Near Death in the ICU [1 ed.] 0996510303, 9780996510301

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Near Death in the ICU STORIES FROM PATIENTS NEAR DEATH AND WHY WE SHOULD LISTEN TO THEM Laurin Bellg, MD

Copyright © 2016 by Laurin Bellg All rights reserved. No part of this book may be reproduced, stored, transmitted or used in any form by any means – including mechanical, electronic, photocopy, scan, recording or any other method – without express written permission of the author and the publisher. Published by Sloan Press, Appleton, Wisconsin Sloan Press is an imprint of LifePath LLC, 1620 S. Lawe St., Appleton, Wisconsin 54915. www.LifePathGroup.org Near Death in the ICU is a trademark of LifePath LLC ISBN 978-0-9965103-0-1 eISBN 978-0-9965103-1-8 Library of Congress Control Number: 2015918653 Interior design and formatting by Whole Enchilada Cover design concept by Patty Ray Avalon www.avalonart.gallery Final cover production by Accurance Laurin Bellg, MD www.laurinbellg.com

“Dr. Bellg’s book Near Death in the ICU is an extraordinary piece of writing by an extraordinary physician. It’s a must read for physicians and medical students, who can benefit from her ways and her wisdom. In fact, a must read for all of us. Her story, her patients’ stories, and her reflections offer us opportunities to reconsider what we may understand about life and death. And in the process, we may find comfort, inspiration and hope for navigating our experiences of living, illness and dying.” – Patricia Muehsam, MD, Founder of Transformational MedicineTM, Developer of the Association of American Medical Colleges’ and The Mount Sinai School of Medicine’s first initiative in curriculum development in alternative and complementary medicine. “What a wonderful book! Laurin Bellg writes beautifully – I couldn’t put the book down, read it from front to back in about four hours. Laurin’s writing is clear and well-organized and reaches both the lay person and the most sophisticated surgeon. Every chapter of the book is really instructive, for the public and medical professionals – especially for doctors – but affords the reader complete freedom to decide what these experiences mean. The book’s narrative is totally believable because of the detailed descriptions of the medical cases. In nearly all of the cases, Laurin was right there as the primary witness, in charge of the medical emergency and the follow-up care. The book leads the reader on a fascinating journey exploring the different aspects of near-death experiences and demonstrating the need to keep an open mind about the phenomenon, because we don’t really know the whole story yet.” – Robert Mays, researcher in near-death studies and board member at the International Association of Near-Death Studies.

This book is dedicated to all those having near-death experiences, whose stories deserve to be heard, respected and honored.

Introduction 1. When Doctors Die 2. The Fatality of Fear 3. The View From Above 4. Reality Is Relative 5. Rethinking Impossible 6. The Unusual Question 7. The Heart Can Wait 8. Seeing the Whole Elephant 9. Shades of Blue 10. Bedside Visitations 11. The Anchor of Limiting Beliefs 12. Honor My Truth Conclusion Afterword – by Dr. Janice Holden Acknowledgements

twenty-something and sick – really sick. I wouldn’t know how ill I was I was until years later, when I understood septic shock and how quickly and badly normal body function unravels under its influence. Bacteria had slipped quietly into my bloodstream, and I had no idea how terribly it was assaulting me until it was almost too late. I was working in viral research at St. Jude Children’s Research Hospital in Memphis, Tennessee when it happened. My back had been hurting all day, but I assumed I had pulled a muscle while transferring the large wooden trays filled with dozens of eggs from an incubator to my workbench so I could harvest the influenza virus I had injected several days earlier. I often came in at odd hours to make sure my cultures were advancing as expected, so I assumed I was just overworked and tired when the tiny pipette, which I used to carefully pierce the shell and withdraw the virus-rich liquid, began to tremble. My usual steady hand wasn’t working, and my clouded brain couldn’t make it work. Under the aggressive attack of Escherichia coli that had made its way from my intestine (its natural habitat), through my bladder and to my kidneys before moving swiftly throughout my entire body, I don’t really remember driving home. I didn’t have the good judgment to know I really shouldn’t have – that I should have called for help. When I quietly said to my fellow lab technicians that I wasn’t feeling well and needed to leave, they were so absorbed by their own work that they didn’t recognize how ill I was either. I can’t even be sure they heard me. The next hours were a jumbled collection of fragmented moments breaking through my consciousness that was fading in and out – nothing was making sense. I don’t recall how I got home, but I do remember trying to steady my right hand with my left as I attempted to fit the key into my apartment doorknob. My hand was trembling so badly I couldn’t control it. When I was finally able to open the door, I remember puzzling over why it was raining

