What Is Lazarus Phenomenon?

First, you receive a phone call from the hospital. The officials reveal to you that your loved one has been pronounced dead. What would your reaction be if 2 hours later, the doctor calls you again to tell you that your loved one back alive? Puzzled? Numb? Going to get a second doctor’s opinion whether your loved one is really alive or dead by checking the name once again? Simply overjoyed? Call the doctor again and ask him to use a different stethoscope? Or maybe, call all your friends and relatives to have a “Welcome back, party?”.....Well, a series of perplexed thoughts are sure to run wild in our thoughts if this happens to our families. Of course, the variations, your heart beat rate and the intensity differs from individuals. Imagine the joy, of having to call out your relatives and friends again to notify that your loved dead is back from the dead. As for their reaction, your guess is as good as mine. After all, some would still want to see him/her and pat on the back and may want to say, “Hey, your lifeline has just been renewed and extended for an indefinite period of time, don't screw up your life and health with your second chance.” ...It’s called the Lazarus Phenomenon (sometimes called Lazarus syndrome) , and goes to prove what a fantastic machine the human body really is.

What is Lazarus Phenomenon? The Lazarus phenomenon is described as delayed “Return Of Spontaneous Circulation” (ROSC) after cessation of cardiopulmonary resuscitation (CPR). This was first reported in the medical literature in 1982, and the term Lazarus phenomenon was first used by Bray in 1993. The term was coined from the story of Lazarus, who was resurrected by Jesus Christ four days after his death. Even though Lazarus phenomenon is rare, it is probably under reported. There is no doubt that Lazarus phenomenon is a reality but so far the scientific explanations have been inadequate. So far the only plausible explanation at least in some cases is auto-positive end- expiratory pressure (PEEP) and impaired venous return. In patients with pulseless electrical activity (PEA) or asystole, dynamic hyperinflation should be considered as a cause and a short period of apnoea (30-60 seconds) should be tried before stopping resuscitation. Since ROSC occurred within 10 minutes in most cases, patients should be passively monitored for at least 10 minutes after the cessation of CPR before confirming death.

Case Report A 66-yr-old man, weighing 80 kg, was emergently brought to the operating room (OR) with a suspected leaking abdominal aortic aneurysm. His past history included hypertension and a transient ischemic attack 4 yr earlier. He also had a 50-pack/yr smoking history and chronic renal insufficiency (creatinine 2.3 mg/dL). He had no history of metabolic disorder. He had received 2600 mL of lactated Ringer’s solution before arrival in the OR. Vital signs on arrival included a heart rate of 120 bpm and a systolic blood pressure of 60 mm Hg. The patient was pale, mottled, diaphoretic, and tachypneic. Rapid administration of warmed IV fluids via two rapid infusion systems increased his systolic blood pressure to 120 mm Hg. Induction of anaesthesia proceeded uneventfully with d-tubocurarine 3 mg, fentanyl 250 µg, etomidate 20 mg, and succinylcholine 160 mg IV before rapid sequence endotracheal intubation. Maintenance of anesthesia included inhalation of isoflurane (as tolerated by blood pressure) in 100% oxygen. Pancuronium 6 mg was given for continued neuromuscular blockade. With induction of anesthesia, the vital signs remained stable (systolic blood pressure 110–120 mm Hg by automated cuff pressure) and surgical incision promptly followed at 5.30 p.m. An arterial blood gas drawn at this time revealed hemoglobin 8.1 g/dL, + K 3.8 mEq/L, glucose 185 mg/dL, pHa 7.24, PaCO2 41 mm Hg, PaO2 479 mm Hg, HCO316 mEq/L, and base excess −10.6 mEq/L. At this time, the end-tidal CO2 was 29 mm Hg. Electrocardiogram (ECG) showed a cardiac rhythm of sinus tachycardia. At 5.48 p.m. the surgeon placed a cross-clamp across the suprarenal aorta. This led to an increase in systolic pressure to 160 mm Hg, but no apparent changes on the ECG. At 5.53 p.m. the clamp was shifted to an infrarenal position. At 5.59 p.m., the cardiac rhythm suddenly deteriorated into ventricular tachycardia, which rapidly progressed to ventricular fibrillation. Chest compressions were initiated, and the patient was ventilated with 100% oxygen. This resuscitation continued for the next 17 min during which time the patient received a total of nine countershocks of 360 J each. Additionally, a total of 5 mg of epinephrine, 4 mg of atropine, 2 g of CaCl2, 400 mg of lidocaine, 150 mEq of NaHCO3 and 2 g of MgSO4 were given IV. Chest compressions were initially thought to be effective as the end-tidal CO2was maintained at 25–32 mm Hg. No arterial line was yet available to observe a waveform or to draw blood gases, and no single-stick arterial blood gas was drawn during the resuscitation. Despite the resuscitation efforts, the underlying rhythm continued to be asystole. This was confirmed by the palpation of a flaccid and pulseless (in the absence of chest compressions) proximal aorta. End-tidal CO2 had diminished to 8–10 mm Hg, and the pupils were widely dilated. Because of the patient’s complete lack of response and the apparent deterioration by end-tidal CO2, the attending surgeon and anesthesiologist mutually agreed to discontinue the resuscitation. The patient was pronounced dead at 6.17p.m. With cessation of the resuscitation, the IV medications and infusions were discontinued. The monitors were turned off, and the ventilator was disconnected although the endotracheal tube was left in situ. The surgeon stayed at the operating table, using the opportunity to teach residents and students. At 6.27p.m., 10 min after the pronounced death of the patient, the surgeon announced that he had begun to feel a pulse in the proximal aorta above the level of the aortic cross-clamp. Ventilation with 100% oxygen was recommenced and revealed an end- tidal CO2 of 29 mm Hg. The ECG was reconnected and showed a sinus rhythm of 90 bpm. Systolic blood pressure was 90 mm Hg by automated cuff. A radial arterial line was now inserted successfully, and at 0630, arterial blood gases were: hemoglobin 9.5 mg/dL, K+ 3.5 mEq/L, glucose 323 mg/dL, pHa 7.17, PaCO2 54.4 mm Hg, PaO2 438 mm Hg, and base excess −8.0 mEq/L. An esophageal temperature probe was inserted and measured 33.4°C. It was decided to proceed with the operation although neurologic prognosis was anticipated to be bleak. The patient was hemodynamically stable throughout the remainder of the procedure, requiring no inotropic support. Total fluid administration for the operation was 16 U of packed red blood cells, 8 U of fresh frozen plasma, 20 U of platelets, and 12 L of crystalloid solutions. Despite warming of all IV fluids and blood products and the use of a forced air warming blanket, the patient’s temperature ranged between 33° and 34°C for the remainder of the operation. The leaking aneurysm was resected uneventfully and the patient was transported to the intensive care unit.

Postoperatively, the patient was maintained on mechanical ventilation for several days in the intensive care unit. The postoperative course was complicated by mild renal insufficiency and two bouts of atrial arrhythmias (both of which were self-limiting). Remarkably, the patient improved dramatically and, after tracheal extubation, was found to be completely neurologically intact. He appeared to have no short- or long-term memory deficits. He also had no recall of any events of the day of operation except for being initially brought into the OR. He was discharged home on postoperative Day 13 in excellent condition with no apparent neurologic deficit. Follow-up at 5 wk revealed that the patient had fully recovered, and had resumed full physical activities and his lifestyle of prior to the surgery.

PROPOSED MECHANISMS The exact mechanism of delayed ROSC is unclear and it is possible that more than one mechanism is involved.Dynamic hyperinflation of the lung causing increased positive end expiratory pressure (PPEP) is one of the proposed mechanisms, which has some supporting evidence in patients with obstructive airways disease.

