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Keeping a brain dead patient 'alive'
microscopic - thingy...
pekover wrote in little_details
terms searched: permanent vegetative state, coma, brain dead, withdrawing life support, euthanasia

I have a character that I want to be essentially dead, but kept functioning for about a year (the decision to pull the plug is a major plot point). I don't want there to be any real intellectual controversy about the decision, I just want it to be emotionally difficult.

So, I'm thinking the character has had a head injury leading to brain death, but the more I read, it seems like keeping a brain dead person on life support for a full year would generally be considered a bit inhumane. So my questions are:

1) How common is it for a brain dead patient to be on life support for about a year?

2) Is there anything less 'severe' than brain death that would be more appropriate for this situation? I was looking at permanent vegetative state, but people apparently sometimes recover from that, so a year doesn't seem long enough to wait in that situation. And I'd like to avoid the trauma of withholding feeding, etc. if possible - I'd like it to just be a 'pull the plug' type situation.

3) If brain death seems like the way to go, what would the patient's body be like after about a year? I found some effects of long-term paralysis and coma, but would the effects be the same for a brain dead patient?

So, in summary - an injury a year ago, kept in stasis for a year, now deciding to let him go. Characters doing the deciding are emotionally involved and therefore not totally rational, but not totally insane either. What details do I need to know?

Thanks very much for any help!

1) brain dead = dead. Even if the family throws a fit, usually in a week or so the hospital lawyers can force the plug to be pulled by court order. It doesn't happen often but it does happen. I saw a case like this when I was a med student which was very tragic (a woman had a massive stroke in childbirth and was brain dead, but her family didn't want to believe it)

2) permanent vegetative state is a good one ... perhaps the person goes downhill near the end? Lying in bed like that, you can get all sorts of nasty issues: infection, blood clot, etc. that might kill someone.

3) irrelevant, since no one keeps a dead person around for a year.

So the issue is that the person is lying around for a year but brain dead now? Have it happen right near the ending is my suggestion. YMMV.

Is there a way to do that (have the brain death occur right near the end)? Like, if he was injured a year ago, and then deteriorated to the point of brain death? Oh, but, again, there's really no decision to be made in that case, is there? I mean, if doctors wouldn't allow a brain dead patient to be kept alive regardless of the family's wishes, then...the family has no decision to make, and I need them to be making some sort of decision, in a 'we've let this go on for long enough' sort of way.

If it was a permanent vegetative state, would the patient be left to essentially starve to death, as opposed to having life support removed? And do you know is there some clear indicator that the family could look at as evidence that the patient would never recover?

I guess what I'm getting at is... in your experience, what's the most common case for people to have to debate about whether to 'pull the plug' or not? That is, I don't really care what's wrong with the guy - I want it to be from an injury, I want it to last about a year, and I want the family to be emotionally torn about deciding to pull the plug. Can you think of a diagnosis that fits these criteria?

And, in case I'm sounding too demanding - thanks very much for your time and expertise!

Terri Schiavo? Eluana Englaro?

It's uncommon, but it happens.

To the OP: The issues surrounding these patients may help with your follow-up question below.

Yeah, they weren't brain dead, though.

I've got some information on the permanent vegetative state, but that's less severe than brain death...

I think I'm hoping to find something somehow in between the two.

You did mention persistent vegetative states in your original question, so I thought it was relevant. Sorry if it wasn't.

1) I'd say it would be unusual, unless the family flat-out refused to pull the plug and went to court to prevent it.

2) There's a difference between brain death and severe vegetative state:

"Brain death is not medically or legally equivalent to severe vegetative state. In a severe vegetative state, the cerebral cortex, the center of cognitive functions including consciousness and intelligence, may be dead while the brain stem, which controls basic life support functions such as respiration, is still functioning. Death is equivalent to brain stem death. The brain stem, which is less sensitive to anoxia (loss of adequate oxygen) than the cerebrum, dies from cessation of circulation for periods exceeding three to four minutes or from intracranial catastrophe, such as a violent accident."

In the case of brain stem death, there wouldn't be much reason to keep a person on life support unless the family agreed to organ donation. Then the respirator, etc. would be a way of keeping the organs fresh for the surgeon who'd be removing them from the corpse, rather than letting them deteriorate.

3) Here's a case in New York about a little boy whose brain died and whose parents didn't want to accept it. This is what he was like after a week:

His eyes are fixed and dilated. His body neither moves nor responds to stimulation. His brain stem shows no electrical function, and his brain tissue has begun to decompose.

Basically, a person whose brain is decomposing is a corpse.

The doctors of that little boy didn't want to keep his body hooked up to machines. And no other hospital was willing to accept the corpse and treat it as if it were alive.

So I'm not sure anyone would keep a brain dead patient on respirators for a year. It would be a waste of the family's money, a waste of the hospital's resources, and a cruel abuse of hope, convincing the family that this person is alive and may recover when that's never going to happen.

