“The question is not whether we will die, but how we will live.”

-Joan Borysenko

For some, the question is: Will they kill me before I have a chance to live?

The emotionally shaken father of a 16-year-old girl in an irreversible coma at Montefiore Medical Center is wavering in his opposition to ending what’s left of her life.

“I’m 85% changed in my mind now, but I don’t know the legality,” said Leonard Peters, whose daughter Javona Peters is in a permanent vegetative state after what was supposed to be a routine operation on Oct. 17.
[…]
Javona’s mother, Janet Joseph, has said she wants “to let Javona go in peace” by taking her off her feeding tube. The case is set for a Jan. 7 hearing in Bronx Supreme Court.

The case, first disclosed Wednesday in The News, has attracted national media attention to what could be another right-to-life battle, as in the Terri Schiavo case.

Javona was a healthy, outgoing high school junior until she went into the operating room 10 weeks ago. Now she is blind, deaf and unable to move, think or eat on her own.

October 17th? of this year? It’s too soon to make the rush for death here. Way too soon.

Remember little Haleigh Poutre? The 11 yr old girl in MA, who was beaten into a coma? Her doctors told everyone she was brain dead too; that she was blind, deaf and in a vegetative state. The MA supreme Court had even given it’s legal blessing to the hospital where Haleigh was staying- to pull her off life supports. They were hours away from doing this when Haleigh woke up. She’s made remarkable progress and continues to do so at a rehab center in northern MA.

What’s the rush?

Joseph has asked the courts to appoint her Javona’s guardian so she can finally pull the plug and also begin a medical malpractice action against the hospital.

Javona’s parents say hospital officials have never satisfactorily explained what happened to their daughter.

Montefiore maintains her condition was caused by oxygen deprivation triggered by an “extremely rare” allergic reaction to “a routine anesthesia agent.”

Javona’s operation was a ventriculostomy, a routine procedure that involves boring a hole in the brain to drain cerebral fluid into a cavity.

Javona’s Mother can sue the hospital NOW; she need not have a dead daughter to do so. Of course, a dead child would up the ante in any settlement. A dead child always produces more cash in these situations.

The operation Javona underwent is anything but routine, for a normal healthy girl. I suspect she had other problems we’re not hearing about right now. Nonetheless, tragically she had a reaction to the anesthesia and apparently the OR staff didn’t catch this until she been oxygen deprived for too long.

At my work we recently took care of a 12 yr old boy who underwent a routine operation, having his tonsils removed; he too had a severe reaction to the anesthesia; he didn’t go long without 02, though. But his brain reacted as though he had. He was in a coma for 14 weeks. No one gave up on him and he woke up, delved into rehab and walked out of my facility with a big smile on his face. He is able to do all his own things again- and now he’s back in his school getting ready to play basketball.

Meanwhile, the hospital has told Joseph it’s time for her daughter to be transferred to a permanent nursing facility. The hospital contends there is nothing more it can do for Javona.

Given some hope, she might live.

Javona should be transferred to a rehab facility for a short term evaluation and coma-stimulation program. Given time she might wake up; given good nursing care she might recover from the medical aspects of all this. I think people are too focused on the monetary “awards” of these situations. Sure, parents are grieved and saddened. But they often keep their eye on a prize that makes me question the motives here. Medical people are not always right. Especially in situations where brain “death” is concerned. We know SO LITTLE about how the brain works. We do know that what we often label “Brain Dead” suddenly comes back to life though, with no warning.

There is one thing common about those who wake up: They were given time. Why the rush?

Last week some may have read articles about Justice Sandra Day O’Connor’s husband- who is in love with another woman. He has Alzheimer’s Disease and this isn’t a rare occurrence.

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The irony abounds once again in Great Britain. Keeping the politics out of this as much as I can, remember that your priorities might not equal those of a national health care system.

LONDON (AP) - For two years, Frances Kinley-Manton says she lived with arthritis pain in her hips, a condition that kept her in a wheelchair.

She wanted hip replacement surgery. But doctors at Britain’s National Health Service said she was too fat for the operation.

“They wouldn’t even put me on a waiting list,” Kinley-Manton recalled.

