Tuesday, May 27, 2008

Back from the Dead

By now most people have noticed in passing the “odd” medical story about the woman who was dead for seventeen hours and then “came back,” apparently none the worse for wear. Most people I’ve discussed this with fall into one of three camps:

  1. those who aren’t familiar with the details, and assume this was just another of those “patient’s heart stopped for a few minutes” stories.
  2. believers, who are in full-throated “Halleluia! A miracle from the Lord!” mode.
  3. rational materialists/secularists like myself who uncomfortably mumble something about “the mysteries of the human body” and then don’t want to think about it any more.

To emphasize the important, often-overlooked details that make this case so problematic: the woman was dead. And we’re not talking about the sort of “heart stopped, then restarted” return from the “dead” that is almost commonplace these days. Rigor mortis had set in. Freaking rigor mortis. The woman had no brain waves for seventeen hours. I believe the medical-science types when the tell me that brain activity is what we “are.” I believe them when they tell me that when brain activity ceases, we cease. To ask where we “go” when our brain activity ceases is a medically absurd question, because we don’t go anywhere when our brain activity ceases. When brain activity is gone, we no longer are. Period. I believe this. I do. When this woman’s brain activity stopped, she no longer was. And then, seventeen hours later, she was again.

So the question, the one that squats there and leers and mocks our hubristic belief that we understand life and death, is this:

Exactly where the hell was she for those seventeen hours?


They said Thomas suffered two heart attacks and had no brain waves for more than 17 hours. At about 1:30 a.m. Saturday, her heart stopped and she had no pulse. A respiratory machine kept her breathing and rigor mortis had set in, doctors said.

"Her skin had already started to harden and her fingers curled. Death had set in," said son Jim Thomas.

However, Thomas was kept on a ventilator a little while longer as an organ donor issue was discussed. Ten minutes later the woman woke up and started talking. "She (nurse) said, 'I'm so sorry Mrs. Thomas.' And mom said, 'That's OK honey. That's OK," Jim Thomas said.


CatMoran said...

There are problems with this story. I want to see a clearer timeline, for one thing.

After that procedure, her heart stopped again.

"She had no neurological function," said Dr. Kevin Eggleston.

Her family said goodbye and doctors removed all the tubes.

However, Thomas was kept on a ventilator a little while longer as an organ donor issue was discussed.

Ten minutes later the woman woke up and started talking.

So -- "a little while longer" is 17 hours?

And they obviously played a little lose with the reporting -- someone who's on a vent doesn't just start talking. (Granted, it could be very little -- "ten minutes later she started coughing and struggling against the vent" doesn't sum up "both alive and with a functioning brain" quite as well.)

How long after they determined there was no neurological function was the machine to measure brain activity left on? What, if anything, do they do to make sure that the machine isn't malfunctioning, and that the pads (or whatever is attached to the patient) are properly in place?

(Are there any suspected issues with a doctor in this hospital 'cheating' to get organ donors? Hey, it was an ep of Law & Order, that means that somebody has tried it.)

Did she remain in a hypothermic state the whole time?

I think there was some combination of incompetence (not measuring brain activity correctly) and the wonders of inducing hypothermia at work here.

CrustyPolemicist said...

I also have to believe that there's a bunch of other details here that weren't covered in this story (which after all looks like it was their local news station's coverage, which as we all know tends to be ridiculously skimpy). I'm going to be googling this from time to time in order to see if someone does something in-depth. I am rooting for something as simple as "the idiots didn't have the brain monitor plugged in so of course they didn't see any brain waves," something like that. I really really want it to be something like that. I don't want to think that we are still in some sense still "in there" even after we no longer show any brain activity and rigor mortis starts setting in. That's a little too Edgar Allen Poe for my tastes ...

CatMoran said...

You know, the more I think about it... the less remarkable this seems. (It also seems to prove that we don't exist without our bodies.)

There's a saying, something along the lines of "the body isn't dead until it's thawed."

Her heart stopped. Power failure, power spikes -- bsod. Literally. But because she was on life support *and* hypothermic (life support alone isn't sufficient if the body is 100% incapable of operating on its own,) her volatile memory didn't degrade. And at some point during the thawing process, her brain rebooted.

