How to Save a Life

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I am very, very pregnant, I have a extra big baby inside, I just found out at the doctor.

Which means I will be one sort of disappearing from the regular rhythm here for a little bit, although we've preloaded some things. I'll pop in and out. But also it means that I am past my fly safe date, so I am not allowed to fly anywhere.

But you just, you flew, and you got to do an event with our resident, E.R. doctor correspondent Avir Mitra. And I truly know nothing except that I had total Fomo and authentic jealousy because you're both so shiny and fun on stage. But we're going to get to hear about it now, right?

I am your friendly neighborhood radio lab host Lathip Nasser. Basically, what this came out of. Okay, so people probably remember the stories that Avir has done on this show. He did one about this mysterious epidemic of vultures dying, he did one about this miracle drug that they took out of the soil. So he's done all these great stories, right?

But he came to me with this idea of something kind of different. Avir has been able to convince me. And hopefully, with some special guest friends we have, he's going to be able to convince all of you that. Not only does he make saving a life look easy, that actually in this one particular way, it actually kind of is easy. Basically, he wanted to take on in a sort of straight ahead, practical way one particular topic. And show how. In this one case, all of us, including you Lulu, including you listener, how you can be the difference between life and death.

Yes, yes.

Yes, thank you guys.

So the story goes, you know, I had. There was a patient. She was a 78 year old woman coming in from Jersey. It was her birthday, Her family took her to see a Broadway show, Husband's with her, some kids, some grandkids.

And you know, while they're waiting in line, she sort of collapses. The family responds immediately, like they lay her flat. okay, they start fanning her.

Someone calls 911, literally in under a minute, they call 911, ambulance, comes in record time, and the EMS finds that she's actually in cardiac arrest.

So she's in cardiac arrest, she comes to the hospital. And that's where I get involved in the story. Because I'm the resident there and so I'm like a second year resident. Which means I'm sort of, I know some things and I'm cocky about it, but I don't know what, I don't know type of thing. So I'm seeing this patient come in, it's cardiac arrest.

And I know my algorithms, and I'm like, Oh, I got this. So we start doing everything, we're doing chest compressions, we start IV. We put a line into her shin so we can put synthetic adrenaline in there. We're shocking the heart.

You know, we're putting her on a ventilator, we're doing all these things, we're working on the heart for like, at least 20 minutes, maybe 30 minutes. So I'm there and I'm just like, so eager about it. So we shocked the heart.

We look with an ultrasound, it's not beating. Shock it again, shock it again, and eventually, all of a sudden, boom. Just like that, the heart restarts, blood pressure is normal.

All of a sudden, all these vital signs that were all beeping at me start looking great and so I was super excited. The families all around me, they're crying, and now they're crying. I tell them she's back and they're crying like tears of joy. They're like, Wow, amazing.

So the next step is now she's more stable, so now we have to bring her to get a cat scan. So-.

But what I saw next was this.

And I guess, in my eagerness to sort of be the guy who knows what to do, I just sort of didn't even think about this. And now I have to go out and, you know, talk to the family. And it was, I just wanted to disappear. It was like a terrible, terrible moment for the family and now I'm part of it.

So I had to tell them and I felt terrible, because now I have to tell this family that actually your grandma is brain dead. And now I had to sort of make them withdraw life support, and, you know. And I felt like I wanted to save her life and what I ended up doing was making her sort of die twice.

Right, so that sort of stuck with me forever, I guess, and I think about that case a lot.

Because, you know, I was thinking, in our society, we worry about so many things. You know, wake up in the morning, start doom scrolling. And we worry about, you know, we're worried about climate change, we're worried about gun control.

We're worried about terrorism. But like, really, the reality is the majority of human beings die because of heart problems. It's not sexy, but it's just true like this is across the world.

Like, they're real. But fires, suicides, murders. HIV is somewhere on this list, but cardiovascular disease, it's just insane.

It's one of the three.

