Letters to My Countrymen: Otto Warmbier

This was a fairly amazing press conference, by the team attending Otto Warmbier.  I wish they could coach the president on how to speak very carefully and avoid creating an international incident.

IMHO, what the doctors masterfully said without saying is that Otto was chemically restrained.  They very clearly said respiratory arrest, while ruling out all of the other things including trauma and botulism. As Etgar Keret once said, a human body is not a mystery egg.  The pathophysiology of brain death is fairly well-understood.  There are only certain ways that Otto’s results could be created.

Guys like Otto don’t just randomly stop breathing, that’s not a thing.   I wondered if Otto had a naturally occurring stroke, like his blood pressure went haywire from the stress, but no.   The doctors made it clear enough to read between the lines.  There were no indicators of a classic stroke, there was respiratory arrest.  The respiratory arrest was not trauma-related.  The only thing they said about the MRI was the massive tissue loss, nothing about an AVM or other congenital issue.  Otto just stopped breathing for a while.

I was trained to do a thing called Rapid Sequence Intubation.  I walked out of that training thinking about what to do if I were ever called to do that, like if there was a way not to do it without losing my job.  RSI is a way to knock someone unconscious through a drug cocktail for medical purposes.  There are many combinations of drugs, and thus a wide range of things can go wrong.  Respiratory arrest is one of the biggies, especially with  benzodiazepenes. There are medically appropriate reasons to immobilize someone, mostly to control the airway (as Sarah Silverman learned when she contracted epiglottitis).  The other reason is to gain control of them, i.e., chemical restraints.

In an emergency setting, fast-acting antipsychotics are often chased with Benadryl to help knock the person out, for an example of a chemical restraint.   I know someone who died from a reaction to medications used to immobilize him.  This wasn’t a medical necessity, but done to control him for their own purposes, make him manageable.  Benzodiazepenes, such as Xanax, Valium, Ativan, and the famous Midazolam that allegedly needed to be used up before it expired, are notorious for causing respiratory arrest.  It is not such an exact science. Benzodiazepenes work with the individual’s brain chemistry, and in my experience your mileage may vary.  Any time I gave a benzo, I watched like a hawk.  Others took a much more cavalier approach.

[Edit:  I have subsequently seen other reports, such as one on Jezebel, claiming that Otto was beaten or worked into a coma because he was in a camp where people don’t live long.  I stand by my stated opinion.  The UC team was quite clear, it was cardiac arrest reference respiratory arrest.  No sign of broken bones or beatings.  Would they take the time and effort to chemically restrain a prisoner in such a notorious place?  Yes, if  his name is Otto.  He was a high-value prisoner.  This is further evidenced by the fact that the doctors noted no skin breakdown, and that Otto had been fed on a tube.   He was in skilled nursing for a year.  So no, he wasn’t fed to the dragon like an unfortunate Korean would have been.  If Otto flipped all the way out at some point, they would not come and hit him with a shovel until he shut up, in other words. He was very valuable *intact*. They sent Otto back based on his return on investment.]

I mention Rapid Sequence Intubation because it is controversial, not that I believe they intubated Otto.  Had they intubated him, he would have lived.  That is clear from the statement in the video above.  Respiratory arrest led to cardiac arrest led to massive brain damage, very straightforward.   I mention RSI because it’s the sort of thing that can go extremely wrong.  It is an example of a thing where chemical cocktails come into play, which can potentially have disastrous outcomes just like Otto’s.  Drugs are easily weaponized, especially by doctors.  I’m pretty sure Kim Jong Un has control of the North Korean Medical Ethics Board.

The concept of botulism followed by a sleeping pill is ridiculous on its face.  Makes no sense at all, and the American doctors ruled out botulism anyway.  When they said they gave him a sleeping pill, I had an image of him freaking out, becoming combative, and being overdosed on benzodiazepenes and left unattended in his cell, where he stopped breathing and then had a heart attack.  That scenario fits every bit of everything I have seen.

Though I was developing a huge crush on the George Clooney look-alike Dr. Jordan  Bonomo on the left, I suddenly felt very sleepy and went to lie down.  I didn’t fall asleep, but I immediately had a sense of Otto Warmbier in my imagination/intuition, my imaguition.    My sense of him was that he was lingering until his mother could internalize his passing, to give her a chance to say her goodbyes.

But in the coma, his soul had an extensive opportunity to expand and explore the themes of his life, and contribute to a better future between America and North Korea.  I know that doesn’t sound logical considering how this has amped up the tensions on our side.  But I feel things have shifted much for the better overall, as is often the case with an innocent person murdered, if you take the long view.

Otto really had no idea how different other people’s lives are.  His loss has created a lot of awareness, and is an important cautionary tale.  Importantly, it lets Kim Jong Un look and feel like a bigshot.  He got our attention.  He gets to drink our tears.  As messed up as it may be, it relieves the pressure to do something to get our attention.  He looks powerful to his citizens, a real player in the game.  He showed us!

People are criticizing Otto’s poor judgment.   By that logic, we should ask what in the hell Sandra Bland was doing in Texas, before we go hypercritical on their justice system.  The two cases are eerily similar; a person who should never have been in jail in the first place dies under mysterious circumstances with zero accountability.

I don’t remember where I saw it, but one year for their Festival of the Sun, Kim Jong Il basically sacrificed the entire graduating class of their top university’s engineering students.  That entire cream of the crop, the best and brightest, hardest-working scientists in their country, their version of MIT’s graduating class, was sentenced to agricultural labor for life.   It wasn’t to punish them, they hadn’t done anything wrong.  Their lives were arbitrarily ruined because he could, to make the party more fun.  Slow-motion human sacrifice.

What I’m afraid people don’t know is that we created this monster.  Otto Warmbier is our chickens coming home to roost.  When the United States Air Force bombed North Korea, they joyfully destroyed their agricultural systems.  They took the attitude of making sure those rice-eating bastards never see rice again.  This is the kind of thing that pushes people to the wall, puts them into a state of mind where all bets are off.  Kim Jong Un may be fucked, but he is all they’ve got.  We left those people desperately hungry.  Not saying, just saying.  History will judge us.

I see that all things are perfect, whether I understand them or not.

Anyway when I got up from my nap, I saw that Otto had passed.  I am glad I was able to send some good thoughts to him and his mother in their dark hours, and I appreciate the contribution he is making in these interesting times.










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