Oops. Doctor J, the “simple debate” thread in GD also contains legal interpretation.
regards,
widdley
There are wisps of brain tissue left on the scan; I would stop short of saying that her cortex is completely gone (in that CT, which was many years ago–it is probably worse now). However, I look at CT scans of elderly, demented patients all the time, which tend to show a similar pattern of cortical atrophy; the most demented, unresponsive, end-stage patients I’ve ever seen still had twice the cortical tissue that Terri’s scan shows.
I don’t think that someone with a scan like that could have significant cortical function. (Remember–that whole thing about us only using 10% of our brain is crap. Also remember that even if there is a little bit of brain tissue, there is no reason to think it is working, and plenty at this point to think that it isn’t.)
I don’t think so, but even if it were, I think it’s very reasonable to discontinue life support on someone who will never rise above the stage of an infant if we think that’s what she would want.
That’s why all the fine cuts regarding Terri’s exact diagnosis and prognosis are medically interesting, but really beside the point. She is in a state in which a reasonable person could choose not to continue life support, a fact bolstered by polls lately showing that 87% of Americans would not want to be kept alive in Terri’s state. The only question is who makes the decision.
DoctorJ,
Don’t consider it “stealing”, but do know that I had a great pause of what-to-post, and those words came out as the best to from my own mind…Spread it around at will, especially in the medical community, such a grace of pun…
What I would like, though, is a consideration of the other points in my post, from a medical perspective. In reading about this case, quite significant for the future of Heroic medicine, I think it important.
Thank you for taking the time to discuss the CT scans and outcome.
regards,
widdley
Drudge apparently has audio of Terri responding to her father after the tube was pulled:
http://www.frc.org/DL/20-MAR-05__EF05C38_0003AAE3-2D4F-123E-84811014AC14F856.mp3
I can’t get through to it though.
In April, I go back to medical school for the first time since fall 1999. This whole thing has made me very, very nervous about the future of American science and medicine.
This whole thing, the embrace of lunatic emotion over all rational thought, makes me want to vomit and dissociate myself with as much of this country’s government as possible. This decision has made me as angry as any political action ever has.
Just a word on the CT, not that I’m qualified. (It’s at http://www.pharyngula.org BTW, which is a good blog about science). What you are really looking at, primarily, is the black stuff. In the normal brain (although these may not be at the same level), there is a little black stuff (CSF – cerebrospinal fluid) in the little slivers of ventricles and in the sulci (folds) of the exterior surface of the brain. Schiavo’s brain has massively dilated ventricles cause by a death of surrounding brain structures. This can happen a little with age but in this case its pretty profound.
IIRC, it is often hard to correlate CT findings with exact clinical picture. PVS is a clinical diagnosis. But CT is a rough diagnostic tool for this kind of damage, and the ability to see such a large change means that the damage is quite extensive.
Here’s the audio:
Speaking of Hippocratic Oafs:
Are hospital administrators covered by it, ethically, as well as working physicians? Could Frist be considered to be in violation of any part of it?
What frightens me is not what happens to her, though that is tragic. It is that the Republicans in Congress have so lost sight of their duty that they can hijack the power of the government against one person. Those who claim they love marriage are destroying one of the most important aspects of the marriage bond: the ability and power to make joint decisions. What’s next: the government telling me I can’t use birth control since that is against life? Oh, they’re moving in that direction already, aren’t they?
A better example of absolute power corrupting absolutely I’ve rarely seen.
Oh, Jesus H. Christ. I couldn’t even listen to all of that. Can anyone who has managed to stomach the whole thing tell me if it is anything but three and a half minutes of Terri moaning while her father asks her questions over and over?
I feel sick and nasty just having listened to what I did of that. I also feel the same way I did about the videos–if that is the best they can put forward, then she is in sad state indeed.
I have tried to feel for her parents the entire time, but for the first time, let me say–fuck her parents. Fuck them for taking away the last scraps of dignity Terri might have ever had.
Pathetic.
Here’s a for those who don’t want to wast their time waiting for their players to load.
Terri: Uuuuuuuuuhhhhhhhhhhhhhhhhhhh.
Adult Male Moron: Hi Terri, can you say hi?
Terri: Uuuuuuuuuuuuuuuhhhhhhhhhhhh.
