Doctored by Sandeep Jauhar Read Free Book Online

save a severely brain-damaged patient anyway?) All the medications Ethan had mentioned had half-lives, so it was hard to know how to interpret the results. “I would back off on the vaso,” I said carefully. “Just start some dobutamine at 2.5 micrograms per kilogram per minute. I’ll be there in a couple of minutes. Did you call the wife?”
    â€œI got through to her a few minutes ago,” he replied. “I told her to come right away.”
    When I arrived back in the CCU, the code had already begun. A group of doctors and nurses were at the bedside. The rhythm on the monitor was ventricular fibrillation, random electrical oscillations. An intern was doing chest compressions. Saline was running wide open through an IV. Defibrillator pads adhered to Richardson’s hairy chest. His body jerked up and down with every administered shock. Because his heart had effectively stopped, his lungs had filled up with pink, frothy liquid, mostly blood plasma, like beaten-up Jell-O, which came up through his breathing tube. The compressions sent the nurses scrambling for face masks and yellow gowns to protect themselves from the red spray.
    â€œThis is a conspiracy to prevent me from getting my afternoon coffee,” quipped a doctor who had shown up to help. I chuckled at the wry shoptalk.
    After a couple of adrenaline injections, Mr. Richardson regained a pulse; but it immediately started to die down, and within a few minutes it disappeared. It seemed his body had finally given up. The sequence continued: shocks, chest compressions, and drugs. He got four doses of adrenaline at 1 milligram each, then 5 milligrams, then 10, but the pulse did not return. He received several ampoules of sodium bicarbonate. By then he was blue in the face, a sickening color, like an old hematoma. We continued CPR while I called for an echo machine, which takes ultrasound pictures of the heart. “Let’s take a quick peek before we call it,” I said. When the machine was wheeled in, I pulled the window shades closed and applied the ultrasound probe to his chest. The heart was in standstill, hazy clots filling the ventricles. I pressed a button to take a picture. The room was quiet as I pronounced him dead.
    Gowns and masks were stuffed into a trash bin, and people started filing out of the room. Then a strange thing happened. My gloved fingertips, soaked with blood on his pulseless groin, started to vibrate. Wait, I ordered the group.
    In the Bible, Lazarus is raised from the dead by Jesus. In medicine, Lazarus is the patient who, believed dead, spontaneously starts to circulate blood.
    About forty cases of the Lazarus phenomenon, a number that experts believe is too small to be valid, have been reported in the medical literature. (I have seen at least three cases in my own career.) Though most patients died soon after the event, in eight cases they left the hospital, neurological functions intact. The cases share a kind of morbidity: A man, eighty, is pronounced dead after thirty minutes of CPR. His doctor showers and returns five minutes later to find his patient has a pulse. A man, eighty-four, goes into cardiac arrest while biking. After fifteen minutes of CPR he is pronounced dead and taken to a mortuary, where attendants see him breathing. A woman, sixty-eight, suffers a heart attack and goes into prolonged cardiac arrest. Removed from her ventilator, she is taken to a separate room, where about twenty minutes later a nurse notes she is breathing and moving under the sheet. She is discharged from the hospital and dies three months later in her sleep.
    Why are certain deaths “reversible”? The phenomenon remains a mystery. Some have speculated that cessation of CPR decreases pressure in the chest cavity, allowing blood to return to the heart. In 1993 a doctor described the Lazarus phenomenon in a seventy-five-year-old man with a lung hemorrhage. “How [increased blood return] would stimulate the