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ANNIE MINOFF: It's 9:30 on an April morning in Amsterdam, the year 1769. And two men are dragging a woman out of a canal. She's soaking and she might be dead.

ELAH FEDER: Her name is Anne Wortman, or her name was. She's not breathing. She doesn't have a pulse, her skin's turned a weird speckley blue color. But the two men seem curiously undisturbed by all of this.

ANNIE MINOFF: Yeah. For these guys Anne's lack of pulse, it's not a tragedy, it's a challenge.

DR. DAVID CASARETT: Well, the important thing to know is back in 1760s there was a lot of interest in Amsterdam in trying to bring back the recently dead.

ANNIE MINOFF: That is Dr. David Casarett. He writes about Anne Wortman in his book Shocked, and he explains that a lot of people were drowning in Amsterdam's canals around this time, this was not just Anne Wortman's problem. And it got to be so bad that saving drowning victims became a thing. It was a hobby.

ELAH FEDER: It was so much of a thing people were actually papering Amsterdam with these instructional pamphlets, how to bring a drowning victim back to life. Because they might look dead--

ANNIE MINOFF: Like they're speckley and blue.

ELAH FEDER: Yes. But with the latest science and technology anything was possible.

ANNIE MINOFF: And so these two men, they are not about to give up on Anne Wortman. Instead, they--

DR. DAVID CASARETT: Reached into their bag of tricks. And one of the first things they tried was to drape her over log and rolled her back and forth, they said, for 15 minutes.

ELAH FEDER: A bunch of canal water comes out of Anne's mouth, but whatever else this is supposed to do, it doesn't.

ANNIE MINOFF: So plan B. The guys pick up Anne, and they bring her to not to a hospital but to the next best thing in 18th Century Amsterdam--the pub.

DR. DAVID CASARETT: Which is actually a popular site for a lot of resuscitation efforts.

ANNIE MINOFF: So they get to the pub, the apothecary arrives, and he warms Anne by the fire. He gives her this cranial massage with the spirit of Rosemary, put a hot water bottle on her feet, and for the piece de resistance--

DR. DAVID CASARETT: Uh, they took a knife out of its sheath, cut off the end of this sheath, inserted the sheath into poor Miss Wortman's rectum, believe it or not, and use bellows to blow tobacco smoke.

ELAH: [SOUNDS OF DISCOMFORT] What?

ANNIE MINOFF: Yeah. Which is maybe where this expression came from.

DR. DAVID CASARETT: Blowing smoke up someone's rectum, is the technical term.

ELAH FEDER: Well you know, if an expression came out of it then I guess it's...still not ok! What possible justification could you have for doing this to a person?

ANNIE MINOFF: Well, maybe this?

DR. DAVID CASARETT: If you've ever taken a drag from a cigarette, you know that nicotine has the effect of raising heart rate.

ANNIE MINOFF: Which, maybe if you have no heart rate, maybe that's good. Anyway, we do not know what eventually worked for Anne Wortman, but after a few hours of this, she...comes back to life.

ELAH FEDER: That's the craziest part of this story.

ANNIE MINOFF: It's the craziest part of the story.

ELAH FEDER: She's back, they offer her some booze, and then, one last 18th Century medical intervention, they bleed her.

ANNIE MINOFF: Welcome back to life, Anne.

ELAH FEDER I'm Elah.

ANNIE MINOFF: I'm Annie. And you're listening to Undiscovered.

ELAH FEDER: So tobacco smoke and booze obviously did not bring Anne Wortman back to life. Probably because she wasn't that dead to begin with.

ANNIE MINOFF: The point is, doctors have thankfully gotten a lot better at resuscitating people in 250 years. Their tools are more sophisticated, way more effective than a log or tobacco smoke.

ELAH FEDER: So effective in fact that they raise a whole new set of questions that those guys at the Dutch bar did not have to deal with. Questions like, when we can keep someone alive on machines for months or years, when do you declare someone dead? Who is actually beyond saving?

