" No further tests have been done on her as far as I know that actually contradicts the tests done in CA. We are only told what the family wants us to be told."
According to the article further (and more comprehensive) tests were later conducted by neurologists interested in the case which pointed to a conclusion that she wasn’t brain-dead (by definition).
I found some info. It appears that catastrophic bleeding can occur if the clots on the tonsil area come off, which is why patients are not supposed to talk or eat regular food. (Hence the popsicle.)
I haven’t been able to find any evidence that the hamburger-feeding witness actually exists. But the family openly acknowledges that they were all there and talking to Jahi and that she was “laughing and talking,” which was strictly against advice and protocol.
Sandra the grandmother stated on a TV press conference that she is an RN–and no, she didn’t just say “nurse”–and that therefore she felt qualified to suction Jahi’s throat, which she said she did.
She is NOT a registered nurse, and the suctioning equipment is standard and normally bolted to the wall for use in an emergency. It has been stated that the nurses specifically told her NOT to use it. It has also been stated that they would have, according to standard procedure, given a graduated basin so as to be able to measure blood loss. (Hence the appearance of the second basin.)
What seems likely is that the grandmother decided to use the suction equipment, disturbed the clots and/or sutures, and caused the catastrophic bleeding.
The only reason I bring this up is that NONE of this was presented in the article. Instead a pared down version of the family’s current story–it has changed–was presented. And of course none of the other questionable behaviors of the family at the time–all of which, as far as I can tell, they documented themselves in social media–are present. It is all smoothed out.
I suppose that Rachel Aviv made these decisions in order to focus on the long term picture. But I find it disturbing. It makes me rethink my initial reaction to the article.
“What seems likely is that the grandmother decided to use the suction equipment, disturbed the clots and/or sutures, and caused the catastrophic bleeding.”
That’s total speculation. And this whole scenario didn’t happen in a matter of minutes.
Didn’t help that the carotid artery was closer than expected and documented in the chart by the physician. And when she was bleeding that nobody took immediate action.
With the usual level of New Yorker fanatical fact-checking, I have to assume they’re not just taking the family’s word on what happened, but verifying against the record and other accounts.
^^^The only way they see records is if it is in the public record i.e., as part of the lawsuit. CHO has said repeatedly that they cannot comment due to the mom’s refusal to allow them to do so.
That is what the family has said, but have these tests been released for scrutiny? And which tests have been done? By which “neurologists”? I haven’t followed the case recently, so I haven’t seen this evidence that is being spoken of. I have read the report by the Stanford pediatric neurologist. Every legal test was done to determine brain death. Jahi failed every single one of them. They went even further than legally required, with a brain scan that looks at cerebral perfusion. Jahi had no blood flow to the brain. Someone please explain how someone who had no blood flow to the brain for not only 10 minutes, but several days, “recovers” from that.
If someone has access to all of the new tests which have been done in NJ which prove the initial 5-6 doctors who examined her in CA were wrong, please link. This is important information to examine.
@gouf78, I think that you are taking the family’s version at face value. You are speculating that they are correct when they claim that no one paid appropriate attention to them.
It is if anything MORE likely that the nursing staff paid appropriate attention and were monitoring the situation waiting until the clotting fully took hold until the suctioning–which remember the grandmother SAYS she did–dislodged the clots or caused bleeding in some other way. I find it strange that the article, which purports to tell what actually happened, does not mention the suctioning at all.
I wonder what kind of negotiations with the family and their lawyer Aviv went through in order to get access. The more I think about it, the more this part of the article smells. Honestly, this is not what I expect from The New Yorker. The rest of it has value, I think.
BTW, in one of the many things I read on this this morning, some of which were medical blogs, there was a mention that one of the doctors that examined her early on, at the hospital, said that the brain stem was destroyed by that there was some minimal activity in another part of the brain: pretty much the same thing that the MRI showed as far as I can tell.
From other stuff I’ve read it is probably worth asking why other measures, such as a cpap machine, were apparently not tried before this surgery, which was far more than a simple tonsillectomy. But that’s another story.
@consolation, I have wondered many times why other measures were not tried first. Jahi was very obese. Was a sincere effort made to improve her diet? Was CPAP ever tried? This surgery was a pretty radical approach to a problem which can usually be cured in very young people with some noninvasive tactics. The whole thing is very very sad.