inside until I realized it was my own sweat dripping onto my hands that were now shaking with intense rigors. I don’t recall running the cool bath, but I do vaguely remember my husband lifting me out of the tub when he arrived home some hours later. I can still see how scared he looked when he said, “You’re burning up!” I barely remember the thermometer being in my mouth, but I somehow was aware of a thought drifting into my awareness that a fever of 105.3 wasn’t good. I can still recall the distinct feeling and sound of the glass thermometer clicking wildly against my teeth. As sick as I was, I thought it strange how I was beginning to feel so relaxed – surreally so – and I know now how easy it would have been to drift into a peaceful state of oblivion. I was clueless about the risk. I shudder to think how dangerous it is to lie in a full tub of water while dangling over the precipice of consciousness, but at the time I didn’t even remember getting into the tub. How I got to the hospital and what happened in the first days is lost to me. Days passed, or so I’m told. I don’t really remember. What I do recall, and quite vividly, is a visitor I saw that apparently no one else did. She was a child, age nine or ten, and although I didn’t know her, she was vaguely familiar to me. I just couldn’t place her. She had red hair that was in somewhat of a short frizzy bob and held to the side by a small white barrette. It was a bit of a mess. She rarely made eye contact but on the few occasions that she did, I registered on some level that she had brownish eyes – not deep brown, probably more hazel. When she did hold my gaze, however briefly, it was with an impassive expression, showing no particular emotion that I could detect. The child was wearing a distinct burnt-orange, gingham-check dress, bobby socks and a white cardigan sweater. Really, she looked like she could have stepped right out of the 1950s. The first time I saw her she was sitting on a straight-back chair that was in the corner of the hospital room, along the wall just off to the right side of the end of my bed. She had her legs drawn up underneath her with one hand holding her ankle and the other resting loosely in her lap. She was looking out of the window as if she were lost in thought. I tried to clear my head, thinking it was a waking dream, but after shifting in bed and rubbing my eyes, I still saw her. It’s hard to recall now, some twentyfive years later, why I thought this, but I wondered if she was real. Was she a ghost? Was I hallucinating? I didn’t know. Was she a child who had somehow

lost her way and wandered into the wrong room and didn’t realize she was lost? I tried talking to her but there was no response, so I just watched her. She looked real. I could see the light from the window glinting off her red hair, but she said nothing. When she turned and looked at me in that almost blank way I offered her a weak smile, but she did not return it. Her look was hard to read – neutral but not unkind. She only held my gaze for a brief moment before turning her head again to resume looking out of the window. Again, I noted that she seemed familiar somehow, but I could not figure it out. When my husband returned, I asked him, “Who is that young girl?” I pointed to the corner. “What girl?” he asked. “That one,” I said, pointing again to where I could still see her sitting on the chair in the corner. “There’s no one there,” he replied. The tone of his response conveyed a lot – concern, confusion and a firm implication that what I was experiencing wasn’t real. “But I see her. She’s right there!” He shook his head. “No.” I was more confused than alarmed, because I could see her so clearly. Rather than become entangled in what seemed to be the truth of my seeing something he couldn’t, and afraid of what that might mean, I settled back into the pillow and just watched her. I had tuned in quickly to what I perceived to be my husband’s unspoken judgment of my experience and turned away. Her presence was comforting to me and if somehow she wasn’t real, I didn’t want to know. I watched her until my eyes became heavy and I drifted off to sleep. When I opened my eyes again, she was no longer there. I did see her one other time, however, before being released to go home. This time, perhaps a couple of days later, she was leaning against the wall with her arms tucked neatly behind her back, appearing to be lost in thought. She didn’t seem to be looking at anything in particular, as far as I could tell. There were a few other people that I knew in the room at the time. Family and friends who had stopped by to pay respects brought flowers, magazines and other tokens of sympathy. But after the reaction from my husband the first time I saw her, I chose to say nothing. Feeling tired from the buzz of conversation and wanting to give more attention to the anomaly of the young girl in the corner – the girl I saw but

