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bnuckols

Conservative Christian Family Doctor, promoting conservative news and views. (Hot Air under the right wing!)
bnuckols has written 1097 posts for WingRight

Interview with Dr. Immanuel

14 minute interview with Houston TV reporter.

She’s a warrior, all right! Worth your time!

I would like to see some data, but lots of other doctors report the same results, and I’d like to see some of their patient information, too. (Ages, other meds, vitals, timing, symptoms.)
She does say wear a mask if you can’t be on prophylaxis and to make other people comfortable. I would call her regimen a “treatment” rather than a “cure.”

But the biggest fuss has been about Dr. Immanuel’s religious beliefs. I’ve heard Baptist, Assembly of God, even Church of Christ preachers say much the same about the hidden powers in the world. Maybe not the origins, but their existence and, as Jesus Himself said, the need for prayer and fasting to deal with them.

I’ve been told that her religious views are a distraction and counter-productive for the Medical issues and “science.” But Dr. Immanuel doesn’t even bring up her religion until she’s questioned in this interview and didn’t bring it up at all in DC.

The detractors don’t understand the cultural background and how many Christians – across the spectrum from those who believe in the indwelling of the Holy Spirit to those who only remember the story of St. Michael – will recognize the theme.

Dr. Stella Immanuel and political eugenics

Were you triggered by the religious views of Nigerian born and trained, Texas licensed and practicing, Dr. Stella Immanuel?

Not only is she a passionate, powerful, and persuasive speaker and a professional black woman who committed the sin of going against the grain on an unreasonably politicized medical treatment. Worse: she was praised by President Trump. So, she had to be put under the political microscope.
There was a video of a press conference held on the steps of the Supreme Court in Washington, DC by a group called “Front Line Doctors.” The group spoke in favor of Hydroxychloroquine therapy for treatment of COVID-19 an included a Congressman from North Carolina and 15 to 20 doctors. Virtually all of the various online video tech hosts keep censoring the video, removing it almost as soon as it’s posted.
After reading about the censorship of the video, I was able to access a site and watch about 10 minutes before called away from my phone. When I came back, the video had been removed.
The five docs I originally heard (& possibly the 10 to others who were lost to censorship) spoke about their experience and preferences for treatment. Were any of the other docs the object of deep background scrutiny?
I disagree with some of the claims made in the video, especially the use of the word “cure” (rather than treatment) and with the opposition to the routine use of face masks to decrease exposure and viral load.

Dr. Immanuel only talked about her clinical experience. She spoke about successfully treating patients with Hydroxychloroquine for malaria in Nigeria and, along with zinc and Zithromax (azythromycin), as treatment for COVID-19 in her practice in Texas.
Ignoring the fact that the WHO resumed trials of Hydroxychloroquine June 3, the policy that masks were not helpful was promoted by both the WHO and CDC just a couple of months ago. Are the old documents from these organizations being removed from servers?
From what I understand, Dr. Immanuel is a preacher in addition to being a doctor. The things I’ve read about her sermons seem bizarre to me, but they remind me of a certain Chicago minister who had a few bizarre beliefs about HIV/AIDS, the US, and roosting chickens.
Nigeria has a different folklore tradition than mine in Texas; with a background of animalism and spirits, instead of our Greek mythology and Judeo-Christian history.
Cultural explanations and practices for disease have evolved, but traditions and habits persist: in the West, we knock on wood or throw salt over our left shoulder to chase off the “evil humours” that were the explanation for something that couldn’t be seen before microscopes.

I trained in South Texas, where I learned to ask about and counsel on the curanduras’ advice and practices. Curanduras still tell mamas to put pennies on baby’s umbilical cord to ensure an “innie”belly button and to place raw eggs under the bed to draw away sickness. Never was able to do as well with devotees of homeopathy & “adjustments” for asthma and “subluxation” or the irrational opposition to vaccinations.
I’ve had my medical and political credibility questioned because I’m a Christian. In contrast, I try to be respectful of people of different ideologies, evaluating their actual knowledge of science and practice of medicine, no matter what I think about their religion.
Would the theories of the origins of disease have been familiar to people from Dr. Immanuel’s culture? More importantly, does she understand and practice medicine according to the germ theory and current science?

There are no PROVEN therapies for COVID-19! Hydroxychloroquine/zinc/azithromycin is no more “unproven” than any other. It’s “unproven” that HCQ is unsafe.

(As of Midnight, 30 July, the video was available at https://www.bitchute.com/video/09K3kIwzeewO/?fbclid=IwAnR2E-LChNhpqOktcV4GPeT0ZS79cdf1tjdlnfNSlpGNWMCW6vVYYnHLCbjU so I was able to watch the rest of the docs.I am impressed especially by Dr. Joseph Ladapo, beginning at minute 33.)

A real class act

CNN has an opinion piece disguised as a report on yesterday’s “hearing” with Attorney General William Barr. Even as the author, Jerry Herb, repeatedly declared statements by Barr and President Trump as “false,” he took note of the poor treatment of Barr by the Democrats.

“Jerry Nadler of New York and the panel’s Democrats did not offer Barr any niceties congressional witnesses typically receive. Democrats repeatedly cut off Barr’s responses, accused him of being wrong or lying and made clear they weren’t interested in the explanations he was offering. Barr wasn’t allowed extra time at the end of each lawmaker’s five minutes to respond to questions that witnesses typically receive — forcing Republicans to use their time to let Barr push back on the Democratic accusations.”

Indeed, rather than a ” hearing” to learn from General Barr, the Democrats made sure *they* were heard. One after the other ranted angrily and refused to allow the General to speak, much less respond to any questions. All too often, the Dem shouted, “I’m reclaiming my time!”

(“I’m reclaiming my time!” “I’m reclaiming my time!” “I’m reclaiming my time!” It started sounding like one of the rioter’s chants.)

There were few questions with an opportunity to answer, only
character attacks and accusations that the AG is guilty of politics and doing the bidding of the President. (Wingman?)

More than once AG Barr was accused of racism and causing people to die. One man flatly declared that the Attorney General of the United States was guilty of breaking his oath of office. And, of course, there were threats of impeachment.

Cedric Richmond from Louisiana ironically gave us a great example of racism by noting that when the AG came to his office, he didn’t have a black staffer.

Is there supposed to be a “quota?” Isn’t hiring according to race the definition of “racism?”

I kept waiting for someone to have a stroke – not the AG, he was usually amazingly cool and calm.

(Or spontaneously combust?)

Bizarrely, toward the end of the day, Nadler committed the most egregious act by harshly refusing AG Barr’s request for a 5 minute break.
The meeting began an hour past schedule: Nadler was late because he had an automobile accident on the way to the Capitol. He then jumped into a hostile rant about Barr, skipping the Chairman’s routine notification that the witness could request such breaks as needed.
Throughout the day, the Representatives had, as is customary, individually left the hearing room, coming and going at will. The Attorney General, however, sat for over 5 hours with only three (3) 5-10 minute breaks. There was no lunch break and no scheduled recesses.
The only reason to breech the usual House protocol – not to mention common courtesy – in such a way would be to force the 70 year old witness to ask repeatedly before being excused.
The Democrat members of the House “Justice” Committee could have acheived the grandstanding they apparently craved by simply holding a press conference or giving one of their “One Minute” speeches. Rather than *hearing from* the Attorney General of the United States, they shamefully went out of their way to abuse – and even humiliate him.
I agree with the General: Nadler, indeed each of his Democrat colleagues, are a “real class act.” Not.

