Sen. Ben Nelson has reached an agreement with Democratic leaders on health care reform, senators say.

Dr. Sanjay Gupta | BIO
AC360° Contributor
CNN Chief Medical Correspondent

Last night I was up late covering the senate vote on health care for CNN. The number of e-mails I was receiving while discussing this on air was staggering. I realized that as much as we talked about cloture and reconciliation, most people who didn’t read the 2,000+ page bill (which is most everyone) really wanted to know what this bill means for them. They didn’t care as much about the compromise that was struck by Sen. Ben Nelson, which would obligate the federal government to pick up the Medicaid tab for his state of Nebraska into perpetuity. They are still not sure if a public option is a good thing or not, and they aren’t sure how the exchange would work for them. In short, there is a collision of politics and health care, and sometime the impact on individuals gets a little lost in the shuffle.

I want to use this blog as a platform to try and address some of your specific question and to also throw out some key information that may have flown under the radar. I will start with a number. 2014. This is the year most of the provisions of the bill would kick in under this version of reform. That’s right – four years away. Many people think health care reform in binary terms. One moment there is a vote, and the next moment you have it. Many wish it were that easy. It is true that children may benefit earlier in some areas, but for the vast majority of the more than 40 million uninsured, things aren’t going to change significantly for a few years. And, speaking of the more than 40 million uninsured, this bill won’t impact all of them, but instead roughly 31 million.

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Sanjay Gupta | BIO
AC360° Contributor

Lake Chad once was the sixth-largest lake in the world, but in 45 years it has shrunk to half the size of Rhode Island – only 10 percent of its earlier size.

The shallow body of water borders four countries: Cameroon, Chad, Niger and Nigeria – and provides water to 20 million people.

In Nigeria, the shrinking lake has a huge effect on human health – farmers find it more difficult to siphon water into irrigation and they have a harder time growing food, which means people become more vulnerable to diseases like malaria and yellow fever.

Scientists say water diversion (irrigation and new dams on nearby rivers) and drought are equally to blame for the shrinking lake levels.

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Dr. Sanjay Gupta | BIO
AC360° Contributor
CNN Chief Medical Correspondent

Located in the South Pacific, the Carteret Islands are fighting a losing battle against the ocean. It's estimated the six islands will disappear into the water by 2015. Papua New Guinea plans to relocate the Carteret's 2,000 residents.

But a debate centers on what is causing these islands to disappear: Is global warming to blame, or are the islands sinking into the sea, or have the residents permanently damaged the reefs that help to protect the islands from the ocean?

U.S. Marines patrol with Afghan soldiers in Helmand Province, Afghanistan.

Dr. Sanjay Gupta | BIO
AC360° Contributor
CNN Chief Medical Correspondent

This week we will be talking a lot about Afghanistan and the impact of the President’s speech. Having spent a fair amount of time there, including a trip just a couple of months ago, I am always reminded of the human impact of any conflict. I am reminded there are consequences to all those booms and explosions we see on television. I am reminded of the horrific injuries I saw due to IED explosions where young men and women are robbed of their legs, and their lives. I am also reminded of the remarkable sacrifice the doctors, nurses, medics and all the medical personnel make every single day out there. They truly risk their lives to save the lives of others.

Medicine and the military are embraced in an awkward dance and no where is that more true than in Afghanistan. Because of the terrain, most of the med evac missions are carried out by chopper. They typically have 20 minutes to fly to the patients, 20 minutes to stabilize and treat, and 20 minutes to get the patients to more medical care. It is one golden hour. Right now, even as I write this, these medics are sleeping in forward operating bases just behind the front line troops – with their boots on, and eyes half open in dusty desert tents waiting to get the call. Waiting for a chance to save their fellow soldiers who got the call before them.

Truth of the matter, nearly three-fourths of the time, the call they get is to take care of an Afghan local or soldier. In fact, if you look at the breakdown of operations performed at the coalition force run Kandahar Role III, the largest trauma hospital in the country, most are performed on Afghan patients. The local medical system in Afghanistan lacks the infrastructure to take care of most of these sorts of injuries. There is only one vascular surgeon in the country, two neurosurgeons and really no ability to perform cardiac surgery. It made me wonder what will happen to patients with trauma a year from now or in five or ten years.

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Dr. Sanjay Gupta | BIO
AC360° Contributor
CNN Chief Medical Correspondent

Dr. Sanjay Gupta
CNN

Dr. Sanjay Gupta | BIO
AC360° Contributor
CNN Chief Medical Correspondent

From the office to the operating room, Dr. Sanjay Gupta tweets.

