Neurologist, Mayo Clinic Lab Director: Terri Is No Vegetable

[MMMMMM]

He examined her yesterday.

"Florida neurologist:
Terri's no vegetable
Doctor for state's adult protective services finds Schiavo has been wrongly diagnosed
Posted: March 24, 2005
1:00 a.m. Eastern

By Joseph Farah
© 2005 WorldNetDaily.com


Dr. William Cheshire

An eminent neurologist who evaluated Terri Schiavo for the Florida state Department of Children and Families yesterday concluded she has been wrongly diagnosed as being in a persistent vegetative state and urges immediate removal to another facility and the restoration of food and water to the dying woman who has become the focal point of the nation's attention.

In his affidavit to the court, obtained by WorldNetDaily, Dr. William Polk Cheshire Jr. found Schiavo is aware of pain and reacts visibly to it. She also reacts to the expectation of pain based on conversations she overhears in her room.

"If Terri is consciously aware of pain, and therefore is capable of suffering, then her diagnosis of PVS may be tragically mistaken," he writes.

Florida Gov. Jeb Bush announced yesterday that Dr. Cheshire, Jr., as part of a DCF review team, had concluded that Schiavo might not be in a persistent vegetative state but rather in "a state of minimal consciousness." Bush said. "This new information raises serious concerns and warrants immediate action."

DCF Secretary Luci Hadi said that under state law the agency is authorized to intervene and have Schiavo's sustenance restored even without a court order.

But last night, Bush spokesman Jacob DiPietre said the administration had no plans to defy Greer's order.

Pinellas County Judge George Greer said he expected to have a final ruling on the case by noon today after reviewing the new evidence. He blocked an effort by DCF to rescue Schiavo.

"It is my understanding that nearly three years have passed since Terri has had the benefit of neurologic consultation," Dr. Cheshire wrote in his affidavit. "How then are we to be certain about her current neurologic status? There remain, in fact, huge uncertainties in regard to Terri's true neurologic status."

Dr. Cheshire is the director of a laboratory at the Mayo Clinic branch in Jacksonville that deals with unconscious reflexes like digestion.

Cheshire cited studies indicating a high rate of false initial diagnoses of PVS.

"Furthermore, the diagnosis of minimally conscious state had not yet become standard parlance in the field of neurology at the time of Terri's initial diagnosis," he wrote. "The minimally conscious state has emerged as a distinct diagnostic entity within the last few years."

Cheshire also pointed out that Schiavo has not undergone functional imaging studies, such as positron emission tomography, or PET, or functional magnetic resonance imagining, or fMRI.

"New facts have come to light in the last few years that should be weighed in the neurologic assessment of Terri Schiavo," he said. "Significant strides have been made in the scientific understanding of PVS and minimally conscious states since Terri last underwent neurologic evaluation. As usually happens with science, the newest evidence is prompting the medical community to think about this field in new ways. With new evidence comes fresh appreciation for what is actually happening in the brains of persons with profound cognitive impairment."

Cheshire said news studies show that when patients in a minimally conscious state listen to narratives read by a familiar person "large areas of the cerebral cortex normally involved in language recognition and processing lit up." He said the presence of metabolic activity in those brain cells was far more than expected.

He cited seven reasons to doubt the prior diagnosis of PVS in Terri Schiavo:

# He found her facial expression brightens and she smiles in response to the voice of familiar people such as her parents or her nurse. Her agitation subsides and her facial demeanor softens when quiet music is played. "When jubilant piano music is played, her face brightens, she lifts her eyebrows, smiles, and even laughs." Cheshire said several times he witnessed Schiavo laugh when someone in the room made a humorous comment.

# She fixates her gaze on colorful objects and human faces for up to 15 seconds at a time and occasionally follows with her eyes as objects move from side to side. "When I first walked into the room, she immediately turned her head toward me and looked directly at my face. There was a look of curiosity or expectation in her expression, and she maintained eye contact for about half a minute." Cheshire said she also appeared to attempt to speak to him.

# Although he did not hear her utter distinct words, the doctor said "she demonstrates emotional expressivity by her use of single syllable vocalizations and cooing sounds. In reviewing previous affidavits, he noted that as late as 2003, the patient was heard to tell nurses to "stop" during certain procedures.

# He noted that in a previous examination by a neurologist, the patient appeared to try to follow certain commands – such as closing her eyes. She also raised her right leg four times when asked to do so in 2002 under examination.

# In that same 2002 examination by a neurologist, captured on videotape, Schiavo was turned on her side and probed with a sharp piece of wood. She reacted with sounds of discomfort. After that procedure, the neurologist commented to her parents that they would have to roll her over on her other side. Schiavo vocalized a crying sound in response. "It is important to note that, at that moment, no one is touching Terri or causing actual pain," he writes. Rather, he says, she appears to comprehending what was said and anticipating pain.

