Is Terri Schiavo Dead? Eat, drink, and vegetate

Reason ^ | 10-23-03 | Ronald Bailey

[ambrose]

October 23, 2003

Is Terri Schiavo Dead?

Eat, drink, and vegetate

Ronald Bailey

Terri Schiavo has been in a persistent vegetative state since 1990. Her husband wants to withdraw the nutrition and hydration her body has been receiving and allow her body to die. Her mother, father, and sister—and now Florida Governor Jeb Bush—want to continue supplying her body with food and water until... what? She wakes up? Dies of pneumonia?

What is a persistent vegetative state? According to the National Institute for Neurological Disorders and Stroke people in PVS "have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns. Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing and circulation remain relatively intact. Spontaneous movements may occur, and the eyes may open in response to external stimuli. They may even occasionally grimace, cry, or laugh. Although individuals in a persistent vegetative state may appear somewhat normal, they do not speak and they are unable to respond to commands." People suffering from PVS can generally be distinguished from afflicted but cognitively intact patients who suffer from "locked-in syndrome" by the fact that "locked in" patients can track visual stimuli and use eye blinks for communication.

According to most neurological experts, Terri Schiavo is definitely PVS—her eyes do not really track visual stimuli and she cannot communicate using eye blinks. However, Terri Schiavo's parents have posted several short ambiguous video clips online which are meant to show that Ms. Schiavo responds to stimuli. But what they show seems to fit an AMA's report of how PVS patients can respond to environmental cues without being aware. Specifically, the report notes, "Despite an 'alert demeanor', observation and examination repeatedly fail to demonstrate coherent speech, comprehension of the words of examiners or attendants, or any capacity to initiate or make consistently purposeful movements. Movements are largely confined to reflex withdrawals or posturing in response to noxious or other external stimuli. Since neither visual nor auditory signals require cortical integrity to stimulate brief orienting reflexes, some vegetative patients may turn the head or dart the eyes toward a noise or moving objects. However, PVS patients neither fixate upon nor consistently follow moving objects with the eyes, nor do they show other than startle responses to loud stimuli. They blink when air movements stimulate the cornea but not in the presence of visual threats per se."

Ms. Schiavo has been in this state for 13 years. What are her chances of recovering at least some awareness? Minnesota neurologist Ronald Cranford told the Washington Post, "There has never been a documented case of someone recovering after having been in a persistent vegetative state for more than 3 months. However, the journal Brain Injury reported the case, of a 26-year-old woman who, after being diagnosed as suffering from a persistent vegetative state for six months, recovered consciousness and, though severely disabled, is largely cognitively intact. However, it is generally agreed that if a patient doesn't become responsive before six months, his or her prognosis is extremely poor. A report on PVS by the Australian National Health and Medical Research Council finds that "patients in a state of post-coma unresponsiveness may emerge from it to become responsive," that "the probability of emergence becomes progressively less over time," and that "there is general agreement that emergence is less likely in older people, and in the victims of hypoxic brain damage." Terri Schiavo is the way she is because oxygen was cut off to her brain for 14 minutes; in other words, she suffered severe hypoxic brain damage.

So is Terri Schiavo still alive? The odds are way against it. It's time that her long-suffering parents and the grandstanding politicians let her go in peace.

[ClancyJ]

Gee, your points are so simple, so straightforward and cut to the very heart of the matter. Thank you.

[Calpernia]

>>>I'd like his detailed comments on the "isolated living tissue" and it's implications for therapy.

From the OPINION George Wythe posted:

"Dr. William Hammesfahr claimed that vasodilation therapy and hyberbaric therapy "could help her improve." He could not testify that any "specific function" would improve."

Doctors aren't suppose to make specific predictions on functions. Any doctor, or in this case, Alleged Expert, that makes specific predictions are negligent.

[Hildy]

Speaking of souls...why do you want to lock Terri's up in a non-functioning body? Are you religious? Don't you believe that are spirit and souls live on?

[tallhappy]

Your christ-like attributes are in the hall closet, go get them back.

I don't understand your comment.

[MarMema]

Urinalysis would be helpful as well. Specific gravity and ketones. Wouldn't you love to be able to see all of her medical charts? I would.

[ChemistCat]

I think it would be wrong for ME because of my religious beliefs.

Other people have other beliefs. If they impose those only on themselves, IE through a living will, I respect that. I don't agree because we do not share the body of beliefs that result in that decision, but I respect their decision. That's how it is with my mom and I. I honor my mother and father, and will respect their decisions. I will NOT pull the plug, and they know that. But I won't stand in the way if, by the conditions of their living will, it's time for that to be done.

