To want to shout at my new colleague "you didn't die, if you had you wouldn't be here talking shite"

[Whatdoesitmatteranyway]

Just that.

Apparently he was in a bad accident several years ago and "died" three times.

No he didn't. We haven't the ability to resurrect people.

DH does this as well. Tells me about his friend who "died" for 10 minutes after a heart episode. I have pointed out that he can't have died and I get told that no, he did. the doctors told him.

I want to go find a plank and hit either me or him over the head with it - which ever is quickest to shut up his bollocks.

I want to get an ad campaign stating this bloody obvious point because its ridiculous the number of people who parrot it out.

As someone who stops hearts every day in a professional capacity, I think that the OP has a point - death is more than the absence of a heartbeat. And guidance on determining death from the Academy of Royal Medical Colleges would seem to agree with this, as they state:

"the definition of death should be regarded as the irreversible loss of the capacity for consciousness, combined with irreversible loss of the capacity to breathe."

Historically when the heart stopped, that was it, you were dead and there was no coming back from that. With modern medicine our understanding of death has moved on from the idea of heart stopping = death. That is evidently not the case anymore and it is possible for someone to carry on living after their heart has stopped beating. You don't get a death certificate if you are successfully resuscitated, have open heart surgery or have a heart transplant! I think most people would agree that what makes us alive is what goes on in our brain and as far as medicine is concerned, the death of the brain is absolute. You can potentially recover from your heart stopping, but once your brain has died there is absolutely no way of coming back from that.

So I would agree with the OP that her colleague wasn't actually dead in any legal sense. Having said that resuscitation is massively traumatic both physically and emotionally and he could probably do with a bit of tolerance and understanding!

The definition of death changes with medicinal advances. So maybe colleague would have been classified dead 50 years ago. Ask them if that’s what they mean. Or maybe they’re a zombie. I bet someone else has suggested that, we are on page 7

I know someone who was declared dead and then came back alive when the DR was signing the death papers. (Google Lazarus syndrome) So yes people can actually die and come back to life. If your heart stops you're dead. Your body is no longer working and you are dead. And we do have the ability to re start hearts and bring people back to life even after their body has given up. So actually people can die, multiple times before a doctor can stabilise the body and preform treatments.

I have to agree with the OP on her opinion of when I person is dead, and the ability (or lack of) other humans to bring people back from the dead.

As a Paramedic I would never consider someone I was working on who had the faintest chance of recovery to be dead until we concluded our resus efforts (regardless of the number of shocks administered).

As Paramedics we can recognise life extinct (as opposed to doctors who can pronounce death, just different legal terminology and slightly more restrictions on us).

So in the following circumstances I can recognise death...

Firstly when it's so unbelievably obvious that someone who has never seen a dead body before would know...

Decapitation, massive cranial and cerebral destruction, hemicorporectomy (think Jaws!!) or similar massive injury, incineration, decomposition/ putrification, hypostasis (when gravity causes the blood to pool and settle in whatever part of the body is lowest), Rigor Mortis.

And then in circumstances where resuscitation would be futile or has been attempted and has proven to be futile...
If it is more than 15 minutes since onset of the cardiac arrest, where no bystander CPR has been attempted, and the person has been asystole (flatline) for more than 30 seconds we would recognise that they were dead (there are a few exceptions to this where we would continue working on them for longer ie hypothermia...they're not dead until they're warm and dead!). Also we can not attempt CPR, and recognise death sooner than this in someone with a terminal illness (but pre hospital without access to medical notes we don't do this one that often) and or if a do not attempt CPR in place.

Submersion (not immersion) for longer than 60minutes

None of the people walking around claiming to have been brought back from death will have met this criteria for death at anytime. They will of course have been very poorly and been saved from dying by high quality modern medical care, but never actually died.

In the UK, the official time of death is not the time that cardiac function and breathing is observed to have ended. It is the time that a Doctor (or other suitably qualified health professional) has listened to the chest for heart sounds for at least 2 minutes, and looked and listened for breathing for at least 3 minutes (5 mins total), and looked for fixed and dilated pupils. Only at that point can the patient be regarded as dead. So, a patient can 'die' at, say, 15.30, but have a Time of Death as 17.45, as the doctor was busy with another patient until that time.

What CPR does, vitally, is maintain oxygenation of the brain and the organs, whilst reversible causes of death are assessed, then treated. That's why there is a saying 'you're not dead until you're warm and dead' for people with hypothermia. The patient has to be warmed slowly to avoid brain swelling, etc., and CPR has to be maintained during that time. Sometimes they will use a 'thumper' which attaches to the chest and performs compressions automatically, but they aren't as good as people, I think.

Either way, this poor man has gone through a very traumatic time and it doesn't matter how he phrases it, he was in a desperately awful state and survived.

