Namo amitabha Buddhaya, y'all.
This here's a religious establishment. Act respectable.

Saturday, January 4, 2014

The Walking Dead, or, How Not To Be The Next Corpse Hooked To A Machine

(Alert: This post is kind of gross.  You might want to skip it if you don't want to know anything about human decomposition or how certain organs work.  Those who elect to get over it, read on:)

It's been a good year for zombies.  In case y'all aren't fans of The Walking Dead, the brilliant show on A&E, here's a quick primer.  Somewhere in Georgia, where we lay our tale, a rapidly-spreading virus turned most men, women and sometimes children into ravenous flesh-eating brain-dead zombies. (You know, like Ted Cruz.) We don't know what's happened to the rest of the world because there hasn't been any communication, but this part of the U.S. is a postapocalyptic nightmare.  Our group of civilians, who are either immune to the virus or have had the good luck not to catch it, attempts to survive around zombie attacks, natural disasters, political infighting and occasional conflicts with other groups of civilians.  It's not pleasant watching but it's very real.  You get the feeling that this is how people would probably really act in this situation, and that you, yourself, might not do any better.  Warning, lots of people die in this show.  Don't get too attached to any particular character.  The producers aren't shy about killing off lead characters, either, providing numerous shocking moments.  (Spoiler alert!) When twelve-year-old Sophie, who had been missing for most of Season 2, suddenly reappeared as a zombie, I about jumped into Joan's lap.

Zombie children are not restricted to TV this year, though.  In Oakland, California, a 13-year-old girl named Jahi McMath died on December 12 after surgery on her tonsils and adenoids.  We don't yet know what went wrong, though something clearly did because although she awoke from the anesthetic, she began to bleed heavily and went into full cardiac arrest. The docs got her heart beating again, but her brain died.  Brain death, by the way, means that there is no electrical activity in the brain and no blood circulating from the rest of the body to the brain.  If you meet those two criteria, you're deceased.  Oh, they can hook you to a ventilator, which might keep you breathing and your heart beating for a little while, but as soon as you disconnect the ventilator, the heart stops for lack of oxygen.  There's no brain stem (it's dead, remember?) to remind the heart to keep going.  

Before we get any further into this, let me just clarify that brain death is not a Terri Schiavo situation. The unfortunate Ms. Schiavo did not have a dead brain.  Instead, she spent fifteen years in what was suspected to be a "persistent vegetative state," which means a person has some unknown level of awareness but is not "awake" or "conscious" in any real sense. After she died, her autopsy indicated that she was probably not conscious at all, owing to the massive brain damage on the parts of her brain that controlled consciousness.  She was also blind, which is only interesting if you saw that video that was repeated on TV over and over again (viral video wasn't a "thing" yet) which allegedly "proved" that she was watching a balloon drift across her room.  (Ie, couldn't possibly have been watching the balloon because was blind, and yes, I do have to spell it out like that.)  

The difference between brain death and a persistent vegetative state is huge and unmistakable.  People in a persistent vegetative state are alive. Many of them can survive without a ventilator and some even regain some ability to communicate, though they remain severely disabled. Brain death is death.  No one "comes back from it."  In fact, without a blood supply, the brain begins to decompose and leak out of your ears (like your mother said would happen if you watched too many episodes of Keeping Up With The Kardashians). Other organs quickly follow and eventually, the whole body. The only reason brain dead persons are not considered "truly dead" by some people is that the heart will keep beating for quite a while, as long as it has an oxygen supply.  Of course, it will eventually fail because the other organs are dying (kidneys, for example, last less than a week) but one can be dead and hooked up to a machine that makes it appear that one is alive for weeks, maybe even a couple of months.  

Jahi McMath's story has become somewhat of a spectacle, as her parents are trying to move her to a nursing home on the belief that she might suddenly wake up.  This will not happen, as I'm sure most of us know.  Jahi is dead, and soon she will start to decompose.  No legitimate skilled nursing facility would take a brain-dead patient because the patient is, you know, dead. Which makes me seriously concerned about these nursing homes that the parents claim to have found.  I suspect that these "homes" are much more interested in keeping Jahi's body going for a while so they can get chunk of dough from the eventual lawsuit--which is something else a legitimate nursing facility would not do. As lots of persons who have had to negotiate the nursing-home maze on their own behalf or for a loved one are painfully aware, legitimate nursing facilities want to be paid up front, on time, and often.
Meanwhile, here in Texas, we have our very own zombie.  Marlise Munoz, who died on or around November 26, 2013, is still breathing thanks to a ventilator and the state of Texas.  Ms. Munoz was a paramedic, and one can assume that when she said, "I don't want to be hooked up to machines if anything bad happens," she meant it.  Oh, did I mention she's pregnant? See, there's the rub. In Texas and some other states, it is illegal to disconnect life support from a pregnant woman.  The fetus that Texas is so worried about suffered the same loss of oxygen that Marlise did when she died, and it may well also be dead, though it still had a heartbeat last time anybody checked.  Marlise was only 12 weeks along when she collapsed from a pulmonary embolism.  If she was, say, 32 weeks, the fetus might have a decent shot at survival (if it's not brain-dead itself, which is likely), but this early in the pregnancy, the fetus's survival odds are pretty close to zero.  Legally, though, the hospital has no choice but to keep this dead woman alive as long as possible and hope for a miracle. I don't believe in miracles.  Sure, they happen once in a while, but there's usually never one around when you really need it, fickle bastards that they are.

