Into the Magic Shop

by James R. Doty, MD

  My eyes were still closed, but I could hear the beep of the monitors.

  I just had to open my eyes.

  “Jim, can you hear me?” I felt a prick on my foot and opened my eyes. The bright light of the recovery room shined directly into my face, and I blinked rapidly.

  “Jim!” the voice said. “I told you we needed you around here. Who’s going to make us laugh and catch all the heat if you’re not here?”

  I reached my hand out and touched her arm. “Am I alive?”

  “Of course you’re alive. We had to pump a lot of blood into you, but you’re going to be fine. You’re stable.”

  “Are my friends OK?”

  “They’re fine. You guys are all lousy patients, but you’ll be fine. Unless we kill you in your sleep.” She laughed.

  “Did I die?” I asked.

  “You’re alive.”

  “No, I mean, did I die? Did I have to be resuscitated in there?”

  “No. You were pretty unstable and your blood pressure was really, really low, but you didn’t have a cardiac arrest. They found a bleeder they had missed near your spleen. You had four liters of blood in your belly. No wonder your pressure was low. They had to transfuse you sixteen units. But no, you weren’t dead. At least, not that I know of.”

  She looked at me questioningly.

  “It’s nothing. It was just weird. I was on a river.” I stopped talking then. Whatever that experience was, I had no need to explain it. The scientist in me started reviewing the physiology of the event. Could my experience be an extreme form of low oxygen to my brain? Had I had a massive release of neurotransmitters? Was it all a hallucination due to shock and trauma and blood loss? While I was in this experience, I wasn’t a neurosurgeon looking on it with medical knowledge, but now I was. Was this a mystery of the brain I could ever solve?

  • • •

  IT’S ESTIMATED that up to fifteen million Americans have had a near death experience, or NDE, as they’re commonly called. In 2001, the journal Lancet published a study showing that between 12 and 18 percent of patients who experienced cardiac arrest or cessation of breathing might have had near death experiences after medical conditions involving low blood pressure, impaired brain oxygenation, or global impairment of brain function through trauma or disease. These similar experiences often include descriptions of being out of one’s body, floating, a flashback of one’s life, having a feeling of being with deceased loved ones or hearing their voices, a feeling of warmth and unconditional love, and often traveling on a river or being in a tunnel while being drawn toward a light. Such descriptions have also been described in multiple cultures and throughout recorded history.

  In Plato’s Republic there is the “Story of Er,” in which a soldier has been slain, is found not to decay, and awakens on his funeral pyre twelve days later. He gives a similar description of his own near death (or death) experience, including several of the common elements associated with modern NDEs. Some have claimed that the famous sixteenth-century painting Ascent into Empyrean, by the Dutch artist Hieronymus Bosch, is a representation of a near death experience with its tunnel that leads to a bright light with shapes and forms possibly representing the world beyond life on earth. There is also the story of British admiral Beaufort, who described his near drowning in 1795, and American physician A. S. Wiltse, who in 1889 described his own similar experience during a bout of typhoid fever. Each of these descriptions has several components associated with classic NDE—seeing their body from a distance, a sensation of floating, seeing loved ones, and traveling toward a white light.

  In the late nineteenth century, Victor Egger, a French epistemologist and psychologist, used the French term expérience de mort imminente (experience of imminent death) to describe a similar phenomenon occurring in climbers who “saw” their lives pass before them as they fell to what they thought would be their deaths. More recently, Celia Green, in 1968, published an analysis of four hundred accounts of out-of-body experiences that led people to question whether our consciousness can exist out of our bodies, and in 1975, psychiatrist Raymond Moody published a book of such experiences and coined the term near death experience, garnering the interest of scientists in this phenomenon, which previously had been described only in the realm of religion, philosophy, and metaphysics. Many descriptions include religious symbols like angels and figures such as Jesus or Muhammad. Usually such symbols correlate with the faith or religious beliefs of the individual. For many, such experiences are life altering. Individuals who are atheists report many of the common NDE elements as experienced by believers. One of the most famous is that of Sir A. J. Ayer, a British philosopher and the author of Language, Truth, and Logic, an avowed atheist, who in 1988 almost choked to death while eating. Following the event, he was quoted as saying, “My experiences have weakened, not my belief that there is no life after death, but my inflexible attitude toward that belief.” Among the recorded NDEs of atheists, a number report no impact on their beliefs, while for others there has been a spiritual conversion.