Her doctor told the 210-pound woman to lose about 30 pounds before he would consider her for surgery.

Unable to drop the weight through dieting, the 68-year-old Scotland resident took out a mortgage on her house to pay for a private operation on the Mediterranean island of Malta. She had her first hip operation in July. Now she’s awaiting surgery on the other hip.

“I had no alternative,” she said in a telephone interview from the island. “NHS said they wouldn’t operate on me because I’m overweight, but I think they were just trying to keep their costs down.”

There are increased risks with surgery to overweight people, for sure. Mrs. Kinley-Manton was/is NOT morbidly overweight however. People in the US and most other nations can and do have hip operations at this weight; many are heavier. The risks are there, but not high enough to deny someone this operation. Doctors and other medical people realize the risks of doing nothing in these cases far outweigh the small chances of problems occurring during the surgery: A hip problem increases immobility, which leads to dependence and eventually the inability to take care of oneself. Um, this often leads to nursing home placement which is much more expensive than the operation in question here.

Contrary to what the NHS considers to be vital and important, we see the NHS pays for women to have their hymens repaired, so they have the look and feel of a virgin on their wedding night.

Women are being given controversial “virginity repair” operations on the NHS, it emerged last night.

Taxpayers funded 24 hymen replacement operations between 2005 and 2006, official figures revealed.

And increasing numbers of women are paying up to £4,000 in private clinics for the procedure apparently under pressure from future spouses or in-laws who believe they should be virgins on their wedding night.

Doctors said most patients are immigrants or British of ethnic origin.

Of course this is for women who are Muslims. That’s not important in my point here. What should concern people is the stark reality of a culture that disregards a real medical condition vs. a politically correct and religiously based “demand”.

Muslim non-virgin women should be the ones going to other countries and paying for their own non essential surgeries with their own money; not slightly to moderately overweight women who could very well end up living in nursing homes for the lack of a simple and very effective surgery. Of course Mrs. Kinley-Manton could claim herself a Muslim, demand a hymen repair and perhaps as an added benefit ask for the hip replacement surgery: She would probably have a good chance of getting both.

I just remembered Teach does open trackbacks now and again and I think this article is worthy of sharing. So go over and see what he has to say…

An post over at the WSJ Health Blog caught my eye:

Nurses are beaten and abused, pinched and punched by deranged and demented patients.

The rough treatment of nurses by some of the people they care for isn’t an issue that gets much attention, but it should, Illinois doc Ben Brewer writes this his WSJ.com column. “Nurses get assaulted all the time at work,” he writes. “They get assaulted in small and large ways at every hospital and nursing home in the country.”

The subject comes up occasionally in the medical literature (see this study, for example), but for the most part everybody assumes it happens and there’s not much to do about it. Nurses are the infantry of the health-care system.

Brewer rolls out one example after another. The young nurse with the long scar on her forearm, where the surgeon went in to fix tendon damage after a patient violently twisted her hand and bent back her fingers. The ICU nurse with a deformed finger and nerve damage from a patient’s bite. The nurse who got punched in the ear.

He notes that patients are restrained less often than they used to be, but he suggests that more frequent use of restraints probably wouldn’t do any good. “Usually it’s the one you don’t see coming that gets you,” he writes.

Yea? Let’s talk about this rough treatment:

Nurses and aides are:
Hit
Punched
Kicked
Bitten
Pinched
Held semi captive by hair pulling
Picked up and thrown
Targets of objects being hauled across rooms- everything from a simple hair brush to entire hospital beds.

…and otherwise roughened up and abused by our patients.

On a daily basis.

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The mother of one of my patients (a Marine) pointed me to this article this morning. She was quite upset with the portrayal of wounded soldiers and Marines in the manner presented in this story…and her words resonate strongly:

“Be grateful they have memories of their battles. I would give anything including my own life for my son to remember.”

TEMECULA, Calif. (AP) - He was one of America’s first defenders on Sept. 11, 2001, a Marine who pulled burned bodies from the ruins of the Pentagon. He saw more horrors in Kuwait and Iraq.

Today, he can’t keep a job, pay his bills, or chase thoughts of suicide from his tortured brain. In a few weeks, he may lose his house, too.