General Barr is, however.

(This is an edited version to clear up typos.)

COVID-19 Treatment – Analysis of 65 global studies showing high effectiveness for early treatment

https://c19study.com/?fbclid=IwAR2QTfcqe3nlW81BG8rE7pgxyUMgMlcPC2J7Un3xDTT2mqsazlHTzJurpFc

39 of the studies were peer-reviewed.

Kristallnacht mobs or Gestapo? Burn, smash stores as police watch

“Police made no effort to interfere…” This is happening to Americans all over the US and multiple factions compare their opposition with the abusers of Nazi Germany.

There’s been looting and vandalism in broad daylight, and 2 months of nightly destruction of property and fires in Seattle, Washington and Portland, Oregon. (And Atlanta, Georgia, New York City, Chicago, Minneapolis, St Louis and virtually every large city in the US) This weekend in Columbus, Ohio, a peaceful rally was disrupted by obscene “Black Lives Matter” protestors, with one woman waving what looks like severed male genitals (here, at about 6:35).

Local police are being *ordered* to stand down and limit their efforts to interfere by Mayors and Governors, but when they do – or Federal law enforcement is sent in – who is criticized, even called the “Gestapo?”

House Majority Whip James Clyburn, D-S.C., compared federal law enforcement in Portland to Nazi Germany’s Gestapo police force on Monday.

Sometimes, even “Black Lives” are victims of both vandalism and assault.

The parallels with Kristallnacht are not precise, but they’re there: the rioters have unofficial approval from the same local governments that are throttling down law enforcement. Only, this time, another governing body would stop the vandalism if allowed.

The question is not whether Godwin’s law has been broken, but whether we learned anything from history in general. I’m also reminded of the chair of the French Revolution which ended when the original leaders were sent to the guillotine, and George Washington’s response to the Whiskey Rebellion with an army of Federal soldiers attacking members of the mob who were accused of harming Federal agents and burning the home of one a official.

How long will the voting public allow their elected officials to be “distracted” by the anarchy and politics?

(Edited for grammar 21/07/20 17:30. BBN)

Say her name: Jennifer Long, murder victim

Jennifer, 16 yo

All humans have the right not to be killed, except to defend life. Because I believe and defend this right, I hate the death penalty. I’m not sure that “punishment” is an ethical element of “capital punishment.” Ethicists and philosophers, as well as religious leaders, disagree about whether human life is endangered more by allowing killers to live versus execution.

This 2001 article about the 1998 kidnapping, rape, murder by stabbing, and dismemberment of 16 year old Jennifer Long takes my sympathy away.

While on parole after serving 17 years for shooting a robbery victim in the head twice, the man whose name I won’t give, killed two women, one 16 years old and the other, 80.
Jennifer’s murder was the first of at least two. Convicted and in a Kansas prison for beating 80 year old Mary Ruth Bales, a frail survivor of childhood polio, to death with a claw hammer, the murderer tried to game the prison system. He offered to trade information about an unsolved case – Jennifer and her death – for a transfer from a State to a Federal prison.
The murderer of two, attempted murderer of at least one, was executed by Federal authorities, 22 years after Jennifer and Mary died at his hands.

Laugh or cry? (Mueller, Stone, Trump)

Special Prosecutor Robert Mueller wrote an op-ed for the Washington Post condemning President Trump’s commutation of the sentence of Roger Stone.

We made every decision in Stone’s case, as in all our cases, based solely on the facts and the law and in accordance with the rule of law. The women and men who conducted these investigations and prosecutions acted with the highest integrity. Claims to the contrary are false.

Mueller must live in some alternate reality. Since we know that Mueller’s team didn’t uncover the lies used against Carter Page or Michael Flynn – and some of them actually were the ones who lied – how can anyone believe that the Stone prosecution was more honest? Why are we supposed to accept that no evidence in favor of Stone has been withheld, no accusations are known to be false?

Only after Inspector General Horowitz investigated the FBI handling of a “counter intelligence” surveillance into the Trump campaign, did we learn that the investigation into Carter Page was based on a bogus & even falsified FISA application. At least some at the FBI knew Page actually reported to the CIA & one agent stands charged with lying in the FISA application.
Only a deeper investigation by the DOJ – after the Mueller and Inspector General investigations – discovered documents revealing communication between FBI agents that had been withheld from the Michael Flynn defense team, the court, and the Senate. Texts, emails and handwritten notes indicate that Michael Flynn was set up. Even after his initial investigation was about to be closed it was reopened by Strzok, Comey, others on “the seventh floor.” Former President Obama and Vice President Biden directed at least some of the later investigation, at a January 5, 2017 meeting. Texts show the “302” report of the Flynn meeting w/Stzrok was rewritten by Stzrok & Page. It appears from defense attorney letters that Flynn was coerced into pleading guilty to protect his son from similar harassment.
Mueller missed all of this, yet we’re supposed to care about his comments about ethics or trust his investigators?

The Mueller investigation and charges and even the whole FBI surveillance of the Trump Campaign reminds me of 1995/96 when I was foreman on a Federal District Grand Jury in San Antonio during Bill Clinton’s impeachment hearings for perjury & obstruction of justice. Many times, when I swore in a witness, some jury members and even the witness would laugh. “Nothing but the truth.”
Integrity? Laugh or cry.

43% of COVID- 19 deaths linked to nursing homes

Traditional germ theory explains the deaths & spike in COVID-19 cases in the US better than any political accusations going around. But, some politicians do carry real blame, however denied:
“”You had this political conspiracy theory that the deaths in nursing homes were preventable,” said Mr. Cuomo.””

At a press conference today, New York Governor Andrew Cuomo insisted that his March order requiring NH’s to accept COVID positive patients from the hospital didn’t cause deaths – in spite of the fact that it’s estimated that those orders caused more than 6300 such transfers.

The NYTimes previously reported 43% of COVID19 deaths have been linked to nursing homes.
State NH deaths

Click to view the percentage of death in NH by State

The problem with the spread of disease has been a lack of common infection control where it counts: in the care of the most vulnerable in nursing homes (“NH” ) and hospitals, as well as the failure to protect healthcare workers who come into close contact with the vulnerable and infected — and who travel between facilities & the community.
The first reported US case led to an outbreak in a Washington State nursing home and the local hospital. It began after a traveler returned from China – while that country still denied person-to-person spread – and sought treatment at the hospital. Employees carried it between facilities and into the community.
In spite of this history, New York & New Jersey governors each ordered nursing homes to accept COVID positive patients from the hospital & the Minnesota Department of Health insisted that hospitals discharge positive patients back to NH’s that weren’t prepared. It’s estimated that 1/4 of NY NH workers contracted the disease between March and June.

NY didn’t mandate NH testing until mid-May. NJ required testing by May 26th!

The Atlantic” gives more details about the lack of anticipation about the NH risk in a July 6 article.
The cycle of poor infection control in facilities caring for the vulnerable elderly – with inadequate protection for residents, employees, & their contacts – spread the virus.

Wear a mask if you, too, are at risk or will spend time with someone who is. Wash your hands! But, please don’t politicize this disease.

