Published May 29, 2023, 5:20 p.m. by Violet Harris
In his TEDxNTU talk, "science vs. death: A Trauma Surgeon's View," Russell Gruen argues that science has made great strides in prolonging life, but has not yet conquered death. He cites advances in medical technology, such as organ transplantation and artificial ventilation, as examples of how science has prolonged life. However, he argues that these advances have not yet conquered death, as patients often die despite the best efforts of medical science.
Gruen argues that the problem with death is that it is an unpredictable event. He cites the example of a patient who appears to be recovering from a heart attack, but then suddenly dies. He argues that death is a random event that cannot be predicted or controlled by science.
Gruen argues that the only way to conquer death is to find a way to predict when it will occur. He argues that this is possible with the help of artificial intelligence. He argues that artificial intelligence can be used to create a "virtual autopsy" of a person, which would allow doctors to predict when death will occur.
Gruen's TEDxNTU talk has generated a lot of discussion about the role of science in prolonging life. There are those who agree with Gruen that science has not yet conquered death. However, there are also those who argue that science has made great strides in prolonging life and that it is only a matter of time before science conquers death.
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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
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