The words covered in this article are overt, mediate, rescind, skepticism and skeptical, and volition and volitional. Previously done words that will reoccur today are cerebral and cessation.
Till the court case was going on, Jahi’s intensive-care unit stay at the Children’s Hospital in her home city of Oakland, California was being funded via Medicaid and came down to roughly a hundred and fifty thousand dollars per week.
Jahi’s family and lawyers found that there were two states in America that not only allowed people to reject brain death as the reason for declaring death but also required insurance providers to keep providing coverage to the patient in such cases. These states were New York and New Jersey. So, if Jahi could be moved to one of those states, Medicaid would have to continue funding her life-support treatment. The family’s lawyers found a long-term care facility in New Jersey that was willing to have Jahi.
To understand how big the decision to relocate Jahi was for her family, consider that New Jersey is on the east cost of America while California is on the west coast. It takes about 7 hours by flight, 70 hours by bus and 80 hours by train to cover the nearly three thousand miles distance between the two states. Jahi’s mother, Nailah, and stepfather, Mervin, shifted to New Jersey with her. Nailah arranged for her son to go live with his father and for her youngest daughter to move in with her aunt. Nailah also gave up her old job in Oakland and sold her house.
Though Jahi remained totally dependent on machines for her survival and her eyes were always closed and face, expressionless, her mother slowly started to notice some signs of consciousness in her. For example, Jahi’s heart rate lowered in response to Nailah’s voice or when soothing music was played by her bedside. She even responded overtly at times: when she was asked to move different body parts, the corresponding limb did move a few seconds later.
Overt
The adjective overt means open to view; not hidden or secret. If a person shows overt signs of depression, this means that just by looking at him (or talking to him), you can tell that he is feeling unhappy and rather low.
Nailah recorded and shared videos of Jahi’s overt responses. They attracted the attention of many brain researchers.
In due course, the teenage girl’s periods started. As the process of menstruation is mediated by the hypothalamus, a part of the brain, this event strongly suggested that Jahi’s brain was not completely dead.
Mediate
To mediate means to bring about by acting as the middle-agent or the connecting-link between two or more things. For example, a mediated contract is one that has been signed through the efforts of an intermediary (a middle agent, a go-between) who talked to both the parties and brought them to common ground. Without this mediator, the person in the middle, the contract would not have happened.
Therefore, the adjective mediated means: happening via an intermediary, not direct
Origin: Latin medius, ‘middle.’
The process of menstruation is mediated by the brain. This means that it cannot happen without the brain. The hypothalamus produces a hormone – let’s call it G – that activates the pituitary gland to produce two hormones, labelled here as F and L. The F and L hormones, in their turn, stimulate the ovary to produce estrogen and progesterone, respectively. These two ovarian hormones are directly involved in ovulation and the menstrual cycle. Can they be produced if the hypothalamus does not produce G? No. But is the hypothalamus the main organ that is involved in menstruation? No, that is the ovary. The hypothalamus is an important character in the story, without whom the story simply cannot be, but it is not the star of the show. This is what we mean when we say that menstruation is mediated by the hypothalamus. Its role is like that of a mediator in a mediated contract: if this person was not there the contract could not have come about, but the leading characters of the show remain the two parties who are entering into the contract.
If Jahi could menstruate, her hypothalamus must be doing its job; she could not be completely brain-dead! Some well-respected neurologists visited Jahi and took her brain MRI scans.
If the original diagnosis of brain death was correct, then how should her brain images have been? Let’s see.
A brain-dead person, by definition, has no cerebral blood flow. If blood flow to the brain stops for even a few minutes, neurons get damaged irreversibly, and if it remains stopped for 30 minutes, neurons all across the brain are completely destroyed. Jahi’s scans were being done many months after the supposedly complete cessation of cerebral blood flow. So, the scans should have shown nothing more than a squishy mix of fluid and dead tissue.
Instead, what they showed was that, though parts of the brain were indeed nearly destroyed, a large part of her cerebrum was structurally intact. This could only have happened if blood flow had continued to the brain all these months, which in turn meant that Jahi had not been brain-dead even when the initial tests were conducted in December 2013; the blood flow to her brain may have been too faint to be detected by the brain tests that had were conducted then, but it had not been zero.
Submitting the findings of the brain researchers to the state of California, Jahi’s lawyers asked for her death certificate to be rescinded so that the family could return to their home and continue Jahi’s care there. The request was rejected.
Rescind
To rescind means to take back, to declare null and void.
In the new brain scans, large parts of Jahi’s cerebrum were found to be still intact; this finding helped explain why Jahi could understand the instructions of her mother and respond to them. The cerebrum mediates consciousness, language, and voluntary movements. Her severe brain damage may have rendered her mostly incapable of overt communication, but she still was conscious for at least a few hours each week.
I will soon quote D. Alan Shewmon, one of the neurologists who studied Jahi, but before that, here are the GRE words that you’ll encounter in that quote:
Skepticism
Skepticism means a doubting or questioning attitude towards facts, persons, religion or institutions. If you are skeptical about somebody’s claim, you do not accept it at face value; you are not sure that the person is speaking the truth.
Volitional
The noun volition means free will. So, the adjective volitional means done or chosen by free will, by conscious choice; voluntary. A volitional movement is one that you choose to do; examples of such movement are raising your arm or getting up from the chair and walking. On the opposite pole are non-volitional movements, which are outside of our conscious control. Beating of the heart is one such movement.