SCOTUS redefines words. Again. (Say goodbye to single sex sports & spaces)

There’s a right way and a wrong way to change a law. The Constitution doesn’t provide that the Courts make the big decisions, leaving the inconsequential matters to Congress. And yet, nominally “textualist” Supreme Court Justices Gorsuch and Roberts joined with the”living document” Progressives to do it the wrong way.

Gorsuch wrote the majority opinion in Bostick v. Clayton County and got at least two points right:

  1. “When the express terms of a statute give us one answer and the extratextual considerations suggest another, it’s no contest. Only the written word is the law, and all persons are entitled to its benefit.” and,
  2. There’s no way that the 1964 Congress would have intended for the word “sex” to include sexual orientation or gender identity.

In his 37 page argument, Gorsuch stuffed and fluffed strawman after strawman to fit an extratextual interpretation of “because of …sex” into the redefinition of “sex.” As noted in the dissents by Justices Alito & Kavenaugh, his is a redefinition that wasn’t even attempted when SCOTUS redefined “marriage” in Obergefeld.

In other words, as Justice Alito wrote in his dissent, Gorsuch and the majority “legislated.”

I agree that this law needed changing to give more protection to employees in the public market place. Congress should have been encouraged to work out those protections, while also preserving religious freedoms and single-sex spaces and even women-only sports. I can’t help but wonder whether – perhaps – both political Parties took a dive, hoping the Supreme Court would do exactly what they did.

And the Country will witness lawsuits, year after year, that might have been averted.

In the meantime, though, I’ll bet Senator Chuck Schumer feels caught in a whirlwind of his own. What price, now, Chuck?

Virtue signalling

A friend just posted a definition of “virtue signalling” and asked, “Is this supposed to be a bad thing?” His definition: “the action or practice of publicly expressing opinions or sentiments intended to demonstrate one’s good character or the moral correctness of one’s position on a particular issue.” (I also found it on Google, attributed to Oxford Languages.) Well, no. It’s not supposed to be a bad thing. But in the real world, it too often is. The definition I found on Dictionary.com touches on the important distinction: the righteousness and superiority of the virtuous.
“the sharing of one’s point of view on a social or political issue, often on social media, in order to garner praise or acknowledgment of one’s righteousness from others who share that point of view, or to passively rebuke those who do not. “
Instead of “tolerance,” the virtuous demand positive affirmation of their superiority, and in fact seem (to me) to be expecting and finding offence. It’s too often weaponised, used to “cancel” previously unsuspecting people, especially on social media.

Petty lies

The Democrats and their allies in the media lie about the small things, it shouldn’t surprise us when they ruin lives by lying about the real issues.

From just one weekend, just three of the petty lies:

  1. Hitler and a Bible: even Snopes agrees that it was photoshopped.
  2. White House lights turned off because of riots: photoshopped photo from the Obama era.
  3. Tear gas ordered to facilitate a photo shoot: the Park police deny that they used tear gas.

About that tear gas, there’s proof in the photos and videos they didn’t falsify (yet?): the police aren’t wearing gas masks.

Here

And, here, where neither the horses nor the police are affected the way they would have been by tear gas.

Please leave comments at my WingRight Facebook page.

Right to Life, COVID, 16 May, 2020

The “Right to Life” means the negative right not to be killed by intentional acts. It’s not the right to force others to invest our life, liberty or property other than the duty to intervene against infringement. This is a basic negative right, not a positive right.

There’s a huge difference between personal responsibility in avoiding a risk to yourself and actively causing harm to someone else. Self-defense rather than selfish demands, using only appropriate force on others.

You know, the old “your right to swing your fist ends at my nose!” (Especially Appropriate in this case.)

*You* take the actions *you* believe are responsible. Only frequent places/businesses that require masks if you want, do the work necessary to maintain the social distancing you are comfortable with. Don’t force everyone else to do your work for you.

In-Justice “In like Flynn” (after 3 years)

This all makes me physically ill. Documents withheld for over 3 years.

Hand written note “get him to lie.”

Special ProsecuterMueller’s investigation had some of these documents. Did Horowitz?
I have said that justice died the day that Kelo was decided and Terri Schiavo was killed by medically pulling her feeding tube & threatening her mother with Sheriff’s deputies guarding her to ensure dehydration.

Then, Comey pulled his Hillary stunt and the DOJ handed out immunity like candy. Then, the Russia hoax, and impeachment with Schiff claiming ownership of interview documents.

Law enforcement forcing the elderly to sit on sand rather than beach chairs and parents arrested for playing with their own children.

Now FISA courts subverted, 66 yo’s are arrested in their homes in SWAT assaults, and this, with Flynn. The FBI leadership planned to go after Flynn, in order to prosecute or get him fired.

Then, the documents and others proving the plan were held – hidden – for over three years in spite of a judge ordering them turned over.

The real story is the lies they told, and especially the fact that they hid these documents 3 years after they were ordered by a judge to turn them over!

They didn’t appeal the judge’s rulling: they obstructed justice, hiding and denying their existence! The Sztrok/Page texts were supposedly destroyed, remember? Then some were turned over as if the complete record.

Justice is dead and the body has been repeatedly mutilated.

Edit: 509 PM AST 30/04/20 To add 2nd & 3rd to last paragraphs BBN

Test the story! (COVID-19 Fake News)

Even after all this time, bad explanations – fake news and myths – are being spread in Social media about COVID-19.
One of the more pernicious is the accusation that the hypoxia caused by COVID-19 isn’t due to pneumonia or ARDS. Oh, no, instead, there’s a “secret, ” new mechanism for the morbidity and mortality caused by COVID-19. The theory is based on the fact that one of the complications in the sickest COVID-19 patients, as well as earlier SARS1 and MERS patients, is increased coagulation that causes lots of tiny blood clots in the tiniest blood vessels in all the organs if the body. We’ve known for quite a while that viruses cause inflammation, causing the body to inappropriately produce antibodies against proteins called phospholipids. These antibodies attack the platelets and red blood cells, causing blood clots.
Last night I was referred to what my Facebook friend, a non-physician, called “one of the more detailed links” on the research. I would hate to see the others.

Right at the top of the page is this disclaimer: “”Anyone can publish on Medium per our Policies, but we don’t fact-check every story. For more info about the coronavirus, see cdc.gov.'” Good advice.

The author the blog post isn’t identified except by a pseudonym and avatar. While he does admit that he’s not a doctor, we aren’t given a real name, much less a profession or qualifications and clicking on the avatar yeilds no information. There’s not even a link or citation for the origin of the “scientific” quote upon which he bases his entire premise.
(In contrast, a quick Google search, “Coronavirus red blood cell iron,” yeilds an article,“Debunking the hemoglobin story,” by a man who not only gives his name, he also describes his credentials, a seven (7) year MD/Ph.D program in hematology. He tells us he is writing with two other, *named,* Ph.Ds. Dr. Armdahl is worth reading for more detail than I give, here.)
The pseudonymous author has a brand new explanation for the hypoxia due to COVID-19: the virus supposedly breaks iron free from the hemoglobin molecule in red blood cells (RBC), poisoning the cells so they can’t carry oxygen. That is proposed as the cause of hypoxia, low oxygen, that leads to the need for increased oxygen and ventilation, as well a being responsible for the damage to organs other than the lungs.
The first author describes the virus “attacking” the red blood cell (RBC) with a “glycoprotein ” produced by the virus. He’s apparently unaware that the RBC does not have a nucleus or the cellular apparatus to produce proteins, much less copies of viruses. That’s a dead end for that virus particle and for any virus that does work that doesn’t enable reproduction.
Further, where is the evidence that these glycoproteins exist in the blood or bone marrow (where RBCs are produced) in concentrations that are significant? Where are the measurements of these mythical glycoproteins , any free iron or the RBCs containing free iron?
Why would there be a “secret?” ***What would be the purpose of the medical community ignoring a valid explanation of the etiology for morbidity and mortality due to SARS-CoV-2? *** The hematologists would be all over this.
The pseudonymous writer isn’t happy with promoting fake physiology and function of the RBC. He also displays his ignorance of the fact that we’ve known at keast since 2007 that the proper treatment for ARDS is low, not high, tidal volume ventilation. More important still, are personalized ventilator settings. More information, here.
If I may make a suggestion, when you come across a story that interests you and that seems new and significant – especially if it’s outside your area if expertise – don’t just share it. I suggest that you do a search looking for evidence that it’s false, as well as evidence that it’s true. Test the story!