So, like, when we pronounce a death, we'll listen with a stethoscope to the heart. I'm sure you've seen that on TV and stuff, but actually, this idea that a dead heart is a dead person kind of goes back. As long as humans have been around, this is gonna sound weird, but I was just reading Gilgamesh for some reason. Great book, I don't know.

I highly recommend it. Gilgamesh, turns out, is the oldest story that we know. It's like the first written story, and even in Gilgamesh, they sort of reference, they say, what is this? Someone dies in the story.

What is this sleep which has seized you? You've turned dark and do not hear me? He touched his heart, but it beat no longer. So even then, I was listening to it and I was like, Oh, wow.

Like, even then, 4,000 years ago, they knew that when someone doesn't have a heartbeat, they're dead. And as long as humans have known that. We've been trying to restart hearts, so there's this sort of been this practice of like reanimation, bringing a heart back from the dead that we've been working on for thousands of years. The oldest reference is actually, and we don't have to read the whole quote, but is in the Old Testament.

Here, there's actually this guy, Elisha, Elisha, Does anyone know how to Elisha? Okay, so this guy? Was he a prophet? or? a he's a prophet, so he did this.

So there's this story of when he goes into someone's house, a boy's house, and he goes and sees that he's dead. So he goes and closes the door behind him and prays. And then lays on top of the boy, puts his lips on the boy's lips, eyes to eyes, and just lays on him. And then the boy's body grows warm, the boy sneezes and comes back to life.

Yes.

But it, you know, no surprise to anybody here. It didn't really work. Actually. The phrase blowing smoke up your ass, that's where that came from.

So this guy is a pharmacologist and he's studying chloroform.

And so I don't know if this is true, but this is what I think. He was spending too much money getting all these cats, he kept killing cats. So he's trying to figure out how can I work on my budget here.

So these are the first times that we were able to bring people back from the dead, and since then we've progressed a very, extremely long way. Now, we have so many ways to do it, we almost take it for granted, right?

We can shock people back into a normal rhythm, we can give super strong medicines, we even have machines that will pump for the heart when the heart can't pump. I mean, we're so used to it, honestly, that in the or in places. People will induce cardiac arrest just to test the heart so that they know what causes it, to bring it back on certain patients.

And all of a sudden it goes into cardiac arrest. You'll see right here. They induce cardiac arrest. Now. The heart is dead, it's dying as we speak. Wow.

Okay, and then you hear a shock charging. They shocked the heart, and now it's back and you can hear it. By the way, they're casually playing Bon Jovi in the background.

Unfortunately, that's just not the case.

It's like you never had a chance to see a nurse, see a doctor. It's like you had died a hundred years ago or a thousand years ago. It's really no different, and that's how a lot of people are still dying.

Do you want to take a guess where it is?

Okay, that's good Denmark the gym, maybe.

So, you know, it turns out that it's the perfect practice space for cardiac arrest. You have a lot of older, elderly people right at a casino, okay, they periodically lose a lot of money and get very stressed.

Yeah, no kidding, right? And they often manage that stress by doing potentially unhealthy things like smoking cigarettes or drinking alcohol. Okay, so cardiac arrests happen a lot at casinos and everybody there is on camera, and everybody who works there, like the dealers, you know, everybody. They're all trained in CPR. So as a result the arrest, the survival rates of cardiac arrest in casinos is actually 53%.

Oh.

It's unreal. I'll take your life, but take your shirt. Yeah, yeah, wow. Sorry residents, it's not where we work.

It's not, yeah, wow, yeah. So to me, that's saying, like, you know, we can do something. If we could do CPR, we can really increase these numbers.

You're in Nebraska or somewhere else where a good time would be 30 minutes, right? So that's the problem, right? And just to put this in context, like cardiac arrest in the U.S happens 1000 times every day.

