Erin go Bragh; Lazarus Go Home

A far cry from dead, emerging from Blarney Castle

On St. Patrick’s Day I remember five years ago my first visit to the auld sod, which I undertook 19 years to the day following my near-fatal caronary event and subsequent surgery. It’s been an eventful second chance I’ve been enjoying.

According to the manner of people, I can say I was dead once. Of course that would mean I was raised from the dead, because here I am, typing away, munching on snacks and writing this. So what is meant by “dead”?

I once had a friend (he is dead now) who, having been knifed in an altercation, had his heart stop three times during wild efforts to stem the bleeding, repair the severed jugular and carotid, and replace his blood, all the while keeping his brain alive. He used to say “I died three times on the table.” I would look at him and think “Well, not exactly…” and keep my mouth shut, because he was big and tough and feisty and liked his I was dead story. He earned it, too.

Mine was just once, following heart surgery, and I am pleased to report that during the 24 hours after I was resuscitated I remember absolutely nothing. It is a blank in my life, but I was in an intensive care area so I don’t really regret having no memory of any of that. I don’t regret having no “tunnel of light” story, either. I mean, we’ve all heard that. We’ve heard it quite enough. If I were to have had that happen I would be more cynical about that whole thing.

Right way

Still, there is something to all this, to wit: In 1970 when I was a habitual ambulance “aid man” (there were no EMTs then and the short-lived Maryland Ambulance Corpsman program of which I had been a part and which eventually gave way to a nationwide network of emergency medical services, was seen as a kind of freak legion of the bloodthirsty), I once went on a long, wild ride to the northern end of our district to find a woman in cardiac arrest. How long she had been that way was not entirely clear, but we knew back then how to perform a sort of CPR, even though the American Heart Association had not yet started issuing certification for it (that happened in 1972). CPR had been devised in 1960, and had become rather popular despite the rarity of its success. Sometimes it worked, and that was better than if it had never worked.

Wrong way

The woman in question got the Academy Award performance from us, which resulted in some bloodshed as the two of us in the back of the Cadillac coach ambulance (remember them?) were thrown all over the rather crowded and sharped-edged patient compartment while the driver lead footed it to a hospital even farther north. When we got there we scrambled to deliver what we were pretty sure was a dead woman to the hospital staff, who could at least take her off our hands.

Well we were right. They took over CPR (it used to look funny sometimes, and the good old precordial thump, once a staple of medical TV shows, was still in vogue and was administered with great gusto by one of the doctors in the ER). Eventually, after calculating the patient had been in arrest for at least a half hour, and with everyone believing brain death would take place in 4–6 minutes, they gave up, the doctor called the time of death, and we all, exhausted, took turns at the water fountain, cursed to ourselves, and spent some time recovering. It is a hard job sometimes, performing CPR. Especially in the back of an ambulance made out of a hearse (which those Cadillac ones were, you know).

No way (at least in the olden days)

We huddled with the doctor to help him choose a cause of death (the usual “heart failure” with no real explanation), and watched him put the pen to the paper.

What happened next was odd, to say the least.

The dead patient threw the sheet off her face, propped herself up on one elbow, and said “Whew! I thought I was gone for a minute there!”

Mrs. Lazarus, welcome back to the world.

Since that time, it has become more and more common to discover people in morgues, side rooms, even in funeral homes (pre-embalming stage) gasping, sitting up, recovering from being dead, and sometimes even complaining about the accomodations.

Now post-death resuscitation is becoming a specialty.

Acts 20: 7–12

Jesus therefore again groaning in himself cometh to the grave. It was a cave, and a stone lay upon it. Jesus said, Take ye away the stone. Martha, the sister of him that was dead, saith unto him, Lord, by this time he stinketh: for he hath been dead four days. Jesus saith unto her, Said I not unto thee, that, if thou wouldest believe, thou shouldest see the glory of God? Then they took away the stone from the place where the dead was laid. And Jesus lifted up his eyes, and said, Father, I thank thee that thou hast heard me. And I knew that thou hearest me always: but because of the people which stand by I saidit, that they may believe that thou hast sent me. And when he thus had spoken, he cried with a loud voice, Lazarus, come forth. And he that was dead came forth, bound hand and foot with graveclothes: and his face was bound about with a napkin. Jesus saith unto them, Loose him, and let him go.

