MY “WORST” PATIENT

I was a newly divorced mother of three young children when I returned to nursing to support our little family.

I had been a happily stay-at-home mom for years until my husband had a mental breakdown, took all our money, and fled the state after one of our children died, but I was grateful to find a job on an oncology unit and some childcare.

I was a little nervous about being a working nurse again, but when I started my first day back, I was startled by loud shouting from a patient’s room, even through the door was closed.

I asked what was going on and the other nurses told me that the patient was abusive and shouting all the time, even though he didn’t seem in pain.

The other nurses said they had all agreed to change nurses every day because he was so nasty and they told me I was going to be assigned to him later.

I read the man’s chart and talked to the man’s doctor to ask him what was going on. I was shocked when the doctor said he thought the man was “evil”! I asked the doctor “Like Hannibal Lecter in the movie Silence of the Lambs?” He said yes and I felt a cold chill.

So I made a plan.

When my turn came up to care for the man, I asked to have him all week on the night shift. “No problem!”, the other nurses said.

The first night, the man didn’t sleep and kept shouting loudly. He ignored my questioning so I sat next to his bed and tried to understand what he was shouting.

I discovered that he was enraged and cursing God Himself. I listened quietly until he stopped.

After a while, I held his hand and every time he started to yell again, I replied “God still loves you” over and over until he eventually he fell asleep,

This went on night after night until one night he stopped and slept through the night.

The next day, he woke up and said he wanted to take a walk so I took him to the hallway just as the day shift came in.

The man smiled at them and said “Good morning, ladies!” Everyone was stunned but his whole attitude changed from then on.

Weeks later, I met a student nurse who asked how he was doing. She said she had made a big mistake with his portacath IV access and had to have it replaced surgically. She was devastated but when she apologized, he told her not to worry and that he was fine.

The student told me that she was the nicest patient she ever had!

I told her my story and said that sensitively caring for the most difficult patients can be the greatest reward of all!

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“Suicide Helpline” in Canada Suggested Euthanasia for a Person with Disabilities

In a stunning article on Ales Schadenberg’s May 31, 202 blog titled “Suicide helpline suggested euthanasia for my disabled friend”, Meghan Schrader, a disability justice advocate and scholar, warns that “it is best to nip the USA assisted suicide movement in the bud and not let that movement get its foot in the door” and tells the story of her Canadian friend “Amy”. (Emphasis added)

Ms. Schrader writes that Amy reached out to her for help after Canada legalized euthanasia for disabled people in 2021.

“Amy had endured child abuse, which left Amy with PTSD and physical injuries that caused severe chronic pain. As an indigent disabled person Amy was unable to access thorough medical treatment for these disabilities, so even though Amy wanted to live and was deeply offended by Canada’s decision to expand euthanasia to people with disabilities, Amy’s suffering was so great that Amy thought constantly of dying by “MAiD” (Medical Aid in Dying).”

“However, when Amy called a mental health and suicide crisis support hotline for poor people and asked the operator for help fighting against these thoughts, the operator said, “Well, MAiD is a legit and legal option. Maybe it’s something you should consider. The medical system seems to be failing you. And you are never going to get the opiate pain medication that you think you need.” (Emphasis added)”

“With help from about ten different people, including the Euthanasia Prevention Coalition, Amy was eventually able to take a train four hours away from home and show up in the emergency room of a hospital that opposes “MAiD” and specializes in chronic pain and mental illness. Amy finally received excellent care. Although Amy sometimes still has symptoms of chronic pain and PTSD and life is still often quite a struggle, Amy’s symptoms are manageable and Amy is not planning to die by “MAiD.” It was my honor to attend Amy’s Zoom birthday party recently.

But thanks to Compassion and Choice’s friends in Canada and the systemic ableism that is enabling their cause, the Canadian medical system would have killed Amy before providing adequate medical treatment or support.”

