LEGEND HAS IT THAT in the early 1400s, a French chemist named Nicolas Flamel discovered the elixir of life. The elixir was reputed to be a substance that could prolong human life for hundreds of years. Flamel lived with his wife, Perenelle, in what is now the oldest stone house in Paris. Located on a narrow street on the right bank of the Seine, the gray stone house was built by Flamel himself and served as his main laboratory. He worked late at night by candlelight, mixing exotic concoctions in an effort to create the elusive potion to sustain life.
Flamel was pursuing an ancient ritual. The search for an elixir of life dates back millennia. According to the Hindu scriptures, the elixir was churned from the deepest ocean waters and called amrita. Throughout the centuries, alchemists searched for the elixir of life to stave off death. They were certain there was a magical potion that could make people live longer, or more hopefully, forever. In ancient China, the emperors were convinced that the right combination of metallic compounds had the ability to effect eternal life. They ordered their surrogates to mix cocktails of precious substances, such as jade and cinnabar, and combine lead with mercury, and even with arsenic. But more often than not, when the emperors ingested these concoctions, not only did they not prolong their lives, they ended up inadvertently poisoning themselves to death!
Flamel took a more measured approach. He toiled for years on the elixir, which, as legend holds, he created from the philosopher’s stone. The stone was reputed to be able to turn lead into gold and, if ingested, the resulting substance would extend life for hundreds of years. In J. K. Rowling’s blockbuster novel Harry Potter and the Sorcerer’s Stone, Flamel appears as the creator of the stone that is central to the plot. In the book, his elixir has clearly worked, as he lives to the age of 665, while his wife lives to be 658. In fact, Flamel reportedly died at eighty-eight in 1418, and his tombstone, in which he carved arcane alchemical signs and symbols, is now on display at the Musée de Cluny in Paris. Clearly, he did not find the elixir of life.
So is there an elixir of life, and is it possible to overcome death? Why can’t we just live forever or at least for, say, 150 or 200 years?
In the normal course of life, as people age their cells accumulate toxins such as lipofuscin that cause their skin and their organs to slowly deteriorate over time. So when people get up in years, to around ninety, their cells stop working properly because they have built up so many toxins. Environmental factors also contribute to the cells’ aging, as do smoking and heavy drinking. People who are lifelong smokers or abusers of alcohol often appear to be older because these vices leave behind toxins that cause premature aging.
But throughout history most people don’t die of “old age.” They die “prematurely” as the result of an illness or accident. There are thus two processes that cause people to die—naturally through aging, or prematurely through an accident or disease such as a heart attack or stroke that interrupts the body’s functions. Though theoretically a person could live far longer than 100 or 150 years, the reality is that most people do not because as we age our cells progressively accumulate toxins and this ultimately ends up shutting them down. Hence death through natural causes is due to a biochemical and metabolic process in the cells and consequently the organs. But either way, death is not something mystical; it arises because of the cessation of function in the cells and organs in the body and eventually cellular death.
Now if we could prevent the cells from aging, then in theory, we could prolong life. Scientists and doctors of all stripes are working in this field. One who has garnered attention is Aubrey de Grey, a larger-than-life figure who has polarized opinions and stimulated debate. He studies the biological aspects of aging and contends he has discovered a process that will prevent the cells from building up those harmful toxins. He claims that a tissue-repair strategy he is developing, called Strategies for Engineered Negligible Senescence (SENS), has the potential to allow a very long life span. He has identified seven different areas of cellular decay that occur through metabolic processes and believes that if they are combated through SENS, human life can be prolonged far beyond anything we imagine. Of course, whether or not this will actually work has not been proved, and people continue to die of old age in their eighties and nineties every day.
Although the work that de Grey and others in his field are doing on extending cell life may someday help prolong the lives of people who would die of old age, it will not help those people who die because something breaks down in the body due to an illness, such as an infection, a stroke, or a heart attack. This is the job of resuscitation science.
