Comments on: Jahi McMath’s “routine tonsillectomy”

By: Kathy

Kathy — Sun, 19 Jan 2014 17:08:08 +0000

Brian- we have only heard one side of the story- from the family. CHO cannot comment due to HIPAA laws. A small amount of bleeding would be normal after such a procedure but the timeline is not clear to me – how long did the bleeding last? At some point- emergency action was taken but what did it involve? Obviously, if she was given blood transfusions- CHO was aware of a critical situation – we just don’t know the details. And I know (from personal experience) family recollection of events is NOT always accurate…….

By: brian

brian — Fri, 17 Jan 2014 11:41:41 +0000

Kathy, you are a doctor. Please give your opinion: why did they not send Jahi to the OR to try to cauterize the bleeding? They just gave her blood transfusions and had her spit clots into a cup to measure..? the bleeding was going on and on and quite profusely, but no emergency action taken. Thank you.

By: Kathy

Kathy — Tue, 14 Jan 2014 04:59:31 +0000

Costa! I was just reading up on poor Jahi and saw your name -I believe I know you! We met at the Smart Bar when you where in med school in Chicago…… Wow! That was a long time ago!!email me Drkittykathy@hotmail.com
As a pediatrician ( yea, I actually graduated college & went to med school!), I have seen patients diagnosed with brain death – it is heartbreaking and stressful to care for these patients. Although details of intial events are not known, CHO cared for Jahi w current standards/laws regarding brain death; they had an ethics committee determine what would be acceptable interventions/surgeries. Currently, actual brain death is considered irreversible by most neurologists- but I am interested in reading articles cited by Costa above.
The sad fact is that brain death occurs everyday to people of all ages- but is hardest to face when children are involved…..

By: K McG

K McG — Sun, 12 Jan 2014 06:46:29 +0000

Thank you for comments that reflect an understanding of not only neurological functions but also cardiac. I’m amazed at the craziness of the responses that are being thrown about in the non medical community. I’ve been an EMT for 38 years and even with my limited understanding of this subject I know the bottom line. I want to thank everybody that have posted responses. You’ve given me the opportunity to hear from people with far more medical understanding than myself. My heart goes out to the family. It’s too bad organ donation wasn’t a consideration.

there are people who can express this tragedy

By: Larry Leverett, MD

Larry Leverett, MD — Thu, 09 Jan 2014 22:23:08 +0000

There are a lot of assumptions. But as a surgeon, I have seen this story in my office. I have a patient (44yo) who presented w a breast mass. When it was removed by another surgeon, she bled so much that she had a hematoma and tissue loss requiring reconstruction. That surgery bled so much that she developed and clot around her implant with subsequent hardening. Her history was LATER revealed that when she had a tonsillectomy as a kid, she bled so much that she had to be replaced on the ventilator for days and taken back to the OR. When she had a kid, she bled so much that she had to have a hysterectomy to stop the bleeding. She ended up have a severe bleeding factor deficiency that was undiagnosed until I worked her up. She required transfusion of factors BEFORE and after surgery to be safe. Most likely, that’s what caused this degree of bleeding and one doesn’t to suspect it until severe bleeding occurs. Routine testing doesn’t pick it up. And worse yet, the diagnosis cannot be made now because the hospital has likely transfused the clotting factors into her system in an effort to stop the bleeding.

By: brian

brian — Wed, 08 Jan 2014 23:11:12 +0000

Can someone who works in medicine answer: if the girl started bleeding over a long period of time – time enough that they asked her to collect the blood clots in a cup and then to be given blood transfusions which are a slow process – why was this not treated as an emergency and she be taken to the OR? The mother said blood was pouring out of her nose, to the point that Jahi thought she had a runny nose?

By: JH/RN

JH/RN — Mon, 06 Jan 2014 19:58:08 +0000

IMO, questioning minds are often intelligent minds.

My hope is that the attention called to this case, will in some way help to avoid future incidents. Obviously, all such cases will never be eliminated, but I choose to be on the side of attempting to help to keep those numbers as low as possible.

All my best to all of those on this forum who showed compassion regardless of arguing who was “right or wrong”, or whose point carried more merit.

I am off to do what I have done for 20 plus years…care for patients..

JH/RN

By: John Fembup

John Fembup — Mon, 06 Jan 2014 14:29:16 +0000

JH/RN says, “IMO it is never too early to speculate ”

IMO, it is often too early to speculate.

Which I think is Olson’s point– and with which I still agree.

IMO it is frequently too early to speculate when, as in this case, facts are sparse, and unreliable besides because they are known only thru the media. Wondering what happened is one thing; but actually debating hypothetical causes, errors, etc. is quite another when facts needed to reach valid judgments are sparse and unreliable. In this case, because reliable information will surely become known, it seems to me a waste of time to debate hypothetical possibilities now.

“I just thought people were free to express themselves here.”

Of course people are. Even when the people offer opinions that cannot objectively be supported – people have the freedom to express themselves. But that freedom does not ensure a rational analysis when facts are sparse and unreliable. In those circumstances, it’s not much more than a freedom to gossip

By: Costa Kokoropoulos

Costa Kokoropoulos — Mon, 06 Jan 2014 13:26:24 +0000

The responses that the mother reports would involve brain function. They are responses that the official investigators have been unable to elicit, which is why they gave the diagnosis of “brain death.” That the mother says she sees the response where others can’t is not unusual. It may or may not be accurate on her part. We can all see things that we want to see, whether or not they are actually happening. Awareness is a field that is only really beginning to be explored with functional MRI’s and other tests, which can measure awareness where routine exams(such as the physical exam in a brain death examination) cannot.

As for assuming that the cranial nerves have died, this is not clear. Autopsies of brains from patients that have been declared “brain dead” show no pathology compared with brains of patients with other cause. The brains look the same. There are no “brain death” lesions that a pathologist can point to to confirm the diagnosis.

The vagus nerve is a cranial nerve.

By: jh

jh — Mon, 06 Jan 2014 06:22:11 +0000

I agree with JW… people seem to gloss over the sometimes laundry list of possible complications inherent to invasive and surgical procedures. When they occur, everyone wants the doc held responsible in every way possible. The yeilds of medicine are not perfect, as those that deliver it are’nt perfect. It’s no joke that a Tonsillectomy alone carries the risk of post-op hemorrhage… that’s 101. We (docs, nurses) all know (or should know) that a post T, T&A, etc. bleed is serious… vigilant observation is fundamental. But, there are many other complications that could also be the etiology of the arrest. We just dont know right now. Someone will get to the bottom of whether or not the situation was reasonably recognized and dealt with according to protocol (assuming one was in place).
I would like to know, If anyone is willing to shed some light, mom reports her daughter responds to her presence, touch, and voice with movement,and increased heart rate; what sensory-motor pathways would have to be intact for this to happen.? I would assume that cranial nerve cells have died…. but what about the portion of the nerve-cells that exists outside the cerebrum, like the Vagus nerve for instance?