You have a breast bone up top and you have vertebrae below it. And all you're basically doing is just sandwiching the heart between those two bones and manually pumping it. And you can't do it forever. But this actually works. Is it fixing the problem? This is where a lot of people get confused.

Is it fixing the heart? No, is it just pumping the blood around to sort of buy you time? Yes, that's exactly what it's doing now. All of a sudden, your survival goes down much more gently.

You're buying yourself time for someone to come in and do something about it.

So it really just comes down to you guys, what would you do, really put yourself in that situation? Because it sounds good on paper. But imagine you're just walking down the street and someone collapses, or you're with someone and they collapse.

I would say, Does anyone else here know what to do?

And I mean, I'd be really scared to do the wrong thing, and I'm probably so frozen. I'm probably just calling 911 and waiting and hoping and searching for someone who knows what to do.

And when we come back from break, we are going to have a couple of very special guests come up to the stage and tell a story that is, on the one hand, completely heroic. But at the same time, when you hear it, you realize just actually how easy stepping up to a moment like that can be. So just stick around, we'll be right back.

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S military has kept from the public for years. Did you think that a war crime had been committed?

So I wanna bring up Will Flannery and his wife, Kristen Flannery.

Yeah, thank you.

Hi everyone. So yes, I am a internet comedian, ophthalmologist, which I swear is a real job that I made it up, but it's still a real job if you don't know what an ophthalmologist is, though. I am an eye surgeon, so that means I went to med school and I learned everything there is to learn about the human body, the entire human body.

And then I said, I don't wanna do any of that. It's like I'll just devote my career to the eyeball.

And that's what I did. So now I'm a practicing ophthalmologist and Kristen has been with me since the beginning.

The pandemic hit, and when the lockdown occurred, my practice shut down so I couldn't see any patients, so I had all this free time on my hands. I did start making TikToks around that time. But there were also there were a few times where I honestly thought I might get redeployed to the hospital to help out.

And do you know how bad a public health emergency has to be?

For someone in the ICU to be like, Are there any ophthalmologists we could get up here?

Now, fortunately, it didn't happen like there were plenty of more qualified people than an eye doctor to go help out. But I had all this free time on my hands making all these videos, trying to do virtual ophthalmology, which is as hard as it sounds. And then, on Mother's Day in 2020, we had a wonderful day, we were at my in-laws house.

We had a nice meal out in the backyard.

And that day, Kristen took a lot of photos, and those were almost the last photos that were ever taken of me. Because later that night, I had a cardiac arrest in my sleep.

45 in the morning, I woke up to him making some very strange sounds. Fortunately, they were loud. And I'm a mom, so I'm a light sleeper. All you moms know exactly what I'm talking about. And I woke up and I thought he was snoring.

I was still really groggy. I'm not in medicine, I studied cognitive, neuroscience, and then education and marketing, basically everything you need to know. I'm not in anything but medicine. Bodies are gross.

And so I thought he was snoring, I did the thing that you do, like, ugh, quit it, you're waking me up and tried to get him to turn over and stop snoring. But he wasn't responding, and he was just something about how he wasn't responding. Kind of raised a red flag, like, whoa, that's weird, and I couldn't put my finger on why, but it just didn't seem right.

And so I tried a little bit harder, still nothing. And so then I started to get a little freaked out. And so I started kind of slapping his face a little bit and yelling his name, and then he still wasn't responding.

And I had no idea what was happening, but I knew this isn't right, this is very bad. And so I just did the only thing I could think of to do, which was I called 911..

And it was the most bizarre period of time in my whole life.

I sort of part of my brain was in the moment and just really focused on what needs to happen and just in emergency mode. And then another part was just sort of. It was almost an out-of-body experience, I wasn't the one dying, but I was the one having an out-of-body experience. Just sort of watching myself and this scene unfolding and just feeling like, what, this is just so wrong. He went to bed perfectly healthy.

I take that back. You were not perfectly healthy. He had survived testicular cancer two times before that, so he's used up three of his nine lives so far. But hopefully-.

