A follow up on baby Joseph Maraachli...

[stephen55]

Our two Canadian apologists are singing in two-part-harmony, crooning seductively about social democracies and Universal Health Care just as a 'Death Panel' in Canada has sentenced a 13 month old child to death against the will of its' parents to a point they are fleeing Canada to the free United States of America.

Go figure.

Amicus

edited to add: http://www.rightpundits.com/?p=8294 account of Canadian Death Panel...

I thought I'd do a follow up on Baby Joseph. I've already vented at length on ami's ignorance of all things Canadian. I've already given what I felt was a fair reflection of what I thought was going on back in London, Ontario from a retired doc's point of view. As for Canadian Death Panels, they exist only in ami's fevered brain.

14-month-old Joseph Maraachli has had a tracheostomy done at the Cardinal Glennon Children's Medical Center in St Louis, Missouri.

When I first read about this poor child, I had a suspicion that the diagnosis, not at first made public, was Leigh's Disease. The whole story rang a very painful bell. When I was a resident, I was involved in the care of a one year old boy who was dying of this exceedingly miserable condition. I've just read that little Joseph does have Leigh's Disease, the same neurometabolic disorder that took the life of his sister.

Leigh's Disease, or Subacute Necrotizing Encephalomyelopathy is a very rare inherited disorder that usually effects children before they are two years old. It is 100% fatal. There is no cure or even partially effective palliation. Life expectancy is usually about one year following onset of symptoms.

It is characterized by movement disorder which progresses to dystonia, rigidity, tremor, chorea, hypokinesia and myoclonus. Other symptoms include loss of appetite, vomiting, irritability, continuous crying (in infants), and seizures. Later problems can also be episodes of lactic acidosis, which can lead to impairment of respiratory and kidney function. Brain function deteriorates, coma ensues and finally a persistent vegetative state is followed by death. Once the child can no longer eat or drink, the child's life can be prolonged by assisting ventilation, IV fluids and parenteral nutrition, but the neurological condition is irreversible. The brain continues to deteriorate and death is inevitable.

http://i.dailymail.co.uk/i/pix/2011/03/22/article-1368559-0B49405600000578-781_306x354.jpg

This is Joseph Maraachli. That "chubby cheeks" you see is not a sign of health and vitality. It is the irreversible edema of irreversible kidney failure. Those eyes are never going to open.


http://i.dailymail.co.uk/i/pix/2011/02/28/article-1361593-0D6A674C000005DC-174_634x432.jpg

His father, Moe Maraachli wants his son to live as long as possible. I don't blame him one bit.


http://i.dailymail.co.uk/i/pix/2011/03/21/article-1368559-0B2EC85C00000578-174_634x404.jpg

The priest is father Frank Pavone of the Priests For Life charity, who are footing all the bills for both hospital care and the air ambulance that brought little Joseph to St. Louis. I'm not going to argue with a Catholic priest about when a patient with a terminal illness and in a persistent vegetative state should be allowed to die of their disease as opposed to be kept going by heroic measures.

I will argue a bit with the hospital spokesperson who had this to say...'It is our hope that this procedure will allow Joseph and his family the gift of a few more months together and that Joseph may be more comfortable with a permanent tracheotomy.

'As with any of the children we help, our primary focus must remain on the patient and what is best in his or her individual circumstances.'

Joseph is comatose. He is not more comfortable with a tracheostomy and the last thing that tracheostomy will ever be is permanent. It's a judgment call, but I'm not at all sure that the docs at Cardinal Glennon Children's Medical Center have done Joseph any favors. They certainly have made his parents happy but his parents aren't the patient.


Having spent the better part of my three month rotation in paediatrics dealing with a baby dying of Leigh's Disease, all I can say is that I'm very grateful that the parents of my patient did not wish any heroic measures taken to prolong their baby's life. I was in the room when their baby died. I was fighting back tears then and I'm losing tears now. Sometimes life really, really sucks.

 

[Handley_Page]

Thank you for that lucid and proper explanation.

 

[JAMESBJOHNSON]

They shoot horses, dont they?

The whole while I worked for the state I suffered MDs who are incompetent, starting with the ER doc who sent me a headache referral quote,"CUZ THE PAIN'S IN HER HEAD." Huh? Or the ER docs who diagnose pneumonia as common rhinovirus, and bubble bath allergy as sexual penetration.