THE HUMAN BODY IS an incredibly complex machine composed of different components, each with a specific role that enables this machine to function. Like all machines, the body needs fuel to produce energy, which it uses to sustain its biological activities, also known as metabolism. This fuel comes in the form of the foods we eat, but the food alone does not sustain us. Once consumed, these raw products must be burned and converted into energy. This combustion process requires a constant supply of oxygen, the same way an engine needs a mixture of oxygen and fuel to combust. The fuel in the engine is supplied through a gas tank while the oxygen is injected through vents, and in both cases, when they meet, combustion takes place. This creates the energy that enables the other components, such as the wheels, power steering, and lights, to function, but the combustion process also produces waste products. In a car, the waste products are pushed out through the exhaust system; in the body, the gastrointestinal track functions like the gas tank, taking in food that comes from the stomach, while oxygen is supplied through the lungs acting as massive vents. This entire process in both the car and our body is stimulated by the intake of oxygen. Thus, like a car, if our activity revs up as we run, we need far higher levels of oxygen in order to burn more fuel and keep the cells and organs working.
This is the formula of life: taking in oxygen and delivering that oxygen to all the cells in the body in a way that is so extraordinarily precise it makes even the highest-performing supercomputers in cars look basic. This regulation system constantly and effortlessly receives feedback from all organs regarding exactly how much oxygen is required on a millisecond-by-millisecond basis and adjusts the delivery of oxygen to match their requirements so that the cells in each organ can burn the fuel that is in the form of glucose (derived from the nutrients we eat and stored in the body as glycogen) and generate energy. This energy then drives the complex machinery of all the trillions of cells in the human body. However, we cannot store oxygen in the tissues, which is why we can only sprint for a short time or hold our breath for a few minutes. The reason we don’t store large amounts of oxygen is that oxygen itself is potentially toxic to the cells (in excess it turns into a strong oxidizing agent such as hydrogen peroxide). Therefore, we must inhale oxygen continuously to feed the cells and keep them working by providing just the right amount.
The cells run much like a highly productive factory that produces special protein-based chemical products such as hormones that are either used locally or sent all over the body (through the bloodstream) to be used by distant organs where they are needed. This is in fact what the enormous amounts of energy provided through the burning of glucose using oxygen is needed for. Just like factories, the cells also have multiple smaller component parts, called organelles, which work cohesively together to produce all the products the trillions of cells in the body need to keep it alive and functioning. Every cell has a membrane on the outside that regulates what goes in and out, much like a wall or perimeter, and specialized small pumps on the wall that can more actively pump substances in and out of the cell. The pumps in the cell membrane take in what the cell needs—glucose that will be converted to energy (as well as many other materials)—and throws out what it doesn’t need, such as toxins that can poison the cell. To break down the glucose, the cells rely on oxygen. Small component parts of the cell called mitochondria generate energy by using oxygen to burn ATP (adenosine triphosphate) molecules, which is how glucose is stored in the cells. ATP is thus stored-energy molecules in cells. So the cells need a continuous supply of energy, which they get from burning ATP using oxygen. If we don’t give the cells oxygen, the supply of energy runs out and the cells don’t function.
When we inhale oxygen through our lungs, it is almost insoluble in our blood, meaning that it won’t dissolve in our bloodstream (which could pose a major problem since we need enormous amounts of oxygen every second). This is why we have red blood cells. Red blood cells are like special transporters that bind and carry lots and lots of oxygen through the bloodstream and to all the body’s organs. Understanding the formula of life (a phrase coined and often used by one of my old colleagues and mentor, Dr. David Berlin, at Weill Cornell Medical Center) is simply understanding how oxygen is taken in, or inhaled, through the lungs and then attached to red blood cells that can carry an enormous amount of oxygen through the arteries in the body. For instance, an average man can take in up to around three liters of oxygen through his lungs every minute. A man who is a highly trained athlete can take in up to more than five liters (or well over a gallon) of oxygen a minute, which then attaches to the red blood cells and is transported to the farthest parts of the body. When the red blood cells reach an area where there is a need for oxygen, they release their own oxygen supply and take carbon dioxide that has been produced as a waste product from the activity of the cells and carry it away. The carbon dioxide attaches in place of the oxygen to the red blood cells (the transporters) and is taken back up to the lungs, where it is exhaled. Thus the lungs act like a vent that takes in oxygen when we breathe in and an exhaust pipe when we breathe out. Because carbon dioxide is a waste product, it will become poisonous to the cells if it is not removed, just like the smoke in the factory or exhaust fumes in a car.
