Working Code: Not Dead Yet
A true story of a miracle
CART MASTER: Bring out your dead!
CUSTOMER: Here's one...
DEAD PERSON: I'm not dead!
CART MASTER: What?
CUSTOMER: Nothing. Here's your nine pence.
DEAD PERSON: I'm not dead!
CART MASTER: 'Ere. He says he's not dead!
CUSTOMER: Yes, he is.
DEAD PERSON: I'm not!
CART MASTER: He isn't?
CUSTOMER: Well, he will be soon. He's very ill.
DEAD PERSON: I'm getting better!
CUSTOMER: No, you're not. You'll be stone dead in a moment.
CART MASTER: Oh, I can't take him like that. It's against regulations...
CUSTOMER: Well, can you hang around a couple of minutes? He won't be long.
-- Monty Python and the Holy Grail
It was another too-busy day, and I knew I wouldn't get out until late. However, this was the last shift for another week, so I was feeling pretty positive. But then, I had one of my most bizarre cases ever. A 96-year-old man came in by rescue squad with his heart paced by external pacing pads after a fainting spell. These are adhesive pads wired to a machine that delivers a shock to the heart to keep it beating when it won't beat on its own. He had a signed "Do Not Resuscitate" order with him, but the family wanted everything done despite that. He arrived yelping with each pacing shock, begging us, "Please don't hit me anymore!" Family members began arriving one by one as his pacer went tick-tick-tick causing his muscles to painfully twitch-twitch-twitch.
I wanted to talk with the family to see about stopping this painful pacemaker given his Do Not Resuscitate form and his obvious discomfort. But, the elderly man's son wanted me to "get him four more years so he can get to 100 years old!" We discussed the futility of persistent external pacing as he would need an implanted pacemaker for long-term support, but the patient clearly did not want it. After discussing his previously written wishes, the family agreed not to do CPR or intubation. Pulling me aside, his son said, "Doc, we're looking for a miracle here." I told him that miracles were out of my league. After several more family members arrived, they agreed we should stop the external pacemaker. They could see how he was suffering from the distressing shocks. He begged us repeatedly to please turn it off. As they came to a consensus to honor his wishes, I advised that he would likely die, maybe in minutes. They said stop it. Stop the machine. With numerous relatives at the bedside, I turned off the pacemaker, and his heart slowed, then stopped beating. We observed him for a while, with all the family members holding his hands and watching. He had one twitch and one gulp, but I told them that was a common reflex. We waited a couple more minutes, and they asked me if he was gone. I said I thought so. We watched a bit more, and I waited until there were no more tiny muscle twitches. I considered him dead.
Suddenly, his head turned pink after more than eight minutes of no heartbeat and no CPR. I saw his neck veins begin to pulsate, and he started to breathe on his own. Mumbling, "No fucking way" under my breath, I turned the monitor back on. He had a normal heart rhythm! It wasn't even slow. The family was as shocked as I was. I ordered some morphine to keep him comfortable while we watched him begin to slip away again. It was not long before his heart stopped again briefly, then started, then stopped, then started. These are signs of a dying heart. The family hovered at the bedside. A half-hour later, the nurse came to me and said it looked like he had finally expired. I laughed and said I wasn't falling for that again. But another nurse called me to the room and said he was definitely dead this time. I said I would wait a bit before I came back in. Two minutes later, you guessed it: his heart started again after all this time of not breathing. He cycled a couple more times, starting and then stopping. Then suddenly and shockingly, he opened his eyes and he started talking! I had never seen anything like it.
I called in the cardiologist after the twenty family members at the bedside voted to have a permanent pacemaker implanted. Up he went to the heart catheterization lab and got his pacemaker. He was alive when I left the hospital three hours later. I doubted his future was bright, and I felt we just sucked $50,000 off his savings. Amazingly, he was discharged several days later. There it was, the miracle the son wanted. I don't know if he got the four years they were seeking, but he got four days against tremendous odds! Not dead yet.
Sometimes truth is stranger than fiction! Enjoyed the essay!
God’s work. I hope he got to his millennium.