ANNIE MINOFF: Well, today we have an Anne Wortman story for 2018. It’s a story of life, and death, and miracle machines, and it's got an unlikely protagonist. A doctor who thinks maybe our love affair with technology has gone a little too far.

ELAH FEDER: That's coming up on Undiscovered.

ANNIE MINOFF: There's a picture of Jessica Zitter as a kid. She's holding her dad's stethoscope up to her Teddy bear.

ELAH FEDER: Yeah. Jessica clearly knew from a very young age what she wanted to be when she grew up. She comes from a family of doctors.

DR. JESSICA ZITTER: A lot of great uncles, a lot of uncles, my father, my grandfather, all doctors. And they were a particular type of doctor in general.

ELAH FEDER: They were surgeons. They were ER docs. The kind of doctors who are in the thick of the action snatching patients back from the brink of death, making those really heroic saves.

ANNIE MINOFF: And so you can understand this is the kind of doctor that Jessica wanted to be. And she never doubted her career choice until the day of her first code.

ELAH FEDER: It was 1992. Jessica was a few weeks into her medical internship at a hospital up in Boston, when over the hospital intercom she hears code blue.

DR. JESSICA ZITTER: And I just ran with the pack, running towards this room.

ELAH FEDER: Code blue means a patient's heart has stopped beating. And it sets off this rush, doctors sprinting to the scene of the emergency ready to perform CPR.

ANNIE MINOFF: And Jessica had reviewed the CPR protocol so many times. So many times she said she used to dream about it. How many chest compressions? How many breaths? What medications? But as she's running she's

DR. JESSICA ZITTER: Terrified. But I was like, no, it's OK, it's OK, I know what to do. I've got these protocols down.

ANNIE MINOFF: This was her chance to save a life.

DR. JESSICA ZITTER: And I got into this room.

ELAH FEDER: There's a patient on the bed. A resident above them doing chest compressions, throwing their weight on this patient's chest.

DR. JESSICA ZITTER: And all of a sudden I realize that this patient, I couldn't tell if it was a man or a woman, it was just this body that was so shriveled and had been sick clearly for so many, probably, years with chronic illness. There was not an ounce of fat or muscle on this person's body. And I thought, oh my goodness what is this? This seems like it's not going to work. And I hear this clicking noise. It's kind of like, really, a clock. And my friend said, who was standing next to me, oh my gosh, the chest is breaking. And then I was called in to the fray.

ELAH FEDER: Chest compressions are really hard work. Most people get worn out after a minute or two, so doctors rotate.

DR. JESSICA ZITTER: And I'm on top of this patient doing compressions on a breaking chest, on this body that really has been so diseased for so long. And I know this person is never going to survive this. What are we doing? It wasn't really conscious that way and it took years for me to understand this feeling of ineffectiveness. But in that moment I just felt that something wasn't right.

ELAH FEDER: Jessica couldn't put her finger on it at the time, but years later she can.

ANNIE MINOFF: And she thinks it's not just the brutality of the code that was bothering her. It was this feeling that they all knew what they were doing wasn't actually going to help. This wasn't treatment to help the patient, this was treatment for the sake of treatment.

DR. JESSICA ZITTER: It was just the sense that give it 30 minutes, a round number shows that we've tried everything, even though we knew it wasn't going to help.

ANNIE MINOFF: Like a performance almost.

DR. JESSICA ZITTER: A protocol. A protocolized performance. And act.

ANNIE MINOFF: Jessica's done chest compressions on patients whose chests were breaking, who wanted a miracle and didn't get one. She's put in breathing tubes for people who won't come off them. And it's convinced her over time that in medicine more is not always better. In fact, sometimes more treatment can hurt.

ELAH FEDER: Today Jessica works in an intensive care unit but she's also an activist. She writes opinion pieces. She wrote a book.

ANNIE MINOFF: She wrote about that first code with the patient with the breaking chest, because she wants us to understand what can happen when the medical miracle doesn't come through. Which is why this next story kind of disturbs her a little bit. It's not like those cautionary tales that she's told before.

ELAH FEDER: The beginning’s familiar though. This story starts with a code blue.

