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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