RIP, Joan. You blazed the way for many.

Isn't that tragic. That's too bad.....
Apparently her surgery that she had done on her throat is being investigated.

There will never be another Joan Rivers. RIP

I never cared for Joan's style of humour, which was too often nasty and demeaning, in my opinion. But I am very sorry to hear of her death, as she was still very lively, and might have survived for a number of years, if not for whatever caused her heart and lungs to stop, during the endoscopy.

I'm sure they will not only investigate the clinic to see if anything was done wrong, but also do an autopsy to ascertain if she perhaps had an unexpected reaction to the throat anesthetic used, or had an unknown heart problem.
My thoughts and prayers are with her family and friends.

My all-time favorite Joan Rivers quote:

"If God had meant us to exercise He would have put diamonds on the floor."

As hard as she was on others, she was hardest on herself. In her club acts, which were very blue, she dismantled herself.

An item I find interesting - Joan and Prince Charles were very close friends. Difficult to picture!

I thought Joan was a bit mean spirited. I did admire her spunk and she was a very smart business person. Maybe the adverse reaction to the surgery was a blessing in disguise. Joan would not have wanted to waste away in a chair or bed. These last few days gave her daughter a chance to say goodbye. I hope Melissa and her son are able to find some peace.

Very sorry to hear this. Her humor wasn't for everyone, but she paved the way for so many. RIP Joan!

Thank goodness somebody finally took the poor woman out of the ICU and removed life support! What has it been -- a week -- since her heart stopped and she stopped breathing during the throat procedure?

I also thought that she was mean spirited, but I have been praying for her this past week, and am sorry to hear of her passing.

I heard her say today there was nothing she wouldn't make a joke of because if we can laugh at it we can deal with it. I do not think she was mean spirited at all. I think she was blunt, and many people misinterpret bluntness.
Elective surgery killed her. That is SAD.
I read that bodily bucking, resisting invasive throat scopes and such is not unusual. It is protection for the lungs--gag reflex type reaction. She fought against it HARD and it killed her.
I liked her older work. I was not a fan of all her plastic surgery and work since her husband killed himself. There is no arguing she was a women who opened may doors for other women.

Not sure I'd call her mean-spirited, but she told her stories/jokes usually at the expense of the person who was the but of her 'joke/story'. Very Don Rickles-ish, and I didn't happen to appreciate or find him funny either!

RIP Joan,
Kathi

Chisue, it takes a lot of time to do the several brain scans that need to be done to determine brain death. It also takes time for the family to adjust, which is why it has been days. Because I can guarantee you that is what occurred in this case. It takes several minutes to cardiac arrest after a respiratory arrest and by that time there has been too much hypoxia to the brain (lack of oxygen). I knew when I first heard about this incident that this would be the outcome, which is why I said somebody screwed up. My question is who was doing the anesthesia? Was it an anesthesiologist, a nurse anesthetist, or just a nurse. If propofol is used in my state, it must be administered by an anesthesiologist or CRNA, but I don't know NY law. Whoever administered the drug was not vigilant and was negligent, IMO.

I really liked Joan Rivers and I am saddened by her death. I thought she was a funny, funny lady and I loved watching fashion police. She made me cringe sometimes, but always laugh. I think she forged a difficult and trailblazing path throughout her career and overcame the sexism that is the entertainment industry. I'm sorry she felt the need to undergo so much plastic surgery, but I understand the pressure she was under to maintain youth in a youth obsessed industry. I hope she can rest in peace, and that her family finds peace in her memory.

Exactly what Sleeperblues said - seen it a few times.

RIP Joan - you were one of the great comedians and you will be missed.

Your crass reviews on Fashion Police made me spit all over myself in laughter more than once - thanks for the daily laughs!

Have to agree with Sleeperblues too-knew when it was announced a week ago,that she was "finished"

RIP Joan....sincerest sympathies to her family.

I really liked Joan Rivers. God bless her soul. And God bless her daughter and grandson that they can eventually find peace from their grief.

So tragic that Melissa had to lose her father to suicide and now this, another unusual death. I hope the M.E, finds that she had a fatal heart attack. Admired her so much, she helped so many people get their start and gave me wonderful laughs.