Rapid manual ventilation without adequate time for exhalation during CPR can lead to dynamic hyperinflation of lungs. Dynamic hyperinflation may lead to gas trapping and an increase in the end-expiratory pressure (called auto-PEEP) leading to delayed venous return, low cardiac output and even cardiac arrest in patients with obstructive airways disease. The link between mechanical ventilation of patients with obstructive ventilatory defects and circulatory failure was first demonstrated in 1982. One report describes a patient with respiratory failure due to asthma whose blood pressure was undetectable five minutes after initiating artificial ventilation with a tidal volume of 700 mL and respiratory rate of 25 breaths per minute. Even after inotropes the systolic blood pressure did not exceed 70 mm Hg. The ventilator was adjusted to a respiratory rate of six breaths per minute and a tidal volume of 400 mL and the blood pressure gradually rose to 126/84 mm Hg.

The physiology of severe auto-PEEP is similar to pericardial tamponade, where circulation can only be restored after removing the obstacle to cardiac filling. Auto-PEEP is a possible cause of pulseless electrical activity (PEA), and rapid ventilation during CPR should be avoided. Hypovolaemia and decreased myocardial contractility could exaggerate its effect on venous return and cardiac output. Some authors recommend discontinuing the ventilation transiently for 10 to 30 seconds in PEA to allow venous return.

It is tempting to apply this theory even to patients without obstructive airways disease. Dynamic hyperinflation can theoretically happen in any situation where rapid manual ventilation is carried out. One could argue that in the presence of decreased cardiac output— as in myocardial infarction and hypovolaemia—dynamic hyperinflation could compromise the cardiac output even more, leading to cardiac arrest.

Even though auto-PEEP due to dynamic hyperinflation seems most plausible and has some evidence in patients with obstructive airways disease, this alone would not explain all cases of delayed ROSC. In one report, CPR was terminated after 30 minutes and the patient was in asystole. Because the patient had MRSA and CPR was performed without proper infection control measures, the physician involved in the CPR went to shower and change clothes, leaving the patient still being ventilated in the intensive care unit. Returning five minutes later, he found the patient with a perfusable rhythm. The patient died two days later.

Delayed action of drugs Some authors suggest delayed action of drugs administered during CPR as a mechanism for delayed ROSC. It is possible that drugs injected through a peripheral vein are inadequately delivered centrally due to impaired venous return, and when venous return improves after stopping the dynamic hyperinflation, delivery of drugs could contribute to return of circulation. In some cases, however, drugs are actually administered through a central line. Even though this theory is plausible it would be impossible to either prove or disprove.

Hyperkalaemia There are few reports of delayed ROSC in the presence of hyperkalaemia. It is a well-known fact that intracellular hyperkalaemia could persist longer, rendering the myocardium retractile for long periods of time. There is a report on a 68-year-old lady with cardiac arrest due to hyperkalaemia who did not respond to CPR and conventional treatment up to 100 minutes, but later responded to dialysis and made a complete recovery. So even though prolonged cardiac arrest refractory to conventional treatment could respond to dialysis, it is unlikely that hyperkalaemia on its own could explain delayed ROSC after cessation of CPR.

Myocardial stunning Prolonged myocardial dysfunction can occur following myocardial ischaemia, taking up to several hours before normal function returns. Of the 38 cases, 13 had myocardial infarction, and at least seven had hypovolaemia which could have contributed to transient myocardial ischaemia and stunning.

Transient asystole Asystole or PEA following countershock of prolonged VF is common and occurs in around 60% of patients. Even though restoration of circulation occurs in 16% of patients, the prognosis is poor: only 0-3% are discharged alive. It is possible that asystole or PEA after countershock could be transient before a perfusable rhythm restores circulation. Transient asystole following defibrillation would explain at least one case, where CPR was interrupted after a last cardioversion attempt resulting in asystole, and ROSC occurred soon after. However, transient asystole would not explain delayed ROSC in majority of patients in whom the duration of asystole was much longer. In another case, CPR was stopped while the patient was still in ventricular fibrillation and haemodynamic activity returned few moments later. The authors of the case rightly point out that CPR should not be halted in a patient with ventricular fibrillation.

CONSEQUENCES OF DELAYED RETURN OF SPONTANEOUS CIRCULATION Delayed ROSC can lead to serious professional and legal consequences. Questions will be asked about whether CPR has been conducted properly and whether it was stopped too soon. The medical team might be accused of negligence and incompetence and even be sued for damages if a patient survives with severe disability. A doctor involved in resuscitation and certification of death followed by delayed ROSC has recently been accused of culpable homicide. The conduct of ALS can only be assessed from the case record, so it is vital to record the events during cardiac arrest as accurately as possible. When to discontinue CPR is still a medical decision and so it is absolutely essential to get a consensus from the arrest team and to document the reason for termination of CPR. Some authors recommend measurement of end-tidal carbon dioxide during CPR. Values above 10-15 mmHg indicate a favourable prognosis and should preclude termination of CPR. This technology is not widely available outside the intensive care setting, but should be considered in difficult clinical situations. Whether this would identify patients in whom delayed ROSC might occur is nevertheless questionable.

HOW WOULD ONE RECOGNIZE DEATH?

It is important to realize that death is not an event, but a process. The conference of Medical Royal Colleges in the UK advocated that death is a process during which various organs supporting the continuation of life fail.Cessation of circulation and respiration is such an example. The physical findings to support this—absence of heartbeat and respiration—are the traditional and the most widely used criteria to certify death. Since these findings alone are not a sign of definitive death, it is quite possible to declare death in the interval between cessation of CPR and delayed ROSC.

Because delayed ROSC occurred within 10 minutes in most cases, many authors recommend that patients should be passively monitored for at least 10 minutes following unsuccessful CPR. During that period the family should be informed that CPR had been stopped because of poor response and further efforts are not in the best interests of the patient. It should also be mentioned that the patient is being closely monitored to establish death beyond any doubt. Death should not be certified in any patient immediately after stopping CPR, and one should wait at least 10 minutes, if not longer, to verify and confirm death beyond doubt. This is in line with what was said by W H Sweet in 1978:‘ the time honoured criteria of the stoppage of the heart beat and circulation are indicative of death only when they persist long enough for the brain to die.

NON-MEDICAL LITERATURE Newspapers In addition to medical literature, there are many newspaper articles, websites and a few anecdotes in medical journals describing patients who were certified dead, but later found to be alive. Many of these articles refer to these incidents as ‘Lazarus phenomenon’. There is even a movie called Lazarus phenomenon describing two cases of resurrection after death. However, the authenticity of one of these cases has been questioned.

Websites A website (www.snopes.com/horrors/gruesome/buried.asp) describing people who have been buried alive by mistake in the last few centuries provides entertaining reading. In olden days a number of illnesses could cause coma and there was a danger of hasty disposal of the body especially in those with infectious diseases.

Literature Edgar Allan Poe's most hair-raising tale is The Premature Burial, in which a young wife was incorrectly pronounced dead and kept in a coffin in the family vault. When the vault was opened a few years later to receive another coffin, a shrouded skeleton was found in the doorway suggested that the lady had survived and eventually died unable to open the vault door. It is believed that he based his story on a widely reported incident that took place around that time. It seems that the chances of being buried alive were not so remote in 1800s. The fear of being buried alive was so prevalent that many people specified in their wills that tests must be carried out to confirm their death, such as pouring hot liquids on the skin, touching the skin with red-hot irons, or making surgical incisions prior to the burial. A coffin was invented and patented in 1897 to allow a person accidentally buried alive to summon help through a system of flags and bells. The fear of being buried alive is called ‘taphophobia’ in the medical literature. There was even a Society for the Prevention of Burial Before Death, which recognized the difficulties in diagnosing death and issued educational leaflets to assist members of the society.

LAZARUS IN OTHER CONTEXTS The term Lazarus has also been used to describe many other unexpected and scientifically unexplainable phenomena. Lazarus complex describes the psychological sequence in the survivors of cardiac arrest, near-death experiences and unexpected remission in AIDS. Lazarus syndrome is described in paediatric palliative care, when a child is expected to die but unexpectedly goes into remission. Spontaneous movement in brain dead and spinal cord injury patients has been described as Lazarus sign. Survival of species after mass extinction has been called Lazarus effect. The term Lazarus phenomenon was also used for unexpected survival of renal graft patients.

