Dr. Sanjay Gupta goes into the world of medicine to uncover the latest techniques that doctors use to save lives. What he found were techniques that increased heart attack recovery rates by 20 percent, a new method for therapeutic hypothermia that prolongs the efficiency of treatments, and many other techniques that have led to medical miracles.
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PrologueI don't want to achieve immortality through my work. I want to achieve it through not dying. —Woody Allen
I'm going to let you in on a little secret: When the heart stops beating, it's not the end. In fact, you might say that your troubles have only just begun. As it turns out, life and death is not a black-and-white issue. There is a gray zone—a faint no-man's-land where you are neither truly dead nor actually alive. In order to control it, in order to cheat death, we have to fi rst better understand it.
The last thing Zeyad Barazanji remembers is the silence. 1 Thirty seconds earlier, he had been watching election returns on CNN, his head turned up from the treadmill, where he was huffi ng and puffi ng through his daily afternoon workout. His attention had drifted from the television to the sound of his own pounding feet, the whir of the machine, and his rasping breath as he strained to match his usual pace. That Tuesday, it felt like he was running uphill, and Barazanji cut it short, turning off the machine after only twenty minutes of jogging. A retired literature professor, Barazanji was in a bustling gym near his home in the Spuyten Duyvil section of the Bronx, surrounded by the banter of his neighbors and the clanking of weights. But then, nothing. Silence.
He doesn't remember what happened next, only what people told him later. One woman will never forget it. One minute she was working out, and the next there was a blur in the corner of her eye. The wiry, older man with the white undershirt and headband crumpled in a heap at the foot of the adjacent treadmill. At least a dozen people saw him go down. Two called 911 from their cell phones. An athletic trainer, the gym's manager, Juan Echevarria, grabbed the automatic defi brillator off the wall and rushed to Barazanji's side.
Elbowing the crowd aside, Echevarria kneeled and placed the defi brillator's electrodes on Barazanji's chest. Upon getting a signal from the device, he sent a shock into the chest of the unconscious man. Two successive bursts of electricity—200 joules apiece—shook the crumpled body. Each jolt ran through the beaded sweat on Barazanji's chest, through the breastbone, and into his still heart, shocking the muscle into a contraction. Another contraction followed, and then another. As the trainer held his breath, Barazanji's heart caught a beat of its own. The heartbeat was back. The line between life and death had shifted just enough.
The professor groaned and remained senseless, but his heart was once again sending weak pulses of blood through his sixty-three-year-old arteries. About four minutes later, a team of emergency medical technicians raced across the basketball court, stretcher in hand, to Barazanji's side. Two minutes later, a breathing tube was down his throat, he was on the stretcher, and the paramedics were sweeping toward the exit.
We're used to thinking about dying in stark terms: dead or alive. You're here and then you're gone. In our imagination, this is how the moment of death plays out: The villain or hero or soldier gasping last words, stretching out a hand . . . until his eyes roll back in his head and we know it's all over. Or the cancer patient surrounded by family. A light flickers behind her eyes and then goes out. You've read it in a thousand stories, seen it in a thousand movies, a hundred episodes of ER . The alarm sounds. The monitor flatlines. Time of death, 2:15 a.m.
It only takes a few minutes for life to slip away. Without a heartbeat, circulation slows to a halt. Blood no longer flows to your brain or any other organ. It takes just a couple of minutes before everything goes dim, and you're blissfully unaware of the catastrophe unfolding inside your body. Starved of blood, the first organ to suffer is the brain, which in happier times consumes about 20 percent of all oxygen the body takes in, though it constitutes just 2 percent of our body mass. After ten seconds without oxygen, the brain's function slows. Without oxygen or signals from the brain, other organs break down as well. Diaphragm muscles no longer contract and release to bring in air. The kidneys stop filtering blood. At the same time, an elaborate chain of chemical reactions triggers a breakdown in cells throughout the body.
