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Girl Brain Dead after Tonsillectomy

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EaglesWings21 is a ASN, RN and specializes in Medical Surgical.

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Considering how many family interactions I've been a part of or witness to that the family has completely skewed what really happened, I'm not judging a hospital based on a one-sided account of what happened.

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...The wording and statement itself shows a Hospital more concerned about policy than doing what is right....

What exactly, do you think, would the right thing be?

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ixchel specializes in critical care.

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It is hard to judge without knowing what all was going on. I formulated an opinion from a previous article about this where a family member stated that the mother kept asking the nurses if that was normal and some said yes and others did not know. I was screaming in my head NO it's not normal to lose pints of blood!!! Thanks for all the responses.

The one thing I remember from my peds class's tonsillectomy lecture was hemorrhage is the biggest, most dangerous risk and the requires immediate transport back to the OR. The number one sign was repeated swallowing.

I wonder if maybe the conflicting nurse responses weren't just coming from nurses. It seems in hospital settings, anyone that walks in wearing scrubs gets called nurse until corrected. Heck, my husband does it all the time, even with his current CNA- soon to be nurse- spouse telling him otherwise several times. He escorts prisoners to the hospital in his work, but still, he uniformly calls everyone nurse.

Regardless, I think this family is struggling to let their daughter go, and I can't blame them for that. A generally uncomplicated procedure with a generally uncomplicated recovery ended with their daughter's death. I wouldn't want to stop treatment either. I would fight to know 1,000,000% it was the right decision before it was made. If I stopped life support before that, I would wonder for the rest of my life if it was really the right time. I hope the family and the hospital are able to work together to allow this grieving family the space and time they need to let go.

As for the details leading up to her death, none of is will ever know what really happened. I don't imagine that the entire hospital staff actually allowed this girl to hemorrhage so profusely without responding. That doesn't seem possible to me. But, we'll never know.

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Esme12 is a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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The one thing that dissappointed me was the way the hospital responded. And i quote"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. " I was like what? who handles PR at the hospital needs to be fired especially that the case is being broadcast across the nation. The wording and statement itself shows a Hospital more concerned about policy than doing what is right. I would never take a child to such a place.
But the child is dead. Legally, medically, technically....deceased. They sound frustrated to me.....while there may be gross negligence on their part we may never know it...but something isn't right. It doesn't add up.

There are no laws that obligate the hospital to care for someone who is legally dead. There are extremely rare isolated cases where someone who is brain dead really isn't.....it makes me wonder what criteria was used to determine brain death.

Technically they don't even have to ask to remove life support once brain death has been determined. There has to be more to the story for someone to become brain dead after a tonsillectomy while receiving transfusions....not taken back to the OR...it just doesn't add up. They can feed her and keep her on life support but she will not survive....her little body wil only comoensate do long without brainstem function...she will begin to deteriorate.

My heart breaks for this family....I have no words that can comfort them. It is just so tragic.

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JenRN30 has 10 years experience as a BSN and specializes in Endoscopy/MICU/SICU.

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This is a very sad case.

We cannot know if there was anything else that should have been done, since the family is not allowing the hospital to release details of the case. However, the nurses obviously knew that the pt was hemorrhaging since they checked blood levels which required multiple transfusions. As Kel said, we can't know why she wasn't taken back to surgery. However, I think that for a "perfectly healthy child," as the mother put it, to code rather quickly is pretty suspect. I think she probably had some major comorbidities that aren't being discussed.

As far as the "dead, dead, dead" comment by the Dr., and some other quotes about a dead person not getting medical care, this girl had her surgery on Dec. 9th. She was declared brain dead on Dec. 12th. And here we are on Dec. 21st with a court order to continue life support. Family wants the pt to be fed? Obviously, the physicians are unable to get through to the family that the patient is dead and will not wake up. I can't imagine how many of these family meetings they've had with no resolution, ie: family will not withdraw support from the dead pt after determination of death was made over a week ago. I have a sneaking suspicion that the family is very hard to deal with, I'm sure they blame the Dr.s, nurses, and the hospital for the horrible outcome. Everyone must be extremely frustrated, and this is horrible PR for the children's hospital.

