Soapy Science: Strange But True

It’s been a little quiet here in Soapy Science land, and I’m sorry for that because we’ve had some good stuff in the last couple of episodes. It’s like the writers know what I am trying to do here and are throwing me a bone. So let’s get down to it.

To recap: Alex is doing scut (a word that can apparently mean anything from the erect short tail of a rabbit to a medieval shield, but which in this case means distasteful work usually carried out by a new doctor) as a sort of penance for his sins (see last week.)

In the clinic, Alex has a hard time shutting down his instinct to do a thorough job, trying so hard to get through to a young woman he thinks is an alcoholic that it borders on harassment. Richard, the consummate father figure, joins in. The poor girl insists that she had a single beer (yeah, right, the audience is supposed to think) and just needs a saline drip to rehydrate and get back on her way. Most of us who have had a beer or two the night before don’t check in at free clinics the next day for saline drips, so it certainly seems suspicious.

But then Richard dislocates her shoulder by grabbing her arm as she gets up to leave, and Alex puts the pieces together. And we are introduced to Ehlers-Danos syndrome, a range of inherited conditions that affect the connective tissue (everything that holds your body together, including bone, muscle, fat, and ligaments.)

Ah, I thought. We’re back to doing what Grey’s does best. Brilliant, brooding young doctors redeeming their egregious personal behavior by making unlikely and life-saving breakthroughs. (I tried to watch an episode of Chicago Med last week and couldn’t get past the second commercial break. Not enough brooding or egregious personal behavior, I guess.)

I read a few articles on this rare condition but didn’t come across anything that would explain why this girl was prone to dehydration. I did come across this fascinating advice from the Mayo Clinic:

“Avoid certain musical instruments. To prevent a collapsed lung, avoid playing reeded wind or brass instruments. The violin or piano would be safer options and would take advantage of the increased flexibility of your hands.”

I did not know that there was a condition that made playing the clarinet dangerous.

But the real star of the last few weeks is the woman who came back to life in Episode 3.

In case you missed it: a car plowed into a funeral procession and all the mourners (and the mourned) wound up at Seattle Grace (whoops, I mean Grey Sloan.) The embalmed corpse stayed dead but the man’s wife, who was pronounced dead after a heart attack in the hospital, did not. The family files in to say goodbye, but their plans are dashed when she sits up straight and gasps. I was delighted when this happened because, while Grey’s certainly exaggerates, the show never just makes things up out of the blue, so I knew there had to be some actual medical explanation that is at least kind of true.

The fictitious doctors told us very clearly what to Google: The Lazarus Syndrome.

Lucky for us, there’s an excellent Smithsonian article on the topic, which I highly recommend. As strange as this concept seems, the author points out that people have been aware of the possibility of being mispronounced dead for a long time, going so far as to equip some coffins in the 1800s with alarm whistles and breathing periscopes just in case.

So how often does this happen? According to one review (and Edwards), 38 times between 1982, when the first case was reported in medical literature, and 2007, when the author of the review felt compelled to compile evidence in response to a lawsuit. An elderly patient he and his team had failed to resuscitate resumed breathing and stayed alive for several more days. The man’s family subsequently sued the doctors, assuming that they hadn’t performed CPR long enough and had given substandard care that led to the man’s eventual death. The doctor combed the literature to find other examples that would convince the court that yes, this can happen without the physicians in the room being at fault.

So although it might seem that doctors would want to run out and tell everyone they know they had experienced a first-hand resurrection, it can actually lead to sticky legal situations. And it’s pretty embarrassing to misdiagnose death. As Bailey says, “It’s a low, low bar for a physician.”

That’s why some think the phenomenon is under-reported. And perhaps, as a result, it’s poorly understood. One hypothesis is that CPR might actually be counterproductive in some circumstances. If the lungs are “hyperinflated,” blood isn’t sent back to the heart of what would have been the exhalation. Once CPR is stopped, the pressure eases and blood can slip back to the heart. That alone might bring the patient back– or, it might be that the drugs delivered to the patient during the emergency finally get to circulate through the body and do the trick.

Still, Grey’s plotline seems totally unlikely and is surely exaggerated, right? Actually, it’s not that far afield from a few cases that have actually occurred. The phenomenon has occurred after a full 75 minutes of CPR (the doctors on the show worked for 45 minutes); the recovery occurred, on average, about 7 minutes after CPR stopped (on the show, it was 20 minutes) and about a third of patients were eventually discharged from the hospital without apparent neurological damage (Riggs tells Meredith that the woman made a full recovery.)

This is why I like medical shows, and true crime, and bizarre Wikipedia pages. The truth is just so much stranger than anything you could make up.

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