Thanks, Sleeperblues. Surely it doesn't take a week to know with certainty that a patient in her condition is not coming back -- and the ICU is medically inappropriate. I hope no one who needed an ICU bed during that week went without.

Yes, it does take that amount of time and the patient is on life support so an ICU is essential. These are usually critically ill patients on multiple medication drips with multiple IVs and central lines. One on one nursing. Sometimes arrangements are being made to donate tissues and organs. This all takes time.

Thanks, you are a wonderful resource! I had no idea this could be so prolonged. Will my list of no-no's* protect me (and my family's inheritance) from a week in the ICU if I have no heart beat and am not breathing? Wouldn't I be *dead*?

*No intubation, no nutrients or hydration, no dialysis.

When they said they put her "on life support" I thought that was the step before "pulling the plug", death. Sorry to hear of her passing, does anyone survive, normally or at all, once they are put on "life support"? (excuse my ignorance if it's a survivable situation)

Yes, Sue - if you have a notorized DNR in your file at your doctor's office AND in your chart at the hospital and your MPOA has a copy at hand, you will not be resuscitated nor put on life support.

You also need a copy in your purse and car glove box, so anyone will be aware of your wishes. I even have one in my attorney's office file.

There was a photo of her with her 2 Pekinese dogs on facebook;
the article said that she was a dog lover & was active in rescue work.

a nice insight into a warm aspect of her character.

I just saw one of the charities listed in lieu of flowers is a dogs for the blind organization.

Yes, as Kay says, an advanced directive will save you from this if those are your wishes. The term life support means basically intubation and ventilator and IV fluids (sometimes blood pressure supporting medications) to put it simply. If you were in a car accident and you could survive the injury but needed surgery or some time to heal and were placed on "life support" that would be done. If it was determined that you had irreversible brain damage and could be kept alive but without quality of life, then your family could use your advance directives and take you off of life support. I hope that explains it without muddling it.

I wish this was more readily available 'general knowledge'. This is a little complicated, but hardly 'rocket science', and you really want to know your choices *in advance*.

How long does it take to make the determination about irreversible brain damage? I can see my DH brandishing the DNR if we already know my life is ending soon due to a diagnosed condition. However, if I'm still relatively healthy, but (as you say) am seriously injured...would it take more than 24 hours to determine that "Sue" isn't going to make it? How long is too long to just keep a body going? In a situation where there is no family, is there a medical protocol about this?

I don't know if Joan had advance directives, but it does take time. I haven't been an ICU nurse for over 20 years now, and this isn't something we deal with in my current anesthesia career so I may need some help out there from those in critical care. But when I was working there needed to be 3 EEGs that showed brain death, or otherwise irrefutable evidence that the person couldn't survive with their injuries but could be "kept alive". Older people would generally not survive due to co-morbidities but young healthy folks (which a lot of trauma patients are) would. If your brain is intact, there usually is no danger of "having the plug pulled", no matter your age. Not sure about those without families, I'm sure there would be ethics meetings and such. Nothing happens fast when determining to let someone die, which is as it should be.

Thanks. I'm less worried about being 'unplugged' than kept 'alive' when "Sue" is not coming back.

Pekemom, my Mom was on life support 3 times when she was trying to overcome an illness. She would get better, and breathe on her own and would be put into a regular room.

Something would go awry and she would end up in CCU (Critical Care Unit). At one time a woman who deals in trauma or helping the family deal with it, came in to counsel us about pulling the plug. Mom was awake but couldn't speak because of the ventilator. It was her decision. She (and us) decided not to go that route, and lo and behold she got better and once again was in a regular room, eating regular meals.

Her mind was never diminished at all, neither was her spirit.
Eventually, after being in the hospital for 8 months, her body did give up.

Thank you jasdip, for answering my question...I'm glad to hear that there is some hope for those on life support.

Yes, Sue - if you have a notorized DNR in your file at your doctor's office AND in your chart at the hospital and your MPOA has a copy at hand, you will not be resuscitated nor put on life support.