Many terminal patients "turn their faces to the wall and refuse to eat." I think their bodies tell them it's time. That's SO DIFFERENT from cutting off someone else's food and water when they haven't expressed the desire and ARE NOT TERMINAL as Terri wasn't!

[Calpernia]

>>>Dr. Webber did not show up. Did Dr. Webber have a change of heart?

Are you examining Dr. Webber's absence with the eyes of a laypersons and considering that his absence translates into a change of heart?

[TrebleRebel]

I agree that all media representation of this issue is on a slippery slope.

[george wythe]

Thank you for posting the parents' accusations one more time.

They seem to imply that Schiavo changed his mind about medical care for Terry after he testified in the original malpractice suit.

Schiavo has admitted that he was also fanatical about giving Terry's the best care available for many years, even experimental care.

Schiavo has also said that he changed his mind after hitting a brick wall numerous times, all those treament never improved Terry's condition.

Of course, the Schindlers assign more sinester motives to the husband. Since the Schindlers are involved in current legal litigation againt Schiavo, such nastiness is expected.

As I posted before, I saw first hand a divorce battle between one of my best friends and his wife. The vile anger coming out of those beautiful, nice people was shocking, to put it mildly. The court system seems to bring the worst on people, even the nicest folks.

The bottom line is that the courts have reviewed all this testimony, and the courts have found Schiavo's testimony to be credible.

[nickcarraway]

What scientific proof do we have that ``she lost her thinking abilities?'' There have been other articles recently, that call this idea into a lot of doubt?

Shouldn't we be sure that she ``can't think,'' instead of just assuming what we would like to believe? Many people, with the possible inclusion of Supreme Court justices, believed blacks ``couldn't think,'' to the same level as others. That was their conventional wisdom, that they beleived had every bit of legitimacy. Don't we owe it to ourselves to actually know the truth?

[ChemistCat]

At my husband's grandmother's highly-rated expensive nursing home, they were taking her dentures out every night (at least they remembered that) and dropping them in a glass of water every night. The same glass of water. One day her daughter was visiting and trying to track down the bad smell in her room. It was that glass of water. Turns out that Grandma Ruth had a HORRIBLE mouth and throat infection from the fact that her teeth were being put in every day without being cleaned--only soaked in filthy, unchanged water. It was horrible. And this was a GOOD nursing home.

[ClancyJ]

Since when is the only criteria for not being killed that a person will be restored to health?

You have been very blessed in your life if you have not had to care for a loved one that is crippled, a quad, retarded, an Altzheimer's, MS, cerebral palsy, polio, mentally insane patient. All of these could fall under the criteria some on this thread espouse.

Yet, who appoints others to judge whether these people get to live or not. The healthy are no better than the weak. How do I insure I am of the "elite" judgers instead of the victimized judgees.

I do not relish living in your version of the world.

You are setting yourself up for a big eye opener one day. You may have to eat a lot of those words when a loved one or child of yours with those sweet little eyes looks at you and can do little else. Talk then of it not being worthy of life.

It comes down to this -- we have only the right to say we do not want our life extended with artificial means when there is never any hope. Not some other person - just us for our own lives. To do other than that is murder.

[Calpernia]

>>>all those treament never improved Terry's condition.

What treatments did she have in the past?

[george wythe]

If you ever learned why Dr. Webber never testified on the Schindlers' behalf, please ping me.

Gone to the beach to see if the waves are good enough for surfing.

Have a nice weekend.

[headsonpikes]

To do other than that is murder.

Bump your post.

[Ethan_Allen]

http://www.freerepublic.com/focus/news/1007965/posts?page=45 #45

If this weren't so sad, it would be funny.

[TrebleRebel]

...moot...

No, we don't control how we die. But if the argument of 'suffering' is used as reason to keep her alive or end her life, then it must be clarified that this woman, regardless of when she dies, will most certainly die from a long illness, due to the circumstances of her being bedfast.

But this is beside the point. I've already stated what I think is the over-riding issue, and I won't post it again after this. This is a highly personal issue which should only be left to the dialogue of immediate family. To try it in the media is cruel. The best that can come from such highly charged public dialogue is that citizens plan for their own futures with legal documents.

Now if you'll excuse me, I have a flame-retardant suit to don.

[sweetliberty]

I have sent this information to Greta, since she seems to be the only one of the Fox people who is really on this story. Of course, it wouldn't hurt to send it to some of the others as well, especially Larry King, since Schiavo will be on there. Of course, I doubt that Larry will ask him any tough questions anyway, but then at least we'll know it is deliberate if he has the information and chooses to ignore it.

