Cheating Death

by Sanjay Gupta

  It’s a small study and the results are not definitive, but Nelson is confident he’s cracked the code. The feeling of being dead would be caused by REM atonia—sleep paralysis. The tunnel and light would stem from loss of blood flow to the retina, combined with REM-stimulated visual imagery in the brain. The emotional aspects of the NDE would be fueled by the limbic system. An out-of-body feeling is common in the REM state and can also be triggered by stimulation of the same brain regions.

  Nelson points out a few other things, as well. We know that a lack of oxygen can trigger an out-of-body reaction. Fighter pilots who experience blackouts or near blackouts from extreme g-forces—which block blood flow to the brain—often report intense dreams or dream imagery. There was also a 1994 study by a researcher who trained a bunch of college kids to hyperventilate and then suddenly stand up. Head rush, man! Not surprisingly, a fair number of the students reported brief blackouts; many also reported an out-of-body experience. I should also note that a life-threatening moment can be extremely stressful, and we know that stress can cause shortness of breath and perhaps a shortage of oxygen.

  But here’s something less obvious: stick your face into ice-cold water, and you will find yourself instantly gasping for breath. That’s the diving reflex—sometimes referred to as the vagal reflex, named for the vagus nerve; it is so powerful that there are cases where people suffocated before they had a chance to drown after falling from a boat into icy waters. 19 The nerve can also be triggered by emotional stress. It sounds weird, but think about people who faint when they’re extremely frightened—that’s emotion triggering the vagal reflex.

  Intriguingly, Nelson says you can trigger a REM-like state by stimulating that very same vagus nerve. This could help explain something that was nagging me before I heard his theory. People who go through a terrifying experience unharmed—such as someone who narrowly avoids a head-on highway collision—may also describe aspects of an NDE, like an out-of-body experience or a sense of time slowing down. Of course, all these NDEs and out-of-body experiences could just be the brain’s protective reflex, a way to protect you from intense fear and stress. While the rest of your body is fighting for its life, your brain transports you to another place, full of bright tunnels and strong emotions.

  Nelson’s theory is fascinating, but it has raised a lot of hackles among other near-death researchers. After Nelson’s study was published, Jeffrey Long and a therapist named Janice Miner Holden published a detailed thirty-five-page critique politely but firmly challenging every one of Nelson’s conclusions. 20 Long (who had helped Nelson to recruit research subjects) is a radiation oncologist who runs one of the most prominent websites in the near-death community. Long says his Near Death Experience Research Foundation (NDERF) is a public service—he runs no advertising and takes no money for the work. According to Long, the NDERF website, nderf.org, receives more than fifty thousand unique visitors every month from more than twenty countries (Poles seem to take a special interest—there were 2,500 visitors from Poland alone the month we first spoke). Over the years, more than 1,600 people have described their NDEs and taken the time to fill out an elaborate questionnaire. 21

  Long is a restless soul. Born and raised in Iowa, he says he’s been licensed in ten different states over the past two decades. He moved to Albuquerque in early 2007 because he wanted to work with patients from the nearby Navajo territory. He traces his interest in NDEs to an article he stumbled across in 1986, by the Atlanta cardiologist and author Michael Sabom. “I was immediately fascinated. It should be impossible to be clinically dead and still have these lucid experiences,” says Long. “I was astounded, and I remember vividly wondering, ‘Why aren’t more people studying this?’ ” He committed to doing the research himself after a drunken evening with a friend and his wife, where the wife told the story of an NDE she had had many years earlier—an experience where she coded on the operating table due to a severe allergic reaction; she says she floated away from her body, down the hall to a nursing station.

  Long complains that Nelson’s comparison group—the non-NDEers—is not typical; many are medical professionals and colleagues of Nelson. He also told me the research questionnaire was poorly designed and that Nelson fails to recognize dramatic differences between near-death experience and REM intrusion. For one thing, says Long, hallucinations stemming from REM intrusion—just before waking, or while falling asleep—are often “bizarre and unrealistic,” such as seeing objects appear through cracks in a wall or movement in a painting on the wall. By contrast, says Long, memories from an NDE are lucid and rooted in the real world.