Lazarus premonition describes an unexpected state of brief resurrection in terminally ill patients, when they experience an increase in vitality, appetite and general improvement. This was recognized at least a thousand years ago in the medieval Chinese literature and was described as hui guang fan zhao, meaning reflected rays of setting sun. Recently a ‘Lazarus Pill’ (Zolpidem, a non-benzodiazepine sedative) has aroused medical interest in patients with persistent vegetative state. This was following a report where a patient with persistent vegetative state showed a brief remarkable neurological response to zolpidem.

RESURRECTION There are many other resurrections in addition to that of Lazarus. Three resurrections are recorded in the Old Testament, one each by Elijah, Elisha and Elisha's bones. There are many resurrections in the New Testament, four by Jesus (including Lazarus) and one each by Paul and Peter. In Hindu mythology Sathyavan's wife Savithri convinces the Lord of death (Yamaraj) to resurrect Sathyavan following his death after being caught under a falling tree. These stories illustrate that humanity's preoccupation with death and resurrection is universal. The greatest example of Lazarus phenomenon is probably the death and resurrection of Jesus Christ himself.

KEY POINTS · Lazarus phenomenon is described as delayed ROSC after cessation of CPR; · Dynamic hyperinflation should be considered as a reversible of cause of PEA; · Patients should be observed for at least 10 minutes using blood pressure and ECG monitoring after the cessation of CPR before confirming death.

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St. Lazarus of Bethany

Christ Raising of Lazarus, Athens, 12-13th Century Four-days dead, Friend of Christ Honored Eastern Orthodox Church in Oriental Orthodox Church Roman Catholic Church Eastern Catholic Churches Anglican Communion Lutheran Church Feast • Eastern Churches: Lazarus Saturday;[1] March 17;[2] October 17.[3] • Western Churches: December 17.[4][5] • Martyrologium Romanum (2005): July 29. Attributes Sometimes vested as an apostle, sometimes as a bishop. In the scene of his resurrection, he is portrayed tightly bound in grave clothes, which resemble swaddling bands Lazarus of Bethany, also known as Saint Lazarus or Lazarus of the Four Days, is the subject of a prominent miracle attributed to Jesus in the Gospel of John, in which Jesus restores him to life four days after his death. The Eastern Orthodox and Roman Catholic traditions offer varying accounts of the later events of his life. In the context of the Gospel of John, the narrative of the Raising of Lazarus forms "the climactic sign... Each of Jesus' seven signs illustrates some particular aspect of his divine authority, but this one exemplifies his power over the last and most irresistible enemy of humanity—death. For this reason it is given a prominent place in the gospel."[6] Elʿāzār, Eleazar—"God is my , עלא ז ר :The name Lazarus (Latinised from the Hebrew help"[7]) is also given to a second figure in the Bible: in the narrative of Lazarus and Dives, attributed to Jesus in the Gospel of Luke.[8] Also called Dives and Lazarus, or The Rich Man and the Beggar Lazarus, the narrative tells of the relationship (in life and in death) between an unnamed rich man and a poor beggar named Lazarus. While the two characters named Lazarus have sometimes been conflated historically, they are generally understood to be two separate characters. Allusions to Lazarus as a poor beggar taken to the "Bosom of Abraham" should be understood as referring to the Lazarus mentioned in Luke, rather than the Lazarus who rose from the dead in John. In referring to John's account of the resurrection of Lazarus, the name Lazarus is often used to connote apparent restoration to life. For example, the scientific term "Lazarus taxon" denotes organisms that reappear in the fossil record after a period of apparent extinction; and the Lazarus phenomenon refers to an event in which a person spontaneously returns to life (the heart starts beating again) after resuscitation has been given up. There are also numerous literary uses of the term.

Contents [hide] 1 The "Raising of Lazarus" 1.1 Narrative 1.2 Depictions in art 1.3 Tomb of Lazarus in Bethany 2 Additional traditions about Lazarus of Bethany 2.1 Bishop of Kition 2.2 Bishop of Marseille 3 Liturgical commemorations 3.1 Eastern Orthodoxy 3.2 Roman Catholicism 3.3 Lutheranism 4 Conﬂation with the beggar Lazarus (of Lazarus and Dives) 5 Order of Saint Lazarus 6 Lazarus as Babalu Aye in Santería 7 In culture 8 Notes 9 References

The "Raising of Lazarus"[edit] Main article: Raising of Lazarus Narrative[edit]

Raising Lazarus, Oil on Copper Plate, 1875, Carl Heinrich Bloch (Hope Gallery, Salt Lake City) The biblical narrative of the Raising of Lazarus is found in chapter 11 of the Gospel of John.[9] Lazarus is introduced as a follower of Jesus, who lives in the town of Bethany near Jerusalem.[10] He is identified as the brother of the sisters Mary and Martha. The sisters send word to Jesus that Lazarus, "he whom thou lovest," is ill.[11] Instead of immediately traveling to Bethany, according to the narrator, Jesus intentionally remains where he is for two more days before beginning the journey. When Jesus arrives in Bethany, he finds that Lazarus is dead and has already been in his tomb for four days. He meets first with Martha and Mary in turn. Martha laments that Jesus did not arrive soon enough to heal her brother and Jesus replies with the well-known statement, "I am the resurrection, and the life: he that believeth in me, though he were dead, yet shall he live: And whosoever liveth and believeth in me shall never die".[12] The narrator here gives the famous simple phrase, "Jesus wept".[13] In the presence of a crowd of Jewish mourners, Jesus comes to the tomb. Over the objections of Martha, Jesus has them roll the stone away from the entrance to the tomb and says a prayer. He then calls Lazarus to come out and Lazarus does so, still wrapped in his grave-cloths. Jesus then calls for someone to remove the grave-cloths, and let him go. The narrative ends with the statement that many of the witnesses to this event "believed in him." Others are said to report the events to the religious authorities in Jerusalem. The Gospel of John mentions Lazarus again in chapter 12. Six days before the Passover on which Jesus is crucified, Jesus returns to Bethany and Lazarus attends a supper that Martha, his sister, serves.[14] Jesus and Lazarus together attract the attention of many Jews and the narrator states that the chief priests consider having Lazarus put to death because so many people are believing in Jesus on account of this miracle.[15] The miracle of the raising of Lazarus, the longest coherent narrative in John aside from the Passion, is the climax of John's "signs". It explains the crowds seeking Jesus on Palm Sunday, and leads directly to the decision of Caiaphas and the Sanhedrin to kill Jesus. It is notable that Lazarus is the only resurrected character in the Bible (besides himself) that Jesus personally refers to as "dead." The Daughter of Jairus, whom he resurrected at another time, was said by Jesus to have been "sleeping." A resurrection story that is very similar is also found in the controversial Secret Gospel of Mark, although the young man is not named there specifically. Some scholars believe that the Secret Mark version represents an earlier form of the canonical story found in John. Depictions in art[edit] The Raising of Lazarus is a popular subject in religious art.[16] Two of the most famous paintings are those of Michelangelo Merisi da Caravaggio (c. 1609) and Sebastiano del Piombo (1516). Among other prominent depictions of Lazarus are works by Rembrandt, Van Gogh, Ivor Williams, and Lazarus Breaking His Fast by Walter Sickert. Wikimedia Commons has media related to Resurrection of Lazarus.

