Brain Fertilizer

Yeah, the issue has been pounded. So what?

Over the weekend I talked with friends about the issue. I had a certain impression of issues different from their impressions because they seemed to pretty much depend on mainline news media. I had a difficult time giving any verbal evidence they would accept as credible as CNN. I could point out that the brain scans were 10 years old; I could point out that other credible neurologists gave a different prognosis from the doctor who saw the case. But nothing I said made a dent because I didn't have the links in front of me, and "CNN Said".

So what follows is just the information I found in about 30 minutes of research. If I get in such a discussion again, I'll have more ammunition. Now so will you, if you didn't already.

If anyone knows of any other factual or authoritative collections of material supporting the idea of reasonable doubt toward the PVS prognosis, please leave the link in the comments.

UPDATE: But none of the following points are proof that Terri Schiavo was murdered. All I ever wanted was more time for a thorough review based on current evidence, not a single CT scan more than 10 years old and a prognosis from a single doctor that spent less than an hour with Terri. Don't we usually get 2nd opinions on weighty medical issues?

Common sense about the video tape.

If she *was* actually braindead, why should she need
morphine? (buried near the bottom of the article, she
received morphine on 19 and 26 March) ...and why does the MSM always bury the information indicating Terri Schiavo is not in PVS at the bottom of their articles? Rule of thumb: the question is the answer, many times.

Supporters of the ruling should address this, as well:
Good points and good questions by a medical authority who has interpreted more than 10,000 CT scans.

I link posts when the entire post is salient. When I feel only a portion of the post is applicable to the point I'm making, I tend to blockquote the important parts. Like this:

"The Schiavo Issues

None of this changes the observations I have made on
the Schiavo case and I stand by every single one of
them. I have been grilled -- live -- on the radio
twice by neurologists, neuroradiologists, and sundry
experts concerning everything I have said, and I have
not been knocked off any point.

The problem always seems to come down to people not
reading what I said. Because I usually mean exactly
what I say and no more. But people cannot help
expanding, changing, and transmuting what I've
written.

Orientation

I do not come from the perspectives of what people
would consider a strict "right to lifer," the
"religious right," or a "radical conservative."

My original issue was the feeding tube. I did not --
and still do not --understand how food and water came
under the rubric of life support in the same category
as intubation, forced breathing, and cardiac pacing.
The best analogy I can use is the Foley catheter (tube
through the urethra into the urinary bladder to allow
urine to drain). If you are going to remove food, then
why allow patients to urinate?

As a physician, I strongly object to actuating death.
That is not what I was trained to do, and if society
decides that is what it wants, I would propose some
different professionals be assigned the duty to pull
these tubes when the law orders it. For me, as a
physician, it is an act that is inimical to all the
reasons I went into the health care field.

Making terminal patients comfortable during their last
days is, to me, is in a different philosophical and
ethical cosmos than removing a feeding tube from a
severely impaired patient.

The Infamous CT Scan

I saw, and heard neurologists, ethicists, and hospice
physicians in media outlets such as NPR, Fox News,
MSNBC, CNN, and all the newspapers, declaring that
Terri Schiavo's higher brain functions were nil. To
describe this they used terms like: "her brain is:
"water," a "bag of water," and "totally without
cortex." One medical ethicist on NPR said
(paraphrased) that Terri's brain was completely
without a functioning cortex and since the cortex is
where the complex functions and emotions of life are
carried out, she is therefore not alive, but dead.

I, like every one else I assume, took this as it was
stated (it didn't change my mind about the feeding
tube anyway) until I stumbled on the single
mid-ventricular CT image of Terri's brain that was
done either in 1996 or 2002 (no matter).

Upon seeing the CT slice I was shocked that, yes there
was severe atrophy, yes, there was severe damage, and
yes the cortex was markedly thinned, but the CT itself
did not reflect the descriptions I'd heard; and worse,
I have seen many old and debilitated nursing
home/assisted living patients as well as younger
patients with chronic brain damage, with similar or
worse atrophy. And not all of these patients were
nonfunctioning.

That same CT slice was used as a visual graphic on
television and in the newspapers -- by the same group
of experts -- to demonstrate why Terri Schiavo was
suitable for euthanasia. I objected to this strongly
as, to me, the implications for all the other patients
with similar or worse CT scans was morally and
ethically frightening (talk about slippery slopes!).

I've been heavily criticized as unethically
interpreting Terri's CT from this single slice, and
speculating from the limited data. Let's get something
straight. First, this was the only slice available.
Second, it was the same and only slice everyone other
expert was commenting upon. The University of Miami
bioethics webpage thought it was appropriate to use
that single slice on their web page as a testament to
Terri's brain damage. Third, I made observations, not
a diagnosis. Fourth, this was a scan done in the
remote past. Looking at that slice and speculating
about questions it raises is no more unethical than
looking at a fossil and speculating on the size and
shape of a dinosaur. It's a fragment of an old map, or
a puzzle. And putting puzzles together to try and
figure out possibilities is one of the things
radiologists do for a living.

I also felt strongly that it was disingenuous for
experts to put Terri's CT slice side-by-side with a
normal 25 year-old female's CT. To the nontrained eye,
the striking disparity nailed the case shut. To me
that was unfair journalism and tendentious in the
worst way. It would have been far more appropriate to
put up the CT of a patient with severe cerebral palsy
or chronic atherosclerosis. But this would not have
made their case so strong, and one must question why
these experts were given a pass for passing judgment
on a single slice of a CT and for a deceptive
comparison. I certainly was given no similar pass by
readers and commentators when I said something
different using the same data set.

It is also my contention that if the media are going
to use limited data to solidify important and weighty
issues, then there better be someone in the audience
who asks these questions. Because the reporters don't
The reporters and interviewers often try to probe
deeper, but they cannot sidestep trained physicians
and academics whose depth of knowledge and familiarity
with the issues easily circumvent and obviate any
inquiry that might undermine their theory or proposal.
I have never seen a medical "expert" exposed, thwarted
or seriously undermined by a question from the
journalistic audience.

That all came from here.

http://codeblueblog.blogs.com/codeblueblog/2005/03/codeblueblog_is.html

More stuff. Read about misdiagnoses:
Misdiagnosis of PVS? Probably.

Read about the affadavits that Terry Schiavo was
responsive:
The second half of this post points out that Terri Schiavo was quite responsive several years after the PVS diagnosis. Therapy probably would have helped.

Even the supposedly Right-wing-propaganda machine, Fox News, buries the important stuff near the end of a long article.

Evidence that Terry was responsive just days before
dying.

A nobel-nominated physician said she would probably have improved with therapy.

She had periods of consciousness.

Where there is life, there is hope.

· Did you know that Michael Schiavo never mentioned any alleged statement by Terri that she did not want to be kept alive this way until years later, when a settlement was reached in a malpractice lawsuit awarding him more than $1 million for Terri's rehabilitation, and around the time he moved in with the other woman?

· Did you know that the description of Terri being in
a "persistent vegetative state" is disputed by more
than 30 physicians, including a neurologist from the
Mayo Clinic?

From Here.

And, sadly, it looks like Michael Schiavo *did* manage to cover his
tracks:
Terri was cremated without the family getting to have
an independent expert at the autopsy.