#BVILove, #Coronavirus Delayed, not “beaten.” (One small country’s COVID-19 story)

Here in the small Nation of the British Virgin Islands, we’ve delayed, but we haven’t “beaten,” or completely avoided, the disease caused by the novel, or new, Coronavirus, COVID-19. Everyone who hasn’t yet been infected is still at risk. A lot of us will eventually catch the virus if and when we once again interact with the world at all.

If you want to learn about the current state of the science, this video is excellent by a fantastic teacher.

The Nation has done an excellent job of blunting the effect of the disease, beginning with closing all ports of entry to everyone except residents, back in March, followed by a 6 day “lockdown” with an in-home curfew at night and limitedbusiness and shopping.

Beginning about April 2, Government began enforcing a 24 hour in-home curfew, shutting business and forbidding residents from leaving our homes.

There have been 5 people with positive tests. 4 of them caught the disease in other countries and one person may have caught the disease from the last of those 4. The first 3 had mild cases and appear to be recovering.

Unfortunately, that last case was a woman whose disease was only discovered when she became very sick and had to be admitted to the hospital. She died the next day. One of her contacts has tested positive, but has mild symptoms. Unfortunately, not all of the people she might have interacted with have been identified and tested.

Hopefully, over the last 6 weeks, the BVI health department has had time to plan and prepare for multiple sick patients.

Even more: I hope that researchers around the world will come up with good treatments and discover why some patients get so sick so fast.

If there’s ever a vaccine, it’s years away There haven’t been any successful vaccines for other human strains of coronavirus.

It appears from some recent random testing in the US, that about 25% – 30% of an exposed population contracts the disease. Most either have no symptoms or mild symptoms. A small minority gets sick enough to be hospitalized, and a fraction of those end up in the ICU.

You may have heard about the high “case fatality rate,” reported anywhere from 0.01 to 10. Remember that this statistic only counts those who have been tested, predominantly those sick enough to be admitted to the hospital.

There is good news in addition to the fact that most infected people have mild or no symptoms: evidence that we have immunity after recovery comes from one of the treatments undergoing research: serum containing antibodies from the blood of recovered patients helps other people get well.

The scary part of the story is that the virus is very contagious, largely because people without symptoms can spread the disease. Medical personnel have been surprised by what appears to be the unprecedented, rapidity of the onset of Acute Respiratory Distress Syndrome (ARDS) in some patients, usually about day 12 to 14 of the symptoms. In a matter of a few hours, patients become very short of breath, requiring intubation. 80%- 90% of those intubated have died in the ICU.

The virus can also cause the body to produce proteins causing increased coagulation (the tendency for blood to clot). It also can directly infect the heart muscle and brain.

As our country opens up, and goes back to (relatively) more normal interaction, it’s important to remember that infected people may not have symptoms, but are still able to share the virus and spread the disease. They don’t know they have it and you certainly can’t tell by looking at them.

We will probably see our neighbors continue “social distancing” and wearing face masks when we leave our homes. And yes, inevitably, some of us will get sick.

“Mostly False,” Politifact “Fact Check”

Researching the what-about-isms & dueling accusations about who didn’t take the novel coronavirus seriously enough, soon enough, I came upon a “fact check” on PolitiFact that defies understanding except as a lie. An intentional lie.

Let me tell the story with screen shots, no more.

“Mostly False”

Biden quote Number 1:

Biden quote link, here

Biden quote Number 2:

Link, here

Biden quote number 3:

Link to this quote, here.

Front lines in the ICU with COVID-19

Reality is teaching a hard reality lesson with COVID-19.

This video concerns the minority of COVID-19 patients who require intensive care and the less than 1 percent who die of the disease. The discussion about the course of the disease and treatment is possibly too technical and brutal for the general public, so watch the whole thing with care.

However, I’m hoping to spur conversations about end of life in light of the broader COVID-19 crisis and specific crisis events.

This is a tough, highly technical discussion between Dr. Zubin Damania, a blogger otherwise known as “ZDoggMD” and Barbara McClean, MN, RN, CCRN, NP-PC, an expert in Critical Care & Intensive Care medicine in an Atlanta, Georgia teaching hospital with over 100 ICU beds. The first few minutes show Barbara McClean as a compassionate caring practitioner and educator. I believe and trust what she says about the worst case (stressing, again: fortunately these are the minority!) outcomes with COVID-19.

If you want to get to the meat of the video, there’s a “philosophical discussion” about the very real, unique in this modern age, futility of CPR in COVID-19 patients whose hearts stop due to the disease at 35:00 to 41:00.

There’s also interesting information about Personal Protective Equipment (PPE) difficulty (not shortage, but the physical reality) at the segment 30:00 to 35:00 minutes.

COVID-19 is, as Ms. McLean says, an unpredictable, sometimes deadly disease. Currently, patients can go from minor symptoms to death due to respiratory failure and cardiac arrest in as little as 4 hours. There is very little success to date in attempts to resuscitate patients who “code,” whose hearts stop, while in distress due to the virus.

I can’t stress enough that we need to talk, we need to make decisions among our families and to understand that this disease takes some options, some autonomy we have come to assume are our rightful “choices,” completely off the table. This disease doesn’t care what we want.

I’m unable to turn comments back on for this post. Please post comments to my Facebook page and I will try to keep up with replies. Let’s keep this on the level of philosophy and medical ethics. I will delete political criticisms.

Let’s keep this on the level of philosophy and medical ethics. I will delete political criticisms.

People ‘shed’ coronavirus early, but most likely not infectious after recovery

A study of only 9 people, but it’s a start.

Essentially, you can spread the virus even when your symptoms are mild, but probably won’t after 8 days.

Don’t eat the COVID-19 (Coronavirus)

The good news is that we were warned and it’s Spring, not Winter. (And we don’t routinely greet acquaintances with real kisses in the US.)

The really good news is that you aren’t helpless.

Chances are, most of the people who get sick picked the germs up with their hands and put them in their mouth, nose or eyes. (Gross, I know, but, trust me, I’m a doctor and a mother. I can be more gross than that when I want to get your attention.)

I tend to be a skeptic about panics, and so much of the news coverage about coronavirus is political hyperbole, but … I’m reading some worrisome stories from doctors dealing with the outbreak of COVID-19 in Italy.