She ends by stating:

“I’ve read statements from proponents of recent assisted suicide bill’s saying that their supporters are “real people with grief and loss, not hypothetical scenarios.” Well, Amy and Rachel are not hypothetical scenarios, they are my friends. I’ve read statements describing myself and other disability rights movement opponents of assisted suicide as “abusive, bullying and cruel.” (Emphasis added)

But I can think of few things more abusive, bullying and cruel than for a suicide prevention hotline operator to tell a caller to go ahead and be killed. I don’t want to live in that world, and like others in the disability justice movement, I won’t be quiet while the proponents lay the scaffolding for that to happen.

I’m sorry if that makes me cruel.”

CONCLUSION

As I wrote in 2015:

“In 2009, I lost my 30 year old daughter Marie to assisted suicide after using an assisted suicide technique after a 16 year battle with addiction.

Marie’s suicide hit our family, her friends, and her therapists like an atom bomb. We had all tried for years to help her, with periods of success. Suicide was always our greatest fear, and we made sure she was armed with crisis helpline numbers and our cell phone numbers at all times. I trust in an all-merciful God Who loves my daughter as much as I do, and I don’t regret one minute of those 16 years of trying to save her.

Both personally and professionally, as a nurse, I’ve cared for many suicidal people whose lives were saved. It’s a myth that suicidal people are destined to commit suicide eventually, and studies have shown that only 10 percent (or less, according to some studies) complete a suicide.1 I’m still determined to save vulnerable people from suicide, regardless of their age, socioeconomic status, or condition. Giving up hope is not an option.

Not surprisingly, since suicide contagion is a recognized risk factor for suicide, one of Marie’s close friends became suicidal on the first anniversary of her suicide but was saved. Is it really just a coincidence that Oregon, which doesn’t include assisted suicide in its suicide statistics, now reports a suicide rate that’s 41 percent above the national average?4

But the “assisted suicide/ euthanasia” machine still rolls on in the US.

The Patients Rights Action organization keeps track of states with bills to legalize assisted suicide and those states that defeated assisted suicide. (see state status updated 5/29/2025)

Please check the status in your state and take the necessary action.

We cannot become like Canada!

How to Bury Your Baby After a Miscarriage Today

10 years ago, I wrote my blog “How to Bury Your Baby After a Miscarriage” after my miscarriage:

“In 1983, my daughter Karen, who had Down Syndrome, died at 5 1/2 months from a complication of pneumonia just before her open heart surgery. In 1984, we suffered a miscarriage at 10-12 weeks.

My 7-year-old son and 5-year-old daughter were devastated and asked what the name was. Since the doctors could not determine the sex of the baby, I had each of my children select a boy’s or girl’s name. Naming the baby Jeff Candy helped make my children feel better but then they questioned why Jeff Candy did not have a funeral like their sister Karen. Good question!

I brought this up to my mentor Fr. Joe Naumann (now archbishop of Kansas City) when he headed the St. Louis Archdiocesan Pro-Life Committee and the next thing I knew, I wound up on a committee. Now we have “The Order for the Naming and Commendation for an Infant Who Died Before Birth” (copyright 1989)
.
I am so proud of the results of my children’s long-ago question and I am so happy to see the long-term results in this article, which should be shared with everyone, especially if they are Catholic. Here is an excerpt:

How to Bury Your Baby After a Miscarriage

by JoAnna Wahlund • June 10, AD2015

“The loss of a child is a nightmare for every parent. In the first few hours and days of grief and shock, it’s hard to know what to do. It’s especially hard when the loss occurs in early pregnancy, since our culture isn’t accustomed to treating unborn babies as human beings — and this happens even in pro-life circles.

If you are reading this article because you recently lost a baby via miscarriage, there are three things I want you to know:

1. I am so sorry for the loss of your baby.

2. You have the right to bury your baby.

3. If you did not bury your baby, do not not feel ashamed or guilty. We can only do our best in the circumstances we’re in according to the knowledge that we have.”

A MISCARRIAGE AND FUNERAL TODAY

Recently, I was invited to an ultrasound of a close relative.

“Anne” (not her real name) was so excited about her third pregnancy, and since I was a nurse, she thought I might be able to discern the sex of the baby.

I held her hand as the ultrasound began, but tragically, there was no heartbeat.

