Book review: ‘Shocked,’ on bringing back the recently dead, by David Casarett

So far in our history, revival after death has been a rarity. Occasionally, a seemingly miraculous recovery makes headlines. Witness the cases of Michelle Funk, a 2¹ / ₂ -year-old Utah girl who drowned in 1986 and was successfully resuscitated after three hours without a heartbeat, and Anna Bågenholm, a 29-year-old Norwegian skier who, in 1999, spent 80 minutes submerged under the ice of a frozen creek, was brought to a hospital cold and dead, was resuscitated, and went on to become a doctor.

Yet, despite medical progress, including the invention of lifesaving, implantable defibrillators to treat episodes of abnormal heart rhythm, most people don’t survive cardiac arrest or make it through overwhelming trauma, such as gunshots or stab wounds that produce massive blood loss. Might that someday change? Will we find reliable ways to use technology to cheat death?

In “Shocked,” David Casarett, a hospice physician and researcher at the University of Pennsylvania, sets out to investigate that question. Casarett, who has spent his career trying to improve care for patients at the end of their lives, approaches his subject with a mix of fascination and skepticism. As a student, he writes, he intended to become an emergency physician but became disillusioned after his first hospital “code”: The patient, a retired steelworker, was resuscitated after a cardiac arrest and went on to survive emergency heart surgery, but never regained consciousness. The animal research Casarett describes in this book may eventually give doctors the tools to put their patients into a state similar to suspended animation, preserving their brains and other organs while the patients undergo what would otherwise be considered last-ditch treatments.

Indeed, the University of Pittsburgh announced recently that doctors there are undertaking a study in which some patients with catastrophic wounds will have their blood replaced with cold saline solution, cooling their bodies to 50 degrees Fahrenheit and stopping their hearts. The hope is that hypothermia will protect the brain while trauma surgeons operate, after which the warm blood will be returned to the patient, allowing body temperature to rise and the heart to resume beating.

”Shocked: Adventures in Bringing Back the Recently Dead” by David Casarett. (Current)

I’ve rarely encountered a popular science book in which the author’s attitude toward his subject seemed so conflicted. Early on, Casarett voices his doubts about recent pioneering research into resuscitation: “I wonder how technology is going to change the way that we die. Because if there’s one thing I’ve learned as a hospice doctor, it’s that we’re all going to die.”

However, he traces the colorful history of efforts to revive the dead with meticulous reporting and humor, starting with the establishment in 1767 in Amsterdam of the optimistically named Society in Favour of Drowned Persons. (One of its alleged successes was the 1769 rescue of Anne Wortman, who was pulled, apparently lifeless, from a canal and woke up after her throat was tickled with a feather. The fact that the maneuver worked, Casarett writes, suggests that she was more likely unconscious than dead.) Despite the widespread use of ineffective methods — blowing tobacco smoke into a victim’s rectum, flagellation, or rolling drowned persons over logs or barrels — some early resuscitation efforts in Holland, England and elsewhere eventually led to important discoveries.

For example, passing a breathing tube through the mouth into a victim’s windpipe — a standard measure today — was a technique first reported by London’s Royal Humane Society in 1844, and the first recorded use of electric shock to restart the heart occurred in London in 1774. Cooling the body of a newly dead person in ice or snow was a revival method commonly employed in Russia 200 years ago, but only in the mid-20th century did cardiologist Wilfred Bigelow show that cooling could dramatically prolong the survival of animals after cardiac arrest. Today, it is routinely used during some kinds of heart or brain surgery.

Casarett enthuses like any good science reporter over recent, intriguing discoveries about how hibernation appears to be chemically triggered in ground squirrels, mice and lemurs, speculating about whether doctors may one day be able to inject a drug to bring about a similar state in seriously ill or injured human patients. However, a few pages later, he turns a gimlet eye on the claims of the Alcor Life Extension Foundation, an organization that charges its members $200,000 to have their bodies “cryopreserved” after death — essentially, frozen and kept in extra-cold storage, Han Solo-style — “with the intent of restoring good health when technology becomes available to do so.” Casarett emphasizes that no one knows how far in the future that might be, if ever, and that meanwhile, scientists haven’t overcome the problem that ice crystals, formed as a human body freezes, can puncture cell membranes and leave organs irreparably damaged. Although some frogs and fish do use natural forms of antifreeze to survive freezing and thawing, he reports finding no evidence that any scientist so far has artificially frozen, thawed, and revived a human or an animal — or indeed, any organ larger than a rabbit kidney. (The rabbit that received that thawed-out and apparently functioning kidney lived for only nine days after the transplant.)