• Paintings of the Resurrection of Lazarus

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The Resurrection of Lazarus. Byzantine icon, late 14th — early 15th century, (From the Collection of G. Gamon-Gumun, Russian museum)

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The Resurrection of Lazarus, Russian icon, 15th century, Novgorod school (State Russian Museum, Saint Petersburg)

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The Raising of Lazarus, Oil on canvas, c. 1517-1519, Sebastiano del Piombo (National Gallery, London)

• The Raising of Lazarus, Oil on canvas, c. 1609, Michelangelo Merisi da Caravaggio (Museo Regionale, Messina)

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The Raising of Lazarus, 1630-1631, Rembrandt van Rijn (Los Angeles County Museum of Art, Los Angeles)

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The Raising of Lazarus, 1540-1545, Giuseppe Salviati

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The Raising of Lazarus (after Rembrandt), Oil on paper, 1890, Vincent van Gogh (Van Gogh Museum, Amsterdam)

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The Raising of Lazarus, 1857, Léon Joseph Florentin Bonnat

Tomb of Lazarus in Bethany[edit] Main article: Tomb of Lazarus (al-Eizariya) Reputed tomb of Lazarus in al-Eizariya The reputed first tomb of Lazarus at al-Eizariya in the West Bank (generally believed to be the biblical Bethany) continues to be a place of pilgrimage to this day. Several Christian churches have existed at the site over the centuries. Since the 16th century, the site of the tomb has been occupied by the al-Uzair Mosque. The adjacent Roman Catholic Church of Saint Lazarus, designed by Antonio Barluzzi and built between 1952 and 1955 under the auspices of the Franciscan Order, stands upon the site of several much older ones. In 1965, a Greek Orthodox church was built just west of the tomb. The entrance to the tomb today is via a flight of uneven rock-cut steps from the street. As it was described in 1896, there were twenty-four steps from the then-modern street level, leading to a square chamber serving as a place of prayer, from which more steps led to a lower chamber believed to be the tomb of Lazarus.[17] The same description applies today.[18][19] The first mention of a church at Bethany is in the late 4th century, but both the historian Eusebius of Caesarea[20] (c. 330) and the Bordeaux pilgrim do mention the tomb of Lazarus. In 390 Jerome mentions a church dedicated to Saint Lazarus, called the Lazarium. This is confirmed by the pilgrim Egeria in about the year 410. Therefore, the church is thought to have been built between 333 and 390.[21] The present-day gardens contain the remnants of a mosaic floor from the 4th-century church.[22] The Lazarium was destroyed by an earthquake in the 6th century, and was replaced by a larger church. This church survived intact until the Crusader era. In 1143 the existing structure and lands were purchased by King Fulk and Queen Melisende of Jerusalem and a large Benedictine convent dedicated to Mary and Martha was built near the tomb of Lazarus. After the fall of Jerusalem in 1187, the convent was deserted and fell into ruin with only the tomb and barrel vaulting surviving. By 1384, a simple mosque had been built on the site.[19] In the 16th century, the Ottomans built the larger al-Uzair Mosque to serve the town's (now Muslim) inhabitants and named it in honor of the town's patron saint, Lazarus of Bethany.[22]

Lazarus Tomb Bethany According to the Catholic Encyclopedia of 1913, there were scholars who questioned the reputed site of the ancient village (though this was discounted by the Encyclopedia's author): Some believe that the present village of Bethany does not occupy the site of the ancient village; but that it grew up around the traditional cave which they suppose to have been at some distance from the house of Martha and Mary in the village; Zanecchia (La Palestine d'aujourd'hui, 1899, I, 445f.) places the site of the ancient village of Bethany higher up on the southeastern slope of the Mount of Olives, not far from the accepted site of Bethphage, and near that of the Ascension. It is quite certain that the present village formed about the traditional tomb of Lazarus, which is in a cave in the village. The identiﬁcation of this cave as the tomb of Lazarus is merely possible; it has no strong intrinsic or extrinsic authority. The site of the ancient village may not precisely coincide with the present one, but there is every reason to believe that it was in this general location."[23]

Additional traditions about Lazarus of Bethany[edit] While there is no further mention of Lazarus in the Bible, the Eastern Orthodox and Roman Catholic traditions offer varying accounts of the later events of his life. He is most commonly associated with Cyprus, where he is said to have become the ﬁrst bishop of Kition (Larnaka), and Provence, where he is said to have been the ﬁrst bishop of Marseille. Bishop of Kition[edit]

Church of Saint Lazarus, Larnaca. According to Eastern Orthodox Church tradition, sometime after the Resurrection of Christ, Lazarus was forced to flee Judea because of rumoured plots on his life and came to Cyprus. There he was appointed by Paul and Barnabas as the first bishop of Kition (present-day Larnaka). He lived there for thirty more years,[24] and on his death was buried there for the second and last time.[25] Further establishing the apostolic nature of Lazarus' appointment was the story that the bishop's omophorion was presented to Lazarus by the Virgin Mary, who had woven it herself. Such apostolic connections were central to the claims to autocephaly made by the bishops of Kition—subject to the patriarch of Jerusalem—during the period 325– 431. The church of Kition was declared self-governing in 431 AD at the Third Ecumenical Council.[26] According to tradition, Lazarus never smiled during the thirty years after his resurrection, worried by the sight of unredeemed souls he had seen during his four-day stay in Hades. The only exception was, when he saw someone stealing a pot, he smilingly said: "the clay steals the clay."[1][25] In 890, a tomb was found in Larnaca bearing the inscription "Lazarus the friend of Christ". Emperor Leo VI of Byzantium had Lazarus' remains transferred to Constantinople in 898. The transfer was apostrophized by Arethas, bishop of Caesarea, and is commemorated by the Orthodox Church each year on October 17. In recompense to Larnaca, Emperor Leo had the Church of St. Lazarus, which still exists today, erected over Lazarus' tomb. The marble sarcophagus can be seen inside the church under the Holy of Holies. After the sacking of Constantinople by the Franks during the Fourth Crusade in 1204, the Crusaders carried the saint's relics to Marseilles, France as part of the booty of war. From there, "later on, they disappeared and up to the present day they have not been traced."[25] In the 16th century, a Russian monk from the Monastery of Pskov visited St. Lazarus’s tomb in Larnaca and took with him a small piece of the relics. Perhaps that piece led to the erection of the St. Lazarus chapel at the Pskov Monastery (Spaso-Eleazar Monastery, Pskov),[note 1] where it is kept today.[27] On November 23, 1972, human remains in a marble sarcophagus were discovered under the altar, during renovation works in the church of Church of St. Lazarus at Larnaka, and were identified as part of the saint's relics.[28][note 2] In June 2012 the Church of Cyprus gave a part of the holy relics of St. Lazarus to a delegation of the Russian Orthodox Church, led by Patriarch Kirill of Moscow and All Russia, after a four-day visit to Cyprus. The relics were brought to Moscow and were given to Archbishop Arseniy of Istra, who took them to the Zachatievsky monastery (Conception Convent), where they were put up for veneration.[30] Bishop of Marseille[edit] Autun Cathedral (Cathédrale Saint-Lazare d'Autun), Autun, France also said to be built over the tomb of Lazarus In the West, according to an alternative medieval tradition (centered in Provence), Lazarus, Mary, and Martha, were "put out to sea by the Jews hostile to Christianity in a vessel without sails, oars, or helm, and after a miraculous voyage landed in Provence at a place called today the Saintes-Maries."[31] The family is then said to separate and go in different parts of southeastern Gaul to preach; Lazarus goes to Marseilles. Converting many people to Christianity there, he becomes the first Bishop of Marseille. During the persecution of Domitian, he is imprisoned and beheaded in a cave beneath the prison Saint-Lazare. His body is later translated to Autun, where he is buried in the Autun Cathedral, dedicated to Lazarus as Saint Lazare. However, the inhabitants of Marseilles claim to be in possession of his head which they still venerate.[31] Pilgrims also visit another purported tomb of Lazarus at the Vézelay Abbey in Burgundy.[32] In the Abbey of the Trinity at Vendôme, a phylactery was said to contain [ ] a tear shed by Jesus at the tomb of Lazarus. citation needed The Golden Legend, compiled in the 13th century, records the Provençal tradition. It also records a grand lifestyle imagined for Lazarus and his sisters (note that therein Lazarus' sister Mary is conflated with Mary Magdalene): Mary Magdalene had her surname of Magdalo, a castle, and was born of right noble lineage and parents, which were descended of the lineage of kings. And her father was named Cyrus, and her mother Eucharis. She with her brother Lazarus, and her sister Martha, possessed the castle of Magdalo, which is two miles from Nazareth, and Bethany, the castle which is nigh to Jerusalem, and also a great part of Jerusalem, which, all these things they departed among them. In such wise that Mary had the castle Magdalo, whereof she had her name Magdalene. And Lazarus had the part of the city of Jerusalem, and Martha had to her part Bethany. And when Mary gave herself to all delights of the body, and Lazarus entended all to knighthood, Martha, which was wise, governed nobly her brother's part and also her sister's, and also her own, and administered to knights, and her servants, and to poor men, such necessities as they needed. Nevertheless, after the ascension of our Lord, they sold all these things.[33] The 15c poet Georges Chastellain draws on the tradition of the unsmiling Lazarus:[34] "He whom God raised, doing him such grace, the thief, Mary's brother, thereafter had naught but misery and painful thoughts, fearing what he should have to pass". (Le pas de la mort, VI[35]).

