en een respectvolle manier van sterven
In ‘De Morgen’ van 6 maart 1999 lezen we het volgende over Ruth Oliver.
'ARTSEN WACHTEN NIET OP DOOD PATIENT'
In Canada worden organen voor transplantatiedoeleinden soms al verwijderd als mensen klinisch dood zijn, maar nog ademhalen, zo bleek deze week uit de hoorzittingen van een parlementaire onderzoekscommissie die onderzoekt hoe het tekort aan transplantatieorganen verholpen kan worden.
Tweeëntwintig jaar geleden stelde de arts van Ruth Oliver vast dat ze klinisch dood was. Haar brein was zo gezwollen dat het uit de chirurgische incisie in haar hersenpan puilde. De dokters probeerden haar drie keer te reanimeren. Inmiddels is ze vijftig, kerngezond én beroemd in Canada als 'de mirakelpatiënt van Kingston General Hospital'. Oliver werd wakker de dag nadat ze was opgegeven. Ze kon zelfs weer aan de slag als psychiater in Vancouver.
Deze week zorgde ze voor ophef door zich voor de parlementaire onderzoekscommissie te verzetten tegen orgaantransplantatie. In Canada kan momenteel worden overgegaan tot het 'oogsten' van een orgaan als patiënten hersendood zijn, maar wel nog steeds aan beademingsapparatuur liggen om organen warm en gezond te houden. Levensgevaarlijk, meent Oliver, die verwees naar een recent geval waarin de betrokken donor op de operatietafel weer tekenen van leven gaf. "Ik ben een levende getuige dat mensen die hersendood werden verklaard toch nog kunnen leven", zei ze deze week volgens de krant Mail & Globe. Oliver maande de publieke opinie aan "hun donorkaart niet te tekenen omdat artsen wel eens niet alles zouden kunnen doen om je het leven te redden". In Canada wachten 3.200 mensen op een orgaantransplantatie, maar konden vorig jaar slechts 1.612 patiënten aan nieuwe organen worden geholpen - een opmerkelijk laag cijfer in vergelijking met andere (westerse) landen.
Hieronder het letterlijke verslag van haar verklaring in de parlementaire onderzoekscommissie.
The Chair: Colleagues, we will continue our presentation on issues related to bioethics and ethics in general as associated with organ donations and transplantations.
We have in this panel, from the Medical Research Council of Canada, Dr. Francis Rolleston, director of ethics and international relations; someone who appears before us as an individual, Dr. Ruth Oliver, psychiatrist; from the University of Victoria, Dr. Eike-Henner Kluge, chair of the philosophy department; from the Ottawa Hospital, Dr. Robert Nelson, professor of medicine in neurology; and appearing as an individual, Dr. Michael Brear.
I noted that some of you were in the audience during the last panel, so you may be familiar with the process. We're going to ask you to make a presentation of about five minutes. I would ask you not to go beyond that. Then we'll go into questions from colleagues on both sides of the table.
Let's begin with Dr. Ruth Oliver.
Dr. Ruth Oliver (Individual Presentation): The most important thing I can offer you today is that if you can see me, hear me, and understand what I am saying, whether or not you believe what I say or agree with what I say, you need to know that I, 22 years ago this month, survived the criteria for clinical death—some might say brain death. Within a period of less than 24 hours, I was there at least two times, and had to be resuscitated three times.
Now, 22 years later, I'm living testimony that people survive so-called clinical death and brain death, and not just survive as vegetables—a derogatory term—but can become totally functional, totally contributing members of society.
I was a third-year psychiatric resident when this event took place. Eighteen months later, I wrote my fellowship, my specialty exam. Six months after that, I wrote my licensing exam, because as a foreign medical doctor, I needed to get a licence to practice as a doctor independently. So I jumped a few independent intellectual hoops after this event.
So remember, you've seen one and heard one. You know they can survive. That's the most important message.
I'll give you a little bit of the clinical background here. This information was provided, but unfortunately has not yet been translated into French. I left another two English copies here, but it was not soon enough to have the translation done in time.
This took place down the road, at Kingston General Hospital. I was at Queen's, a third-year resident in psychiatry. I was 30 years old, and I was pregnant for the third time. My pregnancy was completely normal until the baby was at 35 weeks' gestation. I presented at emergency because I had heart palpitations.
