US, WASHINGTON (ORDO NEWS) — In March 2015, baby Gardell Martin fell into an ice stream and was dead for more than an hour and a half. In less than four days, he left the hospital alive and well. His story is one of those that prompt scientists to reconsider the very meaning of the concept of “death.”
At first it seemed to her that her head just hurt – but in a way she had never hurt. 22-year-old Carla Perez was expecting a second child – she was in her sixth month of pregnancy. At first, she was not too scared and decided to lie down, hoping that her head would pass. But the pain only intensified, and when Perez vomited, she asked her brother to call 911.
An unbearable pain twisted Karla Perez on February 8, 2015, closer to midnight. An ambulance took Karla from her home in Waterloo, Nebraska, to the Methodist Women’s Hospital in Omaha. There, the woman began to lose consciousness, her breathing stopped, and doctors inserted a tube into her throat so that oxygen continued to flow to the fetus. Computed tomography showed: extensive cerebral hemorrhage created tremendous pressure in a woman’s skull.
Carla suffered a stroke, but the fetus, surprisingly, was not injured, his heart continued to beat confidently and evenly, as if nothing had happened. At about two in the morning, repeated tomography showed: intracranial pressure irreversibly distorted the brain stem. “Having seen this,” says Tifani Somer-Sheli, the doctor who observed Perez in both the first and second pregnancies, “everyone realized that nothing good could be expected.”
The woman found herself on the shaky line between life and death: her brain stopped functioning without a chance of recovery – in other words, she died, but the vital activity of the body could be maintained artificially, in this case, to enable the 22-week-old fetus to develop to the stage when it will be able to exist independently.
There are more and more people who, like Carla Perez, are in a borderline state every year, as scientists more clearly understand that the “switch” of our existence does not have two on / off positions, but much more, and between white and black there is room for many shades. In the “gray zone” everything is not irrevocable, sometimes it is difficult to determine what life is, and some people cross the last line, but return – and sometimes they tell in detail about what they saw on the other side.
“Death is a process, not an instant,” writes resuscitator Sam Parnia in the book Erasing Death: the heart stops beating, but the organs do not die at that very moment. In fact, the doctor writes, they can remain intact for quite some time, which means that for a long time “death is completely reversible.”
How can one whose name is a synonym for ruthlessness be reversible? What is the nature of the transition through this “gray zone”? What happens with our consciousness? In Seattle, biologist Mark Roth experiments by immersing animals in artificial suspended animation using chemicals that slow heart rate and metabolism to levels similar to those observed during hibernation. Its goal is to make people who have a heart attack “a little immortal” until they overcome the consequences of the crisis that put them on the brink of life and death.
In Baltimore and Pittsburgh, teams of traumatologists led by surgeon Sam Tisherman conduct clinical trials in which patients with gunshot and knife wounds are lowered in order to slow down bleeding for the period needed to suture. These doctors use cold for the same purpose that Roth is a chemical compound: it allows you to “kill” patients for a while, in order to ultimately save their lives.
In Arizona, cryopreservation specialists store the bodies of more than 130 of their clients in a frozen state – this is also a form of “border zone”. They hope that someday in the distant future, maybe in a few centuries, these people can be thawed and revived, and medicine by that time will be able to cure the diseases from which they died.
In India, neuroscientist Richard Davidson studies Buddhist monks who have fallen into a state known as tukdam, in which the biological signs of life disappear, but the body does not seem to decompose for a week or longer. Davidson is trying to fix some activity in the brains of these monks, hoping to find out what happens after blood circulation stops.
And in New York, Sam Parnia enthusiastically talks about the possibilities of “delayed resuscitation.” According to him, cardiopulmonary resuscitation works better than is commonly believed, and under certain conditions – when the body temperature is lowered, indirect heart massage is correctly regulated in-depth and rhythm, and oxygen is supplied slowly to avoid tissue damage – some patients can be returned to life even after they have not had a heartbeat for several hours, and often without long-term negative consequences. Resuscitation is an important area to discuss as DNR laws may vary by state, so doing this practice may go against the wishes of those who have a DNR order if they reach that point, however, with this happening there are some moral questions that need to be discussed.