So sad, and right before Christmas :(

Edited by JenRN30

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LadyFree28 has 10 years experience as a BSN, RN and specializes in Pediatrics, Rehab, Trauma.

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Our ENT docs routinely reserve a PICU bed for their tonsillectomies that are being done for severe sleep apnea WITH obesity. This poor child had multiple co-morbidities (per the family's report) - but I hesitate to judge when all information is being filtered through the family's lens. Reminds me, in a way, of the lung transplant girl in Philly (or was it Pittsburgh?) a few months back- family controlled the release of all information and put their own 'spin' on it. The press reported such as cold, hard medical facts.

It was in Philly. :yes:

If this child had a co morbidity, then it's impossible to know the outcome of the course of treatment; she went to the ICU, was given blood transfusions, etc; I am sure more was done; and I'm sure they assessed her as brain dead.

At best from what I read from the article, the nurses and doctors did what they could. :yes:

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Emergent has 25 years experience.

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My opinion is that, hopefully the facts will all come out in the inevitable lawsuit. It's a tragedy for the family, I don't blame them one bit for their emotional reaction. They don't have the perspective on brain death and life support like medical personnel do.

I do think that society has a right to draw the line and not keep hopeless cases on life support interminably. That comes out of the communal health care pie, no matter how you slice it. It takes resources away from living people who need it more.

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"I can feel her presence, I can still feel her smile," said Sealey. That's why the family refuses to give up...
While I understand the denial, these are emotional statements...

The judge needs to remove the restraining order and CHO needs to turn off the monitors and the ventilator.

It's tragic but it's happened... the child has died...

Just because technology can support the shell indefinitely doesn't mean that the child hasn't died... she is gone... now her body needs to be permitted to leave, too.

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Healthcare professionals or not, we cannot judge either side. No one knows the entire story aside from those that were there, and the only thing that we can collectively agree on is that a child's life was lost. It's an unfortunate tragedy but hopefully some good comes out of it and the staff can learn from it. I can't imagine losing a child and I'm sure its extremely difficult to be a parent in a situation where you feel helpless. My thoughts and prayers are with the family and the staff that were involved. RIP Angel.

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KelRN215 has 10 years experience as a BSN, RN and specializes in Pedi.

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It is hard to judge without knowing what all was going on. I formulated an opinion from a previous article about this where a family member stated that the mother kept asking the nurses if that was normal and some said yes and others did not know. I was screaming in my head NO it's not normal to lose pints of blood!!!

Thanks for all the responses.

I cannot fathom any pediatric nurse telling a parent that bleeding post tonsillectomy is considered normal. When patients are discharged post tonsillectomy they are told to call for ANY bleeding, no matter how small. If the mother told a family member, the family member told the media, the media published it, you read it and are now telling us we're talking about a 4th hand version of the story here. There's no way I believe that any nurse told the mother the bleeding was "normal".

If the mother described the child as "perfectly healthy" she is lying to herself and to the media. If you google her, there are many pictures of her and you can see that she was very overweight. She had the T&A for sleep apnea. Healthy 13 yr olds don't have sleep apnea. This is a very sad case but brain dead is brain dead.

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KelRN215 has 10 years experience as a BSN, RN and specializes in Pedi.

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The one thing that dissappointed me was the way the hospital responded. And i quote"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. " I was like what? who handles PR at the hospital needs to be fired especially that the case is being broadcast across the nation. The wording and statement itself shows a Hospital more concerned about policy than doing what is right. I would never take a child to such a place.

And what is "right"? Continuing to provide treatment to a corpse? This statement is true. Brain death is legally determinant of death and hospitals are under no obligation to treat dead persons. Consent is not needed to withdraw support from a dead person. That's why there was a court order in this case because the parents saying "keep her on the vent" was not enough. She is dead.

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OrganizedChaos has 10 years experience as a LVN and specializes in M/S, LTC, Corrections, PDN & drug rehab.

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It's really scary how business oriented hospitals have become & this is a perfect example. I mean we don't have the full story, just one side. But after reading it, it scares me. What if the child I'm about to have needs that surgery? How can I trust any hospital. I haven't been a nurse for long but I knew right away that wasn't normal & they should've taken care of it right away!

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