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  CURRENT

  Published by the Penguin Group

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  First published by Current, a member of Penguin Group (USA) LLC, 2014

  Copyright © 2014 by David Casarett

  Penguin supports copyright. Copyright fuels creativity, encourages diverse voices, promotes free speech, and creates a vibrant culture. Thank you for buying an authorized edition of this book and for complying with copyright laws by not reproducing, scanning, or distributing any part of it in any form without permission. You are supporting writers and allowing Penguin to continue to publish books for every reader.

  LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

  Casarett, David J., author.

  Shocked : adventures in bringing back the recently dead / David Casarett.

  p. cm.

  Includes bibliographical references and index.

  ISBN 978-1-101-63727-2

  I. Title.

  [DNLM: 1. Resuscitation—Popular Works. WA 292]

  RC86.7

  616.02'5—dc23

  2014004313

  Version_1

  It is the heart that kills us in the end

  Just one more old broken bone that cannot mend

  —Emmylou Harris, “The Pearl”

  CONTENTS

  Title Page

  Copyright

  Epigraph

  1

  The Big Mac Rule of Resuscitation and the Search for the Limits of Life

  2

  Why Amsterdam Used to Be a Good Place to Commit Suicide

  3

  The Ice Woman Meets the Strange New Science of Resuscitation

  4

  Science Fiction, Space Travel, and Suspended Animation

  5

  The Deep-Freeze Future: Cryonauts Venture to the Frontiers of Immortality

  6

  Crowdsourcing Survival

  7

  When Is “Dead” Really Dead? Listen for the Violins.

  Acknowledgments

  Notes

  Index

  1

  The Big Mac Rule of Resuscitation and the Search for the Limits of Life

  When I was a kid, long before I contemplated going to medical school, the television in our living room was the sole source of all of my medical knowledge. Before I ever dissected a cadaver or listened to a heart, shows like M*A*S*H; St. Elsewhere; Doogie Howser, MD; Chicago Hope; and ER taught me how to be a doctor. Specifically, they taught me that doctors are firm, decisive, quick-thinking, and almost always successful.

  Television also taught me how to bring someone back to life. Fortunately, that was a simple lesson for an eight-year-old. The television version of resuscitation followed a script that was mercifully predictable, and that predictability was helpfully marked by several reliable guideposts along the way.

  First, someone’s heart would stop. That cessation of a heartbeat was usually heralded by unmistakable signs, including but not limited to gasping, choking, eye rolling, and chest clutching.

  Next, and typically without any discernible delay whatsoever, everyone within hailing distance would descend on the newly dead character. One of these self-appointed rescuers would then place two hands on the character’s chest and bounce up and down heroically. It was also at about this point that another rescuer—usually a tall, handsome doctor—performed a strange sort of kissy procedure with his mouth, guaranteed to provoke slack-jawed fascination in a boy not yet in middle school, especially if the victim was a woman. Finally, if the episode were really top-notch, someone would produce a pair of paddles, apply them to the victim’s chest, and yell, “Clear!” (At some point, I developed the unshakable conviction that this shouted incantation had some ill-defined yet essential electrical effect on the victim’s heart. I have a hazy recollection of standing over my freshly late hamster one sad morning and yelling, “Clear!” repeatedly in hopes of encouraging little Frankie to rejoin the living. Alas, Frankie was unfamiliar with the rules of televised resuscitations, and he remained persistently and unambiguously deceased.)

  Then there would be a strategic yet wholly incongruous commercial break, after which we’d be back in the thick of things. On cue, the victim would tire of being kissed by a tall, handsome doctor and would wake up. Or, occasionally—and just for variety’s sake—the handsome doctor would tire of kissing a person who was becoming increasingly dead. Then he would stand up, say something solemn, and stride off purposefully toward the next crisis.

  It was thanks to these scenes that I developed a deep and lasting impression of how resuscitation works when people try to die. For instance, I came to believe that resuscitation works. Maybe not always, but almost always. It seemed as though even if you were dead, as long as there was a good-looking doctor nearby, you wouldn’t be dead for long.

  I also became convinced that if resuscitation is going to work, it’s going to work very, very fast. A perceptive watcher of these shows would conclude that the fate of a newly dead person is determined in the span of time that it takes to learn about the merits of cookies made by Keebler Elves or a sing-along of the McDonald’s Big Mac jingle. Let’s call this the Big Mac rule of resuscitation. By then, your victim is probably wide-awake and hugging the rescuers. If she isn’t, then you might as well switch channels.

  So I persisted in my fantasies about resuscitation for quite some time.

  But then a girl named Michelle died.

  THE MIRACLE GIRL

  Years later, I was driving home from college when I stopped at a rest area on the Pennsylvania Turnpike for a bite to eat. As I took a seat I found a weathered copy of a local paper stuck to the table by layers of French fry grease and ice cream scum. Amid reports of troubles in city government and announcements of tax hikes and education cuts, one story caught my attention.

