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The Case of Theresa Schiavo

An order was already in place authorizing the removal of the feeding tube; from the point of view of the Schindlers, the move to a hospice facility, for which insurance eligibility requires certification by a doctor that the patient has only six months to live and in which the patient relinquishes all treatment other than that for pain, could be meant only to facilitate that order. The Schindlers had asked the court to order their daughter returned to a nursing home; then, after Michael Schiavo agreed to notify them if he decided to withhold treatment, they withdrew the request. In fact Michael Schiavo had tried to withhold treatment for an infection as early as 1994. The Schindlers tried to remove his guardianship, their main legal recourse throughout. (“When you made the decision that you were not going to treat Terri’s infection, and you were going to, in effect, allow her to die, did you think that you had any obligations to tell her parents?” he was asked during a deposition for one such guardianship action. “To answer that question,” he said, “I probably would have let them know sooner or later.”) In this instance, the nursing home had overruled his instructions to withhold treatment. The Schindlers had dropped their petition.

None of this is surprising. What happened to Theresa Schiavo is the kind of accident that breaks families in every possible sense. Were a novel to be written about the situation we would expect it to turn on the years during which an immature wife and her equally young husband were to one degree or another supported by the wife’s parents. “Control issues” would be mentioned, and in fact they were: it was said that Michael Schiavo’s need for control was such that he kept track of the mileage on Theresa’s Toyota Celica. An insensitivity to the disposition of the absent wife’s most sentimental property would be cited, and it was: asked during a 1993 deposition what he had done with Theresa’s jewelry, Michael Schiavo, astonishingly, said this: “Um, I think I took her engagement ring and her…what do they call it…diamond wedding band and made a ring for myself.” Marital unhappiness would be alleged, and it was: Bobby Schindler, according to The New York Times, said that his sister had taken him into the bathroom of a restaurant one night and broken down in tears. “She said her marriage was falling apart, but she didn’t have the guts to divorce him.” A friend with whom Theresa worked at the Prudential, Jackie Rhodes, was reported by The Washington Post to have spoken to an unhappy Theresa on the day that preceded the 911 call. From the Post:

The last time she spoke to Terri, Rhodes says, she had just gone to get her hair done. Terri was toying with going back to her natural color, so Rhodes called that Saturday to ask what she had decided. Terri, Rhodes said, was in tears; she and Michael had had a fight over the cost of the salon visit.

In the bright light shed by family disaster, few marriages look good. Old resentments swamp any possibilities for empathy. All parties look for an explanation, someone to blame. In this particular family disaster the opportunities for blame got magnified, blown up not only by the Internet postings and e-mail alerts of conservative action groups (among those adopting the case as their own were National Right to Life, Focus on the Family, the Family Research Council, the Traditional Values Coalition, and Operation Rescue) but by the counterreaction to those efforts. Allegations got made from which there was no turning back. Calls got made to the Florida Department of Children and Families, which investigated eighty-nine complaints dating back to 2001 (including one that Theresa Schiavo’s parents were selling videotapes of her on-line for $100) and found no evidence that she had been or was being abused or exploited by either her parents or her husband.

Accusation was nonetheless the air all parties were by then breathing. There were the frequently repeated suggestions circulating on the Internet (based on what, it was hard to say) that the paramedics responding to the initial 911 call had thought the circumstances “suspicious,” that the police had been notified, and that the police records had been suppressed. In fact the routine incident report of the St. Petersburg police noted that “the police were called because of her age and because the situation seemed unusual” but that “there were no signs of a struggle or anything that would indicate that a crime had been committed,” that no illegal drugs and only trace amounts of alcohol had been detected in Theresa Schiavo’s system, and that examination of her head and face showed “no signs of trauma.”

There were the suggestions having to do a 1991 bone scan done on Theresa Schiavo at Manatee Memorial Hospital in Bradenton, Florida, a year after the cardiac arrest. The scan had been ordered by James Carnahan, M.D., a rehabilitation physician who saw patients at the Mediplex Rehabilitation Center in Bradenton, where Theresa Schiavo, then at Mediplex, was said to be expressing unexplained pain during physical therapy. The report on this scan had been dictated by William Campbell Walker, M.D., a radiologist at Manatee Memorial who later testified in a deposition taken for a 2003 hearing. He was asked what the words meant that appeared below the date on the scan report: “Indication: Evaluate for trauma.”