Don’t panic, and don’t share! The coronavirus is spread by particles, droplets that have to enter your body by way of your nose, mouth or eyes. While it’s possible that someone might infect you by sneezing or coughing in your face, most viral infections are spread because of poor personal hygiene.

Virtually no one is immune to this coronavirus and we won’t have a vaccine for months, so people are panicking. I’m not, and here are some reasons why:

The US isn’t Italy. For one thing, we have a younger population. And, although the Lombardy region in Italy is modern and advanced, we have a higher intensive care capacity.

After all, we easily absorb the burden of influenza: up to 49 million infections, half a million hospitalizations, and 50,000 deaths every year due to influenza and hardly anyone even notices.

And we’ve had more warning than they did.

Here’s how fast influenza spreads each year in the US. If we don’t practice excellent self- protection, it’s a preview of how fast COVID-19 could spread.

Confirmed hospitalization history for Influenza in the US. Red = 2019-20, Orange =2017-2018

What’s the rate of spread of influenza in the US each year? This year? The graph above shows the historic rates of confirmed hospitalizations in the US. The red line is this year and reflects just over 16,000 patients, so far. The bright orange at the top is 2017, when we had a poorly matched vaccine.

There have been 200,000+ positive influenza tests reported to the CDC this year, 16,000 hospitalizations, and 136 pediatric flu deaths – not elderly patients with chronic diseases – this year.

We call it “seasonal” influenza for a reason. People tend to share the virus more in winter because of Thanksgiving and Christmas gatherings (and travel) and because children are in school. Sharing germs.

The coronavirus cases in the US sometimes have unknown “patient 1,” but the bulk have all involved clusters of patients with known physical and/or close contact with someone who was sick. The deaths have mainly been patients in one nursing home and a (different) hospital. In these sites, sick people were exposed to the droplets much more than you or I might be, because medical treatment accidentally aerosolized secretions.

COVID-19 symptoms are a fever over 100.5, a dry cough, and, for some, rapid onset of trouble breathing. Ther might be a runny nose or diarrhea, but there isn’t vomiting.

Use common sense and easy-to-achieve precautions. Wash your hands, don’t touch your face (eyes, nose, mouth), stay out of crowds, kindly and gently use what influence you have to encourage others to do the same.

If you get a fever, don’t go to the ER unless you are having trouble breathing. Call your doctor, and “self-quarantine.”

Most of all, Don’t share your germs and don’t pick up others’ viruses and put them in your body.

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To kill or not to kill – or even to call it killing?

It seems that an advocate of Euthanasia and Assisted Suicide (EAS), which is legal in Canada since 2016, complained to the “The Protection of Conscience Project” administrators about their use of the word, “killing,” rather than “Medically Assisted Death” (MAD) when writing about the law. The wording of the objection exposes the potential limitations even on thoughts, much less the act of refusal, of physicians who object to participating in EAS.

In response, Sean Murphy, an Administrator of the Project, discusses and defines the acts and prohibitions involved in EAS, threatened conscience protection in law as decided by Canadian legislators and courts, and policy statements of the Canadian Medical Association.
A recent case decided by the Supreme Court of Canada considered “whether or under what circumstances physicians and institutions should be allowed to refuse to provide or collaborate in homicide and suicide.” While the Canadian courts have not made it illegal to refuse, the author points out that the Canadian Medical Association now considers EAS medical treatment. Although refusal isn’t illegal, if it becomes “unethical,” the licenses of conscientious objectors may one day be at risk. (Mr. Murphy let me know that the CMA is trying to respect both views)*
Just as all inalienable rights are dependent on the protection of the right to life, all medical ethics principles (autonomy, beneficence, justice) are based on the foundation of nonmaleficience, “Cure when possible but, first, do no harm.” This is the First Principle of Medicine.
The editorial gives an useful “litmus test” for discerning between ethical and unethical acts carried out under the umbrella of medical therapy: it’s considered a “failure” if the patient doesn’t die as a result of EAS.
In contrast, the intent of withdrawal or withholding medical treatment is not necessarily to cause death, but to stop acts that are unwanted or medically inappropriate because they do not heal, cure, slow the progression of the disease or relieve pain and suffering, but actually exasperate suffering and may cause damage beyond that inflicted by the disease.
To use a current case in the news in the USA (which I recently covered here), Baby Tinslee Lewis’ doctors wish to withdraw life sustaining treatment that they believe is medically inappropriate. The doctors would not consider it a failure if, rather than die of her severe heart and lung damage, she continued to live.
Canada is already far down the slippery slope of mandating participation in induced (elective) abortion and “MAD” by designating each as “therapeutic and medical services.” The Project Conscience authors rightly predict the possible consequences:
“[I]f the state can force unwilling people to kill or help to arrange for the killing of other people, there would seem to be nothing that the state cannot demand of its citizens. This would promote the development of dangerous forms of authoritarian and even totalitarian government: ultimately more effective and deep-rooted, perhaps, within a democratic framework than they ever have been in dictatorial regimes.”

(*EDITED An earlier version stated that licences were at risk. Not yet.

BBN 11 February 2020 12:30 AM)

More thoughts on Texas Advance Directive Act

I was asked about the #BabyTinslee case and what we should do, what can we do, in the disputed cases.

We need to educate more. People don’t understand basic medical ethics in this day of “choice.”

Autonomy doesn’t supersede nonmaleficience. In other words, the First Principle of medicine, “Cure when possible, but first do no harm,” always should guide us, rather than “wants” or “choice.”

In the end, doctors are the ones actually performing the acts and we’re most likely to understand the projected outcome. We benefit from oversight by colleagues and the community, both informally and in the process prescribed by the Texas Advance Directives Act.

Some people demand that every one of these cases go to court, for “due process” and “cross examination.”

But judges and courts can’t be as knowledgeable as doctors are. Their decisions are necessarily informed by dueling (paid) lawyers and (hired) medical experts.

In all the cases that have gone to court, the family has had quite a lot of notice, but the 48 hour notice before the committee meeting is perceived as too abrupt, especially since the relationships all appear to be adversarial by that point.

(And who could get your family to a meeting in 2 days?)

The 10 days isn’t thought to be long enough to arrange a transfer, either. Again, in many of the Court cases, the attempts to find another doctor willing to accept the patient’s care has begun before the committee meeting.

Doctors acknowledge the great trust and privileges we are given by agreeing not to abandon our patients. When we have a disagreement with a patient or surrogates (usually a familymember), we accept that we must continue treatment for a period of time. But not indefinitely.

If we could get the reforms that have been attempted to lengthen the statutory timeframe (multiple times) since before 2005, the TADA would be much better. It’s still the best process we have, currently.

A Lawyer, A Life, A Lie

Lawyer Wesley Smith has done good work in the past on end of life issues, but he is once again lying in order to score political points.

In his January 7, 2020 op-ed column for National Review, Smith accuses the doctors in the Tinslee Lewis case of wanting her to die, writing, “continued life is precisely what the doctors/bioethicists don’t want.”

Smith laughably misnames Texas’ Attorney General, Ken Paxton:

(He’s also evidently unaware that Tinslee’s “parents” are actually a single mother. Which would be irrelevant other than the fact that he refers to the “parents,” so often.)

Mr. Smith is so wrong. The doctors do not want Tinslee to die. They want to stop causing her near death several times a day.

They want to do for Tinslee,  not to her.