"two hours till #1023. about to turn 40. I hit my goals for physical fitness. now, feeling contemplative. good time to reflect and meditate."
7:07 PM Oct 22nd from TwitterBerry

Follow Dr. Sanjay Gupta on Twitter: @sanjayguptacnn

Laura Geraghty was shocked 21 times before she came back from cardiac arrest with tales of the afterlife.

Caleb Hellerman
CNN Medical Senior Producer

Our special this weekend, “Another Day: Cheating Death,” includes the story of Laura Geraghty, a school bus driver in Massachusetts who survived a cardiac arrest that left her without a heartbeat for 57 minutes. While the medical aspect is astounding, just as interesting is the story Geraghty told when she was revived.

She’d floated out of her body, and found herself in a world of incredibly bright light – heaven, she says. While there she saw her son, daughter, granddaughter and even her ex-husband – who wouldn’t take her hand when she reached out to him. Eventually she came back to the real world.

Many cultures and religions describe a vivid world on the border of life and death, but the classic modern near-death experience, or NDE, was described by Dr. Raymond Moody in his 1966 book, “Life After Life.” While not every NDE includes the same features, among the most common – according to Moody – are bright lights, a tunnel, a sense of being out of the body and an intense feeling of peace and calm.

Most people who return from the verge of death with memories like this say it’s a life-changing experience. Many view it as direct proof of an afterlife – that the place they “visit” is the world we all will see after we die. But increasingly, near-death experience (a term coined by Moody) is being studied from the perspective of science.

Dr. Kevin Nelson, a neurologist at the University of Kentucky, believes an NDE is caused by REM activity, the same type of brain activity that’s linked to dreaming. REM activity, says Nelson, can be triggered by intense stress or even lack of oxygen. In fact, he says many people experience an out-of-body experience during fainting episodes, or if they momentarily lose blood flow to the brain – as in a massive head rush.

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Sanjay Gupta says the latest CPR techniques can save the lives of vicitims of cardiac arrest.

Dr. Sanjay Gupta | BIO
AC360° Contributor
CNN Chief Medical Correspondent

Program Note: Tune in tonight to watch Dr. Sanjay Gupta report on a near-death experience. AC360° at 10 p.m. ET.

Editor's Note: Dr. Sanjay Gupta, a neurosurgeon, is author of the new book "Cheating Death," which will be published next month. This article originally appeared in the September 20, 2009, issue of Parade and Parade.com.

I am going to let you in on a secret: When a person's heart stops beating, it's not the end. Contrary to what you may think, death is not a single event. Instead, it's a process that can be interrupted.

Mike Mertz knows this firsthand. On January 23, 2008, the 59-year-old Arizona man was driving home from work. The last thing he remembers is pulling into his complex's driveway. Then his heart stopped. Corey Ash, a passing UPS driver, noticed a silver Saturn wedged between a palm tree and a wall, with the engine running and a person slumped at the wheel. Ash stopped to investigate. He switched off the car's engine, pulled Mertz out, and laid him on the ground. Ash called 911 and started pumping the older man's chest. The next few minutes would be absolutely critical for Mertz.

If you had been there, standing over Mertz's lifeless body, would you have known what to do?

A person's life can slip away in a few minutes. Without a heartbeat, circulation slows to a halt. Blood no longer flows to the organs, and the brain is the first one to suffer. In normal times, the brain, which constitutes 2 percent of our body mass, consumes about 20 percent of the oxygen the body takes in. After 10 seconds without oxygen, the brain's functions slow. Without oxygen or signals from the brain, other organs begin to break down. Diaphragm muscles no longer contract and release to bring in air. The kidneys stop filtering blood. At the same time, an elaborate chain reaction triggers a breakdown in cells throughout the body. Parade.com: 4 diseases you can fight with exercise

Scientists and physicians are now learning that this process can be reversed. When it comes to cardiac arrest, however, the chances of surviving an episode outside a hospital are poor. Only 2 percent of victims pull through without long-term damage.

The No. 1 thing that has been shown to make a difference is the action of a bystander. If a passerby jumps in and gives CPR, as Corey Ash did, the likelihood of survival rises significantly. But if onlookers do nothing, those chances drop - fast. According to the American Heart Association, for every minute that goes by without someone attempting CPR, the survival rate decreases 7 to 10 percent.

