Monday, June 20, 2005

Schiavo Autopsy Far From Open & Shut

So says Dr. William Hammesfahr, nominated for a Nobel Prize for his work in medicine and recognized by agents for Medicare, the federal government, and others for new approaches to helping the brain injured:

We have seen a lot on the autopsy of Terri Schindler Schiavo in recent days, that I feel needs to be addressed. To ignore these comments will allow future 'Terri Schiavo's' to die needlessly after the wishes of clinicians and family are ignored.

Considering that there were so many physicians and therapists who were willing to step forward to treat Terri Schiavo, from university based practitioners to those in private practice, it clearly shows that the mainstream medical community across the board, those involved in treating patients, knew that they could help Terri.

The record must be set straight. As we noted in the press, there was no heart attack, or evident reason for this to have happened (and certainly not of Terri's making).

Unlike the constant drumbeat from the husband, his attorneys, and his doctors, the brain tissue was not dissolved, with a head of just spinal fluid. In fact, large areas were "relatively preserved."

The purpose of the therapies offered by so many, from major universities, brain injury centers, and from private practice physicians, is to improve and restore quality of life, and function, which the mainstream medical community clearly tried to get to her.

I have had a chance to look at Dr. Nelson's analysis of the brain tissue, and essentially, as a clinician, these are my thoughts.

The autopsy results confirmed my opinion and Dr. Maxfield's opinions, that the frontal areas of the brains, the areas that deal with awareness and cognition were relatively intact. To use Dr. Nelson's words, "relatively preserved." In fact, the relay areas from the frontal and front temporal regions of the brain, to the spinal cord and the brain stem, by way of the basal ganglia, were preserved, thus the evident responses which she was able to express to her family and to the clinicians seeing her or viewing her videotape. The Spect scan confirmed these areas were functional and not scar tissue, and that was apparently also confirmed on Dr. Nelson's review of the slides. Dr. Maxfield's estimates of retained brain weight were apparently accurate, although there may have been some loss of brain weight due to the last two weeks of

Dr. Maxfield and myself both emphasized that she was a woman trapped in her body, similar to a child with cerebral palsy, and that was borne out by the autopsy, showing greater injury in the motor and visual centers of the brain. Obviously, the pathologists comments that she could not see were not borne out by reality, and thus his assessment must represent sampling error. The videotapes clearly showed her seeing, and even Dr. Cranford, for the husband, commented to her that, when she could see the balloon, she could follow it with her eyes as per his request.

That she could not swallow was obviously not borne out by the reality that she was swallowing her saliva, about 1.5 liters per day of liquid, and the clinical swallowing tests done by Dr. Young and Dr. Carpenter. Thus, there appears to be some limitations to the clinical accuracy of an autopsy in evaluating function.

With respect to the issue of trauma, that certainly does not appear to be answered adequately. Some of the types of trauma that are suspected were not adequately evaluated in this assessment. Interestingly, both myself and at least one neurologist for the husband testified to the presence of neck injuries. The issue of a forensic evaluation for trauma, is highly specialized. Hence the wish of the family to have observers which was refused by the examiner.

Ultimately, based on the clinical evidence and the autopsy results, an aware woman was killed.

Amazing how different the results can be when personal and/or ideological malevolence is not involved.

I'd ask people like E.J. Dionne where their apologies are, but unlike them I'm not brain-impaired enough to believe any will be forthcoming.