  Because of the work of Moody and others there is a growing interest among scientists to study this phenomenon. In addition, we know that similar experiences can be artificially induced through such medications as the anesthesia drug ketamine and some psychedelics. They can be triggered by electrical stimulation of the temporal lobe or hippocampus in the brain. They can happen during decreased levels of brain oxygenation through decreased blood flow to the brain (as experienced by fighter pilots) and even during hyperventilation. It’s interesting that, while induced experiences have components of the NDE, with the exception of psychedelics, they are not typically associated with transformational or life-changing responses in the individuals who experience them. Is it truly the risk of death (or a part of the brain that interprets the situation as such) that is the common denominator in these situations that makes them transformational?

  It has been postulated by psychologist Susan Blackmore that the experience of passage down a tunnel toward a bright light is a result of increasing neural noise occurring as more and more brain cells start firing in response to a lack of oxygen to the brain. She also suggests that the sense of serenity and peace is due to a massive endorphin release from the stress of the event. In a recent study, physiologist Jimo Borjigin, using a rodent model of hypoxia, demonstrated a transient surge in synchronous coherent gamma oscillations, which were global and highly coherent, occurring within thirty seconds of cardiac arrest. In other words, rats deprived of oxygen and who go into cardiac arrest and die had brains that showed a heightened consciousness after death. These gamma oscillations are noted in both wakeful consciousness and heightened states of consciousness associated with meditation as well as during rapid eye movement (REM) sleep, which is the period during sleep when memories are consolidated and strengthened. Clearly, there are a number of well-documented neurophysiologic events that are occurring during NDEs and that can occur during other types of brain stressors or be replicated utilizing a variety of methods not associated with an NDE.

  Like so much of life, our beliefs are a manifestation of our life experiences. And our brains are the consolidation of those experiences. But what about the experiences of the heart? Even more interesting to me than the science, the research, and the questions about an afterlife that result from a near death experience is the common thread that runs through these experiences. Why is it that so many travel toward the light and the warmth and the love? Perhaps what we experience during NDEs are our heart’s greatest longings. To be loved unconditionally. To be welcomed. To feel the warmth of home and family. To belong.

  I don’t know exactly what happened to me after that car accident when my blood pressure dropped precipitously low, and in the end, I realized that it didn’t matter. I didn’t need to solve it or explain it. Maybe I died, maybe I didn’t.

  I just don’t know.

  What I do know for sure is that I have
died many times in this life. As a lost and hopeless boy, I died in a magic shop. The young man who was both ashamed and terrified of his father, the one who had struck him and got his blood on his hands, died the day he went off to college. And although I didn’t know it at the time of my accident, eventually the arrogant, egotistical neurosurgeon I would become would also suffer his own death. We can die a thousand times in this lifetime, and that is one of the greatest gifts of being alive. That night what died in me was the belief that Ruth’s magic had made me invincible and the belief that I was alone in the world.

  At the time I felt the warmth of a light and a sense of oneness with the universe. I was enveloped in love, and while it didn’t transform my religious beliefs, it informed my absolute belief that who we are today doesn’t have to be who we are tomorrow and that we are connected to everything and everyone. I woke up in that hospital bed, and I remembered just how far I had come from that orange Sting-Ray bike and a summer spent in a magic shop. What I didn’t know then was how far I still had left to go. Seeing Ruth along that river, feeling love and connection to so many, was perhaps a warning sign that I was straying too far away from what she had been trying to teach me. But it would be many more years and many more painful mistakes before I realized it.

  NINE

  The Sultan of Nothing

  Newport Beach, California, 2000

  One morning I woke up worth $75 million. I didn’t actually have this money in hand. In fact, I’d never seen it or counted it, but it existed in a place even more powerful than any bank—my mind.

  I was single, having already been married and divorced by this time. The long hours of being a neurosurgeon and the pursuit of wealth and success hadn’t made me a very good husband or a very good father to my daughter. The divorce rates among physicians are said to be 20 percent higher than those of the general population, and the rate for the neurosurgery profession is even higher. I was no exception to this rule.

  I reached my arm across the bed until my hand landed on the warm body next to me. Her name was Allison, or maybe it was Megan. I couldn’t remember exactly, but her skin felt warm and smooth and soft. I heard her murmur as she rolled onto her side.

  I quietly got out of bed and headed downstairs. I needed coffee, and I needed to check what the stock market had been up to while I was sleeping. I turned on the computer and waited while it hummed and cranked to life. I was forty-four years old, and my plan was to retire within the next year. My life in Newport Beach was a long way from Lancaster. I had become one of the most successful neurosurgeons in Orange County. I lived on a bluff overlooking Newport Bay in a seventy-five-hundred-square-foot home. My garage held not only the Porsche I had dreamed of as a boy but a Range Rover, a Ferrari, a BMW, and a Mercedes.

  I had everything on my list and more—much more.

