Prior to certifying death, medical officers are advised to observe a patient for about 10 minutes. However, some patients seem to be dead only to 'resurrect' several minutes or hours after the recommended time, writes Vicky Wandawa
Real life experiences:
A 27-year-old man in the UK went into cardiac arrest after overdosing on heroin and cocaine. After 25 minutes of resuscitation efforts, the patient was verbally declared dead. About a minute after resuscitation, a nurse noticed a rhythm on the heart monitor and resuscitation was resumed. The patient recovered fully.
An 18-year-old woman in Missouri, USA, attempted suicide by overdosing on sleeping medication. Resuscitation was attempted, but failed, and she was declared dead. Seven minutes later, her heart started beating and she started breathing on her own again, though she was unconscious. The woman regained consciousness five days later and was oblivious to what had happened.
l A 45-year-old woman in Colombia was pronounced dead, as there were no vital signs showing she was alive. Later, a funeral worker noticed the woman moving and alerted his co-worker that the woman should go back to the hospital.
l A 65-year-old man in Malaysia came back to life two-and-a-half hours after doctors at Seberang Jaya Hospital, Penang pronounced him dead. However, he died three weeks later.
l Ex-footballer Fabrice Muamba of Bolton Wanderers in England suffered a cardiac arrest and collapsed while playing on the pitch. He was 'dead' for 76 minutes.
Spooky! They are confirmed dead, but minutes or hours later, they sneeze or call out for help to signal they are still alive. Stories have been told of people who have been retrieved from the mortuary because they rose from the dead.
Medically known as the Lazarus syndrome, Rogers Besigye, a pathologist at Mulago Hospital, says the name was derived from Lazarus' experience in the Bible, after being risen from the dead four days later by Jesus.
Besigye defines the condition as "a spontaneous return of circulation after failed attempts at resuscitation."
Henry Bukenya, a doctor at Mulago Hospital, defines resuscitation as the act of attempting to maintain or restore life by establishing or maintaining the airway, or breathing and circulation through cardio-pulmonary resuscitation and other related emergency care techniques.
Similarly, Susan Ndidde, a pathologist at Mulago Hospital, explains: "A person is believed dead when unresponsive to all resuscitation attempts. However, without any medical intervention, they can spontaneously come back to life (regain circulation and breath)." Hence, the Lazarus syndrome is also known as auto-resuscitation.
Ndidde notes that cases of Lazarus syndrome are extremely rare, but they do happen.
"In my practice and from my senior colleagues, none has been noted and neither has it been noted in the Mulago Hospital and Kampala Capital City Authority mortuaries."
Nonetheless, in those few cases that occur, Bukenya notes that the condition is common in patients suffering from diseases like diabetes, hypertension, heart condition and trauma, for example, following accidents.
Furthermore, Ndidde adds that from medical research, over dosage of drugs like barbiturates (act as central nervous system depressants), heroin and cocaine, stampedes and death at home are common causes of the condition.
Confirmatory signs of death:
"Prior to certifying death, it is recommended to observe a patient for five to 10 minutes after cessation of resuscitation," Ndidde explains.
The pathologist adds that the confirmatory signs of death include bilateral dilatation and fixation of the pupils. "Here, no response is noticed from the pupil, for example, not even to sharp light."
She also notes that there is absence of all reflexes, for example, the gag and corneal reflexes. The gag reflex is a reflex contraction of the back of the throat, evoked by touching the soft palate and occasionally the back of the tongue. The corneal reflex, also known as the blink reflex, is an involuntary blinking of the eyelids elicited by stimulation of the cornea (such as by touching or by a foreign body), or bright light.
There is also cessation of respiration without mechanical support.
Also, cessation of spontaneous cardiac activities occurs. Here, on listening to the heart, there is absolutely no sound.
Furthermore, death can be confirmed when there is a completely flat brain wave tracing, hence brain inactivity. However, this should be in absence of strong sedatives.
This is because sedatives are capable of generating flat brain wave tracing, but during that period it does not mean one is dead. Therefore, if there is a flat brain wave tracing yet such sedatives have been given, the person may still be alive. But if there is a flat brain wave tracing and no such sedatives were given, then death is confirmed.
The medical experts also can feel the pulse points on the body to figure out whether one is alive or not. Pulse points are sites on the surface of the body where arterial pulsations can be easily palpated, for example, the carotid, located on the side of the neck and the radial, located on the wrist.
Ndidde notes that all these conditions should happen for some time, five to 10 minutes, for death to be confirmed.
However, there are pitfalls in circulation, where extra caution has to be taken to confirm death, for example, palpation of the pulse.
"Here, the heart continues to pump, but with a feeble pulse so there is need for auscultation of the chest with a stethoscope." Auscultation, which is based on the Latin verb auscultate "to listen", is the term for listening to the internal sounds of the body, usually using a stethoscope.
What is more, there might be distant heart sounds on auscultation due to thick chest wall or pleural effusion, so there is need for an echo cardiography (ECG) before declaring absence of cardiac activity.
Bukenya explains that ECG is the use of ultra sound waves to investigate and display the action of the heart as it beats.
One can still live despite being injected with a corpse preservative.
When death is confirmed, the post-mortem procedure follows. Corpses are treated with a chemical known as formaldehyde.
"It contains a mixture of 40% formalin, 85% methyl alcohol and 2% water. It is used to temporarily preserve and disinfect tissues or bodies," Ndidde explains.
A person who undergoes the Lazarus syndrome may survive the effects from the chemical. Bukenya explains that this is because "formaldehyde is meant to stop the body from rotting, but it cannot stop the resuscitation."
He adds that although the amount of formaldehyde used depends on the size of body and level of trauma and rotten tissue, for example, in cases of cancer, among others, its concentration is dilute and hence not fatal.
Regarding the period of occurrence, Bukenya notes that there is no definite time and, therefore, the Lazarus syndrome can last from seconds to hours and that it is possible that some people are buried 'alive'.