Lance B. Becker

MD

There are few things that bring you to total alertness as much as when you’re working desperately to bring someone back to life after they’ve suffered a sudden cardiac arrest or major traumatic injury. It is not an easy task and the odds are not good, but it is precisely what we are trained to do during emergencies.

If death is a process occurring over time, we have the opportunity to modify and alter the process and thereby the outcome.

As a medical student 30 years ago, I was usually the person who performed chest compressions on the dying person. Failure meant death. That bothers me just as much today as it did then. When our therapies are unsuccessful, we pronounce the patient dead. The first time I was involved with this I said, “Is that really it? What point did we pass that told us the patient was dead? Do we just stop?” What happened at 8:42 that was not true at 8:40, or that might not have been true at 8:45? After a lot of these experiences, it occurred to me that the time of death is an unsettlingly flexible time and that one physician might, for example, call the moment of death at 8:42 and another one will do it at 8:45. Still another would do it at 8:47, and somebody else would continue the same resuscitation efforts until 9:00, and there didn’t seem to be any particular rhyme or reason to what happened when. It was my first insight into the mysteries of death and the possibilities for restoring life. We began to theorize that death does not occur in a single moment -- rather death is a process that occurs over time.

If this is true – and increasingly, our research at Penn shows that it is -- it would imply that we have vast opportunities to save lives lost using our current therapies. If death is a process occurring over time, we have the opportunity to modify and alter the process and thereby the outcome. Scientists and doctors are standing on the brink of a new understanding of death – and as a result of understanding death, a better understanding of life. It will mean new definitions for when a patient is declared dead, when their organs may be used for transplant into a sick patient waiting for their own second chance at life, and it will force us to confront some ethical dilemmas on how to use limited high technology resources. But this new understanding will allow us to save the lives of people who will otherwise die – and so we are going for it. Dr. Lance Becker practices Emergency Medicine and is Director of the Center for Resuscitation Science at the University of Pennsylvania School of Medicine