Gamal Awad, the American son of a Sudanese immigrant, exemplifies an emerging group of war veterans: the economic casualties.
[…]
“The wounded and their families no longer trust that the government will take care of them the way they thought they’d be taken care of,” says veterans advocate Mary Ellen Salzano.

How does a war veteran expect to be treated? “As a hero,” she says.

Not all soldiers and Marines will agree with this. A great many of them would prefer not to be known as heroes. My work is with profoundly brain injured young people- teenagers, young adults and we serve some wounded Marines now. You learn a lot about human strength through the struggles these families must endure. And like my patient’s Mom says- theres a fine line between garnering sympathy and expecting the government to fix every problem, vs. taking charge of your own problems and working towards a solution. The battle of recovery can be optimistic or pessimistic. Most people find a balance- they mourn what they have lost, yet they are also grateful for what they have.

Every morning, Awad needs to think of a reason not to kill himself.

He can’t even look at the framed photograph that shows him accepting a Marine heroism medal for his recovery work at the Pentagon after the terrorist attack.

It might remind him of a burned woman whose skin peeled off in his hands when he tried to comfort her.

He tries not to hear the shrieking rockets of Iraq either, smell the burning fuel, or relive the blast that blew him right out of bed.

The memories come steamrolling back anyway.

“Nothing can turn off those things,” he says, voice choked and eyes glistening.

You know, when I read lines like this, I lose respect and sympathy…does that make me cruel or cold? I don’t think so. Mr. Awad should realize he is lucky to be alive. He should visit with some of my patients- who are alive, but who have lost it all. My patients who have little to no recollection of their personhood- or their family and friends. They who have lost portions of their brain yet manage to breathe and who are kept alive by machines.

When the time comes for the machines to stop doing the work, many of my patients continue to live, but they are never ever going to be the person they were prior to their injuries. As mean as it sounds, the Mom made reference to the sad thought she had- where she wishes her son would be able to express feelings and suicidal ideation. She would give almost anything for her son to express his thoughts, to cry, to have emotions and to feel anger.
She hasn’t heard her sons voice in 5 months. Chances are very high she never will hear him speak again either.

He stews alternately over suicide and finances, his $43,000 in credit card debt, his $4,330 in federal checks each month - the government’s compensation for his total disability from post-traumatic stress disorder. His flashbacks, thoughts of suicide, and anxiety over imagined threats - all documented for six years in his military record - keep him from working.

The disability payments don’t cover the $5,700-a-month cost of his adjustable home mortgage and equity loans. He owes more on his house than its market value, so he can’t sell it - but he may soon lose it to the bank.

“I love this house. It makes me feel safe,” he says.

Awad could once afford it. He used to earn $100,000 a year as a 16-year veteran major with a master’s degree in management who excelled at logistics. Now, at age 38, he can’t even manage his own life.

Sometimes people take advantage of post traumatic stress syndrome and all the havoc it can wreck. Other times people blame their already present problems and use a newly DX PTSD as an excuse. It’s very difficult to differentiate from the real honest life altering problems PTSD can create. Is it up to our government, the VA and military, to cover the expenses of those who are taking advantage? I think not. My patient’s Mom was extremely irate about this because, again, she would move mountains to hear her son complain about his finances.

There’s another twist. This dedicated Marine was given a “general” discharge 15 months ago for an extramarital affair with a woman, also a Marine. That’s even though his military therapists blamed this impulsive conduct on post-traumatic stress aggravated by his Middle East tours.

Luckily, his discharge, though not unqualifiedly honorable, left intact his rights to medical care and disability payments - or he’d be in sadder shape.

Hmm…Problems in marriages are forever present; and yes the separation of wars and battles can amplify them. An act of infidelity could be called impulsive…but a longer term “affair” cannot. We make choices, and we know the possible outcomes of our actions for most choices we make. Mr. Awad is trying to pass the buck here, and I’m pretty shocked his therapists have helped him along. In my opinion he is certainly taking advantage now.

Divorced since developing PTSD, Awad has two daughters who live elsewhere. He spends much of his days hoisting weights and thwacking a punching bag in the dimness of his garage. He passes nights largely sleepless, a zombie shuffling through the bare rooms of his home in sunny California wine country.