DR. JESSICA ZITTER: That day I was the attending in the intensive care unit.

ELAH FEDER: It's a November morning in 2016. Jessica is leading ICU rounds at the hospital where she works in Oakland, California, and that's when she hears it, code blue.

ANNIE MINOFF: Up in the hospital's cardiac catheterization lab someone's heart has stopped beating, and Jessica runs. The residents run. Half a dozen people are huffing and puffing up three flights of stairs to this lab where this code is happening.

ELAH FEDER: And when they bust through the lab doors--

DR. JESSICA ZITTER: We see this guy who's on the table and we see somebody doing chest compressions.

ANNIE MINOFF: The man on the table looks like he might be in his 50s. And he's already surrounded by this scrum of people, nurses, cardiology staff, and presiding over this controlled chaos is the cardiologist. He's this calm white-haired guy wrapped in a hot pink led vest.

ELAH FEDER: With a Tasmanian devil--

ANNIE MINOFF: Embroidered on the front.

ELAH FEDER: Yes. His name is Tom Frohlich

DR. THOMAS FROHLICH: It all happened pretty quick.

ANNIE MINOFF: Tom's job is hearts, and half an hour ago he'd been trying to fix this guy's. The guy had come in to the hospital with a heart attack. Tom found a major artery that carries blood to the front of the heart was completely blocked, and he was trying to open it when--

DR. THOMAS FROHLICH: He arrested.

ELAH FEDER: The man went into cardiac arrest, which means his heart wasn't beating regularly anymore. Instead, it was quivering or wiggling

DR. JESSICA ZITTER: We call it like a bag of worms.

ANNIE MINOFF: This is actually how every medical textbook describes this.

DR. JESSICA ZITTER: It actually is wiggling like a bag of worms and completely ineffective.

ANNIE MINOFF: That wiggling rhythm is called ventricular fibrillation or VFib. And every minute of VFib is another minute that this man's organs, including his brain, are not getting oxygen. And so Jessica launches into lifesaving mode.

ELAH FEDER: They strap on a machine that does automatic chest compressions.

DR. JESSICA ZITTER: Literally, it's like a jackhammer

ELAH FEDER: Pushing on this guy's chest.

DR. JESSICA ZITTER: Going down at 100 beats per minute.

ELAH FEDER: They get a ventilator set up pumping oxygen into this guy's lungs, and every few minutes Jessica pauses, calls for another shock. A jolt of electricity.

DR. JESSICA ZITTER: Slapping the heart in the face. It's like saying, you know, pull yourself together.

ANNIE MINOFF: In between all this, Tom is attacking that blocked artery. He's nudging it open. He actually succeeds, inserts a stent. He even gets the heart to beat again for eight minutes and then nine and 10 and then it goes back into VFib, bag of worms.

DR. THOMAS FROHLICH: So it became clear to me, I think by about 12:30, that we had done pretty much everything that we could do.

ELAH FEDER: Tom and Jessica were an hour into this now. They'd shocked this man at least a dozen times. They'd given him every medication, multiple doses, nothing was working. So Tom and Jessica step aside for a huddle.

ANNIE MINOFF: The facts of this case have not changed. The ventilator is still pumping oxygen into this man's lungs. The compression machine is still jackhammering away trying to circulate that oxygen to his organs and to his brain. But these machines cannot be this guy's heart and lungs.

ELAH FEDER: Right. They can only keep him alive for so long. And now Tom and Jessica are running out of things to try.

ANNIE MINOFF: But Tom has been thinking, and this is where he suggests something a little radical.

DR. THOMAS FROHLICH: I said, well, the only thing I think that is a remote possibility is if we could get ECMO for him.

ANNIE MINOFF: What about ECMO? ECMO is--

DR. JESSICA ZITTER: Extracorporeal membrane oxygenation.

ELAH FEDER: For adult patients this is a pretty new thing. It's a therapy that can replace your heart and lungs. Say those organs stop working, ECMO can do their jobs for days, for weeks, for even months.