The amount of oxygen that is attached to the red blood cells (as well as a tiny amount that actually does manage to dissolve in the bloodstream) is referred to as the oxygen content in the blood, but of course, in order for it to be useful to the body, it has to reach the organs where it is needed. So even if a person takes in a million gallons of oxygen and it is contained in the blood, if the oxygen can’t be delivered to the person’s organs, the oxygen is useless as far as the body is concerned. To deliver it, a pump is required—and that pump is the heart. Oxygen delivery is a factor that is made up of how much oxygen is contained in the blood (the oxygen content) multiplied by the cardiac output (the pumping of the heart). If for any reason the heart does not pump enough oxygen to meet the body’s requirements, a person cannot stay alive and will eventually die. This is why the heart is so vital and why heart disease can kill someone. Also, if we lose too many red blood cells too quickly, such as when we hemorrhage after a car accident or a bullet wound, we will die because without the red blood cells to transport oxygen, we will not be able to meet the body’s oxygen requirements. The same would be true if our lungs stop functioning and cannot deliver the oxygen needed. Interestingly, in the event that the body develops a major illness (say following an overwhelming infection) and requires much higher levels of oxygen than can normally be delivered to the organs, then the organs will stop working, resulting in organ failure and eventually death. When we suffer failure of the heart (which itself needs a constant supply of oxygen), we die since the heart is the pump that delivers oxygen to all the organs. So there is a magical ingredient that we need and can help us stay alive. It is not nickel, mercury, or arsenic. It is good old oxygen.
In our normal lives, as we drive to work or sit on the couch and watch TV, the body maintains a constant balance between oxygen requirements and oxygen supply. The red blood cells can carry an enormous amount of oxygen in the blood to not only satisfy daily requirements but also to meet higher requirements. The fact is, in many circumstances we need much higher than normal levels of oxygen. When we become critically ill, say with an overwhelming infection that could kill us, it is often a catch-22: not only can we not deliver enough oxygen, but the cells also need more. This is because the cells have gone into hyperdrive to produce chemicals that will fight the infection. For example, the body might suddenly multiply our white blood cells to try to fight off the infection. The white blood cells act like soldiers and defend against infections from bacteria and viruses. Many chemicals are mass-produced by these cells and released on bacteria to kill them—in a way that is not dissimilar to chemical warfare—and that’s why we get a fever.
Think of it like that factory working overtime, because in wartime a country needs many more supplies than in peacetime. But then consider that the country also has problems receiving the raw materials it needs to make those supplies it needs to fight the disease, which is the enemy. This is analogous to the state that Great Britain found itself in during World War II, and why many people believed it was on the brink of collapse. In the body, under these extreme circumstances, we need to be able to deliver much higher levels of oxygen. However, if the body is diseased, it is no longer able to do so, and this can hasten the process of dysoxia and anaerobic metabolism, which eventually causes the organs to stop functioning.
So while we need a constant supply of oxygen, we also need red blood cells to carry it. That is why people die if they bleed heavily due to an accident and become critically anemic very rapidly. Other conditions will also lead to death if the heart cannot pump forcefully and there is not enough blood pressure to deliver the oxygen and the red blood cells through the bloodstream to the organs. When cells reach a point where they do not have enough oxygen being delivered to them, this is called shock, which is a very dangerous state.
