Saturday, December 28, 2013

brain death...ramble

there is much in the news and chatter at work about the current case down in Oakland, California.  it is an unfortunate 13 year old who had complications post tonsilectomy and is now determined to be brain dead.  her parents are apparently in total denial of this and have taken to the courts.  currently an additional neurologist has determined yet again that this child is indeed brain dead and the judge has ordered that the hospital may remove the life support at 5pm on December 30th i believe.  the parents have apparently found some long term care facility that is willing to take in their dead daughter but only if she is given a trach and feeding tube.
oddly i have often joked, yes i am quite sick and jaded, that i should open a hospital that would just have dead people on ventilators as this seems to be how our society is headed.  our culture is becoming more and more set on permanently ending death in our nation.  it's not allowed.  court cases such as these make my make believe hospital seem like it may one day become more of a reality.  if you can pay your dead relatives can stay.  many worried about Obamacare having death panels, but they should also worry about a culture that absolutely seems to deny patients the right to die with dignity and peace. keeping dead people alive on machines is a pretty spendy plan.  not to mention all the loss that will occur to the organ donation programs if we stop allowing dead people death.
these parents are hoping for a miracle. i guess my feeling is that if this is true then they should have enough faith to remove their daughter from the machines. at some point you have to say,  thy will be done.  if a miracle is to happen it will happen, if not then you must accept that there will be no miracle.
my other view is becoming that how we deal with the death of our loved ones will come back to us in those last days, if those last days are to come.  if there is a judgement, my sense is that we will be asked about how we dealt with these deaths.  did we attempt to keep people on earth with us despite the outcome or did we allow them to be returned to the heavens at the behest of God.  what was the intention, was it selfish or was there grace.  you always have to ask, why am i making these decisions. is it because i can't bear to lose this person or will it benefit them in the end.
there is obviously much confusion about what brain death is and coma and vegatative states.  this is clear by reading all the varied responses to news reports on the internet of this case.
brain death is determined by a variety of tests.  the basics being a patient in a deeply unresponsive coma, no brain stem function noted with neurologic exams, no spontaneous ventilation or respiration.  hospitals may also order an eeg which measures brain wave activity.  i have also seen, especially with children, ct scans with angiography to determine if there is blood flow to the brain.  it is an impressive thing to witness, the arrest of intracranial circulation.
this happens when the intracranial pressure exceeds the arterial perfusion pressure.  in the icu's we monitor icp's and make attempts through various treatments to avoid this happening.  you may be able to increase the arterial blood pressure enough to cause some reperfusion but any neurological function lost is forever lost basically.
i find this case interesting and sad. it's just a sign of the direction our society is going with regards to death. i do hope that my idea of hospitals filled with the dead loved ones we refuse to let go of does not become a reality.
these are very difficult decisions and i feel for this family as this is a huge loss, made worse by the fact that this was seemingly a routine medical procedure.  understand that there is nothing routine with medicine.  things go bad and bodies react differently.
as a society though, we really need to look seriously at how we deal with death, or don't deal with it.  we are born, we live and we die.  that is the reality.  how we treat each other, the respect we show is as important in our deaths as it is in our lives. we can do a great deal to keep bodies going despite terrible outcomes.  we have to determine as a society at what cost is that life we save.  at what cost to the individual who now must exist in a dramatically altered state, at what cost to families, who must care for their loved ones and suffer the financial burden, at what cost to society who takes on the financial burden often and finds itself with more people to care for than to care for them.
i do not have answers,  but if we don't start looking for answers we will be a society that collapses.


  1. what a horrible thing to have to consider--to let go of your child after what seemed routine surgery. any surgery can be major though and it is what is--no one wishes the family be stronger at a time when grief hit hard. it seems even more cruel to keep people in a half-life state where they must have constant dreams of not being able to move on to the next world amazing but at first scary. maybe should get some good hospice nurses in there with them...tell them stories. thank you for the explanation of what happens in the brain--i had not understood that before. just on break this week and returning to whole personhood. angela
    new blog address...

  2. thanks for stopping by and for leaving your new blog address...thought i'd lost ya. :-) all the best to you and your girls!!