ANNIE MINOFF: It works like this. The ECMO machine pulls the blood out of your body, filters out the CO2, swaps in oxygen--

ELAH FEDER: Just like your lungs do.

ANNIE MINOFF: Exactly. And then it pumps that oxygenated blood back into your body and circulates it around.

ELAH FEDER: Like your heart would do.

ANNIE MINOFF: Exactly. Which for certain patients can have a pretty nifty effect. It can put a pause button on death.

ELAH FEDER: So maybe, Tom's thinking, ECMO can buy this patient enough time for his heart to restart. This is the idea that he's pitching Jessica.

ANNIE MINOFF: And there's no question, this is a Hail Mary pass. Most CPR attempts, they don't go past 20 minutes. Tom and Jessica, they've been at this for an hour. That's an entire hour this man's brain hasn't been getting enough oxygen.

ELAH FEDER: So maybe they should stop. Right? This is an actual option. I mean, remember, Jessica is the person who thinks more treatment is not always better. But she says that in this case it didn't feel like a choice whether or not to bring this miracle machine in, because this guy--

DR. JESSICA ZITTER: He was moving. The guy was moving his arms and legs.

ANNIE MINOFF: Were you surprised to see that?

DR. JESSICA ZITTER: Shocked. Yeah.

ANNIE MINOFF: Ever since this guy went down he had been resisting. He wasn't awake or talking to them. But he could feel everything that they were doing and he was trying to make it stop, pushing his doctors away, trying to push away that CPR machine that's pounding on his chest.

ELAH FEDER: And this is really huge because it means even after an hour of CPR this man's brain is working. There is someone in there to save.

DR. JESSICA ZITTER: You wouldn't stop. I wouldn't stop on a guy like this.

ELAH FEDER: And so Jessica's on board. Do ECMO. This is a chance for technology to do some good.

ANNIE MINOFF: One problem. Neither Tom or Jessica has actually ever seen an ECMO machine. This is still a pretty new technology for a lot of hospitals. Their hospital doesn't even have this machine. But Tom knows that UC San Francisco across the Bay, they do. And so he calls his colleague there Dr. Klein.

DR. THOMAS FROHLICH: I said, do you have ECMO to go?

ANNIE MINOFF: Like, basically is this thing portable? And Dr. Klein says--

DR. KLEIN: I think I might be able to pull together a team. Let me get back to you.

ELAH FEDER: While we're waiting for Dr. Klein, a bit more about ECMO. Putting a pause on death.

ANNIE MINOFF: Yes.

ELAH FEDER: That is the upside to ECMO. There are some downsides.

DR. KEN PRAGER: It gets harder to die.

ANNIE MINOFF: Yeah. That's Dr. Ken Prager. He's a bio-ethicist at Columbia University Medical Center here in Manhattan, which is one of the leading ECMO centers in the US. And Ken realizes how nonsensical this sounds, that ECMO making it harder to die could be a bad thing.

DR. KEN PRAGER: Although that sounds great. Who wants to die? We all must die at some point.

ELAH FEDER: And people do die on ECMO. The mortality rate can be as low as three in 10 patients, or as high as seven in 10. A lot depends on what you're using it for and on who.

ANNIE MINOFF: Ken's point is for the patients that it can't save ECMO can make death worse. It can draw it out.

ELAH FEDER: Ken remembers the case of one woman he calls Ms. L. Ms. L was an accountant who lived with her mother. She also had terrible lung disease, and her doctors put her on ECMO hoping to keep her alive long enough to get a lung transplant

ANNIE MINOFF: But after being attached to ECMO Ms. L got worse. Her lung collapsed, she got a drug resistant infection, and soon she was too sick to get a transplant.

DR. KEN PRAGER: And so here you have a patient who is awake, and who is alert, who has zero chance of surviving, and the patient knowing that they are on death's row, as it were. This is a horrible situation.

ANNIE MINOFF: Ms. L knew how this was going to end, but she couldn't bring herself to agree to turn off the ECMO machine. It's hard enough to reckon with the fact that you are dying, but to actually pick a day to make it happen, Ken says not a lot of people can do that.

