Magazine article American Scientist


Magazine article American Scientist


Article excerpt

Nightstand Journeys to the Brink SHOCKED: Adventures in Bringing Back the Recently Dead. David Casarett. x + 262 pp. Current, 2014. $27.95.

Whether they're prime-time dramas like House or Grey's Anatomy, comedies like Scrubs or MASH, or afternoon soaps like General Hospital, medical shows hinge on a particular drama riveting to viewers: the heroic resuscitation of patients. The typical revival occurs in a busy emergency room, and the patient's passage from death back to life is characteristically swift and decisive.

Author David Casarett, a practicing hospice physician, explains in his book Shocked: Adventures in Bringing Back the Recently Dead that his own early notions of medicine were shaped by such scenes. As a youth, having watched his share of medical drama Cliffhangers, he believed physicians could usually revive patients in the span of a single commercial break, a conviction he dubs the "Big Mac rule of resuscitation": "A perceptive watcher of these shows would conclude that the fate of a newly dead person is determined in the span of time that it takes to learn about the merits of cookies made by Keebler Elves or a sing-along of the McDonald's Big Mac jingle____By then, your victim is probably wide-awake and hugging the rescuers."

With this early impression as his starting point, Casarett embarks on a journey to examine the boundaries pf resuscitation in real life. His encounters along the way range from the clinical to the bizarre, and in the process he examines the historical, scientific, pseudoscientific, medical, and social aspects of reviving the dead or nearly dead-a transition zone that, contrary to popular belief, remains ill defined. Combining the insights of a physician with an accessible writing style, Shocked raises important social and ethical issues, particularly around resuscitating very old, profoundly ill patients in view of the high costs and the potential for patient harm.

Casarett's personal evolution guides the book's narrative. Initially he had planned to be an emergency room physician. As a student he was captivated by the story of a revived toddler whose heart had stopped after she had lain submerged for over an hour in a stream brimming with snowmelt. Over the years, however, following training in medical anthropology and ethics, he changed his focus to palliative care. Casarett covers territory familiar to him throughout the book, and he proves an apt, reassuring guide; he presents his findings as a kind of travelogue, narrating with wit and aplomb visits to historical sites and cutting-edge medical labs. In the process he also weaves in interviews with patients, witnesses, and practitioners from the spectrum of biomedical sciences.

The journey begins in Amsterdam, the city of canals, where drowning was once common-hence the city's emergence as the earliest recorded venue for resuscitation research (dating back to 1767) with the formation of the curiously named Society in Favor of Drowned Persons, a group of volunteers who gathered information from rescues, aiming to develop better resuscitation treatments. Various methods emerged for reviving the near-dead. Among the techniques purported to have saved lives were rubbing the body with liniments and brandy, blowing tobacco smoke into the rectum, and tickling the back of the throat with a feather. In London, under the aegis of what later became the Royal Humane Society, similar methods were being developed contemporaneously to save drowning victims ' in the Hyde Park Serpentine, an elongated lake with an adjacent receiving house (essentially an emergency room that doubled as a research laboratory). The receiving house served as the proving ground for many novel methods of resuscitation. Some of the techniques developed there, although largely useless by modem standards, were precursors of ones used today, such as warming some victims who suffered severe hypothermia and chilling others for complicated surgeries.

From these 18th-century origin stories, Shocked moves on to notable recent successes, taking note of research milestones along the way. …

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