Alleged actual tomb of Lazarus

In the words of William S. Burroughs, “Lazarus, go home.”

He was not heard from again.

Notice, in the Jesus story, how the motions gone through are comparable to modern medicine at its most primitive. Where it says “again groaning to himself,” it is sometimes interpreted as “sighed deeply.” There is that almost hopeless resignation that we are undertaking to do something that probably won’t work, and yet we do it. Why? Because we are crazy? Religious? In denial? Because sometimes it actually does work and if we don’t do it we know for damn sure the patient will die? Check that last one. And what about the conversation with “Father”? Trust me, something like that goes through our heads when we get ready to jump on the chest of someone who is trying to die who by rights should not be dying. It is some sort of very rapid internal dialogue and for some it may be an actual prayer to some God, but for most of us it is more a prayer to ourselves and the universe: “Give me strength.” And the adrenal glands answer, as they always do. And as for “Lazarus, come forth!” it should be no surprise to the reader than many times there are those of us who say similar things to the unresponsive patient who, more often than not has only been in arrest for seconds to minutes, not a half hour or hour or more. We argue with them mentally and often verbally. We curse them, too. “Come on, damn you! Breathe!” And when they do, as they sometimes do (sometimes with the help of an occasional jolt of electricity via paddles applied to the chest, connected to a defibrillator), we gasp things like “Thank you!” Or “Awright!” or “Jesus!”

It is, and is not, a variety of religious experience. Statistics tell us it is unlikely to work, but that the sooner and more effective the efforts, the better the chance. Still, it is a sketchy thing. We have, then, to have faith in something that is almost absurd: That we can raise the dead.

Now comes the next wave: Resuscitation Medicine, the nascent specialty of reviving people after even long periods of time, based on experiences like that one in 1970 and thousands of others since, and also on the unfolding of research that tells us what is a major “No shit!” moment for many: That death is almost never instantaneous but is a process, and that as organs are starting to shut down on a cellular level, they do it slowly and in stages, and that the brain, like the heart (even my very own personal heart) can be stunned but not destroyed, and can recover, often at least in part on its own power, and better with some help.

Resuscitation medicine grew out of the mid-2oth century discovery of CPR. Over time and with the help of seemingly freakish circumstances it became clear there is more going on than meets the eye. Now, says Sam Parnia, a specialist in this new field, and quoted in Wired Magazine, “…if I were to die this instant, the cells inside my body wouldn’t have died yet. It takes cells time to die after they’re deprived of oxygen. It doesn’t happen instantly. We have a longer period of time than people perceive. We know now that when you become a corpse, when then doctor pronounces you dead, there’s still a possibility, from a biological and medical perspective, of death being reversed.”

Well no shit. I knew that more than 40 years ago, and it wasn’t because of the story about Lazarus, which has for centuries provoked discussion as to what might actually have happened on that occasion (if it happened at all, which is not within the scope of this article for God’s sake). It certainly did, according to the story, get Jesus into more hot water with the high priests, as though he’d needed that.

Parnia allows that if we leave a patient alone long enough, the body will start to break down irretrievably, and resuscitation will become impossible. One would think Lazarus would have been one of those — but of course there is no reliable witness to attest as to when he actually stopped breathing, or why, let alone what Jesus might have done in some variations on that story, where he went into the tomb momentarily. CPR? Sorry. Just kidding. Maybe. Or not.