ELAH FEDER: It would be a full month and a half. That's a month and a half of increasing pain and withdrawal before Ms. L was so far gone, that her family agreed to turn off ECMO and Ms. L finally died. She was 42.

DR. KEN PRAGER: So these are gut wrenching situations that our technology has created. And again, I'm not anti-technology, don't get me wrong. I have seen amazing and wonderful cases when we have saved lives that would have been lost without this technology. There is a flip side.

ANNIE MINOFF: So this is the gamble that Jessica and Tom have taken. Their patient could get better with ECMO. He could even go back to his life.

ELAH FEDER: Or he might die, a longer drawn out death connected to a ECMO or a shorter one without it. They're hoping for the best case scenario. That's why they picked up the phone to UCSF. And sure enough 45 minutes later, Dr. Klein calls back. ECMO? On its way.

ANNIE MINOFF: But it's going to take a while. They've loaded the machine into the back of an ambulance. Now that ambulance has to get all the way across the Bay Bridge in traffic. Which is not what Jessica wants to hear, because it's becoming increasingly clear that her patient is getting worse.

DR. JESSICA ZITTER: I said to Dr. Frohlich, I'm having trouble oxygenating him.

ANNIE MINOFF: The ventilator and the compression machine are still going but it's starting not to be enough. The man's oxygen level is plummeting. And the fact that he's still thrashing around, it's not helping.

ELAH FEDER: To give the ventilator a fighting chance Jessica sedates and paralyzes the man, and the moving stops.

DR. JESSICA ZITTER: That was when I started to feel, ooh, OK, the reason we've all been going for it here is because we see this guy moving and we know there's something in there, now what is this, what is this thing.

ANNIE MINOFF: Did people say that?

DR. JESSICA ZITTER: Yeah. There were a few people saying, what are we doing? You know, this is never going to turn out well. I had been so gung-ho, let's do this, and now I started to feel worried.

ELAH FEDER: Was this treatment or was it an act? Jessica wasn't sure anymore but maybe it didn't matter.

DR. JESSICA ZITTER: There's a whole freight train of energy that's been set in motion. It was going and there wasn't really any turning back at that point.

ELAH FEDER: Coming up on Undiscovered, the arrival of the miracle machine.

ANNIE MINOFF: The ECMO team did finally arrive at 4:09 PM. By that time, Jessica had been trying to resuscitate this man for four and a half hours.

ELAH FEDER: When Tom had picked up the phone to call ECMO he'd been optimistic but not anymore. Because this man's oxygen levels were so low. Normal oxygen saturation is in the high 90s. This man's oxygen is skimming 20%.

DR. JESSICA ZITTER: They came in and they surveyed the situation very calmly. And they were quietly surprised at how long we had been doing this, as were we, obviously. But they got to work.

ANNIE MINOFF: The ECMO machine, it's about the size of a laser printer and it's got two big catheters coming out of it.

ELAH FEDER: The surgeons connect one catheter to a vein, another to an artery to complete the circuit. When they turn on the machine blood comes out one tube gets oxygenated inside the machine and gets pumped back into the body through tube number two.

ANNIE MINOFF: And when the UCSF doctors turned on the machine, Tom and Jessica could hardly believe what they were seeing. Out of one tube came blood that was--

DR. JESSICA ZITTER: Dark, dark maroon.

DR. THOMAS FROHLICH: Very dark, almost black blood.

DR. JESSICA ZITTER: Which shows us that it's completely unoxygenated, very low oxygen level. And one revolution through the ECMO machine and it comes back out to go back into the other side, and it was bright red.

DR. THOMAS FROHLICH: Bright red filled with oxygen.

ANNIE MINOFF: There's a quote by the sci-fi writer Arthur C. Clarke about magical machines. It says any sufficiently advanced technology is indistinguishable from magic.

DR. JESSICA ZITTER: That is a great quote because that's how it felt. There were gasps in that room. And by the way these were all really experienced cardiac catheter personnel, a bunch of ICU personnel, lots of people who've seen a lot of stuff, and there were gasps.