apparently no one else did – I rolled over to face her. Against the backdrop of people I knew to be real, she was different somehow but I couldn’t sort it all out. After looking at her for a while I once more began to grow sleepy. There was a weariness I felt from company who had stayed just a bit too long. I wanted to sleep. Right before I closed my eyes, her gaze swung toward me and met mine. It was the one and only time I saw her smile. It was such a faint curl of her lips, but her impassive nature softened for an instant. I felt comforted by it. When I was finally discharged from the hospital several days later, my husband and I stopped on the way home at a diner for an early lunch. It was mid-morning and the place was relatively empty and quiet. I wasn’t hungry and could barely touch my food, so I toyed with a piece of toast, tapping it on the side of the plate and watching crumbs collect in a small pile. Then something caught my attention. I looked up and there I saw her once again – curled up in a booth by herself across the aisle a couple of rows down from ours in the nearly empty restaurant. I stared at her, disbelieving, but it was definitely the same girl I had seen in the hospital – the same hair, the same dress. I saw again that familiar something but remained unable to name it. I did not draw my husband’s attention to her. I somehow knew he would not be able to see her, but she was very real to me. Strangely, I found myself thinking that, for a lot of reasons, if she wasn’t real I didn’t want to know. It wasn’t until I was writing this book, writing this very passage in fact, that a curious awareness quietly rose to the surface and gave me pause. Years ago, before my life in medicine, I was in a theater company. I hadn’t worked there long before I met Jill and we became fast friends – soul sisters, really. Our connection was instant and strong. She was from Australia but our company headquarters was in the United States, so during her time off she used my mother’s place as a home base between tours. Her parents sent letters and packages to my address to hold for her until she came through to collect them. She was an easy member of our family – for me, my mother and both of my brothers – and over time she left more of her things behind each time she swept through her American home, as she came to refer to our place. When she returned to Australia it was before the days of the Internet, so we wrote often and saved up money for the occasional phone call. Our connection remained strong as we circled around her dream of moving to the United States. We played out several scenarios of doing some kind of work together – forming

a theater company perhaps. We never had the chance. At twenty-three years of age, two months after what would be our final call, she was killed in an automobile accident. I was devastated. Learning of her death, I recalled something with chilling clarity that she had said when we talked for what would be the last time. She told me that when she looked into her future, all she saw was a blank space, and as hard as she tried to see beyond that blankness, she couldn’t. It was so different from our usual, upbeat chats of scheming and planning how we could live closer together. It didn’t make sense to me until she died. Perhaps she could not see beyond that blank space because there was nothing there for her to see. Jill was an actress. She had been somewhat of a child star in Australia, even landing the leading role in a stage version of Annie when she was nine or ten and gaining some national attention because of it. Thinking back to that time, and knowing it was a highlight for her, I wonder now about the young girl I saw in my hospital room when I was so sick. Jill had reddish hair. When she was younger, it was distinctly redder – that much I knew. She also had hazel eyes. I don’t have any pictures of Jill from her role as Annie during her moment of transient fame, but now I can’t help but wonder if that is why the girl I saw, whom no one else could see, seemed so familiar. We were in our late teens when we met, and remained deep friends until she died in her early twenties, three years before I was hospitalized. Losing her was hard for me – it still is. I’ve not experienced that depth of friendship since knowing her, and I can’t help wondering if that bond survived her death – and in my own moment of hovering so near the edge, if she was there for me. No matter the truth of that, it offers me comfort to think so, and it set me up to eventually be there for my patients in ways I don’t think I could have been without having had that personal experience. Now, many years later, I work as a critical care physician, a medical specialist in the intensive care unit (ICU). After realizing research wasn’t my passion, I entered medical school in the fall of 1992. I have since navigated all aspects of patient care as a medical student, intern, resident, fellow and finally an attending physician. Thirteen years after completing my training, I’m still in the same hospital system where I started my professional work life in the summer of 2002. Although it was within the hallowed halls of my conventional medical

