Question for medical types: Killer Kowalski & brain death

[Bix]

So a few weeks ago, George Steele posted on his message board that Killer Kowalski was brain dead and had been taken off life support. A week or so later, he wasn't dead, so I noted that obviously this wasn't true on another board and somehow got into a ridiculous argument over it.

 

So Kowalski dies about 2 weeks later...and now we get this in the new WON:

 

The decision was made to remove him from most life support equipment early on, when doctors made the call he would not recover, and he was only expected to last perhaps a day, not 22 days. But he continued to breath on his own while wife Theresa, whom he married just two years earlier, stayed by his bedside. After he was pronounced brain dead on 8/17, his feeding tube was removed and he was expected to pass away imminently.

 

“The doctor said it could be minutes, hours, maybe a day or two at most,” said Bruno Sammartino, who was Kowalski’s most famous opponent and who was in contact with Kowalski’s wife Theresa on a nightly basis since the heart attack. A family relative actually first reported his death at that time. He kept lying there breathing and his heart continued to beat on its own for nearly two more weeks. It made no sense, but at the same time, there was no hope at all for a miracle. Likely due to his decades of hard conditioning and healthy living, his vital signs remained strong even while his brain was no longer functioning.

This is Bruno, Steele, Kowalski's family, et al working Dave, right? Everything that I've ever heard about brain death and read about it after this news item came out indicates that brain death means that the person is dead. Brain death is determined in part by the patient being unable to breath when taken off of life support (the apnea test). From the Journal of the American Medical Association (PDF):

 

A person dies when brain function ceases, the heart stops beating, and breathing and blood circulation cease. Because life-support techniques have become so advanced, it is possible that even in the face of fatal injury or unrecoverable illness, the heart can be kept beating with medication and respiration (breathing) can be artificially performed with a ventilator. The concept of brain death developed in response to these advanced medical techniques that can maintain some bodily functions. Brain death, as understood in US law and medical practice, occurs when there is no function of the entire brain. The brainstem is the area of the brain that controls breathing and circulation and therefore controls essential life functions. When the brain, including the brainstem, has ceased to function, the individual is truly dead by medical and legal standards. Thus, brain death is real death. The May 14, 2008, issue of JAMA includes an article about ethical questions sometimes raised in cases of brain death.

 

CLINICAL CRITERIA FOR BRAIN DEATH

 

• No response to any stimulus—no movement, withdrawal, grimace, or blinking

• No breathing efforts when taken off the ventilator (the apnea test)

• Pupils dilated and not responsive to light

• No gag reflex, no corneal reflex (blinking when the surface of the eye is touched), and

absence of other specific reflexes

As far as I can tell as a layman doing a bit of Google-assisted research, I would guess that Kowalski was in some sort of other vegetative state and his family along with the wrestling community downgraded it to brain death so he would seem like some sort of medical marvel who continued breathing while his heart beat AS HE WAS DEAD thanks to his vegetarian diet and incredible conditioning, and somehow Dave Meltzer, the top wrestling & MMA journalist who Frank DeFord thinks is the best reporter in all of sports got worked to think that Killer Kowalski was able to bring himself back from the dead. A great worker even as he was dying in a hospital bed.

 

Am I off base here?

[kjh]

Could it just be that he was misdiagnosed or his family and friends simply misinterpreted his diagnosis, rather than his family and friends actively trying to deceive everyone and Dave being dumb enough to fall for it?

[Johnny Sorrow]

I've worked in geriatric care for over 18 years, and I can recall many times when a patient was declared brain dead and breathing tubes were removed and they hung on for awhile longer, sometimes a week or so.

[Bix]

I've worked in geriatric care for over 18 years, and I can recall many times when a patient was declared brain dead and breathing tubes were removed and they hung on for awhile longer, sometimes a week or so.

Thanks...but now I'm really confused.

 

How are they usually diagnosed? The JAMA article emphasizing that "brain death is real death" really throws me for a loop if this can happen. Is it possible that since there will be no organ donation with the elderly patients, that the term "brain dead" is used without testing to make the family more comfortable or something? I honestly don't understand how someone could legitimately be brain dead and then live off life support, especially since not surviving off life support is criteria for brain death in the first place. They seem mutually exclusive if "brain death is real death."