  A two-and-a-half-year-old girl named Michelle Funk had fallen into a stream and drowned a week or so earlier. By the time rescuers pulled her out—more than an hour after the accident—she was dead. Not just dead by the Big Mac rule, but really dead. Really, truly dead.

  Then the article went on to report that she was alive. In critical condition, but alive.

  Huh?

  I reread that passage a couple of times. Michelle Funk had really died. And then she really was alive. So much so that she was on her way home.

  The full story, which I read about much later in a medical journal, was even more impressive. On June 10, 1986, in Salt Lake City, Michelle was playing with her brother near a creek still swollen with snowmelt when she slipped and fell in. Her brother couldn’t help her, so he ran to get their mother, who searched frantically for several minutes before calling 911.

  Paramedics arrived quickly, but by the time they were able find her and bring her to the creek bank, sixty or so minutes had passed. For more than an hour Michelle hadn’t been breathing. And for probably almost as long, her heart hadn’t been beating.

  As she lay on the bank of the creek, the paramedics could see that Michelle was cold and lifeless. The journal article describing her case put her condition in stark medical terms: “The child was cyanotic, apneic, and flaccid,” it reports, “with fixed and dilated pupils and no palpable pulse.”

  In English, that means that she was dead. She wasn’t breathing (that is, she was apneic). She also had the dusky-blue (cyanotic) color of someone whose body has been starved of ox
ygen. And the fact that her pupils were fixed and dilated meant that her brain—specifically her brain stem, one of the areas that controls the eyes’ response to light—had shut down.

  Put yourself in the position of those paramedics, standing next to Michelle on the bank of the creek. You have to decide whether to try to resuscitate her. What would you do?

  Would you walk away? You might.

  But you might also think: She’s very young. And isn’t even a tiny chance of success worth it for a two-year-old?

  At the time, no one had ever survived after more than an hour underwater. In fact, the conventional wisdom was that drowning victims like Michelle had the best chance of survival if they were revived within fifteen minutes. That chance dropped precipitously after a victim had been underwater more than twenty minutes. And Michelle had been in the water for an hour.

  Now would you walk away?

  Logically, you probably should. And most paramedics probably would have. There was no reason to believe that they could do any good. There was no point in trying.

  But those paramedics did try to revive Michelle Funk. For some reason—intuition, instinct, or just blind hope—they thought that they might be able to bring her back.

  So they transported Michelle to an emergency room, where she was met by a team that began to try to get her heart beating. They tried all of the tricks they could think of, without success. One hour turned into two. Then two hours turned into three.

  Then Michelle took a small, almost undetectable breath. A moment later, her heart began to show evidence of activity. This was only a confused flutter, the medical term being fibrillation—little more than background noise. But soon it became more organized, breaking spontaneously into a normal rhythm. Then she was alive. After three hours of being dead, Michelle Funk was alive.

  Later, when Michelle’s survival was described in the prestigious Journal of the American Medical Association, an editorial accompanying that article called Michelle’s survival “miraculous.”

  Try searching the pages of a mainstream medical journal for that word, and you’ll find that it’s rare indeed.

  Michelle’s story left a deep impression on me, and I decided right then, sitting in that rest stop on the Pennsylvania Turnpike, that I wanted to be an emergency room physician. I wanted to bring people like Michelle back to life. And I wanted to see just how far I could push science. If three hours was possible, what about twelve? Or a day? Or a month?

  For the rest of my six-hour drive home, I kept thinking about Michelle. One day, I thought, I’d like to find out what happened to her.

  Twenty years later, I did, and I found out enough to draw my own conclusions about whether cutting-edge resuscitation for someone like Michelle Funk is a good thing.

  A LESSON IN BASS FISHING

  Michelle’s story seemed clear-cut and almost cinematic in its simplicity when I first encountered it. She was a little girl who was dead, and then she was alive. That really was worth celebrating, and it struck me as fair for that journal article to have called her survival “miraculous.” But a few years later, in medical school, I met a patient who taught me that these sorts of stories are rare.

  Joe was one of the first patients I ever took care of as a medical student. He was a gregarious guy. A retired steelworker, Joe loved bass fishing more than anything else in the world. He’d happily display a Polaroid gallery of fish he’d caught to anyone who evinced even a modest interest.

  Joe was admitted to the hospital with an almost complete blockage of his left main coronary artery, the principal supply of blood to most of the heart. That blockage had been discovered during a cardiac catheterization that morning. When I met him, Joe was waiting for surgery that would take place the same afternoon. His blockage was severe, and we knew it would only take a little exertion on his part for his heart to shut down entirely.

  Joe and I were sitting in his hospital room, and he’d just told me that the secret to bass fishing was quiet. You had to sneak up on them, he said. Especially the big ones. They couldn’t see worth a damn but their hearing, he claimed, was acute.