Terri's Army ping! If you want on or off this list, please let me know.

[Republic]

Please read post #214 in its entirety. And then read the affidavit below. Thanks. I know you want to know the full story before weighing in on something as precious and priceless as a life.

AFFIDAVIT STATE OF ILLINOIS COUNTY OF COOK BEFORE ME the undersigned authority personally appeared Sara Green Mele, MS, CCC-SLP, who being first duly sworn, deposes and says:

1. My name is Sara Green Mele, and I have been engaged in the continuous private practice of speech-language pathology since 1996, and have served on the staff of the Rehabilitation Institute of Chicago from 1996 to 1999 and from 2001 to the present. Prior to that I practiced cognitive therapy at Baylor Institute for Rehabilitation in Dallas Texas. In both settings I worked with the broad range of brain injured populations.

The Rehabilitation Institute of Chicago is affiliated with Northwestern University Feinberg School of Medicine, and is recognized in the United States rehabilitation community as the top facility in the United States. The Baylor Institute for Rehabilitation is affiliated with Baylor University Medical Center, and is recognized in the United States rehabilitation community as one of the top ten facilities in the United States.

I am a clinical lecturer at Northwestern University Feinberg School of Medicine, and lecture for continuing medical education credits (CME) through the Rehabilitation Institute's continuing education program as well as at national conferences.

In April of this year I participated in the presention of a two-day head injury course entitled Interdisciplinary Rehabilitation Management in Traumatic Brain Injury to over two hundred health professionals in Tampa, Florida. My full curriculum vitae is attached.

2. In my practice, I treat many patients who have had diffuse brain injury, both anoxic and hypoxic, and I am familiar with states of impairment known as coma, coma-like, minimally conscious and persistent vegetative state. I regularly participate in the evaluation and cognitive/linguistic diagnosis of patients whose differential diagnosis include such conditions. In connection with my practice of speech-language pathology, I also evaluate patients, and train others in the evaluation of patients for swallowing function. During my career as a speech-language pathologist, I have personally treated approximately thirty patients similar to Terri Schiavo.

3. In evaluating patients for rehabilitation, the Rehabilitation Institute of Chicago does not track the diagnosis of patients by their referring caregivers, but rather evaluates them for itself because the misdiagnosis rate is so high.

4. While I have not physically examined Terri Schiavo, I have looked at her medical records at MediPlex covering the period from January to July of 1991, including physical therapy, speech and language therapy, and occupational therapy.

Also, I have studied the video clips presented at the October 2002 Medical Evidentiary Hearing, along with audio recordings of Terri Schiavo interacting with her father in November of 2002.

The observations that follow are all within the parameters of speech-language pathology, and are similar to the observations that I am called upon to make regularly in the course of treating patients as a speech-language pathologist.

All conclusions are based on standards used in the speech-pathology profession in the treatment of patients such as Theresa Schiavo.

5. Based on my experience and my observations, Mrs. Schiavo is clearly aware of her environment and interacts with it, albeit inconsistently.
She is able to comprehend spoken language, and can, at least inconsistently, follow simple one-step commands.
This is documented both in the MediPlex records and in the following behaviors noted in the following video segments: C 01 (Examination of Dr. Cranford on July 9, 2002) -
Terri appears to respond to her mother's voice, although there is not much to differentiate between a generalized and localized response in this clip. C 02 (same exam as above) - Terri appears to track a balloon. This is difficult to verify with complete certainty for two reasons. First, many of the camera shots are too "tight" on Terri's face to be certain of the location of the balloon.

Second, Dr. Cranford presents a great deal of information to Mrs. Schiavo very quickly. Even moderately brain-damaged patients have severe difficulty responding that quickly to commands. Such patients display a significant delay in processing, which Dr. Cranford does not seem to allow for. In the same clip, Terri appears to move her head toward Dr. Cranford's voice, despite limited motor ability. Clearly, once her head is positioned, she appears to move her gaze toward a voice. M 01 (Examination of Dr. Maxfield 9/4/02) - Although it is difficult to hear on the video, Terri appears to respond to the sound of her mother's voice on a cell phone held to her ear. Additionally, Terri appears to move her head as well as her eyes in tracking a balloon. M 03 (same exam as above) - Terri appears to have a purposeful laugh in response to the story from her childhood as related by her father in the video. This would appear to be an appropriate emotional reaction to latent memory. H 01 (Examination of Dr. Hammesfahr 9/3/02) -