A: Well, in the best of all possible worlds when we are asked to produce an imaging study, there’s a question that’s been asked for which we are being asked to provide an answer…. So if somebody comes in with a history that says “Closed head injury,” belongs to Dr. Carnahan, for example, who’s a known rehab doc, and the indication that was given us is “evaluate for trauma,” then our mind-set is to look for those things that are most likely related to trauma and to possibly give some additional possibilities if we don’t see something that fits what we expect.

The scan, according to Dr. Walker, did show extensive evidence of the kind of remineralization that indicates previous trauma. Among the affected areas were several ribs, both knees (the 1990 discharge summary from Humana Northside notes a “right knee fusion” that “she developed after she was transferred to the Progressive Care Unit”), both ankles, what appeared to be a previous bone bruise on the upper front of her right leg, and a compression fracture of her spine.

Q: Is there any way to tell how old that fracture would be?

A: Well, as I’ve alluded to, the bone scan gives some suggestion of that.

Q: More recent rather than less recent?

A: Correct. Typically in trauma the rule of thumb is that a traumatic fracture is not active on a bone scan after 12 to 18 months…. Now, bodies being very variable, there’s a lot of variation there, but that’s the typical rule of thumb. So if a fracture shows up active on the bone scan, then one makes the presumption that it is relatively recent; i.e., within 18 months….

Q: The report goes on to say, “The presumption is that the other multiple areas of abnormal activity also relate to previous trauma.”

A: That’s what it says.

Q: And, again, that relates to the fact that Dr. Carnahan is a rehab physician, that you were asked to evaluate for trauma?

A: And the pattern of activity is fairly typical of multiple traumatic injuries of relatively recent origin.

Q: I realize you can’t assign a cause to these injuries that you picked up in this report. But typically in your experience, what would be the causes of this pattern of abnormality?

A: In somebody her age, an auto accident is by far the most typical cause.

Q: Assume that she was not in an auto accident but that she had suffered an anoxic or hypoxic encephalopathy type of injury from a cardiac arrest and had been bedridden for a year at this point. What might account for these abnormalities?

A: In my knowledge, that type of injury would not account for this pattern of abnormalities.

George J. Felos, the Florida attorney to whom Michael Schiavo turned for representation in this matter, was not perhaps the ideal personality to locate some common ground on which both his client and the Schindlers could stand. At the time when he fell into the first of what he called his “right to die” cases, in the late 1980s, George Felos was at a point when, he wrote in his 2002 Litigation as Spiritual Practice,

…I found clients, at best, an unwelcome distraction from my all-consuming spiritual practice. Each morning I eagerly awoke at four-thirty for three or four hours of yoga and meditation. The office felt painfully mundane to me and for good parts of the day there I would devour scripture. At home, after making dinner and putting my son down for the night, I would consume spiritual books of every sort and persuasion, then practice more yoga and meditation before bed. I considered most talk, other than of God and Spirit, inconsequential.

For anyone living with me this would have been more oppressive had it not been for the deep passion and transformative energy that was expressing itself through me.

The case that seemed to at least channel if not exactly dispel this mood involved a client, Doris Herbert, who was the guardian of and sole heir to a stroke-damaged cousin, Estelle Browning. Mrs. Browning was being kept alive in a nursing home via a nasogastric feeding tube. Mrs. Herbert, in accordance with the wishes expressed in a “living will” signed by Mrs. Browning before her stroke, wanted the feeding tube removed. Florida at that time permitted the termination of feeding only for patients who were either facing imminent death or in an irreversible coma or vegetative state. Mrs. Browning was neither. Felos tells us that before taking the case he hesitated (“We would never absolutely know if Mrs. Browning indeed retained, underneath that impaired exterior, cognizance of her dilemma. Did I want the responsibility of implementing a choice that perhaps was no longer hers?”), but finally agreed to see Mrs. Browning at the nursing home.

His description of what he saw there might seem, to anyone who has actually observed tube feeding, on the lurid side. There was the “plastic sack half filled with sickly beige-looking fluid,” not the “homogenized ham sandwich” the lawyer feared we might mistakenly imagine when we heard the word “feeding” but “an amalgam of chemicals in a fluid delivery system registered as a drug with the FDA.” There was the plastic tube that “snaked down” from the sack into Mrs. Browning’s nose. There was the “unbearable” (in Mrs. Browning’s case hypothetical) discomfort. There were the “digestive and excretory problems” (also hypothetical) that could ensue, the “frequent vomiting.” There at the bedside he tried to meet Mrs. Browning’s blank gaze, waiting for “some sign.” No sign was forthcoming. Nonetheless he remained, “sensing that my question would somehow be answered before I departed.” In a chapter called “Soul-Speak,” he described what happened next:

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