David Casarett M.D. - Shocked: Adventures in Bringing Back the Recently Dead

W hen 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, someones 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 characters chest and bounce up and down heroically. It was also at about this point that another rescuerusually a tall, handsome doctorperformed 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 victims 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 victims 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 wed 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, occasionallyand just for varietys sakethe 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 wouldnt be dead for long.

I also became convinced that if resuscitation is going to work, its 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 McDonalds Big Mac jingle. Lets call this the Big Mac rule of resuscitation. By then, your victim is probably wide-awake and hugging the rescuers. If she isnt, 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.

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 outmore than an hour after the accidentshe 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 couldnt 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 hadnt been breathing. And for probably almost as long, her heart hadnt 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 wasnt breathing (that is, she was apneic). She also had the dusky-blue (cyanotic) color of someone whose body has been starved of oxygen. And the fact that her pupils were fixed and dilated meant that her brainspecifically her brain stem, one of the areas that controls the eyes response to lighthad 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.