ELAH FEDER: And with that the code ended, six hours after it had started. They stopped the compression machine. Without ECMO going, the patient's heart didn't need to beat. He was loaded into an ambulance and pretty soon he was gone. Taken away to UC San Francisco.

ANNIE MINOFF: It started with a code blue at 11:45 AM, now, it was almost 7:00 at night. Jessica went into medicine over 20 years ago dreaming about making heroic saves. And this, keeping a dying man alive for six hours, getting him onto ECMO. This was a save.

ELAH FEDER: So you might think Jessica would feel thrilled.

DR. JESSICA ZITTER: I was numb, really numb. I didn't know what was going to happen to this guy, and to be honest, I didn't think it was going to be very good.

ANNIE MINOFF: ECMO was new to Jessica, but the concept of miracle machines, that was not new. She knew about ventilators and VADs and dialysis machines. And she knew that the saves that doctors make with those devices, they're not always the saves we patients think they're going to be.

ELAH FEDER: When a lot of people imagine the worst it goes something like this.

DR. DANIELA LAMAS: Something horrible happens to you. Perhaps you die. But if you don't die you probably get better.

ELAH FEDER: That's Daniela Lamas. Like Jessica she's an ICU doctor. She works at Brigham and Women's Hospital in Boston. And like Daniela says, two options, you die or you get better.

DR. DANIELA LAMAS: Those are kind of the two poles. But this idea that there is this middle that might last forever, that's something that I really don't think is in the public sphere.

ELAH FEDER: Once upon a time there were just two ways to go. If you think back to Anne Wortman and the Dutch pub 250 years ago, she was either going to die or she was going to live. And what Daniela's saying is that's not really true anymore.

ANNIE MINOFF: Because now there's this third trajectory. This thing Daniela's calling, the middle. These middle patients are saved by our life support technology. They do not die. But here's the key thing.

DR. DANIELA LAMAS: They don't really get better necessarily either

ELAH FEDER: They're not getting back to their lives.

ANNIE MINOFF: So a few years ago Daniela got curious about these middle patients. She wanted to know what their lives are like. And so she went to one of the places where they often end up, a place called an LTACH.

ELAH FEDER: It's a long term acute care hospital.

ANNIE MINOFF: Up on the LTACH's third floor, Daniela remembers hearing familiar ICU sounds.

DR. DANIELA LAMAS: You hear the heart rate monitor, regular staccato beeping, you hear the beeps that ventilators make when a patient needs suctioning.

ELAH FEDER: This was the ventilator unit. Every patient on this floor relies on a machine to breathe. You walk into a room and a patient--

DR. DANIELA LAMAS: Might be sitting up in bed hooked to a ventilator, staring at the wall, staring out the window. Other patients, you can tap them on the shoulder and maybe they'll turn toward you but they won't make any meaningful response.

ANNIE MINOFF: These patients couldn't answer Daniela's questions. But other patients could. They could speak or they could mouth words, and they described a quality of life that a lot of us might not want.

DR. DANIELA LAMAS: They described hunger, thirst, difficulty communicating, boredom.

ELAH FEDER: One patient described his time at the LTACH as torture.

DR. DANIELA LAMAS: Torture.

ANNIE MINOFF: He actually had to mouthed the words. He said it's torture all day like this. It's awful.

ELAH FEDER: But most people didn't think they'd be at the LTAC for that long. This was just a stopover on their way to recovery. The goal was to go home.

DR. DANIELA LAMAS: There was one man who told me that he wanted to get back to a ping pong group that he was part of. They played ping pong tournaments. He's was a sweet guy.

ELAH FEDER: Of course, what Daniela knew was that many LTACH patients don't go home. Only one in 10 are home and living independently after a year, half have died.

ANNIE MINOFF: This is what Daniela means by a middle between life and death. And it didn't really exist until a few decades ago. And what changed was, basically, technology. Ventilators got better. Suddenly we had these miracle devices to prop up failed organs.

ELAH FEDER: Better dialysis machines to support failed kidneys. VADs, these mechanical pumps that take the place of the heart.

