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I remember the weeks following my cardiac arrest where my experience of life was really quite different. I was much more present for each moment of each experience that I had. While my mind was much less cluttered with the thoughts that typically tumbled one after another like an endless line of circus clowns, I was much clearer about life.

It’s not that I knew what life was all about, as far as having it in a nice neat little pigeonhole; it was just that I wasn’t making up all of the extra crap that I had been used to making up about it. I was so much more sensitive to each individual experience, each individual person, and awe-inspired by each of them! It was really the simple things in life that were most amazing (love, connection, presence) and the absurdities that typically characterize human relationships were simply unintelligible gibberish that was easy for me to simply ignore. The precipice of death has this uniquely clarifying quality that is rather compelling. I have found myself drawn towards this space, wanting to return ever since. Secretly, I can even be defiant at times, taunting death in my own mind, pushing limits, rather unconcerned about my mortality and the temporary nature of this life (not that I put myself at mortal risk, really).

but, what a peculiar a thing to say!? To want to return to this edge between life and death!? What is this paradoxical attraction? No, I’m not afraid of death and no, I don’t want to leave this planet either. And yet I also long for this freedom from the absurdity that characterizes most human interactions! How is it, that we human beings have turned this precious and amazing existence into a funhouse hall of mirrors? Hiding from each other, posturing, and getting our highest priorities completely wrong!? How is it that I find myself entranced by this, yet again, after such a profound clarity? Swept up by utterly inconsequential interactions!?

A friend, a fellow SCA survivor, recently said, “I want to die again. Just so I can remember how unimportant all of these trivial day-to-day emotions/feelings/experiences really are. I mean, I don’t really want to die, but…” As someone who has been to this edge, I completely understand this compelling attraction, but unless one has stepped onto the precipice of death, it is difficult if not impossible to understand. Some of us (SCA survivors) remember having what could be called Near-Death Experiences. Others, like myself, don’t remember having such experiences. However, I have a sneaky suspicion that I nevertheless had such an experience, but simply don’t consciously remember it! Otherwise, why would I feel this way?

How do you explain to somebody, who has not been to this edge, the compelling nature of it? It would seem crazy to them, but to us it was so much more sane than the insanity of what everyone else seems to call “normal life.” To just about every SCA survivor that I have met, “normal” life is absurd and incomprehensible and even though most of us eventually, reluctantly, become re-entranced by its illusions and absurdities, we also remember the clarity of being beyond the fray. We long for that clarity again and worst of all, find ourselves perpetually in a neither-land, stuck between the two. We no longer live in the land of clarity of presence and yet we can no longer completely buy into being “normal.”  We are left with having a foot in each world and yet at are at home in neither. It’s a purgatory, of sorts, that we now live in. I don’t see how those who have never died could possibly understand the depth and breadth of this paradox that we live each day.

I have a special affinity for Daniel Ladinsky’s translations of Hafiz because of his ability to speak certain truths that resonate with me.

For your consideration:

“Listen: this world is the lunatic’s sphere,
Don’t always agree it’s real,

Even with my feet upon it
And the postman knowing my door

My address is somewhere else.”

~ Hafiz

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At one point, shortly after my sudden cardiac arrest (SCA), I very carefully reviewed the string of memories from just before my SCA until I woke up in the hospital. In doing this, I was very careful to not add anything to the string of memories or to subtract anything. Specifically, I did not add interpretation or elaboration.

I remember starting my run. I had just started the running app on my phone (Endomondo) and the song on my randomized playlist was Satori Waterfalls, by Ohmna. I particularly love listening to Trance music while running. Then, I have a memory of running down Grand Avenue towards Lake Merritt, but honestly it seems to blend in with the numerous other times that I’ve run down Grand Avenue so I’m not particularly confident in its veracity. The next thing I remember is this subtle reddish brown color and then, eventually, a recognition of other people nearby whom I couldn’t quite make out, but they felt very familiar and comforting to me. Later, I would recognize them as family members (mom, stepfather, sister) and the room was a hospital room and that I was lying in a hospital bed. I would have further memories of increasing mental acuity as the drugs that were used to put me into a coma so that I could undergo the hypothermia protocol wore off. My head was well clear of the drugs by the time I undertook this very specific and precise review of my memories.