# According to the definition of PVS, he writes, patients do not have the capacity to experience pain and suffering. Yet, he concludes, after reviewing her medical records, pain issues frequently arise. "The nurses at Woodside Hospice told us that she often has pain with menstrual cramps." The pain and agitation subside when she is given ibuprofen. "If Terri is consciously aware of pain, and therefore is capable of suffering, then her diagnosis of PVS may be tragically mistaken," he concludes.

# "To enter the room of Terri Schiavo is nothing like entering the room of a patient who is comatose or brain-dead or in some neurological sense no longer there," he writes. "Although Terri did not demonstrate during our 90-minute visit compelling evidence of verbalization, conscious awareness, or volitional behavior, yet the visitor has the distinct sense of the presence of a living human being who seems at some level to be aware of some things around her."

"As I looked at Terri, and she gazed directly back at me, I asked myself whether, if I were her attending physician, I could in good conscience withdraw her feeding and hydration," he wrote. "No, I could not. I could not withdraw life support if I were asked. I could not withhold life-sustaining nutrition and hydration from this beautiful lady whose face brightens in the presence of others."

Cheshire indicated he could see no reason to withdraw the sustenance.

"This situation differs fundamentally from end-of-life scenarios where it is appropriate to withdraw life-sustaining medical interventions that no longer benefit or are burdensome to patients in the terminal stages of illness," he wrote. "Terri's feeding tube is not a burden to her. It is not painful, is not infected, is not eroding her stomach lining or causing any medical complications. But for the decision to withdraw her feeding tube, Terri cannot be considered medically terminal. But for the withdrawal of food and water, she would not die."

On the basis of all of those findings, Dr. Cheshire concluded "it would be wrong to bring about her death by withdrawing food and water."

"At the time of this writing, Terri Schiavo, as the result of decisions based on what I have argued to be a faulty diagnosis of persistent vegetative state, has been without food or water for five days," he wrote. "She is at risk of death or serious injury unless the provision of food and water can be restored. Terri Schiavo lacks the capacity to consent to emergency protective services and must trust others to act on her behalf. If she were to be transferred to another facility, it would be medically necessary to initiate hydration and ensure that her serum electrolytes are within normal values."

Cheshire concluded: "How medicine and society choose to think about Terri Schiavo will influence what kind of people we will be as we evaluate and respond to the needs of the most vulnerable people among us. When serious doubts exist as to whether a cognitively impaired person is or is not consciously aware, even if these doubts cannot be conclusively resolved, it is better to err on the side of protecting vulnerable life."

http://www.worldnetdaily.com/news/ar...TICLE_ID=43470

[tanda]

This doctor has NOT evaluated Mrs. Schiavo. He has observed her which is but one part of a full examination and evaluation. He has conducted NO diagnostic testing.

He may be right, he may not. Each side has demonstrated that each can find experts to support their position, so this is old news. He is not the first expert to support the Schindler's position. No doubt Mr. Schiavo can find a new expert to support his position as well. And where does that leave us? Where we were a decade ago, dueling experts and positions.

A fact-finder reviewed the competing experts as well as other evidence and made a determination. If we do it again and the Schindler's lose, will they go away? I doubt it.

This case, like most contested cases that go to appeal, is about the losing side not be able to accept the results. At some point, the decision must be implemented and one side will be unhappy. Nothing can be done to prevent this.

[MMMMMM]

Did you read the whole article? The doctor points out that Terri has not been evaluated in the last few years, during which time new developments in the understanding of reduced or impaired states have taken place.

I think not having a current evaluation before killing her is criminal. What if she has improved since the last evaluation, years ago??? Still kill her???

The doctor also notes in Terri responses and behaviors which, if accurate, would be hard to reconcile with a true vegetative state.

As I posteds elsewhere, we really do not know what is going on in Terri's brain and mind. Based on what I've read about Terri, a "minimally aware state" seems a more likely description than a true vegetative state. But this should be further explored--and before killing her.

[Zygote]

please just give up.

your article tell qutie a different story than CNN.

Most importantly, the doctor NEVER examined terry. He watched a tape. Based on this, all his conclusions are unprofessional and irrelevant.

Just out of curiousity, do you think are court system is filled with a bunch of retards? The supreme just denied the case as well. No court will hear it becasuse the doubts have been settled and noone has raised a new reasnoble doubt about her condition that can even convince the courts for a re-trial. All of Cheshire's questions could easily hve been answered by past nuerologists. He hasn't seen terry or reviewed all her examinations. You don't think the court or any doctor before noticed she moves and reacts? You do'nt think they ever considered these doubts in diagnosing her? Lets assume she is PVS, does that change anything for you anyways? A lot of poeple complain that she has been misdiagnosed, but assuming she was correctly diagnosed, how would this change your opinion?

[sam h]

I haven't been following this story much and basically think it's an absurd and overblown piece of political theater. But for what its worth here is the Times' piece on this doctor.

