March 29, 2024

Playing God: a trauma surgeon's views on Death vs Science | Russell Gruen | TEDxNTU



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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