Back From the Dead

Bill Bondar knows exactly where he died: on the sidewalk outside his house in a retirement community in southern New Jersey. It was 10:30 on the night of May 23, a Wednesday, and Bondar was 61—a retired computer programmer with a cherry red Gibson bass guitar, an instrument he had first picked up around the same time as Chuck Berry. He was 6 feet 1 and 208 pounds, down about 50 pounds over the last several years. On that night he had driven home from a jam session with two friends and, as he was unloading his car, his heart stopped. That is the definition of "clinical death," one of several definitions doctors use, not always with precision. He wasn't yet "brain dead," implying a permanent cessation of cerebral function, or "legally dead," i.e., fit to be buried. But he was dead enough to terrify his wife, Monica, who found him moments later, unconscious, not breathing, with no pulse. His eyes were open, but glassy—"like marbles," Monica says, "with no life in them. They were the eyes of a dead man."

In a general sense, we know what happened to Bondar. His doctor at the University of Pennsylvania Hospital, Dr. Edward Gerstenfeld, later determined that Bondar's left anterior descending artery was 99 percent blocked by a coating of plaque, leaving a passage "the width of a hair." A blockage in that vessel, the largest artery feeding the heart, is known to cardiologists as the widowmaker. A tiny clot lodging there would have sent his heart into a brief burst of the ineffectual rhythm known as fibrillation, before it stopped altogether. Within 20 seconds the hundred billion neurons in Bondar's brain would have used up their residual oxygen, shutting down the ceaseless exchange of electrical charges that we experience as consciousness. His breathing stopped as he entered a quiescence beyond sleep.

About 250,000 times a year in the United States, someone's heart stops beating on the street, or at home or at work. This can be the result of a heart attack, when a clot chokes off a coronary artery, or a host of other conditions including congenital defects, abnormal blood chemistry, emotional stress and physical exertion. Without CPR, their window for survival starts to close in about five minutes. Life or death is mostly a matter of luck; response time to a 911 call varies greatly by location, but can exceed 10 minutes in many parts of the country. In rough numbers, they have a 95 percent chance of dying.

How long has it been since you've read an article about heart attacks that didn't mention saturated fats? Our age is obsessed with "health," but when health fails, the last line of defense is in the emergency room, where doctors patrol the border between life and death—a boundary that they have come to see as increasingly uncertain, even porous. This is a story about what happens when your heart stops: about new research into how brain cells die and how something as simple as lowering body temperature may keep them alive—research that could ultimately save as many as 100,000 lives a year. And it's about the mind as well, the visions people report from their deathbeds and the age-old questions about what, if anything, outlives the body. It begins with a challenge to something doctors have always been taught in medical school: that after about five minutes without a pulse, the brain starts dying, followed by heart muscle—the two most voracious consumers of oxygen in the body, victims of their own appetites. The emerging view is that oxygen deprivation is merely the start of a cascade of reactions within and outside the cells that can play out over the succeeding hours, or even days. Dying turns out to be almost as complicated a process as living, and somehow, among its labyrinthine pathways, Bondar found a way out.

Monica tried to recall what she had learned in a CPR class decades earlier. She bent over Bondar and began pushing down on his chest, then rushed back to the kitchen to dial 911. "My husband is dying!" she gasped to the operator.

Compressing Bondar's chest would have sent a trickle of blood to his brain, supplying a fraction of its normal oxygen consumption, not enough to bring him back to consciousness. But the West Deptford police station was only three blocks away, and within two minutes of Monica's call three officers arrived with a defibrillator. They placed the pads on Bondar's chest, delivered two jolts of electricity to his heart, and got a pulse back. Soon paramedics arrived with oxygen and rushed him to a nearby community hospital. The report Monica received there after an hour was equivocal: Bondar was "stable"—his heart rate and blood pressure back to near normal—but he was still in a coma. It was then that Monica made a decision that may have saved his life. She asked that her husband be moved the 15 miles to Penn, the region's leading university hospital.