  “NDEers almost uniformly don’t say, ‘Oh, that must have been a dream.’ [On the website] we ask if they were conscious and alert, and about 75 percent say they were more alert, more conscious than normal,” says Long. What’s more, “there’s a consistency of elements. This is not like a hallucination.”

  After hearing thousands upon thousands of NDEs, Long wonders, “Why do people 98 percent of the time encounter deceased relatives, as opposed to [their] dreams where it’s common to encounter living people? We’ve even had people encounter deceased relatives who[m] they didn’t know at the time were dead… . The totality of evidence shows there’s something going on that’s outside the medical evidence. NDEers almost always say, ‘That wasn’t a dream.’ It was some different realm, some different aspect of their existence.”

  Long didn’t really convince me that NDEs are evidence of another world. After all, my dreams can seem pretty realistic; often the only reason I know it was a dream is because when I wake up in bed the three-headed alligator or the tropical beach or the supermodel isn’t there. But Long also raises another important point. REM intrusion—whether sleep paralysis or hallucinations—tends to be frightening or deeply unsettling. By contrast, most people who go through an NDE say the experience is almost supernaturally calm and peaceful, even joyful. Not only anecdotes, but real evidence does support this. In a 2001 study in the medical journal The Lancet, of sixty-two cardiac arrest patients who reported a near-death experience, more than half said the main emotions they experienced were “positive.” 22 Long says these distinctive, positive emotions are powerful evidence that a near-death experience is not just REM intrusion in disguise.

  An even fiercer critic of scientific NDE explanations is Dutch cardiologist Dr. Pim van Lommel—the author of that Lancet study. Now in his late sixties, van Lommel has the graying hair and kindly smile of a beloved family doctor. When he opens his mouth, though, he sounds like the commanding medical general who ran the cardiology ward of a major hospital in his native Holland. Even in English, his tone is clipped and certain. Like most physicians who study near-death experience, van Lommel traces his interest to an early patient—in his case, a man who was bitterly disappointed to be back among the living. Van Lommel says, “He told me about the tunnel, and the light, and music, and a beautiful landscape so beautiful that he was unhappy to be back in his body.” 23

  Intrigued by the vivid story, van Lommel started asking his patients who survived a cardiac arrest if they remembered anything from the period of unconsciousness. Many did, and he began to analyze their accounts. His Lancet study looked at 344 cardiac arrest patients, only sixty-two of whom had what van Lommel categorized as a near-death experience. To van Lommel, this was proof that something was going on outside the body. “Our results show that medical factors cannot account for occurrence of NDE,” he wrote. “Although all patients had been clinically dead, most did not have NDE. Furthermore, seriousness of the [physical] crisis was not related to occurrence or depth of the experience. If purely physiological factors caused NDE, most of our patients should have had this experience.”

  In the Lancet, van Lommel describes a signature case—a forty-four-year-old man, cyanotic and comatose, who had been discovered an hour earlier, lying unconscious in a meadow. He had no detectable heartbeat. To insert a breathing tube, van Lommel had to remove the man’s dentures, which he placed on
the crash cart in the medical bay. Only after defibrillation, “extensive” CPR, and ninety minutes of touch-and-go waiting was the patient stable enough to transfer to an intensive care unit.

  A week later, the man was recuperating in the cardiac ward when van Lommel found him awake for the first time.

  The moment he sees me he says: “Oh, that man knows where my dentures are.” I am very surprised. Then he elucidates. “Yes, you were there when I was brought into hospital, and you took my dentures out of my mouth and put them onto that cart; it had all these bottles on it and there was this sliding drawer underneath and there you put my teeth.” I was especially amazed because I remembered this happening while the man was in deep coma and in the process of CPR. When I asked further, it appeared the man had seen himself lying in bed, that he had perceived from above how nurses and doctors had been busy with CPR. He was also able to describe correctly and in detail the small room in which he had been resuscitated as well as the appearance of those present like myself. At the time that he observed the situation he had been very much afraid that we would stop CPR and that he would die.