Tinslee’s doctors report that due to the delicate balance of Tinslee’s lung capacity and heart function she has 2-3 “death events” every day, each of which requires aggressive resuscitation efforts.

The difference between doctors and this lawyer in the tragic case of Tinslee Lewis is that the doctors are at the bedside all day, every day.

The doctors are the ones putting their hands on and minds to work for Tinslee while  Smith sits in his office calling them murderers and writing about coercing them to act against their best medical judgment. Her medical records submitted to  the court report that her doctor and nurses often spend time educating and counseling Tinslee’s single mother.

Shame on lawyer Smith for once again distilling months of highly competent, complicated and excellent care down to an accusation of murderous intent.

That’s a lie.

Miracles in a predictable universe

We are blessed with a universe that’s predictable and testable, yet we pray for miracles. And we pray for miracles, but act as though human actions can block them. Is the will of the Creator Who spoke the physical laws into existence limited by humans if they act as though the universe is predictable and testable?

Those of us who practice medicine are limited by the physical laws, the predictable and testable, with an emphasis on the tested. Our education and experience is based on these tested predictions and guide our decisions, and we’re watched and sometimes redirected by our colleagues, patients, laws and the community.

And then, there’s the best test of all: time.

In fact, I once noted that a patient who outlived the “10 Day Rule” might have proved the doctor (who instigated the process from the Texas Advanced Directive Act) wrong. There might have been a few cases like this, just as I believe there have been miracles. 

However, can you tell me how to measure these events and predict their occurrences, much less practice medicine based on them?

In the majority of TADA cases when treatments weren’t withdrawn, the patient died in the exact manner the doctors predicted, after the same interventions -and sometimes more invasive and tortuous “treatments” than the ones the doctor originally objected to. 

Doing to, not for (Baby Tinslee & TADA)

“We’re doing things to her. Not for her.” (Wini King, spokesperson for Cook’s Children’s Hospital, January 3, 2020) This may be the best description of a very sad case. 

Tinslee Lewis was born prematurely on February 1, 2019, with severe heart and lung defects. She had cardiogenic shock and was admitted to the Cardiac ICU at Cook’s Children’s Hospital immediately. ♡(See Cardiac Pathology ♡below.)

Even after three open heart surgeries, a fourth to close her sternum, a short time on ECMO (essentially, heart-lung bypass) and constant ventilator since July, of 2019, Tinslee’s enlarged heart and small, damaged lungs can’t keep up with the necessary blood circulation and exchange of oxygen and carbon dioxide, even with the assistance of multiple blood pressure medicines, diuretics and the ventilator on high, except when she’s still and quiet with the help of sedating and paralyzing drugs.


In response to a lawsuit against Cook’s Children’s Hospital,  where Tinslee has been in the CICU since birth, Tinslee’s medical records were submitted to the Court.  I’ve been able to review approximately 200 pages that are now public record, describing the constant,  repetitive interventions necessary to keep Tinslee alive on the ventilator.  

Tinslee’s doctors (and, the notes show, the nurses and staff) believe that they are being forced to cause Tinslee pain and suffering, while keeping her paralyzed and sedated. They report increasing difficulty with managing the ventilator so that her damaged heart & lungs can maintain oxygenation. She requires repetitive heart, lung and blood tests to guide adjustment of meds & treatments and has had several infections requiring treatment. In contrast to my earlier presumption, the notes in the records show that the ventilator and all its required meds and manipulations are indeed causing undesired problems, including fluid overload, infections and cardiopulmonary distress, in addition to her underlying lung disease. Even the baby’s growth, something we usually celebrate, increases her risk of cardiopulmonary insufficiency. 

Those records also contain notes from many attempts to explain and council Trinity Lewis,  Tinslee’s mother,  about her baby’s underlying problems and prognosis and the reasoning behind, in contrast to some past media reports.

Ignoring the fact that doctors, not hospitals, practice medicine in Texas, Texas Right to Life Lawyer Joe Nixon is quoted, claiming that the “hospital ” has decided to withdraw treatment. Texas Attorney General, Ken Paxton, is shown to have Tweeted that the problem is a “legal issue,” rather than an ethics and justice matter of forcing doctors (and by their orders, nurses and other staff) to cause pain and suffering for a little girl who is dying as her body fails to heal, in spite of every intervention possible.

Many people, out of compassion, object that “the family ” should decide when to withdraw life support. Yet, the family  members aren’t watching the oxygen levels drop while they rinse Tinslee’s airways with a bicarbonate solution to keep her lungs clear. And it’s certainly not the lawyers that are probing, injecting, measuring and adjusting constant, innumerable hourly interventions done to a baby who must be sedated and paralyzed to prevent cardiac and respiratory distress. 

In spite of the diligent  complicated interventions and care of the doctors and nurses at Cook’s, there have been comments in blogs and social media that the “hospital” wants to “kill” Tinslee. Startlingly,  AG Paxton called the latest Court ordered, indefinite hold on removal of life support  a “Stay,” as though the doctors, not her multiple medical problems, would kill Tinslee. He also misrepresents the process that Cook’s Children’s Hospital and Tinslee’s doctors followed,

“The statute fails to require that physicians provide an explanation of why they refused life-sustaining treatment and provide the patient’s family with adequate notice and opportunity to argue their position prior to the committee reaching a decision, effectively allowing the government to deny an individual’s right to his or her own life and to do so without due process.”

In fact, though, it is the lawyers, particularly at Texas Right to Life, who are turning a little girl’s tragedy into a continuation of their legal battle against the Texas Advance Directive Act. I’ve covered the benefits of and the struggle to improve the Act – repeatedly blocked by TRTL and their lawyers – for years on both WingRight.org and Lifeethics.org

The Act, TADA, was hammered out in 1999 by a group of stakeholders   including  patient and disability advocates, hospitals, doctors, ethicists and lawyers. Texas’ prolife organizations,  including TRTL and the organization for which I served on the Board of Directors for 15 years, Texas Alliance for Life, and for whom I wrote this essay.  

Briefly, TADA allows a balance and legal options when there’s a difference in opinion between a patient’s desire for a given treatment and the medical judgment (a combination of education, experience, and the standard of care) of the doctors who are tasked with the most difficult medical and surgical cases. 

I’ll admit that it’s my opinion – and only my opinion – that the lawyers hate that TADA provides a safe haven from lawsuits if doctors follow the law (!). I slowly came to this conclusion over the years because at virtually every Legislative hearing and stakeholders’ meeting about any changes to the Act, the lawyers bemoan the fact that doctors don’t have to go to court over each of these cases and that they face no legal penalty or “liability.” 

Poor Tinslee Lewis will most likely never leave the hospital alive. Disease and death don’t respect “due process,” but, they are predictable and an inevitable part of life. Hopefully,  we will see her mother and those who love her come to find peace with her death, celebrating the time they’ve had to be with her, especially these last 2 months. However, I fear that the lawsuits will continue for years, adding to their grief.

Edited 1/19/2020 for a typographical error: in the secondparagraph, “cardiogenic” replaced “carcinogenic.” BBN

♡Ebstein Anomaly – Cardiac Pathology 101, about as simple as I can make it (and understand,  too);

Ebstein Anomaly
(Thanks to Mayo Clinic)

Babies born with Ebstein Anomaly have a malformed right and atrium and ventricle and misplaced (tricuspid) valves between the right sided ventricle and atrium. The larger right ventricle can’t pump efficiently. 

