I was sorry to hear the news about comedian Joan Rivers passing away last Thursday. However, I wasn’t the least bit surprised after hearing about what had happened to her a week earlier at a doctor’s office. Some people seemed to have been caught off guard by her death, but they shouldn’t have been. There are two major reasons for that. First, many Americans are quite ignorant when it comes to medical issues. Second, the details of what happened to Ms. Rivers and the condition that she went into immediately thereafter were never fully explained.
All we could get was that she experienced some kind of complication during a medical procedure at a doctor’s office, and had to be hospitalized because of it. Then we heard that she was in critical condition and later we were told that she was in stable condition but that her situation was still serious. We also heard reports that she had been put into a medically induced coma and that the doctors were later trying to bring her out of it and wake her up. In addition, it was reported that she was put on life support several days after being admitted to the hospital. Then, the day before she died, we heard that she was moved out of ICU and into a private room. I’m not a doctor and I don’t play one on TV, but I have been around medical situations similar to hers often to enough to have been able to piece together and reconstruct what likely happened to her at her doctor’s office and shortly after being rushed to the hospital.
It was told that Joan Rivers had some kind of endoscopic outpatient procedure at her doctor’s office during which she stopped breathing. From what I can gather, it probably involved placing some kind of tube with a small camera in it down her throat in order for the doctor to view her vocal cords. More than likely, it was not the procedure itself that caused her to stop breathing and go into cardiac arrest, but rather the anesthesia that was administered to her. This anesthesia either put her into a heavily sedated state or caused her to completely lose consciousness (the latter of which is referred to as a general anesthetic).
One of the risks of a general anesthetic, especially for older people like Ms. Rivers, is that it can cause a person to go into respiratory and/or cardiac arrest. That’s why it’s usually done at a hospital setting where a ventilator and a crash cart are in place just in case something goes wrong. Conversely, that doctor’s office where Ms. Rivers had her procedure done did not seem to be prepared for such an eventuality. Therein lies the problem. That doctor and his nurses were unable to get Ms. Rivers’ heart beating again. They had to call the EMT’s to rush her to the hospital, where the ER doctors were finally able to resuscitate her.
By that time, however, too much precious time had gone by. When a person goes into cardiac arrest and their heart is not restarted within five minutes, their brain and other vital organs will incur irreversible damage due to the lack of oxygen. With that kind of damage, a person will either suffer brain death shortly thereafter or enter into a persistent vegetative state (a kind of permanent coma). When brain death occurs, a person is dead, so life support at that point is futile. Very often, however, life support is required for a person to continue to live when they are in a persistent vegetative state, due to their limited brain activity. That was likely the case for Ms. Rivers. When she was moved out of the ICU and into a private room on Wednesday, it was not because her condition had improved. Rather it was probably because daughter, Melissa, had agreed to have her removed from life support, knowing that her mother would not have wanted to be kept alive with no chance of ever regaining consciousness. Within 24 hours, she was gone.