I did my certification case with a woman accused of criminal medical neglect (Munchhausens by proxy) by an ER doc. But the baby really did have a respiratory infection. After I cleared momma with psychiatric and psychological assessments I convened a medical panel to review the evidence. I asked the doc, HOW EXACTLY DO YOU INTENTIONALLY INFLICT A RESPIRATORY INFECTION? The doc was fired and hates me to this day. The report, btw, was retaliation for a complaint momma made to the hospital about the doc. The doc dismissed momma's concerns about the baby, momma complained, the doc called the cops on momma, and the baby had to be admitted cuz he really was sick.

I could go on with my fund of stupid MD stories. I'm not in awe of them. And when an MD is hot to kill a kid I naturally get anxious.

 

[stephen55]

And when an MD is hot to kill a kid I naturally get anxious.

Jimbo, take your Haldol and get your poopy diaper changed.

You're embarrassing all the other inmates...oops...wards of the State.

moron

 

[vrosej10]

i often wonder in these cases how much life extending measures are about the comfort of the relatives not the patient. I have a friend who works in NICU and she has told me about babies who are born very premmies (below 25wks) who consciousness never really shows up. To me consciousness is the defining thing about life, the you in you. One wonders whether the parents are in a sane enough state of mind to know what they are asking for in life extending measures for these babies.

 

[stephen55]

These parents have been through this before. Their infant daughter died of the same illness and in the same way eight years ago. In her case, the docs in London, Ontario did a tracheostomy and the girl lived for six more months. She would have also been in a persistent vegetative state, unable to eat or drink, much less control her own airway, which is why she got the trach in the first place.

What isn't mentioned in any of this is what was necessary to keep her alive those six months. IV hydration and parenteral feeding would be just the start. Once the decision is made to prolong the life of someone in a vegetative state, you're committed to take it to the bitter end. Infections are a certainty when someone is that flaccid. Chest physio to keep the lungs aerated is mandatory.

My guess is that the caregivers involved with the poor girl over those six months came to understand that the tracheostomy was a mistake. Watching a vegetative infant girl die by inches over six months, putting out continuous medical fires, only to deal with them again on a weekly basis and all the while knowing that the poor girl was next to brain dead before she got the life extending trach...no wonder that when faced with the same situation again with little Joseph...they said "no more".

This situation was a no-win scenario from the beginning.

While no doctors recite or even have much of a clue about the Hippocratic Oath these days, the Canadian Medical Association does have a code of ethics. It's centered around always doing what's right for the patient. It demands that a physician consider above all, what is in the best interests of the patient.

There has always been, and hopefully only ever will be, one rule in medicine.

First, do no harm.

As I said earlier, giving little Joseph a tracheostomy was a judgment call. An ENT surgeon in St. Louis made the call. If I was that ENT surgeon, I would have made a different call but I can't and won't fault the decision.

What I will do is predict that several months down the road, an ENT surgeon in St. Louis will be kicking his or her own butt from here to next Tuesday. I know that in London Ontario, an ENT surgeon is keeping very quiet. Having gone through it eight years ago with Joseph`s sister, the lesson learned was that while everyone is entitled to think they have all the answers, a long hard look at the question may have served Joseph Maraachli`s interests in a clearer light.

 

[Keleigh]

Stories like these make me very sad. I agree that the measures taken are making his parents feel better but certainly not helping that baby.

 

[JAMESBJOHNSON]

Jimbo, take your Haldol and get your poopy diaper changed.

You're embarrassing all the other inmates...oops...wards of the State.

moron

Whats embarrassing is when one of your MD pals sez a headache is a psychiatric problem, and sez it with a straight face. I mean, how tough can medical school be!

 

[amicus]

JBJ...after listening to Stupid Stephens meanderings....and talking intimately with a host of other MD's associated with my long term illness, I too, begin to question the efficacy of medical school. Perhaps one should compare it to a modern automobile mechanic, what with the computerized systems and such; the intellectual commitment might just be rather equal. One deals with human bodies, the other with car bodies.

I offer a theoretical question in the abstract; the disease is described as incurable, 100 percent fatal...should that not be a 'challenge' to the profession rather than an excuse to terminate life?

It is just these kind of cases, at the beginning and ending of life, that require huge expenditures of resources that National Health Care, and yes, Private Insurance Carriers, approach from a cost/benefit approach. It is only a practical/pragmatic approach and oh, so damned logical, that continues to trouble me personally and should trouble all; but the Stephens of the world, making ethical excuses all the way, continue to promote the collective approach to individual problems.

If anything, the Canadian health authorities ought to welcome this challenge and turn loose the research and develpment aspect of medical science to try every remedy possible, even experimental methodology to make this 'incurable' disease a curable or even a 'preventable' one.