ANNIE MINOFF: And for many patients these machines have been truly miraculous. They have kept them alive. Maybe it's not the same life they had before but it's life.

ELAH FEDER: But for other patients it's a life they didn't want, and that's what worried Jessica in the days after the code.

DR. JESSICA ZITTER: We may have a guy who the best that we could hope for will be a persistent vegetative state, where he will be living on a machine for the rest of his life. Which could be quite a long time, actually. He's a young guy. And we didn't know anymore what his outcomes were likely to be.

ELAH FEDER: But then this happened.

DR. THOMAS FROHLICH: I'm just looking at my text messages.

ELAH FEDER: Tom the cardiologist, he'd been texting with Dr. Klein, the doctor over at UCSF, asking, how's our patient. And he starts getting these messages back.

DR. THOMAS FROHLICH: Got a note back from Dr. Klein saying he's alive.

ANNIE MINOFF: Which was not a given. But still no heartbeat.

DR. THOMAS FROHLICH: Still with no cardiac function.

ELAH FEDER: But then a little bit later another message from UCSF, and now there is a heartbeat.

DR. THOMAS FROHLICH: Holy crap. I mean, he spent 14 hours in VFib.

ANNIE MINOFF: No more bag of worms. This man's heart is beating. Jessica gets the news in the middle of rounds.

DR. JESSICA ZITTER: I keep calling, Tom, what's going on with that guy? I was shocked.

ELAH FEDER: It got more and more unbelievable. A few days later, a colleague of Dr. Klein's chimes in with this little bit of information.

DR. THOMAS FROHLICH: Yeah he seems to be responding. And I said, what?

DR. JESSICA ZITTER: Say what?

DR. THOMAS FROHLICH: What are you talking about? And he says, well, you know, the nurses tell me he's responding to commands and I think he is too. Each step it just seemed like--

DR. JESSICA ZITTER: Are you kidding me?

DR. THOMAS FROHLICH: You've got to be kidding me.

ANNIE MINOFF: It kept on like that for a few weeks. The man was being moved down to the step-down unit. His breathing tube was coming out. He was going to rehab.

DR. JESSICA ZITTER: And guess what. He went home.

DR. THOMAS FROHLICH: Hi there.

DR. JESSICA ZITTER: This is the man who made it all happen.

ANNIE MINOFF: Hey! It's nice to meet you. I recognize the voice.

A year after their big save, I went and I visited Tom and Jessica at Highland Hospital, the place where this all happened in Oakland, California. Even a year later good news was still coming.

DR. JESSICA ZITTER: Do you want to say hi to Dr. Frohlich. You never met him, but he's the guy who--

ANNIE MINOFF: Jessica had talked to the patient after the code but Tom hadn't. And he wondered if he'd ever get to talk to the man again, get to say congratulations and how are you feeling. And now Jessica was on the phone with the patient.

DR. JESSICA ZITTER: Sure. Here he is. This is Dr. Tom Frohlich. Hold on one second.

DR. THOMAS FROHLICH: I'm doing fine. I'm really thrilled that you're doing fine.

ELAH FEDER: They chatted for a while, Tom and the man, and I could watch Tom's smile just get wider. After he handed the phone back to Jessica, he got quiet for a second.

DR. THOMAS FROHLICH: That's just amazing because, I knew he went home. I knew that he got out of rehab. And in talking to Jessica I knew that he was doing OK, but OK means many different things. From where he started OK could mean just being able to feed himself, but he sounds normal. It's pretty it's unbelievable.

ELAH FEDER: Both Tom and Jessica use the same word to describe this story.

ANNIE MINOFF: They called it a miracle.

ELAH FEDER: A miracle. Which for Jessica is, kind of, a problem. Don't get her wrong. She is thrilled that this case has a happy ending. But at the same time--

DR. JESSICA ZITTER: The fact that it ended up with this guy walking away and being at home now confuses me a little bit.

ELAH FEDER: How does she make this story fit with all of the other stories that she's heard and told people about patients living in limbo in LTACHs? About Ms. L?

