Sunday, April 23, 2017
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How the theoretically dead can be ‘resurrected’

Readers, patients, fellow doctors and health advocates have been requesting me to write an opinion about a recent tragedy, in which a 29-year-old single mom died after undergoing plastic surgery. Out of respect for the victim, her family and her attending physicians, I would rather not.

Although it’s good to draw lessons from the case, I think it’s not fair to discuss it, based merely on details from newspaper reports.

No matter how objectively one tries to analyze it, it will still be like rubbing salt into a wound. It deters the healing process for the family, and for the doctors, too, who, I’m sure, never intended the procedure to end in tragedy. It’s not fair to presume there were judgment lapses without really knowing the full details of the case.

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I think we should just leave the evaluation to the expert witnesses to be presented by both sides, and the decision to the courts, which I’m sure will have a tough time.

So, I hope that journalists, broadcasters and doctors could temporarily let this case rest while the courts hear the arguments and finally decide on it. I heard some doctors have been discussing it during teaching rounds with their residents, or during case-discussion conferences. I suggest we refrain from such discussions.

Resuscitation

Well, it’s two days after Easter Sunday, the day we commemorate the glorious resurrection of Jesus Christ from the tomb after lying lifeless since late Friday afternoon. Only Jesus Christ, being God, can do that by Himself.

Humans can occasionally successfully “resurrect,” too— with some help from physicians or, sometimes, by the sheer luck of having someone knowledgeable in cardio-respiratory resuscitation (CPR) around when they go into cardiac arrest.

When one’s heart stops beating and one stops breathing, too, he or she is considered theoretically dead. But for so long as resuscitation is done promptly and successfully, blood circulation is effectively restored and no permanent damage to the brain or other organs happens.

When our patients undergo open-heart surgery—like when the heart has to be sliced open to replace the valves, or multiple clogged arteries are to be bypassed (coronary artery bypass surgery)—the heart is made to stop beating so the surgeons can work on it.

One can just imagine how difficult it would be to operate on a pumping heart, although this is now done in selective, less complicated cases (minimally invasive heart surgery).

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Again, theoretically, the patient undergoing open-heart surgery is “dead” for some time, but the circulation and breathing are maintained artificially through machines, so the patient wakes up after surgery without any damage to the brain.

However, a stroke may be a complication of prolonged open-heart surgery due to the lack of oxygen in the brain. This may occur in around 5 percent or one in 20 cases. The older one is, the higher the risk for stroke.

‘ICD’

Other instances of the momentarily dead being brought back to life are people with an implantable cardioverter defibrillator or ICD. An ICD is embedded in the fatty tissues beneath the skin in the chest area in high-risk individuals, including young people, who suddenly go into a life-threatening irregular heartbeat (ventricular fibrillation), ending in cardiac arrest.

For a few seconds, the heart may fibrillate (which is almost a standstill), and because of the interrupted circulation to the brain, the person faints or collapses. (So, ideally, repeated fainting in young people called syncope has to be investigated to rule out a transient, potentially life-threatening irregular heartbeat.)

When this happens, causing the patient to faint or collapse, he or she is theoretically dead for a few seconds. But for those with an implanted ICD, this can be taken care of.

Every time the heart fibrillates, the small, matchbox-sized ICD gives the heart a mild electric shock, and that brings the heart rhythm back to normal. Modern technology is really amazing.

While preparing for a recent lecture on sudden cardiac deaths, I had the chance to meet online and chat with a popular soccer player in Europe who has an ICD and is still allowed to play soccer. I asked his permission to discuss his case in my lecture, and he graciously consented.

He has a genetic defect in the heart, making it prone to go into ventricular fibrillation and sudden cardiac arrest.

His documented cardiac arrest while playing soccer was really touching to watch on YouTube. He collapsed in the middle of the soccer field, and was noted to have no pulse.

For several tense seconds, everyone was anguished, not sure of what would happen to him. But the ICD fired, which was indicated by his lower extremities suddenly jerking. After a couple of seconds, he sat up, and even wanted to resume playing.

Of course, he was brought to the hospital for reevaluation, but now, he’s again actively playing. And all the rough-and-tumble action of the sport does not seem to deter him from continuing to play his favorite sport, with his ICD acting as his safety net.

Praise God for these modern-day “resurrections” made possible by modern technology and, in some instances, some basic skills on CPR of a good Samaritan nearby.

(For healthcare professionals and lay people who are interested in learning Basic and Advanced CPR, call the Philippine Heart Association at 0915-2674366, 470-5528 for their training schedules.)

You’ll never know when the knowledge and skills in CPR can come in handy to save someone’s life.

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TAGS: Plastic Surgery
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