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January 10, 2014 4:22 pm
Do they die?
I alone keep a memory of this night: we strode home laughing, not for any good reason but because, when you live in the delirium of the desert, everything spins magically into another hopelessly laughable anecdote. Soon we stood in our underground apartment speaking of ordinary things: what time to set the alarm, was it chilly or warm, did we have milk for morning . . .
When his heart, which over the course of a minute contracts around 75 times, suddenly failed, his eyes rolled back like two marbles suddenly shot toward the heavens. His tongue hung slightly forward as he swallowed each breath until another did not follow, and his body started, in what seemed like a slow cede to gravity, to collapse. Like twin dead fish his legs flopped and extended; outstretched on the ground, a deep purple visage coloured the only evidence that not 20 seconds ago his frame stood full of life. By now blood had stopped circulating, brain activity ceased, his lungs were staid. All this happened without resistance on the part of the arrested; even a fly caught between a person’s fingers struggles more.
Historically, my husband would have been pronounced dead. Today, those suffering sudden cardiac arrest will be considered “clinically dead” – a term coined to reflect the possibility of resuscitation. Most organs and tissues, bone, skin and tendons can go unharmed for up to 12 hours without oxygen. Only the brain, our signature, at times inscrutable, cardinal organ, is unlikely to recover after just three minutes without it. Modern emergency medicine deals in the very small possibility of bringing the dead back to life. Today, the dead do not always die.
. . .
A wood frog resembles anything from the pale to the dark brown bark of a tree, and so can disappear in a pile of leaves and appear again as the keen extension of a branch. Its call sounds something like a “quack” led by an r, very vital and piercing. This frog can freeze solid in winter. During the thaw, no breathing, no kidney function, and no heartbeat persist. Its internal organs lie wrapped in solid ice while “cryoprotectants”, a kind of antifreeze, shield the liver by producing compounds that allow cells and tissues to survive. Held in the hand, the creature is indistinguishable from a small, cold stone.
In spring, after months of what can be called “clinical death”, the ice around the frog’s organs starts to melt. The water spreads to the cells; then the heart spontaneously bursts thumping into rhythm. The dark glazy eyes flicker and bulge. Finally the frog pushes off with its front arms, back with its legs, and springs away, lively as a tadpole.
The ancient Greek physician Hippocrates spoke of coating wounded soldiers with snow and ice but it was not until the 20th century that more in-depth, practical study of induced hypothermia began. In 1945 the first article about induced hypothermia focused on patients who had suffered brain injury. Early experiments often lowered the body temperature to as little as 20C, inviting a host of side effects that rendered the treatment counter-productive.
In 1966 a tragedy befalling the Austrian-Czech doctor Peter Safar would propel the study of cold treatments into its next stages. Safar lost his 11-year-old daughter, Elizabeth, to an acute asthmatic crisis. Elizabeth was revived, but her brain was lost. Her father’s mission became to “save the hearts and brains of those too young to die”. He searched for a way to “pickle” the organism, giving the brain a chance to recover after a time without oxygen. His team’s experiments showed how an animal quickly chilled following an injury may be resuscitated after two hours of “clinical death” without noticeable brain damage. Applied to humans, “suspended animation” (as Safar called it) or “therapeutic hypothermia” lowers the body’s temperature to about 32C, thereby slowing down the metabolism, reducing brain swelling and lessening the likelihood of seizure.
For his 70th birthday, this thrice Nobel Prize nominee, the man responsible for the establishment of the first intensive care unit in the US in 1958, received a gift from his co-workers. They summed up Safar’s philosophy and framed it: “It’s up to us to save the world.”
. . .
A cure for everything
In March, as I lowered my young husband’s body to the cold floor of our apartment in Ramat Gan (a town near Tel Aviv where we were living for the year), I had never heard of “clinical death” or “therapeutic hypothermia”. I knew only one thing: at 26 years old, after less than a year of marriage, for reasons unknown, my husband had died in my arms.
