Joan Rivers' daughter Melissa distraught as comedian remains in medically induced coma

I've always liked Joan Rivers and I hope and believe that she'll pull through this tragic situation.

I like Joan Rivers too. She is incredibly quick witted and totally irreverent.

I wish her and her family well.

What is a medically induced coma?

So basically what happens with a medically induced coma is that you take a drug and administer it until you see a certain pattern in the monitor that follows the patient's brain waves, the EEG [electroencephalogram]. Patients with brain injuries who are in a coma have a similar pattern. If that pattern is there, then you feel comfortable that the patient is in a drug-induced coma. You are doing it so that you can hopefully protect the brain.

What are you protecting the brain from?
If you've had a brain injury, what happens is the metabolism of the brain has been significantly altered. You may have areas without adequate blood flow. The idea is: "Let me reduce the amount of energy those different brain areas need." If I can do that then, as the brain heals and the swelling goes down, maybe those areas that were at risk can be protected.

But the main thing about a drug-induced coma, as opposed to a coma, is that it's reversible. If you do this to someone with a normal brain, they would come right out of it once you removed the drugs.

But it's used in the case of people with brain injuries. So what are the risks?
Speaking generally, the main effects that these drugs have outside the brain is they reduce blood pressure. So people trying to do this are giving a lot of other medicines to keep blood pressure up and keep the heart pumping in a nice way. You're protecting the brain on one hand and, on the other hand, all areas of the brain are not getting the blood they need necessarily.

If you do this for an extended period of time, the drugs can accumulate and it may take them a while to wash out of the system as well. As long as you're mindful of these things you can see someone through a period like this.

How long is that period?
It really depends on the injury, whether it's a brain injury or seizing. One patient was kept in [a drug-induced coma] for six months. Obviously, that's the tail end of the distribution.

It depends on how the person is progressing and the nature of the injury. What the neurologists or [intensive care unit] doctors do is try to have them come out as soon as possible. In a case like Gifford's they have swelling. If they see the swelling recede, then they may try to lighten up the coma to see if she can come back and see what her level of function is.

How safe are drug-induced comas?
A drug like propofol, we use this every day in the operating room. It is probably the most used drug in all of anesthesia. Every day essentially, when patients go under general anesthesia that whole state is a reversible coma. It's a difference in dosage.

How does a medically-induced coma differ from a natural coma?
The body doesn't usually decide to enter a coma. A coma is a profound shutdown of brain function. It typically results from profound trauma, brain injury, a drug overdose, stroke—some very gross insult. There isn't a natural analogue for [a medically induced coma].

Are there after effects?
It's hard to sort out, because if you're going to these extremes you're already dealing with a very dire situation. If there are effects later on, it's an extremely difficult distinction to make whether it is an effect of the drug-induced coma. People who do this are very mindful of watching and monitoring. They make every effort to only use this option for as long as they need to.

Scientific American.com ( 1/10/2011)

Thanks for the info, Miller.
She's a woman I can't say I was crazy about, but I do appreciate her in several ways, including for gumption, brains, and a lovely lack of caution. Tough decision for the daughter now.

Which brings up the matter of.. a living will.

I've had a very hard time finding any info on Joan Rivers present condition in either Boston or NY papers. I suppose the family wants to keep a tight lid on Joan's condition and I can appreciate their sorrow at this time.

I can recall several of Joan's jokes and I only thought they were real funny when I finally reached adulthood. I still recall one, a fairly recent one when she appeared on one of the late talk shows. This joke concerned the subject of the "bar pickup".

I still laugh, when I think about it.

How much do you trust TMZ?

http://www.tmz.com/2014/08/30/joan-rivers-life-support-hospital-melissa/

"Joan Rivers is on life support ... and sources close to the legendary comedian tell TMZ she is completely reliant on machines to stay alive.

According to our sources, the family will have to decide in the next couple of days whether to keep the 81-year-old on life support. We're told the family remains hopeful that if they do decide to turn off the machines, she will make a turn for the better and fight through it."

Joan Rivers on life support as daughter Melissa remains ‘in denial’ about mother’s condition.
No decisions will be made about the comedienne’s future for the next few days, according to a report.

BY Caitlin Nolan , Heidi Evans , Larry Mcshane
NEW YORK DAILY NEWS
Published: Saturday, August 30, 2014, 4:09 PM
Updated: Sunday, August 31, 2014, 11:16 AM

Joan Rivers was on life-support Saturday as her daughter, family and friends kept an increasingly grim vigil at a Manhattan hospital.

The 81-year-old Rivers, initially placed in a medically induced coma after going into cardiac and respiratory arrest on Thursday, was dependent on the machines to keep her alive, TMZ.com reported.

Sources told the Daily News that Rivers’ daughter, Melissa, is “in denial” over her mother’s condition.

“She still thinks everything is going to be OK. She is refusing to admit that a world might exist without her mother in it,” said a source close to the Rivers family.

“Others that are close to Joan are starting to realize that the outcome they want is very unlikely.”

No decision on the acerbic comedienne’s future will be made for a few days, TMZ.com reported. Neither Melissa Rivers nor the hospital had any comment Saturday on the Emmy-winning Rivers’ condition.

Sources have told The News that Rivers would not want to live unless she could enjoy “a full and active life....(She) would never want to be a burden on anyone.”

Rivers’ grandson, Cooper, 13, and her daughter’s ex-husband, John Endicott, were spotted leaving the hospital Saturday morning in a Lincoln SUV and returning to Melissa Rivers’ East Side apartment.

Rivers was rushed to Mount Sinai Hospital after she stopped breathing during an otherwise routine doctor’s visit for a throat procedure.

It was unclear how long Rivers was without oxygen. Doctors placed her in a coma within hours as they attempted to assess the damage, and her daughter was expected to discuss treatment options with the medical staff.

But it appeared the talk show host/jewelry saleswoman/fashion critic’s condition took a turn for the worse at some point, leading to the decision to place her on life-support.

Melissa Rivers flew cross-country Thursday after her mother’s medical emergency, arriving at the hospital that evening.

While thanking fans for their support and prayers, she has said little about her mother’s condition.

For the first time since Rivers fell ill, her daughter made no public comments Saturday.

“As independent as she likes to think she is, Joan is the center of Melissa’s life,” the source said.

“They even live in the same building in (New York) and work together on ‘Fashion Police’ ... It’s all heartbreaking.”

The Brooklyn-born Rivers became a Hollywood mainstay after her 1965 breakout on “The Tonight Show".

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Since Joan Rivers is now on life support, the family needs to make some very serious decisions and this, of course will take time.

I have to suppose that Ms Rivers lawyers have been in contact with Melissa and the rest of the immediate family. I also have to suppose, that the family through Melissa and other members of Ms Rivers family and staff have arranged for a 2nd or even a 3rd medical opinion relative to a prognosis for Ms Rivers from physicians not associated with the patient's hospital.

Very serious decisions must now be made relative to Ms. Rivers care.

I haven't mentioned religion, but I think it very wise to have a Rabbi visit Ms Rivers and her family in the hospital. I'm sure the hospital has several on-staff Rabbis at the Chaplain's office. If the family already has a Rabbi, I'd seek out his/her advice relative to Jewish Law concerning Ms Rivers condition and what possible actions ( medical/spiritual) would be most beneficial in the present and the future for this patient.