AMM: How do you feel?
Terri: Uuuhhhhhhhhhhhhhhhhhh.
Repeat for about two minutes.
There s nothing going on in this audio. There are no “responses” from Terri. She seems to be moaning but it’s random and it sounds to me like she’s just breathing and her vocal cords are vibrating as she breathes. The douchebag who keeps yammering at her is putting on a show for his intended audience by pretending that she’s “answering questions.” It’s disgusting.
Is that male voice in the tape her father? That guy needs a serious ass-kicking.
Doc, could you tell me if I’m right about my guess that it’s just some sort of reflexively “vocalized” breathing (I don’t know what the medical term would be if there is one)?
Ahh fuck man, I listened to that and it cheapened me. My mind feels dirty.
(hijack)
I need a distraction. DoctorJ, you have any new music suggestions? Preferably available on emusic, but iTunes will do…
Yes, that’s the whole thing, and that is her father.
Yeah, that’s pretty much it. “Vocalization” is what I’ve always called it.
The more I think about it, the more it just puzzles me. Why bother putting this bit out on the internet? Do people really, honestly think she is interacting with her father in this clip? Is this supposed to make me say, “Oh, well, I was completely mistaken; as long as she’s able to moan, it’s absolute murder to remove that tube!”? On the contrary, it makes me hope that death can finally come for her before Congress is able to stop it.
New Kathleen Edwards is good if you liked the first one, which I did. A band called Conshafter has a live show from the Cat’s Cradle up on eMusic that’s pretty good; I know of them mostly because their guitarist’s father is my program director, but they really do kick my ass.
I’ve been writing posts and calling bullshit and writing letters about this all weekend; maybe I need some distraction myself.
Ah, crap.
You know that bit in Neal Stephenson’s Quicksilver, where Waterhouse and Wilkins have hooked up a bellows to the severed head of a cadaver, and are blowing air through the larynx?
That audio makes the way I imagined it seem like a Tori Amos performance.
Mr. Schindler’s attempts to shoehorn his Mr. Rogers interjections into the spaces between the awful sounds in an attempt to simulate a conversation is just pathetic.
I think they are indeed counting on people responding that way.
Sorry, I’m a coward - I’m not going to listen to that audio file.
But if it’s as non-responsive as those of you who did have the stomach to listen are saying - can we hope that this will backfire on the parents, and the Repugs who are making this a test case for euthanasia? I sure hope so.
One of the sad things about all this is that I’m very leery of physician assisted euthanasia, and because of that I tend to lean towards a more conservative (In an engineering sense, not political, here.) approach. I am particularly afraid of doctors pressuring patients to allow themselves to be euthanized, as some groups have reported happening in the Netherlands.
But this is so far from a marginal case, IMNSHO, I can’t see the point to all this effort. It’s not a good test case, or even a likely repeatable situation. From reading the comments of health care professionals in this thread, and some of the others on this topic, 15 years of assisted breathing, and feeding, are almost unheard of for a patient to survive. If I’ve gotten mistaken impressions from reading through these threads, please correct my ignorance, but unless someone tells me my head’s up my arse again, I’m going to continue thinking this is the wrong case for a stand against euthanasia. The only thing here that’s notable is the level of self-delusion in the family of the victim.
I just went to the House web site to check the roll vote for the bill the idiots passed.
Of those voting (261 members)
203 voted for the thing - 156 Republicans, and 47 Democrats.
58 voted against it - 5 Republicans, and 53 Democrats.
That’s right, folks, of those who bothered to show up for the special midnight session, approximately half the Democrats supported this atrocity. 
:mad:
And because this was an irregular vote, it could have been stopped if they didn’t get a 2/3’s majority voting for it.
And my rep was one of those who didn’t bother to show. :mad:
I am betting that SCOTUS will now hear a constitutional challenge of this law. Congress clearly has no authority to intervene in individual cases, and I doubt the Supremes are going to look kindly on any usurpation of judicial authority. This is only prolonging the inevitable. Shame on Congress.
My rep voted against it–makes me feel better about living in Virginia, albeit in a bright blue chunk of it.
I don’t understand how the GOP’s minions can swallow what their party is doing, blocking a husband’s right to make a decision for his incapacitated wife. What happened to “the sanctity of marriage”?