David Casarett, M.D. was first inspired to become a doctor after reading a newspaper article in 1986 about the strange case of a toddler named Michelle Funk. She drowned in an icy creek near her home, fully submerged in the frigid water for over an hour. She was half-frozen and without a pulse, declared dead -- until a team of emergency room doctors used a novel warming protocol and an external heart and lung pump to bring her back to life. The medical feat was the subject of news stories around the world.
Fast forward nearly 30 years and Casarett is a respected professor at the University of Pennsylvania's School of Medicine. He's also a specialist in hospice and end-of-life care -- some would argue, the very opposite medical specialty from his initial interest. But in a new book, Shocked: Adventures in Bringing Back the Recently Dead, Casarett returns to the idea of resuscitation, exploring the science and ethics of bringing life to those declared otherwise.
In a conversation with The Huffington Post, Casarett discussed the exciting technologies that may lead to improved chances for young victims of trauma like Funk -- but also about the implications for an aging population.
From the obvious religious overtones to news stories and TV shows about people returning to life, it's clear this is a story we're drawn to. Why do you think we like resurrection narratives so much?
The obvious one is that a "back from the dead" narrative is almost by definition a good news story. We all love good news stories, like the patient whose cancer was cured or the guy who survived with a heart transplant. Of course, they aren't always realistic: Many people who are brought back from the dead go into comas or recover with brain damage, and obviously those are not happy stories.
There's a related fact, which may not be as obvious: The people who survive in those amazing stories are generally young. So that adds a layer of "good" to the good news story -- you are not talking about the miraculous survival of an 85 year old, you are talking about the miraculous survival of a 2 year old or a 7 year old or sometimes somebody in their early 20s. Young people tend to do better, so it's not just any survival but a survival of somebody with a long life ahead of them.
And then also there's an additional layer of, if not appeal, then maybe morbid attraction. If it is possible to bring someone back from the dead who has been apparently dead for 30 minutes or a couple of hours, then that raises some interesting and potentially scary questions. If you die, are you really dead?
What are some of the ways scientists are learning to bring people back from the dead?
I was really impressed by a lot of the research on suspended animation. I stumbled across a story about a Japanese office worker who got lost in the woods and was found after a couple of weeks in a state that looked an awful lot like hibernation. That story got a lot of press -- he was discovered and survived. It was a good news story, but also confusing because humans don't hibernate. I heard that story and started looking at research that is being done now by a scientist who had kind of the same idea: What if you could induce hibernation in people?
People don't hibernate, but what if you could trick them into doing it? What if you could convince the human body that hibernation really is both possible and a good thing? What could that do for survival, for limiting brain damage for instance, for a stroke, or myocardial infarction or cardiac arrest?
The connection between hibernation and resurrection isn't so obvious to the average person.
It's really the idea that using some combination of cold or drugs it's possible to reduce a person's metabolism by 95 percent. The logic there is that if someone is the victim of an accident or cardiac arrest or a soldier who is wounded on the battlefield -- whose heart stopped or has substantial blood loss -- the amount of time that such a person can survive and still recover is inversely proportional to how much oxygen their body and their brain is using. So if you can decrease somebody's metabolism by 90 or 95 percent, you can actually help them survive longer without a heartbeat or in a situation of extreme blood loss.
The implication is that potentially in the not-too-distant future somebody who suffers cardiac arrest or a soldier on the battlefield who normally wouldn't survive would get an injection of a drug that would put them into a state that looks kind of like hibernation and that would allow them to survive for half an hour, an hour, potentially days until they could be stabilized. That is a surprise, and it's pretty neat.
You're an end-of-life doctor. What inspired you to write a book about resuscitation?
In medical school and residency I saw all of the downstream effects of what happens when we try to bring people back from the dead. Sometimes we ended up keeping people alive under poor conditions. The idea behind the book was partly to revisit that distinction: Is this technology the best thing to ever happen or is it the worst thing? And how is it different for the young and healthy versus the old and sick? So it was probably a test for myself as well.
What are your concerns about the way we think of and discuss resuscitation?
We're getting much better at resuscitating people than we are at having conversations about whether resuscitation is what a patient wants.
Though the book is humorous and a popular science take on resuscitation, there is a message here: If you don't think about this stuff and you don't make a decision about whether or not you want to be resuscitated and under what circumstances, chances are good you'll be on the business end of a defibrillator unless you let somebody know that you'd like otherwise.
Will we ever be immortal?
In the book, I tell the story from Greek mythology of Tithonus, who was granted immortality but not eternal youth. So he stayed alive, but got older and older and weaker and weaker -- and that's a more likely outcome within immortality.
It's entirely possible that we could be immortal from a cardiac perspective. You could imagine a scenario where somebody's heart stops beating, we restart it; if that no longer works, we install a pacemaker; if that no longer works, we implant an automatic defibrillator; if that doesn't work, we implant an artificial heart.
Not to be gruesome, but when I take care of nursing home patients, I see something like the Tithonus problem: I see patients who have been brought back from the brink from pneumonia and cardiac arrest, but whose brains are failing. They continue to get weaker and have all sorts of complications. We can keep their hearts going but the rest of them keeps getting weaker and more tired. So I would say that to me, at least in the near future, immortality seems like more of a risk.
So the answer is: Maybe. But I think there's a question of whether we want to be.
This interview was shortened and edited for clarity.