The Jahi McMath story is a tragic soap opera, and I feel sorry for everybody involved, but the outcome is preordained and won't take long to come about.  Ms. Munoz's case, though, is seriously irritating. There are options here.  This could end.  The husband, who has stayed out of the media glare for the most part except to say he doesn't want to be involved in a legal battle, could transfer Ms. Munoz to another hospital in another state and disconnect her life support there. He could also go to Federal court and obtain an order to have the life support disconnected, because the Texas law is unconstitutional on its face. But he won't, or at least he hasn't.  I think on some level he might be hoping against hope that the fetus will make it.  I can understand that.  It's his wife, for God's sake, and his hoped-for child.  But if it were my wife, I'd be doing everything possible to honor her wishes--up to and including taking a gun to the hospital, ordering everybody out of the room and turning the life support off my damnself.  Let a jury decide what it thinks about that.

(I am not a licensed attorney in any state, but I'm thinking it will be hard to convict someone of murder if the allegedly murdered person was already dead.  I read a sci-fi novel about something like that once. It turned out the ex-wife did it.  But anyway:)

Here's the important question, though.  How can you, a living, breathing person reading this blog post, keep from becoming the next corpse hooked to a machine?  Better still, how can you stop something like this from happening to a loved one?  

(Once again, I am not a licensed attorney in any state, and nothing that follows should be construed as any kind of legal advice. Yes, I hate disclaimers too, but I live in Texas, people.  Texas don't like it when you act like a lawyer when you're not one.)  

Well, first off, GET A LIVING WILL AND A MEDICAL POWER OF ATTORNEY, or, as it's called in some states, an Advance Directive.  This is easy to do and you don't need a lawyer.  Every state allows persons over the age of 18 (and sometimes younger persons) to refuse medical tyranny, er, medical treatment.  (You'd never know it from some of the stories I hear, but that's a whole nother blog post.)  Most states have preprinted forms (here's a set for Texas) that you can find by Googling "living will form" or "advance directive form" and the name of your state.  However, you don't have to use the state form; you can also write your own.  Hospitals generally have them available in the admissions office.  You might want to talk to your doctor, who might have a form of her or his own and will probably also have answers to any questions you might have.  In addition to a living will, you need to designate someone, called a medical power of attorney, to make decisions for you if you can't. You can be incredibly specific in your advance directive (mine, for example, covers kidney dialysis, burns over a certain percentage of my body and medically-induced comas) but things happen and sometimes the situation needs to be assessed by someone with a brain. A living brain.  

Second, if you know or live with someone that is terminally ill or might become so in the near future, HAVE THAT CONVERSATION NOW.  Let the person tell you what he or she wants done and when.  Write it down, if you can, so there's a record.  In fact, have this conversation with all of your loved ones, or at least the ones for which you might be called to make decisions.  

Thirdly, don't get pregnant in Texas.  Well, that's good advice for anybody.  Myself, personally, crossed out the supposedly legally required language (I later found out the language doesn't have to be on the form to make it valid) that stated life support cannot be withdrawn from a pregnant person.  I instead wrote in the case citations to Roe v. Wade 410 U.S. 113 (1973), Cruzan v. Director, Missouri Department of Health 497 U.S. 621 and Cruzan v Mouton CV 384-9P (Mo. Cir. Ct. December 14, 1990) and added that I instructed my medical power of attorney to immediately begin litigation if the medical facility refused to terminate life support, regardless of the reason. No, I don't fuck around with this stuff.  Why?  Because what if you can't leave?  What if you're dead, you've even moved out of your body because it's started to smell, but because your heart is still technically beating you can't go on to the next life or the next plane of existence? What if you're stuck there? For years, maybe decades?  Who knows how fast time moves after you're dead?  What if the health care facility you're stuck in doesn't even have a decent library?  

Fourthly, and this is going to sound very strange, DON'T CALL 911.  Again, if you know or live with someone who is terminally ill, and you know what that person wants done, you don't want to call the paramedics to haul them off to the hospital if something happens (unless, of course, they've told you they want to go to the hospital).  We're trained from childhood to call 911 in case of an emergency, but a terminally ill person dying is not an emergency.  It's what's supposed to happen.  And you can't expect paramedics to stop and read a legal document that tells them what they can or can't do.  That's not their job.  They exist to take the afflicted person to get medical treatment.  It can be days, even weeks after you call 911 before you regain control of the situation, if you ever do. 

If you're taking care of someone who's in imminent danger of dying, and that person collapses, stops breathing, or if God forbid you walk into the house one day and find the person already dead, what you want to do is call the person's doctor.  Tell the doctor who you are (presumably she or he already knows you, but you might be just a tiny bit stressed by the circumstances and not sound like yourself) and that you just arrived home and found Person X dead, or whatever else happened.  The doctor will probably take a few minutes to calm you down and then give you some instructions.  As long as they're in line with what you know Person X wants, do whatever the doctor says.  Then the doctor, not you, will contact the police and inform them that Person X has died.  Stay there until the police come and then let them take over.  If they feel at that point that a call to 911 is in order, it probably is.  

In case you're wondering, there's no hard and fast Buddhist doctrine about end of life decisions.  Buddhists tend to be pro-life, but that means pro-all life, including ants and bugs and paramecia and even germs.  However, there are several instances of prominent Buddhists, who were sick, old or otherwise didn't want to hang around anymore, committing suicide (three times with full knowledge and approval of the Buddha himself; here's a citation that means nothing to me, but will point the scholarly among you to where in the Dhammapada these stories can be found: S.v.344 (Diighaavu); S.iv.55, M.iii.263 (Channa); S.iii.119 (Vakkali); S.iii.124 (Assajji); M.iii.258, S.v.380 (Anaathapi.n.dika). Also, I came across an article that discusses these contradictions and makes some suggestions as to how Buddhists should approach end of life decisions.

But really, the most important thing you can do to protect yourself and your loved ones from becoming zombies is talk to them.  Make sure you know what they want.  Make sure they know what you want.  And stay the heck out of Texas while pregnant, unless you're in your third trimester.  

No comments: