BlackBox

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So... I just read another article involving Jahi McMath- the 13yo girl who bled out following a tonsillectomy and has since been pronounced brain dead by two physicians.

As many of you know, the family has been fighting to keep Jahi on a ventilator as they believe she is still alive and responding to verbal commands. With the help of a lawyer, Chris Dolan, and now family members of Terri Schiavo (by way of the Schiavo foundation), direct relatives of Jahi are attempting to get her moved to a long-term care facility for "treatment." One of the major obstacles in all of this is the lack of anyone willing to perform a tracheotomy and gastrostomy to keep her airway accessible and provide nutrition.

I was wondering what the pre-allo SDN community thinks about all of this. What would you do from the position of 1. Parents, 2. Judge, and 3. the Hospital (Dr.s or administration)?
 
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Out of curiousity, what is the family interpreting as responses to verbal commands from the girl's body?
 

SouthernSurgeon

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So... I just read another article involving Jahi McMath- the 13yo girl who bled out following a tonsillectomy and has since been pronounced brain dead by two physicians.

As many of you know, the family has been fighting to keep Jahi on a ventilator as they believe she is still alive and responding to verbal commands. With the help of a lawyer, Chris Dolan, and now family members of Terri Schiavo (by way of the Schiavo foundation), direct relatives of Jahi are attempting to get her moved to a long-term care facility for "treatment." One of the major obstacles in all of this is the lack of anyone willing to perform a tracheotomy and gastrostomy to keep her airway accessible and provide nutrition.

I was wondering what the pre-allo SDN community thinks about all of this. What would you do from the position of 1. Parents, 2. Judge, and 3. the Hospital (Dr.s or administration)?
Parents: No clue. I can't possibly put myself in their emotional/spiritual shoes. Despite what comes across in some interviews as ignorance, I'm in no position to judge and I just feel incredibly sorry for them.

Judge: This is the person I am the most mad at in this situation. He has agreed in a formal, legal setting that the patient meets the criteria for brain death. Yet he won't act - just keeps pushing back the deadline. It's frankly chickens**t, and could set a potentially dangerous legal precedent for future cases.

Hospital/Doctors: The doctors involved in the case are stuck in an impossible position. At this point, I would do absolutely nothing to upset the status quo without direct communication with the judge. This is obviously going to end in litigation. As a surgeon, if consulted, I would not agree to perform a completely elective procedure (trach/peg) on a brain dead patient.
 
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BlackBox

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Out of curiousity, what is the family interpreting as responses to verbal commands from the girl's body?
This is unclear. I was paraphrasing what I read in the linked article.

It's kinda tough to have voluntary movement w/o higher brain function.
 
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Parents: No clue. I can't possibly put myself in their emotional/spiritual shoes. Despite what comes across in some interviews as ignorance, I'm in no position to judge and I just feel incredibly sorry for them.

Judge: This is the person I am the most mad at in this situation. He has agreed in a formal, legal setting that the patient meets the criteria for brain death. Yet he won't act - just keeps pushing back the deadline. It's frankly chickens**t, and could set a potentially dangerous legal precedent for future cases.

Hospital/Doctors: The doctors involved in the case are stuck in an impossible position. At this point, I would do absolutely nothing to upset the status quo without direct communication with the judge. This is obviously going to end in litigation. As a surgeon, if consulted, I would not agree to perform a completely elective procedure (trach/peg) on a brain dead patient.
I completely agree about the judge. His decision will extend her breathing for a time, but "starvation" is inevitable. I believe the family's lawyer will use this as leverage to pressure the hospital.

EDIT: from the mother-

"To watch my daughter just sit there and not have food ... I'm just so happy that she is kind of a thick girl so she still looks good," Nailah Winkfield told ABC’s "Good Morning America." "I tell her every day, 'Jahi, you losin' weight girl, but you still look good.' I just think it's inhumane to not feed my child, to not refer to her by her name, and stop us in our tracks."

http://www.nydailynews.com/news/national/brain-dead-jahi-mcmath-starving-california-hospital-mother-article-1.1563261#ixzz2pGKzAwAv
 
Nov 8, 2013
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In any case, it's a sad story, and clearly the family loses in all scenarios.
 

