The Story of Jahi Continues

scaredsilly, BSN, RN · Dec 29, 2014

As far as I know, this is a rumor which has been floated about quite a lot but absolutely never confirmed by any credible source. Or has that changed?

No, it didn't change, but given how much that scamfam talks, if it was false I would expect to have read a denial and there hasn't been. Also, look at a timetable, they get real quiet for months at a time, then as soon as there are zero donations they start up with the lies some more. It is just too obvious that it is about money. The mother that kept her brain dead 4 year old on support for 20 years was not trying to be a media star!

OrganizedChaos, LVN · Dec 29, 2014

I sure did see the MRI. Her midbrain, pons and brainstem in general are toast. She appears to have intact areas primarily in the cerebrum and a little bit in the cerebellum. This MRI is a picture of ONE SLICE of hundreds and no matter what it shows, it's missing 98% of the necessary context to make any statements.
The five independent neurologists who declared Jahi brain dead used evidence-based parameters to declare brain death, and that was their conclusion. I don't doubt their expertise at all. What's in question -- maybe -- is the value of the parameters of brain death. We are always improving on pre-existing knowledge. The improvements that get made happen when the old tried and true fails and then further investigation happens.
You don't know if she can thermoregulate or not. I have read 90% of the Jahi threads. Blankets on Jahi, no matter how many or few are not clinical indications of thermoregulation, and we shouldn't assume they are as nurses who know better about human physiology.

I just can't believe you think she's NOT brain dead. Wow. ðŸ˜³

Gooselady, BSN, RN · Dec 29, 2014

I would think a nurse would know that the fact that Jahi hasn't "rotted in the bed" has not ONE IOTA to do with her being brain dead or not. She is on a ventilator, which is keeping her heart beating. That beating heart is distributing oxygen rich blood to her entire body. There would be no reason for her body to "rot" while her healthy heart continues to nourish her other tissues.

I made that statement about 'rotting in bed' as it has been such a touchstone in threads about Jahi, and a source of disgust expressed by posters. I probably used it carelessly, as yes of course, a beating heart pumping ventilator-supported oxygen rich blood will indeed perfuse a body and it's organs just fine, especially the heart of a child.

The brain's function, though, directly influences the function of her organs. If these functions were not preserved somehow in the brain, she would have had multiorgan failure and died (again lol) on the ventilator. Plenty of patients have died this way, more in the past though as our criteria for brain death and subsequent removal of life support has spared patients from going through this.

Neurologists use criteria to determine brain death to the extent of their best knowledge. Perhaps these criteria are only 98% accurate (a decent percentage), and the only way we'd know about that lingering 2% is in cases like Jahi. What makes this case so unique is that the family refused to go along with removing life support. I would have had it removed per the first recommendation of a pair of neurologists. I wouldn't want a future like Jahi's for any of my loved ones, not even my most precious grandchildren. I would be visiting their graves and trying to make sure their life was not in vain. I don't agree with what this family did. But I don't see my disagreement with that family as EVIDENCE of this family doing it wrong. My opinion has nothing to do with the reality of it, no one's opinion does.

As for the Shaivo case, I wasn't aware that the autopsy revealed that Terry was incapable of the signs of life her family insisted she had. How sad. But not surprising. I've seen and cared for people in PVS and been quite heartsick for the 'fantasies' the family spins. But this body in the bed is all they have left. I hesitate to judge them because what if I find myself in such a situation, and the media is in a frenzy, my good name up for anyone's nastiest opinion? I don't want to BE PART of that kind of behavior, however common and accepted it is.

It takes some heavy denial to think that these purchases are being made with anything other than donated funds or government benefits intended for necessities. How one judges these purchases may be another matter, but NW doesn't have a job, and last I heard, neither did her husband.

Denial? Hardly :)

We have money yanked out of our paycheck for things that will put a curl in our nostril hairs if we knew clue number one. If the fifteen or twenty dollars yanked out of my check in a year's time, the bit actually ending up in this mother's pocket as spending money goes toward an effing purse she can clutch while she imagines Jahi is responding to her is the LEAST of my concerns.

