Ah, what the hell, I'll pit Michael Schiavo

The BBQ Pit
41

Jesus H. Christ, I don’t think that she was abused. That’s merely an example of another theory thrown out there by people with little or no supporting evidence.

I didn’t see much to respond to in the later half of you post, except that the same argument that eating disorders often went unrecognized due to ignorance could apply to the medical community as well. 13 years ago, the prevalence, risk, and importance of treating eatings disorders wasn’t in the standard of care in the same way that it is now.

Please, do me a favor, download this:

Read from the bottom of pages 28 to the top of 31. Unless the Pinellas County coroner is now an attention whore/crackpot as well.

42

threemae-do you not get how the legal system works?

The evidence is weighed up, the defense makes a case, the plaintiff makes a case, and on the basis of the available evidence, a decision is made.
As for what he “should have known”, you’re talking crap. People often manage to hide their addictions, eating disorders, self-harm, promiscuity etc from their family and friends. It’s not a new thing. Sometimes people are better at hiding things from those they know, sometimes the family and friends don’t know what to look for or what to ask.

Sometimes strangers are better at working out the real situation, simply because they have some distance. Ever met someone you knew was gay straight off, but the person’s family were all still under the impression they were straight? It happens.

About Medical negligence:
If your wife, who has been drinking a lot of water recently and losing some weight collapses in front of you and you don’t know how to revive her, you’re not guilty of anything except not having a lot of medical knowledge.

If your wife walks into her doctor’s office, with a history of thirst, weight loss and urinary frequency, and collapses, and the doc doesn’t treat her for presumed Diabetic Ketoacidosis, it’s negligence.

More knowledge equals more responsibility. Not proximity or a close relationship to the person concerned, but professional skills in that area.
If you’re treating a woman for infertility secondary to recent onset amenorrhea, with a history of a significant weight loss in her recent past and you don’t outrule an eating disorder, you’ve made a serious error in judgement. Because you DO know what to look for, and you DO know what to ask.

How are you still not getting this?

43

Why not? Mr. Schiavo, his lawyers, the jury, and the entire tort system are wrong, so why not one more person?

44

Oh bollocks. I did not mean to imply in any way that TS had Diabetes, it was just an example I picked out of the air.

45

To go a step further, it’s wasn’t really Michael Shavio’s job to decide whether or not the doctor “should have known”. He doesn’t/didn’t even have the basis of knowledge to make that decision, he doesn’t know what’s reasonable for a doctor to be able see and what would be too obscure. I mean, that’s why you go to a doctor–cause they know SO much that lay people don’t.

My husband had a chest X-ray three months ago and everything was fine. If in six months (god forbid) he is diagnosed with lung cancer, I own’t be able to go back and look at those chest films and see whether or not they should have caught early signs of cancer–hell, if I could tell that, we wouldn’t have needed the experts in the first place. And if some doctors told me they Xray guy should have known, and others tell me no, they couldn’t have seen it, well, situations like that --where experts disagree–are EXACTLY what the legal system is designed to deal with.

46

As for the saline, not really. The vast majority of the body’s potassium stores are inside the cells, and the balance between that and the serum level (which is what we measure) is actively maintained. So potassium generally doesn’t “dilute” the way some other things will.

You can see potassium drop with epinephrine, and this is a plausible explanation for the low potassium. I just don’t think it’s the most likely one.

No, I’m putting all the available information together and coming up with the explanation that most neatly puts all the facts together. We have two sayings in medicine:
–Common things are common. (Hard to explain, but it’s a way to remind ourselves to look at the common causes for a situation rather than try to come up with bizarre ones.)
–Uncommon presentations of common things are more likely than common presentations of uncommon things.

Among young women, eating disorders are, unfortunately, incredibly common. I don’t have a cite handy, but I’d guess that if you’re looking at women between the ages of 15 and 30 who spontaneously go into fatal arrhythmias, electrolyte derangement from a disordered eating pattern has to be far and away the #1 reason. So we would say that a young woman who collapses from such an arrhythmia has a high “pre-test probability” of having an eating disorder (not that there is a test–it just means that it’s likely).

Then you start looking at other pieces of evidence–she had just lost a large amount of weight in a relatively short time. Her friends and her husband considered her eating habits to be strange. She had recently started to see a doctor for amenorrhea. Putting all that together, it’s just incredibly unlikely that you’re looking at anything else.

If there are a few facts that don’t quite fit (and I’m not sure what they would be in this case), it still falls under the “uncommon presentations of common things” rule. Yes, facts could be uncovered that point to another cause, or you could find strong evidence that she did not have an eating disorder, and that would make it less likely, but I’m not sure what it would be at this point, and we certainly haven’t seen it.

47

Granted. I hope you realize that if you’d started off by asking me for a cite instead of saying “you seem to have fabricated this amenorrhea bit out of whole cloth,” I’d have responded differently.