A Diagnosis With a Dose of Religion
By JOHN SCHWARTZ and DENISE GRADY

Published: March 24, 2005


illiam P. Cheshire Jr., the Florida doctor cited by Gov. Jeb Bush yesterday in his announcement that he would intervene again in the case of Terri Schiavo, is a neurologist and bioethicist whose life and work have been guided by his religious beliefs.

Dr. Cheshire directs a laboratory at the Mayo Clinic branch in Jacksonville dealing with unconscious reflexes like digestion, and he is director of biotech ethics at the Center for Bioethics and Human Dignity, a nonprofit group founded by "more than a dozen leading Christian bioethicists," in the words of its Web site.

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In an article last year in Physician magazine, published by the evangelical group Focus on the Family, Dr. Cheshire, 44, said doctors are too quick to declare that a patient is in a persistent vegetative state.

"I'm not sure the diagnosis is used consistently," he told Physician. "I am sometimes asked if a patient is in P.V.S., but it's only been a few days. By definition, you have to wait at least a month."

Yesterday, in an affidavit supporting a petition by the Florida Department of Children and Families in the case, Dr. Cheshire said it was more likely that Ms. Schiavo was in a "minimally conscious state."

"Although Terri did not demonstrate during our 90-minute visit compelling evidence of verbalization, conscious awareness or volitional behavior," he wrote, "yet the visitor has the distinct sense of the presence of a living human being who seems at some level to be aware of some things around her."

Mr. Bush called Dr. Cheshire a "renowned neurologist," but he is not widely known in the neurology or bioethics fields. Asked about him, Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, replied, "Who?"

Dr. Cheshire, who graduated from Princeton and earned a medical degree at West Virginia University, did not return calls to the Mayo Clinic seeking comment. The clinic said in a statement that his work on the Schiavo case was not related to his work at the clinic and that the state had invited his opinion. "He observed the patient at her bedside and conducted an extensive review of her medical history but did not conduct an examination," the statement said.

Dr. Caplan said that was not good enough. "There is just no excuse for going in and making any pronouncement about the state that Terri Schiavo is in unless you're going to go in and do some form of technologically mediated scanning that would overturn what's on the record already," he said.

Dr. Ronald Cranford, a neurologist and medical ethicist at the University of Minnesota Medical School who has examined Ms. Schiavo on behalf of the Florida courts and declared her to be irredeemably brain-damaged, said, "I have no idea who this Cheshire is," and added: "He has to be bogus, a pro-life fanatic. You'll not find any credible neurologist or neurosurgeon to get involved at this point and say she's not vegetative."

He said there was no doubt that Ms. Schiavo was in a persistent vegetative state. "Her CAT scan shows massive shrinkage of the brain," he said. "Her EEG is flat - flat. There's no electrical activity coming from her brain."

Dr. Cheshire entered the field of bioethics relatively late in his career. A profile of him on the Web site of Trinity International University, where he enrolled in the master's program in bioethics in 2000, states that he was "searching for how he should integrate his faith with his medical career." After getting the degree, he became an adjunct professor of bioethics there.

A search of his publication record in the online medical library PubMed yielded articles in medical journals, with a focus on headache pain, in particular trigeminal neuralgia, a painful disorder originating in a cranial nerve called the trigeminal. None of the papers dealt with persistent vegetative states.

His papers show a fondness for puns, as in the title of a letter to The New England Journal of Medicine about a patient whose fillings caused an electrical current that made her condition worse: "The shocking tooth about trigeminal neuralgia."

He was also the author, with others from the Center for Bioethics and Human Dignity, of a paper opposing stem cell research.

The center's Web site notes that he and his wife and four children are members of the Episcopal Church of the Redeemer in Jacksonville and that he has done medical missionary work in Honduras and Siberia.

He has also written poetry, including "Exit Ramp," a poem about the movement to allow physician-assisted suicide that uses the metaphor of a highway off-ramp to warn of a different kind of slippery slope:


Such killing fast degenerates,
Despite concern for patients' best,
Into a plot that terminates
Without explicit prerequest.

[jaxmike]

[ QUOTE ]

your article tell qutie a different story than CNN.


[/ QUOTE ]

hence i think its much more reliable.

[Zygote]

[ QUOTE ]
What if she has improved since the last evaluation, years ago??? Still kill her???

[/ QUOTE ]

What if chris reeve improves since his last examination where they conlcuded he was dead? should we remove him from his grave?

my guess is he will never improve so the second question will never need to be answered. see the comparison?

[Zygote]

wat a stupid comment.

[MMMMMM]

Strange post, Zygote. Terri is still alive or did I miss something that happened in the last few hours?

[Zygote]

terry's body is still existant. terry, the person, is dead and is never coming back. if she is, then it is just as likely that chris reeve will arise from his grave. you can dream as much you want, but her brain tissue will not regrow.