Shocked

by David Casarett

  PREMATURE BURIALS AND “SAFETY COFFINS”

  These first forays into the science of resurrection gave us the tools to save lives. But they also gave us another gift. And it’s one that we’re still living with, 250 years later.

  The incredibly common fear of being buried alive is arguably the direct result of advances in the science of resuscitation. Think about it: If someone who is apparently dead can come back to life, what would happen if that person comes back to life a little too late? What if—just for instance—that poor guy comes back to life in a coffin? And if there was one outcome that terrified people more than anything else, it was waking up in a coffin. Underneath a lid that’s been firmly nailed down. Six feet underground. The thought alone is enough to give anyone nightmares.

  Right now I’m wandering through a cemetery just outside of Williamsport, Pennsylvania, looking for the grave of one person whose nightmares must have been particularly vivid. It’s very late on a cold spring afternoon, and the anemic sun has already disappeared behind a wooded hillside. A particularly chilly gust slips through my thin jacket, and I shiver, thinking that an early evening stroll in a graveyard is enough to make a generally well-adjusted person feel a little spooked.

  In fact, if I were alone, I would probably turn around and head for the nearest bar in search of a good stiff drink. But fortunately I’m not alone. I’m tramping along behind a tall, gaunt, whip-thin Lincolnesque figure named Gerald, who happens to be a bona fide grave digger. (Here and throughout, I’ve used first name pseudonyms for people who don’t want to be identified.) He is leading me through the sprawling Wildwood Cemetery to the grave of Thomas Pursell, a nineteenth-century fireman whose fear of being buried alive went further than most.

  Pursell was so terrified of this fate that he had a five-coffin crypt built for his entire family with felt-lined walls, so if any of them woke up flailing, they wouldn’t injure themselves. And he made sure that when he died, which he did in 1837, the vaults would be stocked with bread and water. This was a guy who really planned ahead.

  I’m pondering this as I notice, just in time, that Gerald has stopped right in front of me. We’re facing a wide stone structure that looks nothing like the tomb of a humble fireman. Across a grand façade of limestone blocks, there are five elaborate body-wide iron doors, with bas-relief figures gracing each one. Copper edging around the doors gives them an added air of elegance. In my opinion the tomb looks more like a fancy pizza oven than a place to keep your dead.

  Now that we’re here, I can’t resist asking Gerald if he was ever tempted to look inside.

  He stares at me like I’ve just suggested breaking into one of his graves, which, I suppose, is more or less exactly what I’ve done.

  I clarify that I’m just asking about looking. I wasn’t suggesting . . . grave robbing or anything.

  Gerald gives me another couple of moments of uncomfortable scrutiny before he relents.

  “Can’t.”

  “Can’t?”

  “Doors only open from the inside.”

  I’d like to ask why Pursell would want to keep people out of his tomb. But Gerald is waiting, and so I thank him. He heads back to his unfinished grave, and I try to find my car, still thinking about Pursell’s odd obsession.

  The oddest thing about Pursell’s story, though, is the fact that he was hardly unique. Just as the Royal Humane Society and others were making impressive progress in reviving the “apparently dead,” the public was becoming increasingly concerned that they might be buried when they weren’t really dead. As William Hawes and his fellow resuscitationists trumpeted their successes in bringing back the dead, the message—clearly and unmistakably—was that if you love your relative, you’d better make good and sure he or she is really, truly dead.

  That, at least, is the message that the public heard. All this talk about people being only apparently dead was enough to make a lot of otherwise normal people like Thomas Pursell very anxious. His anxiety even has a name: “taphephobia,” or a fear of being buried alive.

  One of the earliest symptoms of that growing phobia was a lengthening of the funeral process. Rather than getting a loved one into the ground immediately, in the mid-eighteenth century there was a growing sense that it might be best to wait a day, or two, or longer.