Oddly enough, if I don’t add anything to this stream of memories, I didn’t die, I didn’t have a cardiac arrest, and I wasn’t rescued by Good Samaritans to beat the astronomical odds against my survival. If there were no memories, these things really happen? According to my memories, I simply started my run and woke up in the hospital with nothing special in between. I didn’t feel any sense of space or time that occurred between my memory of running down Grand Avenue and that brownish reddish color. None whatsoever! So, from a purely experiential perspective (direct unembellished memories of experiences), how can I say that any of it happened?

And yet, my rescuers (Andy, Mario, Jon, Alis, etc.) my doctors and my family all have very clear memories and they have told me everything they remember. I even have a picture of myself that my sister snuck when I was still in the hypothermia protocol. To them, I died, was resuscitated, taken to the hospital, phone calls to next of kin were made, and the start of almost $200,000 in hospital bills were acquired (luckily I had insurance). To them I absolutely did die! So, which is it?

Now, that I volunteer as a caregiver in hospice and have outlived the first patient that I have worked with, I too can attest to the fact that she is no longer with us. But, did she experience death? Does she experience death or nonexistence? Or is it only the survivors that experience it? Is death just a concept, a mental construct, a label for the phenomena that someone that we know and love is no longer with us? Just a label for this seemingly disturbing phenomenon? I suspect that this idea does not apply to those who are no longer with us, but only to the survivors. It’s so very easy to make something up. One thing that I know, is that if I had never woken up from my cardiac arrest, I would not have ever known. It would not have been a problem.

What I am not doing here, in writing this, is providing any number of concepts or ideas or beliefs to fill in the gap of unknowing about this most mysterious of phenomena. Some believe in heaven and hell. Some believe in perpetual reincarnation. Some believe in oblivion. They one of them or all of them may be true and maybe not. We seem to want a definitive answer!

(And an especially loving note for many of my dear SCA friends who have had Near-Death Experiences of various forms (light at the end of the tunnel, etc.), I say TRUST YOUR DIRECT UNADULTERATED EXPERIENCE! It’s unassailable! But don’t think too much about it; it’s enough to just trust the fearlessness that arises from your direct experience! Besides, it’s the stories that we make up about it and the need to defend them that can cause the fear.)

These concepts, ideas, or beliefs about our temporary presence here and what happens when we are no longer here are infinite, but I have personally never found any of them to be verifiable in any directly observable sort of way. Besides, I am no longer interested in making something up to soothe some sense of anxiety about death. I lost that anxiety when I died, even though I wasn’t given any beliefs to hold onto. 🙂

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I wrote this three months after my cardiac arrest.

On March 1, 2011, at the age of 42, I was about 20 min. into a routine two-hour run around Lake Merritt in Oakland when I collapsed from Sudden Cardiac Arrest (V-Fib). To my fortune, there was a runner, Andy Hill,  who happen to be close enough to help break my fall and provide immediate aid.  Additionally, three other bystanders rendered CPR and contacted 911. While under the care the paramedics, they continued CPR and used a defibrillator 2x before getting some semblance of a life-sustaining rythm from my heart. They took me to the hospital where I was put into a drug-induced coma and put in a therapeutic hypothermia for 24 hours in order to protect my brain as my heart stabilized.   I spent three days in the intensive care unit and a total of 10 days in the hospital.  All I remember of this event is beginning my run that day and then waking up in the hospital, days later.

While in the hospital, they ran numerous tests including: a cardiac MRI, and did an EPS (Electro-Physiological Study).  Unfortunately, the doctors were never able to determine the reason for the deadly arrhythmia that I had and, in the end, they implanted an Implantable Cardioverter Defibrillator (ICD) in my chest  just in case my heart ever goes into a similarly deadly arrhythmia. I hear that it’s not particularly comfortable to be shocked, but I haven’t had that experience yet. I have since learned that I now belong to a rather exclusive club of survivors given that only about 8% of people survive sudden cardiac arrest.  I consider myself profoundly lucky to have had good Samaritans that quickly stepped up to care for me when I could not care for myself by providing CPR, impressively high quality medical care, as well as having previously invested in my own physical health.

