Need to vent a little

[Guest]

I think you're missing something here....I said that given his prior medical history AND the insult he suffered, there is little chance in him surviving. If this were a 80 year old with end stage Alzheimer's who coded we wouldn't be having this debate, despite a similar baseline level of mental function and similar likelihood to live for a long period of time. What is it with the warm and fuzzy feeling that so many people have for the mentally retarded? It's a medical condition just like anything else that destroys or prevents the capacity to function like the rest of us, so I don't understand the disparate opinions.

I think in all I am more in line with your thoughts, yes while it may be unfortunate that this pt didn't make it whether due to his handicap or due to the Doc, it is not up to us to decide. We are here to give greater comfort in transit to definitive care, sometimes you comfort the pt or in this case you would comfort the family also, we are not here to judge who should live and who should die just hope that it isn't us that cause this.

[THE_DITCH_DOCTOR]

uh oh

mental and physical ailments are two totally different ballgames buddy, unless physical ailments result from the underlying mental impairment. My sister has cerebral palsy and lives in a home, but she has a productive and very happy life (as productive as you can have without the ability to fully function in the outside world)

Down's is a condition with both mental and physical manifestations SHP, as I'm sure you're aware. It's still a long term illness and it will negatively affect the outcome. That's what I'm saying.

[shorthairedpunk]

"What is it with the warm and fuzzy feeling that so many people have for the mentally retarded?"

I take it you dont have any kids either?

[Guest]

Now not to be a wise ass and ruin Shorthairedpunks run at picking a fight but if I remember right Dr's have a ton more schooling to go through than myself as an EMTB and even EMTI's and P's for that matter. Is it possible that this Doc may have learned something about head trauma with downs that we may not be taking into account????

[shorthairedpunk]

not tryin to pick a fight, but you n yer buddy can try to provoke one if you want

[Guest]

not my buddy.....just the one of the two of you that seems to post with common cents....may be new around here but I can associate names and posts pretty darn good

[THE_DITCH_DOCTOR]

As a matter of fact SHP, I'll be a dad as of September. If my son or daughter were born handicapped and then placed in this situation, I'd be the first to say pull the tube and let them go. It has nothing to do with being a parent or not, it has everything to do with being a realist.

Perfect example: My cousin Tomi is mentally retarded due to hypoxic brain injury as a result of seizures, and I know that if she coded her chances of recovery are next to nil because she's already starting out at a serious, serious disadvantage. So if the chances of survival in a healthy person are in the single digits, or low teens even under the best of circumstances, then what are her chances? Probably zero. That knowledge would affect my decisions for her care (and I know my grandmother, who is Tomi's caregiver, would turn to me for advice and guidance if something happened to her) more than my love for Tomi would, because I know with almost guaranteed certainty that whatever the outcome, she won't be the cousin I grew up with and came to love very dearly.

It's not that I don't believe the mentally retarded don't deserve good care- quite the opposite- I was just openly wondering why people seem to be so hostile to the realization of the levels of medical complications that come along with these conditions. Down's and other congenital disorders are no different than other diseases and disorders, except perhaps in their cruelty- they strike at a time of what should be great joy and they only bring great sadness.

You're not going to pick a fight, because there is no fight to pick.

[Richard B the EMT]

What follows is from a received E-mail from Sara B, the EMT's Mom. She is a retired NYC Board of Education teacher, who worked with "special needs" students, including Down's Syndrome kids. I had asked her to look at the string and comment.

Now, her comments:

In reference to that article about the Down's Syndrome patient: Since when is Down's Syndrome an incurable illness as one corespondent said? You know how important to their lives (name of student removed for patient confidentiality by Richard B, the EMT) is and has been for almost thirty years. How dare a hospital decide not to "waste" resources on a patient. Some of the issues mentioned in the responses may be different for this type of patient since advanced directives and health proxy may not be possible unless the patient is very high functioning. If the patient is a minor, the parents decision counts, otherwise it is the state that decides. Nowhere in this discussion did I see any mention of a court or other state official taking part in the decision. Did you have the same reaction?

Yes, I did. By the way, we are referring to this as under New York State and City policies.

[THE_DITCH_DOCTOR]

I guess I just see the exceedingly dismal chances of this patient having any recovery, and a few people don't. I also

I would also like to put out that I am correct in saying that it is an incurable condition- last time I check there was no drug, no procedure, no therapy that could erase the genetic error that underlies this syndrome. The symptoms are somewhat treatable to varying degrees- although ameliorating would be a better way to describe what can be done for these patients. We shouldn't delude ourselves by believing that amelioration equals a cure. It doesn't, and even amelioration is a pipe dream in many developmentally disabled kids.

It's not that I think they should all be rounded up and summarily executed- I don't think that, never have and I wouldn't question the sanity and humanity of anyone who believes that such a course of action is proper and appropriate. It is that I believe that Down's patients should not be treated any differently than those with any other long term debilitating illness. If this patient had end-stage Alzheimer's or was schizophrenic (using examples of conditions that mess with people's cognitive ability and ability to function), no one would have batted an eye to pull the plug following a closed head injury sufficient to cause cardiac arrest. The only reason this discussion is going on is because of the mental images we all possess of what a few of these DS patients can achieve, we feel for them, we empathize, we want to see them succeed. We should check our feelings at the door in cases like this and make decisions based upon what we know about the pathophysiology of cardiac arrest related insults to the brain and long term disease.

Sure a special education teacher knows Down's kids very well, but this isn't a normal case- this patient suffered a hypoxic brain insult on top of the effects of the Down's. Perhaps asking a neurologist would be a better choice.

[iMac]

Waw that would have been a screwy call. Not sure I would have wanted to be around for that one. I would hope that the pt's Down Syndrome was not the reasoning behind pulling the tube.