The Lazarus Effect with Joe Sills, MD
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What is the premise of The Lazarus Effect story and why does it matter?
At The Nocturnist, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
From a distance, death looks absolute. A person is either dead or alive. But up close in the hospital, death isn't always that simple. Sometimes, the line between life and death can blur. I'm Emily Silverman, and this is The Nocturnist, stories from the world of medicine. We were really encouraged by the response to season one of our podcast. So after several months of hard work, we're so excited to finally be able to share a brand new set of stories with you. This season, we'll be transported from the emergency room to the inside of a prison to the plains of Montana and beyond. Whether you're a fellow doctor, a student, another health provider, or just someone interested in the nuances of medicine, we hope you'll find these narratives as meaningful as we do.
We're also thrilled to announce our first storytelling contest. So if you're a student or a resident, consider submitting a story to us related to the theme of learning. If your story is selected, you'll receive a $500 cash prize and a slot on season three of the Nocturnist podcast. To learn more about the contest, visit our website at thenocturnists.com. In our first episode, emergency medicine physician Joe Sills describes a startling moment with a patient he's already pronounced dead. Later on, Joe and I talk about what it means to die, the scripted art of delivering bad news, and the challenge of being transparent with our patients. Here I give you Joe Sills.
When I was an intern, sometimes I'd be asked to go to a room and pronounce a patient dead. Later on, I realized that this was one of the least important jobs, which is why it was assigned to me. These were always patients who had been expected to die, and they didn't want to be resuscitated, and all that was really needed was a doctor's signature for the paperwork. But at the time, I was terrified of getting it wrong, that later in the morgue, the patient would unzip herself out of the body bag, and I would end up in the news. So I once listened with my stethoscope on this 100-year-old woman's chest for five entire minutes until the nurse finally came over and lifted up the diaphragm of my stethoscope and said into it, is this thing on?
But since then, I've called the time of death for lots of patients that have died in my emergency department. or at least enough to be unable to remember most of them. And that's because there is just a predictability and a repetition about the work that I do and the people that I meet. The kid with asthma gets an inhaler. The guy with heart failure gets a diuretic. The patient in cardiac arrest gets chest compressions. And maybe she lives, but usually not. And after enough iterations of that, the texture of a specific experience flattens into the broad and regular patterns of shift work. And on your drive home, it can be hard to say exactly what it was that happened to your patients or to you. So when something happens that defies my expectations, I know that I'm probably going to remember it whether or not I want to, which brings me to Mark.
On the day that I met Mark, the day that he was brought to my emergency department, he didn't look so good. His skin was gray and sweaty, and I could see that it was hard for him to breathe, but he made eye contact with me, which is enough for me to at least try and quickly introduce myself before going about the rapid work of keeping someone alive. Hello was about as far as I got when Mark's heart stopped. Mark's nurse started chest compressions and I intubated Mark to try and help him breathe and we went through the typical sequence of resuscitation until Mark's pulse came back and then it was lost again and then it came back and was lost again and after a few more episodes of that I searched for Mark's pulse and found nothing and used an ultrasound probe to view his heart up on a monitor where I could see its musculature had gone still.
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Chapters
4 chapters
1
What is the premise of The Lazarus Effect story and why does it matter?
0:00–8:33
2
How did Dr. Joe Sills first encounter the patient who was pronounced dead?
8:33–16:41
3
What happened when Mark’s pulse returned after being declared dead?
16:41–27:15
4
Why did Dr. Sills describe the patient’s final movements as an agonal reflex?
27:15–33:34