Liturgical commemorations[edit] Lazarus is honored as a saint by those Christian churches which keep the commemoration of saints, although on different days, according to local traditions. In Christian funerals the idea of the deceased being raised by the Lord as Lazarus was raised is often expressed in prayer. Eastern Orthodoxy[edit] The Orthodox Church and Byzantine Catholic Church commemorate Lazarus on Lazarus Saturday,[1] the day before Palm Sunday, which is a moveable feast day. This day, together with Palm Sunday, hold a unique position in the church year, as days of joy and triumph between the penitence of Great Lent and the mourning of Holy Week.[36] During the preceding week, the hymns in the Lenten Triodion track the sickness and then the death of Lazarus, and Christ's journey from beyond Jordan to Bethany. The scripture readings and hymns for Lazarus Saturday focus on the resurrection of Lazarus as a foreshadowing of the Resurrection of Christ, and a promise of the General Resurrection. The Gospel narrative is interpreted in the hymns as illustrating the two natures of Christ: his humanity in asking, "Where have ye laid him?",[37] and his divinity by commanding Lazarus to come forth from the dead.[38] Many of the Resurrectional hymns of the normal Sunday service, which are omitted on Palm Sunday, are chanted on Lazarus Saturday. During the Divine Liturgy, the Baptismal Hymn, "As many as have been baptized into Christ have put on Christ",[39] is sung in place of the Trisagion. Although the forty days of Great Lent end on the day before Lazarus Saturday, the day is still observed as a fast; however, it is somewhat mitigated. In Russia, it is traditional to eat caviar on Lazarus Saturday. Lazarus is also commemorated on the liturgical calendar of the Orthodox Church on the fixed feast day of March 17,[2][note 3] while the translation of his relics from Cyprus to Constantinople in the year 898 AD[41] is observed on October 17.[3][40][note 4] Roman Catholicism[edit] No celebration of Saint Lazarus is included on the General Roman Calendar of the Roman Catholic Church. At one time, his memorial was listed in the Roman Martyrology for December 17.[42] The 2005 edition of the Martyrology moved his memorial to July 29, the same day as the memorial of his sister Martha.[43] In Cuba, the celebration of San Lázaro on December 17 is a major festival. The date is celebrated with a pilgrimage to a chapel housing an image Saint Lazarus, one of Cuba's most sacred icons, in the village of El Rincon, outside Havana.[44] Lutheranism[edit] Lazarus is commemorated in the Calendar of Saints of the Lutheran Church on July 29 together with Mary and Martha. Conflation with the beggar Lazarus (of Lazarus and Dives) [edit] Historically within Christianity, the begging Lazarus of the parable (feast day June 21) and Lazarus of Bethany (feast day December 17) have often been conflated, with some churches celebrating a blessing of dogs, associated with the beggar, on December 17, the date associated with Lazarus of Bethany.[45] Another example of this conflation can be found in Romanesque iconography carved on portals in Burgundy and Provence. For example, at the west portal of the Church of St. Trophime at Arles, the beggar Lazarus is enthroned as St. Lazarus. Similar examples are found at the church at Avallon, the central portal at Vézelay, and the portals of the cathedral of Autun.[46]

Order of Saint Lazarus[edit] Main article: Order of Saint Lazarus The Military and Hospitaller Order of St. Lazarus of Jerusalem (OSLJ) is a religious/military order of chivalry which originated in a leper hospital founded by Knights Hospitaller in the twelfth century by Crusaders of the Latin Kingdom of Jerusalem. Sufferers of leprosy regarded the beggar Lazarus (of Luke 16:19-31) as their patron saint and usually dedicated their hospices to him.[47]

Lazarus as Babalu Aye in Santería[edit] Via syncretism, Lazarus (or more precisely the conflation of the two figures named Lazarus) has become an important figure in Santería as the Yoruba deity Babalu Aye. Like the beggar of the Christian Gospel of Luke, Babalu-Aye represents someone covered with sores licked by dogs who was healed by divine intervention.[44][48] Silver charms known as the crutch of St. Lazarus or standard Roman Catholic-style medals of St. Lazarus are worn as talismans to invoke the aid of the syncretized deity in cases of medical suffering, particularly for people with AIDS.[48] In Santería, the date associated with St. Lazarus is December 17,[44] despite Santería's reliance on the iconography associated with the begging saint whose feast day is June 21.[45]

In culture[edit] Resurrection of Lazarus by Mauricio García Vega. Well known in Western culture from their respective biblical tales, both figures named Lazarus (Lazarus of Bethany and the Beggar Lazarus of Lazarus and Dives), have appeared countless times in music, writing and art. The majority of the references are to Lazarus of Bethany, including the following: • In literature, allusions to Lazarus are made in several notable works. A few prominent examples include Crime and Punishment by Fyodor Dostoevsky, several novels of Robert A. Heinlein, Frank Herbert's novel The Lazarus Effect, A Separate Peace by John Knowles, A Canticle for Leibowitz by Walter M. Miller, Jr., a short story entitled 'Lazarus' by Russian writer Leonid Andreyev,[49]"A Tree of Night" by Truman Capote, "Lazarus," by Edwin Arlington Robinson,[50] and "Lady Lazarus", a poem written by Sylvia Plath. The poet David Constantine published a pair of sonnets, Christ to Lazarus and Lazarus to Christ in his 1983 collection Watching for Dolphins. Stephen King's novel, "Pet Sematary" also refers to the resurrection of Lazarus on several occasions within the text. John Derhak's novel, The Bones of Lazarus, blends fact and fiction, portraying Lazarus as an immortal creature of Judgment. MacArthur Foundation grantee Aleksandar Hemon's landmark 2008 novel The Lazarus Project is probably the most recent work of note to have referenced the story. The 1991 novel The Famished Road written by Nigerian writer Ben Okri follows the story of a boy called "Azaro", nickname for "Lazarus" and alludes to the story several times in the text, probably conflating both Lazarus the beggar and Lazarus of Bethany. • In music, a popular retelling of the biblical Lazarus story from the point of view of Lazarus in heaven is the 1984 gospel story-song "Lazarus Come Forth" by Contemporary Christian Music artist Carman.[51][52] A modern reinterpretation of the story is the title track to the album "Dig, Lazarus, Dig!!!" by the Australian alternative band Nick Cave and the Bad Seeds. Several other bands have composed songs titled "Lazarus" in allusion to the resurrection story, including Porcupine Tree, Conor Oberst, Circa Survive, Chimaira, moe., and Placebo. •In Joshua, My Brother, author O.F. Gnal suggests that the "death" of Lazarus was a rebirth ritual of the very early Church and that the name relates to an earlier Egyptian resurrection of "Al-Azarus". • In the video game Mass Effect 2, the Human terrorist organization Cerberus organizes a special project, codenamed Project Lazarus to resurrect the main protagonist, Commander Shepard, after their untimely death in the beginning of the game. • In the steampunk video game Darkwatch, Lazarus is the main antagonist of the game. In this version, he was a former vampire hunter who, in his arrogance, fused his body and soul with a demon in the hopes of acquiring a stronger power to fight against the vampiric forces who destroyed ancient Rome. However, this attempt failed as he became a vampire lord as a result of the experiment and turned against the Darkwatch organization he created. • Lazarus is shown in the film The Last Temptation of Christ, Lazarus is shown resurrected but later he is killed by Saul in order to discredit Jesus.