Laying him down, I seemed to fly chest first (I did not know the local number for an ambulance but I could be sure that, whatever it was, it wasn’t 911) out on to the street wailing for help. I was later told that my cries, cries of desperation such as can be imagined on an ancient Greek stage, reached the whole block and those who heard them felt their hair stand on end and shivered. I ran back inside where I saw no change in his condition and shot back out. “Come! Somebody! Please! Help!” I ran around to a neighbour’s door, pounded my fists and screamed. A man appeared before me, terrified. I pulled him into our apartment. He resisted, confused and alarmed. Bevakasha, I cried, in Hebrew. Please. I mimed the act of CPR. Neither the several stark pumps he administered with his fists nor the mouth-to-mouth he tried next rendered any signs of life. Together we felt the body for a pulse and, finding none, turned to face each other. I could not suffer a stranger’s expression telling me how sorry he was; there was nothing more he could do. In one last surge of hope, I lowered my hand to feel for a breath that might brush by my palm. Nothing. Only the deep purple of his face stared back at me like a final word.
I thought of Blanche Dubois. Yes, I had time to think of her, and of many others, on my way to the hospital in the front seat of the ambulance and in the days that followed. This is the sort of thing that happens to tragic heroes, in the books and plays I love – and now it has happened to me. It came as no comfort. I did not want to know such loss, not at a young age or an old one. The paramedics handed me my husband’s watch. “And then the searchlight which had been turned on the world was turned off . . .”
The distinguished cardiologist and professor Hanoch Hod, director of intensive care at Tel Hashomer hospital, sat facing me with his deep-set, gentle brown eyes hovering above two dark half-moons that marked a lifetime of lurid labour. He informed me that my husband’s brain was not responding. He asked how much time had elapsed from the collapse until the ambulance arrived. Five or six minutes, I guessed. He let me know that my husband would be undergoing therapeutic hypothermia. He would be sedated, ventilated, his temperature lowered to about 32C. In 48 hours we would know more. I sat before the professor unwilling to let go of his gaze. What was there to say? Then I asked one question. The only question:
“Is there any chance?”
“A very small one.”
In that unforgettable scene from Vittorio De Sica’s 1948 film Bicycle Thieves, when Antonio the desperate protagonist finally gives up searching the swarming streets of post-second world war Rome for his stolen bicycle (not just any stolen bicycle – the one on which his family’s future depends), he takes his son to lunch at a restaurant. “Let’s forget everything,” he suggests, relaxing. “We’ll eat and be happy for now. There’s a cure for everything, except death!” I knew, during those 48 hours, that I was living one of the supreme moments of our time – I was waiting to see if modern medicine could cure death.
. . .
When a 65-year-old victim of cardiac arrest warmed up after receiving therapeutic hypothermia showing no trace of brain damage, his children ran to our neighbouring room to tell us of their good fortune, graciously hoping ours would follow. I walked away, unwilling to hear. Stunned by my inability to share in anyone else’s happiness, I dragged my feet down the hallway.
I could not have guessed just how many of my companions at this time would spring from the pages of literature
“You have to hope,” someone said. It was the hospital’s psychologist. I looked at her dumbfounded. I did not want to hear that phrase one more time. What reason had I to hope? Caught suddenly in this swift, sudden turn, I realised the true peril: as effortlessly as a wind dismantles a flimsy tent, nature had the power to take down my world. The tears streamed down my cheeks like hot oil.
Later that day, when the professor informed our families that my husband’s lungs were infected and full of water, that he was not ventilating well, that his condition was worsening, my father asked if we needed a miracle. The professor turned sharply toward him, as though he had been stung: “I cannot answer that. ‘Miracle’ is not a word I use.”
We are, as the sociologist Norbert Elias writes in The Loneliness of the Dying (1985), “a community of mortals”, bound together beyond love and animosity, war and peace, by one common end: we die and we experience the death of others. And yet the experience of loss can be isolating in the extreme. Friends and family shared in my grief, but I remained frightfully aware that it would not be their beds lying barren at night. As someone who has spent much of her life depending on the kindness of books, it came as no surprise to find that those I felt closest to, those who exactly understood my grief, were none other than the protagonists of fictional narratives and the voices of autobiographers long dead. Yet I could not have guessed just how many of my companions at this time would spring from the pages of literature.