Reckoner

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What a sad story. CNN published an interesting piece several days ago about how the current use of terms like brain dead and life support inspire false hope in these families. They hear "brain death" and think it's somehow different from "regular death." Relevant quote from Nailah Winkfield (McMath's mother):
I would probably need for my child's heart to stop to show me that she was dead. Her heart is still beating, so there's still life there.
Link to article: http://www.cnn.com/2013/12/28/health/life-support-ethics/index.html
 
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It's easy to talk about a situation and what decisions should be made when it's not your sister, daughter or cousin. Before you so easily say she should be taken off life support....just think about how quickly you would want your close family member to be taken off life support after they ended up brain dead for what you thought would be a routine in and out surgery....
It's always easy to say anything when you don't know the person

This from someone who fully understands what brain dead means....
 

SouthernSurgeon

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It's easy to talk about a situation and what decisions should be made when it's not your sister, daughter or cousin. Before you so easily say she should be taken off life support....just think about how quickly you would want your close family member to be taken off life support after they ended up brain dead for what you thought would be a routine in and out surgery....
It's always easy to say anything when you don't know the person

This from someone who fully understands what brain dead means....
If there was a clear diagnosis of brain death, with an appropriate second exam to confirm, I'd want them off life support as soon as their organs had been allocated.
 
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There was an episode of hopkins that I watched way back when where the physician was not able to convey the parents about the meaning behind brain dead of a 6-10 y.o. girl that had apparently drowned. It had occurred during a family meeting or under parental supervision and by mistake. So the parents were very broken since they blamed themselves; alongside that, the mother was pregnant with another baby on the way. It was very sad and hard to watch how the physician was not straight-forward and in the end prolonged the emotional rollercoaster the parents went through since they also (like in this case) decided to hold on to hope. Unfortunately, I don't believe the daughter survived. It just goes to show the high importance of a physician that is not only smart but is able to communicate well with his/her patients.
As a parent though, I can always believe that hope is the only thing they have at this point. There are stories where such things happen and they are rare. Hoping that the child wakes up and recover could be a possibility but very slim. Hopefully, the parents are right but I can't imagine how hard it is for someone to keep holding that string and being that person to live with a harsh reality.
 
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There was an episode of hopkins that I watched way back when where the physician was not able to convey the parents about the meaning behind brain dead of a 6-10 y.o. girl that had apparently drowned. It had occurred during a family meeting or under parental supervision and by mistake. So the parents were very broken since they blamed themselves; alongside that, the mother was pregnant with another baby on the way. It was very sad and hard to watch how the physician was not straight-forward and in the end prolonged the emotional rollercoaster the parents went through since they also (like in this case) decided to hold on to hope. Unfortunately, I don't believe the daughter survived. It just goes to show the high importance of a physician that is not only smart but is able to communicate well with his/her patients.
As a parent though, I can always believe that hope is the only thing they have at this point. There are stories where such things happen and they are rare. Hoping that the child wakes up and recover could be a possibility but very slim. Hopefully, the parents are right but I can't imagine how hard it is for someone to keep holding that string and being that person to live with a harsh reality.
I don't think this is an issue of the doctors not being able to communicate, as 6 separate physicians have all reached the same diagnosis and explained this to the family. Also, I think "very slim" would be an overstatement in this case, as the tests showed that there is no blood supply to the brain, no electrical activity, and no capacity to breathe on her own for the past several weeks.
Although there have been instances where people considered brain dead or in a coma have woken up, all sources I have seen have said no one who has actually met the criteria for brain death (which after 6 physician exams, hopefully they would be diagnosing correctly) has survived.
 

Reckoner

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It's easy to talk about a situation and what decisions should be made when it's not your sister, daughter or cousin. Before you so easily say she should be taken off life support....just think about how quickly you would want your close family member to be taken off life support after they ended up brain dead for what you thought would be a routine in and out surgery....
It's always easy to say anything when you don't know the person

This from someone who fully understands what brain dead means....
But you're language implies that you don't understand what brain dead means, which is why I posted the link above. The girl is dead - the criterion used to determine death just happened to be irreversible cessation of brain function. I've had family members die, and obviously it was heartbreaking, but never once did it cross my mind to hook up one of their organ systems to a machine while fighting for meaningless procedures. I'm not trying to blame or demonize the family, I just think it's important to look at why they (and others) have this incorrect notion that somehow brain dead is not "really dead."
 