Instead, hell no, bring in the Death Panel and make a 'practical' decision.

Fuck all of you!

Amicus Veritas

 

[JAMESBJOHNSON]

AMICUS

Youre right on every point you raise.

MDs forfeited the art of diagnosis to affirmative action & testing labs. Run enough expensive tests and the tests will give you the answer, and then you follow the orthodox recipe for treatment. So simple a Usual Suspect can do it.

But false positives are stalked and false negatives are ignored. And the docs are not gonna wander outta the corral for greener pasture.

The process covers a multitude of sins and buries its mistakes.

 

[amicus]

Well, thank you, James. It has always been my understanding that conversations, debates, ought to have opposing positions aired and considered. On this forum, in particular, any opposing position to the established mantra is considered heresy, quite like the Inquisition insisted.

I would prefer to read reports of research being done to discover the cause of this problem and possible avenues of prevention and treatment, as I mentioned before.

Izzat asking too much?

ami

 

[JAMESBJOHNSON]

AMICUS

No! Its not too much. But it embarrasses the Usual Suspects cuz their favorite science is POLITICAL SCIENCE a la Stalin and Lamarck. Disease is caused by low taxes and private property.

 

[stephen55]

Jimbo, so an American MD fucked up with a headache patient (if you're being honest...let's assume you are). Your American MD must have forgotten that lesson from med school (or was out playing golf) where he/she was supposed to be have been taught that a psychiatric/psychological cause of headache goes at the very bottom of your list of differential diagnoses.

Your American MD was simply being lazy and indifferent. After getting tossed from Emergency Medicine after a few more fuck ups, the schlock probably made a fortune testifying to the wave of auto-immune disorders directly related to silicone breast implants.

I recall you mentioning this case a ways back. I believe you said the patient actually had an intracranial tumor and died. I hope the patient (or family) sued the bejezaas out of that MD. Those type of mistakes occur when someone is simply too lazy to do a proper work-up.

But then I recall a certain head shrinker who stated that PTSD was the easiest of all psychological problems to treat and is curable in one session...

I wonder if said head shrinker was in a hurry to get back to his garden.

*********************


ami, I recall a certain auto mechanic who told my town's resident (and unwilling to suffer fools gladly) general surgeon that his working on a car's engine was just as complicated as the surgeon's working on a human.

The old surgeon paused for the requisite few seconds and then replied, "Okay...let me see you do it with the engine running."

You never went to medical school. If you did, you would know that paediatricians, ENT surgeons and anaesthesiologists don't investigate the etiology and possible amelioration of conditions like Leigh's Disease. They treat patients. Unfortunately, some of those patients have Leigh's Disease.

Medical geneticists, neuroimmunologists and medical neurobiochemists study conditions like Leigh's disease, along with about one hundred thousand other ongoing investigations. With any luck, Leigh's Disease may become a manageable condition some day. Right now, it isn't. The future of Leigh's Disease patients isn't looking much brighter, either. There's a reason for that.

But seeing as how you've stated that the only person on this planet you've met who knew more about everything than you do was some ex-Luftwaffe fighter pilot, do us all a favor. Look up the etiology and pathogenesis of Leigh's Disease and then tell all those researchers the true path. I won't be holding my breath.

While ignorant fucks like you get to sit back and toss out disingenuous comments on "Medical Death Panels" and pretend that cases like that of Joseph Maraachli are managed on a cost/benefit basis because it fits with your mythical tin foil hat, Randroid vision of health care outside of Capitalism, there are well trained, experienced and very much human nurses and docs who by choice, have to deal with the little Joseph Maraachlis of this very unfair world. As a resident, I was not one of them. I was as green as grass.

To this day, I remember my simplistic and naive attitude that when the chips were down and the hard decisions were going to have to be made regarding that little kid with Leigh's Disease, that as a mere resident in family medicine, I would be absolved and the high priced help would call the shots. Close to the end, when the poor child was not responding to the chest physio and his lungs were getting edematous and then finally infected, I asked the attending Paediatrician if putting the child on antibiotics was appropriate. The guy, who had spent the first two decades of his career out in the boonies as the only paediatrician for miles before returning to academia and a major teaching center, just looked at me and said, "Well...If he was my patient, I'd know what I would do," and dismissed me. There's a reason I was in a teaching hospital.


You really are one sick fuck, ami. But then I wasn't expecting a turnip brain like you to let a tragedy like this go to waste.