  Joe was propped up in bed and I was perched on the arm of a chair nearby. I was only half-listening. Instead, most of my attention was focused on the chart on my lap, open to the page that described the results of Joe’s cardiac catheterization.

  Then I noticed that Joe wasn’t talking anymore. I thought that perhaps he was illustrating the principle of quiet. He was showing me how a successful fisherman sneaks up on an unsuspecting bass. I smiled and I looked up.

  As I did, I saw Joe staring at me with the vacant expression of alarm that you might wear if the person in front of you has a spider on his forehead. Then Joe’s eyes rolled back in his head, and he took a couple of gasping breaths. Then he stopped moving.

  My medical training kicked in and I checked for a pulse. Then I ran to the hall and asked a nurse to call a code—medical-speak for gathering doctors and nurses from all over the hospital to try to resuscitate a patient who has had a cardiac arrest. In the meantime, another nurse and I started CPR.

  A minute went by. Then two. Those two minutes were about the longest two minutes I’ve ever experienced.

  Finally, the resuscitation team arrived, and I was grateful to step back into a supporting role. I told the resident what I knew about Joe, and his left main blockage. Then the code team ran through the drill of defibrillation and injections of medications.

  After about fifteen minutes, they got a heart rhythm back. By that time the team had inserted an endotracheal tube into Joe’s lungs and was breathing for him. He had a heart rate and blood pressure, which was good.

  However, an EKG showed that he’d had a massive heart attack, which was very bad. The resident had Joe’s cardiothoracic surgeon on the phone, and he decided that Joe needed to go to the operating room for surgery right then. So off they went, leaving behind an empty bed and a pile of well-thumbed fishing magazines.

  Joe made it through surgery, technically, but he never woke up. His heart was too badly damaged to pump blood effectively, and the rest of him had “taken a beating” too, as Joe would have said. Both his liver and his kidneys had failed, for instance. And his brain had probably been severely damaged by being without oxygen for those fifteen long minutes while we were performing CPR.

  I went to see him every day in the ICU. I looked at his chart. I checked his lab tests. And I looked at Joe.

  Every day I saw his family—wife, three grown children, half a dozen grandchildren—filing in and out of his room, having tearful conversations with the surgeon. They’d be hopeful one day as they got some good news, and then sad the next. That went on for eighteen long days.

  And every one of those eighteen days I wondered whether I should have been so quick to run out into the hall to call the code and begin CPR right away. I did everything by the book, like a good Boy Scout. But by my logic, thanks to me, Joe and his family were stuck in a medical limbo that they couldn’t escape.

  On the nineteenth day, Joe’s bed was occupied by a young woman who’d barely survived a motorcycle accident. I learned that the previous evening the surgeons had said that there was nothing else they could do for Joe. His family was sad, but—I imagine—a little relieved, too. They agreed to take him off the ventilator. He wasn’t able to breathe on his own, and so he died quickly.

  THE TITHONUS PROBLEM

  It was as a result of my experience with Joe that I’ve strayed a little in my medical career. Well, more than a little. I started medical school wanting to work in an emergency room, but now I’m a hospice doctor. It’s a little like trying out for the Philadelphia Eagles as a quarterback and ending up as the coach. Not better or worse, but very, very different.

  At least once a week I see a patient who makes me think about either Michelle or Joe, or both. Some days, I see miracles like Michelle. These are people who have benefited f
rom advances in the science of resuscitation and who have gained years of good life. And each time I meet one of these patients, I wonder what’s possible. I think about the science that will be available to all of us in a year, or in a decade. And I wonder whether Michelle’s miraculous survival is the tip of the iceberg in terms of preserving human life.

  But other days, I meet a patient like Joe. These are people who have been kept alive by the same advances, often for weeks or months in an ICU. When I meet those patients, I have to ask whether we should be trying so hard to push the limits of what’s possible. Maybe we should heed the Big Mac rule? Maybe if someone can’t be revived quickly and easily, we should leave well enough alone?

  Most of all, I wonder how technology is going to change the way that we die. Because if there’s one thing I’ve learned as a hospice doctor, it’s that we’re all going to die. Sure, the science of resuscitation can delay death for minutes or hours or—for someone like Michelle—decades. But it’s still going to happen to all of us.

  Although the science of resurrection can rescue people like Michelle, those rescues come at a cost. What kinds of costs? Well, since Michelle’s story achieved almost mythical status in popular culture, it makes sense to look for the answer to that question in mythology.

  Tithonus is described in Greek mythology as a mortal, one of the lovers of Eos, goddess of the dawn. That, you’d think, would be enough to make any guy happy. Who could ask for more?

  Well, he did ask for more. Or, in some tellings of the story, Eos did. In any event, one of them asked Zeus to grant Tithonus immortality so they could be together forever.

  The problem, though, was that neither of them thought to ask for eternal youth. That proved to be a serious oversight. And Zeus, no doubt chuckling quietly as Greek gods always seemed to do, didn’t suggest it either.