This is the process of dying. Whether because of a car accident, a blockage in an artery, or a tumor somewhere in your body, it is generally understood that when the heart stops beating, life has ended. I have seen this play out more times than I care to remember. The first time, I was a third year medical student at the University of Michigan. The patient was not much older than I was. I remember the call coming over the emergency radio: "Twenty-three-year-old unrestrained driver in an MVA [motor vehicle accident], found with the windshield starred and steering wheel bent." Even then, I knew those details were important; it takes a lot of force to bend a steering wheel with your chest or smash a windshield with your head. I remember the trauma surgeons, neurosurgeons and orthopedic surgeons descending on this young man. They attempted to replace blood, stop bleeding and relieve pressure in his brain. It was a whirlwind of activity until . . . his heart stopped. And then everything else stopped, too. Everyone knew that was the end. After all, that's what we were taught in medical school and throughout our training. But what if it doesn't have to be that way? What if there were a way to give that twenty-three- year-old man and millions like him just a little more time, to shift the line between life and death? Ever since I watched that young man die, I have pondered that very question: can we move the line?
Surrounded by friends and family in his Bronx apartment, Zeyad Barazanji told me his story of cheating death in a warm, friendly way. Barazanji, a translator and retired Columbia professor, immigrated here from Syria back in the 1970s. His two-bedroom apartment was filled with artwork and mementos from a lifetime of traveling between New York and the Middle East. A delicious smell was in the air; his wife Raoua was whipping up a feast of Syrian delicacies and dinner was almost ready. I leaned in to listen over the buzz of activity and clinking glasses in the kitchen. We were interrupted more than once as Barazanji got up to answer the door, clapping friends on the back and hanging their coats.
It was hard to believe that this man, so full of life, was dead not long ago, but that's exactly what happened. His heart pumped no blood, his brain sent no signals, he thought no thoughts. Make no mistake—this is death. But maybe not the way we tend to think about it.
For all that's been said about immediate death—"I'm sorry, she was killed instantly"—in truth, there's no such thing. As a doctor, I can assure you that when the heart stops beating, it's not the end. Death is not a single event, but a process that may be interrupted, even reversed. And here's the exciting part—at any point during this process, the course of what seems inevitable can be changed. That is precisely what we are going to explore in this book: the possibility of cheating death.
As the ambulance screeched away from the curb in front of Bally's Total Fitness, Barazanji was in the gray zone—not dead but not quite fully alive, either. Millions of cells in his heart were already dead, suffocated by a lack of blood flow. It was too soon to say whether the damage was enough to cause a broader failure, similar to the collapse of a wall from which termites have taken one too many nibbles. It was also too soon to say if a significant number of brain cells—cells which had been nourished by a constant diet of oxygen for more than sixty-three years—had starved in those first precious minutes. There was no way to know just yet if the march toward death might be reversed. Barazanji could easily be you or me, our father or mother. In a sense, what happened to Barazanji is extraordinary, but in another sense, it happens to us all eventually. It's been said that life is a terminal condition, that nothing lasts forever, and the minute we're born, we start the long process of our end. I think everyone, at one point or another, has probably wondered: does it really have to be that way? When we explore the story of Barazanji, we're exploring the chances of cheating death—for you or me.
What you're holding in your hands is a medical thriller that explores an exciting and fast-moving realm of science. In these pages, we'll take you to the thin line that separates life and death, along with the doctors who struggle to keep their patients on the right side of the line. We will also explore that border through the eyes and ears of people who have found themselves straddling it, and we'll introduce you to scientists who are taking on incredible challenges. These determined pioneers are true optimists who believe that even if we don't yet have all the answers, we may find them.
From womb to deathbed, we'll see the myriad ways that modern science is changing our understanding of life and death. You'll see that neither the starting nor the finish line is written in stone; they are written in sand, shifting with each new wave of medical understanding and technology. In our journey to understand death—and to find a way to stave it off—we're going to explore the gray no-man's-land between this life and whatever lies beyond it.
Before we tell what happened to Barazanji, we're going to introduce you to another explorer, a woman who has been to the no-man's-land and lived to tell the tale. She arrived there by accident, on a faraway mountainside, in a world where people are used to working and playing in bitter cold and near darkness. That mountainside is the first stop on our remarkable journey.