Euthanasia / Assisted Suicide - Archive

They Died, and Lived to Tell All About It (2009)

[This article appears flippant. However, the information is worth ignoring the flippancy.]

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, Cheating Death, 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.

Review of Dr. Sanjay Gupta’s Book ‘Cheating Death’ – NYTimes.com

[ABIGAIL ZUGER, M.D., A version of this article appeared in print on November 24, 2009, on page D5 of the New York edition, http://www.nytimes.com/2009/11/24/health/24books.html?_r=1&ref=health&pagewanted=print ; http://www.nytimes.com/2009/11/24/health/24books.html]

COMMENT: Note this stunning quote at the end of the article: “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.”

Note that this writer, like so many in the media, is confused about “dead brain” and “irreversible coma.” But, as usual, this doesn’t seem to stop her from criticizing people like Dr. Gupta.

Having worked with people who recovered after being pronounced “hopeless”, I have found it so discouraging that when such great recoveries occur, the medical people and ethicists often get angry. I call it the “blood on the hands” syndrome meaning that once a person makes a death decision, he or she has to continue to justify it. Apparently, even the possibility that these health care professionals might have made a mistake is just too hard for them psychologically.

I have been criticizes when I talk about the amazing recoveries I’ve seen. The “experts” call them mere anecdotes. But these “anecdotes” often eventually show a pattern and that is often how medical advances are made. For example, babies with Down Syndrome were routinely institutionalized in the 1960s but as the result of some parents insisting on trying to help their children-anecdotal evidence-people with DS are living longer and achieving more than ever. This was not the result of new scientific technologies but rather heroic parents who refused to accept the status quo.

I so hope that the self-proclaimed “medical experts” will eventually open their eyes and truly look at these kinds of cases. As I have written before, in the “old days” of the late 60s and 70s, we didn’t automatically talk about withdrawing treatment as soon as the person seemed to be on the terminal trajectory to death and, as a result, we were surprised and humbled with some of these patients recovered. We need to get back to that wisdom instead of embracing a “right to die” mentality that insists that death is something to be gotten over with as soon as possible by any means possible.