[RADIOLAB INTRO]

LULU MILLER: I'm Lulu Miller.

LATIF NASSER: And I'm Latif Nasser. This is Radiolab.

LULU: How do we—how should we start?

LATIF: I mean, you probably should lead with the big news from yourself.

LULU: [laughs] Okay. The big news, which I actually just found out, is particularly big. I am very, very pregnant. I have an extra-big baby inside, I just found out at the doctor. Which means I will be one, sort of disappearing from the regular rhythm here for a little bit—although we've preloaded some things. I'll pop in and out.

LATIF: Mm-hmm.

LATIF: But also it means that I am past my fly safe date, so I'm not allowed to fly anywhere.

LATIF: Right.

LULU: But you just ...

LATIF: I flew.

LULU: You flew, and you got to do an event with our resident ER doctor correspondent, Avir Mitra.

LATIF: Yeah.

LULU: And I truly know nothing, except that I had total FOMO and authentic jealousy because you're both so shiny and fun onstage. But we're gonna get to hear about it now, right?

LATIF: Right. Okay, so let me—let me set the stage a little bit. So the place we performed at was our kind of—WNYC's very own live space called the Greene Space.

LULU: Yeah.

LATIF: Hello, hello. Welcome everybody! I am your friendly neighborhood Radiolab host, Latif Nasser.

LATIF: And basically what this came out of—okay, so you people probably remember the stories that Avir has done on this show. He did one about this mysterious epidemic of vultures dying. He did one about this miracle drug that they took out of the soil.

LULU: Rapamycin.

LATIF: Yeah.

LULU: Yeah.

LATIF: So he's done all these great stories, right? But he came to me with this idea of something kind of different.

LATIF: Avir has been able to convince me, and hopefully with some special guest friends we have, he's gonna be able to convince all of you that not only does he make saving a life look easy, that actually in this one particular way, it actually kind of is easy.

LATIF: Basically he wanted to take on, in a sort of a straight-ahead, practical way, one particular topic, and show how in this one case, all of us—including you, Lulu, including you, listener—how you can be the difference between life and death.

LULU: Like, a thing you could actually do?

LATIF: It's a thing you could actually do to save a life.

LULU: Ooh! Okay!

LATIF: Okay. So you ready?

LULU: Yeah.

LATIF: Here we go.

LATIF: So is everybody excited?

[applause]

LATIF: Please welcome to the stage Avir Mitra.

AVIR MITRA: Thank you, guys.

LATIF: All right, what are we gonna do?

AVIR: Just get going?

LATIF: Let's get going.

AVIR: Well, I guess I was kind of hoping we could start with a little story.

LATIF: Okay.

AVIR: Does that sound good?

LATIF: Sounds great.

AVIR: So the story goes, you know, I had—there was a patient. She was a 78-year-old woman, coming in from Jersey. It was her birthday. Her family took her to see a Broadway show. Husband's with her, some kids, some grandkids. And, you know, while they're waiting in line, she sort of collapses. The family responds immediately. Like, they lay her flat, okay? They start fanning her. Someone calls 911. Literally in under a minute they call 911. Ambulance comes in record time, and the EMS finds that she's actually in cardiac arrest. So she's in cardiac arrest. She comes to the hospital, and that's where I get involved in the story, because I'm the resident there. And so I'm like a second-year resident, which means I'm sort of—I know some things and I'm cocky about it, but I don't know what I don't know, type of thing.

LATIF: Okay.

AVIR: So I'm seeing this patient come in. It's cardiac arrest and I, like, know my algorithms and I'm like, "Ooh, I got this!" So we start doing everything. We're doing chest compressions, we start IV, we put a line into her shin so we can put synthetic adrenaline in there. We're shocking the heart. You know, we're putting her on a ventilator. We're doing all these things. We're working on the heart for, like, at least 20 minutes, maybe 30 minutes.

LATIF: Okay.

AVIR: So I'm there and I'm just, like, so eager about it. So we shock the heart, we look with an ultrasound. It's not beating. Shock it again, shock it again, and eventually all of a sudden, boom! Just like that, the heart restarts, blood pressure is normal. All of a sudden, all these vital signs that were all beeping at me start—start looking great. And so I was super-excited. The family's all around me. They're crying. And now they're crying. I tell them, "She's back." And they're crying, like, tears of joy.

LATIF: Wow!

AVIR: They're like, "Wow. Amazing." So the next step is now she's more stable, so now we have to bring her to get a CAT scan. So ...

LATIF: So Avir had brought some visuals with him, and at this point he showed us a slide of a CAT scan of a healthy brain.

AVIR: This is kind of what a good CAT scan of a brain would look like. I know it's hard to see, but it's, like, a cross-section of a brain, okay?

LATIF: Kind of looks like how you would picture a healthy brain with, you know, folds and everything.

LULU: Mm-hmm.

AVIR: Got these nice, black ventricles in the middle. You have all this nice brain matter there. To me this is a beautiful picture. I don't know if you guys feel that way. But what I saw next was this.

LATIF: Then he showed us the CAT scan of the brain of this patient—Avir calls her Mrs. W. And this is what he saw in that moment.

AVIR: And this sort of made my heart sink into my stomach.

LATIF: It's just a blob. It's just a gray blob.

AVIR: What I'm seeing here is that this brain is dead, completely dead.

LATIF: Oh my God.

AVIR: And I guess in my eagerness to sort of be the guy who knows what to do, I just sort of didn't even think about this. And now I have to go out and, you know, talk to the family. And it was—I just wanted to disappear. It was like a terrible, terrible moment for the family, and now I'm part of it. So I had to tell them, and I felt terrible, because now I have to tell this family that, "Actually, your grandmom is brain dead," and now I had to sort of make them withdraw life support. And, you know—and I felt like I wanted to save her life, and what I ended up doing was making her sort of die twice.

