A day after winning the three-week battle to take their brain-dead daughter from Children's Hospital Oakland, the family of Jahi McMath conceded Monday they are losing the ghastly war against nature.
Her body, checked in at an undisclosed care facility Monday morning, has deteriorated so badly, that "Right now, we don't know if she's going to make it," said attorney Christopher Dolan.
"She's in very bad shape," he said. "What I can tell you is that those examinations show that her medical condition, separate from the brain issue, is not good."
Dolan's frank and sober assessment echoes a Friday legal declaration by Children's Hospital Oakland critical care pediatrician Dr. Heidi R. Flori, who opposed surgical insertion of a feeding tube because the girl's body was deteriorating.
Brain-dead for 25 days, Jahi has been sustained under court order with a breathing machine and other medical interventions since complications arose after surgery to remove her tonsils and other tissue.
Until Monday, she had gone without nourishment because the hospital had diagnosed her as legally and medically dead. Dolan said Monday that Jahi is now receiving potassium, minerals and hormones through an IV, in addition to antibiotics.
But even the best medical tools cannot replace the brain's role in regulating the critical balance of essential hormones, immunity and other chemicals, said Dr. Neal E. Slatkin, a neurologist and chief medical officer at San Jose's Hospice Of The Valley.
"The brain controls pretty much everything in the body," Slatkin said. "Without it, everything begins to break down."
A 2000 study by Harvard transplant surgeons, who closely examined donated organs after death, details the changes that occur after brain death, ranging from heart failure to diabetes.
"The insult" of brain death "evokes profound physiological and structural derangements in the peripheral organs," concluded Dr. Martin Gasser and his team in an Annals of Transplantation paper. Blood and other infections are likely, they wrote.
What happened to Jahi -- unlike the highly publicized cases involving coma patients Terri Schiavo and Karen Ann Quinlan, who each lingered for more than a decade -- was more than damage to the intellectual and emotional part of her brain, filled with mystery and memories and thoughts.
She has also lost the far more fundamental part of her brain, the brain stem, which plays a primal role in day-to-day health, regulating the interplay of the heart, lungs and other organs.
Both Schiavo and Quinlan had intact brain stems that maintained their physical being. Jahi does not.
There are two major ways that Jahi's brain death -- likely caused by catastrophic bleeding, brain swelling and heart attack, based on family reports -- damages the organs, according to Slatkin and other physicians.
One is the trauma of the initial injury, called a "sympathetic storm," which triggers a massive stress response -- flooding the bloodstream with chemicals and likely damaging the hypothalamus, a small area at the top of the brain stem that regulates body temperature, appetite and the release of many important hormones.
The other is the cascade of later complications, like when a computer crashes. Cellular metabolism goes haywire. So do cardiac and lung function. There is often severe hypertension and imbalances of important regulatory hormones.
Even heroic efforts to sustain her, such as a ventilator, can backfire, said Slatkin.
"You're applying abnormal pressure to keep the lungs open and functioning, which creates small tears in the lining of the air sacs and bronchial tree, opening up the possibility of infection."
Every cell in the body is programmed to die, he noted. But the assault of stress hormones, immune dysfunction and massive inflammation accelerates death, he said.
In her court declaration, Children's Hospital Oakland pediatrician Flori laid out the clear indications that Jahi's body was deteriorating. The tissues under her skin were losing their elasticity, and her muscles were contracting. Her blood pressure spiked but was gradually declining. Blankets were needed to maintain a constant temperature.
"This deterioration became inevitable the moment she died," Flori said. "Additional and more dramatic signs of the body's deterioration will continue to manifest over time, regardless of any procedures and regardless of any heroic measures that any facility might attempt."
There's no good data to suggest how long her heart will keep beating. In two other cases involving brain-dead but otherwise healthy young women -- 34-year-old Stacy Rojas, of Dallas, and Christine Bolden, 26, of Detroit -- their bodies were successfully supported for a month, until their babies were born.
To support the body that they fought so hard to save, Jahi's family has authorized some nutritional support, including potassium, minerals and hormones. She's also getting antibiotics to combat a possible infection.
But she's not receiving regular feedings due to physical problems that do not allow surgical insertion of a feeding tube, Dolan said. He would not disclose what those issues were but said Jahi was being examined by medical staff at the new facility. He would not disclose its name.
Alameda County Sheriff's Sgt. J.D. Nelson said that while he does not know where Jahi was relocated, it was his understanding that she was taken out of the state. Nelson noted that the autopsy will be required to complete the existing death certificate, and added that Jahi's cause of death will be more difficult to determine the longer her body is kept on a ventilator.
Relieved that she is now "safely where she needs to be," Jahi's family believes she is still alive, uncle Omari Sealey said Monday.
"We're not going to play God," he said. "If her heart stops beating while she's hooked to the ventilator, we can accept that."
Staff writers Rick Hurd, Natalie Neysa Alund and Erin Ivie contributed to this report. Contact Lisa M. Krieger at 650-492-4098.