They Died, and Lived to Tell All About It
Matthew Kruk
Books
They Died, and Lived to Tell All About It
By ABIGAIL ZUGER, M.D.
Electric circuits will break your heart every time. Take my cellphone
(please): it went out in the rain a few weeks ago and then lay neglected
in a sopping wet coat pocket overnight. The next morning, it was dead.
Nothing revived it, not the usual prayers and imprecations nor the
overnight immersion in rice recommended by Internet experts. After 72
hours, it was clearly time to give up and head for the store.
But when the moment came to unplug the corpse from its charger and plug
in its immensely expensive replacement - executioner, stay your hand:
Look who's waking up!
Dr. Sanjay Gupta's new book deals with the human equivalent of this
little drama, and if it seems insensitive to equate a smart piece of
plastic with a catastrophically ill human being, absolutely no
disrespect is intended, but the analogy still holds. This is a can-do
book about death by the well-known medical correspondent for CNN and
Time (and near nominee for surgeon general), which means no bittersweet
philosophic reflections on the natural arc of human existence. The
subject is simple science: the ways the body's circuitry can betray us,
and the ways we are learning to fight back.
The science, of course, is far from simple, which makes it a fitting
showcase for Dr. Gupta's skills as a popularizer. Straightforward and
readable, it is a book that will undoubtedly infuriate many experts with
its elisions and oversimplifications.
But the stories are great. A young skier falls into an icy crevasse and
dies of exposure; a healthy 68-year-old man has a cardiac arrest at the
gym and dies on the treadmill; a 59-year-old man has a fatal heart
attack behind the wheel of his car. Fifty years ago, all of them would
be underground, but the last decade has seen enough progress in
resuscitation - or perhaps resurrection is the word - that they are all
now alive and more or less intact.
Their deaths were actually, in Dr. Gupta's words, visits to "a gray
zone - a faint no-man's land where you are neither truly dead nor
actually alive."
Those words could easily describe the average intensive care unit, where
imperiled organs are carefully nurtured while the rest of the patient
comes along for the ride. However, dead hearts and dead brains have
traditionally been the end of the line in intensive care.
Not so much anymore, Dr. Gupta says.
For instance, it has been known for a long time that freezing can mimic
death - a standard E.R. dictum states that no man is dead till he is
warm and dead. But the process of rewarming a frozen human is perilous,
for often it is not the lack of warmth or oxygen that kills so much as
their restoration, which sets off a cascade of cellular destruction.
Cautiously rewarming the frozen skier took a few days, but her recovery
from the revival took many months. That was 10 years ago, and experts
have since begun to manipulate cellular processes with more finesse.
Cold is now used specifically to minimize organ damage, as it was for
the man who died on the treadmill. After his heartbeat was restored, he
was transferred to an I.C.U. specializing in therapeutic hypothermia,
where he was chilled for days. Weeks later he emerged from a coma to a
long recuperation but, finally, complete health.
The man who died behind the wheel of his car had an easier time: "Just
six weeks after he died, the only lingering effect is a set of sore
ribs."
He was revived with a new resuscitation technique that uses only rapid
chest compressions with no mouth-to-mouth breathing at all, under the
assumption that maintaining high levels of oxygen in the blood is far
less important than keeping the blood moving along. In some places, this
technique has transformed the routinely dismal survival rates of
out-of-hospital resuscitations.
Dr. Gupta visits scientists who can put laboratory creatures into deep
hibernation with various gas mixtures, a pseudo-death that reverses
instantly with no ill effects. Their goal is to create a chemical "pause
button" for humans: "a way to slow the candle, stop time, cheat death"
long enough to get a car accident victim or wounded soldier to care.
The neurology of the near-death experience, with its shining white light
and cascade of memories, is the subject of one chapter; another
addresses the apparent miracle of catastrophic illness that melts away,
with or without prayer.
But the book's focal point, and the place where Dr. Gupta is likely to
get some grief, is a short chapter on the dead brain. He introduces a
man who "can tell his story today" because one doctor refused to give up
on him and pull the plug, despite what appeared to be an irreversible
coma. This leads to several other oft-told anecdotes of hopeless comas
unexpectedly lifting. "Decisions are made every day in this country to
withdraw and remove people from life support without really giving them
a chance," the patient's doctor says.
I can almost hear the ethicists and the transplant surgeons groaning in
unison. This material is complex and inflammatory enough to need a far
longer and more technical discussion than Dr. Gupta's breezy listing of
mistakenly hung crepe. Great stories are fine, but sometimes there is no
getting around the need for highly untelegenic, unromantic, unhappy
data.
Copyright 2009 The New York Times Company