Literatary allusions to the Beggar Lazarus appear in Herman Melville's novel Moby- Dick (as part of a metaphor describing a cold night in New Bedford)[53] and in the poem "The Love Song of J. Alfred Prufrock" by T. S. Eliot (which contains the lines: 'To say: "I am Lazarus, come from the dead,/Come back to tell you all, I shall tell you all" ', in reference to Dives' request to have Beggar Lazarus return from the dead to tell his brothers of his fate). When John Howard lost the leadership of the Liberal Party of Australia, he rated his chances of regaining it as "Lazarus with a triple bypass".[54] Howard did regain the leadership and went on to become Prime Minister of Australia. Former President of Haiti, Jean Bertrand Aristide, was termed the "Haitian Lazarus" by journalist Amy Wilentz, in her description of his return to Haiti from exile and the political significance of this event.[55] The Lazarus Effect (film) is a documentary project for HIV AIDS awareness by U2 musician Bono's private sector brand initiative (RED) (Product Red). Promotion involved the recruitment of high profile celebrities to advocate for consumer funding for effective ARV (Antiretroviral drug) therapy which cost just US$0.40 a day to provide.[56] [57][58] "In as few as 40 days, the medicine can help bring people back to life"[59] from this viral illness, hence its reference to the story of the ((Raising of Lazarus)). The scientific term "Lazarus taxon", which denotes organisms that reappear in the fossil record after a period of apparent extinction. The Lazarus phenomenon refers to an event in which a person spontaneously returns to life (the heart starts beating again) after resuscitation has been given up. The Lazarus sign is a reflex which can occur in a brain-dead person, thus giving the appearance that they have returned to life. In DC Comics, Ra's al Ghul, an enemy of Batman, uses a mystical Lazarus Pit to keep himself young. In many occasions, characters that were dead or sick was brought to the Lazarus Pit to revive or restore their health. In the video game BioShock, the ´´Lazarus Vector´´ is used to bring trees back to life. The Commodore Amiga's operating system's disk repair program Diskdoctor occasionally renames a disk 'Lazarus' if it feels it has done a particularly good job of rescuing damaged files[60]

Notes[edit] 1. Jump up ^ (Russian) Спасо-Елеазаровский монастырь. Russian Wikipedia. 2. Jump up ^ In 1970 a ﬁre that broke out in Church of St. Lazarus at Larnaka destroyed almost all of the internal furnishings of the church.[29] Subsequent archaeological excavations and renovations led to the discovery of a portion of the saint's relics. 3. Jump up ^ In the Synaxarion of Constantinople and in the Lavreotic Codex, reference is made to the "Raising of Lazarus" - the Holy and Just Lazarus, the friend of Christ.[2] The entry for October 17 in the Prologue from Ohrid also states that "Lazarus's principle feasts are on March 17 and Lazarus Saturday during Great Lent."[40] 4. Jump up ^ "...Under today's date is commemorated the translation of his relics from the island of Cyprus to Constantinople. This occurred when Emperor Leo the Wise built the Church of St. Lazarus in Constantinople, and translated Lazarus's relics there in the year 890. When, after almost a thousand years, Lazarus's grave in the town of Kition on Cyprus was unearthed, a marble tablet was found with the inscription: "Lazarus of the Four Days, the friend of Christ.""[40] References[edit] 1. ^ Jump up to: a b c Great Synaxaristes: (Greek) Ἀνάστασις τοῦ Λαζάρου. ΜΕΓΑΣ ΣΥΝΑΞΑΡΙΣΤΗΣ. 2. ^ Jump up to: a b c Great Synaxaristes: (Greek) Ὁ Ἅγιος Λάζαρος ὁ Δίκαιος, ὁ φίλος τοῦ Χριστοῦ. 17 ΜΑΡΤΙΟΥ. ΜΕΓΑΣ ΣΥΝΑΞΑΡΙΣΤΗΣ. 3. ^ Jump up to: a b Great Synaxaristes: (Greek) Ἀνακομιδὴ καὶ Κατάθεσις τοῦ Λειψάνου τοῦ Ἁγίου καὶ Δικαίου Λαζάρου. 17 Οκτωβρίου. ΜΕΓΑΣ ΣΥΝΑΞΑΡΙΣΤΗΣ. 4. Jump up ^ The Roman Martyrology. Transl. by the Archbishop of Baltimore. Last Edition, According to the Copy Printed at Rome in 1914. Revised Edition, with the Imprimatur of His Eminence Cardinal Gibbons. Baltimore: John Murphy Company, 1916. p. 387. 5. Jump up ^ The Benedictine Monks of St. Augustine's Abbey, Ramsgate (Comp.). The Book of Saints: A Dictionary of Servants of God Canonised by the Catholic Church: Extracted from The Roman and Other Martyrologies. London: A & C Black Ltd., 1921. p. 163. 6. Jump up ^ Tenney, Merrill C.. Kenneth L. Barker & John Kohlenberger III, ed. Zondervan NIV Bible Commentary. Grand Rapids, Michigan: Zondervan Publishing House. 7. Jump up ^ William Barclay, The Parables of Jesus, Westminster John Knox Press, 1999, ISBN 0-664-25828-X, pp. 92–98. 8. Jump up ^ Luke 16:19–31 9. Jump up ^ John 11:1-46 10. Jump up ^ John 11:1 11. Jump up ^ John 11:3 12. Jump up ^ John 11:25, KJV 13. Jump up ^ John 11:35, KJV 14. Jump up ^ John 12:2 15. Jump up ^ John 12:9-11 16. Jump up ^ For the treatment of this subject in Western European art, see the discussion in Franco Mormando, "Tintoretto's Recently Rediscovered Raising of Lazarus, in The Burlington Magazine, v. 142 (2000): pp. 624-29. 17. Jump up ^ In The Biblical World 8.5 (November 1896:40). 18.

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St. Lazarus of Bethany

The "Raising of Lazarus"[edit] Main article: Raising of Lazarus Narrative[edit]

• Paintings of the Resurrection of Lazarus

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The Resurrection of Lazarus. Byzantine icon, late 14th — early 15th century, (From the Collection of G. Gamon-Gumun, Russian museum)

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The Resurrection of Lazarus, Russian icon, 15th century, Novgorod school (State Russian Museum, Saint Petersburg)

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The Raising of Lazarus, Oil on canvas, c. 1517-1519, Sebastiano del Piombo (National Gallery, London)

• The Raising of Lazarus, Oil on canvas, c. 1609, Michelangelo Merisi da Caravaggio (Museo Regionale, Messina)

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The Raising of Lazarus, 1630-1631, Rembrandt van Rijn (Los Angeles County Museum of Art, Los Angeles)

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The Raising of Lazarus, 1540-1545, Giuseppe Salviati

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The Raising of Lazarus (after Rembrandt), Oil on paper, 1890, Vincent van Gogh (Van Gogh Museum, Amsterdam)

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The Raising of Lazarus, 1857, Léon Joseph Florentin Bonnat