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BlackBox

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I don't think this is an issue of the doctors not being able to communicate, as 6 separate physicians have all reached the same diagnosis and explained this to the family. Also, I think "very slim" would be an overstatement in this case, as the tests showed that there is no blood supply to the brain, no electrical activity, and no capacity to breathe on her own for the past several weeks.
Although there have been instances where people considered brain dead or in a coma have woken up, all sources I have seen have said no one who has actually met the criteria for brain death (which after 6 physician exams, hopefully they would be diagnosing correctly) has survived.
Okay, I have a really dumb question as a pre-med. If the circulatory system is a continuous loop and the heart is beating, how can there be no blood supply to the brain? Doesn't this require a physical blockage?
 

BlueLabel

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Okay, I have a really dumb question as a pre-med. If the circulatory system is a continuous loop and the heart is beating, how can there be no blood supply to the brain? Doesn't this require a physical blockage?
I was wondering this too. Maybe what he meant was, there was no blood supply to the brain, resulting in tissue death, and even though blood flow has been restored the organ obviously can't come back to life? I'm just grasping at straws, I don't know the real answer.

This is a tragic story.
 

SouthernSurgeon

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Okay, I have a really dumb question as a pre-med. If the circulatory system is a continuous loop and the heart is beating, how can there be no blood supply to the brain? Doesn't this require a physical blockage?
In short, increased pressure from the damaged brain tissue exceeds the pressure of the arterial circulation, so there is no flow.
 
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BlackBox

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I was wondering this too. Maybe what he meant was, there was no blood supply to the brain, resulting in tissue death, and even though blood flow has been restored the organ obviously can't come back to life? I'm just grasping at straws, I don't know the real answer.

This is a tragic story.
In short, increased pressure from the damaged brain tissue exceeds the pressure of the arterial circulation, so there is no flow.

ahh... great thanks
 

Mad Jack

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Honestly, this isn't funny :thumbdown:
It isn't funny, but if you've spent a few years working the ICUs, you see it all the time. People who don't understand medicine that are overwhelmed by grief that are just looking for anything as a sign of life. They'll stare and stare and stare and if an eyelid so much as twitches (their electrolytes could be wonky and cause it) they swear their baby girl/wife/mother/whatever is still in there.

There is a difference between being in a coma and being brain dead. You do not wake up from brain death. When you're starting at a CT scan that shows zero differentiation between gray matter and white, there is no recovery for that patient. This family does not understand that. They've heard stories of people waking up from comas etc before, they think that could be their daughter. The whole denial aspect of it is also likely huge. She was a healthy, normal girl one instant, why can't she go back to that in another.

I feel for the family, I really do. They aren't ready to let go. Ethically, I do not believe the hospital should withdraw ventilation, but I do not believe they should be obliged to perform additional surgeries against the ethics and will of their surgeons either. It's a terrible situation.
 

Mad Jack

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I was wondering this too. Maybe what he meant was, there was no blood supply to the brain, resulting in tissue death, and even though blood flow has been restored the organ obviously can't come back to life? I'm just grasping at straws, I don't know the real answer.

This is a tragic story.
http://www.intechopen.com/download/pdf/35737

19 page PDF with all your hypoxic encephalopathy needs. For anyone out there that is really bored/curious.
 

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Is it wrong to look at this and also think that this is a huge waste of taxpayer money:
- all the time for physicians and other hospital staff
- hospital supplies, equipment, etc
- but not just that, also, the inevitable litigation.


But at the same time, I can completely understand how the sliver of (false) hope and the warmth of a loved one's body would be enough to not want life support removed.
 
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There are stories where such things happen and they are rare. Hoping that the child wakes up and recover could be a possibility but very slim.
How does it feel to be part of the problem?

Before going around endorsing this idea of a slim hope or that this does rarely happen, as a pre-med, I suggest you avail yourself of knowledge. Coma and vegetative state, the situations to which you are referring, are not the same as brain death. The gold standard for diagnosis of brain death in the US is absence of cerebral blood flow -- this means that girl's brain is a necrotic mass of unperfused tissue just as useless as a gangrenous toe.