training that I first encountered patient accounts of the unusual and mysterious during near-death moments, extreme illness and trauma, it has only been within the past few years that I have begun to pay serious attention not only to the medical care of my patients but also to their personal experiences as they approach death. I am often right in the midst of the crisis of many patients who pass through our doors, and am frequently at the bedside of those balanced on the tenuous edge between life and death – directly in the flight path of mystery. I’m grateful that patients felt safe in sharing their experiences with me. It is because of their generosity that I am able to share their stories now with the hope that they will not only inspire you but also encourage you to accept them for what they are – very personally transformative moments, set in authentic lives, that deserve our respect. While I don’t understand precisely what happens during these experiences – I don’t think any of us really do – one thing has become clear to me. For those who do have an encounter not easily explained by today’s science, more often than not, it is deeply transformative and often life-changing. My own thoughts about life and death have morphed over the years. Some of that transition I attribute to having had the honor of caring for the patients whose stories I share and being trusted with the accounts of their transcendent experiences. It’s impossible to be so close to the cutting edge of life and death and not be transformed by it in some way. Our beliefs and opinions about life and death are shaped by what we encounter. By respecting others’ personal experiences, I have supported their journey as well as my own. My hope for this book is that it will create dialogue around these unusual experiences and that we can learn to accept and acknowledge the importance they may hold in someone’s life. The broader invitation is for us to validate the importance these events hold for the people who have them – whether or not we can explain them, prove they happened or personally believe in them. It’s humbling, especially for those of us firmly rooted in scientific training, to realize that there are things in this universe that are important and true whether or not we have a good explanation for them. I don’t profess to understand these phenomena – how or why they happen, or what triggers them in some people and not in others. In my opinion, this question dims in the light of the power these experiences have to change people’s lives. To be able to bear witness, honor someone’s truth without

judgment and assure them that, no, they are not crazy, is what I believe is required of us. All too frequently, though, we do sit in judgment of that which we cannot explain, especially in the hard-science culture of Western medicine. It is an unfortunate human habit. But by dismissing something so personal – under the pretense of not having a scientific or medical explanation for it – we unnecessarily cast doubt and shame on those who are having meaningful things happen to them that we can neither prove nor disprove. The stories I recount have been entrusted to me by patients, acquaintances and friends over the past two decades. In many instances, they are also about how their lives were transformed. In an intentional act of vulnerability, I’ve also included a few of my own. As individuals, caregivers and family members, I maintain that we should not discount these experiences any more than we should dismiss a dream or any personally significant event in a person’s life, however strange it may seem to us. The core of each story I share here is true to what has been related to me. However, where appropriate, names and details have been altered to protect the privacy of those who have so generously allowed me to write about them. Likewise, the dialogue that I’ve written may not be word-for-word, but it remains authentic to the essence of the conversations I’ve had with these patients and their families, as documented in my numerous personal journals over the years. Wherever I have reported connections between a patient’s neardeath experience and surrounding events and circumstances, I have been careful to make those details as accurate as possible. In some cases, I’ve combined accounts where events were similar in order to further limit personal identifiers and preserve anonymity, yet still reveal the heart of these often-transformative moments. In so doing, any resemblance of the events recorded here to the experiences of a reader who has not given express permission for their story to be shared is purely coincidental. My hope is that in reading this book you will not only be uplifted by the beautiful, life-affirming stories, but that you will also accept the invitation to listen to and respect the people you encounter in your life and work who may have similar stories to tell. Laurin Bellg, MD Appleton, Wisconsin October, 2015

“There are more things in Heaven and Earth, Horatio, than are dreamt of in your philosophy.” — Shakespeare, Hamlet, Act 2, Scene 5

lay dying. In his eighty-seventh year, he discovered that he had A doctor cancer, and deciding to decline medical intervention, he chose to let nature take its course. As a physician he knew all too well how chemotherapy and radiation had sometimes wrecked the lives of his patients, particularly those in their elder years, often robbing them of whatever functional ability they might have left. Now in a hospital bed, weak from malnutrition and failure to thrive, it was clear that cancer was winning and, per his request, palliation was in full swing as we sought to make him as comfortable as we could until his inevitable passing. When I first met Dr. Martin, I had been consulted to help manage his increasing respiratory distress from the metastatic disease that had sprouted from his colon cancer and settled in his lungs. Offering him the respect I felt he was due, I addressed him by his title when I introduced myself. Setting formalities aside he invited me to call him by his first name, but professional graces being what they are, I found that difficult so I just called him Dr. John. Smiling, he reciprocated by calling me Dr. Laurin. We immediately hit it off. Over the ensuing days, as he grew weaker, his family increased their vigil, maintaining more of a presence in the inpatient hospice unit where he had recently been transferred. The atmosphere was purposefully serene and he looked peaceful. One day, as I dropped by to see him as part of my daily rounds, I was surprised to find him alone. “Where is everyone?” I asked. “They were too sad and it was bringing me down, so I sent them away,” he