Currently, I am back to running under some limitations set by my cardiologist and have largely resumed normal life except for the fact that I’m not allowed to drive for six months following my loss of consciousness.  As I write this, it is almost 3 months to the day since my sudden cardiac arrest. I still can’t wrap my head around what happened to me and may never be able to, but I am grateful beyond words to everyone that has shepherded me through this experience and feel strongly that we (as a society) should do more to save each other. It’s been quite a surreal and mind blowing existential experience.

I continue to maintain contact with the bystanders and the paramedics that saved my life. This is both good and sometimes challenging as there is a part of me, somewhere deep in my subconscious, that actually remembers the trauma of what happened to me on that day. I know this because of the subtle anxiety/dread that I feel in their presence sometimes our when thinking about spending time with them. Sometimes it can feel a little like opening a Pandora’s box.  Some the feelings are rather uncomfortable. Also, as I have reintegrated myself back into normal life, I have had a few examples of pretty classic post-traumatic stress responses to things such as hearing sirens or like on the day that I went on my first run around the Lake where I had my cardiac arrest. While, I’ve been surprised by the subtle triggers that can bring a very visceral sense of dread or impending doom, I’m also determined to recognize any discomfort for what it is and have not let it dictate the terms of my life!

Additionally, there is a way that this experience helps me understand why many survivors do not seek out or maintain contact with their rescuers.  Contact with one’s rescuers can also trigger a post-traumatic stress response.  What an unfortunate irony! There will probably always be a part of us that remembers exactly what happened, whether were conscious of the experience or not that we were headed, very quickly, towards our own death before we were so miraculously rescued by such earthly Angels!

Life is indeed precious and fragile. May we step up to the plate MORE for each other!

May success stories like mine become more common!

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As a cardiac arrest survivor, I found Dr. George Lundberg’s advocation of nonintervention in out-of-hospital sudden cardiac arrest truly deplorable. As a former longtime editor of JAMA, I would have hoped that he would’ve exercise a little more discernment. Please take the time to read the comment section has a number of cardiac arrest survivors and other medical professionals have posted comments against and in agreement with his position. Below is the text of the statement that he made and my rebuttal.

————-

Why Do CPR?
By MedPage Today Staff
Published: June 06, 2012

http://www.medpagetoday.com/Columns/At-Large/33114

Transcript:

Hello and Welcome. I’m Dr. George Lundberg and this is At Large at MedPage Today.

I don’t know how many of you readers are old enough to remember the frequent use of open chest cardiac massage, first successfully performed in 1901. It began as a way to resuscitate suddenly dead people, assuming that their hearts had arrested or fibrillated.

The surgeon would open the chest between ribs 5 and 6 and rhythmically squeeze the heart to move the blood and re-establish life. Sometimes it worked; usually it did not.

Then, in a JAMA Landmark article in 1960, Kouwenhoven, Jude, and Knickerbocker at Hopkins described closed chest cardiac massage and everything changed. Suddenly, patients who were observed dying could be brought back to life without an open thoracotomy.

Great, or so it seemed.

Big organizations taught the procedure; new categories of emergency medical workers were created; ordinary people were educated to save lives dramatically; medical associations sponsored research and published papers, even entire theme issues in JAMA every several years.

A mass of television shows taught the public that codes were called and enacted with teams of beautiful male and female doctors breathing and beating the dead back to life. It became such a pervasive cultural phenomenon that any person who did NOT wish this effort to bring them back to life after they died the first time would have to file a predeath Do Not Resuscitate order and hope that it would be followed.

After the performance science was solid and positively enacted to create a culture of resuscitation, then came the hard data.

Judged on favorable outcomes (meaning a well functioning body and brain at 30 days) after the drama ended and the TV cameras went elsewhere, the whole schmear was found to hardly ever work to the patient’s or the family’s advantage.

But the culture was already ingrained.

Now we see a huge Japanese study of more than 400,000 people who experienced out-of-hospital cardiac arrest, published in the JAMA on March 21, 2012. Approximately 18% of those who were administered CPR and epinephrine did achieve spontaneous circulation but fewer than 5% survived 1 month and fewer than 2% survived 1 month with good or moderate cerebral performance.

So, if an average adult keels over in the street, is found unresponsive and pulseless by a bystander, and is administered CPR while a 911 call is made, the odds that such a person will emerge from the eventualities of the resuscitation effort healthy and with a normally functioning brain are about 2%.