LATIF: Oof! Well, how did the family take it?

AVIR: They were very gracious about it. They were very nice. They were kind. They were like, "You did everything you could." But it just sort of shook me out of this sort of immature kind of cockiness I had in the emergency department at the time.

LATIF: Right.

AVIR: So that—that sort of stuck with me forever, I guess. I think about that case a lot.

LATIF: But, like, what went wrong? Like, why did it—like, yeah, did you do something wrong? Like, what happened?

AVIR: Right. Well, let's table that, because if we do a good job tonight, I think by the end, you guys will know exactly what went wrong there.

LATIF: Okay.

AVIR: So we'll get there. But yeah, I guess that's sort of the impetus for why I wanted to do this show. Because, you know, I was thinking in our society we worry about so many things. You know, we wake up in the morning, start doom scrolling. And we worry about—you know, we're worried about climate change, we're worried about gun control, we're worried about terrorism. But, like, really the reality is the majority of human beings die because of heart problems. It's not sexy, but it's just true. Like, this is—across the world.

LATIF: So at this point we're all looking at a graph of the leading causes of death worldwide. So, like, all—of all the deaths that happen on planet Earth, and number one is heart disease and heart failure. The number two is not even close.

AVIR: Far and away—like, down here we have terrorism.

LATIF: Wow. Yeah.

AVIR: We have all climate change. I'm not putting any of these things down. Like, they're real. But fires, suicides, murders, HIV is somewhere on this list. But cardiovascular disease, it's just insane.

LATIF: Wow! We should, like, allocate government budgets based on this ...

AVIR: Right.

LATIF: ... graph. Okay. Anyway, yeah. Right.

AVIR: But we do it based on what's scariest-looking, you know?

LATIF: Right.

AVIR: And in America it's a little better. It's only just one in three people will die of heart problems, so I don't know if you guys want—you know, look to your right and to your left, figure out which of the three of you is dying from your heart. It's one of—one of the three.

LATIF: I'm just glad there's only two of us onstage.

AVIR: Right. So okay—so, when hearts do stop, you know, if the heart stops, and eventually when it stops, it can happen slowly or quickly, right? So if your heart starts to die slowly, that's good in a way, because at least you can, you know, get your way to a hospital, see a doctor, make an appointment.

LATIF: When you say "slowly," like, how slowly are you talking about?

AVIR: I mean, I'm saying, like, it's almost like if you're driving a car and the "check engine" light comes on. Like, you know you need to take it into the shop but, like, you can wait a couple of hours or maybe you can wait a couple of days.

LATIF: Right. Okay. All right.

AVIR: But sometimes your heart stops quickly. Like, one minute it's working, the next second it stops working. And when that happens, we call that cardiac arrest, basically. Your heart arrested. And the thing about a heart stopping is basically that means you're dead. So, like, when we pronounce a death, we'll listen with a stethoscope to the heart. I'm sure you've seen that on TV and stuff. But actually, this idea that a dead heart is a dead person kind of goes back as long as humans have been around. This is gonna sound weird, but I was just reading Gilgamesh for some reason. Great book. I don't know.

LATIF: How do you have time to read? I don't get it!

AVIR: Okay, audiobook. It was an audiobook.

LATIF: Okay, all right. All right.

AVIR: An audiobook of Gilgamesh.

LATIF: All right.

AVIR: I highly recommend it. Gilgamesh, it turns out, is the oldest story that we know. It's, like, the first written story. And even in Gilgamesh, they sort of reference—they say, "What is this—" you know, someone dies in the story. "What is this sleep which has seized you? You have turned dark and do not hear me. He touched his heart, but it beat no longer." So even then, I was listening to it and I was like, "Oh, wow!" Even then, 4,000 years ago, they knew that when someone doesn't have a heartbeat, they're dead. And as long as humans have known that, we've been trying to restart hearts.

AVIR: So there's this—sort of been this practice of, like, reanimation, bringing a heart back from the dead, that we've been working on for thousands of years. The oldest reference is actually—and we don't have to read the whole quote, but is in the Old Testament here. There's actually this guy, Elisha—Elisha? Does anyone know how to—Elisha? Okay, so this guy—what was he, a prophet or a—he's a prophet. So he did this thing. So there's this story of when he goes into someone's house, a boy's house. And he goes and he sees that he's dead, so he goes and closes the door behind him, prays, and then lays on top of the boy, puts his lips on the boy's lips, eyes to eyes, and just lays on him.

LATIF: Whoa!

AVIR: And then the body—the boy's body grows warm. The boy sneezes and comes back to life.

LATIF: He sneezes?

AVIR: Yeah.

LATIF: Wow!

AVIR: I mean, okay, I didn't—I didn't learn this technique in medical school.

[laughter]

LATIF: [laughs] Okay. All right. Yeah.

AVIR: But I guess—I mean, in the Old Testament they say it worked.

LATIF: Huh!

AVIR: So who knows if this really happened? I don't know. Do you think it really happened?

AUDIENCE MEMBER: It says that he was alone with the boy in the room?

AVIR: Yes.

AUDIENCE MEMBER: With—the door is shut. So who knows?

[laughter]

LATIF: Oh boy!

AVIR: True New York skeptic right there.

LATIF: [laughs]

AVIR: All right. Yeah, so that. So who knows? But in the modern era we've been trying to do this for a long time. Actually, I don't know if any of you guys have seen this picture.

LATIF: So this is like a—it's a drawing, like, an old drawing you'd see in, like, an old medical atlas or something.

LULU: Okay.

LATIF: There's someone lying on the ground naked on their side.

LULU: Okay.

LATIF: And then there's someone else sitting over top of that person.

AVIR: And this guy puts a tube up this person's rectum.

LATIF: Does he know you can't really get to the heart from there?

