Playing God: a trauma surgeon's views on Death vs Science | Russell Gruen | TEDxNTU

In over 10 years as a

surgeon

specializing in the care of seriously injured people, I have sought divine intervention more than once, most of the time it has been in the operating room when I have been doing everything I can to stop it. Massive hemorrhage, literally, when a patient's lifeblood has been bleeding before me. Unfortunately, I have never experienced divine intervention, but what I am experiencing is technology coming to the rescue, not only to give us better ways to control bleeding, but also to make us wonder. If we can change the end point of life itself since Napoleonic times,

surgeon

s like me have had the challenge of controlling bleeding in wounded people, what should I understand a little about what that's like by taking you with me through one of the most heartbreaking cases? of my career it's 3:00 a.m. at a large American

trauma

hospital.

I'm the surgeon on duty and we found out that a gunman went to a student party and started shooting people. Several were already dead. The five seriously injured were on the way. for us and he would be with us in five minutes as the highest ranking doctor on the floor. I assemble the team and evaluate each patient as they arrive. Then I focused my attention on the most serious one, a 15-year-old boy named Mark, who, although conscious, had his eyes wide with fear and spoke in short, breathless words. He had a large bandage soaked in blood and his shirt was also covered. soaked in blood, obviously underneath there was a bullet hole in her right breast and when I cut off her clothes, what?

I found a large hole where his right collarbone should be and Frost's dark blood gushed out with every breath he took. I knew right away that the bullet had put a big hole in a large vein and we didn't waste his right lung. This is a large hospital that cares for over 5,000 seriously injured patients each year and we knew what to do: airway, breathing, circulation monitors, lines, radiology, make, soon we would need a breathing tube, but right now, stop the Bleeding was the top priority, and so on while my colleagues stood in lines. I put blood and tried to calm him down.

I focused on the wound with suction and gauze, but we quickly realized that Mark had already lost too much blood and we couldn't get it back because blood was gushing around my patient. I knew he would have to rush to the operating room when he lost consciousness, we put him on a breathing tube and rushed him to the operating room, but he didn't actually make it there, his deterioration was so rapid that I ended up having to open his chest and try to cut the vessel. bleeding with the instruments he had available, it was in vain.

Mark deteriorated, his blood pressure dropped to zero, his ECG stopped and his young life ended along with all his possibilities, hopes and dreams. because we couldn't take him to the operating room, where experience and equipment could have given him a chance. I have cared for thousands of injured patients since then and, unfortunately, I have seen the same type of situation happen multiple times upon arrival alive. but seriously ill and in the end we didn't make it, not because we didn't know what to do but because we didn't have time to do it. It has also given me a rather peculiar perspective on life and

death

and the transition from one to the other. others and I can tell you that it is very different from the way it is usually portrayed in movies;

It often happens over a period of minutes, sometimes up to 20 or 30 minutes, where the patient enters a sort of mysterious biological twilight zone, it's a bit like After Dusk, which is neither day nor night, he or She is neither fully alive nor deceased, and during this period a number of things happen. The first is that the body mobilizes all those incredible survival reflexes that have made us such resistant organisms when you bleed three. Important things happen: your blood clots plug the hole, your blood vessels constrict to divert blood to vital organs, and your heart beats faster and your breathing quickens to try to increase oxygenation, but if the bleeding continues, the energy necessary to do all that. is used up and the proteins that are needed for the blood to clot are also used up, it doesn't necessarily happen all at once, but what we see are some telltale signs, heart rate slows down, rhythm becomes irregular, blood pressure drops , the patient begins to suppurate. around the lines and so on and some really strange things also start happening in some patients instead of making the blood clot the body goes into a mode with a blood clot which of course is exactly what you don't want In this situation when these things happen

death

is near and inevitable the heart may still be beating the blood may still be flowing perhaps the brain may still be alive but not for long this is like the event horizon surrounding a black hole the point at which the gravitational pull occurs so strong that there is no longer any chance of escaping its clutches.

Now our job as doctors, nurses and paramedics throughout this process is to try to stop the bleeding to restore and preserve vital blood and support the patient, but sometimes even in the best way. centers, even with the best experience, there is simply no time to do all that and then it's more like Vince Lombardi with the famous baseball coach who once described after one of his team's losses, we didn't lose the game, we just We ran out of time, I hope. You have a little understanding about the dying process and with that I would like to send you a message to share with me some of the excitement of modern technologies and what they are now about to do for us.

They are the product of

science

that has given us a much better understanding of the complex biology that occurs at the end of life and engineering that has found some brilliant solutions to even the most complex problems. I no longer have to rely solely on tweezers, stitches and cotton gauze. In fact, I now have a variety of incredible dressings that are packed with the clotting factors necessary to form a clot that I can apply to a bleeding vessel, even a larger hole in a large artery, and I know it will seal it in a matter of a matter of minutes. minutes. and one of my problems, as in Marks' case, is getting to the bleeding site;

It could be in a hard-to-reach part of the body or deep under the blood. A brilliant engineering solution just published in this month's scientific journal is to make microparticles that are loaded with clotting factors and self-propel themselves by releasing small gas bubbles and propel themselves against the upstream blood flow to reach the last crucial millimeters to the edge of the bleeding vessel. It is absolutely ingenious more than that through technology. It is also giving us more time and it is doing so by interfering with end-of-life processes and moving the event horizon even further away. There are two main ways you are doing this.

The first is by interfering with the process it leads. to break up blood clots and worsen bleeding it turns out there are drugs that can do this, you can give those drugs early enough after a serious injury, it might be that we can somehow inoculate against the damaging processes that lead to that inevitable cascade towards death. We are doing one of the first tests of this approach in a study of 1,100 patients in Australia and New Zealand who have been seriously injured. One of the first things the ambulance officers will do in such cases when they arrive at the scene is to give an injection of this medicine, the second way to get more time is by making the organs themselves more resistant.

We know from organ transplantation that there is a period of time that all tissue has within which it can survive completely disconnected from circulation in good circumstances for the corneas of the eye, for example, it is 14 days for the kidneys, approximately 20 hours for the heart and lungs, it's five or six hours, the brain is the most sensitive to lack of oxygenation, of course, and then the body temperature is about three minutes, but that's already been eliminated. more than ten times more than with modern anesthesia and careful cooling to allow the brain to be completely disconnected from the circulation to operate the main vessels that will supply the doctors, lawyers, scientists and teachers who have undergone this procedure and they've come back with everyone their brain capacity is fully preserved, we're not there yet, but we're certainly looking at whether this kind of approach could be done in an emergency situation.

It is not inconceivable to think that perhaps one day the first thing that will happen to a seriously injured patient is when he comes. to the hospital is that they are put into a sort of temporary suspended animation to give us time to manage their serious injuries. I have to say that

playing

with the limits of life sometimes feels a bit black

playing

God, probably the first time I saw it. God's help around someone's death actually occurred a few years earlier. I was an intern and I came home from work to find two police officers at my door and they told me that my brother Kevin had been in a hang gliding accident and had died.

He was 21 years old, he was a musician and scholar and now he is gone. I know how horrible it feels to lose a loved one at such a young age. Technology is not going to bring Kevin back or at least not in my lifetime, but I can assure everyone. that scientists, engineers and doctors are working together to do everything possible to push the limits of life for the living because people go down and Mark's age surely still has a lot to live for, thank you.