and a golf obsession so that my afternoons are free......

    But instead i have a boat load of kids, just as many bills, a messy house, a sarcastic wit and I am a nurse because I am good at it. (so they tell me).

  • Jan 14 '14

    Re the differing view on referring to the dead body/cadaver/person/corpse/...and whether its appropriate or kind or a dose of reality...
    It came to me that it might be useful to think of the family of the person who died as a person who just had their leg amputated (and the dead person as the leg).
    The phantom pain that they are feeling is real. They may still feel like the person/limb is still there. We need to understand and respect the loss of something that over time influenced so many synaptic paths to form in the brains of friends and family.
    Yes the sad events surrounding the death of the girl in CA have gone to the extreme in how we deal with death. And I believe/hope that this is an exception as to how we deal with death.
    But I think it is appropriate to be kind and understanding to loved ones about how e refer to a recently/just died person. I am in no way advocating terms like 'passed, gone on, left us, ... But we have a responsibility to acknowledge the realities and feelings of the family in a way that helps them to achieve acceptance and closure.
    I can come up with other analogies for this situation, but I believe most will get the point I am making.

  • Jan 11 '14

    When outside of work do you constantly find yourself ready to take action at the sound of a beep/alarm? Do you find yourself looking at a strangers' arm looking for a vein? How about a dirty baby who needs some cleaning? Please share your stories below...

    Click Like if you enjoyed it. Please share this with friends and post your comments below!

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  • Jan 11 '14

    I'm sorry, the idea of talking about people on life support being "cadavers" or speaking of them as just being on "organ support" gives me the chills. I imagine families would simply flip out at having their loved ones referred to in this manner, and I also think the effect would be the opposite of what is intended. They may just as well become more defensive than ever, not more accepting.

    I don't think it is possible to be too empathetic to families in this situation.

  • Jan 11 '14


    Bless you for sharing. Peace be with you.

  • Jan 11 '14

    I unfortunately understand this better than most my son committed suicide in August of last year in jail as such he was a young healthy man other than having bipolar disorder newly diagnosed and after they resuscitated him he coded three times on the way to the hospital and they did neurologic testing and he was pronounced brain dead they tried to wean him off the vent and he didn't even have enough brain stem activity to maintain or even take a breath. It was hard for me to understand he was brain dead even though I am a nurse until I saw him in his bed in ICU and I knew the machines were what was keeping him alive. He would not have been breathing if not for the ventilator and the only reason he had a heartbeat was the multiple meds he was being given to do so.
    I feel first of all the physician did not explain the concept of "brain dead" to the family and the ICU nurses failed to show and teach the family what the machines were doing and the hospital last of all by threatening to turn the girls life support off was wrong. I am saddened that the hospital thought they had that right my son died in a hospital system in the Midwest and the hospital administrators or nursing staff never at any time suggested we turn off the life support .
    We, my ex husband and my daughters decided on organ donation and as such he was kept on life support until organ harvesting could happen its a delicate dance because the transplant team had to fly in and do their harvesting then release him to the coroner and the funeral home. As a parent of a child brain dead it made all the difference to me and my family in how the medical team at the hospital treated us and how they respected it took time to make decisions. I feel the medical team and the hospital did this family a disservice and then threatening to cut the life support off is inhumane and I would be acting the same way as that Mother is.
    I do believe they should change the terminology because the machines are forcing air and medications maintain heartbeats and life is a misnomer in this instance. Sorry this is so long and I haven't been on Allnurses for some time but I wanted to share what is like on the other side of the bed as well. I hope this family gets some closure and comes to a decision soon.

  • Jan 11 '14

    Quote from GrnTea
    This is an idea that originated in a legal nursing group discussion about the brain-dead teen at Children's in Oakland. While I completely understand the family's pain and that a lot of it is due to misunderstandings (e.g., the mother is reported to have said, "She's not dead, her heart is still beating and she breathes,"), I think the language we use in these situations contributes to this, and would like to spread the idea that better language would be more descriptive.