joked. “No, I told them I needed to rest so they stepped out for lunch.” “Would you like me to come back later?” I offered. “No, it’s fine,” he said. “Actually, I wanted to talk to you about something.” “Of course,” I said. Finding a chair and pulling it to his bedside, I sat down facing him. He reached out his hand to me and I took it. We sat there for a moment with him looking down at the covers and I could tell he was gathering his thoughts to speak, so I waited for him to break the silence. Finally, squeezing my hand before releasing it, he looked up at me with direct eye contact and I could see a resolve, as if he had decided to entrust me with something very personal. “I’m not afraid to die,” he said softly, “because I’ve died twice before.” Tilting his head slightly and squinting his eyes, he regarded me, weighing my reaction. “Tell me,” I said, intentionally leaning forward and resting my hands on the arms of the chair in what I hoped was an invitational gesture encouraging him to continue. Seeming to be bolstered by my interest, he told me his story of not one death but two. In 1944 he was fresh out of medical school when he enlisted to serve in World War II as a field physician. As was customary at the time, to make sure she was taken care of should he not return from war, he married his long-time girl friend before heading overseas. After a brief initial training in the United States, he was transported abroad to the European Theater. Barely three months into his overseas assignment, while heading out with part of his unit for duty at an outpost triage area for the freshly wounded, their transport jeep was hit by mortar fire, killing the driver and severely wounding the rest of them. Two of his companions died before help could safely transport them back to the hospital, and Dr. John sustained extensive abdominal trauma. Bleeding heavily from his wounds, he passed out en route back to the Army Hospital they had left barely two hours earlier. His next conscious memory was that of floating above his body in the operating room, watching as blood rushed in and pooled in the crevices of his open abdomen as quickly as they could clear it away. He knew all of the doctors and nurses as friends and colleagues and he found it incredibly strange to be watching them in such a detached manner as they fought intensely to save him. “I can’t find the damn bleeder!” he heard the surgeon say in frustration.

“Keep the blood coming. If you can’t get it fast enough, then I want plasma. Now!” The surgeon’s panic was only barely veiled by his intense determination not to lose this battle. Dr. John heard it all; he saw it all. He was astonished at how aware he was as he looked on. Then a sound distracted him and his attention was drawn to the slowing of his heartbeat on the monitor near his head. At the same time, he felt himself drifting farther away from the drama of his surgery. The last thing he recalled of that scene was the surgeon cursing and yelling out that they were losing him – and his own solitary thought: “I must be dying.” His next awareness found him completely and peacefully enveloped in what he could only describe as a soft shroud of mist with tiny points of light blinking in and out, as they darted quickly back and forth all around him. He felt completely weightless and peaceful, void of any fear. The feeling of love was immense, almost unbearable, and recalling it now, Dr. John’s voice became fragile as he paused to fight back tears. Regaining his composure, after a few moments he continued. He described floating in such a beautiful and bright place of total peace that he lost all thoughts and concerns related to anything connected to his physical existence. He was aware of nothing except how good it felt to be there where he was – wherever that was. How long he lingered in this space he could not say because time had immediately lost meaning for him. Suddenly, though, he heard a very distinct voice say gently but firmly, “You can’t stay, John. It’s not your time to die.” Whether the voice was male or female he couldn’t determine, but it was commanding and he did not protest its directive. Instinctively, he knew it would be pointless to argue. Still feeling peaceful and detached, he felt himself descending and slowly his body came back into view as the mist surrounding him dissipated and he could once more hear the clamor and tension of the operating room. Hovering above the scene, he watched the weak representation of his pulse on the monitor slowly gain strength as the resuscitation efforts of the surgical team reclaimed their hold on Dr. John’s physical body. “Thank God,” he heard the surgeon whisper to himself as he stepped back and let an attendant wipe sweat from his brow. He seemed relieved and exhausted. This was Dr. John’s last awareness of that particular episode. As he lay