  A few years earlier, a friend of mine had shared with me his idea for a technology that would revolutionize the field of radiation therapy and the treatment of solid tumors in the brain. He had just finished his residency and accepted a position at Stanford, where he planned to develop the concept from simply an idea to a reality. He had started a company. I was so impressed that I became one of the first investors. I told him that I would place the first unit outside Stanford down in Newport Beach. Little did I know that one interaction would change the trajectory of my life. I did place the first unit of the newly named CyberKnife in Newport Beach. I convinced another physician friend who had significant family wealth that this technology would change the world. He believed me, and not only did he buy the first unit but he also bought a building to house it and MRI and CT scanners to use with it. He spent millions of dollars based on my enthusiasm and belief in the technology. At the time, the device had yet to be approved by the FDA and there were no codes that one could use to bill for its use. Within two years after his investment, Accuray, the manufacturer, was effectively bankrupt through a combination of mismanagement and an inability to raise adequate capital. Several years later, they still had not been able to get FDA approval, and sales were nonexistent. The company had burned every bridge, not only in Silicon Valley but in the entire United States in terms of raising further capital. Things looked grim, and those who had faith in the potential of the technology and who had put millions of dollars into it were going to lose their investment and the world would lose this extraordinary technology. I had to do something. I decided I was going to save the company.

  • • •

  I HAD no significant background in business, although as a resident, I had invented an electrode for monitoring brain activity that was being sold throughout the world. This was different, though. This was the big time. I told my friend that I had a plan. I’m not sure if he believed that I could help or if he had no other options, but nonetheless, he encouraged me. The company had gone from sixty employees to six. I agreed to fund the company myself while figuring out how to save it. I had no idea what I was going to do. As fate would have it, the answer came while having a drink at the bar in the Four Seasons Hotel, which at that time was located in Fashion Island in Newport Beach. I was waiting at the bar for a woman I was to have dinner with and began a conversation with the fellow sitting next to me. I shared with him the situation regarding the CyberKnife and how the technology could save hundreds of thousands of lives. I just needed someone to raise the money necessary for it to survive. He ended up helping me restructure the company and raise $18 million. The problem was, the principal investor would agree to do it only if I would agree to be the CEO. I not only had sold them on the concept but on me as the critical component to its success. So I walked away from my very successful private practice in Newport Beach to be a CEO. A job for which I had no experience and no expertise. The only thing I had was an absolute belief that I could save the company and that I had to save the company.

  Within eighteen months the company was completely restructured, FDA approval was obtained, and the valuation had gone from effective bankruptcy to $100 million. During this time, I ended up meeting a lot of people, including venture capitalists and entrepreneurs who were starting companies in Silicon Valley. They all thought I had some sort of secret magic to turning around Accuray and making a failure into a success. I didn’t. I tried to tell them I knew nothing, but more often than not, they asked me to invest or become a partner in their firm or at least consult with them. And those investments and relationships resulted in me getting stock. Lots of stock. And in 2000, when the dot-com boom was at its zenith, publicly held stock in a dot-com was better than gold, and it guaranteed a line of credit at any bank.

  The computer finally came online and I checked my numbers. I was still worth somewhere north of $75 million. As a boy I had dreamed of making a million dollars, but the thrill of my first million was nothing compared to my thrill at being worth $75 million. I was rich. I shut the computer down and looked out the window at the expanse of blue Pacific.

  The house was quiet. Megan or Allison hadn’t woken up yet, but I didn’t want to share my news with her. Just the thought of her made me feel a little sad. We didn’t know anything about each other. I knew she was a pharmaceutical rep, and she knew I was rich and had my own private table reserved for me at the best restaurant in Orange County. She had approached me last night with a group of her friends. We had drunk vodka and champagne, and when I had asked her what she thought of all this crazy excess, she had just laughed and said she thought I was great. I knew she had a story, but she wasn’t willing to share it with me, and she didn’t seem all that interested in hearing mine. And so, like many other nights with many other women, we had both agreed to feign an intimacy that didn’t exist. We shared our bodies, but didn’t let our minds or hearts complicate things. It made me feel lonely and hollow, but I had learned how to ignore the voices of doubt and despair in my head a long time ago.

  I had everything I had ever dreamed of having. People respected me. People deferred to me. I had just agree
d to purchase a private island in New Zealand and had wire-transferred the down payment. I owned a penthouse in San Francisco and a villa in Florence overlooking the Ponte Vecchio. I had wealth beyond my wildest imagination, accomplishments that I would put up against anyone else’s in medicine or business, but loneliness was an indulgence I couldn’t afford.

  My plan was to retire and spend part of my time donating my medical services in third world countries and the rest of my time traveling between San Francisco, Florence, and New Zealand. If it felt like something was missing, I didn’t worry about it too much. Whatever it was, I would find it in my travels.