Studies have found that bystanders perform CPR in only 20 to 30 percent of cases. Researchers say it's not because people don't want to help - it's because they're apprehensive about putting their mouths on someone else's, especially if the person is dying. But what I'm about to tell you may change your mind about what you can do in a situation like Mertz's.

More than 15 years ago, cardiologist Gordon Ewy and researchers at the University of Arizona's Sarver Heart Center were puzzling over how to get more people to give CPR. To simplify the method, they wondered what would happen if they advocated performing compressions without mouth-to-mouth respiration. After running successful laboratory trials, Ewy spoke to emergency-services directors in Arizona, Wisconsin, and Missouri. They were intrigued by his findings and agreed to promote the use of compression-only CPR among people in their states. They also implemented a protocol for their paramedics and firefighters that emphasized giving chest compressions with minimal interruptions to keep the patient's blood circulating. Parade.com: 8 ways to stay healthy

The results were remarkable: Not only were survival rates for people who got only compressions just as good as those for people who got traditional CPR, they actually were better. Why was it so effective? Mouth-to-mouth resuscitation supplies oxygen, which we need continuously. As it turns out, our bloodstreams contain plenty of oxygen at any moment. Even if we stop breathing, our oxygen levels remain normal for quite a while. If we do stop breathing, however, the sole way to make the oxygen circulate is by having someone pump our chests.

In 2007, Japanese researchers revealed the results of a massive study on bystander intervention. They looked at cases where a person (not in a hospital) suffered cardiac arrest in view of a bystander - and with his or her heart in a rhythm that would respond to a defibrillator. The survival rate was 11 percent for those who got standard CPR - mouth-to-mouth plus chest compressions - before an ambulance arrived. The rate was 19 percent for those who got only compressions. The act of keeping oxygen circulating could increase a victim's chances of surviving by as much as 70 percent.

This is not a fancy technology born in a gleaming lab, yet it is one of the most significant recent breakthroughs in medicine. Because heart disease is the biggest killer in the United States, this simple act could save thousands of people's lives every year.

Like Mike Mertz's. Shortly after Corey Ash began CPR, paramedics trained in the compression-only technique arrived. Thanks to them and to an alert bystander, Mertz survived. One day, the bystander could be you. Parade.com: 7 habits for a longer life

Remember: As soon as you see someone suffer what you think may be cardiac arrest, call 911, start giving chest compressions 100 times a minute, and don't stop for anything. To get more information and to find classes in your area in emergency cardiovascular care, go to the American Heart Association Web site.

Advances in saving hearts

• Stem cells: Back when I was in medical school, I learned that any damage to the heart from a heart attack was permanent. This past summer, Mayo Clinic researchers working on mice converted adult scar cells into stem cells, which they injected into damaged hearts. The cells restored heart-muscle performance, stopped the progression of damage, and regenerated injured tissue. Scientists at Mayo tell me this will soon be tested on humans.

• Drug-releasing stents: People at risk for heart disease who have a blockage in the vessels supplying blood to their hearts may undergo an angioplasty to open the vessel. Afterward, doctors often insert a stent (a mesh tube) to continue holding the artery open. The newest stents serve a dual role: They also release medication that prevents scar tissue from developing.

• CRP testing: You should have your cholesterol levels checked regularly. But you might also ask your doctor about getting your C-reactive protein, or CRP, checked. It is a marker for inflammation, a powerful risk factor for heart disease. Changes in diet and exercise can usually reduce high CRP levels.

Rescuers worked frantically to save Anna Bagenholm from a hole in the ice of a mountain stream.

David S. Martin
CNN Medical Senior Producer

North of the Arctic Circle, the weather is unforgiving, the population is scattered and the distances are immense. At the University Hospital of North Norway in Tromsø, the northernmost teaching hospital in the world, doctors routinely use a helicopter ambulance and fixed-wing plane to transport the most serious cases for care – or to bring emergency care to the patient. It’s all about buying time.

During a visit Tromsø, we shadowed Dr. Mads Gilbert, who heads the Department of Emergency Medical Services at the hospital, a small city surrounded by water and mountains. He describes trauma care in this part of the world as “cold, dark, distance and dangerous.” The cold poses its own challenges, and Dr. Gilbert and the team see a lot of hypothermia from ski accidents and people who’ve fallen out of fishing boats falling into the water.

Dr. Gilbert was on call 24 hours a day all week when we were there. He is 62, a rangy man with the energy and enthusiasm of someone half his age.

“What we do with emergency medicine — be it airway breathing, chest compressions, bleeding control, treating hypothermia — is to slow or even stop the death process. So it’s really the struggle between life and death and I always feel like we’re standing on the shore with the tide coming up. We’re trying to pull people from the tide of death and onto the dry land of life,” Gilbert said with a flourish.