Shock is a medical term for the point at which the delivery of oxygen to the cells is insufficient to meet their requirement for oxygen; therefore, the cells can no longer perform their function. The mitochondria that generate heat and energy by using oxygen to break down ATP can no longer break down the ATP molecules, so suddenly the energy source is drained. This causes the cells to build up toxins like lactic acid (which causes cramps in runners). The body has a clever system to try to buy itself some time and prevent the cells from completely shutting down, sort of like a gasoline-powered generator powering a factory that loses electricity. The body starts to burn that lactic acid (through a process called anaerobic metabolism), which will generate some energy; however, it’s not enough. Anaerobic metabolism can sustain the cells for a relatively short period of time, but if this period of burning lactic acid without enough oxygen continues, then all the machinery of the cells will stop working. Unless oxygen delivery is restarted soon, then the cells will stop functioning—like the factory relying on a generator that is running out of gasoline, awaiting the electricity to be turned back on.
So it is clear that all the different causes of death share a final pathway and culminate in a state of medical shock. This is characterized by a lack of oxygen being delivered to the organs and, if not corrected in a timely manner, will cause the heart to stop, thus leading to a state that is medically referred to as a cardiac arrest, which is synonymous with death. Causes such as overwhelming bleeding, cancer, infection, poisoning, and heart attacks all can lead to the state of medical shock that, if not stopped quickly, will ultimately lead organs to stop functioning. When this affects the kidneys, the kidneys stop functioning and the person stops producing urine. When it affects the brain, the brain stops functioning, the person loses electrical activity in the brain within about ten seconds, as well as life-maintaining brain stem reflexes that keep us alive by ensuring we breathe and our heart beats, and the person goes into a deep coma. Unlike the deterioration of the kidneys or the liver, which won’t kill us immediately even if these organs stop functioning, when lack of oxygen delivery affects the heart and the heart stops pumping oxygen and nutrients around the body, we die immediately. This usually takes a few seconds after the heart stops. So the definition of death is when a person has no heartbeat and no respiration (because the lungs have stopped working due to a lack of oxygen delivery) and is absent reflexes in the base of the brain (brain stem), indicating the brain has also stopped working due to a lack of oxygen delivery. At this point, a person’s pupils do not respond to light and he or she develops what is referred to as fixed dilated pupils—hence the reason doctors shine a light on pupils to determine if someone is alive. Cardiac arrest is synonymous with death because the heart is the pump and without the pump, the body cannot deliver the blood that contains the oxygen.
So rather than being a mystical process or a philosophical process, as death is often regarded, it is actually a physical and biological process. Without the body taking in oxygen and the heart pumping oxygenated blood to the tissues, death will occur.
WHAT EXACTLY HAPPENS TO the body after death has taken place? I know that many people would simply say: “Well, that’s it. It’s the end.” But is it really? Let’s imagine for a moment that we could step into the body after death and witness what takes place. We know that the heart stops pumping the blood carrying oxygen, that elixir of life. Therefore, the cells no longer have oxygen entering them. Without oxygen, their pumps will shut down, and no energy will be produced. But what is actually happening is that we are entering a second phase that is the period “after death”—the stage that corresponds to the gradual death of the cells, which only starts after we have died and takes many hours.
It is likely that this concept is unfamiliar to most people. To illustrate what happens to the cells after death when oxygen is no longer being delivered to the cells, consider the scenario that occurred in New Orleans during Hurricane Katrina and what precautions the city has taken to prevent such devastation from happening again. There are many individual homes in the different wards of the city. To keep people alive in those houses, a certain temperature and oxygen level must be maintained. The houses also must have water but not too much water. To protect those houses, the city also has protective levees, just as the brain has a protective mechanism for its cells that regulates blood flow into it, because too little or too much blood flow can be highly damaging. During a crisis, much like the levees that regulate water levels, the brain (in a process called autoregulation) regulates the amount of blood flowing into it. This prevents a sudden increase and especially a sudden drop in blood pressure from disrupting blood flow and hence delivery of oxygen to the brain.