AVIR: You know, I'm not sure what they're thinking.

[laughter]

AVIR: But he takes a big drag of a cigarette or a cigar ...

LATIF: Okay.

AVIR: ... and blows the tobacco smoke into the rectum. This was called a "tobacco smoke enema." And it was ...

LATIF: What's the logic here? Like, why do they think this is ...

AVIR: All right, I did spend some time trying to put myself in this guy's shoes.

LATIF: Okay.

AVIR: And the best I could come up with is nicotine is kind of a stimulant.

LATIF: Okay?

AVIR: And the rectum has a lot of tissue. So maybe just blowing a bunch of nicotine in a bunch of tissue was thought to work, you know?

LATIF: Great. Sure.

AVIR: But, you know, no surprise to anybody here, it didn't really work. Actually, the phrase, "blowing smoke up your ass?"

LATIF: Right.

AVIR: That's where that came from.

LATIF: Right. And from the guy next to him, when he's like, "This is working, right?" He's like, "Yeah, for sure it's working."

[laughter]

AVIR: Yeah. After a couple of centuries—or, you know, a couple of decades of this, it just became, "Yeah, blowing smoke up my ass. I get it." But we've tried other things even more recently. You know, so like all things that I love in science, an answer kind of came from probably the most bizarre place that you could ever think of.

LATIF: Okay.

AVIR: This guy, Rudolf Boehm. He's a German guy.

LATIF: Okay.

AVIR: And this is 1878. So this guy is a pharmacologist, and he's studying chloroform.

LATIF: I mean, this is the guy with a big bushy beard. This is kind of the guy that you'd sort of expect.

AVIR: Yeah. And I don't know why they invented chloroform, but he was experimenting on it. And the way he would experiment on it is to take cute cats ...

LATIF: Okay.

AVIR: ... and chloroform them. I know.

LATIF: Just for fun.

AVIR: Just for—I mean, today, he would be labeled a sociopath.

LATIF: Okay. All right. Okay. Okay.

AVIR: But you could do that back then. So he would just kill these cats, or he would chloroform them. And the thing about chloroform is if you don't use enough, it really doesn't do anything, if you use too much it kills the person. You know, you gotta get that happy medium.

LATIF: Right.

AVIR: And so—I don't know if this is true, but this is what I think. He was spending too much money getting all these cats. You know, he kept killing cats. So he's, like, trying to figure out, "How can I, like, you know, work on my budget, here?"

LATIF: He's trying to reduce, reuse, recycle, kind of thing.

[laughter]

AVIR: Exactly.

LATIF: Right. Okay.

AVIR: So what he sort of by doing this over and over again realizes is that if he chloroforms his cats too much, he can start—sort of start squeezing the cat's chest for a few minutes and then the cat would survive.

LATIF: Wow. And that's the guy. That's the guy.

AVIR: And this is the guy.

LATIF: This is how he figured this out.

AVIR: So that happened. He publishes this. And then lo and behold, 20 years later, a young surgery resident is in the hospital. One of his patients dies, and he somehow heard about this and just tries it on a patient.

LATIF: This is in Germany again?

AVIR: No. This is in—I think this was in the US.

LATIF: Okay, yeah.

AVIR: So he—or maybe England. I can't remember where it was. But this is 20 years later, so early 1900s. He just randomly tries it on a patient and lo and behold it works.

LATIF: Wow!

AVIR: So these are the first times that we were able to bring people back from the dead. And since then, we've progressed a very extremely long way. Now we have so many ways to do it, we almost take it for granted.

LATIF: Right.

AVIR: You know, we can shock people back into a normal rhythm, we can give super-strong medicines. We even have machines that will pump for the heart when the heart can't pump.

LATIF: Hmm!

AVIR: I mean, it's—we're so used to it, honestly, that in the OR and places, people will induce cardiac arrest just to test the heart so that they know what causes it to bring it back on certain patients.

LATIF: Wow! It's, like, such a—like, it's now like a standard miracle. Like, it's like—an expected thing that we're totally fine with.

AVIR: It's like—yeah, yeah, cardiac arrest, let's bring him back. So I have a little video here that I think is cool. I don't know if you guys will think it's cool, but this is a heart—oh, we got the music too. So this is them in the OR in a—and this is a normal heart that's beating in a weird rhythm, and all of a sudden it goes into cardiac arrest. You'll see right here, they induce cardiac arrest. Now the heart is dead. It's dying as we speak.

LATIF: Wow.

AVIR: Okay? And then you hear a shock charging. They shock the heart and now it's back.

LATIF: Whoa!

AVIR: And you can hear it by the way they're casually playing Bon Jovi in the background ...

LATIF: This guy's living on a prayer. I mean, it does feel like ...

[laughter]

AVIR: [laughs] I couldn't have said it better myself. But basically it's, like, standard. This is no big deal, right?

LATIF: Right. Right. Right.

AVIR: So you would think at this point cardiac arrest would be, like, no—no big deal. Like, you go into cardiac arrest, we got you.

LATIF: Right.

AVIR: Unfortunately, that's just not the case.

LATIF: Turns out that if you suffer cardiac arrest outside of a hospital, on average, your chance of surviving, of living, is eight percent.

LULU: Eight percent?

LATIF: Yeah.

AVIR: Eight percent. Which—look at that another way. If you—if your heart stops quickly anywhere in the world outside of a hospital, you basically have a ninety-two percent chance of just dying then and there, right?

LATIF: Wow.

AVIR: And that means that, like—I don't know, it's like you never had a chance to see a nurse, see a doctor. It's like you had died a hundred years ago or a thousand years ago. It's really no different.

LATIF: But is that ...

AVIR: That's how a lot of people are still dying.

LATIF: But is that a thing—is that just a thing about the heart? Like, the heart is—it can only be revived eight percent of the time or something?

