Jahi McMath: Merely Dead, or Really Most Sincerely Dead?

GUEST ENTRY BY KZ!

This is a GUEST ENTRY by KZ. KZ is a CRNA (Certified Registered Nurse Anesthetist), who wrote the excellent series Dr. Murray's Death Drip Explained.  KZ weighs in on Jahi McMath's current condition. 

WARNING: Not for the faint of heart. Sprocket. 

 Prior & New Stories:
01/01/14 Jahi's Legacy - by CaliGirl9

01/03/14 The Long, Sad Death of Jahi McMath - by CaliGirl9
01/10/14 Jahi McMath: A Body in Limbo - by Sprocket
01/13/14 Legal History of the Jahi McMath Case - by VenomousFeminist

UPDATE 1/9/14: Sprocket here. For answers to medical questions about Jahi's diagnosis and condition, I highly recommend the blog Stories from the trauma bay, written by a physician who blogs under the moniker Doc Bastard.  Doc Bastard has written several posts on the Jahi McMath case. (You can also find a link to his blog in T&T's blog list, on the right.)

Later today, I will working on a T&T "Quick Links" page for this case. Quick Links pages will gather in one place, links to all the stories written on T&T, the court documents, relevant news stories and links to twitter and Instagram pages. If you have a link to a story from an accredited news source, you can email it to me, or leave it in a comment.  

Also, if you have found T&T helpful in understanding what has truly happened in this case, please consider recommending T&T or a specific post on Google. Thank you!

UPDATE 1/7/14: NCBI- Organ Preservation in a brain dead patient: information support for a neurocritical care protocol development

UPDATE 1/6/14 5:40 PM Children's Hospital Oakland, Supplemental Declaration of Dr. Heidi Flori 

 Jahi McMath

Source: Keep Jahi McMath on life support, Facebook page

Jahi McMath: Merely Dead, or Really Most Sincerely Dead?
By KZ
Last evening, January 5, 2014, the body of Jahi McMath was released by Children’s Hospital Oakland, to the Alameda County Coroner’s office. A Death Certificate has been initiated by the Alameda County Coroner, pending final completion upon the autopsy of Jahi Mc Math at a later time. The Coroner has released Jahi McMath’s body to the custody of her mother, Latasha Nailah Winkfield, for …..

Ongoing care and admission to another health care facility?

Or

Family religious and cultural rituals, including transportation of the body of their loved one, pending final disposition?

Your individual point of view on this tremendously tragic case will determine which of the above phrases you prefer to use to complete the first paragraph.

The family spokesperson, Jahi’s maternal uncle, the family attorney, and the cosmetologist spokesperson for the nonprofit, non-healthcare facility community center in New York (a building which rents space to therapists, not a licensed or regulated health care facility) offering to (care for vs temporarily store) Jahi’s body, continue to advance their agenda that Jahi is merely “brain damaged”, and as such, is entitled to state and federal protections. There is speculation by a number of web commentators and bloggers that this insistence on “brain damaged and disabled” versus brain dead, and “really most sincerely dead” is simply an attempt to preserve Jahi’s “aliveness” in preparation for a flurry of court actions designed at recovering monetary damages in excess of California’s pain and suffering caps. The uncle, in a recorded press conference referred to the number of $250,000 as “chump change”, and suggested that the more appropriate number is $30,000,000. Thirty million versus $250,000. Maybe it’s just me, but it is pretty unseemly to be tossing around these kind of numbers while Jahi is still alive. Or wait—is Jahi alive? Is Jahi dead?

The family took custody of Jahi’s body from the Coroner, and completed whatever process was requested to officially receive HER REMAINS. I can’t apologize for my use of caps there, because I thoroughly believe that the young teen with the bright smile died nearly 4 weeks ago. The last 3 ½ weeks has only been a painful and grotesque battle over who gets her body, and when. A contentious stalemate between a world class health care facility, and a family in the throes of anger, denial, and grief.

For the last 3 weeks, we have all read and heard about what brain death is, and what this family believes it isn’t. We have seen grainy examples of diagnostic tests, and discussions of “electrical silence” from EEG’s, and failed apnea tests. We have marveled and recoiled at discussions of spinal reflexes, and forced ourselves to watch videos of unfortunate souls with brain death who demonstrate Lazarus sign.

But for just a few paragraphs, I’d like to talk about another difficult set of facts that apparently none of the mainstream news reporters are willing to research and discuss. Possibly out of respect and deference to a grieving family, or for some other unknown motivation, I don’t know. Let’s talk about an anatomical certainty for a just a minute.

I am convinced most who read here are well informed about the process for determining brain death, the bedside tests and assessments, as well as the electroencephalograms and SPECT radionuclide perfusion tests demonstrating complete lack of blood flow in brain death.

Approximately 3-5 days after a determination of brain death, a process called “autolysis” begins in the brain dead individual’s brain. To put this in very blunt terms, the non-perfused brain begins to soften and liquefy, coagulating into a congealed mass of dead tissue, enzymes, and other products of cell death.

That is a miserable, grievous paragraph to write when you are discussing what has happened inside the skull of a much loved, shy 13 year old young girl with a beautiful smile, but this is what happens in EVERY case of brain death that is prolonged by mechanical ventilation. EVERY case. And I meant to use caps there for emphasis. The absence of blood flow cannot be reversed. Ever. By any means. There is no “waiting for the swelling to go down.” Most of the studies cited below are for populations of patients brain dead an average of less than 99 hours (4 days). Jahi Mc Math has been brain dead for at least 24 days, as of January 6, 2014.

From: The Paradox of Brain Death, by Pauline W. Chen

While normal brain tissue is firm, a brain that has been dead shows progressive autolysis, a form of biological self-destruction. “It will almost be like soup,” Dr. Harry Vinters, chief of neuropathology at UCLA, recently explained to me. He is the co-author of a major textbook on the pathology of the brain and has performed almost a hundred autopsies on the brain-dead. “It really depends on how long they have been on the ventilator. If they have been on the ventilator for two days, then the brain is grey and softened. But if, for example, a family has had difficulty deciding what they want to do and the patient has been kept on the ventilator for two to three weeks, then there’s tremendous autolysis. The brain gets very swollen, soft, and mushy.” The nerve tissue can become so friable that fragments of brain from the head will break off and float down the spinal column. “Sometimes I’ll be looking at a slide of the spinal cord,” says Vinters, “and I’ll see fragments of cerebellum floating around in the specimen.”

There is no rehabilitation for a liquefied and congealed brain. There is no hope for this individual to ever have any improvement whatsoever. Time and “nutrition” will not heal her brain, because in effect, she has no brain. The organ that was her brain is gone, completely and utterly gone. It is as if she has been “functionally decapitated”. This is what happens in brain death. This is the hard, sad, miserable, awful, grotesque TRUTH about what brain death is.  This is why brain death IS death, and is recognized as death, as certain as cardiac death. No amount of wishing, magical thinking, hope or prayers will bring back Jahi McMath. Jahi does not need our prayers—but her family does.

References:

Wikipedia: Single-photon emission computed tomography

Nuc Med Resource: Brain Death Scan

NCBI: Stability and Autolysis of Cortical Neurons in Post-Mortem Adult Rat Brains

NCBI: On the Autolysis of Brain Tissue

SPRINGER: Autolysis of the granular layer of the cerebellar cortex in brain death

RESEARCH GATE: A clinico-neuropathological study on brain death

VQR: The Paradox of Brain Death