Much the same as it does with little kids who've been in ice-cold water for thirty-plus minutes.

It'd be interesting to see when, exactly, her brain came back online. But I'll bet they shut off the monitor within five minutes of it showing no brain activity.

This may happen more often as hypothermic treatments get more popular. It's probably happened before -- but the patient didn't recover enough, fast enough, for people to realize they were still alive before the machines were shut off.

(As for rigor mortis -- who knows. maybe hypothermia speeds up the affects, or has an affect that mimics rigor mortis?)

CrustyPolemicist said...

That's a good point. If they "called it" after a few minutes and unhooked her and put her on ice, should could've very well "rebooted" mere seconds after they took her off the instruments. She just happened to wake up 17 hours later. I'll be googling this one for awhile to see how it evolves.

Raycaster said...

I think my email response fell into a 4th category. I never said brainwaves are what we are. The connections between neurons is what we are. Brainwaves are merely side effects and measurements of current/ion flow across those connections. In essence the image of your Linux or Windows kernel on a disk is the neurons and connections. The running of that image is the brainwaves. Your computer doesn't cease to be if it is turned off, but rather when the hard drive is wiped.

We don't get a good time line and this is after all an English major relating after filtering what some highly educated doctors deemed worthy to pass on. Sorry maybe they were a journalism major, but I'd say that's the same difference. They are highly educated within their scope, but the story obviously covers something outside that scope.

But we do know that she was kept in a hypothermic condition and on a ventilator. That is enough to keep the enzymes from beginning the process of breaking down the brain for a time. How long? Again the time line is muddy given the info we have.

Rigor mortis, well I must admit I used this as an opportunity to look up the exact cause. I knew it would be related to something being used up or allowed to go out of control. In this case it is a build up of calcium ions because the muscle runs out of ATP. Without ATP the muscle cannot move Ca+ back out of the cell and the muscle fibers contract. As they all contract the joint is locked into position until after 72 hours when the protein breakdown is to a point where the muscles relax. Onset of RM is 10 minutes to several hours depending on temperature (assuming warmer == faster). If the heart restarts and ATP and ADP is gotten back to the muscles RM will reverse itself.

So how/why did the brain reboot? I'm not sure a neuroscientist can definitively answer that right now. They can make educated guesses based on current understanding of how neurons decide to fire or not. Still saying that it requires a deity to make that happen is akin to the invocation of God or Gods moving the planets about the heavens before Galileo or Newton showed us how and what they were.

CrustyPolemicist said...

Some details from my crosspost over on the Center For Inquiry board, from someone who lives in the same TV area where this tooks place. Looks like nothing to see here. Move along. Nothing to see here. Pity, it would've been an interesting "object to think with," if true.

>>>quote begins here:
Here’s some better reporting on the incident from our local afternoon newspaper: (This is from last Tuesday, earlier than the TV reports. I’m not sure why this didn’t show up in a search at the Daily Mail’s website. I found it via Google News.)


* 1:30am Saturday, Ms. Thomas called 911 (and then her son) because she recognized that she what having heart problems.
* She went into cardiac arrest before the paramedics arrived but they were able to restart her heart.
* She was initially taken to Thomas Memorial Hospital and at some point she was transferred to Charleston Area Medical Center for more advanced care.
* During a hypothermia-inducing treatment at CAMC she suffered two more cardiac arrests. The heart was restarted each time. At some point she was also placed on a ventilator.
* At 6:00pm that day the decision was made to take her off of the ventilator and allow her to die. This seems to correlate to 10 hours after hypothermia treatment began - mentioned in the TV report.
* An hour later (7:00pm) the ventilator was turned off (reported elsewhere, the delay was due to organ donation issues. As far as I can find, her heart was still beating when the ventilator was turned off.)
* 10 minutes later, when removing the ventilator tubes, Ms. Thomas’ arm and foot moved and soon she was coughing and talking.

So that’s how you get 17.5 hours: 1:30am to 7:00pm Saturday. There is no indication of a competent medical determination of anything like “no brain waves for 17.5 hours.”

Kelvin Oliver said...

Though I don't have much to say on this story, but when I first read it I found it very interesting. It left me at awe.