May 27 2008

Back from the Dead

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Comments: 15

I have noticed in recent months several examples of absolutely horrific medical science journalism. The two most common themes are a medical miracle that has doctors baffled, or the stunning (yet dubious) medical breakthrough. In the latter category have been a number of cases of people “brought back from the dead” – people who were presumed dead or brain dead but who survived none-the-less.

I wrote previously about the case of Zack Dunlap, who was declared brain dead after a serious injury and while being prepped for possible organ donation regained consciousness. In this case the simplest explanation is that the PET scan used to make the diagnosis was simply in error.

I discussed on my podcast this story about a man whose heart had stopped in the emergency room. He underwent cardiopulmonary resuscitation (CPR) for about 45 minutes to no avail. At that time the cardiologist, Dr. Chauncey Crandall, told the team to shock his heart one more time. That shock did it – the patient’s rhythm returned and he eventually recovered.

This is a completely unextraordinary occurrence – but Crandall, who is a devout Christian and mingles his beliefs with his practice, is using the opportunity to tell a tall tale about how God spoke to him and told him not to give up. During the press interview he uses hyperbole to exaggerate the patient’s condition – for example Crandall says that his skin was “black with death.” What does that mean, exactly?

Now we are being treated to another story in this same genre. Val Thomas, 59, had a couple of heart attacks resulting in cardiac arrest. Her doctors managed to get her heart going again. They then induced hypothermia for 24 hours. The purpose of this (which was not properly related in any news account) is to protect the brain from neurological damage.

After the period of hypothermia, when she was being warmed back up, she had another cardiac arrest. The details at this point are too vague to reconstruct confidently. It is reported that she was on a ventilator but was not recovering consciousness. The prognosis was grim and so the decision was made to withdraw care. However, she was kept on a ventilator so that she could potentially be an organ donor.

From my experience in these cases, it seems that her heart was beating but she had a poor blood pressure and she remained comatose (not surprising following multiple cardiac arrests and induced hypothermia). Therefore the decision was made to take her off the ventilator, but they kept her on as a possible organ donor. But then, after removing her from the vent and IV’s she awoke.

This is not an unusual occurrence at all. In fact I frequently warn families in such situations that their loved-ones may survive even after we take them off the ventilator. We often cannot be sure what will happen.

The only difference in this case appears to be outstandingly terrible science news reporting. The reporting, originating from NewsNet5 out of Cleveland Ohio, mixed together details from the family and the doctors, but never put the story together. The news story was then dutifully copies and paraphrased by numerous secondary news outlets – without any evidence that a single reporter or editor along the line exhibited even the slightest journalistic skepticism, or had the proper background to see that the story made no sense as it was being told.

For example, FoxNews wrote this:

Thomas’ heart stopped around 1:30 a.m. Saturday and doctors said she had no pulse. Rigor mortis started to set in, and she was placed on a respiratory machine.

That last sentence is laughable – why would you ever put someone with rigor mortis on a ventilator? You also would not put someone on a ventilator if they had no circulation. Rigor Mortis occurs 2-4 hours after tissue death. It is the result of muscle cells having no energy – the no-energy state of muscle fibers is the contracted position. It takes energy in the form of ATP to relax and rest the muscle fibers so that they can contract again.

There is no coming back from rigor mortis. To suggest that this patient had rigor mortis and then came back to life is absurdly ignorant. Every journalist involved with this story who let that claim pass should be ashamed of their own incompetence.

Where did that claim come from? The doctor interviewed made no mention of it (or any other salient details – just that she had no signs of neurological function, which is expected in that situation – but more on that below). The family members did mention it, however. They commented that her fingers were stiff and bent back. They likely misinterpreted this as rigor mortis (or the reporters did themselves). However, tight fingers could have results from the induced hypothermia, or from poor (but not absent) tissue perfusion.

It is also reported that she had “no pulse of her own.” What does that mean? Did she have some other pulse? Was she actively being given chest compression? Was her heart being paced with an external pacemaker? We are not told. Or, was it just that the nurse did not feel a pulse? After a cardiac arrest, with a decreased blood pressure, it is easy to miss a pulse. Every now and then patients are sent to the morgue only to wake up there – their faint pulse and shallow respirations were simply missed.