I cannot simply take the family’s word on everything. They cannot be objective, they may have a degree of culpability in what happened, and they have a huge financial interest here. Don’t misunderstand that-I think they love her very much, but they stand to collect a huge settlement, which would affect their ability to move back to CA and care for Jahi for life if they can get her status changed from brain dead. They have no reason to accept any definition of brain death, no matter how it is defined, or by whom.
I would love to be able to read the nurses’ notes to get their version of events that day. I’d like to read the surgery report, doctors’ progress notes, all of it. But as long as Mom refuses to waive HIPAA, there is no chance of that happening unless it becomes public record as part of a lawsuit.
“What seems likely is that the grandmother decided to use the suction equipment, disturbed the clots and/or sutures, and caused the catastrophic bleeding.”
Okay. Maybe. Speculation. But don’t blame her. This whole scenario didn’t happen over minutes.
The carotid artery was closer than expected and documented in her chart by the physician. And when she was bleeding and the family called attention to it that nobody apparently took immediate action.
I even googled it-- Approximately 1 in 200 patients returns to the operating room (OR) so that the bleeding can be controlled. Mortality from bleeding is 2 in 10,000 tonsillectomies. Most cases of fatal postop bleeding occur within the first 24 hours after surgery."
It seems more likely to me that the bleeding was sloughed off by personnel because the incidence is low. Maybe they had no experience with it and just didn’t realize the significance.
I always say statistics are great until they affect you personally.
I used to work in a hospital and I’m glad I did. I know the ropes from both sides as a worker and a patient. I’ve heard a lot of stories and have plenty of my own. I’m very much a patient’s advocate.
I don’t remember if I had ever read that the grandmother lied about her credentials. I find that behavior to be very suspicious if true.
The whole thing didn’t happen over minutes. The crisis did, though, didn’t it? After the grandmother took it upon herself to suction. I flatly do not believe that a nurse GAVE her suction equipment and told her to use it. And she blatantly lied about being an RN.
I am extremely sorry for the family, who I think are laboring under a large burden of guilt, possibly partly justified and partly not.
When my S was in K, he had an operation to correct intermittent strabismus. I also had this as a child, and it was surgically corrected. Although mine was full-on, unlike his. The idea was to correct it before it began to cause him difficulty with depth-perception and so forth. (Something which I have.) He didn’t HAVE to have the surgery. When we were at the hospital, pre-op, the doctor asked S if he had any questions. My 5 or 6 yr old said, “Will I go blind?” It was heart wrenching. The poor doctor! He replied, “No. (pause) Not from this.” (Rigorous intellectual honesty! I admired it.) When they came and took him off to the OR, S walking away holding the nurse’s hand holding his teddy bear, you can imagine my feelings.
If he had been blinded, or even worse, died or been brain-damaged from that surgery, I would have been insane with grief. Believe me, I feel for them.
@gouf78, I think that you are taking the family’s version at face value. You are speculating that they are correct when they claim that no one paid appropriate attention to them.
Perhaps I am taking their story at face value. It seems more plausible to me than the hospital view.
My first post was that they needed a proper apology. And never got one.
I think some respect could have avoided a lot of this.
My view:
Familly:
When I look at the story, I see a family who lost their kid to a seemingly simple operation (I don’t think any operation is “simple” BTW). This is never stressed.
No where is a mention that the hospital or a doc responded immediately to stop the bleeding. (a friend of mine almost died because of this).
The family moved to another state. Not an easy out in anyone’s book… Mom admits she dug her heels in at that time.
It upended their lives. Mom even said she didn’t realize the full extent of that decision. But they have stayed. She doesn’t appear to be hiding ulterior motives in the article.
Hospital:
When I look at the story, I see a hospital who had charts with info that never got communicated. Jahi had potential major complications that were known prior to the surgery written in the chart. It should have been a huge red flag.
I see nurses that probably didn’t realize the impact of not telling the doctor that there were complications.
Or were afraid to alert them immediately.
I see nurses who weren’t following protocol if they still allowed so many family members in the room etc. as someone mentioned above. It’s up to the person in charge to actually take charge.
I see nurses not sticking their necks out to advocate for their patient’s condition.
This one hurts–I’ve bent over backwards in my career life making sure no avoidable harm came to a patient. I’ve wondered at times how much trouble I’d be in–but it never really mattered. I made the calls and stuck my neck out plenty of times. It’s been worth it.
Where was the chain of command that would allow the communication?
