On June 10, 1986, a 2¹/₂-year-old girl slipped and fell into a creek near her Salt Lake City home. She spent 66 minutes in the freezing water, her body lodged against a rock. Conventional wisdom held that 15 minutes was the maximum anyone could survive drowning. When rescue workers pulled her onto the bank, she had no pulse. Her skin had turned a light blue, the color of oxygen deprivation. Her pupils were fixed and dilated, evidence that her brain had shut down.
Clinically, she was dead.
Out of blind hope, paramedics performed CPR. At the hospital, doctors continued CPR, while also connecting her to a heart-lung bypass machine to help rewarm her body, which had plummeted to 72 degrees.
One hour went by. Then two hours. By the third, the girl took a small, almost undetectable breath. Then her heart began to flutter. She continued recovering in the days and weeks that followed, eventually released after having made a “complete neurological recovery.”
It was miraculous — even staid medical journals agreed. So many questions were raised: How could someone go without a heartbeat, without breathing for 66 minutes and survive neurologically unscathed? Was death more subjective, more open to interpretation, than ever believed?
But here’s the wrinkle: Twelve years after the accident, the Journal of International Neuropsychological Society published a little-seen follow-up of the girl at 14 years old, concluding that she displayed a “broad pattern of neurodevelopmental compromise.”
She had difficulties in keeping up with her peers in school and displayed “dramatic memory impairments,” especially in working memory and motor skill.
“Longitudinal tracking and intervention is critical for both patient quality of life and a more complete understanding of the limitations of brain plasticity,” the study concluded.
Odds are against you
Does this make her story any less miraculous? Not in my book. She died and now she’s alive — albeit a little changed. But the full story of her survival reveals how in our rush to embrace black-or-white miracle narratives in medicine, we often turn a blind eye to the many complications and failures of modern science.
We want to believe it’s possible to come back untouched from the dead, and so we do, despite ample evidence to the contrary.
Take, for example, a study out of The New England Journal of Medicine in the late 1990s that tracked rates of recovery following cardiac arrest in TV dramas like “ER” and “Rescue 911.” In these shows, 67 percent of people recover well enough to leave the hospital.
Perhaps inspired by fictional depictions, when older people are asked their rates of survival following cardiac arrest, they believe their chance of survival is more than 50 percent; a quarter think their chance tops 90 percent.
The real number is far more sobering. If you suffer a cardiac arrest outside the hospital setting, your chance for survival is a mere 8 percent.
Then there is how you survive.
by David Casarett, M.D.
(Current)
University of Pennsylvania hospice doctor David Casarett, author of the new book “Shocked: Adventures in Bringing Back the Recently Dead,” often sees the toxic aftermath of resuscitation therapies.
For every miracle case like Anna Bagenholm, a 29-year-old orthopedic surgeon in training who was “absolutely dead” after being trapped under a layer of ice for 80 minutes following a skiing accident but survived and now works as radiologist, Casarett explains, there is one like Joe.
Joe suffered from cardiac arrest, was resuscitated but never woke up, surviving for 18 days in an ICU until his family decided to cut off his ventilator.
“Before I started this book, I thought resuscitation was the enemy,” Casarett told The Post. “But I wanted to test my assumptions.”
Changing definition of ‘dead’
Casarett reached back into the history of resuscitation science, researching the many ridiculous ways that humans have tried to bring back the dead.
If you perished 200 or so years ago, your dead body might have been tickled with feathers, tied to horses for “trotting therapies,” subjected to tobacco cures and flagellation.
Cold therapies, which had been introduced as the “Russian Method” of resurrection two centuries ago, gained clout in the 1950s as a Canadian heart surgeon, Dr. Wilfred Bigelow, began inducing hypothermia on rhesus monkeys before surgery with impressive results (11 of the 13 monkeys survived after removing and replacing their hearts).
Thanks to Bigelow and other follow-up studies, as well as real-world examples like the toddler who fell in the creek and the skier who survived under ice, researchers began to appreciate the important role that cooling plays in halting death and decay. Every second an organ spends oxygen-deprived is a significant step in its death march. When the body is cooled, cells begin to slow, reducing the output of metabolic energy, and curtailing the damage done.
A common refrain in the field is: “You’re not dead until you’re warm and dead.”
Now, thanks to directed, intravenous cooling therapies, we can target certain parts of the body for cooling. One of the riskiest surgeries you can possibly undergo, with a mortality rate hovering around 15 percent, is hypothermic circulatory arrest, where the heart is stopped and the brain is cooled, allowing surgeons more time to perform complicated surgeries.
A significant step toward real-life suspended animation is under way at the Safar Center for Resuscitation Research at the University of Pennsylvania. The institute has devoted countless research hours to studying the effects of suspended animation, first on dogs, then on pigs, and now on human gunshot-wound victims.
In their studies, a heart is stopped (in the case of human patients, the heart has likely stopped on its own), and cooling saline solution is injected into the veins, replacing the patient’s blood. This process has allowed pigs and dogs to remain “dead” for upward of two hours, giving ample time for surgeons to dedicate more time to their work.
But it’s one thing to do this on dogs (depending on how much of a dog lover you are) and pigs, it’s another thing to try it on human beings. Those entered into the study must have a 7 percent or less chance of survival.
Results from the study have not yet been released. But Peter Rhee, author of “Trauma Red,” who is a researcher in this study and is perhaps best known for treating Congresswoman Gabrielle Giffords, told the New Scientist: “After we did those experiments, the definition of ‘dead’ changed. Every day at work I declare people dead . . . I could, right then and there, suspend them.
“But I have to put them in a body bag. It’s frustrating to know there’s a solution.”
When death gets worse
Other researchers are looking into the role that hibernation could play in resuscitation. By examining the importance of hormones and metabolism in animals from the squirrel to the wood frog to the lemur (the only primate to hibernate), they hope to unlock the hidden hibernation abilities latent in us all.
“Some researchers think that maybe, someday, hibernation might also be a routine part of clinical care,” Casarett wrote.
“I’m betting the science we’ve seen up until now is just a warm-up act. I think the pace of advances is going to pick up, and I wouldn’t be surprised to see the field grow exponentially over the next 10 years,” he continued. “Probably in the next five years, patients will be able to expect a better than 50 percent chance of good neurological outcome [following cardiac arrest].”
That’s a tremendous bump (a self-admittedly “optimistic” view) from the dispiriting 8 percent industry average. Though he does note that this number is rising already with interventions from “automated external defibrillators,” which are fairly simplistic aided CPR devices found at most shopping malls and health clubs.
But there is a danger in overestimating the advances in resuscitation research, explains Katy Butler, journalist and author of “Knocking on Heaven’s Door: The Path to a Better Way of Death.”
Though technology has undoubtedly improved, she explains, paraphrasing a surgeon, that the quality of death has declined.
“We are warehousing thousands of people who would have died without resuscitation interventions, who are now living in a limbo state, who can’t move or communicate,” Butler says. “So they’ve survived. But at what cost?”