ANNIE MINOFF: Was it even the right decision to call for ECMO when the odds were that bad? That question at least she thinks she's answered.

With you do anything differently?

DR. JESSICA ZITTER: No. I would have done the same thing.

ELAH FEDER: The same thing with a lot of qualifiers. Jessica would do the same thing for a patient who is relatively young and relatively healthy, who went into cardiac arrest in the hospital where you could get great high quality CPR from minute one.

DR. JESSICA ZITTER: The honest truth is in a situation like this with a young and reasonably young and healthy person, I do believe that it was appropriate to do what we did, and I think we did it well. And I think even though we did it well, I think it was very likely that there would have still been a poor outcome, but I think it was appropriate to try.

ANNIE MINOFF: ECMO's still pretty new for a lot of hospitals. There is so much to learn about who exactly can benefit from this kind of Hail Mary pass. Why did this guy do so well? What was different?

ELAH FEDER: So here's something we have learned. For patients like Jessica's, people who are relatively young who don't have a bunch of preexisting conditions, ECMO can be a game changer. People have actually gotten transplants they never would have gotten a few years ago. They've recovered from flus that would have killed them. These people would have died and now they're going home. They're not ending up in the middle.

ANNIE MINOFF: And so what worries Jessica now, it's not that they made the wrong choice calling for ECMO, it's what happens next. Because the thing about medical technology is once we have it we like to use it. And we like to use it on everybody.

ELAH FEDER: Take ventilators. They started off as a stopgap. Iron lungs kept kids with polio alive until they could breathe on their own. Now we've kicked polio but for thousands of patients in LTACs ventilators are not a stopgap anymore. They're the new normal.

ANNIE MINOFF: As for ECMO, we're using it on adults exponentially more than we were just a decade ago, and on patients who are a little older and a little sicker. And that could mean more amazing saves. It could also mean people saved to lives that they might not want.
ELAH FEDER: Jessica wouldn't blame ECMO for that. She says the problem isn't the machine, it's how we're looking at it. We're not looking at it with open eyes but with hope that we can cheat death, that our loved ones can get better, even in those cases where we know that's probably not true. This story--

DR. JESSICA ZITTER: It's not about ECMO, it's not about a ventilator, it's about this idea of a magic machine. It's about an idea.

ANNIE MINOFF: So here are some ideas that we would like to leave you with. Because there might come a time some day where you have to make a decision about how hard to push and how much to hope, whether it's for you or for someone you love.

ELAH FEDER: There is a man walking the streets of Oakland, maybe right now, whose heart stopped beating for six hours. He would not have been alive a decade ago. Our technology did that.

ANNIE MINOFF: And there are many thousands of people who have not been as lucky as that man. They're lying in limbo attached to their own miracle machines. Machines they might not get off in their lifetime. Don't forget them. Our technology did that too.

Undiscovered is reported and produced by me, Annie Minoff.

ELAH FEDER: And me, Elah Feder. Our editors Christopher Intagliata and our composer is Daniel Peterschmidt.

ANNIE MINOFF: The patient ultimately decided he didn't want to be interviewed for this story, but we want to wish him the very best with his recovery. And if this episode left you wanting to know more about end-of-life decision making, how you can have some control over this stuff, and how to talk about it with your friends and family and doctors, we got you. There are tons of links up at our website, undiscoveredpodcast.org. That's undiscoveredpodcast.org.

ELAH FEDER: Jessica Zitter and Daniela Lamas also have books that are great resources for this kind of stuff. Jessica's book is called Extreme Measures: Finding A Better Path at the End of Life. Daniela's is You Can Stop Humming Now: A Doctor's Stories of Life, Death, and In Between.

ANNIE MINOFF: We got fact checking help from Michelle Harris. I Am Robot and Proud wrote our theme. Special thanks to Lorna Fernandez and the staff at Highland Hospital in Oakland, California.

ELAH FEDER: Thanks also to Sarah Fishman, Danielle Dana, Christian Skotte, and Brandon Echter.

ANNIE MINOFF: We'll see you next week.

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