We are also told that the patient has no brain waves for 17 hours. Again – what does “no brain waves” mean? I doubt they would have kept her on EEG monitoring this entire time. The doctor who was interviewed said she had no signs of neurological function – but how detailed was the exam? Was a neurological consult called? Did the family or the reporter assume that “no neurological function” is the same as “no brain waves?” It is probable that the patient was simply unresponsive, but did not have a true absence of all signs of brain function. Again – pretty typical for someone who just suffered cardiac arrest.

The real story here is the sorry state of much of science reporting, and the way new stories are propagated through the internet without any follow up journalism.  The problem seems to stem largely from the trend in recent years to have fewer science journalists and for generalists to cover science stories.

A competent science journalist should have had the background and common sense to realize that the story, as told, did not make sense. The family (who were just responding to an emotional situation and should not be relied upon for accurate medial information) were giving many details that did not fit or were not in proper context. It sounds like the reporter collected together a bunch of isolated facts about the case but had no idea how to put them together into a coherent medical story.

Most egregious, however, is the reporting that the patient was in rigor mortis before awakening. I would think that basic common sense would be enough to raise a red flag about this detail. The reporter should then have then specifically verified this detail with the doctor, and if they did not get a clear or sensible answer do some further expert follow up.

Perhaps the news editors thought this was not a “science” story but a “human interest” (i.e. fluff) piece. That may help explain the gross journalistic incompetence, but it does not excuse it. The bottom line is that they got the story wrong and misinformed the public.

Mainstream journalism is slowly dying in the age of the internet. This will probably lead to bloggers (or whatever comes after blogs) largely filling the gap. But if journalists want to maintain their central position in news reporting they are going to have to do a better job.

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15 responses so far

15 Responses to “Back from the Dead”

  1. Jim Shaveron 27 May 2008 at 2:15 pm

    Judging from an admittedly modest sample size, it seems to me that there is a common thread to these stories, and that thread is God. Inevitably, these stories are not retold without at least one specific God reference, such as this quote of Val Thomas from the Fox News story:

    “I know God has something in store for me, another purpose. I don’t know what it is, but I’m sure he’ll tell me.”

    I think the people primarily responsible for propagating these “medical miracle” tales are anomaly-hunters with an agenda. If they were to bother to check facts carefully, they could not produce as fluffy a piece of religious propaganda. That’s how I see it, anyway.

  2. mat alfordon 27 May 2008 at 5:16 pm

    That Fox News quote is breathtakingly dumb…

    Steve, do you ever contact these news corporations when they report such utter nonsense?

  3. DevilsAdvocateon 27 May 2008 at 5:17 pm

    Actually, “anomaly-hunters with an agenda” is an accurate description of pretty much all of mainstream media and large chunks of backstream media as well. Their guiding postulate is as old as journalism: Dog Bites Man is not news. Man Bites Dog is news.

    Note how the writer got the sensational, ad-selling aspects correctly – “according to witnesses” a medical miracle has occurred. Anything past that is mere detail, minutiae worried over only by hoary purists, statisticians, and skeptics. If these reporters researched and wrote what actually occurs in these medical miracle stories, it would paint an unglamorous picture of the human capacity to capture meaningful mystery from misinterpreted mundane events. It would be a downer. It would not be accepted by editors, nor ever see print, certainly not in the short form news typical today, articles of very few words, or details. One day a reporter will be asked to look specifically at the truth behind medical miracle claims, with focus on the way misinterpretations, confabulations, and assorted biases of belief create the mysterious miracles, but I won’t hold my breath waiting on it. As print newspapers and magazines transition to the internet, they’re becoming more and more like their ratings-driven compadres on broadcast television and cable, selling news like fast food: hot, salty, and devoid of substance.

    Blogs may be the next main purveyor of public information, but that’s not necessarily going to be any better. Whomever
    ‘catches’ audiences in large numbers will have to deal with serving two masters (ad ratings and professional ethics), bloggers included, and the history on this suggests the bloggers too will succumb to the bottom line. We’ve already got plenty of nonsense blogs.

    It is getting exceedingly difficult, for me anyway, to locate reliable news source in the areas of current events, let alone science, technology, etc. I spent a couple weeks warming up to a new local talk radio host, very much enjoying his style and grasp of current events, when all of a sudden he comes out with a pro-creationism bent, and I do mean bent. I’m not about to double check every fact extended by media types – and I’d have to check everything this guy says. I need a degree of trust, earned by proving reliable when I double check on dubious details or on areas found within the great sea of my ignorances.