  Despite the man’s poor initial prognosis, he was able to leave the hospital a month later. Wrote van Lommel, “He is deeply impressed by his experience and says he is no longer afraid of death.”

  Van Lommel argues forcefully for the view that NDEs prove the existence of an unseen world, a level of consciousness beyond the confines of the brain. In a 2007 article, he writes, “Because of the occasional and verifiable out-of-body experiences, like the one involving the dentures in our study, we know that the NDE must happen during the period of unconsciousness, and not in the first or last seconds of cardiac arrest. So we have to come to the surprising conclusion that during cardiac arrest NDE is experienced during a loss of all functions of the cortex and of the brainstem.” 24 (van Lommel’s italics)

  A lot of people find this convincing. It certainly tackles a question that arises from the most dramatic stories, where a patient seems to have accurate memories from a time when he or she was measurably, clinically dead. There are thousands of stories like this, but it’s extremely rare to find one that comes with medical documentation. Probably the best-known case involves a woman named Pam Reynolds, a Juilliard-trained singer and songwriter who lives just outside Atlanta. In 1991, Reynolds was working with her family’s record business, writing her own songs and also raising five children when she received alarming news—she’d been diagnosed with an aneurysm of the basilar artery, a major blood vessel in the brain. Doctors told Reynolds it could rupture at any time and advised surgery to fix the damaged artery. 25

  Because of the aneurysm’s size and location, the operation would be unusually complicated. The aneurysm was large and fragile, on a major artery, pulsing with blood every second. Any repair work would run an extremely high risk of popping the artery open by mistake; the blood loss would likely be immediate, massive, and fatal. Given the danger, Reynolds’ doctors planned a relatively new type of operation, cooling her body from its normal temperature of 98.6 degrees Fahrenheit to just 60 degrees. Her breathing would stop. Blood flow would slow to a trickle. Brain activity—on a standard EEG monitor—would be unnoticeable. To the casual eye, she would be dead.

  The operation in August 1991 went as planned—a perfect success. But when Reynolds awoke, she had an amazing story to tell. While not in pain, she had been conscious during every step of the procedure. She had felt surgeons drill through her skull with an electric saw (“The noise was awful, like the drill in a dentist’s office”), then floated out of her head and watched the operation from above. 26

  She found herself in the presence of her late grandmother. There was no sound, but Reynolds knew somehow that her grandmother was calling her—down a tunnel that wasn’t quite a tunnel, toward a pinprick of light that kept getting bigger and bigger. In that place of light, she found herself surrounded by deceased relatives, who fed and nurtured her. She was warned not to go farther, because she wouldn’t have a way to get back. Though drawn by the light, Reynolds thought of her family at home and agreed to return. Her late uncle led her back to the tunnel, and she found herself looking down once more at:

  … the thing—my body. It looked terrible, like a train wreck. It looked like what it was: dead… . It scared me and I didn’t want to look at it.

  It was communicated to me that it was like jumping into a swimming pool. No problem, just jump right into the swimming pool. I didn’t want to, but I guess I was late or something because he [the uncle] pushed me. I felt a definite repelling and at the same time a pulling from the body. The body was pulling and the tunnel was pushing… . It was like diving into a pool of ice water… . It hurt!

  When I came back, they were playing “Hotel California” and the line was “You can check out anytime you like, but you can never leave.”

  Michael Sabom, the researcher who first inspired Jeffrey Long, wrote an account of Reynolds’ case, which became a sensation. She’s easily the most-cited example of a person having memories at a time when they were “clinically dead.” The thing is, even the term clinically dead is open to interpretation. In the United States, we use EEG or brain monitoring to declare there is no brain activity—that someone is dead. Transplant surgeons wait for this proof before removing organs, but to an extent, that’s arbitrary. In Japan, it’s only after heart activity is stopped on an EKG that someone is considered dead. Brain death versus cardiac death. Nelson, who has not reviewed Reynolds’ medical records, seriously doubts that she truly had no electrical brain activity throughout the operation.