This works wonderfully except in extreme cases when something (such as an infection or bleeding) causes the blood pressure to become too critically low. Under these conditions adequate oxygen isn’t being delivered to the brain. When oxygen delivery to the brain drops below a critical threshold level, at first a person may become agitated and then go into a coma. If the blood pressure drops even more, then the brain completely stops working within seconds. The constant flicker of electrical activity that is the hallmark of an active functioning brain, like city lights flickering away when we look down at them in the night sky, simply stops. Everything turns into dead silence—the brain is overcome by a “flatline” state. We can measure this electrical activity (or lack thereof) from the surface of the brain using a machine called an electroencephalogram (EEG). Of course, the most extreme condition that stops blood flow to the brain is a cardiac arrest, or death, resulting in no blood pressure at all since there is no heartbeat. When autoregulation of blood flow and hence oxygen delivery to the brain fails, the cells first go into a panic mode and then respond by going into a toxic fury that begins within minutes.
Now imagine that each cell is analogous to each home and also has its own pump built into the wall to regulate what goes in and out. The brain cells need optimal conditions to generate electricity. Electricity is created when there is a large gradient of sodium and other substances such as calcium (with high levels staying mainly outside and a little amount inside the cells) to generate electricity. It is the movement of mainly sodium and other chemicals such as potassium and calcium in and out of the cells that leads to electricity. If we have too much calcium in the cells, they fail. These pumps need a constant energy supply to work, and after a person dies, because there is insufficient oxygen and ATP stored up, the cells start to go through their own process of death.
This destruction and devastation take place sequentially during a process, and so from a medical perspective, if we identify and understand the individual components that take place after the devastation of death has set in, we can try to slow down and stop those changes that are taking place. Then we can also stabilize, restore, and finally repair and return the cells to a working order. This is, in a nutshell, the science and art of resuscitation. This is exactly what we have learned we can now do with respect to the brain and the rest of the body after the devastation of death and cardiac arrest when there is no oxygen being supplied. It is not simple by any means, but with a good system of care it can be accomplished.
What happens in a person who dies is much the same as a city flooding. A person has billions of cells. These cells function best with a small amount of calcium—the same way a house needs a controlled supply of water. To maintain the balance, pumps are needed to remove the excess calcium. Because oxygen cannot be stored in the cells, as soon as oxygen stops, a downhill process begins. Once the heart stops pumping blood, which contains the oxygen, within four minutes the body will consume all the stored oxygen and energy and the pumps will begin to fail.
During this process, there is a massive release of various toxins from inside the cells as they start to swell up and the membranes, which act like walls around the cells, become damaged. All the while, the cells become more and more acidic, swollen, inflamed, and damaged. The pumps that normally regulate what comes in and out of the cells don’t work, and calcium starts to flood in from outside, causing the cells to swell even more and therefore damaging the walls of the cells’ membranes. The cells’ membranes begin to crack holes inside of them, and more and more calcium floods in. This vicious cycle causes the cells to become more and more damaged. The cells experience calcium accumulation that eventually leads to toxicity (called excitotoxicity). They will eventually go through a biochemical program called apoptosis that causes them to quietly shrivel up internally or actually rupture outwardly through a process called necrosis. These processes by which cells eventually die take place through a chemical chain reaction that requires the activity of chemical catalysts called enzymes. Therefore, one way to combat the damaging effects of death, and to halt and reverse it even after it has set in, is to slow down these chemical reactions by targeting and blocking the activity of these chemical catalysts in the brain and other organs. Without the actions of the enzymes in brain cells and cells in other organs, they can’t “die” as quickly because even cellular death is a chemical process. If you stop the chemical process, you halt or at least slow down cell death.
