Prediction of Death and Diagnosis

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.

On Truth and Perception...and Alien Abductions

Just found this in my drafts...no idea why it wasn't published when I wrote it nearly a year ago. 
PLEASE BE CAREFUL - TRIGGER WARNINGS: Abduction, sexual abuse, sexual violence, rape etc.

INTRODUCTION
Recently* I had a big set-to on Twitter because I have issues with transexuality being self-declared. For me it is a matter of the philosophy of identity which is a subject most perplexing. The individual is seen as the epicentre of identity BUT is the individual best placed to determine their own identity when by its very nature identity is how we are seen by others? 

To clarify for anyone not following me on Twitter I have zero problem with transexuality itself. Regularly I see online that self-awareness of depression or eating disorders is not enough, you must be formally diagnosed. This is not to liken transexuality with mental disorders - just a comparison to other situations where a self-identification is regularly denied despite being fairly straightforward matters of self-awareness. Whether we think of the fictional Adrian Mole and his false self-identification as an intellectual or the real-world Rachel Dolezal who faked being black because that is the ethnicity she identifies with - there are a host of reasons why individual perception is not a great way to define ANYTHING, much less an aspect of the self where the ego can warp perception enormously. Lets face it, Muhammad Ali's assertion that he was "the greatest" is itself immensely egotistical...but validated by popular consensus. Similarly Agatha Christie couldn't bring herself to self-identify as an author despite her demonstrable successes.

I mention this as a precursor to today's musings on truth and perception as they revolve around the idea that things are not always as we see, feel or otherwise experience them.

For example, I identify as an empath (chiefly in science fiction a person with the paranormal ability to perceive the mental or emotional state of another individual - see the Doctor Who episode "Hide") so I live by my intuition a fair bit. I don't expect anyone to acknowledge or believe my gut reactions on any subject, it is purely a matter of my self-perception.

I mention THAT as today's musings begin though with, what to me was, an empathic experience. That I was being told a series of highly dubious tales does not make my impression of the teller as untruthful an empathic experience, just as my 'feeling' on the subject could be easily attributed to paralinguistic attributes (intonation, facial expression etc) but - to my way of thinking - the identification of the root cause of untruthfulness IS a matter of empathic experience.

ON TRUTHFULNESS AND PERCEPTION
When we think of a person being untruthful we come up with synonyms such as 'lying' and 'deceptive' but these only address one form of untruthfulness and there are several.

• Lying - deliberate deceit for gain, attention, amusement (either for the act of telling stories or at the gullibility of of others) etc Perception is deceptive and / or defensive 
• Confusion - honest yet mistaken: repeating a story as heard as if true without verification, misremembering, etc Perception can be confused or truthful, not defensive
• Conviction - the self belief that the stories are true such as with conditions preventing a person from distinguishing fact from fiction, delusions, false memory syndrome (being a step up from a simple act of misremembering) and so forth Perception is truthful and / or defensive *

* Defensive perceptions can also be present in truth-tellers who, for whatever reasons, fear or expect to be disbelieved making truth and conviction difficult to distinguish at a perceptive level.

From my perception of myself as an empath I looked at my perceptions of the person who was telling the improbable-to-the-point-of-impossible tales to try to deduce what form of untruthfulness was at play. The stories in question should have fitted into the first category with the deliberate intent of gaining sympathy yet I was struck curiously by sensing no deceit in them. There were certainly elements whereby confusion could be the culprit - especially when it came to misidentifying medical conditions yet that did not fit particularly well to the whole. The third category I also ruled out. I got no sense that this person believed what they were saying.

For me this indicates a fourth category of untruthfulness: the moral lack of distinction between fact and fiction. Sometimes termed a 'compulsive liar' or 'fantasist' (both of which indicate deliberate acts) I feel this is a separate category as, rather than deliberate acts of deception, the concept of deception itself is actually lacking; a form of amorality. Perception is neutral - because truth is irrelevant.

I have encountered such people before but they are, thankfully, rare. In this case the stories were implausible and raised my suspicions but obviously untruths can be highly plausible too.

This led me to thinking...truth itself is a perception. If you believe that something is so it is so, to you. And this leads me to my...

ALIEN ABDUCTION THEORY

At this point I want to stress that if you have had an experience of alien abduction 

I do not recommend you read on; similarly, if you know someone who has 

please do NOT challenge them with my theory. You could do a lot of harm.

I dare say most people are familiar with stories of alien abductions but have you ever contemplated WHY it's a story that is repeated to a very familiar pattern? Unless you happen to ascribe to the idea that aliens ARE abducting humans you probably put it down to mass hysteria or suggestibility from science fiction sources.

Once upon a time I met someone who had experienced alien abduction and I was curious as to what my empathic tendencies would reveal about their story...and what hit me most was the genuine trauma they were experiencing. In terms of untruthfulness this would sit firmly in the the conviction category - they believed it, they felt it, the perceptions I had of them were honest and accurate to their claim.

So what was going on? Admittedly this happened at a time when The X-Files was very popular - so a lucid dream perhaps or the influence of drugs? Plausible but I wasn't convinced, the trauma was just too real. The fact that accounts of alien abduction are SO similar led me to a different conclusion.

What do these accounts have in common?

• Paralysis (almost always not restrained, yet unable to move)
• Partially conscious
• Probing (physical violation)

Do any solutions present themselves to your mind? 

My theory is that the phenomenon of alien abduction, aided by popular media, is the mind's way of coping with a genuine trauma - specifically rape, especially when drugs like rohypnol are involved. Hence the comments in red above - if the mind is protecting itself it's probably best left that way. If a person would rather believe their experience was alien abduction then that's fine.

This brings me back to the concept of self-identity - I don't want to CHALLENGE anyone's perception of themselves in any way cos how you see yourself is pretty much irrelevant. What is an issue to me is validating someone's opinion of themselves...if someone feels they have been abducted by aliens I will not challenge that, especially not with my theory, but nor do I need to validate their experience and declare that alien abduction is real. Truth is in your perception of it. It's never nice to be called a liar or to be told "you don't really think / feel / believe that" but why do people put so much value in external validation?