[Jingus]

Sounds to me like we've just got people using the same phrase to describe different things. Heck, this is the first time I'd ever seen that "brain dead" is supposed to definitively mean that you're incapable of breathing on your own. I always thought it just meant that you were in a permanent coma with no higher brain functions. I don't think anyone's trying to work anyone here, just sounds like a mixup in semantics.

[Bob Morris]

It simply sounds to me like the diagnosis wasn't accurate.

 

It happens. One doctor may give you one diagnosis, but another doctor gives you a different one.

 

It may seem unusual that a doctor would diagnose somebody as "brain dead" when he really isn't, but I would imagine the doctor simply believed Kowalski reached that "point of no return" but it wasn't the case at the point the doctor made his diagnosis.

[sek69]

Honestly, a lot of the times doctors tell the family someone is brain dead when there's nothing more that can be done and the end is pretty much near. People tend to accept the finality of "brain death" more than anything else so it's a lot less likely the family will want heroic measures done like people in vegetative states tend to get put through.

[Johnny Sorrow]

I've worked in geriatric care for over 18 years, and I can recall many times when a patient was declared brain dead and breathing tubes were removed and they hung on for awhile longer, sometimes a week or so.

Thanks...but now I'm really confused.

 

How are they usually diagnosed? The JAMA article emphasizing that "brain death is real death" really throws me for a loop if this can happen. Is it possible that since there will be no organ donation with the elderly patients, that the term "brain dead" is used without testing to make the family more comfortable or something? I honestly don't understand how someone could legitimately be brain dead and then live off life support, especially since not surviving off life support is criteria for brain death in the first place. They seem mutually exclusive if "brain death is real death."

 

It's pretty much that there's no active brain activity to speak of but the other organs are just going on for awhile until the inevitable death. Usually, the patients I'm working with have had suffered from some form of Alzheimer's or related dementia that has ravaged the brain. We never get into the why's and why nots, we just make the patient and family comfortable. But the idea that someone with a healthy history or strong constitution keeping on breathing as there's no discernable brain activity is something that happens. It also happens with chubby little old ladies sometimes. I'm not in the DX end of things, I'm in the "comfort" part. There's a lot of mysteries in the things that can happen at end of life times for seniors.

[ohtani's jacket]

Brain death is not a diagnosis doctors make lightly. One doctor alone can't make that diagnosis. So either he was misdiagnosed or the family misunderstood what was happening to him. The idea that the old bugger hung on for longer than the doctors said he would is comforting for the family and pretty harmless. As far as misdiagnosis goes, the current diagnostic criteria for declaring brain death can lead to misdiagnosis and is one of the reasons why some medical professionals oppose apnea testing. Apnea testing is nasty.

[sek69]

Or maybe it was an 81 year old man who had a massive heart attack he wasn't going to come back from and the doctors didn't want to give the family any false hopes?

 

 

I can tell you from personal experience that when someone that age has an episode they aren't going to come back from, they make every effort to impress upon the family the finality of it all.

 

 

In the end, what does it matter other than it giving people on the internet something else to argue about?

 

 

I will say that Meltzer using jobbing in a match as a metaphor for death got somewhat creepy when he extended it as far as he did. Describing someone fighting off death as "refusing to do the job" is some sub-Kayfabe Memories shit I'd expect to get lampooned on a thread at OLC.

[ohtani's jacket]

Seems like a pretty common form of eulogising to me.

[tomk]

I am sure I am going to fuck this up because I stink at remembering scientific terms but I have heard this discussed in social settings a bunch of times (normally around issues of trying to deal with organ donation from the brain dead).

 

If your hypothalamus can’t function on its own (you can’t regulate your eloctolytes, your glucose levels etc.) if you are taken off the machine your organs will get fucked up (there is a better medical term I’m sure) and you will die. The heart beat is not governed by the hypothalamus. Heart will continue to beat even as rest of your metabolic functions cease to function.

 

Again this is my memory of social conversations. I was probably inebriated for most of these so I probably missed key points. Still I'm postive that heart can continue to beat without hypothalamus.