    Blog Log: As of -this- moment, we are down to 112,965 people on Earth who do not have their own blog.
    112,964…
    112,963…
    112,962…

  4. Tressaon 27 May 2008 at 9:32 pm

    Thanks for this. My grandmother was trying to tell me Thomas’s story but couldn’t remember the full details (she’s going to be 89 next month, I’m just happy she can remember how to go potty by herself ;-) but the rigor mortis remark did click a red flag for me. I am printing this out for her to read. Keep up the great work!

  5. wertyson 27 May 2008 at 11:03 pm

    I was once involved in an in-hospital resuscitation of a man in his early 40s with a severe cardiomyopathy. He arrested while on the ward being treated for a pneumonia, which had essentially resolved at the time of the arrest. After 10 minutes of CPR with no spontaneous output, we ceased CPR as per his advance directive. His heart was asystolic on the monitor. About 30 seconds after we stopped, he suddenly let out a huge breath and his heart kicked in again, at which point we rushed back in and got him ready to go to ICU. Nobody put him on TV. Nobody tried to use him for their own agenda by making a media circus. Stuff like that happens to every doctor at some point. You remember them because they are not like the other 300 you did which were unsuccessful. I think it’s an example of the texas sharpshooter fallacy, where you try to explain every occurrence which suits your argument after the fact, ie you draw the target after you know where the bullet landed.

  6. ellazimmon 28 May 2008 at 12:44 am

    And I think it’s important to say that it could only possibly be considered a fluff piece BECAUSE no one bothered to check the statements with experts.

    Here in England we’ve got tabloid style national newspapers and some of the TV stations also have the “if it bleeds it leads” mentality. My advice to Americans: generously support NPR and PBS. I know they’ve started running quite a few ads as well but I bet a lot of the reporters would argue against it if the money came in.

  7. [...] is my observation that the quality of mainstream science reporting has been generally low, attributed to the scaling back of dedicated science journalists. On this issue I have found the [...]

  8. kvsherryon 28 May 2008 at 2:15 pm

    I was sad to actually find that the story of Dr. Crandall actually made it to a nurses forum. I posted on said forum calling BS and asking the obvious questions and actually had a reply feeling sorry that the skeptics could not have faith and believe.

  9. mjrobbinson 28 May 2008 at 9:58 pm

    I think you’re very sorely mistaken in saying that “Mainstream journalism is slowly dying in the age of the internet.” As I pointed out a couple of months ago, mainstream news sites dominate the internet, and look set to continue to do so (http://layscience.net/?q=node/20). The idea that bloggers will somehow take over at put things right again seems to be wishful thinking…

  10. The Lay Scientiston 28 May 2008 at 9:59 pm

    Brave Old World: New Media and the Future of Science Journalism…

  11. drdirkon 20 Nov 2008 at 3:22 am

    ON YOUR POST BACK FROM THE DEAD CONCERNING “ZACK DUNLAP”, I CAN PERSONALLY TELL YOU HOW IT HAPPENED, BUT HERE IS HOW I KNOW.

    MY SON AND HIS BEST FRIEND WERE INJURED ON A 4 WHEELER THIS PAST FRIDAY. THEY WERE CARE FLIGHTED TO WICHITA GENERAL HOSP., AND HAD THE SAME DOCTOR AS ZACK DUNLAP. THESE BOYS WERE BOTH 20 YEARS OLD AND IN GREAT CONDITION, AND GREAT CONDITION FOR A POTENTIAL DONOR. BEING A POTENTIAL DONOR CHANGED EVERYTHING ON THE TREATMENT THEY GOT AT THIS HOSPITIAL, AND YES THEIR FUNERALS ARE THIS SAT, NOV 22,2008.