So it was just the most bizarre thing. And I was leaning my head over his chest as I was calling 911, and I was sort of noticing like, I don't hear anything. There's no heart beating in here, but it was just kind of like, huh, that's interesting?

I couldn't really fully process that at that time, but I remember taking note of that. And so then the dispatcher came on and they asked what the emergency was, and I said, my husband won't wake up, and the dispatcher asked me. What I have since learned, I did not know this at the time, but I have since learned.

There's only two questions that you need to know, the answer to, to know that it's time for CPR. And that's, is he responding to you? And of course, the answer was no. And is he breathing normally? and that word normally is very important, because I would have said, yes, he's breathing.

In fact, I think I did say, yeah. He was breathing, kind of like taking these weird gasps, and then he would stop for a bit and then he started breathing again. I've learned since then, that's called agonal respiration, it's the body's last ditch unsuccessful attempts at breathing in air, but it's not real breath. And so that second question, is he breathing normally?

The answer to that was no. So, because he was not responding and he was not breathing normally, she said. I'm gonna walk you through CPR and I said, What?

And it didn't make any sense. But I just said, okay. And I followed her instructions, and she told me. She asked me if I could move him off the bed. We were in bed, it was the middle of the night, and so I said, Well, I can't move him. I don't know if anyone's just listening to this, you can't see this, but I have heels on.

He's got a good 13 inches on me and probably a hundred pounds.

And more than that, I had had a neck surgery four months prior that I was still recovering from. And I said, I can't move him off the bed, and she said, Okay, if you can't move him, we're just gonna do it where it is. And I'm so glad I did not know this at the time, but that was bad, that was. You need a hard surface, preferably if you can get the person to a hard surface, do that. But I could not.

And so thankfully, we do have a very firm mattress, thanks to my neck, so that was good, but I did, she told me. Put your hands on his chest, place your fingers together, put your hands on his chest in the center of his chest, between his nipples and just push hard and fast. And she just counted with me one, two, three, four, five, six, seven, eight, nine, 10. Just over and over and over and over for 10 straight minutes. It was May of 2020..

And we lived not far from the station that responded to my 911 call. But they were in full hazmat gear, they had hoods, shields, the whole suit, gloves, everything. And so they had to wait outside of our door, put all the gear on and then try to get in the door, which turned out to be locked. And so they had to kick it down.

Because I didn't want them to see what I was seeing, because you can never unsee that. And they were so young. And I was watching him turn blue and then purple.

He stopped making those noises eventually, and by the time EMS arrived, he was gray. And I saw them take him off the bed, carry him downstairs and lay him down on the hardwood floor and hook a bunch of things up to him. And I may not have medical training, but I have watched television and I heard things that should be beeping. I knew this.

They were making a flat, solid sound and a flat line, and I knew what that meant, and so I turned around. I remember this really distinctly. Unfortunately, I turned around to go back up the stairs because I wanted to check to make sure that the children were still in their beds and weren't trying to come out. And I didn't wanna see what I knew was about to happen because I saw them take out the paddles.

And as I went up the stairs before I could even get halfway up, I heard them deliver that first shock. And I heard the way that his six foot, four inch, all arms and legs body just slammed against our hardwood floor in a really unnatural, weird way.

And from there, I just went up and I was trying to figure out anything useful that I might be able to do. Or just a thing to keep busy to keep from breaking down. And so I packed him a hospital bag and I called into his clinic to tell them I don't think he'll be in today. You might wanna reschedule. His patients and I called both of our sets of parents and during that time, some of the paramedics, one of them was coming up and down the stairs and giving me updates.

And he told me that what had happened was Will's heart had gone into ventricular defibrillation. Did I get that right? Okay, which is what you saw on the screen, where when they stopped the heart, it just sort of shakes like this, but it doesn't actually pump any blood anywhere. And the sounds that I had heard were those agonal respirations.