The doctor is now exploring one of the most mysterious aspects of returning from the dead: why do so many people who have experienced clinical death describe how their consciousness separated from the body? What can these feelings tell us about the nature of the “border zone” and about death itself? According to Mark Roth of the Fred Hutchinson Cancer Research Center in Seattle, the role of oxygen at the border between life and death is highly controversial. “Already in the 1770s, as soon as oxygen was discovered, scientists realized that it was essential for life,” says Roth. – Yes, if you significantly reduce the concentration of oxygen in the air, then you can kill the animal. But, paradoxically, if you continue to lower the concentration to a certain threshold, the animal will live, falling into suspended animation. ”
Mark showed how this mechanism works, using the example of roundworms living in the soil – nematodes that can live at an oxygen concentration of only 0.5 percent, but die when it is reduced to 0.1 percent. However, if you quickly pass this threshold and continue to lower the oxygen concentration – to 0.001 percent or even less – the worms fall into a state of suspended animation. In this way, they are saved when harsh times come for them, which reminds animals that hibernate for the winter.
Deprived of oxygen, creatures that have fallen into suspended animation seem dead, but this is not so: the light of life is still warming in them. The mouth tries to control this condition by injecting “elementary reducing agent” – for example, iodide salt – in experimental animals, which significantly reduces their oxygen demand. Theoretically, this method is able to minimize the damage that treatment after a heart attack can cause to patients.
The idea is that if iodide salt slows down oxygen metabolism, it can help avoid ischemic reperfusion damage to the myocardium. This kind of damage due to the excess supply of oxygen-enriched blood to a place where its deficiency was previously tested is the result of treatment methods such as balloon angioplasty of blood vessels. In a state of suspended animation, a damaged heart can slowly eat oxygen coming from a repaired vessel, and not choke on it.
As a student, Ashley Barnett had a serious car accident on a highway in Texas, far from major cities. Her pelvic bones were crushed, her spleen was torn, she was bleeding. At these moments, Barnett recalls, her mind was sliding between two worlds: in one, the rescuers removed her from a crumpled car with a hydraulic tool, chaos and pain reigned there; in another, a white light shone and there was neither pain nor fear. A few years later, Ashley was diagnosed with cancer, but thanks to her near-death experience, the young woman was sure that she would live. Today, Ashley is the mother of three children, she advises survivors of accidents.
The question of life and death, according to Roth, is a question of movement: from the point of view of biology, the less movement – the longer life is usually longer. Seeds and spores can live hundreds and thousands of years – in other words, they are practically immortal. The mouth dreams of the day when with the help of a reducing agent like iodine salt it will be possible to make a person immortal “for a moment” – for that very moment when he needs it most, when his heart is in trouble.
However, this method would not have helped Carla Perez, whose heart did not stop beating for a second. The day after the terrifying results of computed tomography were obtained, the doctor Somer-Sheli tried to explain to the shocked parents, Modesto and Berthe Jimenez, that their beautiful daughter, a young woman who adored her three-year-old daughter, surrounded by many friends and loved to dance, had died brain.
It was necessary to overcome the language barrier. Jimenezov’s native language is Spanish, and everything that the doctor said had to be translated. But there was another barrier, more complicated than the linguistic one – the very concept of brain death. This term appeared in the late 1960s, when two achievements of medicine coincided: the equipment for maintaining life, which blurred the line between life and death, and success was achieved in organ transplantation, which created the need to make this border as distinct as possible.
Death could not be defined in the old way, only as the cessation of breathing and heartbeat, because the artificial respiration apparatus could support both for an indefinitely long time. Is a person connected to such an apparatus alive or dead? If you turn it off, then when will it be morally correct to remove its organs in order to transplant them to someone else? And if the transplanted heart again beats in another breast, can it be assumed that the donor was really dead when his heart was cut out?
