Sanjay Gupta operates on Mondays and sees patients on Wednesdays. The rest of the week, he leads CNN's medical coverage. Gupta has to be the first (one hopes the last) news reporter to perform brain surgery while on the job in a war zone. He enjoys his weekly responsibilities so much that he turned down President Obama's offer of the surgeon general's position. Cheating Death: The Doctors and Medical Miracles That Are Saving Lives Against All Odds, Gupta's second book, takes a fresh, hard look at assumptions that doctors have accepted for decades: CPR works. You're dead when your heart stops. If your brain looks like mush and the top doctors at a top medical center say you're brain-dead, there's no possibility of coming back. I asked Gupta how the compelling stories he presents should change our ideas about modern medicine and what they might mean for healthcare reform.
Cheating Death and its accompanying CNN specials air some of medicine's basic deficiencies (like how we define death). What's your aim?
I've been thinking about this book since I was a medical student. The way that we pronounce people "dead" and the whole process of death is something that we know more about now than we have ever before. It's not a perfect system. I take some of these concepts that are usually more squarely in the realm of science and the journals and try to make them more approachable for a lay audience. I'm not trying to be controversial or to raise debates. You write about Lance Becker, director of the University of Pennsylvania's Center for Resuscitation Science, who says death occurs when doctors quit. That's pretty harsh. Do you agree with him?
If you're in the middle of a code and there's no response to the resuscitation attempts, at some point someone says, "OK, that's enough." I'm not saying that if we'd only tried another 10 seconds everything would be different. But the world that we live in, based on the assumption of what is alive and what is dead, does have a subjective nature to it. That, in and of itself, is surprising to people, and "death is when doctors quit" is one example. Cheating Death goes off medicine's beaten path into near-death experiences and suspended animation. Is it time to up the credibility and profile of these fields?
The nice thing about writing a book like this is you don't always know what you're going to get when you're heading in. I've been working on this book for several years. When I was first talking about this book and getting other people's thoughts on it, near-death experiences came up a lot. What happens at the time of death to the individual, what are they experiencing? I thought it was a fair question. After exploring so many near-death experiences, I thought I could explain away most of what happens, but I can't explain it all. I've got one of two branch points from there. Either at some point science is going to explain it all, or it's OK not to know everything. It's OK for there to be places in our society where there is an intersection of science and spirituality. If you're someone who's curious about those intersections, this may be one place to look. One chapter deals with the interplay of faith and advanced medical science, yet you never mention your own spiritual background. Why is that? Does your Hinduism influence how you see "medical miracles"?
I didn't put my own religion in there because I didn't think it was really relevant. "Miracle" does end up being one of the words in the subtitle, but if anything I think this is more of an agnostic chapter. Even in the couple of pages I had on prayer, I explained why prayer probably doesn't work. We'll tend to look at some remarkable story, like a guy waking up after 13 years in a coma, and we tend to say, "That's a miracle." Or, "That's an outlier." Or, "That's an anomaly, and we don't have to put it into an equation of things." I wrote about a man who is alive 15 years after he was told that a lethal brain tumor, glioblastoma multiforme, would kill him in six months. He may be the longest documented GBM survivor in the country. It would be easy just to say, "Wow, 15 years, that's a miracle!" Or you could say, "What was it about the combination of experimental treatments he got that really made the difference?" I'm trying to intercept and explain away miracles. You feature one patient, a doctor himself, who languished in two different hospitals for months after complications from heart surgery. His recovery was due to one critical care specialist his family sought out who wouldn't give up even after others said the doctor was brain-dead. The specialist cooled him for weeks (therapeutic hypothermia), hoping his mind would come back—and it did. Are you really saying families should keep holding out?
The diagnosis was wrong. He was never brain-dead. Therein lies the problem; I believe that if someone is genuinely brain-dead, they're never going to recover. Despite the fact that brain death had been documented in his chart, it shows some of the limitations of our system. Brain death is in large part a clinical diagnosis. He was at a large academic hospital, not some small hospital that doesn't know how to make these types of examinations. One hundred years of combined ICU experience was telling his wife to pull the plug, and now he's back to practicing medicine—in that hospital. This case teaches us that we need a better way of diagnosing brain death. Cheating Death was conceived and written before the current debate over healthcare reform. Some of the treatments you write about are expensive: deep brain stimulation for minimally conscious patients, experimental cancer therapies, elective fetal surgery. Will the drive towards evidence-based medicine mean we'll see fewer of the pioneering treatments you write about?
Some of the things that had the biggest impact in the book were not expensive, like chest compression replacing CPR. I'm not sure that evidence-based medicine and innovation are mutually exclusive. Some of these innovations are going to become the platform for the evidence-based medicine of the future. There are things in medicine that we think are going to be grand-slam home runs and end up being harmful to people. I think we have a process that tests those things for a reason. For example, blood clots can develop with therapeutic hypothermia in the wake of trauma and become disastrous if cooling is not done properly. If, as part of healthcare reform, we have information technology where we're collecting health data not only in large amounts but much more quickly, I think some of these best strategies like hypothermia for the cardiac arrest patient walking down the streets of New York or chest compression-only CPR are going to emerge. But I don't think we need a government agency to do that. The data will be more quickly available. In the book, you highlight therapies in various stages of development. Aren't you concerned you're going to be on a shift one day and a family is going to demand that you use hypothermia in their son's brain surgery because they heard you report on it on CNN? How do you handle this conflict between being a doctor and a journalist?
It happens to me. I get patients asking questions after they've read something or heard something. I believe that there's never the exact right amount of content out there. It might be too little or too much, or worst of all it's not in a context that makes sense. It's just noise. As a physician who is also a reporter, I have to believe that information that is somehow converted to knowledge by people like me is a virtue. I fundamentally believe that having more knowledge is a good thing. It should be accurate, it should be well researched, and it should be thorough. If patients read Cheating Death, I hope that they will walk away a little more educated. Might it lead to them asking a lot more questions? Sure. If the relationship between a patient and his healthcare provider is sound, it'll be a good conversation.
Corrected on 12/10/09: In an earlier version of this article, the photo caption incorrectly identified Anna Bagenholm.