The Main purpose of this case summary asked by our CEO Felicia Larue is to give a brief on the patient situation and to ensure that her rights of are preserved and the risks to the hospital are minimized. Been paralyzed refers to patients that needs the use of the latest available procedures for psychotherapeutic work, comatose and treatment for different states of consciousness. Patients in comatose states like Lydia have been traditionally considered as victims of neural pathological procedures that overcome cognitive and communicative functionalities. While the latest procedures on spinal cord injuries suggest that patients may display spaces of consciousness on the worst persistent vegetative states.
Is very common that disputes arise over the treatment of patients that had been unresponsive through injury or illness for certain time lapse. Families get torn between the final decision because for some to end the “artificial life” is the alternative to stop the “suffering”. Cases such as Terri Schiavo can last years on court on a back and forth demand. Medical examination reveals apparently irreversible brain damage in a persistent vegetative state since 1990. Her husband and her family went to court battle to decide if the feeding tube should be removed. Finally her husband prevailed in court on 2005 and Schiavo died in March 2005.Others with firm beliefs wait for the miracle. Doctors in England and Belgium (Owen et al., 2005) found signs of life in a “damage” brain of a woman who was in a vegetative state. She reacts to the physician’s words about playing tennis by showing peaks of activity in the premotor cortex of her brain.
But for healthcare specialist like us our main goal is to try to discover what communication channels are open to the patient and then try to perceive the patient feelings and interact with those life signals. On our case Lydia responses are based on head nobs. Our main goal is to have her alive and to create an atmosphere that can create more responses from her. The final goal of our interaction is to obtain a real feedback from the patient. While the diagnosis for this types of injuries are generally predictable and recovery is rare, the symptoms of this type of injuries are varied and that difficult the prognosis process and final outcome of the patient.
Once the patient is brought to our healthcare facility and the life threatening injuries have been identified it has to be evaluated for spinal injury by using X rays, CT scans and MRI’s. We must pay special attention to complications of spinal cord injuries like: neural shock, respiratory failure, pneumonia, pulmonary edema and emboli and even a deep venous thrombosis, some of these symptoms are easily recognized in the treatment and avoided in the intensive care unit.
As stated before our goal is to preserve life and comply with the law. The Patient’s Self Determination Act stated clearly that the final will of the patient must be fulfilled. But in this case there’s no written informed consent or advance directive evidence that indicates to proceed to the removal from the ventilator or the feeding tube. And even more there’s no court decision which dictates what we should do. We must continue rendering the services to the patient.

References:
Bagnall AM, Jones L, Duffy S, Riemsma RP. (2008). Spinal fixation surgery for acute traumatic spinal cord injury. Cochrane Database of Systematic Reviews, Issue 1. Retrieved February 5, 2012 from: http://injuries.cochrane.org/
Levine, C. (2006). Have Advanced Directives Failed?. Taking Sides: Clashing Views on Controversial Bioethical Issues. 11th ed., Guilford, CT: Dushkin Publishing Co. pp 60-73.
Making the PSDA work for the ederly. Retrieved February 4, 2012 from http://www.thefreelibrary.com/Making+the+PSDA+work+for+the+elderly.-a016456073 Owen, A.M.; Coleman, M.R.; Johnsrude, I.S.; Menon, D.K.; Rodd, JM; Davis, MH; Taylor, K; Pickard,
JD (2005). "Residual auditory function in persistent vegetative state: A combined PET and MRI study". Neuropsychological Rehabilitation 15 (3–4): 290–306.
Euthanasia and Terri Schiavo. Retrieved February 4, 2012 from
http://www.religioustolerance.org/schiavo.htm