Sam Parnia - Erasing Death: The Science That Is Rewriting the Boundaries Between Life and Death

J OE T IRALOSI BEGAN TO feel ill shortly after leaving a Manhattan car wash. He was a little nauseated, somehow off, and was glad his shift had ended. A chauffeur, Tiralosi spent his workdays driving legendary stock trader E. E. Buzzy Geduld around New York City. But on this August afternoon in 2009, a few minutes after he had begun his drive home to Brooklyn, he couldnt stop perspiring. He cranked up the air conditioner in his car, but he continued to sweat profusely.

Tiralosi was a practical man, a married father of two, and not given to panic. So he planned to push through with the rest of his day, figuring his ill feelings would pass. But an hour later, it was unbearable. He called his wife.

Dont take any chances, she told him. Go to the hospital.

But he couldnt drive another block. His wife immediately called a coworker, who found Tiralosi pulled over at the corner of Eightieth Street and Second Avenue in Manhattan and rushed him to the emergency room at New York Presbyterian Hospital.

Tiralosi was helped into the ER by his coworker. The color had drained from his face. He began explaining to a nurse what was wrong, but before he could finish, he collapsed. A Code Blue, meaning cardiac arrest, was called. Tiralosis heart stopped. He was dead.

But fortunately for him, he had died in a hospital where a team of people specially trained in resuscitation was on duty. Doctors and nurses came racing over from every direction and immediately started CPR. They are accomplished professionals whom I have worked with many times, including Dr. Rahul Sharma and Dr. Flavio Gaudio, both very diligent emergency physicians. They were part of the team that lifted Tiralosi onto a gurney, tore open his shirt, and cut off his pants with scissors. They attached the circular electrodes of a defibrillator machine to the skin of his chest. They moved rolling carts lined with medicines into the cramped space around him.

Despite all the modern technology available to them, the medical team also scrambled over him with an everyday itemplastic bags, loaded with ice. They positioned the bags along his sides, under his armpits, and on either side of his neck. They injected his veins with chilled saline. The team did all this in about one minute. His body temperature quickly began to drop. Then they settled into a rhythm: CPR, accompanied by occasional injections of adrenaline and defibrillator shocks.

Joe Tiralosi was now surrounded by some of the best medical personnel, technology, and thinking that modern science has to offer. But he was, with no heartbeat and insufficient oxygen and nutrients feeding the cells of his brain and body, already dead.

Dont take any chances, his wife said. Go to the hospital. Could these or any other words recur to Tiralosi as he lay flat on the table and slipped further into the process of death? Was he aware of anything at all? The dominant, scientific view of the brain is that such a thing would be impossible. The gag reflex and other functions of his brain stem had ceased, meaning his brain had stopped functioning entirely. All the conversations he had with his wife were now seemingly lost to him, and the odds were against him ever seeing his family again.

Seconds passed to the steady rhythm of chest compressions. Minutes passed. They stopped compressions and hit Tiralosis body with an electric shock. Still, no heartbeat. After ten minutes of continuous chest compressions, the medical and nursing staff was starting to lose hope.

Ten minutes without a heartbeat has long been considered a kind of dividing line in resuscitation science. It has long been thought that after ten minutes without a heartbeat, damage to the brain from a lack of oxygen starts to become permanent. Of course, without a properly functioning brain, Joe Tiralosi would no longer be Joe Tiralosi at all. His memories, his personality, what we might call his Joeisms would be gone forever, and only his body would still be here. His wife could hold the hand of the man she had shared her life with, yet they would not really be together.

So ten minutes passed, fifteen minutes passed. Doctors worked well past the old markers; the ticktock rhythm of chest compressions was punctuated by an occasional defibrillator shock.

Twenty minutes.

The call to cease resuscitation attempts in this circumstance belongs to the doctor in charge. But he kept going.

Thirty minutes.

By now, Tiralosi had received thousands of chest compressions and had his heart shocked a half-dozen times. The room was looking more and more like a war zone. Traces of blood and medical debris lay around the gurney. Empty vials of adrenaline littered the floor, like spent gun cartridges on a battlefield. The nurses and doctors providing chest compressions were sweating, consuming their own stored-up energy.

Forty minutes.

Ten years ago, continuing to try and save him at this point would have been considered a tremendous riskfor both Tiralosi and his family. In the best-case scenario, even if Tiralosis heartbeat was restored, his mind would be a messa CT scan likely revealing multiple small and large plumes of damaged, black spaces where functioning neural cells once held his thoughts. But technology and medical understanding have advanced with the years, and so the doctors pressed on because they knew there was a possibility, however remote, that Tiralosi could be saved and returned to his normal life.

Finally, something incredible happened to break the exhausting monotonysomeone screamed with excitement: I feel a pulse, I think weve got him back. Suddenly, in one moment, all those clouds of despair were replaced by a sense of elation in the room. The exhausted staff had a new wind of energy and, more important, after having had more than forty-five hundred chest compressions and having his heart shocked with a defibrillator eight times, and being given countless vials of adrenaline, Joe Tiralosis heart had started to flicker again.

But the emergency was not over. At this point, precisely why Tiralosis heart had stopped functioning properly remained a mystery. Doctors needed to find the problem, or there was a very good chance it would stop again. After his heart was restarted, Tiralosi was quickly taken to the cardiac catheterization laboratory, because one of the likely possibilities for his cardiac arrest or death was an undiagnosed heart issue, or more precisely, a heart attack due to a blockage in one or more of the main arteries that supply his heart with oxygen-rich blood. Dye was placed in his arteries to determine if there were blockages.

Frighteningly, while in the cardiac catheterization lab, he lost his pulse again for roughly fifteen minutesmeaning that he actually died a second time. The doctors resuscitated him again. During this process, they found that he had a number of blockages in the vessels to his heart. They opened them with a fairly common balloon procedure and later inserted stents to keep the vessels from closing again. During this entire time, for a twenty-four-hour period in all, Tiralosis body was kept cooled using a special machine called the Arctic Sun to prevent his brain and organs from suffering damage due to the consequences of a lack of oxygen.

Ten years ago, a man saved after that length of time would most likely have been a kind of living huskhis body present, his mind gone. But today, Joe Tiralosi is a smiling, vibrant man. His face is long and lean with the shade of a well-groomed mustache and goatee covering his lips and chin. He is back at home with his children and the wife whose advice helped to save him, and back at work, continuing his life. The newspapers and television stations that reported on his resuscitation all called his recovery a miracle. If so, Tiralosi and his family were the beneficiaries of a