Earlier, I showed an image of Father Frank Pavone of the Priests For Life charity that is bankrolling the Maraachli family. I did a quick web check of him and his charity. His heart seems to be in the right place. After all, Catholic priests who fight tooth and nail to prolong a terminally ill child's vegetative state...it goes with their territory.

However, even the good Father isn't one to let a world class tragedy go to waste.

Under cover of darkness, Father Frank Pavone, national director of Priests for Life, arrived in Ontario, Canada, Sunday night to rescue Baby Joseph Maraachli from the London Health Sciences Centre. For two weeks, doctors at the hospital in London, Ontario, have been delaying the baby's transfer to a hospital where efforts to save his life will not be officially labeled "futile."

"I knew, after this dragged on day after day, that I needed to be here myself to get Baby Joseph to safety," said Father Pavone. "He needs to be in a hospital that cherishes life over the bottom line. After around-the-clock negotiations, this really became a race against time." Father Pavone was accompanied by Priests for Life staff, who were there to assure the transfer proceeded smoothly.

http://www.priestsforlife.org/press...e-leads-covert-mission-to-rescue-baby-joseph-

As a blogger commented, I see images of ninja-clad priests sneaking into the hospital under cover of night and secreting little Joseph out and away from his State mandated execution into a waiting plane, while no one was the wiser.

Going over the many blogs and even the facebook page titled Save Baby Joseph Maraachli, I am saddened but not surprised that after all the media hoopla about "Canadian Death Panels" and the horrors of socialized (read;Obamacare) medicine, the majority of posts I've read seem to imply that this baby now gets a chance to live a full and happy life.

If only it were so...

I suppose I could close with another f-bomb tossed ami's way but I think I'll just get up and make a cup of tea.

 

[JAMESBJOHNSON]

STEFAN

The patient with the headache was a phenobarb addict.

The tumor patient was diagnosed schizophrenic. He was 42 or so, had a Masters degree, and owned a business prior to his 'schizophrenia.' Its rare for middle aged adults to get schizophrenia; the MD shoulda suspected organicity/injury right from the get-go. And the patient had no history of drug abuse.

Hell! Even House takes a whole show to get the diagnosis right.

 

[stephen55]

STEFAN

The patient with the headache was a phenobarb addict.

The tumor patient was diagnosed schizophrenic. He was 42 or so, had a Masters degree, and owned a business prior to his 'schizophrenia.' Its rare for middle aged adults to get schizophrenia; the MD shoulda suspected organicity/injury right from the get-go. And the patient had no history of drug abuse.

Hell! Even House takes a whole show to get the diagnosis right.

You can go on asserting that your American medical schools turn out useless fucktards all you want. I don't buy it. I've known and testified against a couple of Canadian trained MDs. I've also known and testified against a pathetically incompetent Caribbean trained MD. That said, about 98% of the docs I've worked around were well trained and good at what they did.

On rare occasions I watch House. It's good television. It's abysmal medicine.

 

[stephen55]

but the Stephens of the world, making ethical excuses all the way, continue to promote the collective approach to individual problems.
Amicus Veritas

Ami, while you will never tire asserting that what was going on during the decision making surrounding Joseph Maraachli consisted of Death Panel collective approaches to an individual problem, I know and everyone involved in the case knows that you're a reactionary fucktard who wouldn't understand that a patient's best interests underlies all medical decisions.

 

[Stella_Omega]

stephen, for crissake.

Everyone knows that ami is a reactionary fucktard.

Everyone.

 

[amicus]

One should understand that the issue of this child actually has differing opinions attached to it and that I, personally, am not the only one taking a position that seems to infuriate our local usual suspects who all support single payer, government run medical care.

I have been exceedingly fortunate to have eight healthy children and about twenty healthy, normal grandchildren and I can only imagine the sorrow and suffering the parents of this child are experiencing.

Our resident Canadian MD seems to enjoy name dropping technical terms, perhaps in an attempt to impress, perhaps just to obfuscate the fact that this is a controversial issue with many facets but at the root of the issue is a challenge to the efficacy of government run medical care and here's a news flash, I am not the only one opposed to Nationalized Health Care.

I will continue to advocate market based medical services and use every opportunity that arises to point out the failures and inadequacies of government medicine.

The source of the disagreement remains as it always does, those who desire a more centralized, collectivist society and those who want a market based society. I may be the only one who consistently defends the free market on this forum, but I am certainly not in a minority in the general sweep of society. More people desire to be free than desire to be controlled.

Amicus Veritas

 

[Stella_Omega]

NONE of which has anything to do with the baby and its living death. Which is the topic of this thread.