  William Tebb, an English businessman, antivivisectionist, vaccination critic, and all-around meddler, took up this cause in 1896, calling for measures to prevent premature burial. To his credit, he brought numbers—data—to the argument. For instance, he produced dozen of examples, culled from letters and word of mouth and newspaper accounts of premature burials and near misses. Consider this one, which Tebb found in The Undertaker’s Journal (July 22, 1893):

  Charles Walker was supposed to have died suddenly at St. Louis a few days ago, and a burial certificate was obtained in due course from the coroner’s office. The body was lying in the coffin, and the relatives took a farewell look at the features, and withdrew as the undertaker’s assistants advanced to screw down the lid. One of the undertaker’s men noticed, however, that the position of the body in the coffin seemed to have undergone some slight change, and called attention to the fact. Suddenly, without any warning, the “corpse” sat up in the coffin and gazed round the room. A physician was summoned, restoratives were applied, and in half an hour the supposed corpse was in a warm bed, sipping weak brandy and water, and taking a lively interest in the surroundings. Heart-failure had produced a species of syncope resembling death that deceived even experts.

  Alas, we don’t know exactly what medical condition had convinced “experts” that poor Mr. Walker was dead and gone. It might have been heart failure, or perhaps a profound reduction in heart rate. Or maybe just a really top-notch nap. We’ll never know.

  But that uncertainty didn’t dampen Tebb’s anxiety. Indeed, he evidently thought that these sorts of incidents occurred at an epidemic rate: “ALMOST every intelligent and observant person with whom you converse,” he said, “if the subject be introduced, has either known or heard of narrow escapes from premature burial within his or her own circle of friends or acquaintances; and it is no exaggeration to say that such cases are numbered by thousands.”

  Is that an exaggeration? It’s difficult to tell. Of course there were stories of circumstances in which it appeared that death was declared a little prematurely. And as we’ve seen, without diagnostic instruments like an EKG machine or even a stethoscope, it’s certainly possible that a few unlucky souls woke from a night out drinking to find themselves in a funeral home. Still, it’s safe to say that Tebb’s anxious warning about “thousands” of such incidents is probably not realistic.

  Nevertheless, it was no surprise that Tebb’s will stated unequivocally that he not be put in the ground until his body showed clear evidence of decomposition. Depending on environmental factors like heat and humidity, such evidence can take anywhere from three to seven days to manifest. One can only imagine that anyone making a demand like that, particularly in the days before refrigeration—or air fresheners—was not on good terms with the family he was leaving behind.

  Many of these fears were no doubt overblown, but to be fair there are well-documented cases of people who were sent to the graveyard before their time. One of the best known of these is the case of Anne Green, who was sentenced to be hanged for ending the life of her newborn child, born out of wedlock. After the hanging on December 14, 1650, her body was sent to the home of Dr. William Petty, an Oxford instructor in anatomy, who had requested a female cadaver for dissection. Much to Petty’s surprise, Ms. Green was not quite dead. Actually, she was very much alive. Alas, we don’t know what that moment looked like, but one can imagine that there was considerable consternation on both ends of the dissection knife. Even more surprising was the fact that Ms. Green apparently lived happily ever after. Having been hanged once (one assumes no statutes allowed for a person to be hanged twice for the sam
e crime), she went on to marry and lived for another fifteen years, no mean feat in mid-seventeenth-century England.

  Fears like Tebb’s were enough to make some people very wealthy. One such entrepreneur was George Bateson, an inventor who capitalized on widespread taphephobia by pimping out coffins with a modification that became known as Bateson’s Belfry. (This modification was only one of a multitude that comprised a small cottage industry of “safety coffins.”) In Bateson’s model, a small bell was mounted on a coffin’s lid, and a string was passed down through the coffin and tied to the hand of the deceased. The rationale, presumably, was that an “apparently dead” person who didn’t quite have the strength to lift the coffin lid might still twitch a finger, thereby alerting bystanders that he wasn’t truly dead.

  The rich and famous could afford to do even more to quiet their anxieties—Duke Ferdinand of Brunswick-Wolfenbüttel, for example, who was terrified of the possibility that he might be buried alive. He crafted very clear instructions so that when he died (really, truly died) in 1792, his coffin was equipped with a window and an air tube. And it was a nail-less coffin, just in case.