Hours after we arrived, his team scrambled in the middle of the night, putting on jumpsuits and helmets and climbing aboard the helicopter ambulance. The temperature was just a degree or two above freezing as the helicopter lifted off and a chilling rain soon began to fall. A young man was suffering from an uncontrollable seizure, and the local doctor wasn’t sure whether it was an allergic reaction or something more serious. The helicopter ambulance team brought the patient back to the hospital.

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Anderson Cooper | BIO
AC360° Anchor

Health care workers in Indiana and Tennessee were among the first to receive the H1N1 vaccine.

David Puente
AC360° Producer

“Is Sanjay still in the building?” that’s what I heard a senior producer in New York shouting across the newsroom at almost 6PM today.

“Not likely at this hour on a Friday,” someone else mumbled. But sure enough Sanjay said he’d be ready to be on the set to pretape a segment with Anderson on the rapid rise in pediatric deaths from H1N1. I was assigned to produce the segment so I reached out to our medical unit’s producer and formulated questions.

Then CNN’s medical unit confirmed that there were another 19 deaths of children and teens from H1N1 reported in the past week around the country. That brings the total number of fatalities to 76 among those younger than age 18.

There were two deaths reported in Maryland, three were in Tennessee, seven in Texas and one each in Alaska, Arizona, Colorado, Florida, North Carolina, Oklahoma and Wisconsin.

Tonight we ask Sanjay about what’s believed to be the largest number of pediatric deaths reported in a single week since the pandemic began last spring. Now that the H1N1 vaccine is getting rolled out – will that help put a stop to the rise in pediactric deaths?

On our blog, Mazin asks: “My son does not want my 7 year old grandson vaccinated because he had a bad reaction from last year’s regular flu shot. Does the H1N1 nasal spray vaccination have a potential bad reaction?”

Back in the newsroom a sense of concern especially from those who are parents. With all the doubt, distrust and misinformation out there about the vaccine and when and where to get it, it may not come as a surprise to you.

Tune in at 10PM tonight for the answer to Mazin’s question and Sanjay Gupta tells us whether or not he’s vaccinating his children.

Follow David on Twitter @puenteac360.

Become a Friend on Facebook.

Dr. Sanjay Gupta
CNN

Program Note: Tune in to AC360º tonight at 10 P.M. ET to hear more from Erin Brockovich as she teams up with Dr. Sanjay Gupta to investigate a toxic oil spill endangering the health of the environment and the citizens of Kingston, Tennessee.

Properties near ground zero of the December 22 Tennessee spill are covered in sludge.

Erin Brockovich
The Brockovich Report

It looks like I may be paying a visit to Tennessee. Numerous residents have asked me to come to the community for a meeting on the coal fly ash disaster around Knoxville, and I think I will be going.

I know the question on everyone's lips. What is coal fly ash, and why does it need to be contained? The folks around Knoxville are getting to know a lot more about coal fly ash than they ever wanted to learn.

Coal fly ash. It sounds like someone has been burning fly poop or airborne coal. But seriously, it is akin to the creosote that coated those chimneys and chimneysweep boys of Charles Dickens ancient London.

Fly ash comes from chimneys, specifically the chimneys of power plants. The collection point determines exactly what kind of ash it is. Fly ash apparently contains silicon dioxide and calcium oxide as well as trace concentrations of heavy metals. In other words, coal ash is nasty stuff to have floating around in your river, air, and drinking water.

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Elizabeth Landau
CNN.com Health Writer/Producer

The general anesthetic Diprivan (propofol) has been making headlines as questions about Michael Jackson’s death abound. A nurse who had worked for the singer told CNN that Jackson requested the drug because he had trouble sleeping, and The Associated Press reported that it had been found in his home. Diprivan is not approved as a sleep aid by the Food and Drug Administration. Read more about propofol.

It turns out that propofol, used routinely for surgeries and procedures such as colonoscopies, has been a point of concern among some anesthesiologists because of the potential for abuse by health care workers. A 2007 study published by the International Anesthesia Research Society found that about 18 percent of the 126 academic anesthesia programs in the United States had at least one reported instance of propofol abuse within the previous 10 years.

Researchers also found that six out of 16 residents (about 38 percent) who abused propofol died from it. While these are small numbers, lead author Dr. Paul Wischmeyer, professor of anesthesiology at the University of Colorado, believes this is indicative of a larger problem.

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