AVIR: Right. Yeah, exactly. You could think, you know, is there something inherent to the heart—eight percent? It turns out no, because it turns out there is a place in the world where you can have a cardiac arrest and you'd have, like, much better outcomes. So I don't know, do you want to take a guess where it is?

LATIF: Like, what's the ideal place to have a cardiac arrest?

AVIR: Yeah, maybe we should ask—like, do you guys have any ...

LATIF: Okay, any guesses?

AUDIENCE MEMBER: The hospital?

LATIF: Hospital.

AVIR: Hospital.

LATIF: Where was that? I would think, like, a nursing home, maybe?

AVIR: Nursing home?

LATIF: Anywhere else? Just name places. Who knows?

AUDIENCE MEMBER: Denmark.

LATIF: What's that?

AUDIENCE MEMBER: Denmark.

LATIF: Denmark, okay. That's fun.

AVIR: Denmark!

LATIF: The gym, maybe?

AVIR: He knows something. Okay, so I'm going to shatter all your ...

LATIF: Okay.

AVIR: ... beliefs. The best place to have a heart attack is a casino.

AUDIENCE MEMBER: What?

AVIR: Yes.

LATIF: And why is that?

AVIR: So, you know, it turns out that it's the perfect practice space for cardiac arrest. You have a lot of older, elderly people ...

LATIF: Okay.

AVIR: Right? At a casino.

LATIF: Okay.

AVIR: They periodically lose a lot of money and get very stressed.

LATIF: Yeah. No kidding. Right.

AVIR: And they often manage that stress by doing potentially unhealthy things like smoking cigarettes or drinking alcohol.

LATIF: Okay.

AVIR: So cardiac arrests happen a lot at casinos, and everybody there is on camera, and everybody in—who works there, like the dealers, you know, everybody, they're all trained in CPR.

LATIF: Ah.

AVIR: So as a result, the arrest—the survival rates of cardiac arrest in casinos is actually 53 percent.

LATIF: No!

AVIR: It's unreal.

LATIF: We'll save your life but take your shirt.

AVIR: Yeah.

LATIF: Yeah. Wow!

AVIR: Sorry, residents. It's not where we work. It's not.

LATIF: Yeah. Wow!

AVIR: Yeah, so to me that's saying, like, you know, we can do something. If we could do CPR, we can really increase these numbers.

LATIF: Because the reason the survival rate is so good in the casinos is because there's someone right there, right in that moment, doing CPR, getting that heart beating right away.

AVIR: It really comes down to time. So this is a survival curve.

LATIF: Okay, so another graph here.

LULU: Mm-hmm.

LATIF: So okay, along the side it's survival percentage.

LULU: Okay.

LATIF: Right? Zero at the bottom, a hundred at the top.

LULU: Okay.

LATIF: And then on the bottom you have, like, minutes.

AVIR: And at time zero, that's like when your heart stops. And you can see every minute that passes, your chances of coming back just exponentially decreases. So, you know, think about in New York City, we have, like, the—there's an ambulance on every corner, as you guys know. It keeps you up all night. And the average response time in New York City is five minutes and fifty-three seconds. And that's great.

LATIF: That's pretty good. Yeah, that's pretty good.

AVIR: That's great. But look at where that puts you on this graph.

LATIF: Oh yeah, not—not good. Not so good.

AVIR: Yeah, not so good. You're at, like, between 10 and 20 percent. You're probably at, like, 15 percent chance of survival, right off the bat.

LATIF: Wow!

AVIR: Now picture—you know, I don't know, picture you're in Nebraska or somewhere else, where a good time would be 30 minutes.

LATIF: Right.

AVIR: So that's the problem, right? And just to put this in context, like, cardiac arrest in the US happens 1,000 times every day.

LATIF: No!

AVIR: Yeah. So this is, like, dismal to me, right? Like, you have a 92 percent chance of staying dead, it's happening a thousand times a day.

LATIF: Right.

AVIR: And survival is not great.

LATIF: And Avir's point was, like, given that graph, the real problem is that when this happens outside of a hospital, there's just not enough time, right? The key is the person or people who are right there with them at that very moment on the sidewalk or in the house or the restaurant or whatever, the only way to nudge that number is for those people to do something.

AVIR: We have to squeeze the heart. We have to compress that heart. So it's actually very simple—don't let anyone make this complicated. You have a heart sandwiched between two bones. You have a breast bone up top, and you have vertebrae below it. And all you're basically doing is just sandwiching the heart between those two bones and manually pumping it.

LATIF: Okay.

AVIR: You know, and you can't do it forever, but this actually works. Is it fixing the problem? This is where a lot of people get confused. Is it fixing the heart? No. Is it just pumping the blood around to sort of buy you time? Yes, that's exactly what it's doing.

LATIF: Got it.

AVIR: Now all of a sudden, your survival goes down much more gently. You're buying yourself time for someone to come in and do something about it.

LATIF: Right.

AVIR: So I guess that brings us to, like, the real question is, you know, what would you do in this situation, you know? That's the question. Because the truth is, like, when this happens out in the world, a lot of us just freeze.

LATIF: Right.

AVIR: You know? And I can't help. I'll be at work, you know? You'll be in the recording studio.

LATIF: Right.

AVIR: So it really just comes down to you guys, right? Like, what would you do? Really put yourself in that situation, because it sounds good on paper but, like, imagine you're just walking down the street and someone collapses, or you're with someone and they collapse.

LATIF: So what would you do, Lulu?

LULU: If I saw someone collapse?

LATIF: Yeah.

LULU: I mean, I would call 911, I would say, "Does anyone know here—does anyone else here know what to do?"

LATIF: Yeah.

LULU: And, I mean, I'd be really scared to do the wrong thing.

LATIF: Yeah.

