How ECMO Is Redefining Death

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Every year, nearly four hundred thousand Americans suffer cardiac arrest outside of a hospital. Despite the use of CPR, defibrillators, and powerful drugs, fewer than one in ten survive. “That’s whereECMOcomes in,” Jon Marinaro, an emergency physician and intensivist, told me.ECMOis a medical technology that can take over the work of the heart and lungs completely. Marinaro is using it for cardiac arrest, with about a thirty-per-cent survival rate. “If you were to triple survival with a cancer drug, people wouldn’t believe it,” he said. Robert Bartlett, who pioneeredECMOin the nineteen-sixties, envisions a future in which the technology could be used to create organ banks, revolutionizing organ transplant. “We could take out a liver that’s full of cancer, treat it, and then return it to the patient,” he told me.

But, sometimes, patients who are put onECMOdon’t recover. They’re stuck in the I.C.U., on a bridge to nowhere. They can’t leave because they can’t live without the machine, and they can’t take it home with them. “It’s a trap,” the palliative and critical-care physician Jessica Zitter told me. “The technology is ahead of the ethics,” another expert said.My piece examines the tension between the promise and the peril of this technology. WillECMOreally create banks ready with living organs? Will it allow doctors to pop out a cancerous organ and overhaul it, like the transmission on a car? Or will it complicate life, when it inevitably begins to end?

Nathan Berman has helped rescue Manhattan’s financial district from a “doom loop” by carving attractive living spaces from hulking buildings that once housed fields of cubicles.

Among white-collar workers, theCOVID-19 pandemic led to a profound shift: even as it became safer to return to the office, many employees preferred to work remotely. Nationwide, offices are only about fifty per cent full. For a feature in this week’s magazine, D. T. Max met with Nathan Berman, a real-estate developer who specializes in taking existing structures and converting them into apartments, and who has helped show desperate office-tower owners a way out. Since 1997, Berman, through his firm, Metro Loft Management, has turned eight Manhattan office towers into rental-apartment complexes, adding some five thousand units to the city’s housing stock. Berman spends hours dividing former fields of cubicles into small but clever residences and reconceiving onetime copy-machine nooks as mini laundry rooms or skinny kitchens. Is this a useful solution in a city that’s always starved for housing—and newly wary of the five-day-a-week office routine?Read the story »

P.S. As the days grow warmer,remember that for scientists summer months are “a hothouse for the idylls of research,” Siobhan Roberts suggests, inthis bid for vacation experimentation. Encouraging play and mess and idleness, she writes, “There’s no way of knowing when an idea will coalesce and the stars align, producing a discovery that solves a crucial problem, creates a windfall of googol dimensions, or triggers a smile.”