A second ultrasound showed the same result, and we both cried as a D&C was scheduled to remove the baby.

I had told Anne about the Naming and Commendation Ceremony and she requested the baby’s remains. The hospital was very respectful and put the remains in a small white box.

We met with her pastor, who not only agreed to bury the baby in the church’s graveyard with a short ceremony, but also to have a stone placed!

What a blessing!

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FEEDING IS NOT EXTRAORDINARY CARE– DECISION IN THE NANCY CRUZAN CASE ADDS TO THE LIST OF EXPENDABLE PEOPLE

Before the famous Terri Schiavo food and water case gained national attention 20 years ago, Dr. Harvath and I wrote this Op-Ed in the St. Louis Post-Dispatch (no longer online) about the Nancy Cruzan casw, an earlier case of withdrawing food and water from a “so-called “vegetative state”‘ My family was furious when it was pusblished and told me that I was being “mean” to the family.

Unfortunately, such removal has become common and even recently, has resulted in a brother’s death.

Not surprisingly, so-called “assisted suicide” is now allowed in many states and countries

Nancy Valko, RN

Here is our op-ed:
Friday, August 12, 1988
FEEDING IS NOT EXTRAORDINARY CARE– DECISION IN THE NANCY CRUZAN CASE ADDS TO THE LIST OF EXPENDABLE PEOPLE

By Susan Harvath and Nancy Guilfoy Valko                                                                    

Just a few years ago the Missouri Legislature passed a ”living will” law that specifically excluded food and water from the kinds of care that may be withdrawn from a patient. In 1984, the National Conference of Catholic Bishops stated that legislation should ”recognize the presumption that certain basic measures such as nursing care, hydration, nourishment and the like must be maintained out of respect for the human dignity of every patient.”

Therefore, it is hoped that the Missouri Court of Appeals will overturn the recent Circuit Court decision that would deny tube feedings for Nancy Cruzan, a severely disabled woman cared for at the Missouri Rehabilitation Center. The anguish felt by the Cruzan family, which initiated the suit, is understandable. However, directly causing the death of an innocent person – even for reasons of mercy – violates that person’s basic human rights.

The Cruzan case is perceived by many to be an issue of allowing a person to die. Cruzan has been categorized by some experts as being in a ”persistent vegetative state,” an unfortunate and imprecise term at best. However, she is not dying or brain-dead. Rather, she is severely disabled from brain damage and needs no special technology to survive. Withdrawing her feeding tube would not ”allow” her to die – it would ”force” her to die. She would not die from her injuries, but rather from starvation and dehydration.

Also, starvation and dehydration cause a protracted, agonizing death in a fully conscious person. Some experts have stated that Cruzan would feel no pain if her feedings were stopped. Yet Cruzan’s nurses have testified that she has cried, smiled and even laughed in response to stimuli.

The possibility of pain during the length of time before death occurs has led some to propose lethal injections as a more ”humane” way to cause death than starvation. The passive euthanasia of withdrawing feeding logically leads to active euthanasia by injection or other means. Both are unacceptable.

A recent trend has been to classify tube feedings as medical treatment. However, unlike other medical treatments, denial of food from any person (sick or healthy, in or out of coma) will always result in that person’s death.

Ethically, treatments may be withdrawn if they are useless or burdensome to the patient. However, tube feedings are not excessively expensive or burdensome to the patient and do maintain life and prevent the discomfort of hunger and thirst. In deciding what treatment may ethically be withdrawn one must be careful to judge the treatment itself, not the ”quality” of the patient’s life. A person’s limitations do not decrease a person’s humanity or worth.

In the past few years, we have seen many court cases similar to Cruzan’s in other states. Some have involved people less severely disabled than Cruzan. A recent case in North Dakota resulted in a judgment that even feedings by mouth may be stopped. In most cases, it is not the patient who requests that feedings be stopped but rather a third party, usually a family member. Often, as in the Nancy Cruzan case, there is no clear and convincing evidence that the patient would even want the feedings stopped.