LULU: And I'm probably so frozen, I'm probably just calling 911, and waiting and hoping and searching for someone who knows what to do.

LATIF: Yeah. And I mean, that's fair, right? Because most of us haven't taken a CPR course, it's a little bit scary, feels maybe dangerous.

LULU: Right.

LATIF: But here's the thing about this whole event that actually felt really new, and actually shook me, right? Okay, so because according to Avir, there is a new way of thinking about and doing CPR that is completely changing the game. And when we come back from break, we are going to have a couple of very special guests come up to the stage and tell a story that is on the one hand completely heroic, but at the same time when you hear it you realize just actually how easy stepping up to a moment like that can be.

LULU: Hmm!

LATIF: So just stick around. We'll be right back.

LATIF: Latif.

LULU: Lulu.

LATIF: And we are back from break, where Avir and I were on stage in New York City. We are now about to bring up on stage a couple, they're called the Glaucomfleckens.

LULU: Glaucomflecken?

LATIF: They are ...

LULU: Is that their last name?

LATIF: No.

LULU: Oh.

LATIF: It's sort of their, like, nom de TikTok.

LULU: [laughs] Okay.

AVIR: We're bringing Will Flanary and his wife Kristin Flanary out to talk to us. Now I know about him because of this guy's TikTok channel. He makes comedy videos for healthcare professionals that literally are—like, spread like wildfire. So this guy is, like, literally the Elvis of medical comedy, I swear. I mean, he's—he's amazing. So I want to bring up Will Flanary and his wife, Kristin Flanary.

[applause]

LATIF: Yeah!

WILL FLANARY: Thank you.

LATIF: Okay.

WILL FLANARY: Thank you very much.

[laughter]

WILL FLANARY: Hi, everyone.

[audience, "Hi!"]

WILL FLANARY: So yes, I am an internet comedian ophthalmologist, which I swear is a real job that—I made it up, but it's still a real job. If you don't know what an ophthalmologist is, though, I am an eye surgeon. So that means I went to med school, and I learned everything there is to learn about the human body, the entire human body. And then I said, "I don't want to do any of that." It's like, "I'll just devote my career to the eyeball." And so now I'm a practicing ophthalmologist, and Kristen has been with me since the beginning. We ...

KRISITN FLANARY: Not since birth. We're not siblings.

WILL FLANARY: Not too far after. We met in college, and I went on to med school, Kristin went on to grad school. We were at Dartmouth. But our story really starts in—well, it starts a long time ago, but we're gonna go to 2020. The pandemic hit, and when the lockdown occurred, my practice shut down, so I couldn't see any patients. So I had all this free time on my hands. I did start making TikToks around that time. But there were also—there were a few times where I honestly thought I might get redeployed to the hospital to help out. And do you know how bad a public health emergency has to be for someone in the ICU to be like, "Are there any ophthalmologists we could get up here?"

[laughter]

WILL FLANARY: Now fortunately, it didn't happen. Like, there were plenty of more qualified people than an eye doctor to go help out. But I had all this free time on my hands, making all these videos, trying to do virtual ophthalmology, which is as hard as it sounds. And then on Mother's Day in 2020, we had a wonderful day. We were at my in-law's house. We had a nice meal out in the backyard.

KRISITN FLANARY: Social distancing with my parents. It was very weird but it was nice.

WILL FLANARY: We had a water balloon fight in the backyard. And that day, Kristin took a lot of photos. And those were almost the last photos that were ever taken of me, because later that night, I had a cardiac arrest in my sleep.

KRISITN FLANARY: At around 4:45 in the morning, I woke up to him making some very strange sounds. Fortunately, they were loud and I'm a mom, so I'm a light sleeper. All you moms know exactly what I'm talking about. And I woke up, and I thought he was snoring. I was still really groggy. I'm not in medicine. I studied cognitive neuroscience and then education and marketing and basically everything but medicine. Bodies are gross.

KRISITN FLANARY: And so I thought he was snoring. I did the thing that you do, you know, like, "Ah, quit it, you're waking me up!" And, like, tried to get him to turn over and stop snoring, but he wasn't responding. And he was—just something about how he wasn't responding kind of raised a red flag, like, whoa, that's weird! And I couldn't put my finger on why, but it just didn't seem right. And so I tried a little bit harder. Still nothing.

KRISITN FLANARY: And so then I started to get a little freaked out, and so I started kind of slapping his face a little bit and yelling his name. And then he still wasn't responding. And I had no idea what was happening, but I knew this isn't right. This is very bad. And so I just did the only thing I could think of to do, which was I called 911.

KRISITN FLANARY: And it was the most bizarre period of time in my whole life. I sort of—part of me—part of my brain was, like, in the moment and just, like, really focused on, like, what needs to happen, and just, like, in emergency mode. And then another part was just sort of—it was almost an out-of-body experience. Like, I wasn't the one dying, but I was the one having an out-of-body experience, just sort of watching myself and this scene unfolding and just feeling like, "What?" You know, like, this is just so wrong. He went to bed perfectly healthy. I take that back. You were not perfectly healthy. He had survived testicular cancer two times before that. So, like, he's used up three of his nine lives so far, but hopefully ...

WILL FLANARY: I had a little bout of cancer a couple times.

KRISITN FLANARY: Yeah, yeah, yeah. But that wasn't anything. You know, we had moved ...

WILL FLANARY: I was fine.

