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A man played video games nonstop for 73 hours. This is how his organs shut down.
DC is a 25-year-old man, presenting to the emergency room, dead on arrival. Paramedics were desperately performing chest compressions to try and push blood back into his brain, to try and push blood into his organs, to try to keep him alive. But it seemed like their attempts were all in vain.
DC was a college graduate, but he never wanted to go to school. He worked a minimum wage job, but he was recently fired. He wanted to be an internet video game streamer, but no one was watching. He lived at home with his mom, where she still cooked for him, but she kicked him out when he was no longer going out to look for a new job.
Depressed and lost, DC binged on video games at the local internet cafe for days at a time. Sometimes he’d sleep at the computer and wake up to play some more. He gave up personal hygiene. He gave up friendships. His life was games. He was obsessed and he just couldn’t stop playing.
One weekend, DC played for 73 hours nonstop. Glued to his seat, he barely ate any food. He hardly drank any water. He didn’t even get up to use the bathroom, having already released a few times in-between, and finally couldn’t hold it in anymore.
He got up for the first time in days as he stood up from his chair. He suddenly felt lightheaded. He blacked out and then instantly collapsed. At the front desk of the internet cafe, the owner was oblivious to the fact that someone had fainted on his property. Thirty minutes passed, and DC was found on the floor, unconscious and struggling to breathe.
911 is called. In the ambulance, DC suddenly flatlines. His heart stops beating and he stops breathing. Paramedics desperately begin CPR as he’s brought to the emergency room where we are now.
Doctors in a rush continue chest compressions. Ultrasound immediately reveals that the right side of his heart is swollen. It’s larger than the left ventricle, which is the part of the heart that’s responsible for pumping blood to the entire body. The left ventricle has more muscle, so it’s the largest part of the heart in every normal functioning human. But DC can’t function normally now. His heart is twisted. It’s disfigured.
This immediately tells the medical team that he’s suffering from acute massive pulmonary embolism. “Embolus” from ancient Greek, meaning a “wedge,” or in this case referring to a blood clot. Pulmonary, meaning lung. Massive, referring not to the size of the actual clot, but to the sudden hemodynamic collapse that it caused in DC. A blood clot wedged into the artery going into the lungs causing his heart to disfigure. Causing his heart to stop beating because it is disfigured. Causing his organs to shut down because they’re no longer receiving oxygen due to the fact that his heart has stopped beating. Acute, meaning that he didn’t have any underlying medical issues leading to this problem, except for sitting at a computer playing video games nonstop for 73 hours.
Doing anything nonstop for 70 hours is dangerous, but sitting down nonstop for 70 hours is deadly because of venous stasis. This is a time when a lack of movement of the legs causes blood to pool. The blood pressure in the body’s veins is already low because there isn’t anything directly pumping it back to the heart. Venous blood oozes its way back.
Without moving the legs for 70 hours and given that sitting down compresses the veins, a compartment of the body where blood flow is already slower than normal, then this pooling of blood causes some of it to clump together into a clot called a deep vein thrombosis, which is what happened to DC as he sat there for days.
But there’s more. As the clot formed, it stayed in his legs for as long as he was sitting down. He got up and it broke off. It went directly into the right side of his heart like how blood normally does, but then lodged itself directly into the pulmonary artery where the right side of the heart connects to the lungs. This backup of blood into the right ventricle caused it to stretch, distend, and disfigure.
But this is only the beginning of the dysfunction. The right ventricle of the heart typically has a thinner wall than the left. It has a lower volume-to-surface area ratio. This makes sense because blood from here goes directly to the lungs. You don’t need high pressure going to the lungs when they are right there. But when the right ventricle swells due to flow backing up, wall stress increases. It pushes against the interventricular septum, causing it to bow out into the left ventricle. This increased pressure and volume in the right displaces the left, reducing cardiac output.
In DC’s case of hemodynamic collapse secondary to massive pulmonary embolism, an occlusion into the pulmonary artery meant a filling defect on the left as blood cannot be pumped out to the rest of the body. There is no longer an adequate oxygen supply in his body as his organs all start to die. His heart, while still trying to beat, can no longer function. It arrests as he comes into the emergency room without a pulse.
But it wasn’t like this when they found him. Paramedics tell the medical team that DC was found gasping for air and that he did have a heartbeat when they found him, but it was fast from his body detecting hypoxemia, a low oxygen presence in blood. His blood pressure was low from the hemodynamic compromise, and it was on the way to the emergency room that his heart suddenly stopped beating.
That all of this happened just minutes ago, meaning that it might not yet be too late. There might still be a chance to bring DC back to life.