In 1968, a commission was convened at Harvard to discuss these delicate and difficult issues, which formulated two definitions of death: traditional, cardiopulmonary, and a new one based on the criteria of neurology. Among these criteria, which are used today to establish the fact of brain death, there are three most important: coma, or a complete and persistent lack of consciousness, apnea, or inability to breathe without an artificial respiration apparatus, and the absence of reflexes of the brain stem, which is determined by simple tests: you can rinse the patient’s ears with cold water and check whether the eyes move, or squeeze the nail phalanges with a hard object and see if the muscles of the face react, or act on the throat and bronchi, trying to cause a cough flex. All this is quite simple and yet contrary to common sense.
“Patients who have brain death do not look dead,” James Bernat, a neurologist at Dartmouth College of Medicine, wrote in the 2014 journal American Journal of Bioethics. “This contradicts our life experience – to call a patient dead, whose heart continues to beat, blood flows through the vessels and internal organs function.”
… Two days after the stroke, Carla Perez, her parents arrived with the father of the unborn child at the Methodist Hospital. There, in the conference room, 26 clinic staff were waiting for them – neurologists, palliative care and ethics specialists, nurses, priests, social workers. Parents listened intently to the words of the translator, who explained to them that the tests showed that their daughter’s brain had stopped functioning. They learned that the hospital offers to support the vital functions of Perez’s body until her fetus is at least 24 weeks old – that is, until the chances of his survival outside the mother’s womb are at least 50 to 50. If they are lucky, the doctors said, they it will be possible to maintain vital activity even longer, increasing the probability of a baby being born every week.
Perhaps at that moment Modesto Jimenez remembered the conversation with Tiffany Somer Shely, the only one in the hospital who knew Carla as a living, laughing, loving woman. The night before Modesto took Tiffany aside and quietly asked only one question. “No,” Dr. Somer-Shelley replied. “Most likely your daughter will never wake up.” These were perhaps the most difficult words in her life.
“As a physician, I understood that brain death is death,” she says. “From a medical point of view, Karl was already dead at that moment.” But looking at the patient lying in the intensive care unit, Tiffany felt that she was almost as hard to believe in this indisputable fact as the parents of the deceased. Peres looked as if she had just had surgery: her skin was warm, her breasts were rising and falling, and her fetus was moving in her stomach – apparently, completely healthy. Then, in a crowded conference room, Karla’s parents told the doctors: yes , they understand that their daughter’s brain is dead and she will never wake up. But they added that they would pray for un milagro – a miracle. Just in case.
During a family outing on Lake Slipy Hollow (Sleepy Hollow) in upstate New York, Tony Kikoria, an orthopedic surgeon, tried to call his mother. A thunderstorm began, and lightning, striking the phone, passed through Tony’s head. His heart stopped. Kikoria recalls that he felt himself leaving his own body and moving through the walls to a bluish-white light to connect with God. Having returned to life, he suddenly felt attracted to playing the piano and began to record melodies that seemed to “download” to his brain by themselves. In the end, Tony became convinced that his life was saved so that he could broadcast “music from heaven” into the world.
The return of man from the dead – what if not a miracle? And, I must say, such miracles in medicine sometimes happen. Spouses Martin know this firsthand. Last spring, their youngest son Gardell visited the kingdom of the dead, falling in an ice stream.
A large Martin family – husband, wife, and seven children – lives in Pennsylvania, in the countryside, where the family owns a large piece of land. Children love to explore the area. On a warm March day in 2015, two older boys went for a walk and took Gardell with him, who was not even two years old. The kid slipped and fell into a stream, flowing a hundred meters from the house. Noticing the disappearance of his brother, the frightened boys for some time tried to find him themselves. As time went…
By the time the rescue team reached Gardell (a neighbor pulled him out of the water), the baby’s heart did not beat for at least thirty-five minutes. Rescuers began to do external heart massage and did not stop it even for a minute throughout the 16 kilometers that separated them from the nearest Evangelical community Hospital.