KRISITN FLANARY: ... past that. He had been completely healthy, cleared, all these things. And it just seemed so wrong that anything would be wrong with him. He doesn't have a family history of any cardiovascular incidents, really. He didn't have a personal history. So it was just the most bizarre thing. And I was leaning my head over his chest as I was calling 911, and I was sort of noticing—like, I don't hear anything. There's no heart beating in here. But it was just kind of like, "Huh! That's interesting." [laughs]

KRISITN FLANARY: I couldn't really fully process that at that time, but I remember taking note of that. And so then the dispatcher came on, and they asked what the emergency was, and I said, "My husband won't wake up." And the dispatcher asked me what I have since learned—I did not know this at the time, but I have since learned there's only two questions that you need to know the answer to to know that it's time for CPR. And that's: is he responding to you? And of course, the answer was no. And is he breathing 'normally?' And that word 'normally' is very important because I would have said, "Yes, he's breathing." In fact, I think I did say, "Yeah, he was breathing kind of. Like, taking these weird gasps, and then he would stop for a bit, and then he started breathing again."

KRISITN FLANARY: I've learned since then that's called 'agonal respiration.' It's the body's last ditch, unsuccessful attempts at breathing in air, but it's not real breath. And so that second question: is he breathing normally? The answer to that was no. So because he was not responding and he was not breathing normally, she said, "I'm gonna walk you through CPR." And I said, "What?"

[laughter]

KRISITN FLANARY: It didn't make any sense, but I just said, "Okay." And I followed her instructions, and she told me—she asked me if I could move him off the bed. We were in bed—it was the middle of the night—and so I said, "Well, I can't move him." I don't know, you know, if anyone's just listening to this, you can't see this, but I have heels on. He's got a good 13 inches on me and probably 100 pounds.

KRISITN FLANARY: And more than that, I had had neck surgery four months prior that I was still recovering from. And I said, "I can't move him off the bed." And she said, "Okay, if you can't move him, we're just gonna do it where it is." And I'm so glad I did not know this at the time, but that was bad! That was—you need a hard surface. Preferably, if you can get the person to a hard surface, do that. But I could not. And so thankfully, we do have a very firm mattress thanks to my neck. So that was good. But I did—she told me, you know, put—put your hands on his chest. Lace your fingers together, put your hands on his chest, in the center of his chest, between his nipples and just push hard and fast. And she just counted with me—one, two, three, four, five, six, seven, eight, nine, ten. Just over and over and over and over for 10 straight minutes.

KRISITN FLANARY: It was May of 2020, and we lived not far from the station that responded to my 911 call. But they were in full hazmat gear. They had hoods, shields, the whole suit, gloves, everything. And so they had to wait outside of our door, put all the gear on, and then try to get in the door, which turned out to be locked, and so they had to kick it down.

WILL FLANARY: I've never been so happy to have structural damage to our house.

KRISITN FLANARY: That's right. I will take it any day, if that's what it means. And so they finally, you know, were able to do all of that. But in the meantime, that was 10 minutes of looking over my husband and the father of my two children, who were eight and five at the time, and were asleep in the very next room. And I was thinking, "They cannot come in here. They cannot come in here." Because I didn't want them to see what I was seeing, because you can never unsee that. And they were so young. And I was watching him turn blue and then purple. He stopped making those noises eventually, and by the time EMS arrived, he was gray. And I saw them take him off the bed, carry him downstairs, and lay him down on the hardwood floor and hook a bunch of things up to him. And, you know, I may not have medical training, but I have watched television.

[laughter]

KRISITN FLANARY: And I heard things that should be beeping. I knew this. They were making a flat, solid sound and a flat line. And I knew what that meant. And so I turned around—I remember this really distinctly, unfortunately. I turned around to go back up the stairs because I wanted to check to make sure that the children were still in their beds and weren't trying to come out. And I didn't want to see what I knew was about to happen, because I saw them take out the paddles. And I—as I went up the stairs, before I could even get halfway up, I heard them deliver that first shock. And I heard the way that his 6'4", all arms and legs body just slammed against our hardwood floor in a really unnatural, weird way.

KRISITN FLANARY: And from there, I just went up. And I was trying to figure out anything useful that I might be able to do, or just a thing to keep busy, to keep from breaking down. And so I packed him a hospital bag, and I called into his clinic to tell them, "I don't think he'll be in today. You might want to reschedule his patients." And I called both of our sets of parents. And, you know, during that time, some of the paramedics, one of them was coming up and down the stairs and giving me updates, and he told me that what had happened was Will's heart had gone into ventricular defibrillat—no, ventricular fibrillation. Did I get that right? Okay. Which is what you saw on the screen, where when they stop the heart, it just sort of shakes like this, but it doesn't actually pump any blood anywhere.

KRISITN FLANARY: And the sounds that I had heard were those agonal respirations, and that meant that his heart had stopped. And—but thankfully, they were able to get his heartbeat back after they shocked him five times. They didn't give up on him, and their hoods and shields were fogging up, and they would have to switch off. And it was such an effort and a team effort to get him back, and they didn't give up on him. And they did get his heartbeat back, and they took him to the hospital. And I went into my children's bedroom, and I asked them what they would like for breakfast.

WILL FLANARY: Just to put a little bit of a different context on that from a healthcare professional, 10 minutes of chest compressions, that's an eternity. Like, two minutes you're supposed to pass off to somebody else because it's so hard to continue doing effective chest compressions after two minutes. And even I know that as an ophthalmologist, and so I still don't know how she did 10 minutes.

KRISITN FLANARY: Oh, I know. We had just gotten a mortgage, and we had two young children. You were not getting out that easily.

[laughter]

WILL FLANARY: That's why.

KRISITN FLANARY: Come back here, sir!

[laughter]

WILL FLANARY: And so they took me to the hospital, and from my perspective, you know, I went to bed one night, I woke up in the ICU two days later. I didn't have any underwear on. I didn't know what the hell was going on. And I had all the testing done in the world. And we still, to this day, don't know what caused my cardiac arrest, which is not unusual for young people that have an out-of-hospital cardiac arrest. Often we don't have a good answer for why it happens.