Yeah, I know about the brain dead/vegetative state difference - I'm really hoping that someone can come up with something between the two...

I accept that brain death seems to be out.

I could just go with permanent vegetative state, but apparently people can sometimes recover from that, and the character I want this to happen to is young, healthy, etc., all of which makes me think that his family would wait for more than a year before giving up on him...

I sadly knew first hand of a case like this. The woman in her 30's had a reaction to anesthetic which resulted in prolonged lack of oxygen. She never breathed spontaneously again, brain dead. Husband refused to turn off life support. She was maintained in ICU for a year. Very complex care, infections, risk of bed sores, need for nutrition, maintaining blood pressure etc. Husband did many different things to bring her back including sacrificing roosters in the bathroom, metal pyramids to bring energy and just about every catholic saint figurine possible around her bed.
It is inhumane, but it happens. Hospitals are not in a good position to stop caring. This incident happened in Florida in the 1980's.

After a near-drowning accident, my little brother was in a coma for over a year -- more like two, I think? He could sort-of breathe on his own, most of the time, but was on a ventilator sometimes. He couldn't eat, of course, and was fed through a tracheotomy tube. He had to have a nurse 'round the clock because he would have seizures and/or stop breathing. (It was horribly expensive and stressy.)

He was, overall, in not-too-bad shape -- there was a lot of attempts to bring him out of it via "patterning" (look up the Institute for the Achievement of Human Potential -- -- and their work with brain-damaged children; this was what was being attempted, but the damage was just too great) and moving him around so he didn't get bedsores.

He finally got pneumonia and died in the hospital.

It would probably qualify as permanent vegetative state.

As a note... My sire was just unwilling to accept that my little brother (he was... two? three? at the time of the accident) wasn't going to wake up again. HIs pupils never really responded to light, and... He just wasn't there.

I think my mother would have pulled the plug somehow much earlier; not stopped feeding him, but not tried to start him breathing again when he would stop. She was furious when he went into cardiac arrest in the hospital and a nurse decided to take Heroic Measures to bring him back.

Edit: Oh, most of the time he wasn't at the hospital. He was at home. Did I mention "nurse 'round the clock" and "incredibly expensive and stressy"? Yeah. I remember him as looking rather physically healthy much of the time, but... no one was home. No one was going to be home.

Edited at 2009-03-11 02:38 am (UTC)

"Just pulling the plug," in these sorts of situations, usually is withholding feeding. If the patient's actually brain dead, then they're already dead, life support or no, but it's possible to be deep in a PVS and still have the body able to regulate its own pulse and breathing.

There really isn't anything "between" PVS and brain death either; in practice they're synonymous. If you want to really, really ramp up the emotasticity of the situation you could make the victim locked-in (which IMO is far, far worse than mere brain death).

You'd mentioned people recovering from PVS; it's possible but rare enough that you can generally assume it's not going to happen, especially if there's no higher brain function.

I think rather recently something like this happend. A boy/man had an accident I believe. He was brain dead and had a ventilator to keep his lungs going, but both medically and spiritaully speaking he was dead, he was even descomposing, but the family refused to pull the plug. I'm not sure if it was deal with at the end, but it was horrible for all the medical staff to be tending a cadaver.

So yes, if the family fight it and you have some wacky religious folks with them, you can make the hospital keep him around for a year or so.

My uncle was kept in a severe vegetative state for about six years, even though it was clear to everyone besides my aunt that he was essentially gone after the first month.

A way to simplify the "pulling the plug" issue in the severe vegetative state is what archangelbeth was talking about above--these people get severely ill a LOT. Every few months there would be a crisis where my uncle got pneumonia and had to be rushed back into the emergency room etc. from the home where they kept him. A lot of these times he would be on a respirator. Any time he got sick, basically, my aunt had the choice of "pulling the plug" all over again without going through withholding feedings--it usually happened extremely quickly. So I think developing an illness after a year and having the question come up again would make your family's decision extremely plausible.

Also, to repeat what everybody's been saying--it's grossly expensive.

Thanks to everybody - I guess I'm gonna go with the vegetative state!

Special thanks to those of you who've shared personal experiences about this - I know it's not an easy subject, and really appreciate you sharing the details with me.

my nephew is in the hospital and was admitted 1 week ago after having his lung colasp and died in the tup but was brought back by paramedics in the bathroom and was diognosed with extreme phenomia . Hes ventilator was pulled today yet he is still fighting and alive but 100% brain dead. How long xcan this go on because he is in a constant state of seizure and is ther anyway that he knows this is happening?

If he's having seizures, that means brain activity, so not truly brain dead

The longest documented time a brain dead person's body was kept alive is about a month. The body actually begins to decompose. The most recent case in Texas where they kept a dead women on a ventilator because of a fetus is interesting. There has been some information that she may not have been appropriately diagnosed as brain death according to modern criteria. This is usually the case that someone declared brain dead isn't really dead. Usually the diagnosis was not arrived at correctly.