Florida neurologist: Terri's no vegetable
Doctor for state's adult protective services finds Schiavo has been wrongly diagnosed
World Net Daily | March 24, 2005
By Joseph FarahAn 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."