Oh-- unless you mean that because the hospital can make a profit off his medical care, the family deserves to have it -- instead of perhaps some child who could actually benefit from it?

 

[Tio_Narratore]

Well, thank you, James. It has always been my understanding that conversations, debates, ought to have opposing positions aired and considered. On this forum, in particular, any opposing position to the established mantra is considered heresy, quite like the Inquisition insisted.

I would prefer to read reports of research being done to discover the cause of this problem and possible avenues of prevention and treatment, as I mentioned before.

Izzat asking too much?

ami

Pay attention, ami; it's been done. The syndrome is genetic.

"It is an inherited disorder that usually affects infants between the age of three months and two years, but, in rare cases, teenagers and adults as well. In the case of the disease, mutations in mitochondrial DNA (mtDNA) or in nuclear DNA (gene SURF1[2] and some COX assembly factors) cause degradation of motor skills and eventually death.

Mitochondria are an essential organelle in eukaryotic cells. Their function is to convert the potential energy of glucose, amino acids, and fatty acids into adenosine triphosphate (ATP). Mitochondria carry their own DNA, called mitochondrial DNA [mtDNA]. The information stored in the mtDNA is used to produce several of the enzymes essential to the production of ATP.

Mutations in the mtDNA that cause the mitochondria to fail, to function improperly, a person is at risk for a number of disorders, including Leigh's disease. In the case of Leigh's disease, crucial cells in the brain stem have mutated mtDNA, creating poorly functioning mitochondria. This causes a chronic lack of energy in the cells, which, in turn, affects the central nervous system and inhibits motor functions."

And as for treatment...

"Leigh's disease is a very rare disorder, and there is currently no cure, nor effective treatment. It usually affects infants under two years of age, but, in rarer cases, teenagers and adults as well. A high-fat, low-carbohydrate diet may be recommended. Adults may have puffiness and/or swelling of the eye area and the hands. It is currently treated with thiamin (vitamin B1), but even with treatment, infants rarely live longer than two or three years after the onset of the disease. In cases of older people, the disease takes longer, but is still almost always fatal."

And no, we really can't go into the neural cytoplasm and replace the mitochondria. Prevention is possible, and easy. Just don't reproduce. Given the rarity of the syndrome, though, that might be a bit extreme of an approach.

 

[stephen55]

Ami,

Your stellar ability to argue from your own set of definitions and your iron clad, hermetically sealed ability to ignore the facts of this baby's case are a tremendous tribute to the thoroughness of your indoctrination in the Randian ideal of Objectivism.

Apart from that, your inability to let a family tragedy go to waste is also a tremendous tribute to the thoroughness etc., etc.

Pointing out that in Canada, people are healthier, live longer, never go bankrupt from medical bills, always receive excellent care regardless of financial status and above all, have a much lower rate of infant mortality than people in the US, means something...except to a Randroid.

Have a nice day.

Use it wisely and do a little research. Find out why it took two weeks for Priests for Life to find a US hospital willing to take over care of baby Maraachli and what the financial arrangements were between Cardinal Glennon Children's Medical Center in St Louis, Missouri and said charity before they agreed to take over care.

Prediction:

- you won't try and instead will further decry the Death Panels that exist only in your head.
- you will find out why...and ignore it.


I'll wait a day or two and see how you're doing. For the benefit of those few here who haven't figured it out already, I'll be back later with the answer.

Hint:
-
I will continue to advocate market based medical services and use every opportunity that arises to point out the failures and inadequacies of government medicine.
Amicus

The failures and inadequacies also exist only in your head.

The idea that Canada's government practices medicine is also only in your head. The docs, nurses and all the affiliated health care professions provide the care. Citizens pay for it through taxes and health care premiums. All the government does is make sure everyone is covered and cared for. It's something that your government is unable or unwilling to do.

It's why our health and health care is so much better than yours. Feel free to continue to point out the deficiencies and inadequacies of Canadian health care while not pointing out a single example. Hate to break it to you, ami, but we notice such missing details.

Provide some details but understand that Randian spin doctoring doesn't impress anyone but fellow Randroids.

 

[stephen55]

...tap, tap, tap....

...still waiting, ami...

 

[stephen55]

I will continue to advocate market based medical services and use every opportunity that arises to point out the failures and inadequacies of government medicine.
Amicus Veritas

*yawn*

...still waiting...

 

[sadangel]

*hands you a sandwich and some lemonade so you won't have to leave and perhaps miss when ami makes his big debut with...*

Oh F*ck it, we know he won't...Just enjoy the meal.