Attention: Alex Schadenberg
It’s good to hear that something gave today. I’ve just read the article, and there are points I am interested in:
They did initially intubate him and put him on a respirator, until he was breathing on his own, right?
The next point is, since he has gone since August 17th without hydration and nutrients, and is only being fed by mouth, make sure the nurse consults with a "nutritionist". A nutritionist is not just a dietician. A nutritionist is the scientist of nutrition.
I’m surprised at how ignorant and uneducated most nurses and even average doctors are about nutrition. Everybody knows basic fundamentals about diet and nutrition, but nutritionists need to tailor intake of nutrients and water according to the medical status of the patient.
In the state he probably is in right now, he probably will need a certain prescribed measurement of sodium in his water and soup broths. She will also need to maintain his balance of protein and carbohydrates, until he is able to eat regualar meals.
Somewhere in one of my blogs, I’m sure I posted what happened to me in two hospital ICU’s in May-June 2008. It was an event which turned a simple intubation to have a stone removed from my urinary bladder, into a five week nightmare where the anaesthesiologist had to trache me. Then I was on waiting-lists for the next opening in the OR to do the lazer-surgery. An anaesthesist rejected me due to a leaking trache, and warned doctors that it would probably kill me in surgery.
An RT (respiratory-technician) argued with me, accusing me of fighting the ventilator which was causing my respiratory rate to be too high. I tried to educate the stupid loser, that I wasn’t fighting or forcing anything, but the program running the ventilator had a glitch in the code. Between the program not programmed with unpredictable variables, the computer was generating many unpredictable responses, for which they blamed me.
This earned me a bad reputation with the RVH (Roayl-Victoria Hospital) ICU. Fianally, I think a respirologist got it through their thick, under-educated skulls!
One day, a doctor explained that blood-tests showed that I was potassium and magnesium deficient. He ordered IV infusions. Days were going by, and they never installed a nasal feeding-tube. At one point, I felt so overloaded in my chest with the potassium IV, that I asked for the doctor. The nurse refused. He wouldn’t bend an inch, and would just get mad and check my blood-pressure and saturation. The first time, my blood-pressure was 168/ninety-something. When I pointed to the monitor, he slammed it into the wall, and stomped out to get the doctor. He stopped the potassium, and had to load me with lazex to unload the water-retention.
Initially, I was getting too much water in my IV-line, and asked to doctor to decrease it. He asked what I felt I needed, and I didn’t really know what the rate would be. I miscalculated, and requested too little. Until they kicked me out of the ICU there, they refused to call the doctor to readjust the flow-rate of water.
The next day was the magnesium IV. Two or three hours later, I had a repeat of the same problem as with the potassium. I couldn’t breathe hardly, but the nurse demanded that it was his call, not mine, when to call the doctor. I yelled at that guy, that if I have a heart-attack you eat this-dude!–You are the one who murdered me, not the doctor.–Just because you are embarrassed that you might call a doctor, and it turns out to not be an emergency!
Again, he stomped around the room, and checked my vital-signs. By this time, other nurses ran into the room over the war of words between him and me. The monitor showed my blood-pressure 203/163. He kicked the monitor into the wall, and nearly smashed it. When the doctor came, he shut-down the IV, and loaded me with lazex again. A few hours later, I needed more lazex.–And that earned me another verbal blast from the nurse, that I was damaging my own kidneys. After that I was alright, except for the lack of water.
They kicked me out of the hospital after I passed-out one day, when they were changing my diaper. Throughout this event I requested using diapers, because I’ve been recovering from a respiratory-failure in 2006. They thought they were teaching me a lesson by pushing me into positions which were driving my trache into the side-rail of the bed. I pointed to them to look at where my trache was, at which point two nurses rammed me into the bed-rail.
I woke up being bagged, and an RT using drugs in my trache to get me breathing. Later, they sent me by ambulance with a nurse, a civilized nurse, to this ICU. Within the first fifteen minutes, the acting-head-nurse fired away all kinds of accusations.–And blah-blah-blah! That evening my enemies did a repeat diaper-change as at the RVH earlier that day. Again I passed-out, and woke up being bagged to get me breathing again. After that, a doctor came stomping in there after reading their reports about how abusive I was, to such hard working care-givers!