I was admitted. By scan and X-ray, they discovered I had hydramnios, which is a great deal of fluid, and an anencephalic baby. Labour was induced on March 25. My stillborn, anencephalic son was born just after midnight, March 26.
Between 1 and 1.5 litres of blood were expelled with the placenta. I was therefore found to be very anemic. My first resuscitation involved giving me blood, because at 3 a.m. the following day, March 27, about 26 hours after the delivery, I was bleeding continuously. I deteriorated into a loss of consciousness and was comatose by 8 a.m., with a very stiff neck. Blood pressure was down to 70 systolic.
So that was my first resuscitation. I needed a lot of blood transfused.
At that point they didn't know why I was unconscious. Carotid angiograms were done. They found that the blood vessels were deviated, so they thought I had a hematoma, or a brain bleed, if you like.
A neurosurgeon was called in. They did a craniotomy and found there was nothing wrong with my brain. There had been no bleeding. There was no problem when he opened, but right after he opened, the brain began to swell rapidly and then bleed from every level they had made the incision through. It became uncontrollable.
At this point I went into a coma, and stopped breathing. They put me on a respirator. I had poor eye movement and no response to very deep pain, so I was returned to the ICU in critical condition, because I was continuing to ooze.
One hour after the surgery and right in the ICU, I developed the irreversible symptoms of dying—fixed, and dilated pupils, quadriplegia, and no response to pain. Fortunately for me, my neurosurgeon right there in the ICU opened the flap, put in a syringe, and pulled out a collection of blood. Immediately my pupils came down and started reacting again, and became equal. They then took me right back to the ICU, because they still had this problem of bleeding.
As they were trying to prepare me for the surgery, I went back into the situation of fixed, dilated pupils, quadriplegia, not responding to pain, and not breathing. That was the third resuscitation.
Again, I had bled a collection of 200 ccs of blood. When you have blood and you have brain swelling, the vital section of the brain that controls your pulse, your blood pressure, slips down into the spinal cord. That is called a tentorial herniation.
As my neurosurgeon later told me, nobody had ever been known to survive a tentorial herniation. I survived it twice. He told me it wasn't in the literature. He'd never seen one, known one, or heard of one.
All of this is to point out that what can look extremely critical, and what seems to be failure at all levels...because 24 hours later, I was conscious. The following morning I was intelligent, I was aware, and I was responding to pain. Within 24 hours after that, they took out the respirator.
The rest is history. It was complicated—I was in hospital three and a half months—but I'm basically only covering the area in which I was called clinically dead. Some people may say because no EEG was done I was not brain-dead, but I have comments about that.
After I was conscious enough and aware enough to understand my situation, many people came to see the so-called miracle patient.
After discharge, when I was complaining in his office about a slight speech defect, which you may detect I still have, he just laughed at me because of what he had taken me through. That's the only thing I have left, a little bit of dysphasia, a little bit of a problem sometimes naming something. I know in my head what I want to say, but the word doesn't come out clearly.
I was also epileptic. I had gone into epilepsy for several days, right in that acute phase. The final chapter on that epilepsy was written on April 1 of this year. Many times over the years they tried to take me off the anti-epileptic drugs. Every time I would get a seizure, my EEG would become abnormal again.
On April 1, it was an act of faith. I unashamedly will tell you that I prayed about it, and when I was finished with my prescription at the end of March, I simply did not renew it. I simply did not take any more anti-epileptic drugs.
We are now looking at 10 months, and I haven't had a seizure, not even a slight twitch—nothing.
So I'm completely symptom-free except—and I say this with a little bit of humility—I have some problems naming things sometimes.
The Chair: Can I ask you to bring the presentation to a close?
Dr. Ruth Oliver: You know, in all the years it never occurred to me to ask for my medical records. Last Friday, by FedEx, I received my medical notes from Kingston General Hospital. It's a lot of pages, but they just cover the crisis time. They have in the record over 500 pages dealing with the whole admission, but this is only the nurses' and ward notes. The neurosurgeon at the time was not in the country. I don't exactly know where he is. So I don't have his personal notes, but everything he wrote in hospital is here. So you can verify some of what I say. I'm happy to share my notes with you.
The Chair: Thank you, Dr. Oliver.