  Nelson speculates that Reynolds might have been partially awake for at least part of the operation, despite the anesthesia. So-called “anesthesia awareness” isn’t as rare as you might think. According to the American College of Anesthesiologists, 1 or 2 percent of all surgical patients experience at least partial awareness during their operation. This number is for surgeries where the patient is actually supposed to be knocked out; it doesn’t include operations done under local anesthesia or other cases where the patient is intentionally left conscious. Here’s an interesting aside: the brain is totally free of pain receptors. In fact, in certain brain operations the patient is left awake so he or she can communicate with surgeons during the operation to ensure that no tissue is removed that would affect the patient’s ability to talk or other skills. Of course, it may be that none of this is relevant to the case of Pam Reynolds or any NDEer, but it’s not far-fetched to think that a patient might be partially conscious even during an invasive brain operation.

  Some cases of anesthesia awareness are horror stories where the patient suffers intense pain from the surgeon’s knife but is paralyzed and can’t cry out. This version was dramatized in the 2007 Hollywood thriller Awake; its publicists said it would do for anesthesia what Jaws did for sharks. In other cases, the pain medication portion of the cocktail does work, leaving the patient calm and numb—but still aware, at least partially aware, of their surroundings. Nelson started thinking about a connection between anesthesia awareness and NDEs because of a quirk in his survey results: four of the fifty-five subjects who reported near-death experiences also said they were awake during surgery. 27

  As I continued my discussions with experts around the world, I realized a possibility: that it all comes down to memory. Biologically there’s no physical difference between “real” memories and memories of something that never actually happened. Listening to Nelson, I was reminded of research done by Harvard psychologist Richard McNally and his students. McNally’s specialty is memory, especially the way it can be distorted. He’s done extensive work on false memories, and his work on how easy it is to produce false memories—through suggestion—has strongly influenced the way that courts handle testimony about old, supposedly repressed memories.

  One big question is whether the brain forms and stores false memories any differently from the way it handles real memories. To try and answer this, McNally’s then-student Sus
an Clancy wanted to examine memories that almost certainly were not based in reality. She decided to interview people who claimed to have been abducted by space aliens. Their stories were eerily alike, full of gray-headed aliens with big eyes, taking people aboard spacecraft for medical or sexually themed experiments. Clancy came to an interesting conclusion: she decided that the memories were real, even if the abductions were not. The mechanism for producing these memories, in Clancy’s view, was sleep paralysis. The people had only dreamed about being abducted, but the dreams were so vivid—complete with an intense physical feeling of being unable to move while being examined by aliens—that they were convinced it really happened. 28

  Kevin Nelson says the same about near-death experience. “I don’t think it’s inaccurate recall, although I do think that recall and memory at a time when your brain is potentially impaired by low oxygen or low blood sugar might be called into question,” he says. “When we’re dreaming, the fascinating thing is we don’t know we’re dreaming. There are rare exceptions called lucid dreams, but for the vast majority of people, we don’t have that insight. The brain turns it off normally.”

  There’s reason to think that memory of NDEs is even less reliable than memories of a dream. For one thing, memory is often the first thing to go when the brain is running out of oxygen. The seat of memory is the CA1 region of a brain structure called the hippocampus. According to Larry Squire of the University of California at San Diego, a neuroscientist and expert on memory, when cells of the CA1 region are deprived of oxygen, they go into an overwrought metabolic state, burning energy at a frantic pace. 29 “They basically fire themselves to death over a period of a few days,” explains Squire. “These patients end up with memory loss.” To be blunt, you can’t trust the memory of someone whose brain was oxygen deprived, even for a short time.