This is also exactly what happens during a common stroke. In a stroke, the cells in a limited area of the brain are deprived of oxygen, and they go through this entire process of death. That’s why someone with a stroke can have severe disabilities. Those cells affected by a lack of oxygen delivery have died over the course of a few hours. However, medically speaking, death is a global stroke in which the entire brain is being deprived of oxygen. But in the same way we can limit and reverse brain cell damage from a stroke if we can treat the patient quickly (for a common stroke affecting the brain, most people now quote a time frame of approximately four and a half hours), we can also reverse a global stroke—and therefore reverse death.
During either of these processes, cells damaged by a lack of blood flow and the delivery of essential nutrients and oxygen no longer function; yet they have not been fully destroyed. Thus, if blood flow and the delivery of oxygen and essential nutrients are restored during this time, the cells may either partially or fully recover. So in order for us to fight death, we must not only stop the deterioration process but also prevent it from reaching that point of no return in a controlled manner. Even though cells are going through rapid deterioration during this process, these cells that make up the brain and the other organs are still viable. Again, they are not functioning, because they are all going through this debilitating change, but they can be rescued, built back up, and made to work again. However, if we leave them for several hours (as in someone who has had a stroke many hours earlier), they will become completely shriveled up and die. This is the medical opportunity and challenge we have been offered through scientific progress today—the ability to go beyond death and come back safely.
These methods are central to resuscitation science. This is illustrated by the incredible understanding that cells can be taken from a dead person’s brain many hours after a person has died and been taken to the mortuary and then grown in the laboratory. In May 2001, scientists at the Salk Institute in La Jolla, California, reported that they were able to take brain cells from cadavers and grow them in the laboratory. The scientists showed that these cells taken from people who had been dead for a number of hours could not only grow but also divide and form specialized classes of brain cells. The scientists’ work was focused on growing brain stem cells called neuronal progenitor cells, but it clearly shows the viability of brain cells many hours after the blood and oxygen supply has been cut off, after the heart has stopped beating, and after death. “I find it remarkable that we all have pockets of cells in our brains that can grow and differentiate throughout our lives and even after death,” said Fred Gage, a professor at the Salk Institute and senior author of the study.
As a result of such pioneering work, most remarkable of all, brain cells can now be taken from people even four hours after death and grown in the laboratory—meaning they are still viable. In fact, at a recent conference in New York copresented by the Nour Foundation—a nonprofit and NGO that explores meaning and commonality in human experience—and the New York Academy of Sciences, I met a scientist who told me that she routinely harvests brain cells from cadavers and grows them in the laboratory for research purposes (the people she studies had consented to their cells being removed after death). Even four hours after death, she can take a biopsy of brain and grow it in the laboratory.
Estimates vary on how long cells can survive without a blood supply in different organs (and therefore without oxygen after death) depending on factors such as the type of tissue involved and the ambient temperature. Bone is the most tolerant at up to four days. Skin can survive up to twenty-four hours, and fat up to thirteen hours. Nerve cells and brain tissue (neurons) are thought to remain reversible for up to eight hours. Even with the variations, what this tells us is that there is a significant period of time after death that cells can be brought back.
ONE OF THE MAJOR discoveries in the last ten years that has allowed us to halt the chemical reactions that take place in the cells of the body and brain after death has been the finding about the importance of cooling the cells down. A chain reaction occurs in the brain with all these chemical reactions that are going on, which, like any chemical reaction, depends on temperature. Heat speeds up chemical reactions; cold slows them down. Cooling cells deprived of oxygen slows down the activity of the enzymes that regulate chemical reactions in cells and hence reduces the harmful processes that take place after the toxic fury has set in and gives us time to restart oxygen supply to the cells.