You also need a copy in your purse and car glove box, so anyone will be aware of your wishes. I even have one in my attorney's office file.

When I had a colonoscopy at one of these outpatient procedure offices, their paperwork said that they would resuscitate the patient and take all steps to keep him alive despite any DNR notices. I remember this because I wondered why anyone with a DNR in place would have these types of procedures.

graywings - do you mean you wonder why an ordinary Joe-Blow who happens to have a DNR in place would have a colonoscopy done? They're not just done for cancer or some other hideous disease that makes people die. The person could be going in to have polyps or tumors removed, etc. But if they 'happen' to need life support during the procedure, usually the DNR kicks in. It may just be that this particular doctor is against DNRs (think Hippocratic Oath) and will try everything in his power to keep the patient alive. At that point I think I would find another doctor who would be able to carry out the DNR if it was the patient's wish.

You have to understand, Joan was not just placed on life support when she entered the hospital. When she was first brought in she was placed into a medically induced coma. That automatically requires supportive care.

It was thought the coma offered the best chance for her body to heal itself, if at all possible. While she was in the coma, there's no question that ICU care is necessary.

The process of lifting the coma is done in stages and done slowly. At first there were signs that her brain was functioning. She did respond to a few simple commands.

Tuesday the process was complete. At that point was when she was moved out of ICU. She never really woke and they knew she would not recover any further. She certainly did take someone else's bed in an ICU. And she didn't overstay her welcome.

There seems to be an implication that she got preferential treatment. This was the same hospital that gave over an entire floor to Beyonce when she had her baby. These patients pay cash. No hospital can turn it's back on cash payments.paying. Reimbursement is all too low for the average patient.

Having a DNR doesn't mean that you don't want to live:
If you stop breathing during colonoscopy, you're neither terminally ill nor brain dead.
You're probably having a bad reaction to the drugs.

horrifying to think that someone would die because of a drug reaction which could be countered.

Yarnlover -- Thank you for the 'play by play'. I can see why it took a week due to the induced coma. I also assumed that a 'paying customer' could have whatever was wanted, and that Rivers was exactly that. No surprise.

I guess I'll never know what the medical protocol would be for "Just Anybody" as to when efforts cease.

One of the posters on the KT related that he was whisked out of *hospice* by his MD to spend days in an ICU after a blood test was bad. REALLY? This is just what I want to avoid IF and WHEN I am TERMINAL. (Not before, and certainly not during routine colonoscopy.)

Probably time to 'pull the plug' on my increasingly OT posts! Thanks, all!

Sue, you have a right to understand your human rights, so don't hesitate to ask questions.

As for your statement 'I guess I'll never know what the medical protocol would be for "Just Anybody" as to when efforts cease."

In any questionable life support scenerio, an medical ethics committee will convene and make the decision of whether or not and when to remove life support. The medical staff is under no obligation to provide ventilation for a proven mid-brain-dead patient. There is no such thing as 'half dead' - a patient's mid-brain is either working or it's not - the patient is either treatable or he/she is not. With mid-brain death, cardiac death comes quickly. It makes no difference if they have financial means or not - the patient will be taken off life support.

^^ Not necessarily, the Jahi McMath situation being a case in point. The girl is brain-dead and has been on life-support since post-surgery complications back in January. She was declared completely brain-dead and deceased by various doctors and the hospital. But the mother managed to get her way through legal channels and the girl is still on life support. Even though one of the doctors testified the girl's brain had not received any oxygen for well over two weeks and there was absolutely zero chance for recovery.

There are extenuating circumstances for every rule. I can be confident in stating that if a treatable patient is in need of the ICU bed and equipment,Ms. McMath will be taken off the ventilator. I worked in the various disciplines of a hospital for several years and that's how it worked back in my days working in the hospital. Maybe the 'rules' have changed since I've been out of the field, but I don't believe they have.

^^ Sorry, in my previous reply I should have clarified I was referring to your last sentence that the patient will be taken off life support if they are brain-dead. Apparently, if the family is willing to go through legal channels, they can prevent removal from life support even if the patient is legally dead and has no chance for recovery.

This post was edited by petra on Sun, Sep 7, 14 at 18:28