Some courts have gone even further and have stated that third parties do not need the approval of a court before a patient’s food and water is withdrawn unless there is disagreement, for example, among family members. This trend has unfortunate implications for all people with mental impairments.

There is a vast difference between not prolonging dying and causing death. In the last two decades, we have seen killing promoted as a humane and compassionate response to unwanted unborn children, newborns with handicaps, and the terminally ill. Let us not add a new category of people (the non-dying, severely disabled) to the list of expendable human lives.

Nancy Guilfoy Valko, R.N., is co-chairperson, and Sue Harvath is program director of the St. Louis Archdiocesan Pro-Life Committee.

“I Thought I Was a Useless Old Woman!”

I decided to become a nurse when I was five and received a Golden book titled “Nurse Nancy”.

I loved the stories about how this little girl helped the other children in the neighborhood by applying bandaids and comfort

I also had two wonderful grandmothers and so becoming a grandma became my other life goal. Since both were widowed and aging, I was able to help.

When I finally achieved my RN, I took my new degree to my father’s mother and she was delighted. “Think of all the people you will help!” I replied “Not as many as you have!’

She was stunned and said ” I am a useless old woman living alone and dependent on family” until I told her how much I admired her dedication to prayer.

Every since I was a little girl, my mother told my brothers and me that we were not to call Grandma between the hours of noon and three. As a devout Catholic, she dedicated those hours to praying for the poor souls in purgatory and for those people who had no one to pray for them. I told her that she helped many more people than I could as a nurse.

She burst into tears and said “I thought I was a useless old woman!”

CONCLUSION

I was honored to love and help care for both my grandmothers as they aged and eventually died. Both were examples to me as they helped whoever they could.

And I learned that being a nurse is more than just caring for the physical needs of a patient. The emotional and spiritual needs of patients-and family-are just as important.

Shocking New York Times Article Shows Planned Parenthood in Crisis

In a shocking February 15, 2025, New York Times article titled A Crisis at Planned Parenthood: What to Know, author Katie Benner writes that “Planned Parenthood clinics around the country are facing complaints of substandard health care and poor morale amid chronic funding problems, a New York Times investigation found.” (Emphasis added)

She also writes that:

“While Planned Parenthood is synonymous with abortion, the organization also provides basic health care to millions of​ Americans who have few other options. Financial strains now undermine those services.

New York Times review found that the clinics have been in decline for decades, undermined by structural and political headwinds and left to make do as national leaders prioritized the fight for abortion rights over finding a more sustainable way to fund health care. (Emphasis added)

Planned Parenthood’s health care operation has shrunk from a high of 5 million patients served across 900 clinics in the 1990s to 2.1 million patients and 600 clinics today, with staff members complaining that patient care is compromised by low salaries, chronic understaffing, high turnover, inadequate training and aging facilities.” (Emphasis added)

Katie Benner also writes: “Here are four takeaways from the reporting:

“Planned Parenthood may need structural reform

Few people outside the organization understand that there is a significant difference between the Planned Parenthood Federation of America, the national office that most people associate with the brand, and the 49 Planned Parenthood affiliates located across the country. The national office does not provide health care. Rather, it funds legal, political, and public opinion work that supports abortion rights. The clinics are run by the affiliates, which are stand-alone nonprofit organizations.

The affiliates have been buffeted for years by political challenges that hurt their ability to raise the money necessary to cover procedures that patients cannot afford.

For the past two decades, leaders say they had to prioritize the fight for abortion rights over clinics because the political fight was fundamental to the organization’s ability to operate. They argue that the organization managed to deliver quality health care, despite increasing financial constraints. Yet clinics have degraded over time.” (All emphasis added)

Clinics nationwide face financial problems

“While affiliates in more liberal states like New York and California have had an easier time fund-raising than their counterparts in states with a strong anti-abortion sentiment, rising health care costs and the lingering effects of the pandemic have taken a financial toll on all clinics. Planned Parenthood of Greater New York — one of the few places where abortion is still legal up to 24 weeks — said that a budget shortfall would force it to restrict later-term abortion services, effectively implementing a 20-week abortion ban. (All emphasis added)

Planned Parenthood of Northern California made a hard funding choice “last March when it ended a prenatal care program that served 200 to 250 low-income women a month. And Planned Parenthood of Northern New England expects to run an $8 million deficit over the next three years.

