Doc says pug clinically dead

Karlo Maquinto’s family still won’t let go as the fighter, strapped to a life support system, remains in a deep coma with little hope of recovery at the FEU-NRMF Medical Center in West Fairview, Quezon City.

Neurosurgeon Dr. Rhoby Orata, who is closely monitoring Maquinto’s condition, said yesterday he is clinically dead. “I received the latest updates from (neurologist) Dr. Grace Ang-De Guzman that the patient has stable vital signs but in a Glasgow 3 coma on life support,” he said. “When he arrived in the hospital, Karlo was at level six then slipped to four and now, three. His only vital sign is a heartbeat. He breathes through a ventilator. We could do an EEG test to confirm brain wave activity but at the moment, it may not be necessary under his clinical condition. We do the conformity test to determine electrical cerebral silence. However, it is clear in his condition that he is in a Glasgow 3 coma.”

Maquinto’s sister Virgie, who is keeping vigil by his side, said he was fed through a nasogastric tube the other night and with medication, his blood pressure has stabilized at 120 over 70. She said the family has no immediate plans of taking away the life support system. “We’ll wait until he wakes up,” said Virgie who brought over her mother Marjorie and brother Arnold from Iloilo to be with the stricken fighter in the hospital. Maquinto’s manager Anson Tiu Co, co-owner of the Cooyeesan Hotel Plaza in Baguio City, is paying for all the hospital expenses.

Dr. Orata said he understands why the family won’t give up hope. “It’s a very personal and emotional decision the family has to make,” he said. “When Karlo’s mother arrived, I think seeing her son in a coma had a devastating effect. The family is hoping and praying for a miracle. Removing the life support system isn’t an option at this time. The decision depends on the family. There is no indication that the family wants to let go. Of course, they can opt for no additional aggressive medication and nature to take its course but that decision has to be affirmed in a signed document. It’s true that he may go at any time but we respect the family’s decision to keep Karlo on life support.”

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Dr. Orata said a CT-Scan showed that a blood clot has pushed the right side of Maquinto’s brain to the left. “It’s possible that Karlo suffered primary brain injury when he was knocked down twice in his fight (against Mark Joseph Costa in Caloocan last Saturday night),” said the 38-year-old neurosurgeon who finished his pre-med studies at UP and earned his degree at the Pamantasan Lungsod Ng Maynila. “There was a vascular artery eruption. Additional blows in the succeeding rounds could’ve inflicted more damage to result in the swelling of the brain. But at the age of 21, it’s also possible that Karlo could’ve had a malformation of a blood vessel in the brain, something congenital, that ruptured in the course of the fight because of repeated blows to the head.”

Dr. Orata said that as soon as Maquinto was wheeled into the FEU-NRMF Medical Center, the priority was to clear his airway. “There was no movement, his eyes were closed,” he said. “We immediately took a CT-Scan to assess the problem.”

Dr. Orata said failure to administer oxygen on Maquinto after he collapsed in the ring could’ve had a damaging effect. While an ambulance was on stand-by on fight night, there was no provision for oxygen in case of an emergency.     

“Oxygen could’ve certainly helped,” explained Dr. Orata, a practitioner since 2000. “I would consider the blow to the head as the cause of the primary injury or what you could call the insult. There is also the secondary impact caused by repeated blows and even the lack of oxygen in the brain, which is a rigid shell, meaning it won’t give way. If there is a change in the balance of the brain created by a hemorrhage or a swelling, the compounding effects are serious. The brain is very sensitive and provides little leeway so that a swelling can dramatically reduce the oxygen in the skull.”

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A noted neurologist said it is doubtful if Maquinto’s blood pressure would normalize without medication. “There are ways to elevate the blood pressure,” the neurologist said. “As the patient is in a deep coma, the brain is silent. Output is low. It’s likely he will eventually suffer a malfunction of the organs. Surgery at this point may not be an option as because of the blood clot, the probability is he will go during the operation.”

Two years ago, a seminar on “Boxing and the Brain” was held at the Diamond Hotel on Roxas Boulevard. Organizing committee chairman Dr. Gerardo Legaspi, president of the Academy of Filipino Neurosurgeons, brought in foreign and local experts to speak on traumatic injuries, including craniofacial fractures and brain contusions. Among the topics taken up in the seminar were procedures on medical clearance and guidelines of examination of athletes, particularly boxers. Dr. Orata said with the Maquinto incident, he will suggest to Dr. Legaspi a refresher seminar.

The tragedy that befell Maquinto, an undefeated fighter, has raised several questions: Was he thoroughly examined to be physically fit before the bout? Why did the Games and Amusements Board allow the fight to go on last Saturday without organizers providing for competent paramedics, oxygen, neck brace and slantboard in case of an emergency? Should referee Eddie Nobleza have stopped the fight after Maquinto took a second mandatory eight-count in the second round? Were the ringside physicians equipped to handle a potentially life-threatening situation?

Dr. Orata said at the moment, there is nearly no hope for Maquinto’s recovery but the medical team is doing its best to keep him alive as is the family’s wish. Maquinto’s condition is inoperable because he is in a Glasgow 3 coma state. The blood clot in his brain has created an imbalance of both sides. What’s keeping Maquinto alive is his fighting heart.