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 severely injured people I've had more than a few times that I've sought divine intervention most often it's been in the operating theater when I've been doing everything I can to stop massive hemorrhage quite literally when a patient's life blood has been bleeding out before me sadly I've never experienced divine intervention but what I am experiencing is technology coming to the rescue instead not just in giving us better ways to control bleeding but actually making us wonder whether we can change the endpoint of life itself since Napoleonic time surgeons like I have had the challenge of controlling bleeding in wounded people what should I understand a little bit of what if that is like by taking you with me through one of the more harrowing cases of my career it's 3:00 a.m. in a big American trauma Hospital I'm the surgeon on call and we get noticed that a gunman has gone to a students party and started shooting people several were already dead the five critically injured were on their way to us and would be with us within five minutes as the most senior doctor on the floor I gathered the team together and I assess every patient as they came through I then turned my attention to the most serious one a 15 year old boy named Mark who although conscious was wide-eyed with fear and speaking in short breathless words he had right here a big blood-soaked dressing and his shirt was also soaked in blood obviously underneath was a bullet hole to his right chest and when I cut away his clothes what I found was a big gaping hole where his right clavicle should be and from that was welling up dark blood that Frost with every breath he took I knew immediately that the bullet had torn a big hole in a big vein and his right lung we wasted no time this is big hospital manages over 5,000 severely injured patients every year and we knew what to do airway breathing circulation monitors lines radiology mark would need a breathing tube soon but right now stopping the bleeding was the top priority and so while my colleagues put in lines put up blood and tried to reassure him I focused on the wound with suction and with packing gauze but we pretty quickly realized that Mark had already lost too much blood and that we weren't able to catch up as blood welled up around my pax I knew that he would need to go to the operating theatre fast as he slipped into unconsciousness we slid in a breathing tube and raced him off to the operating room but in fact he didn't get there his deterioration was so quick that I ended up having to cut open his chest and try to cut clamp off the bleeding vessel with the instruments that I had available it was to no avail mark deteriorated his blood pressure dropped to zero his ECG flatlined and his young life ended along with all its possibilities hopes and dreams because we couldn't get him to the operating theater where the expertise and equipment could have given him a chance I've looked after thousands of injured patients since and sadly I've seen that same sort of situation happen a number of times arriving alive but critically ill and in the end not making it not because we didn't know what to do but because we didn't have time to do it it's also given me a rather peculiar perspective on life and death and the transition from one to the other and I can tell you it's very different to the way it's usually portrayed in the movies it often happens over a period of minutes sometimes as many as 20 or 30 minutes where the patient enters a sort of eerie biological twilight zone it is a bit like dusk which is neither day nor night he or she is neither fully living nor yet passed away 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 resilient organisms when you bleed three important things happen your blood clots to plug the hole your blood vessels constrict to divert blood away to the vital organs and your heart beats faster and your breathing goes faster to try and increase oxygenation but if the bleeding continues the energy needed to do all of that gets used up and the proteins that are needed for the blood to clot also get consumed it doesn't necessarily happen all at once but what we see is some telltale signs the heart rate slows the rhythm becomes irregular the blood pressure drops patient starts to ooze around the lines and so on and some really strange things also start to happen in some patients rather than actually making blood clot the body goes into a mode with a breakdown 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 might still be beating the blood might still be flowing maybe the brain is even still alive but not for long this is like the event horizon that surrounds a black hole the point at which the gravitational pull is so strong that there is no longer any chance of escaping its clutches now our job as doctors nurses paramedics through all of this process is to try to stop the bleeding to restore and preserve the life blood and to support the patient but sometimes even in the best centers even with the best expertise there's simply not time to do all of that and then it's more like Vince Lombardi with famous baseball coach once described after one of his team's losses we didn't lose the game we just ran out of time now I hope you've got a bit of understanding about the dying process and with that I'd like to shoot you to share with me some of the excitement of modern technologies and what they're now about to do for us they're the product of science which has given us a much better understanding of the complex biology that happens at the end of life and engineering which has come up with some brilliant solutions to even the most complex problems I no longer have to rely solely on clamps and stitches and cotton gauze I actually now have a range of incredible dressings that are filled with the clotting factors that are needed to make clot that I can apply to a bleeding vessel even a bigger hole in a big artery and I know it will seal it within a matter of minutes and one of my problems as in marks case is actually getting to the bleeding site it might be in a hard-to-reach part of the body or deeply under blood a brilliant engineering solution that was just published in this month's science magazine is to make micro particles that are laden with clotting factors and are self propelling by releasing tiny gas mal gas bubbles and they propel themselves against the flow of blood upstream to get that last few crucial millimeters to the edge of the bleeding vessel absolutely ingenious more than that though technology is also giving us more time and it's doing that by interfering in the at the end of life processes and pushing the event horizon further away there's two main ways that it's doing this we're doing this the first is by interfering with the process that leads to breakdown of blood clots and worse bleeding it turns out there are drugs that can do this you can give those drugs early enough after severe injury it might be that we can in a way vaccinate against the harmful processes that lead to that inevitable cascade to death we're doing one of the first trials of this approach in a study in 1,100 patients in Australia in New Zealand who have been severely injured one of the first things the ambulance officers will do in those cases when they get to the scene is give an injection of this drug the second way of getting more time is by making the organs themselves more resilient we know from organ transplantation that there's a period of time that everybody tissue has within which it can survive completely disconnected from the circulation under good circumstances for corneas of the eye for example that's 14 days for kidneys at about 20 hours for hearts 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 it's about three minutes but that has now been pushed out more than ten times that with modern anesthesia and careful cooling to enable the brain to be completely disconnected from the circulation to operate on the major vessels that go to supply in doctors lawyers scientists and teachers that have had this procedure done have come back with all of their brain power fully preserved we're not there yet but we are certainly looking at whether this sort of approach could be done in the emergency situation it's not inconceivable to think that maybe one day the first thing that happens to severely injured patient when they come to hospital is that they're put into some sort of temporary suspended animation to give us time to manage their major injuries I must say the tinkering with the limits of life does at times feel a bit black playing God probably the first time I saw it God's help around to somebody's death actually happened quite a few years earlier I was an intern and I'd returned home from work to find two policemen at my door they told me my brother Kevin had been in a hang-gliding crash and had passed away he was 21 a musician and a scholar and now he was gone I know how awful it feels to lose a loved one at such a young age technology's not going to bring Kevin back or at least not in my lifetime but I can assure everyone of you that scientists engineers and clinicians are working together to do everything we possibly can to push the limits of life for the living because people caves and Mark's age sure have a whole lot of living yet to do thank you you

Channel: TEDx Talks

Views: 626,823

Rating: 4.8341537 out of 5

Keywords: TEDxTalks, English, Singapore, Science (hard), Death, Medicine

Id: U39wbNMtMVw

Length: 14min 34sec (874 seconds)

Published: Tue May 17 2016