Although Terri seems to fixate on the source of the music, there is little response until she hears her mother's voice, at which time she smiles and moans purposefully. H 04 (Same exam as above) - A loosening of Terri's muscular tone appears to be a result of a soothing effect on Terri of her father's voice.
This could indicate recognition of the voice as her father's, and an appropriate emotional response. Later in this clip, Terri's behavior of looking first at Dr. Hammesfahr and then at her mother appears to be responsive to the request that she do so.
When she opens and closes her eyes, she clearly appears to be following the commands of Dr. Hammesfahr to do so, although she cannot engage in this behavior consistently . H 09 (Same Exam as above) - Terri appears to keep her eyes closed on command, but it would be helpful to assess in other venues, such as relative to her neck position and visual stimulii. H 11 (Same exam as above) - Terri appears to track a balloon but appears to be challenged by motor deficiency to move past midline. This could be secondary to an oculomotor dysfunction.

6. Terri is clearly vocalizing. She does not appear to vocalize at random during these examinations. Her vocalizations are generally purposeful and usually in response to specific environmental stimuli, most particularly family members.

7. Over the years since her injury, Terri has infrequently spoken audible words. The records of MediPlex reflect the fact that she has said "stop" in apparent response to a medical procedure being done to her. The family reports that they have heard Terri say "ugh-hugh," ugh-ugh," and "No" on a few occasions.

8. Since the time of the medical evidentiary hearing in October of 2002, family members have made a concerted effort to encourage Terri to vocalize, and have attempted, as laypersons, to coach her in basic speech. Most prominently, they have coached Terri in trying to say "yea", as a way in which she may answer "yes" to questions.
The family has an audiotape recorded in November of 2002 in which Terri vocalizes in apparent response to her father. Her vocalizations include repeated sounds which approximate the word "yeah," in the same manner in which she was coached. Prior to that time, no member of her family recalls Terri being able to approximate the "yeah" sound. I cannot conclude that Terri can accurately answer a yes/no question without the therapy suggested below.

9. The apparent addition of an approximation of the word "yeah" to Terri's repertoire of responses is clearly a learned behavior. Her use of this sound on the audiotape is apparently in response to her father. It is reasonable to conclude that Terri is trying, despite her motor deficits, to speak as best she can.
Terri is clearly a suitable candidate for speech-language therapy.

10. NOTE: It is not my opinion that Mrs. Schiavo is in a coma or in a persistent vegetative state. In my opinion, she exhibits purposeful though inconsistent reactions to her environment, particularly her family.

Her eye movements, easily observed on the videotape, are particularly suggestive that she recognized family members and responded. She also appeared to have sufficient sustained attention to track a balloon.

It is * not * my opinion that these behaviors are merely reflexive. The entire range of behaviors listed above, and each and every one of them, are inconsistent with a diagnosis of persistent vegetative state.

11. Even without the benefit of any medical treatment which successfully improves this patient's organic medical condition or cognitive abilities, in my opinion Terri would benefit from speech-language therapy, physical therapy and occupational/recreational therapy. Her ability to interact with her environment and her ability to communicate can be enhanced.

Her quality of life can be significantly enhanced.

12. I would specifically recommend that Terri be given access to a system known as an environmental control system. We use such systems at the Rehabilitation Institute of Chicago to permit patients such as Terri to exercise control over their environment, such as to turn their television or radio on or off, change channels, and to control volume. Such environmental controls may also permit Terri to control room lighting. In my opinion, Terri could make use of such a system if it were made available and she received training in its use.

I would further recommend that a yes/no system be implemented, and that Terri be trained in its use from the beginning of her rehabilitation regimen. Such a system could permit Terri to more effectively communicate.

13. It is apparent that Terri has sufficient swallowing ability to handle her own secretions, therefore it would be my recommendation that she receive a modified barium swallow study to assess swallow function for intake trials of thin and thick liquids and pureed consistencies. It has been my experience that patients similar to Terri have been able to accomplish food intake. This would permit Terri greater interaction with her family and in social situations through the enjoyment of mealtimes. I have worked with numerous disabled patients who have expressed to me that being able to eat would make the difference between their desiring to live or die.

14. It is my judgement based on my training and clinical experience working with patients similar to Terri that she would, within a reasonable degree of clinical probability, be able to improve her ability to interact with her environment, communicate with others, and control her environment if she were given appropriate therapy and training as outlined above.

These recommendations, in my opinion, would greatly improve Terri's quality of life. FURTHER AFFIANT SAYETH NAUGHT. Sara Green Mele, MS, CCC-SLP 1

....................END OF AFFIDAVIT.......

So Ambrose...has Terri ever been given a chance? How would you feel as Terri's mom or dad, knowing that Terri had these possibilities, experienced her yearning to communicate, and had to face a tortuous son in law who could give a rat's ass about your dtr's very life?