The boy’s heart failed to start, body temperature dropped to 25 C. Doctors prepared Gardell for transport by helicopter to the Geisinger Medical Center, located 29 kilometers in the city of Danville. My heart still did not beat. “He showed no signs of life,” recalls Richard Lambert, the pediatrician responsible for the use of pain medication at this medical center, a member of the resuscitation team that was waiting for the plane. “He looked as if … Well, in general, the skin has darkened, his lips are blue …” Lambert’s voice trails off when he recalls this terrible moment. He knew that children drowned in icy water sometimes come back to life, but he never heard that this happened to babies who had not shown signs of life for so long. Worse yet
… The resuscitation specialist on duty turned to Lambert and his colleague Frank Maffei, director of the resuscitation department of the children’s hospital of the Geisinger Center: maybe it’s time to quit trying to revive the boy? But neither Lambert nor Muffei wanted to give up. Circumstances in general were suitable for a successful return from the dead. The water was cold, the child was small, attempts to resuscitate the boy began a few minutes later, after he drowned, and since then have not stopped. “Let’s continue, just a little more,” they told colleagues. And they continued. Another 10 minutes, another 20 minutes, then another 25. By this time, Gardell was not breathing, and his heart was not beating for more than an hour and a half. “A limp, cold body with no signs of life,” Lambert recalls. However, the resuscitation team continued to work and monitor the condition of the boy.
Doctors who did external cardiac massage changed every two minutes – this is a very difficult procedure if performed correctly, even when the patient has such a tiny chest. Meanwhile, other resuscitators inserted catheters into the femoral and jugular veins, Gardell’s stomach and bladder, pouring warm fluids into them to gradually increase body temperature. But there seemed to be no sense from this. Instead of completely stopping resuscitation, Lambert and Muffei decided to transfer Gardell to the surgical department to connect him to a heart-lung machine. This most radical way of warming the body was the last desperate attempt to make the baby’s heart begin to beat again. Having treated their hands before the operation, the doctors checked the pulse again. Incredible: he appeared! Palpitations felt at first weak, but even, without characteristic rhythm disturbances that sometimes appear after prolonged cardiac arrest. Only three and a half days later, Gardell left the hospital with his family, offering prayers to heaven. His legs barely obeyed him, but otherwise the boy felt fine.
After a head-on collision of two cars, student Trisha Baker ended up in a hospital in Austin, Texas, with a broken spine and severe blood loss. When the operation began, Trisha felt herself hovering under the ceiling. She clearly saw a straight line on the monitor – her heart stopped beating. Then Baker ended up in the hospital corridor, where her heartbroken stepfather bought a chocolate bar in a vending machine; it was this detail that subsequently convinced the girl that her movements were not a hallucination. Today, Trisha teaches writing skills and is confident that the spirits who accompanied her on the other side of death direct her in life.
Gardell is too small to tell what he felt when he was dead for 101 minutes. But sometimes people saved through persistent and high-quality resuscitation, returning to life, talk about what they saw, and their stories are quite concrete – and frighteningly similar to each other. These stories have repeatedly been the subject of scientific study, most recently within the framework of the AWARE project, which was led by Sam Parnia, head of resuscitation research at Stony Brook University.
Since 2008, Parnia and his colleagues have examined 2060 cases of cardiac arrest in 15 American, British, and Australian hospitals. In 330 cases, patients survived, and 140 survivors were interviewed. In turn, 45 of them reported that they were in some form of consciousness during resuscitation procedures.
Although most could not recall in detail what they felt, the stories of others were similar to those that can be read in bestsellers like “Heaven is real”: time accelerated or slowed down (27 people), they experienced peace (22), separation of consciousness from the body (13), joy (9), saw a bright light or a golden flash (7). Some (the exact amount is not given) reported unpleasant sensations: they were scared, it seemed that they were drowning or that they were carrying them somewhere deep under water, and one person saw “people in tombs that were buried vertically in the ground.”