If you don't believe in ultrasound or EEG or clinical exam enough to accept the fact that half a dozen independent physicians (including those hired by the family) have agreed that she is brain dead, then please consider a different career. Optimism in a case like this is not beneficial, rather it is abusive to the family. The only "good" that could come of this is the opportunity to save another person's child with an organ donation . . . something that will not be a viable option as they destroy her body in misguided "life support."
 
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BlackBox

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There was an episode of hopkins that I watched way back when where the physician was not able to convey the parents about the meaning behind brain dead of a 6-10 y.o. girl that had apparently drowned. It had occurred during a family meeting or under parental supervision and by mistake. So the parents were very broken since they blamed themselves; alongside that, the mother was pregnant with another baby on the way. It was very sad and hard to watch how the physician was not straight-forward and in the end prolonged the emotional rollercoaster the parents went through since they also (like in this case) decided to hold on to hope. Unfortunately, I don't believe the daughter survived. It just goes to show the high importance of a physician that is not only smart but is able to communicate well with his/her patients.
As a parent though, I can always believe that hope is the only thing they have at this point. There are stories where such things happen and they are rare. Hoping that the child wakes up and recover could be a possibility but very slim. Hopefully, the parents are right but I can't imagine how hard it is for someone to keep holding that string and being that person to live with a harsh reality.
How does it feel to be part of the problem?

Before going around endorsing this idea of a slim hope or that this does rarely happen, as a pre-med, I suggest you avail yourself of knowledge. Coma and vegetative state, the situations to which you are referring, are not the same as brain death. The gold standard for diagnosis of brain death in the US is absence of cerebral blood flow -- this means that girl's brain is a necrotic mass of unperfused tissue just as useless as a gangrenous toe.

If you don't believe in ultrasound or EEG or clinical exam enough to accept the fact that half a dozen independent physicians (including those hired by the family) have agreed that she is brain dead, then please consider a different career. Optimism in a case like this is not beneficial, rather it is abusive to the family. The only "good" that could come of this is the opportunity to save another person's child with an organ donation . . . something that will not be a viable option as they destroy her body in misguided "life support."
Okay, no reason to get snippy... I don't think anyone need consider a different career. ;)
 
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Okay, no reason to get snippy... I don't think anyone need consider a different career. ;)
I said IF that person doesn't believe XYZ, then he/she should consider a different path.

The more likely circumstance is that boboyahoo wrote about something he/she was uninformed about and instead of asking a question, expressing uncertainty about the validity of his/her statement, or going to read about it before posting (things it would make sense to do before posting). Essentially, boboyahoo took a stance that people wake up from brain death, which is something that is actually very detrimental to a lot of families who face this difficult decision. You can disagree with me, but I don't think that's a respectable way to address this issue if you're someone who's going into medicine.
 
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BlackBox

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I said IF that person doesn't believe XYZ, then he/she should consider a different path.

The more likely circumstance is that boboyahoo wrote about something he/she was uninformed about and instead of asking a question, expressing uncertainty about the validity of his/her statement, or going to read about it before posting (things it would make sense to do before posting). Essentially, boboyahoo took a stance that people wake up from brain death, which is something that is actually very detrimental to a lot of families who face this difficult decision. You can disagree with me, but I don't think that's a respectable way to address this issue if you're someone who's going into medicine.
My only response to you is to the above bold points:

Yes, that was clear.

If anyone is uniformed, it stands to reason that they may not know it. Hence, there would be no reason in this person's mind to ask a question, or express uncertainty.

I think I can disagree with you and still go into medicine- you haven't convinced me your opinion is relevant.
 

Instatewaiter

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It's easy to talk about a situation and what decisions should be made when it's not your sister, daughter or cousin. Before you so easily say she should be taken off life support....just think about how quickly you would want your close family member to be taken off life support after they ended up brain dead for what you thought would be a routine in and out surgery....
It's always easy to say anything when you don't know the person

This from someone who fully understands what brain dead means....
Brain death is the same as your heart stopping and not being able to be resuscitated... "Life support" or not, she's dead.
 
Jul 24, 2013
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How does it feel to be part of the problem?

