Oh Death Where is Thy Sting?

A few years back my regular doctor heard a sound coming from my aortic valve. 

Turns out that if you have a heart murmur and insurance you get a cardiologist. And cardiologists don’t come as individuals. They come in flocks, like medical tests. I got a flock of those as well. Indeed I’m a regular now. EKGs every time I walk through the door. Blood as well. Echocardiogram every 6 months. Stress test every year. CAT scan every year. I’m the reason your insurance rates are going up and I’m healthy. Because all those tests say so. 

But back to the flock. One member does coronary angioplasty so I had one of those to fix an apparent problem (see stress test) and another to confirm I didn’t have a problem (see stress test.) Did I mention your insurance rates? But its better than dying of a heart attack. At least for me.

Today, as I write, the flock decided to move me in a new direction. I had a little incident of atrial fibrillation back in August, and although it was resolved quickly this is the kind of thing a flock of cardiologists can’t let go. They have both an aversion to patients dying on their watch and a business model that depends on more robust billing opportunities than office visits and EKGs. 

Still, today was worth it because the new member of the flock put things in a nutshell. “Atrial fibrillation is a disease of the privileged. You have it because nothing killed you before your heart started getting old.” He then made unpleasant comparisons between my skin and its signs of age with the inside of my heart. And I’m thinking, “crap, and all he can see is my arms. The nurse who did the EKG must have ratted out my chest.” 

Now it turns out there is a minimally invasive procedure which in 90% of cases nips the a-fib issue in the bud, and sometime in the next couple of months at his convenience it shall be done. He’ll go in and look at the scars in my heart and won’t even let me narrate the terrors of dating in high school. And I’ll live longer and continue to fly in and out of the flock. But that is a mere part of the bigger picture. 

“A disease of the privileged, those privileged to live long enough to get it.” If this had happened 80 years ago my heart valve issue would have slowly killed me, but valves can now be replaced. 80 years ago the slight blockage in the most important artery feeding the heart would have killed me quickly, but now an outpatient procedure installing stents can prevent that very effectively. 80 years ago a-fib would have progressed to the point that it killed me: slowly and rather unpleasantly. 

In short three, well-proven, quite safe procedures developed in the last few decades will insure that I and hundreds of thousands of others will live longer than my parents or uncles and aunts. Maybe much longer. Long enough to get other diseases; cancers, dementia, or just some final fatal accident that comes from failing to act your age. 

So let's turn to Scientific American, Oct 2019, page 34. An article on death I recommend to all. It provides a nice summary of a recent book, Anticipatory Corpse, by Jeffry Bishop. I’ll keep this part easy. 

Up until the 1960’s death was marked by the cessation of the heart and lungs. Without blood and oxygen the rest of the body, including the brain, quickly died. But heart-lung machines made it possible to provide for this lack indefinitely, and so a new definition of death was needed. It was provided in 1968 by an Ad Hoc Committee of the Harvard Medical School. Death was now defined as a cessation of activity by the brain, specifically by those parts of the brain believed to house human consciousness. With the proviso that the cessation could not be reversed. 

Of course measuring whether consciousness is present isn’t something everyone agrees on, and it is useful to keep “dead” people’s bodies alive sometimes. At least 30 known children have been brought to sufficient maturity to be born while in the womb of a brain-dead mother. And thousands of bodies attached to dead brains are kept alive until the organs can be successfully harvested for re-use. 

And now we have something new. A team at the Yale School at Medicine has taken the brains of pigs, four hours after they were removed from pig bodies and bled out. Then using a kind of artificial blood they have restored those brains to something like life. That is, all the parts of the pig brains are working. Powerful drugs were used to suppress any emergence of activity by the neurons that would look like sentience. But the neurons were capable of functioning, even if they weren’t allowed to do so. 

You do get it right? The “cessation could not be reversed” clause in defining death is going to be toast. It will be some time coming, probably a very short time, but eventually the demand to restore a dead brain will mean it will be done. Some machine like the defibrillator that restored my proper heart rhythm will be devised to kick neurons back into synchronous activity. And when a flat-line ECG appears that brain defibrillator will be used, even if the brain is no longer attached to a working body. 

C.S. Lewis imagined such a thing in the 1945 novel That Hideous Strength. The team at Yale took a big step forward with pigs. Now it appears that a privilege of living long enough will be the privilege of seeing it happen with humans. 

Christof Koch, who wrote the article in SA, tells us that humans have developed two powerful ways of dealing with the terror of death: psychological suppression and religion. I’d say those of us who are religious better get woke.