    AFTER FINDING OUT THAT WE MAY HAVE SOME INTEREST IN ORGAN DONATION, THE TREATMENT STOPPED IMMEDIATELY AFTER ONLY 12 HOURS IN THE ER. THEY WERE NO LONGER INTERESTED IN SAVING OUR BOYS BUT PERSERVING THE ORGANS UNTIL WE DECIDED TO GIVE UP. THEY INSISTED THEY THEIR BRAINS WERE SWOLLEN AND THEY COULD DO NOTHING TO GET THE SWELLEN DOWN AND THEY HAD NO CHANCE. WE BEGAN TO ASK ABOUT THE MIRACLE DEAL AND ZACK DUNLAP, THIS WAS A MISTAKE, OUR DOCTOR WHICH WAS THE SAME AS ZACKS, TOOK US IN THE HALLWAY AND SAID THERE WAS NO COMPAIRISON, BECAUSE QUOTE “THE REASON ZACK CAME OUT OF HIS COMA AND WAS NO LONGER BRAIN DEAD WAS BECAUSE HE SIGNED OFF ON THE CT SCAN WITHOUT LOOKING AT IT, STATING HE THOUGHT THE OTHER SPECIALIST KNEW WHAT HE WAS DOING”. HE THEN GOT MAD AT US FOR WANTING ANOTHER OPIONION FROM AN OUTSIDE SOURCE THEN REMOVED HISSELVE FROM BEING OUR DOCTOR. NEEDLESS TO SAY WE HAD DO CALL OUR DOCTOR FROM OUR HOME TOWN TO COME UP AND PRONOUNCE THEM DEAD SO THE ORGAN HARVEST COULD GET STARTED. REMEMBER THIS WAS 2 BOY BOTH 20 YEARS OLD AND THEY DID NOTHING FOR EITHER, TOLD US THAT BOTH WERE A 3 ON A SCALE OF 15 WHEN THEY ENTERED THE ER, THEN TOLD US BOTH WERE COMPETELY BRAIN DEAD 8 HOURS LATER AND NOTHING THEY COULD DO. WE ASK TO BE TRANSFER TO HOSP IN DALLAS, THEY SAID THEY WOULD SEE IF THEY COULD FIND AN OPENING SINCE IT WAS THE WEEKEND, AND WOULD GET BACK TOO US. WE NEVER HEARD ANYTHING BACK.
    WE WERE THERE FROM 2:00 AM SAT UNTIL 3:00 TUES AND NOT ONE TIME DID THE DOCTORS SAY ANYTHING ABOUT TRYING ANYTHING TO SAVE THEM. THE ONLY TIME THEY MENTIONED WHAT THEY WERE TRYING TO DO WAS AFTER BEING THERE 12 HOURS THEY WANTED TO STOP THE BRAIN SWELLING MEDICATION AND SEE WHAT IF ANY KIND OF REACTION THEY WOULD HAVE. THAT WAS THE LAST AND ONLY TIME ANY MEDICATION WAS MENTIONED, AFTER THAT THEY ONLY MENTION ORGAN DONATIONS. AFTER 3 DAYS OF SAYING NOTHING HAS CHANGED AND WE NEEDED TO MAKE A DECISION WE FINALLY DID. WE EVEN HAD THE NURSES CALLING OUR WAITING ROOM AND HOTEL EVEN AT 3:00 IN THE MORNING TELLING US THAT WE NEEDED TO DONATE THE ORGANS. KEEP IN MIND NOTHING OTHER THEN THE BRAIN WAS IN QUESTION, ALL VITIALS AND EVERYTHING WAS DOING FINE. WE WERE NOT EVEN CLOSE TO WAITING TOO LONG IN ORDER TO DONATE THE ORGANS. THEY KILLED OUR BOYS FOR THE DONATIONS AND THATS THE BOTTOM LINE. THANKS

  12. weingon 20 Nov 2008 at 10:34 am

    My condolences to you. Having children that age myself, I cannot even try to imagine how you must feel.

  13. HHCon 20 Nov 2008 at 12:49 pm

    Dear Dr. Dirk:

    You must admit to yourself that you are a superdad. You have run a mental and physical marathon trying to handle all the issues involved in critical care for your son and his friend. You also have to admit that you gave the permission for your son’s organs to be harvested to give life immediately to other American sons or daughters. You need to recover yourself. Take time now to heal yourself. Should you feel like sharing your pain and thoughts further, I would suggest a chaplain. You may wish to see an attorney who handles wrongful death cases to get real counseling on these difficult issues.