  Edgar Allan Poe exploited these fears as well in his short story about a premature burial called—wait for it—“The Premature Burial,” which was published in Philadelphia’s Dollar Newspaper in 1844. A man—the unnamed, first-person narrator—is prone to fits of catalepsy that give the impression that he is, in fact, dead. So, naturally, he goes to great lengths to ensure that he is not buried alive.

  PRECOXMORTIPHOBIA

  It’s not difficult to find humor in those anxieties of yesteryear. Certainly some of the more outlandish stories are difficult to take seriously. A coffin with a window? Really?

  Nevertheless, the anxieties that were at the root of those stories aren’t outlandish at all. If they seem that way to us, perhaps it’s only because we’ve developed a little more trust in medicine and science. We believe—most of us do, anyway—that medicine is good at figuring out which of us is dead. And we can be pretty confident that if there’s any chance we’re not really dead, someone will notice.

  But back then, two hundred years before the EKG had been invented, the hope that you might be resuscitated had to be balanced against the fear that you might not. This phobia—which doesn’t actually have a name—is based on a fear that the definition of “death” is changing, and that we’re going to be caught on the wrong side. And those concerns are still among us today.

  What if, ten years from now, a death due to advanced heart failure will be considered only an apparent death? That’s not just idle speculation. Consider this: the cause of death in people with advanced heart failure is often a fatal disturbance in the heart’s rhythm. When that rhythm was disturbed fifty years ago, even if the person’s heart could be restarted once, his prognosis was grim. Now, though, “sudden cardiac death” is just an indication that a patient needs to have a pacemaker and defibrillator implanted. (We’ll meet one beneficiary of this technology in chapter 6.) So what used to be a fatal event is now little more than a nudge toward a new plan of treatment for a patient who can expect to live for a number of years more.

  A hundred years ago, the belief that a feather or a horse or a well-placed cigar might restore someone who is “apparently dead” created a sense of hope. However, people paid for that hope with a sense of anxiety that someone they loved—or they themselves—would be mistakenly determined to be dead. In the same way, today’s technology is raising similar hopes and fears about whether anything else might be done to prolong a life.

  That, in a nutshell, is the modern equivalent of taphephobia. Let’s call it “precoxmortiphobia.” It’s not listed in the DSM-V, but it roughly translates as a fear of a premature death.

  There’s always another procedure, or another medication, that might be tried. The miracles of resuscitation—when they happen—are so dramatic and sudden that it’s difficult indeed not to imagine that they could happen for us, too. And once we begin to consider that, we’ve opened the door to a profound and inescapable anxiety that whatever death is coming for us is one that can be avoided.

  3

  The Ice Woman Meets the Strange New Science of Resuscitation

  THE ICE WOMAN

  When she was twenty-nine years old, Anna Elisabeth Johansson Bågenholm was training to become an orthopedic surgeon in Narvik, Norway. She was smart, talented, and had a bright future. Life was great. And then, suddenly, it wasn’t.

  On the afternoon of May 20, 1999, Bågenholm and two friends went skiing on a mountain outside of town. They used a route they’d taken many times before, but that particular afternoon, Bågenholm lost control of her skis and tumbled down a steep slope onto a frozen streambed. She landed with enough force to break through the thick winter ice, and seconds later the current dragged her underwater. Only her skis protruded from the opening in the ice.

  Those skis saved her from being swept downstream under the ice in what would have been a horrific death. But the force of the moving water against her upper body was so powerful that her friends couldn’t extract her. So she hung there upside down, trapped. She was almost entirely underwater and unable to breathe.

  Precious seconds ticked by as her friends alternated between frantic cell phone calls and renewed efforts to try to drag Bågenholm from the ice. As those seconds turned into minutes, they thought about giving up, but even after several minutes underwater, Bågenholm continued to struggle. Maybe she’d found a pocket of air under the ice? Something was keeping Bågenholm alive, and she wasn’t giving up, so her friends didn’t either.