Is there a way we can somehow remove the clot from DC’s lungs? Maybe. But it has to be done immediately. Surgery and cutting him open to pull it out is not an option because it would take too long. Guiding a catheter through his veins to direct medicine that can dissolve the clot directly is also not an option because of time.
The quickest solution is to infuse that medicine directly into his entire body. This systemic fibrinolytic therapy is his last hope.
On the emergency room bed, DC is immediately infused with a large bolus dose of lytic as chest compressions are continued. Additional lytic was set for infusion over time as this aggressive dosing means the medical team will continue CPR until he either comes back to life or it is absolutely certain that DC is lost.
As the chest compressions are desperately applied, minutes pass. A detectable heartbeat is found, and this return of spontaneous circulation is a good sign. DC is not lost. But several hours pass and he doesn’t regain consciousness. Admission into the intensive care unit finds that he is missing cognitive factors.
Shining a light into the eyes, a normal functioning human will exhibit a pupillary reflex, where the pupils will constrict in reaction to the increased presence of light. Absence of this indicates brain damage, and in DC, it’s absent.
In a normal functioning human, motor response to pain is a natural reflex. Absence of this reflex indicates brain damage, and in DC, it’s absent. As the days go by, DC’s mother arrives to the hospital to see her son. She tries to speak to him, but no response. He may not have listened to her in life, but the only thing she would like to see now is a response, an indication, something from her son that tells her he can hear her, but nothing is returned.
The several minutes where DC’s body was not receiving oxygen because of a clot blocking the point where his heart and lungs connected caused this permanent anoxic ischemic damage. Most people can easily pick out that healthy individuals can’t stay up and play games for 3 days straight without sleep, without going to the bathroom. Most people can’t stay up 3 days straight for anything. That to be able to play that much means that the person has a problem.
Internet gaming disorder has been described as a condition needing further research for several years now. Back in 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) put that description on paper. In 2018, the World Health Organization placed gaming disorder as a diagnosable condition in the 11th revision of the International Classification of Diseases.
DC is at one extreme end of the spectrum of what can be described as internet gaming disorder. The actual people who will have this are going to be a small subset of the population because most people won’t have this level of obsessive behavior. People who only hear headlines may be under-informed as to what internet gaming disorder really is. It’s probably not describing a kid who wants to play games with his friends after school, who daydreams about the game during class sometimes but is overall a functioning person who is okay if they don’t play games for a couple of days and who can comply with their responsibilities.
It also probably doesn’t describe a 25-year-old who plays 20 hours total on the weekend, but can still show up to work during the week and hold a relationship and family obligations without problem. Internet gaming disorder isn’t describing these people.
But if someone lets their kids or pets starve to death because they were too focused on playing a game, then something might be wrong. If someone continues to obsessively play after getting forcibly kicked out of their parents’ house, plays for several days at a time nonstop — not getting up, not eating, not using the bathroom, and not sleeping — well, then something is probably wrong.
Even worse, if blood pools in the legs while that person is playing because they have been playing for so long, forming a deep vein thrombosis that becomes a massive pulmonary embolism with end organ malperfusion and hemodynamic collapse, resulting in residual organ dysfunction and hypoxic brain damage — something that results in tangible, detrimental, and life-threatening consequences due to one’s lack of self control over playing video games — is a problem. It’s a good thing that we’re able to classify it as a problem.
For DC, limited neurocognitive function was recovered as he suffered from rounds of pneumonia and sepsis during his stay in the intensive care unit. Diminished urine output and elevated transaminase levels indicated kidney and liver damage. The loss of pupillary reflex and absent extensor motor response days after admission were specific factors to indicate poor outcome following anoxic injury, secondary to massive pulmonary embolism.
At autopsy, extensive neuronal damage was found in the parieto-occipital-temporal cortex of his brain. Cerebellar injury was observed along with losses at the thalamic nuclei. Little could be done by the time he was found unresponsive at the internet cafe as too much time had passed in a setting where minutes and seconds matter. The only hope was to salvage whatever the medical team could once DC fell into cardiac arrest.
For gamers today, be sure to keep yourself hydrated and don’t sit — ideally for more than an hour at a time. Get up and walk around, even if it’s just for a couple of minutes. Most importantly, be kind to yourself. Internet gaming is actually stressful, even if it’s fun.
Thank you so much for watching. Take care of yourself and be well.
“Dr. Bernard” is a licensed physician and clinical adjunct professor at the University of Illinois. See more of his videos on his “Chubbyemu” YouTube channel.
Last Updated March 26, 2020