    What would it be like if the health care people involved in this didn't say that a brain-dead person was on "life support," but instead called it "organ support"? In these cases, the life is over.
    This is a great thread on a really important topic with good arguments on both sides. I think allow natural death is a wonderful terminology because I'm sure if you asked lay people what they think resuscitation means you'd get a variety of answers some right on the money and some that are waaaay out there. While I'm among those who cringe when I hear a patient referred to as "the body" (or some other depersonalizing term) I think we need to make sure people have a clear understanding of what "death" is and what is beyond our ability to help. CPR, as one poster commented, is what we do when someone is already dead not something to prevent death, but that's not usually how we present it. It usually goes something like if they need a breathing tube or their heart stops beating do you want us to do everything?

    I work in the ER and someone asked me what I thought about Jahi McMath and I said I heard something about the family wanting treatment for a little girl who was dead but never heard the whole story. They told me that they (doctors, hospitals, etc.,) were refusing to let the family get her treatment and wanted to take her off life support because she was brain dead. Suddenly the whole "controversy" made sense to me. I explained that being brain dead is not the same thing as being in a coma or a persistent vegetative state. When I explained that in brain death there is no brain activity and there is no longer any blood flow to the brain. Just like any other organ or body part that loses blood flow the brain literally dies. Then it made sense to them. Medical professionals weren't being cruel or worrying about the expense of caring for her; she was really dead. Before taking a course on brain injuries and criteria for determining brain death I didn't completely understand what brain dead meant and I'm a nurse so I can imagine how confusing it is for the public, especially grieving families.

    I think life support is a terrible and ambiguous term. Most people associate it with being on a vent which can be necessary for any number of reasons. Organ support certainly sounds accurate but I can see the we just want to harvest your organs connotation some people are talking about. When I hear mechanical support I think mechanical what support, what are we supporting? Body support sounds cold. Metabolic support maybe? Support feels like something that will help you recover so maybe we need to lose the support part all together and call it maintenance or something less hopeful? I don't know. People will hear what they want to hear so a name change probably won't do it and since many people lack even the most basic knowledge of anatomy and physiology there's no easy explanations.

    What really frustrates and angers me about cases like Jahi McMath is that some entity is willing to exploit the family's grief by accepting a dead little girl as a patient. All this does is create more public confusion about brain death, prolong the family's suffering, and keep them from getting closure. And who's going to pay for her care? I highly doubt an insurance company is going to pay for the care of someone who is not only receiving futile treatment but is also deceased. That sort of thing just disgusts me.

  • Jan 7 '14

    She comes home livid.

    She's glaring at the garage door as it cr-cr-creaks its way open, revealing an old, beat-up Subaru parked happily in the one-car space where she was gonna cram her relatively new SUV into. The sight of the vehicle's dull, green paint brings unspeakable, almost unbearable relief. She realizes he is still home and that's the best news she could have gotten after the horrible night she's trying so damn hard to shake.

    She ignores the cheerful dog who greets her at the door. Instead, she kicks off her shoes, scales the stairs two steps at a time, and barges into their shared bedroom. She finds him nestled in their blankets, barely stirring, and promptly drops to the floor by his side like some forlorn heroine in scrubs. She's too gross for the bed, but she'll be damned if she'll stay on her feet one second longer.

    "Good morning," he mutters, and that's all it takes.

    "What is wrong with you doctors!" Begins her rant, but she takes it down a notch almost right away with a guilty apology. "Not all of you, I'm sorry. Just--" And he struggles to crack an eye open, knowing that the apology meant she was about to unleash a hurricane of a vent meant for one of the members of his profession who she could not give a piece of her mind to during her shift. "Is it necessary to be such a horrible human being all the damn time?" she asks in a voice too loud and too shrill for 0745. "Is it my fault you just got a patient admitted under your service? Is this news to you? Why are you acting like I'm inconveniencing you for doing my job and helping me do yours? Do you think it's fun for me to watch your patient cough, and wheeze, and panic because she can't breathe? Do I sound like I'm calling you just because I enjoy your fun personality? Oh, god forbid I actually care for the comfort of my patient and the sanity of her family members! They're in the hospital in the middle of the night thirty-six hours before Christmas for a reason! It's not a happy time for them either, you know."