WILL FLANARY: And, you know, as a—as a physician, I never once thought to myself—like, when this happened, I had been a physician for like, seven years. I never once thought, "Hey, maybe my wife should know how to do CPR, any of my family members, because if something happens, I'm usually there. I'll be the one to help."

KRISITN FLANARY: We never thought about it happening to him.

WILL FLANARY: Yeah. I was the one that needed it. And I'm sure those of you here who know CPR probably have a family or friend who doesn't. And we need to support people who do it. And so we want to thank you all for being here and listening to our story. So thank you all.

LATIF: Please thank the Glaucomfleckens.

[applause]

KRISITN FLANARY: Thank you.

LATIF: Thank you so much.

KRISITN FLANARY: Thank you.

LATIF: Thank you. Thank you so much for sharing with us.

WILL FLANARY: Thank you for having us.

LATIF: Thank you so much for sharing with us.

WILL FLANARY: Thank you everybody.

KRISITN FLANARY: Thank you.

LATIF: And I'm gonna bring back out Avir.

AVIR: Thank you, guys. So what you just heard is literally an eight percent type of outcome. That is very rare, what you just heard.

LATIF: But, Avir says, the reason it did go well, it did become an eight percent outcome is because of what Kristin did. Like, her—those 10 minutes of keeping that heart going while she waited for the EMTs to show up, like, that was the crucial first step that made it possible to bring Will back and to bring him back without any brain damage.

LULU: I'm thinking about the—the weird restraints about not jumping in to do a thing.

LATIF: Oh, right right right.

LULU: And I do feel like—didn't Radiolab once even do a show where doctors themselves were like, "I wouldn't want a stranger doing CPR on me because ..."

LATIF: Yeah.

LULU: Because of the potential risks. Which again, wouldn't be necessarily everyone's call, but that there were a bunch of doctors who were ...

LATIF: Right right right right. So there's that episode. I've heard it recently. It's called "The Bitter End."

LULU: Yeah.

LATIF: Totally holds up. Everyone should listen to it.

LULU: Okay.

LATIF: But it's slightly different, what they were talking about.

LULU: Okay.

LATIF: What they were talking about was—those were doctors talking about let's say you're already in bad shape and something goes wrong. And if you do it in that sort of sense, or even if you do it—if you do it late, if you're waiting a lot of minutes and then—and then you start doing it ...

LULU: Mm-hmm.

LATIF: ... that's when it leads to way worse outcomes. So it does have some risk, but Avir's point is like ...

AVIR: You know, there are, you know, downsides to it. And you gotta think about it this way. Like, out-of-hospital cardiac arrest, you want to do CPR to bridge that person to get to a hospital. So for me, if it's out-of-hospital cardiac arrest, like, I want CPR done to at least get me to a hospital, and then if they think there's nothing that could be done, fine, you know?

LATIF: So at this point the conversation sort of turned back to, like, the reasons why people don't step in to do CPR.

LULU: Yeah.

LATIF: And, you know, they've done studies on this. You know, people are afraid you're doing something wrong, maybe they're afraid of getting sued. But one of the other big fears is the fear of infection.

LULU: Right.

LATIF: Of putting your mouth on someone else's mouth, like a stranger's mouth, right?

AVIR: That brings us to what Will and Kristin were talking about, which is sort of a new form of CPR that's trying to make things a lot simpler, and it's just hands-only CPR. So normally, you know, CPR, it's like 30 compressions, two breaths.

LATIF: Yeah. That's all I remember from learning it in high school or whatever. It's like—yeah, it's like counting the breaths and counting the pumps.

AVIR: Which, like, I can't even—I do this for a living, and I don't understand. I don't know where those numbers came from. And like you said, you gotta take a class. You know, it's expensive. You gotta get a card. Like, we don't have time for that. So what they sort of invented—because they knew no one was really doing CPR—is hands-only CPR, where it's literally just push hard and fast on the chest. That's it.

LULU: Oh!

LATIF: No breathing necessary.

LULU: You don't gotta do any lip-to-lip, mouth-to-mouth action.

LATIF: None of that. None of that.

LULU: Just push. Okay. Huh!

AVIR: And they were saying, "Well, maybe—" they thought maybe this will do. You know, it won't be as good, but maybe it'll be something. And actually, when they found out—they have been studying it now for a couple years, head-to-head trials, this is producing the same outcomes as the big fancy CPR, just pushing hard on the chest.

LULU: Whoa! Really?

LATIF: Yeah, the breath counting, all that stuff. Forget all that. Just literally pump pump pump pump pump pump pump.

AVIR: And the reason is, you know, when you're pushing on someone's chest, you're kind of squeezing their lungs a little bit. You know, you're getting a little bit of everything.

LULU: And that feels a little less scary to do.

LATIF: Way less scary.

AVIR: So hands-only CPR. That's kind of where we're gonna be at because I want to teach you guys how to do hands-only CPR. So if we can have Al come up, we ...

[applause]

AVIR: Yeah, give it up for Al.

LATIF: From the Red Cross, everybody!

AVIR: They're from the Red Cross. They sponsored this. They're bringing all these amazing dummies. So we're gonna show you guys how to do hands-only CPR right now. So what you—why don't you—what do you want to tell them?

AL: I want to basically demonstrate CPR.

LATIF: Yeah.

AL: Hands-only CPR and give them step-by-step instructions on how to do it.

AVIR: All right, so you demonstrate. So you're gonna put one hand over the other, okay? Do it in the middle of the chest, and then you're just gonna push hard and fast down on the chest. You want to go about two inches. It's harder than it is on the movies, but you can see that right there. That's good CPR. Another thing to notice is he's not moving his arms because that—you could do it. It's just tiring. So what he's doing is sort of moving his hips like this. Use your hips as a fulcrum and go up and down like—just like that. Does that make sense? Awesome. All right. Thank you, Al. Basically, you just do that.