In addition,  the blood the right ventricle tries to pump into the lungs leaks/flows/churns (risking blood clots) back into the right atrium, which grows even bigger, with even thicker walls. The ventricle also grows bigger. When the  muscle fibers of the chamber walls get stretched apart enough, they are less inefficient. (Think of two hands gripping at the fingers. The farther out the grip, palm > 1st joint  > fingertips,  the less strength and pull on the opposite hand.) (For the geeks: Frank-Starling law.

The lungs aren’t efficiently filled with blood, they don’t expand, the pressure builds up in them and efficient exchange of gasses doesn’t take place. 

In the meantime, the blood backs up in the body, the liver, kidneys and extremities & eventually the left side of the heart, which can hypertrophy , too. 

The enlarged heart puts pressure on the lungs and nearby soft tissue,  including the blood vessels coming to the heart.

The combination of leaking high pressure blood vessels and the body’s increasing fluid in order to try to pump what oxygen there is, leads to edema or swelling of the body.

Sometimes,  the fetal atrial-septal defect stays open, allowing mixing of the un-oxygenated blood from the right, with the oxygenated blood. This malfunction can help, temporarily. 

With the high pressure, poor flow, and actual physical damage due to the mass of the heart, none of the organs can function well. Increased activity, stress, and growth will increase the demand for oxygen, kidney & lung function.

Experimental Abortion – Schrodinger’s Fetus

What ethics review board approved a randomised trial to temporarily prevent the ending of the life of a human embryo or fetus, with a planned surgical abortion as an end point?

Horrifying report about human experimentation: Obstetricians at the University of Southern California have announced that they stopped a study using progesterone to reverse the anti-progesterone effects of mifepristone in medical abortions.

According to the NPR:

For the study, the researchers aimed to enroll 40 women who were scheduled to have surgical abortions. Before their surgical procedures, the women received mifepristone, the first pill in the two-medication regimen that’s used for medical abortions. The women were then randomly assigned to receive either a placebo or progesterone, which advocates claim can block the effects of mifepristone.

Ignore the fact that only 12 women signed up over 6 months, that in spite if the claims if the researchers, the mifepristone was the actual, immediate cause of the complications that included 3 women needing ambulance transport to a hospital for excessive vaginal bleeding and 2 others dropping out due to some other side effects.

But you should certainly – they hope – forget that 4 of the babies exposed to progesterone and 2 who received placebo after the mifepristone continued to live for 2 weeks until their death at the hands of an Obstetrical surgeon. That’s half of the study group!

There’s no question that I consider it unethical to cause the intentional, interventional death of any human who isn’t a threat to life for another. It’s heinous that our laws allow the best medical technology in the world to kill members of our species, because they aren’t considered human-enough to possess the inalienable human right not to be killed.

But there’s an additional ethics problem in this case: a strong “yuck factor” (aversion) to the idea of purposefully experimenting with ¢ lives of humans, both the mother and her child, planning to monitor the signs of the prenatal human’s life, anticipating his or her death by surgical abortion.

Half of the original mothers had planned two weeks (14-16 days)delay with serial ultrasounds, confirming her baby’s heartbeat. (Remember this experimental protocol the next time an abortion advocate complains about State-mandated waiting periods and pre-abortion ultrasounds.)

Let me repeat: half of the nascent human beings experimented upon/ lived two additional weeks after exposure to the mifepristone poisoning. Only one of the 12 pregnancies resulted in what would be considered a “normal” medical abortion.

Eventually however, all of them were finaly “terminated.” After two weeks of observation – Schrodinger’s humans.

Note: Due to some sort of technical problem at the website, I wasn’t able to purchase the article, so this is based on the abstract and NPR report.

Edit 12/9/19, BBN: I was able to purchase access to the article (24 hours for $60!). There’s no change in the facts other than to note that the authors report continued life of the prenatal humans as 6 of 10 subjects: 4 of 5 who finished the trial and received progesterone, and 2 of 5 who were randomized to the placebo arm.

Parachutes don’t save lives?

Not when the jumper starts only 2 meters from the ground.

“Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial
BMJ 2018; 363

“”Ah, but the method of madness matters! The non-participating passengers flew at 800 km/hr at an altitude of 9,146 m, but the trial participants jumped a whopping 0.6 meter (2 feet) from a plane traveling at an incredible 0 km/hr. The authors point out their trial’s glaring limitation — an inability to generalize to higher altitude jumps — and use it make a point that health journalists would be wise to remember:

“When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice.

This study was conducted in response to a Christmas, 2003 BMJ article decrying the lack of RCT (Random Controlled Trials) for the efficacy of parachutes. As the authors of this article point out, even RCT’s have their limits.

As one review explains,

Put plainly, if most people already think an intervention works, then an RCT may end up with enough bias in its design that the conclusion ends up clinically meaningless. Sometimes, an RCT is truly unethical, and other times an RCT really might be needed to test an intervention taken for granted. Health journalists should scrutinize an RCT’s methods closely.

I’ve disabled comments on the blog. Please leave your comments on my Facebook page, “Beverly Nuckols.”

Cook’s Children’s Press Release on Tinslee Lewis

The Press Release is published in .pdf on the hospital’s website. Here’s the text:

Cook Children’s Statement Regarding Patient Tinslee Lewis Fort Worth, Texas (November 10, 2019) –

Tinslee Lewis is a beautiful baby who has captured the hearts of many at Cook Children’s since her premature birth nine months ago. She was born with a rare heart defect called an Ebstein’s anomaly and has undergone several complex surgeries at Cook Children’s in an effort to improve her heart function. Further complicating matters, she also suffers from chronic lung disease and severe chronic pulmonary hypertension. Due to these complications, she has spent her entire life hospitalized in Cook Children’s intensive care unit. She has required artificial respiratory support throughout that time, and has been consistently on a ventilator since July.

In the last several months, it’s become apparent her health will never improve. Despite our best efforts, her condition is irreversible, meaning it will never be cured or eliminated. Without life-sustaining treatment, her condition is fatal. But more importantly, her physicians believe she is suffering.

To maintain the delicate balance necessary to sustain Tinslee’s life, and to prevent her from pulling out the lines that are connected to the ventilator, doctors have had to keep her constantly paralyzed and sedated. While Tinslee may sometimes appear alert and moving, her movements are the result of being weaned off of the paralyzing drugs. We believe Tinslee is reacting in pain when she’s not sedated and paralyzed.

Cook Children’s has made heroic efforts to treat Tinslee’s condition, all while being very transparent with her family regarding her poor prognosis. Despite those extraordinary efforts, Tinslee’s condition has not improved. At the request of Tinslee’s family, we have reached out to nearly 20 facilities across the country to see if any would be willing to accept Tinslee as a patient. Some of the facilities include:

 Texas Children’s  Children’s Memorial Hermann Hospital  Dell Children’s  Dallas Children’s  Medical City Dallas  Children’s Medical Center Oklahoma City  Children’s Hospital of Atlanta  St. Louis Children’s  Children’s Hospital of Philadelphia  Johns Hopkins  Methodist Hospital San Antonio  University Hospital San Antonio  Boston Children’s  Children’s Hospital of Los Angeles  Arkansas Children’s  C.S. Mott Children’s Michigan  LeBonheur Children’s Memphis  Rady Children’s  Children’s Hospital San Antonio CHRISTUS

All have said our assessment is correct and they feel there is nothing more they can provide to help improve this precious child’s life.