Church of Saint Lazarus, Larnaca. According to Eastern Orthodox Church tradition, sometime after the Resurrection of Christ, Lazarus was forced to flee Judea because of rumoured plots on his life and came to Cyprus. There he was appointed by Paul and Barnabas as the first bishop of Kition (present-day Larnaka). He lived there for thirty more years,[24] and on his death was buried there for the second and last time.[25] Further establishing the apostolic nature of Lazarus' appointment was the story that the bishop's omophorion was presented to Lazarus by the Virgin Mary, who had woven it herself. Such apostolic connections were central to the claims to autocephaly made by the bishops of Kition—subject to the patriarch of Jerusalem—during the period 325– 431. The church of Kition was declared self-governing in 431 AD at the Third Ecumenical Council.[26] According to tradition, Lazarus never smiled during the thirty years after his resurrection, worried by the sight of unredeemed souls he had seen during his four-day stay in Hades. The only exception was, when he saw someone stealing a pot, he smilingly said: "the clay steals the clay."[1][25] In 890, a tomb was found in Larnaca bearing the inscription "Lazarus the friend of Christ". Emperor Leo VI of Byzantium had Lazarus' remains transferred to Constantinople in 898. The transfer was apostrophized by Arethas, bishop of Caesarea, and is commemorated by the Orthodox Church each year on October 17. In recompense to Larnaca, Emperor Leo had the Church of St. Lazarus, which still exists today, erected over Lazarus' tomb. The marble sarcophagus can be seen inside the church under the Holy of Holies. After the sacking of Constantinople by the Franks during the Fourth Crusade in 1204, the Crusaders carried the saint's relics to Marseilles, France as part of the booty of war. From there, "later on, they disappeared and up to the present day they have not been traced."[25] In the 16th century, a Russian monk from the Monastery of Pskov visited St. Lazarus’s tomb in Larnaca and took with him a small piece of the relics. Perhaps that piece led to the erection of the St. Lazarus chapel at the Pskov Monastery (Spaso-Eleazar Monastery, Pskov),[note 1] where it is kept today.[27] On November 23, 1972, human remains in a marble sarcophagus were discovered under the altar, during renovation works in the church of Church of St. Lazarus at Larnaka, and were identified as part of the saint's relics.[28][note 2] In June 2012 the Church of Cyprus gave a part of the holy relics of St. Lazarus to a delegation of the Russian Orthodox Church, led by Patriarch Kirill of Moscow and All Russia, after a four-day visit to Cyprus. The relics were brought to Moscow and were given to Archbishop Arseniy of Istra, who took them to the Zachatievsky monastery (Conception Convent), where they were put up for veneration.[30] Bishop of Marseille[edit] Autun Cathedral (Cathédrale Saint-Lazare d'Autun), Autun, France also said to be built over the tomb of Lazarus In the West, according to an alternative medieval tradition (centered in Provence), Lazarus, Mary, and Martha, were "put out to sea by the Jews hostile to Christianity in a vessel without sails, oars, or helm, and after a miraculous voyage landed in Provence at a place called today the Saintes-Maries."[31] The family is then said to separate and go in different parts of southeastern Gaul to preach; Lazarus goes to Marseilles. Converting many people to Christianity there, he becomes the first Bishop of Marseille. During the persecution of Domitian, he is imprisoned and beheaded in a cave beneath the prison Saint-Lazare. His body is later translated to Autun, where he is buried in the Autun Cathedral, dedicated to Lazarus as Saint Lazare. However, the inhabitants of Marseilles claim to be in possession of his head which they still venerate.[31] Pilgrims also visit another purported tomb of Lazarus at the Vézelay Abbey in Burgundy.[32] In the Abbey of the Trinity at Vendôme, a phylactery was said to contain a tear shed by Jesus at the tomb of Lazarus.[citation needed] The Golden Legend, compiled in the 13th century, records the Provençal tradition. It also records a grand lifestyle imagined for Lazarus and his sisters (note that therein Lazarus' sister Mary is conflated with Mary Magdalene): Mary Magdalene had her surname of Magdalo, a castle, and was born of right noble lineage and parents, which were descended of the lineage of kings. And her father was named Cyrus, and her mother Eucharis. She with her brother Lazarus, and her sister Martha, possessed the castle of Magdalo, which is two miles from Nazareth, and Bethany, the castle which is nigh to Jerusalem, and also a great part of Jerusalem, which, all these things they departed among them. In such wise that Mary had the castle Magdalo, whereof she had her name Magdalene. And Lazarus had the part of the city of Jerusalem, and Martha had to her part Bethany. And when Mary gave herself to all delights of the body, and Lazarus entended all to knighthood, Martha, which was wise, governed nobly her brother's part and also her sister's, and also her own, and administered to knights, and her servants, and to poor men, such necessities as they needed. Nevertheless, after the ascension of our Lord, they sold all these things.[33] The 15c poet Georges Chastellain draws on the tradition of the unsmiling Lazarus:[34] "He whom God raised, doing him such grace, the thief, Mary's brother, thereafter had naught but misery and painful thoughts, fearing what he should have to pass". (Le pas de la mort, VI[35]).

^ "Bethany". Catholic Encyclopedia. New York: Robert Appleton Company. 1913. 24. Jump up ^ Chev. C. Savona-Ventura (KLJ, CMLJ, BCrLJ). Lazarus of Bethany. Grand Priory of the Maltese Island: Military & Hospitaller Order of St. Lazarus of Jerusalem. December 2009. p. 3. 25. ^ Jump up to: a b c Michaelides, M.G. "Saint Lazarus, The Friend Of Christ And First Bishop Of Kition", Larnaca, Cyprus, 1984. Reprinted by Fr. Demetrios Serfes at St. Lazarus The Friend Of Christ And First Bishop Of Kition, Cyprus 26. Jump up ^ Roberson, Fr. Ronald G., (C.S.P.). The Orthodox Church of Cyprus. CNEWA United States. 26 June 2007. 27. Jump up ^ St. Lazarus Church & Ecclesiastical Museum, Larnaca. Cyprus Tourism Organisation. p. 4. Retrieved: 2013-04-17. 28. Jump up ^ St. Lazarus Church & Ecclesiastical Museum, Larnaca. Cyprus Tourism Organisation. p. 14. Retrieved: 2013-04-17. 29. Jump up ^ St. Lazarus' relics brought to Moscow from Cyprus. Interfax-Religion. 13 June 2012, 13:32. 30. Jump up ^ ST. LAZARUS' RELICS BROUGHT TO MOSCOW FROM CYPRUS. Pravoslavie.ru. Moscow, June 13, 2012. 31. ^ Jump up to:

a b "St. Lazarus of Bethany". Catholic Encyclopedia. New York: Robert Appleton Company. 1913. 32. Jump up ^ [1] 33. Jump up ^ "Of Mary Magdalene", Legenda Aurea, Book IV. 34. Jump up ^ Huizinga, the Waning of the Middle Ages p147 35. Jump up ^ p. 59 36. Jump up ^ Archimandrite Kallistos Ware and Mother Mary, Tr., The Lenten Triodion (St. Tikhon's Seminary Press, South Canaan, Pennsylvania, 2002, ISBN 1-878997-51-3), p. 57. 37. Jump up ^ (John 11:34) 38. Jump up ^ (John 11:43) 39. Jump up ^ (Romans 6:3) 40. ^ Jump up to: a b c Bishop Nikolaj Velimirović. October 17 - The Prologue from Ohrid. (Serbian Orthodox Church Diocese of Western America). Retrieved 2013-04-17. 41. Jump up ^ Translation of the relics of St Lazarus “of the Four Days in the Tomb” the Bishop of Kiteia on Cyprus. OCA - Lives of the Saints. Retrieved: 2013-04-17. 42. Jump up ^ December 17, Roman Martyrology (1749). 43. Jump up ^ Martyrologium Romanum 420 (edito altera 2005). 44. ^ Jump up to: a b c With sackcloth and rum, Cubans hail Saint Lazarus, December 17, 1998. Reuters news story. 45. ^ Jump up to: a b Money talks: folklore in the public sphere December 2005, Folklore magazine. 46. Jump up ^ Richard Hamann, "Lazarus in Heaven" The Burlington Magazine for Connoisseurs 63 No. 364 (July 1933), pp. 3-5, 8-11 47. Jump up ^ "History", ofﬁcial international website of the Military and Hospitaller Order of Saint Lazarus of Jerusalem. Retrieved on 2009-09-14. 48. ^ Jump up to: a b Lazarus 49. Jump up ^ Lazarus 50. Jump up ^ http://archive.org/details/threetavernsbook00robiuoft 51. Jump up ^ Carman Bio, MPCA promotional material. 52. Jump up ^ Comin' On Strong discography. 53. Jump up ^ Melville, Herman. Moby Dick. pp. 11–12. 54. Jump up ^ "Thoughts of a bypassed Lazarus", The Age (Melbourne), 29 February 2004, retrieved 25 July 2007 55. Jump up ^ Wilentz, Amy. The Haitian Lazarus. NY Times (Op-Ed). March 15, 2011. 56. Jump up ^ Source: The Lazarus Effect Trailer (Red), 30 April 2010, retrieved 12 October 201 57. Jump up ^ 'The Lazarus Effect' Film from (RED) & HBO on YouTube 58. Jump up ^ Template:Ofﬁcial websiteurl=http://www.joinred.com 59. Jump up ^ "(RED): 2 Pills A Day - The Lazarus Effect". Youtube. 27 May 2010. Retrieved 12 October 2011. 60. Jump up ^ http://www.amigahistory.co.uk/d.html [show] • v t e New Testament people Categories: Followers of JesusSaints from the Holy LandNew Testament peopleGospel of John Navigation menu

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Main page Contents Featured content Current events Random article Donate to Wikipedia Wikimedia Shop Interaction Help About Wikipedia Community portal Recent changes Contact page TooThe standards for defining death in Canada vary so much that the hospital where a dying person ends up may affect when they are declared dead - and that has some Canadian doctors concerned about the implications for organ donation, CBC’s the fifth estate has learned. There are about 2,000 organs transplanted in Canada every year, but hundreds of people die while on a waiting list because of a critical shortage of life-saving organs.