Parnia and his co-authors wrote in the medical journal Resuscitation (“Resuscitation”) that their study provides an opportunity to advance in understanding the diverse mental experience that is likely to accompany death after a cardiopulmonary arrest. According to the authors, the next step should be to study whether – and if so, how – this experience, which most researchers call near-death experiences (Parnia prefers the phrase “experiences after death”), on surviving patients after recovery, does not he has cognitive problems or post-traumatic stress. What the AWARE team has not explored is the typical effect of near-death experiences – the growing sense that your life has meaning and meaning.
Survivors of clinical death often talk about this sensation – and some even write entire books. Mary Neal, an orthopedic surgeon from Wyoming, mentioned this effect when she spoke to a large audience in 2013 at the Rethinking Death Symposium at the New York Academy of Sciences. Neil, the author of the book “To Heaven and Back,” spoke about how she sank 14 years ago during a rafting on a mountain river in Chile. At that moment, Mary felt how the soul separates from the body and takes off over the river. Mary recalls: “I was walking along an amazingly beautiful road leading to a magnificent building with a dome, from where, I knew for sure, there would be no return – and I was impatient to get to it as soon as possible.”
Mary at that moment was able to analyze how strange all her sensations were, she remembers how she wondered how much time she spent under water (at least 30 minutes, as she later found out), and consoled herself with the fact that her husband and children would be good without her. Then the woman felt her body being pulled out of the kayak, felt that both her knee joints were broken, and saw how they were doing artificial respiration. She heard one of the rescuers calling her: “Come back, come back!”. Neil recalled that, having heard this voice, she felt “very irritated.”
Kevin Nelson, a neuroscientist at the University of Kentucky who participated in the discussion, was skeptical – not to Neil’s memories, which he recognized as vivid and genuine, but to their interpretation. “This is not the feeling of a dead person,” Nelson said during the discussion, objecting also to Parnia’s point of view. “When a person experiences such sensations, his brain is quite alive and very active.” According to Nelson, what Neal felt could be explained by the so-called “REM sleep invasion,” when the same brain activity that is characteristic of him during dreams, for some reason, begins to manifest itself in some other unrelated circumstances – for example, during a sudden oxygen starvation. Nelson believes that near-death experiences and a feeling of separation of the soul from the body are not caused by dying,
There are other psychological explanations for near-death experiences. At the University of Michigan, a team of researchers led by Jimo Borjigin measured the waves of electromagnetic radiation from the brain after cardiac arrest in nine rats. In all cases, the high-frequency gamma waves (those that scientists associate with mental activity) became stronger – and even more clear and orderly than during normal wakefulness. Perhaps, the researchers write, this is a near-death experience – increased activity of consciousness that occurs during the transition period before final death?
Even more questions arise when studying the already mentioned tukdam – the state when a Buddhist monk dies, but for another week, or even more, his body does not show signs of decomposition. Is he still conscious? Is he dead or alive? Richard Davis from the University of Wisconsin has been studying the neurological aspects of meditation for many years. He has been occupied with all these issues for a long time – especially after he happened to see a monk in tukdam at the Buddhist monastery Deer Park in Wisconsin.
“If I accidentally went into that room, I would have thought that he was just sitting, immersed in deep meditation,” says Davidson, and notes of reverence are heard in his voice in the telephone receiver. “His skin looked absolutely normal, not the slightest sign of decomposition.” The sensation caused by the close proximity of this dead man contributed to the fact that Davidson began to explore the phenomenon of tukdam. He brought the necessary medical equipment (electroencephalographs, stethoscopes, etc.) to two field research sites in India and trained a team of 12 Tibetan doctors to examine the monks (they should start when they were undeniably alive) to find out if brain activity after death.
“It is likely that many monks enter a state of meditation before they die, and after death it somehow persists,” says Richard Davidson. “But how this happens and how this can be explained, eludes our everyday understanding.”
Davidson’s research, based on the principles of European science, aims to achieve a different, more subtle understanding of the problem, an understanding that could shed light not only on what happens to the monks in tukdam, but also on anyone who crosses the border between life and death.