After Blanche Dubois, Vladimir Petrovich paid me a visit. At 16 years old, the protagonist of Turgenev’s novella First Love learns how his neighbour and first love Zinaida Alexandrovna has died. Having not seen her in four years, he is on his way to meet her when he receives the news:
. . . when I made my way to the Demuth, and asked for Madame [Zinaida] Dolsky, I was told that she had died four days before, quite suddenly, in childbirth. I felt a sudden stab at my heart. The thought that I could have seen her, and did not, and would never see her again – this bitter thought buried itself in me with all the force of an unanswerable reproach. ‘She is dead,’ I repeated, staring dully at the porter, and making my way noiselessly into the street, wandered off without knowing where I was going. The past suddenly rose and stood before me. So that was to be the final answer to it all.
An “unanswerable reproach” – no better words could describe the helpless desperation of every second I was living. Basic needs had become cumbersome, terrible tasks: eating, sleeping, taking a shower – I performed these burdens with bitterness, my own voice sounding to me like a stranger’s, full of sound and fury, signifying nothing.
. . .
But Elias is right. We are a community of mortals, through and though. That is our signature feature, across cultures, ages, generations.
“Non alium videre patres, aliumve nepotes Aspicient.”
“Your ancestors saw no other thing, nor will your posterity.” (Manilius, i, 529)
During what must have been around the 34th hour of waiting, I stumbled out of the room where I had stood for hours next to my husband in the intensive care unit, encouraged by a nurse to speak to him, touch his cold, tube-infested body. I could hardly hold myself up as I moved toward what I could not believe to be, but irrefutably was, live music. In that small lobby outside intensive care, an old rabbi sat surrounded by an accordionist, a keyboard player, two singers and a giddy child, his hands dancing high above his wheelchair. Leaning my desolate body against a pillar, I listened. As I basked in this music born of centuries of suffering, I realised I had regarded my own pain as unendurable. Borne on the brink of the music, it came to me: human beings endure impossible things. With this thought, I felt every cell in me vibrate, as though I were wearing not just my own coat of skin but many. I wore the skins of my great grandparents who had lost their infant son standing outside a pharmacy in Belgium because they were Jewish and had been refused medication. The skins of Turgenev, of Tennessee Williams – the skin of humanity. Yes, humanity – a big word, which for that trickle of a moment I understood. Humanity was a community of mortals who would endure impossible things.
. . .
Not a realist
When my husband awoke with no damage to his brain, I let out a cry of joy so profuse it may have rippled the Dead Sea. A combination of disbelief and boundless ecstasy filled the following days. Over and over again, I misquoted to myself the end of a Brodsky poem: until my throat is stuffed with clay, all I will breathe is gratitude.
My husband awoke with no memory of the 24 hours before he collapsed. Today, he plays the clarinet and celebrates two birthdays. I alone keep a memory of this night and I keep my memory of that time close to me. I had followed the advice Freud gave to his student Theodor Reik on a walk along the Ringstrasse in Vienna:
When making a decision of minor importance, I have always found it advantageous to consider all the pros and cons. In vital matters, however, such as the choice of a mate or a profession, the decision should come from the unconscious, from somewhere within ourselves. In the important decisions of our personal life, we should be governed, I think, by the deep inner needs of our nature.
I had I left my family, my theatre company, my bohemian writer’s life in New York City to live in Israel that year with my husband. What had I come to do in this land born of conflict, whose first prime minister had said “anyone who doesn’t believe in miracles is not a realist” – whose national anthem was “The Hope”? I admit I blush at the religious nature of this question. What is certain: our life together is an afterlife. It is a living testament to the prodigiousness of our times.
I leave you with one last tormenting truth. Around 300,000 people a year suffer out-of-hospital cardiac arrest in the United States. About the same number is true for Europe. Therapeutic hypothermia has yet to become common practice in hospitals around the world. In spite of its evident benefits, many patients do not receive this treatment.
Alexandra Zelman-Doring is a graduate of Brown, Columbia, and Oxford universities. She is a poet, playwright and actor, and recent co-founder of Throes Theater (throestheater.com). She lives in New York with her husband, clarinet player Naum Goldenstein.
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