  In the meantime, two rescue teams had been mobilized. One was coming from the bottom of the mountain and the other from the top. Soon, though, Bågenholm had stopped struggling and was no longer showing any signs of life.

  When the first team arrived, they were unable to free her, and the mood among her rescuers and friends became grim. But they persevered until the second team arrived with a pointed shovel in their toolkit, which they used to hack away enough ice to free her. At that point, Bågenholm had been underwater for eighty minutes. That was considerably longer than the immersion of Michelle Funk, whom we met in chapter 1. What was worse, for at least forty of those minutes Bågenholm had shown no sign of life. So as they pulled her from the stream, her rescuers were not surprised to find that Bågenholm had no pulse, and that she wasn’t breathing.

  She was also cold. Very cold. And that’s where Bågenholm’s story diverges from Michelle Funk’s. Her body temperature was 13.7 degrees Celsius, which was the coldest temperature that had ever been recorded in a drowning victim. The coldest temperature, that is, for anyone who survived.

  Still, she was young and had been healthy. And both her rescuers and her friends—also health care providers—knew that remarkable stories of survival were possible in drowning accidents. So Bågenholm was loaded into the helicopter, where the team placed her on a ventilator and attempted to restart her heart. But they were unsuccessful, and by the time she arrived at the University Hospital of North Norway in Tromsø, about three hours after the accident, the chief anesthesiologist reported that she appeared “absolutely dead.” For the record, that’s pretty dead.

  Still, they didn’t give up. (We don’t know why they were inspired to persevere, but one can speculate that Michelle Funk’s highly publicized recovery might have been in their minds.) Whatever the reason, a rapidly expanding team of physicians and nurses put Bågenholm on a bypass machine that did the work of her heart and lungs. They continued to warm her too. Finally, at 9:15 p.m., almost five hours after her accident, Bågenholm surprised everyone in the ICU when her heart began to beat on its own.

  Her subsequent course was rocky, and was punctuated by numerous complications. But soon she began to show signs of improvement, and on May 30, ten days after the accident, she finally woke up. Paralyzed from the neck down at first, and unable to move or breathe on her own
, she was nevertheless somehow alive.

  Her story was heard around the world. The Straits Times of Singapore christened Bågenholm the “Ice Woman”—a name that stuck. CNN, the BBC, and numerous newspapers and television channels trumpeted her remarkable success.

  In the end, she made an excellent recovery. Her paralysis resolved and although she had some residual nerve damage that forced her to scrap her plans to become a surgeon, her cognitive function was intact and she was otherwise physically fine. Eventually she went back to work as a physician and went on to marry Torvind Næsheim, one of the friends she’d been skiing with that afternoon.

  Bågenholm’s story is just one illustration of the remarkable progress that the science of resuscitation has made over the past fifty years. In that sense, her survival, like Michelle Funk’s, offers an eyebrow-raising glimpse of what might be possible someday. And hearing her story, you have to wonder what the outer limits of resuscitation might be.

  Of course, she was lucky. “I think it’s amazing that I’m alive,” she admitted on a morning news program. So she was lucky. Very lucky.

  Michelle Funk was lucky too. But what sets Bågenholm’s story apart is that it has something to teach us. Bågenholm’s miraculous survival, and her remarkable physical and mental recovery, can be explained by a theory that related to the one that brought us the Russian Method of resuscitation some two hundred years ago. Bågenholm was a clear beneficiary of that theory, which explains why she survived and how others, maybe, could survive too.

  PLUMBING AND WIRING

  Before we take a look at the theory that could explain Bågenholm’s resurrection, a brief course in anatomy will be helpful. That’s why I’m standing in a wide-open space on the second floor of Philadelphia’s Franklin Institute. All around me, the cavernous room is scattered with a wide variety of exhibits that beep and pulse and flash. It’s like the museum world’s answer to Times Square.