And that meant that his heart had stopped.

And but thankfully, they were able to get his heartbeat back after they shocked him five times. They didn't give up on him and their hoods and shields were fogging up and they would have to switch off. And it was such an effort and a team effort to get him back, and they didn't give up on him and they did get his heartbeat back. And they took him to the hospital. And I went into my children's bedroom and I asked them what they would like for breakfast.

And I had all the testing done in the world. And we still to this day don't know what caused my cardiac arrest. Which is not unusual for young people that have an out-of-hospital cardiac arrest. Often, we don't have a good answer for why it happens. And as a physician, I never once thought to myself, like when this happened, I had been a physician for like, seven years. I never once thought, Hey, maybe my wife should know how to do CPR.

Maybe my family members, because if something happens, I'm usually there, I'll be the one to help.

Now Avir.

And if you do it in that circumstance, or even if you do it late, if you're waiting a lot of minutes and then you start doing it. That's when it leads to way worse outcomes. So it does have some risk. But Avir's point is like,-.

You gotta get a card like, we don't have time for that. So what? They sort of invented because they knew no one was really doing. CPR is hands-only CPR, where it's literally just push hard and fast on the chest, that's it.

I wanna basically demonstrate CPR, yeah, hands-only CPR, and give them step-by-step instructions on how to do it all right, so you demonstrate. So you're gonna put one hand over the other, okay?

Do it in the middle of the chest, and then you're just gonna push hard and fast down on the chest. You wanna go about two inches. It's harder than it is on the movies, but you can see that right there.

That's good CPR. Another thing to notice is he's not moving his arms because you could do it, it's just tiring, so what he's doing is sort of moving his hips. Like this, use your hips as a fulcrum and go up and down.

Like, just like that, does that make sense? Awesome, all right. Thank you Al. Basically, you just do that.

Everyone's gonna stand up, we're all gonna practice this, we're all gonna train on how to do hands-only CPR. If you're game, we want all of you to try it.

All right, everybody, come on.

Jolene, Jolene, Jolene just wanna have fun, Cyndi Lauper.

Justin Timberlake rock your body, cause he's, I mean, what you're doing is you're rocking a body right now.

Org let us know.

It's called, of course, it is wife and death. Thanks to the Greenspace here at WNYC's home in New York City. First of all to Jennifer Sendro, who helped us make it work at basically every stage of the process, as well as the rest of the Greenspace crew. Carlos Cruz-Figueroa, Chase Culpin, Ricardo Fernandez, Jessica Lowery, Sky, Paolo Ross, Eric Weber, Ryan, Andrew Wild and Andrew Yanchizen. Also, thank you to the Red Cross for helping us make this happen and providing the CPR dummies and to all the CPR trainers. We had Ashley London, Jeanette Nicosia, Charlene Young, Jacob Stable, Ty Morales, Anna Stacey and Adithya Shekhar.

And, by the way, you can see a video of the entire live show in its raw form on the Greenspace website, thegreenspace.

Org Green is G-r-e-e-n-e, where you can also check out all the other awesome live events happening at WNYC. All right, that's it. That'll do it, yeah.

Take a chance on me.

Our staff includes Simon Adler, Jeremy Bloom, Becca Bressler, W. Harry Fortuna, David Gable, Maria Paz-cuteras, Sindhu Na Nisambadan, Matt Kielty, Annie McEwen, Alex Meason, Sarah Kari, Valentina Powers, Sarah Sambach, Ariane Wack, Pat Walters and Molly Webster. Our fact-checkers are Diane Kelly, Emily Krueger and Natalie Middleton.

Hi, this is Ellie from Cleveland, Ohio. Leadership support for Radio Lab's science programming is provided by the Gordon and Betty Moore Foundation, Science Sandbox, A Simons Foundation initiative, and the John Templeton Foundation. Foundational support for Radio Lab was provided by the Alfred P. Sloan Foundation.