While affiliates in more liberal states like New York and California have had an easier time fund-raising financial toll on all clinics. Planned Parenthood of Greater New York — one of the few places where abortion is still legal up to 24 weeks — said that a budget shortfall would force it to restrict later term abortion services, effectively implementing a 20-week abortion ban.

Planned Parenthood of Northern California made a hard funding choice last March when it ended a prenatal care program that served 200 to 250 low-income women a month. And Planned Parenthood of Northern New England expects to run an $8 million deficit over the next three years.” (All emphasis added)

Patients have felt the effects

“Patients and employees said that clinics are operating like “ a conveyor belt” for patients, leading to botched IUD placements and abortions, patients prepped for the wrong procedures, and other errors, according to legal filings, complaints and interviews. (All emphasis added)

Planned Parenthood has been accused of improperly implanting a birth control device and causing nerve damage; inserting an IUD in a woman who was four months pregnant, and failing to upload sexually transmitted infection test results into charts, leading patients to wrongly believe that their results were negative.”

Employees are feeling the pressure

Employees said there has been constant pressure to more than double the number of patients seen from the present 2.1 million, to help bring in more revenues, with management asking staff to see more than four patients an hour. That is in line with a trend in health care, widely unpopular with both patients and doctors, to keep primary care visits to about 15 minutes. But clinic staff members said that they needed more than 10 to 15 minutes to care for patients who often face literacy and language barriers or face social ills like housing insecurity, abuse and poverty.

Staff members who have decried the conditions are beginning to unionize to push back on demands that they say undermine Planned Parenthood’s mission.”

CONCLUSION

Although abortion is supposed to be only about a woman’s right to choose, the repercussions for all involved are devastating. Abortion is not the answer and we all need to offer help and support to desperate women and their families.

Trump Pardons 23 Pro-Life Activists the Day before the March for Life

In a January 23, 2025 article in the New York Post titled “Trump pardons ‘peaceful’ pro-lifers imprisoned for protesting outside abortion clinics” states:

” President Trump pardoned nearly two dozen pro-life activists Thursday who were convicted under a federal law of illegally trying to block abortion clinic entrances or otherwise keep women from undergoing the procedure.

The pardons, Trump said in the Oval Office, will go to 23 “peaceful protestors” who were prosecuted under the Biden administration. He did not reveal the names of those who will be pardoned. 

“Twenty-three people were prosecuted who should not have been prosecuted. Many of them are elderly people. They should not have been prosecuted,” the president said. “This is a great honor to sign this.”

The Freedom of Access to Clinic Entrances (FACE) Act, enacted in 1994 by former President Bill Clinton, prohibits use of physical force, threat of physical force, or physical obstruction to injure, intimidate or otherwise interfere with “any class of persons [in] obtaining or providing reproductive health services.”

The law also has the same stipulations allowing free access to places of worship — but conservatives say Democratic administrations have been more interested in prosecuting abortion clinic obstruction.”

MY FIRST TIME AT AN ABORTION CLINIC

I was a new nurse when Roe v Wade legalized abortion.

I was shocked and saddened while my other medical colleagues thought this was great.

“What would you do if you found out you were pregnant?”, they asked.
I told them I would have the baby and consider adoption. They thought that was crazy.

I later joined the St. Lous Archdiocese Pro-Life Commitee, the first in the US, and donated items to the Birthright organization that offers “free, confidential resources to any woman regardless of age, race, circumstances, religion, marital status or financial situation.”

In 1987, I was invited to join a group holding signs outside the Planned Parenthood Clinic in St. Louis offering information and help to the women entering. I was nervous walking with my then 2-year-old daughter but there were strict rules about staying on the sidewalk and I was relieved to see the signs with phone numbers and offers to help the women entering the clinic.

But suddenly my 2-year-old daughter dropped my hand and ran to play on the grass in front of the clinic. I panicked, picking her up and running to the sidewalk. I had heard that we could be arrested. Luckily, we weren’t.

