Podcast Title: Unexplainable
Host/Author: Vox
Episode: Mostly Dead is Slightly Alive
Release Date: June 16, 2025

Introduction

In the episode titled "Mostly Dead is Slightly Alive," the Vox team delves into the intricate and often perplexing definitions of death in the modern medical landscape. Hosted by Bird Pinkerton, the episode explores how advancements in medical technology have blurred the traditional lines between life and death, raising profound ethical and philosophical questions. This episode features insights from Adam Richman, a perfusionist at the Mayo Clinic, who provides a firsthand perspective on the challenges and ambiguities faced by medical professionals in defining and managing death.

Evolution of the Definition of Death

Bird Pinkerton opens the discussion by posing a fundamental question: "Are there different ways that humans might be dead?" (00:58). This inquiry stems from a long-standing debate initiated by bioethicist Bob Troog, who highlighted the complexities in defining death beyond the traditional markers.

Originally, death was a clear-cut concept marked by the cessation of the heart, breathing, and muscle stiffness (rigor mortis). As Pinkerton explains, "You just kind of knew it when you saw it. Your heart had stopped, you had no breathing, stiff body, and you were, you" (01:26). However, the advent of technologies like ventilators in the 20th century introduced scenarios where the body could maintain essential functions despite the failure of vital organs like the brain.

This technological intervention led to the recognition of brain death, a condition where the brain and brain stem cease functioning irreversibly, even though other bodily functions are artificially maintained. Pinkerton notes, "Not just the your heart stopped and your cold and still version that we're all more familiar with, but also another version, what we call brain death, irreversible brain damage, where a brain and a brain stem stop functioning and stop sending signals" (02:05).

Insights from Adam Richman

Enter Adam Richman, a perfusionist whose role is critical during cardiac surgeries. Richman provides an insider's view on how his work intersects with the evolving definitions of death. He recounts, "Death is, unfortunately, part of cardiac surgery" (03:15), highlighting the delicate balance medical professionals must maintain between life-sustaining interventions and the finality of death.

Richman explains the process of deep hypothermic circulatory arrest (DHCA), a technique used during complex heart surgeries. "That's exactly what it is. You know, for instance, hear about a child that's fallen through the ice in the winter, and their heart stops, and everything and, you know, they're brought to the hospital and warmed up again. They're essentially reanimated." (05:08). This method involves cooling the patient's body to drastically reduce metabolic rates, effectively slowing down bodily functions to pause life processes temporarily.

He elaborates on the challenges posed by DHCA: "We don't understand very well neurologically what's going on." (07:02). The application of this technique raises critical questions about the state of the patient during surgery—are they truly dead, or merely in a suspended state of life?

The Gray Area Between Life and Death

The conversation delves deeper into the ethical and medical ambiguities of circulatory arrest. Pinkerton probes, "Oh, my God. So are you, by our medical definition of brain death, are you temporarily killing them or are they, like, temporarily dead?" (07:20). Richman responds thoughtfully, acknowledging the complexity: "I can't say. Yes, for sure. Their body's still functioning. It's just extremely slow. But there's no brain activity, there's no cardiac activity. So the only reason that they're actually still alive is because we're actively pumping blood." (07:39).

This revelation underscores the "interstitial zone"—a liminal state where a patient exhibits signs of both life and death. Richman mentions, "I guess so ideally under an hour. But you know, depending on the surgery, sometimes we do have to go over an hour." (10:30). The uncertainty surrounding the patient's status during this period highlights the need for clearer definitions and ethical guidelines.

Reversing Circulatory Arrest

A critical aspect of DHCA is the process of rewarming the patient and restoring normal bodily functions. Richman describes the meticulous procedure: "But we have to do it very gradually, because when you're at such a deep hypothermic level, if you warm the blood up too fast, what can happen is you can create microscopic bubbles." (13:26). This cautious approach ensures that the patient regains consciousness without adverse effects, such as the formation of blood bubbles, which can lead to complications akin to "the bends."

The gradual rewarming process can take up to an hour and a half, during which sporadic bursts of brain activity are monitored: "As we warm closer and closer to normal body temperature, we're starting to get bursts of activity back from the brain." (14:00). This intermittent revival of brain function serves as a beacon of life, bridging the gap between life and death.

Ethical and Philosophical Implications

The episode poignantly captures the moral dilemmas faced by medical practitioners. Richman reflects, "Yeah, it's definitely raised more questions than answers, you know? You know, you think about no brain activity, no heart activity. It's like, well, yeah, our patient is dead. They still have blood flowing. So are they actually dead?" (11:55). This introspection reveals the profound responsibility borne by those who operate at the intersection of life-sustaining technology and the finality of death.

Pinkerton adds, "It feels like something out of science fiction. That kind of melding of person and machine and you're turning people off and turning them on again." (11:30). This sentiment underscores the unsettling reality of medical advancements that can both preserve and obscure the essence of human life.

Conclusion

"Mostly Dead is Slightly Alive" masterfully navigates the complex terrain of modern definitions of death, illuminated by the experiences of medical professionals like Adam Richman. The episode challenges listeners to reconsider preconceived notions about life and death, emphasizing the need for ongoing dialogue and ethical consideration as technology continues to evolve. By highlighting the gray areas and ethical quandaries inherent in contemporary medicine, the podcast fosters a deeper understanding of what it means to be alive or dead in an age where the lines are increasingly blurred.

Listener Engagement

Towards the end of the episode, Pinkerton encourages listeners to engage by sharing their own experiences and questions, emphasizing the podcast's commitment to exploring the unknown through audience participation. She invites listeners to reach out via email or voice memos to contribute to future episodes, fostering a collaborative exploration of unexplainable phenomena.

Notable Quotes:

• "Are there different ways that humans might be dead?" — Unknown Speaker (00:58)
• "Death is, unfortunately, part of cardiac surgery." — Adam Richman (03:15)
• "We don't understand very well neurologically what's going on." — Adam Richman (07:02)
• "I can't say. Yes, for sure. Their body's still functioning. It's just extremely slow..." — Adam Richman (07:39)
• "It feels like something out of science fiction. That kind of melding of person and machine..." — Bird Pinkerton (11:30)

This episode not only sheds light on the medical intricacies surrounding death but also invites listeners to ponder the profound implications of technological advancements on our understanding of life itself.