A year or two back I stumbled across a case which seemed to solve an ongoing medical mystery. I feel like recording it here in case it is eve proven correct so that I can say "I told you so" ;)
In December 2013 Californian girl Jahi McMath underwent a tonsillectomy. It went hideously wrong and four days later she was declared brain dead. Her family, however, refused to accept this and fought to keep her on life support. This 'futile care' was resisted but ultimately allowed...not least as people do not live very long on life support. In many cases, if death does not result from other causes, the dead brain will rot causing the body to expire from massive infection. Four years later Jahi McMath remains on life support, apparently showing none of the usual signs of deterioration. One of the most notable features of her case is the onset of puberty and menstruation experienced while brain dead - such developments being supposedly being unique to life, and controlled by the pituitary gland within the brain.
This has led to her family feeling vindicated and others questioning how death can be diagnosed if we still don't understand it. In September 2017 a judge even ruled that Jahi might still be legally alive (http://www.latimes.com/local/lanow/la-me-brain-dead-girl-20170907-story.html).
A year or two ago I was following a hunch when I felt that I had solved the mystery.
A child, identified only as TK, (Nicanor Pier Giorgio Austriaco in The Linacre Quarterly 2016: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102206/) survived for 20 years on life support / critical care, despite having been declared brain dead at just 4 years of age.
"He remains the individual kept on life support the longest after suffering total brain failure."
There is a condition, extremely rare but well documented, called Lithopaedion. When a foetus dies in utero it is usually expeller from the mother's body as a miscarriage or stillbirth. When this doesn't happen spontaneously medical procedures (D&C or induction of labour) are used. If left for an extended length of time the foetus will degrade and the mother will die of infection. In the case of a Lithopaedion this is circumvented by the mother's body sealing the foetus in calcium - somewhat like a pearl developing inside an oyster - meaning no infection can take hold as the baby becomes 'petrified' hence the colloquial term for the condition - 'stone baby' (Daniel Ramos-Andrade, Caterina Ruivo, M. Antonia Portilha, Jorge B. Brito, Filipe Caseiro-Alves, Luis Curvo-Semedo in Science Direct, 2014: https://www.sciencedirect.com/science/article/pii/S2352047714000082)
In reading the longer account of TK's condition - with autopsy results and imagery in case that bothers you - (Susan Repertinger, MD; William P. Fitzgibbons, MD; Mathew F. Omojola, MB, FRCPC; Roger A. Brumback, MD in the Journal of Child Neurology, 2006: https://hods.org/pdf/Long%20Survival%20Following%20Baterial%20Meningits-Associated%20Brain%20Destruction1.pdf) you may see the connection between Jahi and lithopaedion:
"the specimen [his brain] was seen to consist of a hollow hard-calcified shell containing
mostly semisolid and some cystic areas [...] semisolid areas
consisted of tan (and scattered intermixed orange, red, and brown),
grumous, focally mineralized material, with no identifiable cerebral
structures"
TK's brain had essentially been sealed up like a calcified foetus and I feel sure this will prove to be the case with Jahi McMath.
- TK brain death at age 4; Jahi brain death at age 13
- TK brain death from meningitis; Jahi brain death from massive post-operative bleeding
- TK 20 years of life support; Jahi four years and counting
- TK "developed minimal pubic and axillary hair but little other evidence of secondary sexual characteristics" - whilst the lack of full puberty is unsurprising the fact that hair growth occured at all is perhaps surprising; Jahi's puperty is reported but not in detail. It is likely that given her age at brain death these changes were already happening and occurred due to the developmental stage of her ovaries.
I may not be the only one to have realised the connection, of course. In researching this post I found an article listing TK and Jahi's cases in the same sentence yet somehow failing to address the likely connection:
"...there are at least 30 known cases of pregnant women having been physiologically supported for up to 107 days to gestate a fetus; a young boy meeting 'brain death' criteria was physiologically supported for 20 years; and more recently, a young woman has been maintained on home ventilation for over 3 years following the diagnosis of 'brain death'"
(Michael Nair-Collins, Franklin G. Miller in the British Medical Journal, 2017: http://jme.bmj.com/content/early/2017/08/28/medethics-2016-103867). Note the 107 days for brain dead pregnant women. And that's not 'just' because the women are allowed to expire on delivery of their babies - their medical teams usually have to fight to keep them alive long enough to deliver! In comparison, Jahi has been 'brain dead' for at least 1482 days so far. There seem to be no published dates for TK but 20.5 years is approaching 7500 days. (Dr Alan Shewmon in transcripted interview for The President's Council on Bioethics, 2007: https://bioethicsarchive.georgetown.edu/pcbe/transcripts/nov07/session5.html)
EDIT:
Jahi Kelis McMath passed away (permanently this time) on 22 June 2018 - four years six months and ten days (1653 days total) after she had originally been declared brain dead. She is survived by her mother Nailah and stepfather Marvin Winkfield, and a sister, Jordyn. A second death certificate indicates bleeding caused by liver failure.
(Sources: CNN https://edition.cnn.com/2018/06/29/health/jahi-mcmath-brain-dead-teen-death/index.html Mercury News https://www.mercurynews.com/2018/06/30/jahi-mcmath-death-could-have-costly-implications-in-civil-case-against-hospital-doctors/ East Bay Times https://www.eastbaytimes.com/2018/07/03/of-jahi-mcmath-mom-says-that-little-black-girl-from-oakland-made-history/)
As legal cases remain ongoing at this time (September 3rd, 2018) results of full autopsy regarding the condition of her brain have not been revealed.
My hope is that her brain was calcified and she was utterly unaware of her incapacitation. I also hope that the court cases will be found in the family's favour and they will be compensated for their suffering and Jahi's lengthy treatments will be reimbursed. I don't know that I would like for her case to significantly alter how we define death. The body living on with no functional brain is, in my humble opinion, no life at all. However, my sincere sympathies are with Jahi's family.
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