CONCLUSION

I am glad President Trump pardoned those peaceful pro-life people but being pro-life is about more than picketing.

Every pro-life person I know is also a person who reaches out to anyone in need.

I know I have been blessed by helping single moms in difficult circumstances, families caring for children with disabilities, people considering suicide, women regretting their abortion, older people facing their impending death, and others.

Being pro-life is not just about ending the horror of legalized abortion but rather about cherishing and caring for all lives!

That is why I am so proud of the National Association of Pro-life Nurses’ button that simply says “I care”.

Hawaii Doctor Investigated for Assisted Suicide Murder

A January 8, 2025 news article in the Hawaii Free Press titled “Hawaii Doctor under Investigation for Murder in Woman’s Assisted Suicide Death” reveals that authorities are investigating a doctor for murder after police say he administered assisted suicide drugs to a woman.

Under Hawaii’s assisted suicide law passed in 2018, patients who have been approved for “assisted death” are required to self-administer the lethal dose of drugs.

The newspaper states:

“In this case, the 73-year-old doctor allegedly broke the law and assisted his 88-year-old patient in taking the lethal medication on October 9, 2024. According to the police report, at one point the woman was starting to choke and motioned for the doctor to stop — but he continued, causing her death. After an autopsy, the Medical Examiner’s Office ruled the death a homicide. According to Island News, the doctor is being investigated for second-degree murder, but as of yet no charges have been filed.” (All emphasis added)

In his January 4, 2025 Medical Futility blog titled “MAID Noncompliance Leads to Murder Investigation, assisted suicide supporter Thaddeus Pope, JD.Phd. states:

“All U.S. MAID laws require that the patient self-administer the medications (typically DDMA-Ph). When someone else administers the medications, that is not MAID. Instead, that is assisted suicide which remains criminally prohibited in all U.S. jurisdictions including those that permit MAID. ” (Emphasis added)

CONCLUSION

report released in February 2024 showed that 166 people had died by assisted suicide in Hawaii since its legalization in 2018. According to KTVZ, this is the first homicide investigation related to the OCOCA.

Suicide- medically assisted or not- is never a death with dignity for anyone!

Vindication: The Great Barrington Declaration

President-elect Donald Trump has just nominated Dr. Jay Bhattacharya, a Stanford professor and an outspoken critic of Covid lockdowns as well as the co-author of The Great Barrington Declaration, to head the National Institutes of Health. I am delighted, especially since I wrote a March 2021 blog titled “Is it possible that there is a light at the end of the Covid tunnel?”

Here are some excerpts from my 2021 blog:

“My husband and I just returned from a trip to Florida where we were happily surprised to find the closest place to normal since the Covid 19 pandemic started. Everyone wore masks (except one young man we saw at a distance) and everyone was careful about social distancing. Hand sanitizers were everywhere.

Best of all, people seemed happy and we saw very few stores closed.

When we returned home, we both finally received the first of our 2 Covid 19 vaccination doses.

IS FLORIDA A HARBINGER OF GOOD NEWS?

Florida was among the last states to go into lockdown and one of the first states to ease restrictions.Florida’s Governor Ron DeSantis was vilified by many in the media for adopting something similar to Sweden’s strategy of protecting the vulnerable while keeping businesses and schools open but a year after the pandemic hit the US, that strategy seems to be working.

Despite having the second largest number of elderly people by state, Florida’s Covid death rate numbers are better than New York’s and California’s. And, unlike so many other states, Florida’s economy is thriving.

Now, Governor Abbott of Texas and Governor Reeves of Mississippi have announced that they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates.”

WHAT HAPPENED?

It has been almost a year since the U.S. went on lockdown for Covid 19 when President Trump declared Covid 19 a national emergency on March 13, 2020.

At first, the lockdown was only supposed to be for a few weeks to “flatten the curve” of infections and prevent hospitals from being overwhelmed by Covid patients.

However, as the lockdowns wore on for months, some doctors and other experts started warning about the emotional and health damage occurring.

