Moon has referenced what seems to me a very useful blog on the Schiavo case, which even includes a CT image of her brain. I had not seen these before. There is a lot of talk about her need for an MRI. Sorry, guys, I view CT's of heads every day, of normal folks and folks with advanced dementias from strokes or Alzheimers,, and this is the most pitiably degenerated brain I have ever seen in my 25 years of practice, and that by a very long shot. I can't begin to guess what anyone thinks an MRI will add. There is nothing there. This is not going to be one of those cases where Uncle wakes up and walks out. Ms. Schiavo has already awakened. To be awake requires only a brain stem, not a brain. In medical school we had a horrible cat whose cerebral cortex had been surgically removed. The cat still ate, stood up, walked, was "slinky" like a cat...all that, with only a brain stem and spinal cord. It did not have to be "kept alive" by "extraordinary means". I guess it was still "a cat". It was a miserable, pitiable thing nontheless.
Mr. Hilzoy makes the point (in the blog referrenced) that this is not about the state "killing" someone, and never was. It is about withdrawal of treatment and about consent issues regarding an incompetent patient. Michael Schiavo, like him or not, has been enabled by the courts to make decisions on Terry's behalf. Again, this is done all time, every day, and decisions to not resuscitate or to withdraw treatment are made every day in this way, and must be. If I tell my wife (as I have) that I don't want to be kept alive with a feeding tube, and if I subsequently lose my ability to elaborate on that verbal directive, you better be sure that I don't want anyone else out there preventing her from pulling my tube, especially not to make me a poster boy for the pro-life political agenda. (Which, by the way, has already lost this one, no matter how it goes for Ms. Schiavo. They have turned the eyes of the Leviathan toward this issue, and now there will be no end to legistative and judicial mucking about here.)
That's helpful clarification on the medical questions, Dr Kearns. Thanks.
ReplyDeleteThere remains, though, a lot of conflicting info out there. Are all the major voices here politically or ideologically interested?
You have not commented directly on the Johansen article so far. Do you intend to do so?
Re: my own question above about the problem of interest making it difficult to sort out the Schiavo conflict, here's an interesting short opinion by Fred Barnes of the Weekly Standard. (via Justin Taylor)
ReplyDeleteDr Kearns, I've had a chance now to scan the linked material in addition to your comments here, and see now that the linked material addresses Johansen's report directly. Sorry to have missed your point in effect.
ReplyDeleteAnother doctor blogger's opinion on the scan:
ReplyDeletehttp://codeblueblog.blogs.com/codeblueblog/2005/03/csi_medblogs_co.html
Here's that link by anonymous, fixed:
ReplyDeletehttp://codeblueblog.blogs.com/codeblueblog/2005/03/csi_medblogs_co.html.
The blog's 'about' material identifies the author as a radiologist with about 20 yrs' experience.
A provocative segment from the post:
First of all, the University of Miami's appellation for this scan is inaccurate. "Cortical regions" are not and can not be filled with spinal fluid. The sulci (spaces between cortical ribbons) are enlarged secondary to cortical atrophy and these sulci are filled with cerbrospinal fluid.
The most alarming thing about this image, however, is that there certainly is cortex left. Granted, it is severely thinned, especially for Terri's age, but I would be nonplussed if you told me that this was a 75 year old female who was somewhat senile but fully functional, and I defy a radiologist anywhere to contest that.
I HAVE SEEN MANY WALKING, TALKING, FAIRLY COHERENT PEOPLE WITH WORSE CEREBRAL/CORTICAL ATROPHY. THEREFORE, THIS IS IN NO WAY PRIMA FACIE EVIDENCE THAT TERRI SCHIAVO'S MENTAL ABILITIES OR/OR CAPABILITIES ARE COMPLETELY ERADICATED. I CANNOT BELIEVE SUCH TESTIMONY HAS BEEN GIVEN ON THE BASIS OF THIS SCAN.
The worrisome, no alarming thing, for me, was that I heard a bioethicist and several important figures on the major media describe Terri's brain as MUCH WORSE. One "expert" said that she had a "bag of water" in her head. Several experts described her as a "brain stem preparation"
These statements are wholly inaccurate. This is an atrophied brain, yes, but there is cortex remaining, and where there's cortex (?life) there's hope.
If you starve this woman to death it would be, in my professional and experienced medical opinion, the equivalent of starving to death a 75-85 year old person. I would take that to the witness stand.
(mm – I see that url didn't need fixing. Must have gotten only part of it when I copied & pasted.)
ReplyDeleteHow do reconcile this with the findings of Dr. William Hammesfahr? He examined her medical records and the patient. His opinion differs markedly from yours. And he says he has treated patients who are more damaged than Terri Schiavo. The CT scan is not sufficient - particularly when it is taken without any functional testing. MRI has better imaging and resolution. So why not give her an MRI and do functional tests too?
ReplyDeleteI disagree with the radiologist. I see CT scans AND the patients, whereas he reads scans delivered to him in a stack of pictures.
ReplyDeleteMore importantly, the wrong question is being asked and argued in all these writings, especially those that love to use the terms "execution" and "murder". The question, the original question and the one that concerns all of us most directly, is whether Mrs. Schiavo has the right of self-determination regarding such interventions as gastric-tube placement. (This "feeding tube" is a rubber tube placed through a stabwound in her abdoment, directly into her stomach. It is invasive. Most persons would find it decidedly creepy as well.) I think she has that right. Most people do. Most people would want the tube left out, if they were Terry. The opponents of euthansia, of which ironically I am one, have for the most part labelled such a decision "suicide", which is necessary to the argument that Ms. Schiavo's preferences here should be disregarded. I do not do so. I have seen suicide, and this is not it. I have seen murders, and this is not that either. This whole thing has been talked up into a frenzy, and I feel very disappointed. No good will come of it, I fear.
Thanks, Dr Kearns, for answering that.
ReplyDelete