Few anticipated the high price of caring for Awad and other veterans with deep, slow-healing wounds.

Awad needs to just deal. He needs to get a grip and stop blaming everyone for his own problems, and especially he needs to stop expecting the government to bail him out. He’s lost much, yes. But he’s brought a lot of this upon himself. Whether he was rational or not isn’t in the running here- hes become a loose cannon in his own battle. He can change his course if he wants. He can become the man he once was- he has all his parts and most importantly, he has his brain, his mind. So many others do NOT.

Millions of fine men have seen much worse than he has; millions of men have been to war, come home, canned their battlefield memories and moved on with life. Some suggest repressing those memories is not a good thing. Maybe. But men have the ability to do this and do it well. My own father was a WW 2 veteran, who saw a lot of action, he saw entire ships blown up and men’s bodies strewn across the oceans in bits and pieces…he lost many friends. He also bared witness to the horrors of the concentration camps as they were found in the days right before that war ended. He didn’t dwell upon the sights and scents; he didn’t speak of these things often. He got on with his life, enjoyed that life and made a good name for himself.

Compare the young Marine who lost half of his brain to an IED in Iraq…who is alive, barely and whose body is merely a shell of what he once was; he who cannot look around because his neck is paralyzed. The once strong and handsome young man who had a beautiful and sexy girlfriend- that he bragged about to his buddies and shared tales of lust over. When he sees her picture, the only reaction might be a tear. The young man who has no control over his bodily functions, who cannot eat orally, who will never walk, talk, make love, dance or drive or have children. Never mind the career, the house, the worries about finances, the dreams he had of his life…and God only knows what his nightmares might be like now.

Mr. Awad needs to stop taking advantage of the problems he calls insurmountable. The mind is a terrible thing to waste Mr. Awad; but it’s even worse when its taken away from you. He really needs to meet my Marine patient and his Mother - and take stock of what’s truly a loss.

You know you’re a nurse if…..

You would like to meet the inventor of the call light some night in a dark alley.

Your sense of humor gets more warped each year.

Almost everything can seem humorous….eventually.

You know the smell of different diarrhea to identify it.

You can tell the pharmacist more about the medication they are dispensing than they know.

You check the caller id on your day off to see if anyone from the hospital is trying to call and ask you to work.

You’ve been telling stories in a restaurant and made someone at another table throw up.

You notice that you are using more 4 letter words than you did before you started nursing.

Every time someone asks you for a pen you can find at least 4 of them on you.

You live by the motto “to be right is only half the battle, to convince the doctor is more difficult”

You’ve told a confused patient that your name was that of your coworker and to holler if they need help.

Your bladder can expand to the size of a winnebago’s water tank.

You find yourself checking out other customers veins in grocery waiting lines.

You avoid unhealthy looking shoppers in the mal for fear that they will drop near you and you’ll have to do CPR on your day off.

Your finger has gone places you never thought possible.

You have seen more penises than any prostitute.

If you are not a nurse and have been sent this by a friend who is, its just to help you understand our mind set and questionable mental status/sanity. Most of the time we function in spite of this sick sense of humor, fairly normally and very responsibly.

Believe me, this is how we think, ALL THE TIME. Scary huh??

From Heather….

Often the patients I take care of are young men, who made poor choices that led them to meet me…poor choices or the victims of others who made them. It’s not always like this though; some of my patients were born with deficits that require the services of my facility. Katie is such a patient. She is an inspiration and those who think ending the life of one with severe disability ought to come meet this beautiful young lady…

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Andy is a patient I work with quite often. Six days before Christmas of last year he and some friends smoked some pot laced with heroin. They promptly fell asleep and Andy never woke up.

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I don’t write about work too often here as it can be pretty sad to read about some of the patients I take care of. I decided a long time ago that people know the risks they place upon themselves when drinking and driving. Young people might KNOW the risk but they still don’t heed to it. Sometimes there are others who condone this activity with devastating results.

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I haven’t written about my work, the daily doings of it, in a long time here. Somethings happened over my weekend that need a place here. Life counts. Don’t ever forget it.

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