48

Just for perspective, what choices were open to Michael Schiavo from the get-go?

I have pretty good health insurance, and have purchased some disabilty coverage as well, but neither would begin to cover hospital care that extended indefiinitely. That sucks, but there 'tis. And exactly there Michael Schiavo was.

I refuse to criticise one damned thing he did because he’s already been pilloried, excoriated and been reduced to a political strawman in an obscene, inhumane and opportunistic national game of political ‘gotcha!’.

What the fuck was he supposed to do, in this game of forensic voyeurism? Wife collapsed, panic, heartbreak, bills mounting, hope that erodes inch by excruciating inch, but the meter never stops running…

He coped, and as far as I can see, he did everything within his power to give his wife every possible chance. Was every itty bitty detail ‘perfect’ by some abstruse standard? Damned if I know.

What I DO know is that this was a personal tragedy that was seized by scumsucking bottom feeders for reasons that had absolutely nothing to do with the few tortured souls directly involved.

This has been a travesty of basic decency from the very beginning. Nobody in this unholy, twisted soap opera ‘stands’ for anything beyond ordinary people caught in extraordinarily hideous circumstances. They aren’t pin-up posters to be spit at or hailed as ‘evidence’ of ANYTHING.

49

Brandishing Michael Schiavo as a poster child for tort reform is about as stupid as claiming that trees cause pollution.

50

Well threemae, in your defense you didn’t actually say your were pitting MS’s “abuse of the legal system”, but it’s right there in post #36. THAT is the “abuse” I was speaking of.

THis seems to be the proper use of the legal system to me and I still can’t see what you’ve got to be bitching about.

51

I’m sure I’m not the only person here who’s known someone who suffered from an eating disorder. You can’t simply just say to that person, “Hey! You’ve got an eating disorder!” and get them to realize that they’re putting their life at risk. Some times even telling family members that there’s a problem won’t solve anything, because they themselves are in denial! Perhaps if a doctor had told Michael or Mrs. Shiavo’s parents that she had an eating disorder, she could have gotten the treatment she needed and not suffered that fatal collapse (though I doubt if her parents would have listened, since they didn’t listen to the ones who said she was braindead), but the doctor didn’t. One of the reasons we go to doctors is because they can tell us what’s wrong with us, when we don’t know.

I’ve had doctor’s misdiagnose me, but it was nothing serious, so the thought of a lawsuit never entered my mind. Had the results been something disabling, I would have sued, and if it had been fatal, I hope that my family would sue the piss out of the doctor, so that they wouldn’t make the same kind of mistake again!

52

Would it have been legal for a doctor to discuss Terri’s possible eating disorder diagnosis with Michael or her parents? I think it would be a breach if confidentiality and grounds for Terri to sue, no?

regards,
widdley

53

IANAL, but IIRC medical confidentiality doesn’t apply in instances where a person’s life/health is in danger and other individuals are needed to make sure that the person recieves proper treatment. Given that people with an eating disorder need to have folks around them alert to their actions, I’d think that it would be exempt from any risks of violating doctor/patient confidentiality to let the husband (at the very least) know about this.

54

Yes, but how do you know if she ever had it 15 years after it happened? What are the signs you’re looking for?

55

Probably bone structure:

http://www.serpell.com/osteo.htm

56

That’d be a good clue, but 15 years later I doubt you can conclusively say “Her bone density is low because of an eating disorder.” Too many confounds there, I think.

57

And besides, if there’s evidence of any old fractures, we all know it’s because Michael beat her and…

Oh, never mind. Even the Schindlers can’t possibly still be…

58

So… the information is worthless then. You can’t determine the cause for every possible fracture that you find. It could’ve been the paramedics, the bulimia, the paramedics causing a fracture because of the bulimia, the 15 years of natural bone decay (I’m presuming bones weaken when you don’t use them for that long, no?), etc.

My interpretation was that not even the doctors are sure if she even was bulimic at the time. I found it odd that they’re “looking for that” now. “She looks a little too thin”, spoken of a dead body, seems ridiculous to me.

59

That’s not at all clear. Bone undergoes a constant remodelling process, and it may be that a period of stress, brought on by say, bulimia, would leave microscopic evidence in the shape of healed microfractures or abnormal growth, years after the original insult.
I don’t know what tests they did, do you?

60

You’re right that this is a problem in eating disorders, but I just can’t imagine this showing up fifteen years later. You would expect Terri’s bone density to be crappy at the time of her death; even if her tube feeds provide adequate nutrition, she had not done any weight-bearing in fifteen years. There’s no way her bone density itself could lead to any conclusions.

You might see old fractures, but you might not, and even if you did, she had reason to have such things (the collapse, the code) even with healthy bones.

I’m no pathologist, but I don’t think the bones would tell you much about an eating disorder at this point.