drifting in and out of consciousness on the surgical ward – a large, open room lined with several beds along each wall, separated only by curtains – he found his thoughts often drawn to that mysterious event that defied any explanation he could come up with. What he had seen and experienced had been so real. He knew that under the effects of anesthesia, he shouldn’t have been able to see his body or the surgical team the way he had. Yet it had been so clear. He missed that weightless space, especially when the effects of the morphine wore off. Whenever the wracking pain of his recent surgery washed over him, he actually longed for the loss of physical sensation he had experienced in that cloud of total peace, as he would come to refer to it. But, as Dr. John had suggested when he first started telling me about his experience, it would not be the last time he would be there. As he began to recover and gain strength, he was started on a clear liquid diet to test the ability of his damaged gut to handle oral intake. While sipping tepid broth from a cup one day, it suddenly went down the wrong way and he began to choke. In the violent paroxysms of coughing that ensued, he popped some of the sutures that held his abdomen together and blood began seeping from his belly, soaking the bandages and leaching onto the sheets beneath him. Frantic calls for help erupted all around him. A nearby surgeon grabbed a gurney and began issuing orders to get him back to the operating room. That’s the last he remembered until he was once more in the surgical suite staring down at his body. He watched as the team quickly set up a sterile field and began breaking down the rest of his abdominal sutures. He saw them dive deeper into his belly to reach the repairs from his previous surgery that had broken loose during his intense fit of coughing. Once more, he lost a lot of blood and became very unstable. That’s when he died for the second time. With vital signs losing hold, his body quickly decompensated into an unstable cardiac rhythm and required several minutes of resuscitation to bring him back. Again, he saw the whole thing from above his physical body and watched the team fighting to keep him alive before he drifted away once more into what he referenced as a beautiful space of total love and acceptance. This time he described the reunion with the cloud of total peace as euphoric. It was like coming home after being away for so long. He then slowly became aware of another presence that he could feel but could not necessarily see. He knew he was not alone, but what was strange to him was that the presence

seemed so familiar – he knew it intimately and it knew him. He was certain of this without knowing why. Again, the voice spoke and told him he must return, that it was not his time to die. Once more he descended toward his body as the resuscitation efforts succeeded, and blinked into sudden unconsciousness only to awaken sometime later on the surgical ward. But this time was different. He felt himself only loosely tied to his physical body as he drifted in and out several times, spontaneously floating above and beside himself on numerous separate occasions. When this happened he was fully aware of his surroundings and the conversations going on around him, although looking at his body on the bed below, the physical self seemed to be sleeping or sedated. He shouldn’t have been aware and watching himself, he reasoned, but he was. As he continued to convalesce, his consciousness seemed less labile and he was aware of becoming more fully integrated as he increasingly engaged in physical activity. His long recovery gave him plenty of time to think about and process what he had experienced. He wondered what had happened to him. He battled with the notion that perhaps a lack of blood flow to the brain during his two encounters with death had left him somehow damaged. Finally, after much consideration, he settled on the uncomfortable conclusion that perhaps he now carried a psychiatric diagnosis – that of being totally nuts! Working out for himself that the most logical explanation must be that his medical catastrophes had resulted in some mental imbalance, he decided not to breathe a word of his experience to anyone lest they think him crazy. He had invested too much of his life and energy into becoming a doctor. It was too great a risk to his career to admit that he had perhaps, as he ultimately determined, suffered some type of psychosis. He worried that in talking about his two deaths, as he now referred to them, he would lose credibility and potentially his license to practice medicine. So at age twenty-six, he made an intentional decision. He would not say a word – not to his colleagues, for fear they would question his credibility; not to his wife and family, for fear they would question his stability and basic sanity. The experience changed him though – internally at least. The more time that passed and the more sane he felt, the less inclined he was to think he was crazy. But the experience itself fit no process or paradigm he was familiar with. He couldn’t explain it to himself, so how could he possibly explain it to others? Not