Before going around endorsing this idea of a slim hope or that this does rarely happen, as a pre-med, I suggest you avail yourself of knowledge. Coma and vegetative state, the situations to which you are referring, are not the same as brain death. The gold standard for diagnosis of brain death in the US is absence of cerebral blood flow -- this means that girl's brain is a necrotic mass of unperfused tissue just as useless as a gangrenous toe.

If you don't believe in ultrasound or EEG or clinical exam enough to accept the fact that half a dozen independent physicians (including those hired by the family) have agreed that she is brain dead, then please consider a different career. Optimism in a case like this is not beneficial, rather it is abusive to the family. The only "good" that could come of this is the opportunity to save another person's child with an organ donation . . . something that will not be a viable option as they destroy her body in misguided "life support."
Pardon me for being hopeful for the parents if not the patient herself. Additionally, you have no right over the organ donation part since not everyone will say 'yes' to that matter. I sympathize with those that this girl could potentially help, but that is entirely a sentimental decision in part of the parents that are passing this rough time. Going through this is hard for them and as a future doctor (if you are pursuing this field) I would point out that this isn't what I would imagine a straightforward conversation to be coming from someone who is supposed to be compassionate and might be in a future position of providing emotional support to possible patients. The only way I could have possibly approached this situation was if I could have pulled out some school of knowledge philosophy texts and learned what the best way is to identify the child and cope with the loss. Is it the body or the soul they seek to remember the child by?
Your argument was too harsh given the circumstances presented here. Yes, I know what brain dead means and unfortunately somewhere down the road, someone (anyone in the family or outside) messed up in explaining. This caused subsequent rationale explanations from other learned folks impossible to be understood. So let the parents do what their will power can even if it might be futile; they have decided what they want to do and that's that. Whatever time there was to defray from this decision has long passed; as you can tell they are serious and resistant toward listening to medical advice. I don't believe any doctor can make them turn their backs now to what they want and we can only continue to wish them well and recover emotionally. Maybe allowing them to do everything in their power will eventually let them inhale what just happened and what the end truth/outcome might be. If someone out there can let them recover sooner, then they might stop hurting themselves emotionally and the patient's current conditions. Optimism in these situations is dangerous (true), but harshness will only push people ahead since they want to do their very best to show their best intent. I was not being overly optimistic, I was being cautious since not everything is often released to the press. Hence, I did not mean to imply that out of brain dead, someone can wake up like in a coma. I did point out that hopes were slim...so I was not optimistic, I was just playing to the uncertainty of how much accuracy there was to the amount of detail released to the public. Though whatever your opinion is, I'm sure you are an expert so I won't clarify myself any further.
 
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Aug 22, 2013
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It's easy to talk about a situation and what decisions should be made when it's not your sister, daughter or cousin. Before you so easily say she should be taken off life support....just think about how quickly you would want your close family member to be taken off life support after they ended up brain dead for what you thought would be a routine in and out surgery....
It's always easy to say anything when you don't know the person

This from someone who fully understands what brain dead means....

I understand what brain dead means. I'm also fully aware of what quality of life/death means. No reason to hopelessly physically torture the girl or emotionally torture the family. It's is needless.
 
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If she is in fact brain dead I don't think it is possible to physically torture her....as for emotionally torturing her family....in the long run they may be emotionally tortured by prolonging situation, but since they want to keep her on life support, I think that they will feel worse if they are forced to take her off....just because it will be before when they want it done....will it be pointless to keep her on life support?....yes - I really don't think anyone disagrees with that, but sometimes I think we have to throw logic out the window and allow people to do what will make them come to terms with the situation best.

Should someone sit down with the family and try again (because I'm sure it's been done already) to have a serious conversation about what brain dead means? Yes...but why force them....especially since the girl is not suffering-since she is brain dead and therefore not conscious.
 

SouthernSurgeon

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If she is in fact brain dead I don't think it is possible to physically torture her....as for emotionally torturing her family....in the long run they may be emotionally tortured by prolonging situation, but since they want to keep her on life support, I think that they will feel worse if they are forced to take her off....just because it will be before when they want it done....will it be pointless to keep her on life support?....yes - I really don't think anyone disagrees with that, but sometimes I think we have to throw logic out the window and allow people to do what will make them come to terms with the situation best.