Although it received little media notice, a May 19, 2020 letter titled “600 Physicians Say Lockdowns Are A ‘Mass Casualty Incident’” was sent to President Trump that detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non-COVID patients. 

The doctors’ letter also stated that: “Keeping schools and universities closed is incalculably detrimental for children, teenager and young adults for decades to come.”

Then on October 4, 2020, the Great Barrington Declaration was written and released and eventually signed by thousands of doctors and experts from around the world. The Declaration encouraged governments to lift lockdown restrictions on young and healthy people while focusing protection measures on the elderly, stating:

“Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. “

CONCLUSION

Now it is 4 years since the Covid pandemic started and we can see that Dr. Jay Bhattacharya and the other medical and public health scientists, medical practitioners, etc. who signed the Great Barrington Declaration were right, despite all the criticism from the media and others.

I personally hope that Dr. Jay Bhattacharya is confirmed as head of the National Institutes of Health.

One In Four Brain Injury Patients Who Appear Unresponsive Respond Covertly

Back in May, I wrote the blog “New Study: Brain-injured patients who died after life support ended may have recovered” about a 7 1/2 year study of 1392 traumatic brain injury patients in ICU at 18 US trauma centers.

The researchers designed a mathematical model to calculate the likelihood that life-sustaining treatment would be discontinued “based on demographic, socioeconomic factor and injury characteristics” and then “paired patients continuing on life-sustaining treatment to individuals with similar moded scores but for whom life-sustaining treatment was stopped.”

They found that of the survivors who did not have life-sustaining treatment withdrawn, “more than 40% recovered at least some independence.” (Emphasis added)

This led one researcher to conclude that:

““Predicting who will recover following severe traumatic brain injury, and to what degree, can be challenging. Yet, families are often asked to make decisions about continuing or withdrawing life support, such as mechanical breathing, within just 72 hours of the injury,” Bodien said.

“This decision is based largely on whether the clinical team believes that recovery is possible,” she added. “It is unknown whether some people who died because life support was discontinued could have survived and recovered had life support been continued.” (All emphasis added)

NEW STUDY

Now a newer study, published in August, states that one in Four Brain Injury Patients Who Appear Unresponsive Respond Covertly | MedPage Today, finding that functional MRI and EEG tests can detect awareness in coma or vegetative states.

The authors explain that:

“Cognitive-motor dissociation — a phenomenon that occurs when patients who appear unresponsive perform cognitive tasks that can be detected on functional MRI (fMRI) or electroencephalography (EEG) — occurred in one in four people with severe brain injury, a prospective cohort study found.”

The study evaluated 241 unresponsive patients with brain injury who were given verbal commands, such as to imagine playing tennis or opening and closing their hands.

Of these, 60 patients (25%) repeatedly showed brain activation on fMRI or EEG indicating they were covertly following instructions, reported Nicholas Schiff, MD, of Weill Cornell Medicine in New York City, and co-authors in the 

Cognitive-motor dissociation was associated with younger age, longer time since injury, and brain trauma as an etiologic factor. In total, 11 patients with cognitive-motor dissociation were assessed with fMRI only, 13 were assessed with EEG only, and 36 with both techniques.

“This research shows that a substantial fraction of apparently unresponsive, severely brain-injured persons are aware and can engage in sustained cognitive activity,” Schiff told MedPage Today. These findings importantly point to the need to establish infrastructure to evaluate patients and to begin efforts to test possible therapies to help them.” (All emphasis added)

CONCLUSION

I have worked with brain-injured patients for decades both as a nurse and as a volunteer and I personally saw many amazing recoveries or improvements despite dire predictions and/or recommendations of life support removal.

One of the most amazing cases was a woman with disabilities whose husband wanted to remove life support as the doctors recommended.

As she personally told me, she frantically tried to move her hands to protest but her gestures were seen as seizures and she was given sedatives.

She persisted until finally, one nurse said she might be trying to tell us something and gave her a paper and pencil.

The patient wrote d-i-v-o-r-c-e.

She not only lived but became active in the disability community fighting assisted suicide!