growing up in a particularly religious family, and always a natural pragmatist, he had never even entertained the thought of a life after death or considered the possibility that consciousness could survive beyond the physical body. Yet he had experienced it – twice! As time progressed and he eventually settled back into his post-war civilian life as a physician and family man, his near-death experiences receded further and further into distant memory. Despite his confusion back then about what he had experienced, and his questions about his fundamental mental state, the beauty of those moments would drift into his awareness from time to time. Whenever they would surface, he would be gently reminded that perhaps there was something more, but he never breathed a word to anyone of what had happened to him. Sealed up and filed away, he kept those experiences tucked safely deep inside himself for decades, until he was diagnosed at the age of eighty-seven with colon cancer. Suddenly, thinking about his own mortality in the light of his new diagnosis, he was reminded of the cloud of total peace he had experienced all those years ago but he was still reluctant to share. It wasn’t that he feared a loss of credibility – he was long retired from medicine – and now older and wiser, he cared so much less about what others thought of him. It was more a concern that perhaps in speaking his experience aloud, the magic of those moments would somehow be diminished. So even Dr. John was surprised when early one morning, not long after receiving his cancer diagnosis, with dawn barely breaking across the still water, he told his friend and fishing buddy of several years what had happened to him. In an old wooden rowboat floating in the middle of a quiet lake, enveloped in the serenity of a soft mist that obscured the shore, and feeling philosophical, he shared his story – all of it, as he had with me. They sat on opposite sides of the boat with their backs to each other, casting their lines into the distance. Hearing their lures drop into placid water with a soft plop and then listening to the faint whine of the nylon line as they twirled the handle, they reeled them back in. It wasn’t so much an attempt to catch fish as it was a ritual of keeping good company a couple of times a week that brought them together. Staring intently into the deep morning mists and the shifting pinks and blues that rolled slowly toward them over the rippled water, one friend talked while

the other listened. As decades-old memories unfolded of a life twice left behind and then returned to, Dr. John spoke openly and honestly about his experience for the first time. His companion, listening patiently to the whole story without interrupting and casting no judgment, finally spoke. “Makes sense to me,” his friend said. “I’ve always thought life must be much more complex than our feeble brains have the capacity to understand.” Knowing Dr. John’s diagnosis and being a like-minded pragmatist himself, after a long silence he said, “Well, after dying twice, I guess a third time won’t be that big a deal, will it?” They both laughed. With that simple statement, Dr. John felt deeply the acceptance and validation he had feared he would never receive should he ever dare to tell his story. Now, finally, he had spoken aloud his deep truth, and still as sane as ever, he felt the huge weight that he had intentionally carried all those years lift gracefully from his shoulders. All of the concerns associated with the secret that he had kept neatly tucked away – for fear he would be considered mentally unstable – suddenly untangled and lay released at his feet. He felt free. I’m still not sure why Dr. John told me what happened to him. It was only the second time in his life that he had shared it with anyone, but I’m so glad he did. I was impacted by how reluctant he had been to share his story with even his most trusted colleagues and closest family, and yet I was familiar with the predicament. With the sort of barriers and judgments we, as a medical community, impose upon ourselves around phenomena that we cannot readily explain, it is the rare caregiver who would be open to receive such a story from a colleague. We are reluctant to share our own questions and experiences with each other about what science has yet to prove definitively for fear of being considered crazy. How can we possibly be in a position to hear the unusual and inexplicable experiences of our patients? As he lay dying, he confessed to me deep regret about how he had let the thick veneer of professional code restrict what he shared with others. He went on to tell me that he actually came to resent the fear that he had let bind and gag his truth for so long. When his patients had shared personal stories with him of their own near-death encounters, he confessed that even then he was afraid to tell them what had happened to him. Enslaved by a social and professional persona he felt obligated to uphold, as much as he wanted to, he could never muster the courage to share something so personal with his patients. In