The chapters about Alcor are bizarre and riveting. Attending the organization’s 40th-anniversary celebration, Casarett interviewed Alcor scientists, executives and marketers, as well as some of the “cryonauts” — those who have signed up to have their bodies frozen and stored after death, a group ranging from would-be time-travelers to a young cancer patient with no treatment options left. To get around the problem that hospitals are largely unwilling to make their operating rooms available for the pumping of cryopreservation fluid into the newly deceased, Catherine Baldwin of Florida-based Suspended Animation Inc. urged the cryonauts: “Talk to your doctors. . . . They’re the ones who can make things happen.” Since Alcor offers “neuropreservation” — freezing of the severed head alone — at a cost of $90,000 for clients who cannot afford the whole-body procedure, Casarett viewed CT scans showing vivid images of cryonauts’ frozen brains, then asked pharmacologist Greg Fahy about the chances that such cryopreserved brains could ever function again. “The answer,” Fahy replied, “is that we don’t have a clue.”

Finally, Casarett examines the history and success rate of the resuscitation method in widest use now — cardiopulmonary resuscitation, or CPR. Among other striking facts, he learns that the face of Resusci Annie, the female mannequin routinely used to teach the technique, is based on a pathologist’s plaster cast of a lovely unknown woman who drowned in the Seine in the 1880s. He recounts the story of 9-year-old Tristin Saghin, who successfully administered CPR to his drowned sister by imitating the technique he’d seen in the movie “Black Hawk Down” — while his mother and grandmother stood by helplessly. Statistically, the adults’ inaction is no surprise: During cardiac arrests, bystanders start CPR in fewer than one-third of cases. Even when they do, the chance of surviving bystander-initiated CPR after an out-of-hospital cardiac arrest is only 9 percent.

What’s changing that statistic, however, is the increasing availability of AEDs, or automated external defibrillators, easy-to-operate machines that can be used by a lay person on an unresponsive patient to check the heart’s rhythm and to automatically administer a potentially lifesaving shock if a treatable arrhythmia is identified. When such an arrhythmia is present, survival of an out-of-hospital arrest increases to 38 percent. Small wonder that AEDs are proliferating in public places — although, as Casarett discovered, they’re much more numerous in wealthy, predominantly white neighborhoods than in poor, predominantly African American ones.

But Casarett asks whether our society’s almost automatic reliance on CPR in cases of sudden cardiac arrest is in the best interests of some patients, especially those who are old, fragile and chronically ill. He accompanies two paramedics to respond to a call about an elderly woman who has collapsed in her apartment in a retirement community. Administering CPR, drugs and shocks from a defibrillator, the paramedics restore the woman’s heartbeat and breathing, then rush her to a hospital. But the woman, who already has severe heart failure and diabetes, remains unconscious on a ventilator. After more than a week in the intensive-care unit, at a cost estimated by Casarett at more than $100,000, her husband and daughter decide to stop aggressive treatment, and she dies.

Earlier, after the ambulance trip, one of the paramedics expressed reservations about routinely administering emergency CPR to sick, elderly patients: “People don’t want this, you know? . . . A lot of the time we’re not actually letting people live any longer, we’re just changing how they die.”

The unexplored questions underlying every chapter of “Shocked” show how eager we are to grasp at any treatment, however marginal, that promises to prolong life, and why so many people have such difficulty confronting the reality of death or talking about their wishes with their families. Casarett reports that he is optimistic about the future of resuscitation science. But based on his research and his clinical experience, he holds out little hope that we will get better at resisting the lure of technology, reining in its cost or planning for the inevitable end of our own lives.