Medicine

LAZARUS ON ICE

How hypothermia treatment brought Dan O'Reilly back from the brink of death

CHARLIE GILLIS April 11 2005
Medicine

LAZARUS ON ICE

How hypothermia treatment brought Dan O'Reilly back from the brink of death

CHARLIE GILLIS April 11 2005

LAZARUS ON ICE

How hypothermia treatment brought Dan O'Reilly back from the brink of death

Medicine

CHARLIE GILLIS

TWO UNPLEASANT DREAMS are all Dan O’Reilly remembers from his time in medical limbo, and he’s not sure what to make of them. One involves a couple of parents who are angry at him over a sports game played at a mysterious school where he’s teaching. They’ve chased the 53-year-old math instructor by truck to his home in Edmonton, demanding money, but he can’t pay them until he can move his legs again. “All I can do is pull myself along by the arms,” he says with a quizzical smile. The second is more surreal: a medical

team on a ladder props him upright while performing surgery on the back of his neck. He has no idea why they’re operating, or what he might do to stop them.

For O’Reilly, these recollections are less disturbing than curious—the sole vestiges of a week he spent on the threshold of oblivion, and an intriguing suggestion of activity in the traumatized brain. Three-and-a-half months ago, the father of two all but drowned in the waters off Ixtapa, Mexico after an

enormous wave cast him headlong into the sand, filling his lungs with salty water and compressing a section of his spine that controls breathing. For three full days, he lay comatose in deliberately induced hypothermia, frozen by his doctors while his brain slowly repaired itself. Then, as his family braced for what they feared was inevitable

death, he was slowly thawed out and revived.

Of all this, he remembers nothing—just the calamitous impact of the water and the vivid images that repeated themselves in his mind afterward. In retrospect, it’s tempting to interpret the dreams as some sort of psychic portent: O’Reilly had indeed suffered some paralysis, and would eventually undergo surgery on his upper spine. But the true wonder is that he’s alive to recall anything at all. Through a combination of blind luck, quick-thinking rescuers and one of the all-time great emergency-room gambles, he now represents about the closest thing to resurrection we mortals are likely to see.

“ALMOST DEAD,” after all, was how the doctor who admitted O’Reilly to St. Luke’s

Hospital in Houston summed up his patient’s apparent condition as a medical team wheeled him into the intensive care unit on the night of Dec. 21. Dr. Joseph Varón, a specialist in intensive-care medicine and an expert in the therapeutic uses of hypothermia, privately gave O’Reilly less than a one per cent chance of survival based on an array of dismal indicators. The Albertan’s colour was ghastly, and he was insensitive to touch. When Varón peeled back one of O’Reilly’s eyelids, the pupil stubbornly refused to contract, suggesting a complete absence of reflexive nerve activity. “The only reason I didn’t disconnect him from the life support apparatus was that he had a tiny bit of breathing,” says the physician. “He was drawing one breath per minute himself, the respirator was doing the rest. Other than that, he made all the criteria for being brain dead.”

Earlier that day, O’Reilly had been the picture of middle-aged health, watching his two sons boogie-board across the shallows during a family vacation on the west coast of Mexico. There, while standing knee deep in the water, he recalls, he was “drilled into the sand” by a three-metre wave that had crested unexpectedly above his head. When the rogue swell subsided, O’Reilly’s 13-yearold son, Connor, spotted his father floating face-down in the sea. With help from his 11-year-old brother, Braedan, Connor tugged his dad to shore, crying for help and drawing a crowd. Three Mexican men immediately began administering CPR, and were soon joined by Lucia Gauvin, a retired nurse who now lives in Coquitlam, B.C.

Gauvin can’t recall how long she and the others kept up their resuscitation attempts— “I could say 30 minutes, I really don’t know,” she says—but by the time an ambulance arrived, she remembers feeling exhausted. Paramedics rushed O’Reilly to a local clinic, and about six hours later he was on a plane to St. Luke’s, a hospital known for advanced cardiac care. With him in the cabin was his wife, Diane Persson, clutching his foot in the hope he’d somehow register her touch. By the time they reached St. Luke’s, he was worse than unconscious, periodically going into convulsions and depending on the respirator to keep him breathing.

Lor Persson, the experience now seems a blur of fear and emotion. Seated in the cafeteria of Edmonton’s Glenrose Rehabilitation Hospital, where O’Reilly is living tem-

porarily, she gazes at her husband, recalling the inner panic that seized her as it became obvious he was likely to die. A teacher and musician, she’d maintained composure in part for the sake of her sons, whom she left with friends in Mexico, she says. But not knowing the cause of O’Reilly’s condition was taking its toll by the time they reached Houston. “There was no way to know what was wrong with him,” she says. “Had he had a heart attack? A stroke? Had he choked after throwing up during the CPR?” The only thing that seemed certain was that his brain would become damaged beyond repair' barring some extreme form of intervention. So when she arrived at his room the next morning to find O’Reilly hitched to the medical equivalent of a refrigeration unit,

she hardly batted an eye. “I thought, ‘Why not?’ It wasn’t as if we had anything to lose by trying something different.”