Across the country, physicians involved in organ donation must adhere to what’s known as the "dead donor rule." It seems simple — organs cannot be procured until after the donor has died. 'The challenge is that death is a process, and when it’s a process, taking it to one specific time is very difficult.' - Dr. David Zygun, University of Alberta director of critical care The problem is how to pinpoint the exact time of death, says the University of Alberta’s director of critical care, Dr. David Zygun.

“The challenge is that death is a process, and when it’s a process, taking it to one specific time is very difficult,” he told the fifth estate’s Bob McKeown. The result is that the length of time before a person can be officially declared dead in Canada and around the world may depend less on medical science than where the hospital is located. Health lawyer Jacqueline Shaw in Halifax calls it “postal code death.” “That doesn’t line up with what most people think death is — they think, well, it’s the same standard everywhere,” she said.

• The issues around organ donation after cardiac death • Organ transplants in Canada see 'moderate' increase

The national guidelines for pronouncing cardiac death for organ donation require doctors to wait at least five minutes after the heart stops beating. That is the policy in place at Toronto’s Sunnybrook Hospital and the Toronto General Hospital. But across the city at St. Michael’s hospital, the wait is at least 10 minutes. Defining death

The fifth estate's Bob McKeown examines how we define death in Canada, and what it means for organ donation. 'Dead Enough' airs on CBC Television on Friday March 21 at 9 p.m. EDT, 9:30 p.m. in Newfoundland.

In some parts of the United States, the amount of time before death can be declared is much shorter. In Pittsburgh, Pennsylvania, it is two minutes, while in Denver, Colorado, the wait is just 75 seconds.

In Italy, it takes longer — doctors must wait a minimum of 20 minutes after the heart stops to declare death. There is another layer of complication: at least three Canadian provinces — Manitoba, New Brunswick and Saskatchewan — do not accept cardiac death as a standard; they rely only on brain death. Even if a province has adopted a certain standard, individual hospitals can make their own decisions. In Alberta, the Foothills hospital in Calgary accepts only brain death, while the University of Alberta Hospital in Edmonton recognizes both brain and cardiac death.

Why so much variation?

In Canada, organ donor rates lag behind the United States and Europe. Here, more than 4,000 people are on transplant waiting lists, and each year about 300 people die waiting.

Dr. Sam Shemie of McGill University is an intensive care specialist who was influential in pushing for the new “donation after cardiac death” standard used to determine when someone is clinically dead. DCD is credited with saving hundreds of Canadians’ lives by increasing the pool of viable transplants. (CBC) For years, the standard measurement of death in Canada was brain death: people were not declared deceased until after the brain stopped functioning.

In 2005, the guidelines for declaring death were changed, so that more organs could be donated and procured. Now the national standard also includes "donation after cardiac death," or DCD. Some provinces and hospitals chose to adopt the DCD guideline to wait at least five minutes after the heart stops beating, while others still use brain death as their only standard.

Dr. Sam Shemie of McGill University, an intensive care specialist at the Montreal Children’s hospital, was influential in pushing for this new definition to save Canadians’ lives with more transplants. “DCD has accounted for over 1,000 transplants in this country that otherwise would never have occurred,” he told McKeown. Intense debate

Despite that success, the change to DCD has prompted an intense but largely behind- the-scenes debate in medical circles about the consequences for organ donation. “Some physicians, including myself, believe there is genuine debate about whether organ donors are already dead,” said Dr. Ari Joffe, who works in the intensive care unit at the Stollery Children’s hospital in Edmonton. “I don’t want to be misinterpreted because I do definitely support organ donation, but I have concerns about the process involved in DCD,” he told McKeown.

Dr. Ari Joffe, who works in the intensive care unit at the Stollery Children’s hospital in Edmonton, questions whether the standard five-minute wait after the heart stops beating is long enough to be certain that cardiac death is irreversible. He points out that medical interventions like CPR often bring patients back after five minutes without a pulse. (CBC) Dr. Joffe questions whether a five-minute wait after the heart stops beating is long enough to be certain that cardiac death is irreversible. He points out that medical interventions like CPR often bring patients back after five minutes without a pulse.

He argues that it would take at least 20 or 30 minutes to be sure death is irreversible, but at that point, Dr. Joffe says the quality of the donated organs may no longer be adequate. Doctors need to harvest organs within two hours after the heart stops or they may deteriorate beyond use.

For some doctors, DCD also raises ethical concerns. Intensive care unit physicians are trying to prolong the patient’s life, while the transplant team is focused on saving lives of organ donation recipients. Dr. Shemie said the national guidelines indicate there must be strict separation between those two teams, to ensure the transplant team has no role in determining when death occurs.

“The first sacrosanct rule in organ donation in this country — it’s a moral rule and it’s a law — is that there needs to be strict separation of teams,” Dr. Shemie told McKeown.

But Dr. Joffe says some critical care specialists may still feel pressure. “Although we’re not the surgeons taking the organs, we’re still part of the transplant team. My concern is, I don’t think we can separate those processes as clearly as has been stated.”

Life and death decisions

The families of potential donors can also feel pressure to make critical life and death decisions.

In its documentary Dead Enough, the fifth estate has the stories of two families who both faced difficult decisions about organ donation, because their loved ones were not expected to survive severe brain injuries.

• Watch the stories of two people who might have become organ donors - but recovered

When her daughter was critically injured and paralyzed in a car crash, for example, Sharon Thompson was at her bedside in a Calgary hospital around the clock. Thompson says she was approached to consent to organ donation, and asked to consider taking her daughter off life support.

“When people are in an emotional state, I don’t think that’s the time to be asking those questions. Because the emotional roller-coaster we were on for, I would say, at least three of those six weeks … that’s not a great time to be having to make that decision too, because you’re not thinking,” she told McKeown.

Thompson chose not to take her daughter off life support, and Brandice Thompson made a remarkable recovery.

More public debate

What happened to the Thompson family reflects the complexity of the life and death decisions at stake in the DCD debate.

So far, the debate over defining death has mostly been conducted in the medical community, out of public view. 'I think that we're not doing ourselves justice by not providing frank information about death and about the procedures that go on in organ donation to patients.' - Jacqueline Shaw, health lawyer

Health lawyer Shaw says that may explain why one national survey suggests almost a quarter of Canadians feared physicians might declare death prematurely in order to expedite the procurement of organs.

“That's a serious amount of concern in the population, and it could certainly be affecting donation rates. I think that we're not doing ourselves justice by not providing frank information about death and about the procedures that go on in organ donation to patients,” she told McKeown.

In Montreal, Dr. Shemie says what the Canadian public needs to know most of all is that there is a system that works to both save lives through transplants — and to protect dying patients who could become donors. “We know that organ donation saves lives, and we know that we have standards in this country that protect patients at the end of life to make sure that all efforts are provided to those patients. But when that can’t happen and that patient’s going to die, then we’re able to provide the chance to donate, okay,” he told McKeown.

“So, standards are in place so that public trust is maintained. I can assure the public that we do a great and very credible job in doing tha