The day before getting kicked-out of the RVH, they installed a feeding-tube. Here, ICU doctors in charge rotate every three weeks. At one point, I asked the nutritionist if I could try a higher-calorie, high-protein food so I could recover faster. I wanted to gain weight I’d lost, and the nutritionist explained that I needed to follow instructions with this high-calorie high-protein formula.
With the original formula, nutiritionists always added a specific amount of whey-powder to equal the right amount of protein. With the switch in my feeding-tube things would have been alright. However, when I was so full I had to stop the feed, when I needed water, I was only allowed water two hours after the meal. This was the evening shift. An hour later, I needed more water in my tube, and the nurse refused. I asked another nurse, and she said the decision was my nurse’s decision. By late that evening, I asked to see the evening doctor.
Evenually, after all the arguments I had with ICU staff, somebody explained that anything I get in the ICU has to have a doctor’s order. The evening-shift doctor refused to write an order, and the only order the nutritionist and doctor wrote into my file with the new formula, was water two hours after meals. Trying to talk logic and reason with these people in the medical system, is impossible.
By the night-shift, I knew better than get into bed, because I would have stopped breathing. I had to fight harder to breathe, and my leaking trache was sounding the alarm.–But, it was the only way I could talk, through the leak in my trache! I asked the nurse to check my sugar, because I realized that it was very high. He refused, because it was not ordered.–And I’m not diabetic!
When I started spitting blood, I asked him to get the doctor.–But he refused to wake him up! When I told him I’m not on water restrictions, the nurse just laughed, and went about his business. Just as the day-shift was arriving, I saw the house-keeper (a friend of mine) who quietly placed some water where I managed to reach it. A few minutes later the bleeding slowed down. By morning it was coming from my stomach and my lungs, and when the doctor and nutritionist saw me, they switched me back to the original formula.
When they were writing the order, they didn’t include the whey-powder.–And both of them insisted that the bottle of food was equally balanced, and they are wrong! The fact that I went into the RVH in May weighing 63 lbs., and went down to 50lbs. three weeks later proved my point. Skin was starting to peel off my arms, hands and legs. After I got rid of the stone in my bladder, I was so weak that I asked to not remove the trache until I could recover.
The next doctor who took over the ICU, is somebody who knows all about da-BadBoy!–But she is really a veteran doctor who knows her stuff! She agreed to change my orders and give me a couple of days whey-protein in the tube, and explained that getting rid of the trache would make it easier for me to breathe again without it. Two days later, I was able to check-out and get up here to long-term.
Alex, I’m sorry that some of my rants are so long, but the point I’m leading to in Joshua’s case is that he will need protein and the carbohydrates and fat in his diet, to absorb the gas. IV-fluid bags are equally balanced with necessary electrolites, but not just regular tap-water, bottled-water or so-called spring-water. So, the nurse might consult with a qualified nutritionist–not dietician or dietechnician! Only a nutritionist can make sure he gets enough sodium (and not too much), so his digestive-system is able to digest food properly.
Two of the nurses in the ICU downstairs who gave me the hardest time in 2008, are gone. There are a few decent nurses in every ICU and acute-care wards, but some of them are druggies and behave like gang members.
Personally, I’ve always found that doctors at the hospital ICU’s I ever landed in, to be very fair doctors. It’s the dept. of nursing where I’ve personally witnessed and experienced the most rotten attitudes. The head-nurses many times are very good people, but have a hard time believing some of the accusations against their nurses and nurse-assistants.
At the hospital in Brampton, however, and in Samuel Golobochuk’s case, the doctors really had an agenda.–Now the Quebec GP’s!
On Fri, Aug 27, 2010 at 6:29 PM, Alex Schadenberg <email@example.com>
Thank you to everyone who has done something to help Pastor Joshua (Kulendran Mayandy). If you have not followed the story closely, the article that was printed in the Brampton Guardian is included with this email.
After meetings yesteday with our legal counsel, several doctors and a lawyer from the Christian Legal Fellowship, a major breakthrough happened today. The court appointed Substitute Decision Maker (SDM) has given permission for a nurse, who is a member of the Church, to feed Joshua orally.
Today Joshua was fed orally and I was told it went very well.
We thank the SDM for this wise decision but we remain cautious. This is incredible news but we recognize that an opposite decision may be made at any time.
The decision on August 13, 2010 by the Consent and Capacity Board stated:
"If the attending physician determines that his condition sufficiently improves to the point that aggressive care becomes appropriate, and proposes such treatments, nothing precludes (the SDM) from consenting to same."