That's really interesting and thanks for your input, Cym. My BIL has no recollection of his time on vent until they were trying to rouse him, a process that takes a while, not like the movies or telly where they just wake up and start talking as if nothing happened.

OP why are you so bothered by this?!

Get on with your life. Work hard to not be bothered about things that really, truly don't matter. You'll be happier.

Also to add to my last post...

When we have attempted advanced life support for at least 20 minutes with no success and they are now asystole (flat line).

Reallybadidea that's interesting.

But how about those patients on life support who are still breathing but have no brain activity. Are they dead then?

I'd say that brain death plus lack of heart function would equal death. Because people who are 'brain dead' aren't officially dead.

Because people who are 'brain dead' aren't officially dead.

They are actually. Legally and medically. If someone is brain dead then their time and date of death is officially the time that brain stem death testing confirms absence of brain stem reflexes.

A person who is brain stem dead, but still breathing isn't doing so voluntarily - all the normal reflexes which stimulate respiration have completely gone. If they are removed from the ventilator their heart will stop beating within a few minutes because of hypoxia, but they actually died when their brain did.

Cyw2018

Off topic but I have a living will and do not want to be resuscitated no matter what the cause. Is there a way of alerting paramedics to that if I was involved in an accident say? Or would cpr happen because it's an emergency situation?

@decomposingcomposer I wish more people were like you and would think and plan ahead regarding their wishes.

From Joint ambulance liaison committee guidelines.
3.An Advanced Directive (Living Will) has beenaccepted by the treating physician (patient’s GP orHospital Consultant) as a DNAR order.This shouldbe communicated to Ambulance Control andlogged against the patient’s address.
a.Patients may have an Advanced Directive (LivingWill) although it is not legally necessary for the refusal to be made in writing or formally witnessed.This specif i es how they would like to be treated inthe case of future incapacity.Case law is now clearthat an advance refusal of treatment that is valid,and applicable to subsequent circumstances inwhich the patient lacks capacity, is legally binding.An advance refusal is valid if made voluntarily by an appropriately informed person with capacity.Staff should respect the wishes stated in such a document.
b.In an out of hospital emergency environment,there may be situations where there is doubt about the validity of an advance refusal orDNACPR order.If staff are NOT satisf i ed that thepatient had made a prior and specif i c request torefuse treatment, they should continue toprovide all clinical care in the normal way

Cyw2018

Thank you for that. I've just seen too many in hospital and long ago decided that I didn't want that for myself.

Have often joked about getting a tattoo across my chest saying "do not resuscitate" 😂

I do accept in an emergency that it's likely to be attempted.

I have a half written advanced directive on my laptop that I need to finish and sign and get witnessed.

I have definitely seen things that in my opinion are verging on barbaric and would never want for myself or my family.

Defib pace maker being fitted into someone post arrest before their level of brain function/damage had been assessed, so that when they are lingering in some care home, every time they would go back into cardiac arrest and die instead they are shocked and kept alive!! It makes me so angry and sad. I can't imagine the person who designed this amazing bit of kit would ever have envisaged it being used in this context.

I once came across an interesting anecdote on Quora, where it was explained that at the end of an operation that required the heart to be stopped, the surgeon would restart it simply by prodding it with a finger. Apparently this nearly always works. (When it doesn't, there's a fallback procedure.)

So Grey's Anatomy has lied to me by always showing hearts being restarted with electric shocks.

Cyw2018

It's barbaric. I've seen very frail elderly patients have CPR. We all knew there was no chance.

Horrible when the families refused to agree a DNR though at that time the drs would tell us to take a slow walk to the phone.

I think most people think it will be like on tv and don't know what it's actually like and how slim the chances are of a successful outcome.

I shall be off to Zurich if I get my wish.

the surgeon would restart it simply by prodding it with a finger. Apparently this nearly always works.

The heart has what's known as 'intrinsic automaticity' which means that there are specialised cells within it that, if undamaged, will start the rest of the heart beating again spontaneously when the blood supply is restored. No poking normally required! An electric shock (defibrillation) is only needed when the heart has restarted but the electrical impulses within it are uncoordinated, so that it's in an abnormal rhythm and not pumping properly. That can happen because the trauma of the surgery and not having a blood supply for a period of time 'stuns' it, but it's usually temporary. Once it's got a rhythm then we can use a temporary pacemaker to keep it going at the rate speed.

The heart is utterly dedicated to and specialised for beating. It's an amazing thing to see when a damaged one is removed at the start of a transplant, it will still carry on beating away for a good few minutes out of the body.

Have you seen his medical history? How are you to know. No one, would know I've had two cardiac arrests, unless I told them. Even then, they might be shocked because I look so normal.