Should someone sit down with the family and try again (because I'm sure it's been done already) to have a serious conversation about what brain dead means? Yes...but why force them....especially since the girl is not suffering-since she is brain dead and therefore not conscious.
The problem is now that the family has so heavily lawyered up and gotten the media involved, there really is no way a healthcare provider could sit down and have a heart to heart with them.
 
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The problem is now that the family has so heavily lawyered up and gotten the media involved, there really is no way a healthcare provider could sit down and have a heart to heart with them.
Exactly what I wanted to explain. Instead of arguing over what brain-death implicates, why not discuss about how to best approach families such as these. That to me is the hardest feat that many physicians still struggle with. How do you tell people without giving them false hope? Would you approach it scientifically? religiously? philosophically? or other? Clearly in this case, scientific reasoning is not working and really why should it when the mind doesn't want to believe what just happened. How would a conversation from the part of a humble physician start as? I find that the biggest value is in this; to master something so delicate and controversial. If any doctors on board have ever gone through this, that would be a valuable lesson to learn.
 
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Love threads like this; now all of a sudden everyone has had a brain dead family member within the last 6 months.
 
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Love threads like this; now all of a sudden everyone has had a brain dead family member within the last 6 months.
Out of courtesy to family members that might have gone through such an experience (in fact any death out of an unexpected complication), this type of sarcasm really wasn't called for. You need 2 types of ppl to understand this: one who has had experience and another who knows how to sympathize properly and put themselves in other people's shoes.
 
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Out of courtesy to family members that might have gone through such an experience (in fact any death out of an unexpected complication), this type of sarcasm really wasn't called for. You need 2 types of ppl to understand this: one who has had experience and another who knows how to sympathize properly and put themselves in other people's shoes.
And that's why those who don't possess the latter quality you just mentioned should keep their opinions to themselves. Not everyone can relate to this unfortunate experience, thus being judgmental of the family or ignorant to the facts are both not needed in discussion of this thread.
Out of courtesy to family members that might have gone through such an experience (in fact any death out of an unexpected complication), this type of sarcasm really wasn't called for. You need 2 types of ppl to understand this: one who has had experience and another who knows how to sympathize properly and put themselves in other people's shoes.
I might remind you that a response to my post wasn't called for. I said what I said because all of a sudden everyone can relate when this is simply not true. Hell, there's even discussion as to what being brain dead is (by many of the same posters who claim to have had brain dead family members). It seems that this thread lacks the aformentioned experience of which you speak and people who can sympathize with this family. Again, I love how now everyone in this thread can relate to having a brain dead family member, when in reality many can't. As stated above, put your little sister in that hospital; now do you (people who have had brain dead family members), think that plug should be pulled?
 

gettheleadout

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So... I just read another article involving Jahi McMath- the 13yo girl who bled out following a tonsillectomy and has since been pronounced brain dead by two physicians.

As many of you know, the family has been fighting to keep Jahi on a ventilator as they believe she is still alive and responding to verbal commands. With the help of a lawyer, Chris Dolan, and now family members of Terri Schiavo (by way of the Schiavo foundation), direct relatives of Jahi are attempting to get her moved to a long-term care facility for "treatment." One of the major obstacles in all of this is the lack of anyone willing to perform a tracheotomy and gastrostomy to keep her airway accessible and provide nutrition.
y Dolan

y u do dis
 
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And that's why those who don't possess the latter quality you just mentioned should keep their opinions to themselves. Not everyone can relate to this unfortunate experience, thus being judgmental of the family or ignorant to the facts are both not needed in discussion of this thread.


I might remind you that a response to my post wasn't called for. I said what I said because all of a sudden everyone can relate when this is simply not true. Hell, there's even discussion as to what being brain dead is (by many of the same posters who claim to have had brain dead family members). It seems that this thread lacks the aformentioned experience of which you speak and people who can sympathize with this family. Again, I love how now everyone in this thread can relate to having a brain dead family member, when in reality many can't. As stated above, put your little sister in that hospital; now do you (people who have had brain dead family members), think that plug should be pulled?
what? who said that? No one claimed to be able to relate to having a brain dead family member. If i missed that, please let me know.
From what I have seen following this thread, people in this thread are actually being judgmental of other pre-meds (given the circumstances of the case and what they posted), not the family.
There is a discussion about what being brain dead is because this is a pre-med forum....and it's a medical topic.