[applause]

LATIF: Whoo! Whoo! All right. Okay. Yeah.

AVIR: Should we take some questions?

LATIF: Yeah. Are there any questions, or should we just, like, jump into it? Do we have any questions?

LATIF: So at this point we took a couple of questions from the audience. But we were basically like, you know, "Now is the time. The show is basically over. Everybody's gonna stand up, we're all gonna practice this. We're all gonna train on how to do hands-only CPR."

LATIF: If you're game, we want all of you to try it.

AVIR: Yeah. So let's have people come up. And I just want to say that, you know, my thinking about this is like, for all the modern medicine we have, at the end of the day, when it comes to this, all we really have is each other. So I—that's why I feel very strongly about this. We gotta help each other out. So come on up.

[applause]

LATIF: All right, everybody come on. Yeah, let's do it.

LATIF: And it was awesome. Like, we got a heart-shaped disco ball down.

LULU: Oh, that's great!

LATIF: So it turns out the right beat for doing CPR is between 100 and 120 beats per minute. And it just so happens that the song "Stayin' Alive' by the Bee Gees is 103 beats per minute.

LULU: Yeah, right!

LATIF: Which is kind of perfect.

LULU: I can't act surprised because I learned this at Radiolab, and I will never forget it. It's so good. It's so good.

LATIF: But it turns out it's not just "Staying Alive."

LULU: Okay.

LATIF: There's a whole playlist on Spotify that has songs that are at that exact beat, and it's called "CPR Jams."

LULU: [laughs] That's great. What else is on there?

LATIF: Here, let me look. Okay, there's, like, three Usher songs on here.

LULU: Okay, which ones?

LATIF: "Yeah!," "Burn" and "Caught Up." "Crazy in Love" by Beyoncé.

LULU: Oh, "Crazy in Love" is?

LATIF: "Crazy in Love." "Baby Don't Lie" by Gwen Stefani.

LULU: Okay.

LATIF: "Hold On" by Wilson Phillips. "Hold On" feels like that's right.

LULU: [singing] Hold on for 10 more minutes.

LATIF: "Texas Hold 'Em" by Beyoncé. That's a new one.

LULU: Yeah.

LATIF: "Could You Be Loved?" Bob Marley and the Wailers.

LULU: [singing] Could you be loved?

LATIF: "I Wanna Dance With Somebody," Whitney Houston.

LULU: [singing] I wanna sing with somebody ...

LATIF: "Jolene."

LULU: [singing] Jolene, Jolene ...

LATIF: "Just Want to Have Fun," Cyndi Lauper. Justin Timberlake, "Rock Your Body," because he's—I mean, what you're doing is you're rocking a body.

LULU: You sure are.

LATIF: "Never Gonna Give You Up," Rick Astley.

LULU: Oh, the Rickroll song is?

LATIF: The Rickroll song.

LULU: [laughs] Okay that's the one I think I might, like, channel.

LATIF: Yeah, that one almost feels earlier, yeah. "Take a Chance On Me" by Abba.

LULU: Man, wow! Well, thank you, Latif. Thank you, Avir. Yeah, I feel empowered to just use my hands. Hands-only. This is great.

LATIF: And if anyone does save a life after—because of hearing this ...

LULU: Tell us.

LATIF: Let us know.

LULU: Radiolab@wnyc.org. Let us know.

LATIF: Yeah. Okay.

LULU: Cool. That was great, Latif. Thank you.

LATIF: Yeah, yeah, yeah. And big, big thanks to Will and Kristin Flanary, aka the Glaucomfleckens. You can check them out on their podcast, "Knock Knock, Hi!" And they're actually going on a live tour starting in August. And if you go see that you can hear more details about their story. It's called—of course it is—"Wife and Death." Thanks to the Greene Space here at WNYC's home in New York City. First of all to Jennifer Sendrow, who helped us make it work at basically every stage of the process, as well as the rest of the Greene Space crew: Carlos Cruz Figueroa, Chase Culpon, Ricardo Fernandez, Jessica Lowry, Skye Pallo Ross, Eric Webber, Ryan Andrew Wilde and Andrew Yanchyshyn. And also thank you to the Red Cross for helping us make this happen and providing the CPR dummies. And to all the CPR trainers we had: Ashley London, Jeannette Nicosia, Charlene Young, Jacob Stable, Ty Morales, Anna Stacy and Adithya Shankar. And by the way, you can see a video of the entire live show in its raw form on the Greene Space website, TheGreeneSpace.org—'Greene' is G-R-E-E-N-E. Where you can also check out all the other awesome live events happening at WNYC.

LULU: All right.

LATIF: That's it.

LULU: That'll do it.

LATIF: Yeah. [singing] Take a chance on me. Take a chance, take a chance, take a chance. Yeah, okay.

[LISTENER: Hi, I'm Rhianne, and I'm from Donegal in Ireland. And here are the staff credits. Radiolab was created by Jad Abumrad, and is edited by Soren Wheeler. Lulu Miller and Latif Nasser are our co-hosts. Dylan Keefe is our director of sound design. Our staff includes: Simon Adler, Jeremy Bloom, Becca Bressler, W. Harry Fortuna, David Gebel, Maria Paz Gutiérrez, Sindhu Gnanasambandan, Matt Kielty, Annie McEwen, Alex Neason, Sarah Qari, Valentina Powers, Sarah Sandbach, Arianne Wack, Pat Walters and Molly Webster. Our fact-checkers are Diane Kelly, Emily Krieger and Natalie Middleton.]

[LISTENER: Hi, this is Ellie from Cleveland, Ohio. Leadership support for Radiolab's science programming is provided by the Gordon and Betty Moore Foundation, Science Sandbox, a Simons Foundation initiative, and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.]

 

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