Parnia suggests that in some cases the brain and other organs may remain viable for up to eight hours. We’ve known for decades at least about the mammalian diving response, which allows drowning victims to be revived long after they have been in the water and in arrest, because of a) low water temperatures, b) the poorly understood mammalian response itself, which allows whales, dolphins and other mammals to live underwater for extended periods of time, though not indefinitely, and c) that this is especially true for very young children, who often can be revived after remarkably long periods of submersion. So there was already that, which everyone pretty much overlooked on purpose, even though they practiced it. (It should be noted that freshwater drowning is a cardiac event, while salt water drowning is more a matter of the lungs filling with water and suffocating the victim. It is an academic point, but it matters to emergency medical personnel because we take different approaches to each, and fresh water drownings are far more complicated).

A cautionary note: We in the lifesaving business are not trying to prevent death altogether or offer some sort of sloppy means to eternal life. Sometimes the cards don’t even allow for a “normal” lifespan. But we believe in shooting for normal, even though, as the Trinity College choir in Dublin was practicing as I entered the arch to the quad Queen’s anthem to fully living while dying:

https://youtu.be/5L8-FTvSVxs

This is how we do it.

Parnia says, unsurprisingly, that if the parts are still viable at, say, eight hours, and if there is a way to correct the cause of the initial cardiac arrest, then there is a chance that patient can come forth, more or less whole. He reminds us that certain kinds of terminal events are brought about by slow destruction of those very organs, so, as in the case of cancer or massive physical trauma, it is far less likely that someone could be revived this way. They have been “actively dying” for some time. That is different from a sudden interruption in the usual cycle where everything had been working just fine and the heart alone was knocked off line.

It is speculated now (and there is significant clinical evidence to support this) that even when the brain is technically “dead” for some time, consciousness or some reasonable analog of consciousness, remains after the brain has been deprived of blood and/or oxygen for inordinate lengths of time. This is supported by the endless lists of reports by people who have been “dead” long enough to be dead, but who came back or were brought back, of memories accumulated during that “dead” period. Many of those stories sound exactly the same, but some reflect an inexplicable awareness of what was going on in the patient’s vicinity, and this excludes those “I found myself floating up near the ceiling and looking down at myself.” I am not making light of these — much — but they have become cliche, which means actually there is probably something to them, but there is no good clinical explanation for this, no science. There is, however, some rational basis for believing that “…the idea that electrochemical processes in the brain lead to consciousness may no longer be correct.” [Parnia].

I have long struggled with this notion, myself, and I have my own hypothesis for how this might work. However, I am no scientist. I will defer, here, to science. But I’m probably right, just so you know, and maybe someday I’ll write a about that, as simple speculation. Not now, however.

It has become routine medical practice to cool the bodies of people having acute myocardial infarctions (MIs) or who have already experienced so-called clinical death (cardiac arrest) in order to help slow the deterioration of vital organs, so that the primary cause of the arrest can be corrected and the patient revived. Already more people are recovering better from MIs owing to this technology. We are not talking about cryotherapy, either, where the body (or head) is frozen and stored away until a cure for the cause of death can be found (a la Ted Williams and Walt Disney). No, this is a more here-and-now kind of cooling, not indefinite freezing.

And what about those after death or, more appropriately, near death visions? They do seem to be culture or belief-system oriented, which makes sense. Why would a Hindu, for instance, see the same sort of being a western Christian might? And even atheists have reported seeing some sort of being, but obviously not Zeus. Me? I saw nothing. I remember nothing. I do know I was quite annoyed to learn that this had even happened to me, but that’s about it.

Of course later, days later, after a series of seemingly meaningless and typical ICU hallucinations, while quite awake and aware, in a private room, while I was sitting n my bed, reading a book, something happened. It was a waking experience though, and yes, it involved light, but no tunnel of white light, no being with arms open, nothing easily described.

I had already gone through nearly a week of experiencing what it was like to be a small child again, a helpless infant, a small child learning to walk, to use the toilet, to start from scratch, and it filled me with wonder. I also laughed a lot.

Then one day I simply felt and saw the presence of warm light with no source enveloping me, and I began to cry — and laugh. I have no idea what that was about, but it was a keeper.

And then my life began…

Writer, activist, novelist, sixth generation DC, local historian-storyteller, and 1:1 patient care technician five days a week.