Here is what neurologist D. Alan Shewmon said about Jahi’s case:
“From the start, I followed the case of Jahi McMath with great interest. . . In 2014, her family reported that she sometimes responded to simple motor commands. I shared the general skepticism regarding these reports, assuming that the family was in denial and was misinterpreting spinal myoclonus (a rapid, involuntary twitch generated by the spinal cord) as volitional. The family had noticed that when Jahi’s heart rate was above eighty beats per minute, she was more likely to respond, as though the heart rate reflected some sort of inner level of arousal. So they began to make video recordings. I have been privileged to be entrusted with copies of these recordings . . . All have been certified by a forensic video expert as unaltered. The first thing that struck me was that the great majority of the alleged responses were not spinal myoclonus. . .
Some videos seem to demonstrate a surprising degree of comprehension. For example: extending the thumb upward after previously flexing it and being told to move it up instead; or making a stronger repeat arm movement when told to “move it harder”; or, after a previous motor response when the digits and hand remained tense, relaxing them quickly upon being told to relax them; or moving the middle finger consistently when asked which is the “eff you” finger . . .These demonstrations were not cherry-picked coincidences of spontaneous movements because such movements never occurred during baseline periods.
According to her mother, Jahi’s periods of responsiveness occurred on average about three times per week and lasted several minutes to half an hour at a time. It is therefore unlikely that she would have exhibited responsiveness during a randomly timed examination. When I examined her on December 2, 2014, she was in fact unresponsive to commands; she also exhibited no brain-stem reflexes and did not breathe over the ventilator or during twenty seconds off it. . .
Based on the compelling video evidence and the gross structural preservation of her brain in the 2014 MRI scan, I am convinced that, from early 2014, Jahi McMath was in a ‘minimally conscious state.’”
The Case of Jahi McMath: A Neurologist’s View – Shewmon – 2018 – Hastings Center Report – Wiley Online Library
In 2018, four-and-a-half years after the tonsillectomy, Jahi had liver failure, which led to internal bleeding. When her doctors suggested multiple surgeries whose success was, however, doubtful, her mother sadly asked them to let Jahi go. She was removed from life support then, and her heart stopped.
Jahi McMath became a girl with two death certificates – one issued in 2014 by the state of California, and the other issued in 2018 by the state of New Jersey. For the time in-between, she had been dead in one state but alive in another.
The moving devotion with which Jahi’s family fought for her makes one wonder what love, courage and conviction they must have had!
Tomorrow, we will discuss different ways to define death. But for now, here are more usage examples of the words you learnt today:
- When Lata decided to purse painting instead of engineering, her father was disappointed but kept his feelings to himself, while her mother was overtly unhappy.
- A volunteer is one who steps forward to do a task out of his own volition, not because he is bound or forced to do it.
- Widespread protests by the people forced the king to rescind the new tax laws.
- There seemed to be no overt gender discrimination in the American society of the 1960s; this was not because gender equality had been achieved, but because no voices were raised against the hardships faced by American women. “Although 43 percent of women with school-age children worked, there were nursery schools for only 2 percent-the rest had to work things out themselves. Women were 50 percent of the voters-but (even by 1967) they held 4 percent of the state legislative seats, and 2 percent of the judgeships. The median income of the working woman was about one-third that of the man. And attitudes toward women did not seem to have changed much since the nineteen-twenties.” Quoted from ‘A people’s history of the United States,’ by Howard Zinn.
- With the loss of faith in big powers- business, government, religion -there arose a stronger belief in self. The experts in all fields were now looked at skeptically: the belief grew that people could figure out for themselves what to eat, how to live their lives, how to be healthy.
- When Jane Austen was nearly twenty-seven and already considered past marriageable age by most people, twenty-one-year-old Harris Bigg-Wither asked her to become his wife. He was the brother of very good female friends of hers and the heir to a large estate. She immediately consented and her family too was delighted by the news. She, who had been financially dependent on her brothers till then, would soon be married to a kind and decent man and be the mistress of a large estate! However, Jane knew she did not love Harris. Would it be right to marry without affection? After agonizing about it the whole night, she rescinded her acceptance the next morning.
- “Hollywood films about World War 2—and there were hundreds of them—offered a sanitized picture of the conflict. Whether of their own volition or in consultation with military officials, movie producers usually offered a [similar] narrative of the soldier [as]the government propaganda. In many “platoon films,” death came quickly and without blood and guts. Soldiers behaved courageously, missed home, and found maturity (rather than breakdown) through combat.” Adapted from a passage in the book The Unfinished Nation, by Alan Brinkley
- “The last years of Ronald Reagan’s presidency in the United States coincided with the first years of the Gorbachev regime in the USSR; while Reagan was skeptical of Gorbachev at first, he gradually became convinced that the Soviet leader was sincere in his desire for reform. In 1988, the two superpowers signed a treaty eliminating American and Soviet intermediate-range nuclear forces from Europe—the most significant arms control agreement of the nuclear age.” Taken from the book The Unfinished Nation, by Alan Brinkley
References
To learn more about Jahi’s story, read the article What does it mean to die? by Rachel Aviv, published in The New Yorker. This was the source I referred to most often when writing the Day 4 and Day 5 articles of the Vocab Program.