A team of Cook Children’s doctors nurses and staff have given their all to help Tinslee. While, we believe every child’s life is sacred, we also believe that no child should be sentenced to a life of pain. Removing this beautiful child from mechanical ventilation is a gutwrenching decision for Cook Children’s physicians and staff, however we feel it is in her best interest to free her from artificial, medical intervention and suffering.

Winifred King

Assistant Vice President of Public Relations Cook Children’s Health Care System

Baby Tinslee Lewis and the Texas Advance Directive Act

I was a relieved to hear that the doctors caring for 9 month old Tinslee Lewis decided not to remove her ventilator on Sunday, November 10, 2019. Their decision, most likely due to public outcry, was announced 2 hours before removal was planned. Later in the day, and a local judge issued a restraining order that mandates continuing the ventilator until at least November 22 unless an appropriate transfer to another facility can be arranged.

At first glance, this sounds like several other stories about disputes between the family of a patient and medical professionals who have invoked the provision in the Texas Advance Directives Act(TADA) that allows for removal of life sustaining treatment. However, from what I’ve read and the hospital’s statement, I’m concerned that this time the law may have been invoked based on “quality of life” rather than the futility of the treatment and the suffering it causes.

(Note: I want to be very careful to point out my limits. The following medical and legal information about this case comes from what I’ve gleaned from Facebook, blogs and Twitter posts, as well as a few news articles like this one. I’ve tried to be as factual and accurate as possible. It’s important to understand that I don’t know all the details and that any conclusions I draw are merely my opinion.)

Tinslee has lived her whole life in the ICU at Fort Worth Cook’s Children’s Hospital. She was premature and was diagnosed with a congenital heart defect, Epstein’s anomaly, that in spite of several surgeries led to heart failure and caused her heart to become so enlarged that it damaged her lungs. She’s been on a ventilator since July.

Her doctor or doctors reportedly believe that Tinslee is in pain and suffering. In order to keep her comfortable and to prevent her pulling the ventilator and feeding tubes, they must use paralyzing drugs and sedation. An attending doctor responsible for Tinslee’s care invoked TADA and a hospital committee agreed that the continued use of the ventilator is inappropriate. On October 31, the family was notified that the ventilator would be discontinued at 5 PM on November 10.

I became concerned when I saw the video posted at Texas Right to Life, showing a beautiful girl with apparently healthy skin, reacting to voice and touch. In the video, she doesn’t move her right leg, barely opens eyes and only seems to point her eyes to lower right. Still, the treatments, including sedation, seem to be working and she doesn’t appear to be in distress or pain.

A hospital spokesperson, Winifred King, assistant vice president of public relations for Cook Children’s Health Care System, sent out a statement by email, that is quoted in part by the Fort Worth Star Telegram:

“In the last several months, it’s become apparent her health will never improve,” King said in a statement via email. “Despite our best efforts, her condition is irreversible, meaning it will never be cured or eliminated. Without life-sustaining treatment, her condition is fatal. But more importantly, her physicians believe she is suffering.”

And,

“While we believe every child’s life is sacred, we also believe that no child should be sentenced to a life of pain,” said Winifred King, assistant vice president of public relations for Cook Children’s Health Care System, in a statement. “Removing this beautiful child from mechanical ventilation is a gut-wrenching decision for Cook Children’s physicians and staff; however, we feel it is in her best interest to free her from artificial, medical intervention and suffering.”

(Kaley Johnson, Fort Worth Star Telegram https://www.star-telegram.com/news/local/fort-worth/article237223826.html accessed 11/10/19)

Hesitantly, I find myself second guessing the decision of Tinslee’s doctor(s) to invoke TADA and of the hospital ethics committee to affirm that the ventilator is inappropriate medical care. As I wrote above, I can’t know the real medical circumstances and certainly haven’t examined Tinslee or even read her chart. I’m not a pediatric cardiologist or pulmonologist and may not understand her prognosis as she grows and develops. Has she required chest tubes because of the ventilator? Is she growing? Will a larger body put too much strain on her heart or will growth allow time – and room – for her lungs to heal? Will she be able to have a tracheostomy and would it make her care easier and her more comfortable?

However, there’s no sign that the ventilator itself is causing damage to her lungs and there is evidence that the medication helps Tinslee tolerate the mechanical intervention.

The wording of Ms. King’s statement makes it appear that the doctor(s) decided to end the ventilator treatment based on a perception of her quality of life, rather than on their knowledge of the futility of the treatment and the damage it causes. In my opinion, “quality of life” is a very personal value judgement. As I’ve noted before,

“Although no reason is required by law, in every case I know of the doctor has made it clear that the requested treatment is causing suffering and/or actual harm and violates the First Principle: “Cure when possible, but first, do no harm.”’

The good news is that TADA allows, and Tinslee’s family were able to, access practical and legal assistance.

Ms. King shared a list of 19 hospitals that, as required by TADA, the hospital administration has contacted in an attempt to find other doctors and facilities that will accept Tinslee as a patient. All refused the transfer, apparently agreeing with Tinslee’s doctor (and casting doubt on my conclusion).

TADA also allows the family to seek a delay through the local courts. Texas Right to Life helped Tinslee’s family by providing a lawyer and legal advice. They also sent out a plea on Friday, November 8, asking the public to call and email Cook’s administrators about Tinslee. Several State legislators have also become involved.

Now, Tinslee’s mother and family and the hospital will have another 12 days to try to find someone willing and able to treat her.

Questions still remain: Is there any long term facility that is able to offer the ventilator and sedation that Tinslee needs? Or must Tinslee live sedated and paralyzed in the ICU for the rest of her life?

But there shouldn’t be any question weighing whether Tinslee’s “quality of life” is worth living.

Timeless Frederick Douglas

An excellent essay.
An excellent, timeless quote, that could as easily be paraphrased about elective abortion or euthanasia:
“[T]he constitutionality of slavery can be made out only by disregarding the plain and common sense reading of the Constitution itself; by discrediting and casting away as worthless the most beneficent rules of legal interpretation; by ruling the Negro outside of these beneficent rules; by claiming everything for slavery; by denying everything for freedom; by assuming that the Constitution does not mean what it says, and that it says what it does not mean; [and] by disregarding the written Constitution.”

Texas transgender (7 yo) case

I don’t believe it’s appropriate for a child to undergo transition at such an early age, but there’s a few gaps in this story.

There is very little media coverage of the case, with opinion from only one side published online. I picked the report about the court decision that’s most comprehensive, even with some errors.

Mostly, this appears to be an especially ugly divorce battle. The dispute about transition has been going on since the child was 3 years old.

The child is one of two twins conceived by in vitro fertilization using the father’s sperm and a donor egg. The mother carried the two to term and delivered.

The mother filed the suit to end joint custody, but the father demanded that the jury decide custody, rather than the judge.

The jury was charged with 2 questions: should one parent have sole custody and should that parent be Mr Younger. They answered yes and no: one should have sole custody, but it shouldn’t be the father. The judge will rule this week on who gets custody & conditions.

I’m not sure, but I’m reading that there’s no immediate plans for puberty blockers & finding quite a bit of info that the blockers aren’t permanent.

I can’t help but hope there’s more to this story, because I still can’t accept a decision like this, at this age.

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