Typically, decomposition begins almost immediately after death. When the brain ceases to function, it loses its ability to maintain the balance of all other body systems. Therefore, in order for Carla Perez to continue to bear her baby after her brain stopped working, a team of more than a hundred doctors, nurses and other hospital staff had to act as a kind of conductors. They monitored the readings of devices measuring blood pressure, kidney function and electrolyte balance around the clock, and constantly made changes in the composition of fluids administered to the patient through catheters.
But, even performing the functions of the dead brain of Perez, doctors could not perceive it as dead. Without exception, everyone treated her as if she were in a deep coma, and, entering the room, greeted, calling the patient by name, and leaving – they said goodbye.
In part, they behaved in such a way, respecting the feelings of Peres’s relatives – the doctors did not want to create the impression that they treated her as a “container for a baby.” But sometimes their behavior went beyond the usual politeness, and it became clear that the people caring for Perez, in fact, treat her as living.
Todd Lovgren, one of the leaders of this team of doctors, knows what it is to lose a child – his daughter, who died in early childhood, the oldest of his five children, could have turned twelve years old. “I would not respect myself if I did not treat Karla as a living person,” he told me. “I saw a young woman with nail polish, her mother combed her hair, she had warm hands and toes … Her brain was functioning or not, I don’t think she stopped being a man.”
Speaking more like a father rather than a doctor, Lovgren admits: it seemed to him that something of Perez’s personality was still present in the hospital bed – even though after the CT scan he knew that the woman’s brain wasn’t just not functioning ; significant sections of it began to die and decay (Nevertheless, the doctor did not conduct a test for the last sign of brain death, apnea, because he was afraid that by disconnecting Perez from the artificial respiration apparatus even for several minutes, he could harm the fetus).
On February 18, ten days after a stroke, Perez discovered that her blood stopped clotting normally. It became clear: the dying brain tissue penetrates the circulatory system – another evidence in favor of the fact that it will not recover. By that time, the fetus was 24 weeks old, so the doctors decided to transfer Perez from the main campus back to the obstetrics and gynecology department of the Methodist Hospital. They managed to cope with the problem of blood coagulation for a while, but they were ready to have a cesarean section at any time – as soon as it became clear that it was impossible to hesitate, as soon as even the appearance of life that they managed to maintain began to disappear.
According to Sam Parnia, death is, in principle, reversible. Cells inside a person’s body, he says, usually don’t die right away with it: some cells and organs can remain viable for several hours and maybe even days. The question of when you can declare a person dead is sometimes decided in accordance with the personal point of view of the doctor. During his studies, says Parnia, they stopped making heart massage after five to ten minutes, believing that after this time the brain would still be irreparably damaged.
However, resuscitation scientists have found ways to prevent the death of the brain and other organs even after cardiac arrest. They know that lowering their body temperature contributes to this: Gardell Martin was helped by ice water, and in some intensive care units, the patient’s heart is cooled specially before each massage. Scientists also know how important persistence and perseverance are.
Sam Parnia compares resuscitation to aeronautics. Throughout the history of mankind, it seemed that people would never fly, and yet in 1903, the Wright brothers took to the sky on their airplane. Amazingly, Parnia notes, only 66 years have passed from that first flight lasting 12 seconds to landing on the moon. He believes that similar successes can be achieved in resuscitation. As for the resurrection from the dead, the scientist thinks, here we are still at the stage of the first airplane of the Wright brothers.
Nevertheless, doctors are already able to conquer life from death in amazing, hopeful ways. One such miracle happened in Nebraska on Easter Eve, closer to noon on April 4, 2015, when a boy named Angel Perez was born at Caesarean section at the Methodist Women’s Hospital. Angel was born because doctors were able to maintain the vital functions of the body of his mother, whose brain was dead, for 54 days – enough time for the fetus to develop into a small, but quite normal – surprising in its normalcy – newborn weighing 1300 grams. This child turned out to be the miracle that his grandparents prayed for.
National Geographic material was used for this article.
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