It was autumn of 1983 and I was a senior medical student doing a rotation with a general internist in private practice at one of the community hospitals in Columbus, Ohio. Dr. Bob Murnane epitomized the old school internist. His office was across the street from the hospital – about 100 feet from the hospital entrance. He admitted his own patients and made hospital rounds early in the morning before his outpatient appointments started at 9:00 AM. He finished up his day with late afternoon rounds on his inpatients.
He was regarded as one of the top internists in the city and consequently, his practice included a who’s who of Columbus citizenry: priests and politicians; celebrities and socialites. But he took care of anyone and everyone, whether rich or poor, famous or not. He took in 2 medical students per month and was one of the most popular elective rotations for the 4th years students at the Ohio State University. What made him such a great teacher was not just his breadth of knowledge, but his wisdom about the practice of medicine and about people in general.
One morning, the other medical student, George, and I arrived at his office at 7:30. Dr. Murnane’s nurse told us that one of his inpatients just had a cardiac arrest and Dr. Murnane had left word for us to come over to the hospital right away. We hurried across the street and ran up the stairs to the nursing unit, expecting a crowd of doctors, nurses, and respiratory therapists at her room doing cardiopulmonary resuscitation.
Instead, the door was closed and the hallway was silent. We knocked on the door and went in. The patient was lying motionless in bed and looking, well… pretty much dead. Dr. Murnane was sitting in a chair at the foot of the bed, reading the sports section of the local newspaper. Without putting the paper down, he said “Come on in boys, and have a seat”. So, George and I sat down and waited. For five minutes, the room was silent except for the rustle of newspaper pages being turned. Finally, Dr. Murnane folded the paper, set it down, and went to the bedside. He looked at his patient and felt for her carotid pulse. After about 30 seconds, he said “OK, now she’s dead”. George and I just looked at each other, with no clue as to what was going on.
After calling the family, entering a death note into the patient’s chart, and filling out her death certificate, Dr. Murnane explained. A few years earlier, one of his inpatients had a cardiac arrest and underwent CPR. Despite chest compressions, Ambu bag ventilation, and multiple doses of epinephrine, the patient never regained a pulse, even though there was weak electrical activity of the heart on the cardiac monitor. In medicine, this is called pulseless electrical activity and implies death. After several minutes of CPR and no pulse, the patient was pronounced dead, his family was notified of his death, he was covered with a sheet, and then transported to the morgue. A half hour later, the morgue attendant got the shock of his life when the patient pulled the sheet off his face, sat up, and asked what was going on. Dr. Murnane had to call the family back and tell them that there was a mistake and the patient was not actually dead.
What had happened was that the respiratory therapist had been a bit overzealous with Ambu bag ventilation (aka, bag-mask ventilation) during CPR. In the chaos and excitement of the cardiac resuscitation efforts, the therapist had been squeezing the Ambu bag too rapidly, putting too much air in the patient’s lungs too quickly. When this happens, a condition called “breath stacking” can occur where there is not enough time for the lungs to exhale one breath before the next breath is given. The lungs get a little more inflated with each breath until the lungs are hyperinflated, increasing the air pressure inside the chest. If that pressure gets too high, venous blood cannot get into the chest, so when the heart beats, there is no blood for it to pump. This can result in the heart having electrical activity but there is no palpable pulse in the peripheral arteries. This phenomenon is more likely to occur in patients with emphysema or severe asthma, whose lungs are already hyperinflated due to air trapping to begin with. The treatment for breath stacking is to continue doing chest compressions but not deliver any breaths by the Ambu bag for 30 seconds or so to allow the lungs to fully deflate and thus to allow for venous blood return to the chest and to the heart.
Ever since his presumably dead patient woke up in the morgue, Dr. Murnane always waited for a period of time after CPR efforts stopped before pronouncing a patient dead. At the end of CPR, he would check to confirm the absence of a pulse and of respirations. He would then sit down and read the sports page of the newspaper and when he had finished reading the sports section, if the patient still had no pulse or respirations, then he would pronounce that patient dead.
At the time, it seemed like another quirky Murnane-ism. But four years later, I gained a whole new appreciation for reading the sports page. I had finished my internal medicine residency and was in my first year of pulmonary and critical care medicine fellowship. At the time, our fellowship program only took one new fellow per year. The first year of fellowship was all clinical inpatient rotations and the second and third years were all research. Since I was the only clinical fellow, I would make rounds in the medical intensive care unit in the mornings and then see pulmonary consults in the afternoons.
One day, we had a patient in the MICU who had a COPD exacerbation with respiratory failure. He was intubated and on a mechanical ventilator. That afternoon, he got progressively hypotensive and bradycardic, eventually resulting in a cardiac arrest. The senior resident in the MICU ran the cardiopulmonary resuscitation efforts and called the critical care attending. After 15 minutes with no pulse, the attending physician pronounced the patient dead. The family had been holding vigil in the MICU waiting room and was brought to the patient’s bedside and told of his death. The attending physician stepped out to allow the family some time. A few minutes later, there were shouts of “Praise the Lord! Praise the Lord!” from the patient’s room. The nurses ran in to see what was going on and found the patient sitting up, wide eyed and with his mouth open. One of the family members had a camera and took the patient’s picture at that moment. A couple of weeks later, that photo was on the cover of one of the supermarket tabloids (I believe it was the National Enquirer) with the caption: “Man returns from the dead at Ohio State University”. The article included the attending physician’s name. The physician then had to change to an unlisted phone number because he got calls all day and all night from people who wanted him to resurrect their dead relatives back to life. For my part, I was just happy that I was elsewhere in the hospital seeing pulmonary consults and not in the MICU that afternoon.
In the four decades after watching Dr. Murnane read the sports page with his dead patient, I’ve participated in hundreds of cardiopulmonary resuscitation efforts. I would always pause ventilation breaths for about 30 seconds when patients were in pulseless electrical activity. I would also always wait a few minutes and re-check for a pulse and respirations after CPR had concluded before notifying family members of their loved one’s death. It took up a little bit of extra time but I never had a patient return from the dead.
October 14, 2025
