Death becomes him: Dr. David Casarett

LIKE THE BOY in "The Sixth Sense," Dr. David Casarett spends a lot of time seeing dead people. But as a doctor of hospice and palliative medicine at the Hospital of the University of Pennsylvania, Casarett also has a keen interest in those near death and those technically no longer dead.

His experiences with people nearing the end of their lives tie in nicely with his nearly 25-year fascination with the science behind reviving those believed to have taken their last breath - a fascination that started with the story of a drowned toddler and led to his new book.

Casarett spoke with Howard Gensler about the surprisingly funny Shocked: Adventures in Bringing Back the Recently Dead, which looks at lifesaving (or life-returning) techniques in history and considers what options lie in the future.

Q What do you do as a hospice

doctor?

It's a mix of taking care of patients very near the end of life and a lot of focus on symptom management.

A lot of management of pain, delirium, shortness of breath and nausea. Also help with a lot of psycho-social and emotional support. Help with decision-making.

Much of what we do is help patients think through treatment options - whether the most aggressive treatment is really the right treatment for them.

Q What prompted you to write "Shocked"?

I tell the story in the book of Michelle Funk, a 2 1/2-year-old who died and stayed dead for three hours and then was brought back. Her story originally made me want to be an emergency room doctor, but I strayed a little bit.

I wanted to see what medical advances have occurred while I've been a hospice doc. I decided to write the book the way I did to try to get these issues in front of a larger audience.

I thought if I wrote a hopefully humorous, lighthearted book with a decent amount of weird, interesting science, I'd get people to pick it up.

That's how I try to interact with patients, in a lighthearted, humorous way. It doesn't work with all patients. But particularly when patients get here, some of them are so sick of the sad, frowny faces. [They say] I wish doctors would crack jokes.

Q Any other books?

I wrote an end-of-life book a couple

of years ago called Last Acts. I have

another book coming out in April about medical marijuana called Stoned.

Q Some Cryonauts (folks who

freeze their bodies hoping for

revival) you write about believe that

chopping off one's head and freezing

it is a good plan. But where do you

find a body when you return?

You're not the only person confused by marching boldly forth into the future without your body. One theory is that you take your cells and clone your body and then put your brain in your head on your body.

The other, which gets a little bit more wifty but kind of makes more sense, is that you take the brain signals that are there and replicate them on a hard drive. If you assume that your personality and your memories are a product of these neural connections, in theory you could replicate them in a computer and your consciousness would be revived.

The key is you've got a thousand years to figure it out.

Q Why wait 1,000 years? All your friends will be gone.

If a cure is just a few years away, you wouldn't want to wait. The reason why that time frame is used is because we're at least 50 to 100 years away from being able to bring people back. The best we've been able to do so far is heart valves, chicken sperm and corneas.

Q What might be the best chance for a breakthrough?

Suspended animation. I don't like to use that term much because it sounds like science fiction and everybody laughs. But the theory behind suspended animation is like that of hibernation, which is why folks are studying bears, lemurs and squirrels.

If you could trick the human body, particularly the brain, into a state of hibernation, and drop its metabolism down 90 to 95 percent, you're better preparing those brain cells to survive under conditions in which there isn't enough oxygen - a cardiac arrest, gunshot wound, motor vehicle accident. In these situations you don't want your brain cells using up oxygen at a regular rate. You want to tell them to slow down, peace out.

Ideally, if you revive someone after cardiac arrest, you want them to be able to go back to doing the work they were doing. The way to do that is to protect brain cells. I think suspended animation is the best shot we've got.