Jahi McMath’s medical mystery

In the final act of the fight over Jahi McMath, both her parents and her doctors were proven right.

Yes, she could be sustained. And it was equally true that she’d never, ever, get better.

It’s an unsatisfying coda, reminding us of that hazy line between life and death – and that modern medicine, despite its wonders, remains full of uncertainty.

Jahi confounded all predictions of a quick demise. Her strong teenage heart, assisted by technologies, kept her going far beyond expectations.  She didn’t decompose, as experts predicted. She gave her stunned family the gift of time to gather, and grieve.

But the devastating damage to her brain meant that she remained unconscious, unresponsive, and incapable of thought or emotion.

And that damaged brain wasn’t enough to protect her from the ravages of time, all the while tethered to machines. Her family said she died from internal bleeding and kidney issues.

Only an autopsy will resolve the mystery of how much of her brain was damaged when her heart suddenly stopped, then started again, during routine surgery.

It may also reveal whether she was truly capable, as her family asserted, of listening to Golden State Warriors games and voluntarily moved her fingers and toes.

Typically, the trauma of the initial injury, called a “sympathetic storm,” triggers a massive stress response that floods the bloodstream with chemicals and damages the hypothalamus, a small area at the top of the brain stem that regulates body temperature, appetite and the release of many important hormones.

There also is normally a cascade of later complications, like when a computer crashes. The heart, lungs and cellular metabolism go haywire. There is often severe hypertension and imbalances of important regulatory hormones.

But most of our insights come from studies of older patients who donate organs after death – not teenagers. In these older patients, doctors detail dramatic changes that occur soon after brain death, ranging from heart failure to diabetes.

But even the best medical tools cannot replace the brain’s role in regulating the critical balance of essential hormones, immunity and other chemicals, according to Dr. Neal E. Slatkin, a neurologist and chief medical officer at San Jose’s Hospice Of  The Valley.  Ventilators apply strong pressure to the lungs open and functioning, which creates small tears in the lining of the air sacs and bronchial tree, opening up the possibility of infection.

During the vigil, she remained closer to death than she ever was to life.

Yet her heart kept beating. She seemed suspended in time, making it difficult to accept medicine’s now-universal definition of death: loss of brain function.

But without a well-working brain, even that strong heart, the love of her family and the very best of medical technology couldn’t sustain her.

Source: FS – All – Interesting – News 2
Jahi McMath’s medical mystery