  14. drdirkon 06 Dec 2008 at 9:12 am

    IN REFERENCE TO OUR SONS ORGAN DONATIONS AND ORGAN DONATIONS IN GENERAL. DONT GET ME WRONG WE WERE ALL FOR THE ORGAN DONATIONS, ITS JUST HOW IT ALL TOOK PLACE IS THE CONCERN I HAVE FOR OTHER PARENTS THAT WILL HAVE TO GO THROUGH THIS ORDEAL. 1ST: THE HOSP. IS NOT SUPPOSE TO SOLICATE THE IDEA OF DONATING THE ORGANS UNTIL AFTER THE SUBJECT HAS BEEN PRONOUNCED DEAD. IT DOESNT HAPPEN THIS WAY. THEY CALLED OUR WAITING ROOM, OUR HOTEL AT 3:00 IN THE MORNING AND NOTHING ELSE WAS SAID ABOUT ANY KIND OF POSSIBLE TREATMENT FOR THE BOYS. WE ALSO REQUESTED TO HAVE THEM TRANSFERED TO A HOSP IN THE DALLAS-FTWORTH AREA, ON 2 DIFFERENT OCCASSIONS AND THEY NEVER ANSWERED US WITH ANY KIND OF RESPONCE IN REFERENCE TO WHY THEY WOULD NOT, OR DID NOT ATTEMPT TO TRANSFER. OUR QUESTION IS THIS: DOES THE HOSPITAL MAKE MONEY FROM THE ORGANS THAT ARE DONATED FROM THEIR ESTABLISHMENT. LAST BUT NOT LEAST ON THE ORGAN DEAL, WHEN WE STARTED CONSIDERING THIS ISSUE, TO DONATE OR NOT TO DONATE WE ASKED FOR ANYKIND OF INFORMATION THAT WOULD HELP WITH OUR DECISSON (MAINLY WE JUST WANTED TO KNOW MORE ABOUT HOW IT ALL WORK WITH THE ORGAN NETWORK ECT. ) THEY NEVER BROUGHT US 1 THING IN REFERENCE. THEN WE ASKED ABOUT WHO WOULD GET THE ORGANS, AGES, ECT. THE DAY AFTER THE ORGAN HARVEST BEGIN, SOUTHWEST TRANSPLANT ALLIANCE CALLED US AND INFORMED US THAT THE HEART WENT TO A 12 YEAR OLD BOY. THIS WAS GREAT, WE NEEDED TO HERE SOME GOOD NEWS, BUT IT WASNT GOOD FOR LONG. THE12 YEAR OLD RECEIVED THE LEFT KIDNEY, NOT THE HEART. INSTEAD THE HEART WAS GIVEN TO A 71 YEAR OLD WOMEN. NOT MANY YEARS LEFT FOR OUR 20 YEAR OLD SONS HEART NOW BEING 71 YEARS OLD. ITS GOES ON THE AGES WERE 47,52,71,61, AND 12. ITS JUST ANOTHER LET DOWN, EVEN THOUGH WE ARE HAPPY FOR THE FAMILIES OF THE RECEIPANTS, WE HAD JUST REQUESTED AND WERE TOLD THAT THE AGES WOULD BE A LITTLE YOUNGER. I KNOW THIS SOUNDS SELFISH, BUT UNTIL YOUR IN THIS KIND OR SITUIATION, AND LETS PRAY YOUR NOT, YOU BEGIN LOOKING FOR ANY KIND OF GOOD TO COME OUT OF ALL OF THIS BAD, INSTEAD YOU KEEP GETTING SLAMMED WITH THE MEDICAL INDUSTRIES BRAIN DEAD DOCTORS INSTEAD.

  15. HHCon 08 Dec 2008 at 2:36 am

    Dr. Dirk:

    Your expression of emotion through your writing style has a knock out punch to the gut each time you put your thoughts on the blog. Let’s back up a bit to your first comments. Your boy was given a 3 out of 15 points when he entered the emergency room. The Glasgow Coma Scale was probably used. This measures coma and impaired consciousness for head injury. A 3 on this scale translates to no eye opening, motor response, or verbal response. A 15 translates as normal response in each of these areas. I believe that the three is the lowest score on this scale. Eight hours later, your son was pronounced brain dead by hospital staff. According to your statement, medication to reduce brain swelling continued for 4 more hours. At the end of 12 hours medication ceased to be given, the brain was swollen and had stopped any activity during the 8th hour in the emergency room. Staff requested your permission to harvest the organs. Only after your family physician pronounced your son and his patient dead could the hospital proceed. The hospital could not tranfer your son to another hospital from the beginning because there was no motor response, verbal response, or eye opening. Unfortunately, there was no easy way to tell you there was no hope for your son to regain consciousness. It is sad that there is no customer relations departments at hospitals that service the families of organ donors.

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