Gooselady, BSN, RN · Dec 29, 2014

Not just love and denial; don't forget about guilt -- the mother has to live for the rest of her life with the knowledge that she might still have her daughter if the family hadn't ignored the physician's orders and fed her fast food right after her surgery.

Now THAT gets me. I scoured the internet for this, a link or source. Do you have one? I couldn't find anything myself but I'm not the sleuthiest person either. If this is true, that guilt would explain everything

scaredsilly, BSN, RN · Dec 29, 2014

I sure did see the MRI. Her midbrain, pons and brainstem in general are toast. She appears to have intact areas primarily in the cerebrum and a little bit in the cerebellum. This MRI is a picture of ONE SLICE of hundreds and no matter what it shows, it's missing 98% of the necessary context to make any statements.
The five independent neurologists who declared Jahi brain dead used evidence-based parameters to declare brain death, and that was their conclusion. I don't doubt their expertise at all. What's in question -- maybe -- is the value of the parameters of brain death. We are always improving on pre-existing knowledge. The improvements that get made happen when the old tried and true fails and then further investigation happens.
You don't know if she can thermoregulate or not. I have read 90% of the Jahi threads. Blankets on Jahi, no matter how many or few are not clinical indications of thermoregulation, and we shouldn't assume they are as nurses who know better about human physiology.

Forgive me if I am misreading you, but are you saying that you believe people can come back from the dead? Or that someone can be a little bit dead? That's what this sounds like! We don't have any idea when that mri was taken, but there was very little discernible structure, and as you said no brain stem at all. There was EEG silence on several different tests days apart. What about her failing the apnea test? Or the total lack of any reflexes at all? not JUST ebp, there are national accepted standards and they did not deviate

Gooselady, BSN, RN · Dec 29, 2014

I just can't believe you think she's NOT brain dead. Wow. ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½

Two doctors wouldn't see this MRI the same way, OC. And NO doctor would lower himself to form an opinion from one slice image out of hundreds as seen on Youtube.

scaredsilly, BSN, RN · Dec 29, 2014

Two doctors wouldn't see this MRI the same way, OC. And NO doctor would lower himself to form an opinion from one slice image out of hundreds as seen on Youtube.

WHAT? Are you a nurse? Perhaps we misread your profile. Two Drs (all Drs) WILL see the MRI the same way! There is no question about it, but the mri on youtube isn't in question. We don't know when it was done. We don't even know if it was actually Jahi. Nothing has been verified. The MRI used for diagnosis was done before she was declared dead, and I promise they had more than one slice and all read it the same way. As well as the other tests previously mentioned...they did not rely on a single slice of mri to make the diagnosis.

Horseshoe, BSN, RN · Dec 29, 2014

The brain's function, though, directly influences the function of her organs. If these functions were not preserved somehow in the brain, she would have had multiorgan failure and died (again lol) on the ventilator. Plenty of patients have died this way, more in the past though as our criteria for brain death and subsequent removal of life support has spared patients from going through this.

It is patently FALSE that the absence of multi organ failure on a ventilated patient indicates brain function. Did you just make that up?!

Gooselady, BSN, RN · Dec 30, 2014

WHAT? Are you a nurse? Perhaps we misread your profile. Two Drs (all Drs) WILL see the MRI the same way! There is no question about it, but the mri on youtube isn't in question. We don't know when it was done. We don't even know if it was actually Jahi. Nothing has been verified. The MRI used for diagnosis was done before she was declared dead, and I promise they had more than one slice and all read it the same way. As well as the other tests previously mentioned...they did not rely on a single slice of mri to make the diagnosis.

Asking me if I'm a nurse when my profile clearly states I am doesn't add to the efficacy of your point.