    He hasn't gotten a word in yet. In fact, he's still rubbing the sleep from his eyes with one hand while the other reaches out to soothe the head of the nurse who, in her utter frustration, has now taken to hiding her face in the sheets. "You're talking about B., aren't you?" was the second sentence the doctor manages to form today.

    Of course it's Dr. B. It's almost always Dr. B. He's heard nothing but horrible things about that doctor from nurses and fellow physicians alike, but what can you do? The man desperately needs a good talking to, but none of the hospitals in this city seems to have the guts to say anything to him yet.

    "Ugh, he's so horrible!" she groans into the blanket. "I'm sorry, baby. Good morning. What time do you have to work today?" In twenty minutes, actually, but he ignores the question, knowing it is just an intermission in the full-length opera that is his nurse wife's need to vent.

    She sits there for a while, letting off steam while he tries his damned hardest not to seem uninterested while getting ready for his own work day.

    Their one-sided conversation even reaches the bathroom AND the shower.

    "Next time, I am not waiting for a convenient time to call that -insert a train of expletives here-!" she promises. "Patient has a little itch at 3am, I'm paging him. He's gonna be unprofessional and demeaning anyway, so why should I care if he has to wake up!"

    He actually laughs at that and gives her a hug (since she's finally washed and showered the hospital ickies away). "That's why I don't mess with the nurses. You guys can really make or break a doctor."

    And just like that, her rant ends. She sighs deeply, briefly buried in his arms, and realizes that the heavy feeling in her chest that almost resulted in a fender-bender in her own garage had dissipated.

    This is what baffles him the most about the woman he had chosen to spend his life with. He does not understand how all that fury could suddenly be extinguished. It escapes his comprehension, but he takes advantage of it anyway. He leads her to bed and tucks her in. She's laughing now as she apologizes for the nth time for being ridiculous and waking him up the way she did. She then thanks him for some weird reason!

    In her sudden exhaustion and his rush to get to work on time, they forget a lot of things. She manages a simple, "Have a good day today, doctor." before he's out the door.

    She forgets to tell him that the gratitude is for honoring their agreement from many years ago: that she would be nice to doctors and he to nurses, in the hopes that, somewhere out there, a nurse will be good to him, and a doctor will be kind to her. They were only novices in their professions then, so young and naive. But while she slips occasionally in her frustration with the physicians around her, he continues to be good to the nurses he works with, and she loves him for that.

    She forgets to explain that his little comment about nurses having the ability to make or break a doctor is the first acknowledgement she's received in months of her and her profession's ability to do anything, let alone affect someone else's life that drastically. But he empowered her with that innocent statement, pulling her straight out of her frustration, and he won't even realize it.

    And, like an idiot, he forgets to tell her that he's driving to a thirty-six hour call and he won't be seeing her again till after her shift two days from now. He'll kick himself later for this little mistake, but, for now, the only thought occupying this hospitalist's head is a fervent, desperate hope that he won't get too many admits tonight.

  • Jan 7 '14

    As a nurse who has left the clinical side of the profession, I've had a little time recently to ponder both the good and bad aspects of the vocation I chose long ago. And although it got to be too much for me in the end, there was far more positive than negative. Here are the things I used to love about nursing:

    10) I very much enjoyed working in the most comfortable clothing on the planet. What other field lets you work in what are basically pajamas with lots of pockets? And sneakers?

    9) Variety! There are so many kinds of nursing that it would take several lifetimes to try them all. Just in my own career, I've worked LTC, med/surg, ICU, mother-baby, assisted living, memory care, and skilled nursing. I've been a CNA, charge nurse, floor nurse, care manager, and director of nursing, and now I'm a long-term care surveyor. What else can you do with a two-year degree that offers so many different opportunities?