Now that Joshua has proven that he is capable of swallowing while being orally fed, how can anyone deny him this basic necessity of life?
The final hope is that Joshua will get the opportunity to recover. Today I received an article by email describing how a man in the UK has totally recovered from a massive stroke. I have no idea whether Joshua could recover to that point, but I think he should be given the chance.
Euthanasia Prevention Coalition
This is the story that appeared in the Brampton Guardian today:
Pastor centre of Euthanasia battle
By Peter Criscione – Brampton Guardian – August 27, 2010
The Euthanasia Prevention Coalition (EPC), a pro-life group, has launched a letter-writing campaign in a bid to stop what it says is the unjust treatment of a disabled patient at Brampton Civic Hospital.
EPC is urging residents to file letters en masse after the Consent and Capacity Board, an independent provincial tribunal whose mandate, in part, is to determine a person’s capacity to consent to or refuse medical treatment, gave a public guardian power of attorney over Kulendran (Joshua) Mayandy, a 48-year-old pastor who acquired a cognitive disability after suffering a heart attack in May.
Doctors have determined there is no hope of recovery and suggested all life-sustaining treatment be removed.
But without family members or appointed legal guardian in Canada, the Consent and Capacity Board placed the fate of the Sri Lankan native, a Pentecostal pastor at Humberlea Worship Centre in Etobicoke, in the hands of a Substitute Decision Maker (SDM).
This SDM, in turn, agreed with authorities that no special efforts should be made to prolong Mayandy’s life and on Aug. 17 gave doctors at Brampton the go-ahead to withdraw intravenous hydration and nutrition to speed up his death.
However, EPC members have condemned the decision on the basis that it contradicts Mayandy’s Christian beliefs.
Christians are generally opposed to the idea of interfering with the natural process of death.
“Other than the fact that Joshua is cognitively disabled, he is otherwise healthy and could possibly live many years in this condition,” states Alex Schadenberg, executive director of EPC-Canada. “This is not a case when hydration and nutrition need to be withdrawn because he is actually dying and nearing death, but rather the decision appears to have been made to intentionally cause his death by withdrawing IV hydration and nutrition because he is unlikely to recover from his disability.”
“Society cannot condone intentionally dehydrating a person to death because of their disability or the potential cost of long-term care,” he said.
Hospital officials have refrained from offering up specific details on the matter, stating patient confidentially limits them on what they can disclose publicly.
However, William Osler Health System, which runs Brampton Civic Hospital stressed everyone “involved in the patient’s care is in agreement with his treatment plan.”
“The treatment plan being followed for him has been determined to be medically in the best interests of Pastor Mayandy,” reads a statement prepared by William Osler on the matter. “It was developed according to Ontario law and with the input and oversight of the patient’s Substitute Decision Maker and their lawyer, as well as the patient’s independent lawyer. The course of care is clearly described in an Order of the Ontario government’s Consent and Capacity Board.”
Mayandy’s family, who live in Sri Lanka, and his supporters here, reject that notion, Schadenberg said. “The fact that Joshua did not write down his personal wishes or assign a person to make legal and health care decisions on his behalf in these circumstances, does not negate the fact based on his religious convictions it is unlikely that he would have agreed to death by dehydration,” writes Schadenberg in a blog post at http://alexschadenberg.blogspot.com
The EPC says Mayandy, who has been living with a Brampton family for the last 10 years, was admitted to Brampton Civic after collapsing in front of the emergency department on May 29.
He was revived, but sustained a significant brain injury and fell into a coma.
He was placed in the intensive care unit (ICU) and remained there until regaining the ability to breathe on his own, at which time he was transferred to the respiratory ward— where he still remains, according to EPC.
The group says Mayandy emerged from the coma and regained some ability to communicate.
“He (Mayandy) has the ability to recognize his closest friends and respond with one-word answers and sometimes with multi-word responses. He is able to move his body and appears to be physiologically stable,” Schadenberg states.
However, if Mayandy were physiologically stable, the order issued by the consent board states the attending physician must feed and hydrate Mayandy in the event he makes "a capable request for food or water."
Schadenberg told to The Guardian that EPC has consulted lawyers and is considering legal action. In the meantime, the EPC is encouraging people to send in letters to William Osler to express disapproval.