There is, in fact, well-established science to support cooling cardiac patients and stroke victims. Lowering the body temperature to 32° C, or five degrees below normal, is a time-proven method of slowing metabolic functions in other parts of the body, preserving blood-born oxygen for the brain to repair itself. There’s even machinery specifically designed to do the job—in this case, a gel-filled blanket interlaced with cooling tubes that lies beneath the patient.

The difference, says Varón, was the type of injury O’Reilly had suffered, not to mention the length of time before staff were able to start chilling him. “It had never been

used on a near-drowning case, and it had never been used so many hours after the person had collapsed,” he says. “But we’re talking about a 5 3-year-old man with two children, and a wife who was there telling me, ‘Don’t let this man die.’ And when the pressure’s on, that’s when acute-care doctors are supposed to have their best ideas.” Given the circumstances, Varón decided to freeze O’Reilly for a full three days rather than the 24 hours typically used in brain injury cases. The drastic measure would mean exposing the Albertan to infection, he knew. But having spent years studying the impact of hypothermia on the brain, Varón was convinced that the extra time offered O’Reilly the only chance of a proper recovery when— and if—he finally woke up.

The gamble paid off. On Christmas Eve, Varón slowly began easing O’Reilly’s temperature back to normal, and two days later, a nurse rushed from the intensive care unit to announce that O’Reilly had opened his eyes. Persson had made a quick trip to Mexico to arrange flights back to Edmonton for Connor and Braedan, but got to Houston just in time for the good news. And when she entered her husband’s room, she and other onlookers could have sworn they saw a smile cross his lips.

Will the case go down as a breakthrough in hypothermic treatment? Probably not. Frederick Colbourne, a psychology professor at the University of Alberta in Edmonton, says the extreme circumstances surrounding O’Reilly’s case make it impossible to draw reliable scientific conclusions about his recovery. “There’s an academic risk in considering worst-case situations,” explains Colbourne, who’s spent more than a dozen years studying the use of hypothermia to prevent brain damage, “ft is necessary to conduct a proper clinical assessment, as treating a patient here and there is not sufficient.” That said, neither he nor anyone else is about to fault Varón for taking drastic measures. “Certainly if I was in a situation where I had such a severe injury,” Colbourne says, “I’d appreciate them taking a chance.”

O’REILLY IS THANKFUL, even as he embarks on his long, taxing road to recovery. Today, he’s lying face-up on a gym mat at the Glen-

rose, obviously trying hard as he commences the task of struggling to his feet. Hunching himself into a three-point stance, with two knees and his skull firmly planted on the floor, he draws a gentle admonition from his physiotherapist, Susan Corscadden: “I didn’t say use your head,” she chuckles. Improvisation, however, is a necessary talent for O’Reilly in the short term. Both his arms remain weakened, his left especially so, and he walks with a certain stiffness.

THANKS to luck,

rescuers and a big ER gamble, O’Reilly represents about the closest thing to resurrection we’ll ever see

Still he makes progress every day.

But with twinkling blue-grey eyes and a barking laugh, he gives truth to Elisabeth Kübler-Ross’s maxim that those who’ve come to know death become our teachers about life. “Even though I can’t do as much as I once did, what I’m able to accomplish just seems way more enjoyable,” he says, seating himself on the edge of a mat for a

breather. His recovery has been fuelled by mail and visits from well-wishers, long-time friends and students who heard of his astounding tale through the local media. More than a few have mused that O’Reilly has shown the same perseverance he demanded as a volleyball coach at Bev Facey high school in suburban Sherwood Park. That thought brings him enormous satisfaction.

This week, he is scheduled to return home from Glenrose, and he’s now contemplating a life with some semblance of normality. There’ll be the first walk with the family dog, Pepper, the first full family gathering, and, with luck, a trip to B.C. to thank Lucia Gauvin for not giving up. In time, there will be his first day back on the job, which he hopes will be sometime next year. And high on the list will be an appearance next January at Houston’s annual marathon, O’Reilly’s personal tribute to the place where he as good as came back from the dead. “If I can’t run, I guess I’ll have to walk,” he says, “but I plan to be there.” If nothing else, the trip will allow him to reunite with Varón, a man he doesn’t hesitate to credit with saving his life. He was willing to take a chance on something different, observes O’Reilly, rising to resume his exercises, “and for that I’m just so very grateful.” CT1

charlie.gillis@macleans.rogers.com