In early 2011, I received a call from a colleague in England telling me an incredible story that illustrates this point. Medically, the story was about slowing down the deterioration process of cells deprived of oxygen so that a man who had been dead for three and a half hours returned to a normal life. Though this man had no heartbeat and was not breathing for three and a half hours, he survived and, more important, was discharged home from the hospital without brain damage even though others in his situation don’t survive. How was he able to regain functionality after his heart had stopped for so long? Specifically, what kept his cells from becoming completely flooded out and dying irreversibly?
The story says much about cell viability when the cells are cooled. The man, a fifty-three-year-old named Arun Bhasin, was walking home from a party in East London in 10˚ Celsius (50˚F) weather when he collapsed. A passerby found him suffering from hypothermia and called paramedics. When the man arrived at the hospital, he was in bad shape. His body temperature had dropped to 30˚C (86˚F)—37˚C (98.6˚F) is normal. As doctors began treating him, he suffered a cardiac arrest.
However, because his body was already cooled, the metabolic activity in the cells had slowed down. He also had the luck of the draw on his side as to the technology that was available at that hospital. Two experts in resuscitation medicine, Dr. Nigel Raghuntah and Russell Metcalfe-Smith, were on duty. They hooked him up to a machine called the ZOLL AutoPulse, which automatically administers consistent and very high quality chest compressions, while they began looking for the cause of cardiac arrest. Three and a half hours later, his heartbeat was restarted.
Not only did Arun Bhasin live, he was able to regain full functionality with no cognitive impairments—because his body was cold while his heart was not beating and his cells were not getting oxygen. When he arrived at the hospital, his temperature was two degrees below the optimal cooling level of 32˚C (90˚F) for that situation. Studies show that for every one degree Celsius that we bring down body temperature, we reduce brain metabolic activity by about 6 percent. So if we can cool the body from 37˚C to 32˚C (98.6˚F to 90˚F), we can reduce metabolic activity and thus the rate by which brain cells go through their own death by roughly one-third. That means the brain cells, even though not functioning, will be less likely to become permanently damaged while the heart is stopped and not providing them with oxygen. Although Bhasin was slightly colder than recommended, the fact that he was cold functioned like a braking mechanism on cell deterioration. It didn’t allow the calcium to rapidly back up and flood the cells with toxins. It slowed the process of apoptosis and necrosis that is the hallmark of cell death, because it prevented the enzymes from working and thus prevented the chemical reactions needed for cells to die.
Most of the news reports of Bhasin’s story talked about what a miracle it was that he was both alive and not brain damaged. Well, it wasn’t really a miracle; it was resuscitation science at work. His case is part and parcel of understanding what causes brain and other vital organ damage and how it can be stopped. His brain cells were basically kept cold so all the processes that lead to cell death were slowed down significantly, thus giving his doctors time to try and restart the heart and reverse the destructive damage that ensues after the heart has stopped. That’s why we put food in the fridge; it stops the decaying process. Though cell deterioration isn’t bacterial, cooling the cells slows the enzymes in the cells that generate the chemical reactions.
Bhasin also had another advantage of modern technology. The hospital where he suffered the cardiac arrest used the ZOLL AutoPulse chest compression machine. This machine gives standardized, consistent chest compressions, thereby eliminating human error and fatigue. Again, as discussed earlier, today it’s a complete zip-code lottery if we end up in a hospital that uses such an automated machine or has a truly state-of-the-art system to manage cardiac arrest, because many hospitals don’t.
The advances in resuscitation science are new and continually developing, and they can be overwhelming to grasp. In many ways, they can overtake our social psyche that is based on the idea that there is a physical moment of death. We have inherited this firmly held notion about life and death through many millennia; it has been passed on from the classical Greeks and lived through the Renaissance and Victorian times and remained unyielding until now. Even the change that has come about since then up to this day has been very slowly understood. Much of what we accept as real is socially and not scientifically determined. But we have now moved into this gray zone that corresponds with a period “after death,” which has come about as a consequence of humankind’s persistence in attempting to reverse death after it has set in and which, as we shall see, has significant ramifications for us all.