@gouf78, you are making a lot of statements about the health care team without having any access to the medical record. Just because the family has made accusations does not necessarily mean they were all true. How do we know what the nurses communicated to the doctors? How would the family know what the nurses communicated to each other or to any other person on the medical team? How can we know who said what or did what without having access to those records? This isn’t even a he-said she-said. One party is not allowed to say even one word in their own defense. Why are you making any conclusions without having input from any of the team who were there that day?
This was not a simple operation, not even seemingly, although it was sometimes described as such in the media. It involved not only removal of the tonsils, but the adenoids and part of the soft palate. It was actually quite aggressive. (Hence the question raised above about whether it would have been wise to try cpap first.)
If they were “written in the chart” they were communicated. People read the chart. That’s how it is done.
I see no evidence of this.
Nope, even the family admits that the nurses told the step-father that only one person was allowed in the room at once, and he left. Not clear why, or even IF, they allowed the grandmother in later. (The timelines are contradictory, based on the family’s statements.) At the most, they sometimes allow the rules to be bent a little on compassionate grounds.
Most pediatric units would allow 2 visitors at a time, presumably because most children have 2 parents. I’ve worked various ICUs, and the most restrictive policies always allowed for 2 visitors at a time, unless conditions mandated that NO visitors be in the room at a given time. And as consolation mentions, exceptions were made depending on various circumstances.
@ Consolation – “If they were “written in the chart” they were communicated. People read the chart. That’s how it is done.”
I’d love to think that always happens. That’s the way it’s supposed to work. I’d LOVE that scenario. That’s what health care workers aspire to.
But my personal experiences speak otherwise…
When you have a nurse punch your stomach after a C-section and you double over in pain you can tell me that (she didn’t even know I’d had a C-section). And didn’t seem to care.
When an IV has run out and have to turn it off yourself, you know it doesn’t always work right.
When a nurse refuses to call a doctor before it’s “8am and I don’t want to disturb him”, you can tell me that. (the doctor gave her an earful after I told him).
When an antibiotic doesn’t get administered because it wasn’t mixed properly, you can tell me.
When a doctor orders 50,000 units of in sulin for an IV bag and refuses to listen but instead yells at you for not following his orders --(no, I sent it down and said “you mix it if you’re so smart but you’ll probably kill them”) --you can tell me. (The mere visual was enough to cut that one short I heard)
When I tell the radiology people they are planning on giving iodine to somebody that is clearly marked with an iodine allergy on the chart and everywhere else in capital letters and they need to switch meds. And then they don’t pay attention. To me or the chart. You can tell me. (that person coded by the way but fortunately lived–I heard about it later).
When the nurse calls for the chemo meds that have already been given–you can tell me how people read the chart and “that’s how it’s done”.
Fact is–it’s not always done and charts aren’t always read. That’s why there are double and triple checks.
@Nrdsb4 –
How would the family know what the nurses communicated to each other or to any other person on the medical team?
Because of the final outcome. If nobody showed up to take care of the bleeding and it was considered a “big surgery” like Consolation said then somebody on the medical team should have responded sooner and taken more aggressive measures if the original communication was sent as an urgent message. If it was true that it took hours for any real positive reaction–then the initial lack of action speaks for itself.
Or my original theory that the personnel wasn’t aware how serious the bleeding actually was due to lack of experience in this case and tended to downplay it still stands.
I only know what I read in this particular article and injected my experiences over 40 years. I’m not condemning anyone–either the family or the healthcare team. It’s just very sad all around.
@gouf78, no disrespect intended, your 40 years of experience doesn’t mean that you understand what happened here on that particular day. I personally am making no argument one way or the other. But lacking the medical record, I find your assumptions to be patently unfair to the professionals working that day. I can see that you really don’t know much, because so much of the information is lacking. You are making assumptions based on your own baggage. You “only know what you read in the article.” Well, that says plenty. I would never accuse the professionals involved of negligence based on an article and my own experience. I would absolutely want to hear and see all of the information first. Frankly, I’m kind of surprised at your clear bias.
Without access to the medical record, we really know very very little. I’m surprised that that fact isn’t really obvious.
I repeat --" I’m not condemning anyone–either the family or the healthcare team. It’s just very sad all around."
Until this sad case goes to trial we will never know what causes Jahi to bleed that day, I think it’s counterproductive to speculate on her medical care.
I’ve been a nurse for 27 years and I know that every day we strive to make care safer, we report every error and every near miss event. With the implementation of electronic records less important information is missed and less med errors occur.