And you basically agreed with me anyway. The ONLY recent MRI image made available to the public, via a variety of venues including YouTube is the only MRI we have to discuss. The points you made about it's veracity are all exactly right. It's why I can comfortably decline to 'see' Jahi's brain death in that image.

Gooselady, BSN, RN · Dec 30, 2014

It is patently FALSE that the absence of multi organ failure on a ventilated patient indicates brain function. Did you just make that up?!

No, ironically I am carefully avoiding 'making things up' and asking those that ARE if these assumptions are consistent with the known facts.

From Management of the Brain Dead, Heart-Beating Donor;

Outcomes are better with organs obtained from live donors compared with organs from brain-dead donors, as the widespread physiological changes that occur during brain death are avoided. In addition to acute changes, which if untreated lead to rapid deterioration and cardiac arrest (even if ventilation is continued),¹²^â€“¹⁴ there are ongoing generalized inflammatory¹⁵ and hormonal changes associated with brain death which adversely affect donor organ function and propensity to rejection.

This first 'hit' on Google re: brain death and multi organ failure is more or less my current understanding. It is basic human physiology from nursing school.

Obviously some structures survived the massive assault in Jahi's brain, or she would have rapidly become unstable with cardiac arrest while ventilated. When you say 'brain function' I have no idea what you mean, could you mean consciousness? I don't think medical science has gotten there yet. When I say brain function, I'm referring to specific functional areas, whatever they are, as evidenced by Jahi's 'survival' to date. Something in there is working or she'd have been buried long ago.

scaredsilly, BSN, RN · Dec 30, 2014

Gooselady, sorry, but you do not sound like a trained medical professional so had to ask.

I did not make your point, I said that was not a verified mri and that it may or may not have been jahi. I also said that wasn't the one that mattered, no diagnosis was made from that one.

The article you quoted was concerned with preserving organs for transplant assuming that a person is being minimallty supported awaiting transplant. Pressors to support BP, nutrients and fluids, other medication to manage infection and whatever comes up and heroic thermoregulation can preserve the organs to a functional (though not healthy)state. Read the case on here that has been posted a few times about a woman who kept her 4 year old on life support for 20 years. Autopsy proved he had been dead for decades.

I also noted you failed to comment on the multitude of other exams utilized to made the determination she was brain dead.

Horseshoe, BSN, RN · Dec 30, 2014

No, ironically I am carefully avoiding 'making things up' and asking those that ARE if these assumptions are consistent with the known facts.
From Management of the Brain Dead, Heart-Beating Donor;
This first 'hit' on Google re: brain death and multi organ failure is more or less my current understanding. It is basic human physiology from nursing school.
Obviously some structures survived the massive assault in Jahi's brain, or she would have rapidly become unstable with cardiac arrest while ventilated. When you say 'brain function' I have no idea what you mean, could you mean consciousness? I don't think medical science has gotten there yet. When I say brain function, I'm referring to specific functional areas, whatever they are, as evidenced by Jahi's 'survival' to date. Something in there is working or she'd have been buried long ago.

Again, that is PATENTLY FALSE. Absence of multi organ failure is NOT evidence that brain death has not occurred. The brain interacts in various ways with optimal organ function, but a dead brain does not translate automatically into multi organ failure in any specific time frame if the heart function is maintained. And no, when I say "brain function" I do not mean consciousness. A dead brain has NO function whatsoever.

One CANNOT state that because a patient's organs have not failed while on mechanical ventilation that this is any indication whatsoever that a diagnosis of brain death is wrong. Nor does it indicate that "something in there is working." How you are getting that from the information you provided is beyond me.

From your link:

Brain stem death is frequently followed by a predictable pattern of complex multiple organ failure.

No argument there. Yes, brain stem death is "FREQUENTLY" followed by multi-organ failure. Yes siree, Bob.

Note the absence of the word "ALWAYS" in that sentence. Also note that nowhere in that article does it assert that absence of such an occurrence invalidates the diagnosis of brain death or provides any evidence of brain function whatsoever.