Best care for ‘vegetative’ girl

Press, Volume CXV, Issue 33985, 28 October 1975, Page 18

Best care for ‘vegetative’ girl

rßy WILLIAM HINES, of the "Chicago Sun-Times" through N.Z.P.A.)

CHICAGO. October 27

The parents and friends of Karen Ann Quinlan who have been waiting for a miracle for the last 196 days may have had one already without knowing it.

In the opinion of many doctors who have examined the girl in the coma, it is a virtual miracle that she did not die months ago. As the trial of Joseph Quinlan’s suit, to win guardianship over his comatose daughter and give her “death with grace and dignity” moves into its final stages today, the quality of care the young woman has been receiving is a major topic of conversation here.

Miss Quinlan, then living ! awav from the family home jin Landing, New Jersey, ’somehow lost the ability to breathe early on the morning of April 15. For at least half an hour her brain was starved for oxygen, as a result of which large parts of it — particularly the higher centre that gives meaning to life — died. She has been in what brain specialists call a “persistent vegetative state” ever since.

She can do nothing for herself and cannot communicate with the outside world. Lying in intensive care in St Clare’s Hospital. Denville, in New Jersey, doctors and nurses have fought infectious disease.

As one medical witness put it, an intensive-care unit is full of germs because it is chronically full of very sick people. There is no practical way to isolate Miss Quinlan from germs. She cannot be isolated in a superclean single room because she needs the equipment and round-the-clock care that only intensive care offers. Her bladder has been catheterised to draw off the urine that her body secretes. A tube runs down her throat into her stomach to carry highnutrient liquid food. Other tubes furnish liquids to keep her body’s electrolytic balance at a satisfactory level. Almost continually she is given antibiotics intravenously to stem infections that could gain a foothold by way of the instruments and tubes penetrating her body. The most persistent immediate threat to Karen is infection. She is reported to have had repeated bouts of severe infectious illness that only vigorous medical mea-

sures and constant vigilance’ have licked. Probably one of the other big dangers facing her comes ; from the very tube that is giving her life — the air supply from the respirator. As one physician explained : it, there is the danger that this tube, touching the interior surface of her trachea, or windpipe, as she breathes and moves aimlessly in coma, will wear a hole in : the trachea. ; This not only would interfere with her breathing and

’cause bleeding that could be difficult to staunch, but it also ! could open another avenue of infection, this time from bacteria normally present in the oesophagus, or gullet, only a fraction of an inch away. Every muscle in Miss Quinlan’s body is contorted and wasting away. Blood samples show high levels of enzymes, which, one doctor said, can mean only that her muscles are dissolving slowly. But for all this, specialists who examined her prior to

the trial said last week she is in “remarkably good” condition.

Her heart is apparently strong, and the care nurses lavish on her has kept bedsores to a minimum.

This is remarkable because Miss Quinlan is now little more than skin and bones, and though she is unconscious she is not immobile. Her almost constant reflex motions cause skin sores, that, if not carefully attended to, would mean additional trouble. Little is known about what caused her unconsciousness. Oddly, no-one has been called (as a witness who is known to have been with her when she stopped breathing.

But since she has been in St Clare’s, medical experts have testified, her medical history has been impeccable. The notes of doctors and nurses reflect clearly what has happened to her in the last six months.

“Especially the nurses’ notes,” one witness said. “Besides, thev are a lot more legible than the doctors’.”