    8) The chance to meet many types of people and see so many different situations. I've cared for politicians, doctors, local celebrities, priests, and hospital CEOs. I've also cared for people at the opposite end of the socioeconomic spectrum and found their stories just as compelling. I've seen lives begin, and I've seen many more of them end. I've known 100-year-olds who survived massive strokes and were still living full lives, and I've known 40-year-olds who gave up and died within weeks of receiving a cancer diagnosis.

    7) A decent standard of living. Although wages have flattened out quite a bit in the past ten years or so, nursing still pays better than a lot of professions that require more education. I do believe that the BSN will eventually be the entry point for nurses; however, for some of us who were either super ambitious or simply really lucky, it's been possible to go pretty much anywhere and do anything we wanted with our ADNs.

    6) OK, I'll admit it: I really did enjoy taking care of people and making them feel better. When I was young, I cared for my grandmother who had been a nurse during World War I, and I remember charting her medications and giving report to the doctor who came around to visit (yes, I'm old enough to recall when they made house calls). I carried those memories all the way through my nursing career, and nothing pleased me more than solving a patient's problem and being able to say, "Everything is all right. I fixed it."

    5) Interesting co-workers. Nurses come in all sizes, colors, nationalities, and philosophies of life, and I've learned something from each and every one I've encountered.....even if it was only the way I DIDN'T want to work or live.

    4) Learning about so many fascinating diseases and conditions. In school, I was the only one in my entire class who got to see a real, live case of necrotizing fasciitis as it progressed during my clinicals. And thanks to the curiosity ingrained in me during my days as a student, I've also become something of an expert on the chronic health issues which affect me, as well as several of the people I'm close to. I can't imagine dealing with these conditions without the knowledge base I have as a nurse.

    3) Nursing has also given me some much-needed patience. As a child and even well into adulthood, I had a quick temper and a tendency to go off like a hand grenade at almost any provocation; now, when confused, combative, potty-mouthed Martha asks me for the tenth time in five minutes where the (rhymes with duck) she's supposed to go, I'm not even tempted to tell her.

    2) Nurses are still the most-trusted professionals in America. Need I say more?

    1) To paraphrase the old Peace Corps ad: Nursing is the toughest job you'll ever love. And I did love it, even though I sometimes went home dragging my aching bones like an old tired dog and swearing I wasn't going back. If life events and illness hadn't intervened to make it necessary for me to change course, I'd probably have stayed at or near the bedside until retirement age. Still, as I look back on almost two decades in healthcare, I'm satisfied that I made the right decision to get out before I had nothing left to give.

    But you see, it's like this: you spend a good piece of your life holding the lives of patients in your heart and hands...and when you leave, you discover that it was really the other way around all the time.

  • Jan 5 '14

    Really who cares what we say. The majority of pts families will call it life support. They will also refer to end of life as pulling the plug. Our job is to help educate so the understand what exactly is going on. Renaming it does not educate.

  • Jan 5 '14

    The Jahi McMath case is unfortunate, extreme, and atypical ... with an extraordinary amount of media coverage of all types, with every conceivable level of accuracy and inaccuracy.

    But in terms of caring for critically ill patients and those at the end of life on an everyday basis ... I will say that I have never heard any clinician at my academic tertiary care hospital use the term "life support" or "coma". We (nurses, physicians, respiratory therapists, et al) use phrases such as "supporting her breathing" for a patient who has respiratory and/or neurologic compromise and is intubated & on a vent, but does have spontaneous respirations ... or "breathing for him" for a patient with little to no chance of recovery. We discuss exactly what the patient is or is not doing neurologically (responding to painful stimuli, etc) and what it indicates as far as prognosis. I've had families ask things like "does that mean he's in a coma?" ... but again we respond with specifics ... not labels. The physicians I work with clearly discuss with families assessment findings which indicate brain death.