By keeping them cold, some patients have been revived after hours. (
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Early one afternoon in August 2009, Joe Tiralosi, a 57-year-old professional driver in excellent health, began sweating profusely. He wasn’t alarmed, though — it was, after all, summer in New York City. Tiralosi had just pulled out of a car wash and was heading home to Brooklyn, so he cranked up the air conditioning and figured he’d be fine.
One hour later, Tiralosi was so weak that he felt incapable of driving the car one more block. A colleague found Tiralosi slumped in his car at Second Avenue and 80th Street and rushed him to New York-Presbyterian, where Tiralosi collapsed and died. He’d suffered cardiac arrest.
CPR was performed, but after 10 minutes, doctors still couldn’t get a pulse — and 10 minutes has, for decades, been the metric in medicine. A patient who cannot be revived in that time frame has the potential to suffer massive brain damage, but in Tiralosi’s case, doctors kept at it.
After 20 minutes, they still couldn’t get a pulse. At this point, it’s up to the individual doctor whether to keep going. Tiralosi’s did, even after half an hour had passed, after his heart had been shocked six times. In fact, they kept going after 40 minutes — way past what modern medicine considers viable.
Less than three weeks later, Joe Tiralosi walked out of the hospital and back to his old life in Brooklyn, to his wife and his job, not a thing wrong with him physically or cognitively. And he is just one of thousands who, in recent years, have been dead for unprecedented lengths of time — two, three, five hours — and brought back to life, healthy and whole.
“Death itself we can reverse,” says Dr. Sam Parnia, director of resuscitation research at the State University of New York at Stony Brook. “We have the scientific means.”
With Josh Young, Parnia has just published an astonishing new book called “Erasing Death: The Science That is Rewriting the Boundaries Between Life and Death” (HarperOne).
The implications are as revolutionary as the discovery of fire and electricity, the invention of aviation and manned space flight, the A-bomb and the Internet.
“For millennia, we couldn’t do anything when someone stopped breathing,” he says. “Now, we’re almost having to redefine the way we think about death.”
The science is still in its infancy, and successful resuscitation requires two non-negotiables: a treatable underlying cause of death, such as a clogged artery or fluid in the lungs, and a body that has been cooled, either naturally or artificially. It’s the cooling that retards cell death in the body and the brain, protecting against cognitive impairment.
The possibilities are almost inconceivable. In the near future, if you were to die of cardiac arrest before an organ transplant, you may be dead for hours or days while a new organ is found — or grown from your own stem cells — then transplanted before you’re revived. Studies are underway involving a new drug that slows the rate of brain-cell death by 50%, which could double the viability of a corpse. Death may eventually become less a permanent state than a way station.
“Many who died young and prematurely could have been saved,” Parnia says. “I arrived at Stony Brook in 2010, and we barely had any cooling being done in this unit.”
Last Monday, a 50-something patient died in the cath lab at Stony Brook; she had a diseased heart and was on the list for a transplant. “We got her back in an hour and a half,” Parnia says.
Joe Tiralosi was able to walk out of that hospital intact because his body was cooled, from the moment of collapse through CPR through resuscitation through the removal of blockages in his heart to the insertion of stents — a gradual, methodical approach that lasted 24 hours in all.
“It’s absolutely the cold,” Parnia says, and one of his favorite examples is the Titanic: If we knew then what we know now, Parnia says, almost all of those who died could have been saved, their causes of death ideal — drowning and hypothermia. “Today, we would not have necessarily declared those people dead — at least not in the irreversible and irretrievable sense,” he writes, and when he saw the James Cameron film again recently, he kept coming back to the same question: When did each of those people actually, really die?
Parnia says the most compelling case yet is that of a woman in Japan who was found in a forest; her body temp was 68 degrees Fahrenheit, and it’s estimated she was dead for five hours. Doctors worked on her for another six hours using state-of-the-art medical advances, including an ECMO machine, which provides the blood and oxygen needed to keep organs alive without a heartbeat.
“She walked out of the hospital, unimpaired,” Parnia says. “If doctors put together all the latest advances” — including a machine that performs CPR with far more precision than a human — “we can push back death longer than we ever thought possible.”
The problem, Parnia says, is that there is no external mandate for these protocols in the state or nationwide, no regulatory body in place, not enough doctors and nurses aware these advances exist.
New York City, however, is unique: In 2008, the FDNY — which provides EMS services — began cooling every dying patient intravenously and in 2009 announced that they would not take a patient to any facility that did not have a hypothermia unit. For this reason, every hospital in New York City now has one.
Still, if you get dragged out of the East River four hours after drowning, whether you are brought back to life will depend on the doctor you get and the call he or she makes — precisely because there are no enforceable standards.
“Resuscitation doesn’t belong to one group of doctors, unlike heart attack, which has cardiac care,” Parnia says. “None of this is updated for the 21st century. Most of us will not die of old age; we will die before we were supposed to.”
“Whether we come back well or come back like Terri Schiavo” — who lived in a vegetative state for 15 years before dying in 2005 — “depends what hospital we went to, what doctor we have,” he adds. “We are left at the complete mercy of these random things happening to us.”
Even many in the medical community, Parnia says, are trying to comprehend the impact of these advances. “I’ll go to conferences, and someone will say to me, ‘Oh, that patient was clinically dead,’ and I’ll say, ‘No. They were dead.’ They can’t grasp it — this concept is so ingrained in our heads. We have this social and philosophical notion of death, but it’s biological.”
Parnia also thinks we should replace the term “near-death experience” with “actual death experience” and that resuscitation science can only benefit from taking such accounts seriously. “In medicine, we’ve brushed people who’ve had this experience aside,” he says.
Parnia has no religious belief in this area, he says, and is not out to prove whether there’s a heaven or a hell or an afterlife. “We have this horde of evidence of people who have recollections,” he says, and though such accounts have existed for thousands of years, they were rare until the invention of CPR. “There are many millions of them,” he says. “We try to explain [NDEs] as lack of oxygen, hallucinations — but there’s no evidence to show it’s chemical.”
The commonality and uniformity of these accounts, which cut across cultures and religions — even atheists share similar stories — are evidence, Parnia says, that the experience is real. He thinks that those who report nothing have forgotten, just as not recalling our dreams doesn’t mean we didn’t have them.
“I think this is a universal experience,” he says. “I think it happens to all of us when we die.”
Among the most reported details: a beam of white light, overwhelming feelings of love and peace, the appearance of deceased loved ones, detailed reports on what doctors and nurses were doing and saying, wearing and even thinking while trying to revive the dead patient — all point to a consciousness, Parnia says, that lives after the body and brain have died. And that consciousness, as the late Nobel Prize-winning neuroscientist John Eccles believed, may be independent of the brain.
How long the experience lasts and just what it is — transitory? Does this consciousness itself eventually die? Are our brains simply capable of far more than we know? — will be further explained by those unwitting pioneers of the future who remain dead for days, weeks, months, years and then come back to tell.
“From a medical perspective, I think it’s very hard to argue that when somebody dies, they become annihilated,” he says. “What does that mean for our definition of death? Is this person viable for 24 hours, and if so, where are they? It’s unlikely to think that consciousness dies. The question is: For how long does it exist?”