The other outcomes are death — soon, or within 30 days — after lots of cost and much suffering for many, or being discharged from a hospital, alive but mentally impaired, presumably lifelong.

So, I don’t know about you, but if I drop dead on the street, observed or unobserved, I suppose the observer will feel obligated to call 911, but PLEASE do not administer closed chest cardiac massage to me.

I don’t want my rib caged collapsed and I don’t want to live with iatrogenic squash rot, only to have to die all over again sometime later.

That’s my opinion. I’m Dr. George Lundberg, At Large for MedPage Today.

——————-

This was my response to his article:

“To the world you may be one person,
But to one person you may be the world!”

On 3/1/11, I personally had a cardiac arrest (V-fib). The ONLY reason I am still here and able to practice my craft (psychotherapy) is because complete strangers gave me immediate bystander CPR and I received defibrillation within about 5 minutes resulting in a viable heartbeat. From there, I received quality medical care. The end result: 100% recovery. I do not have any discernible anoxic brain injury.

Would you have just stood by and watch me die? All the while thinking, “Oh, statistically the chances aren’t good.” How would that have impacted my friends and family? How would that have impacted the children and families that I work with? How about the people that I hadn’t impacted yet, but will, because I’m still alive? And last, but certainly not least, how would that have impacted you, personally, to watch me die and not at least try? Would you sleep well at night or have nightmares? As for me, I’m at peace with my own mortality now and yet I recognize life, existence, has so very precious!

Now, of course most people that have cardiac arrest aren’t as fortunate as I have been (this is true), but doesn’t everybody deserve the best chance at life? How about using proven ways to improve the abysmal survival statistics instead of giving up altogether? As a hospice volunteer, I recognize that a DNR can be a very important, appropriate, and respectable choice for the right people and not just for hospice patients, but a wholesale advocacy of nonintervention seems truly myopic and an unnecessary tragedy.

Now, I am part of a very small community of survivors of cardiac arrest. We look after each other across great distances. Some survivors certainly do struggle with some degree of anoxic brain injury, but we all value the additional life that has been afforded to us through the generosity of others. So, when you look at those statistics, try to improve them! Don’t abandon the lives behind them.

“To save one life is as if to save the world.” The Talmud.

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I come to hospice volunteering from an unusual angle in comparison to other volunteers. Most people who choose to do volunteer caregiving in hospice do so because they have been with a relative or loved one during their dying process and it has profoundly impacted them. I can certainly see why they would choose to volunteer. However, I come from the unusual experience of having been the one to die and for some unfathomable reason I was plucked from the jaws of death. I survived odds that no reasonable person would ever choose. Only 6.8% of people survive out-of-hospital sudden cardiac arrest in the US and only 3% survive without debilitating anoxic/hypoxic brain injury. Statistically, I really shouldn’t still be here.

During a conversation/training on the signs of approaching death, there was a discussion about unpleasant odors that are sometimes present and the bodily fluids that can cause them. I was abruptly reminded that night of an undignified part of my own death just over a year ago. In addition to going into convulsions due to oxygen deprivation, my bladder voided its contents into my shorts and onto the grass in front of everyone who was witnessing my death. I was not in control of this body. I was the one that was dying and apparently that’s what dying people do. It’s not the sort of thing that I like to think about because there is no dignity in pissing your pants while being completely unable to care for yourself. I know this all too intimately.

The conversation about this, during the training, had a level of humor and levity that was both understandable and a somewhat painful and jarring for me personally. I understand, respect, and will defend the value and use of humor as a way to help caregivers manage and be present for the difficult or even traumatic experiences of being with the dying. My paramedic rescuers taught me how important this sense of humor was to the preservation of their sanity as they went on emergency call after emergency call, day after day, year after year.

And yet the levity and humor also stung because that was me dying and it was me, pissing my pants during the process, as others were trying to care for me. There was nothing dignified in it. It was humbling and even somewhat humiliating. Maybe that’s why preserving the dignity of our hospice residents is so important to me. In this way, I may understand them like few people can. My hope in writing and sharing this is that it will help others to understand the role of humor as well as to empathize more deeply with those we serve.

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