hindsight he felt that he had robbed them of the gift of validation of their experience from someone they looked up to and trusted. “If I had only had the courage to tell my patients that the same thing had happened to me,” he confessed, “I would have done them a great service. But as it happened, I was too concerned with my own reputation – what my colleagues and patients would think of me – that I held my tongue. And I have to say,” he paused, then continued quietly, avoiding direct eye contact, “it remains one of the greatest regrets of my life, both professionally and personally. “Even as my own wife lay dying,” he continued softly, “I didn’t have the courage to tell her that I believed something wonderful waited for her on the other side. I just couldn’t find the words and in her last moments I didn’t want her to wonder why I had withheld that from her all those years.” Cupping his hands loosely in his lap and with shoulders slumped forward, he lifted his eyes toward me and grinned, “I’m guessing she knows by now, eh?” “Probably,” I affirmed with a smile. We chuckled together. Even in such a vulnerable moment, I admired his ability to soften the edges with humor. “I’m sorry I didn’t honor my patients with at least the basic acknowledgement that something mysterious and spectacular happened to me,” he confessed, more to himself than to me. His poignant account of personal and professional pain, caused by hiding his remarkable experience for decades, challenged me to be more open to mystery – not only for myself, but also for the benefit of my patients. I was struck by how this man of science, a respected physician in the community, felt inspired to share his story with me. It was an honor to hear it. In our culture when marvelous and mysterious things happen that we cannot readily explain with our scientific theories and vocabulary, we are often afraid to share them for fear of professional ridicule, being labeled as a delusional malcontent, or worse, being accused of making up a sensational story for attention or some other self-centered motivation. Like Dr. John, I too harbored reserve in coming forward out of concern that it would affect my credibility as a physician. So it is no small matter that I made a commitment to tell his story and those of others. With respect to their personal truth about what they experienced, their stories stand on their own, regardless of our belief about what happened to them. As physicians, we are generally a cautious and careful breed, feeling that

there is a reputation to uphold and anything that even remotely smacks of quackery is to be avoided at all costs. Usually, if anything anomalous comes too close to the surface, most of us politely avert our curiosity and cross to the more conventional side of the street. Ever on guard against anything remotely askance of the conclusions drawn from evidence-based research, we avoid risking our reputations for fear that our competence would be called into question. We carefully create a truth for others to see that may or may not accurately reflect what we ourselves really believe about life, death and the possibility that something real survives it all. Embodied long enough, though, it can become the truth we accept for ourselves. We don’t often question our definition of reality until something so dramatic happens that we cannot conveniently dismiss it, and it causes us to reconsider. But such powerful experiences can also do us the great favor of shattering the antiseptic veneer we’ve carefully created and give us no choice but to see things differently. So I understand Dr. John’s reserve – I’ve lived it. I’m grateful to him, though, for his display of courage in sharing a very personal story with me. Because of his generosity of spirit and words of quiet wisdom, not only as a patient but also as a fellow physician, I found the confidence to document these wonderful stories that patients have graciously allowed me to share with you. At times the events related here may sound too fantastic. Perhaps they will uncomfortably push against the boundaries of what you feel to be true or are willing to accept. You are encouraged to consider that these are the individuals’ own personal experiences, as reported to me. Our ability to explain them is a separate issue. The invitation is to respect their experiences for what they are – whatever they are. Of the Shakespearian quotes I remember from my undergraduate days, my favorite by far is from Hamlet. His friend walks in on him and discovers Hamlet conversing with his deceased father’s ghost. Seeing the look of shock and disbelief on his friend’s face, Hamlet calmly responds, “There are more things in Heaven and Earth, Horatio, than are dreamt of in your philosophy.” Precisely.

“Life eludes logic, and everything that logic alone constructs remains artificial and forced.” – Andre Gide

many years of practicing medicine, I’ve developed a certain fluency in A fter interacting with patients around their experiences with the unusual and unexplainable, but that is not where I started. In the data-driven environment of science, where you are instructed to only believe what can be proven repeatedly under very controlled conditions, it is natural to emerge from years of medical training with a rigidly logical view of the world and a withered sense of mystery. It is an imbalance born out of a process that often stifles our ability to even consider the possibility that anomalous events exist, let alone marvel at them. Not trained to see them, we usually don’t. I was immersed in this frame of mind – logic fully engaged, sense of mystery on simmer – when, as a first-year internal medicine resident, I met Samuel. He was a graceful and soft-spoken African American man in his seventies who was, as we would soon learn, very ill. I was doing a month-long rotation at a Veterans Administration (VA) hospital associated with the university program where I had recently begun my residency training after graduating from medical school. My role was to admit patients to the hospital, care for them while they were there and then discharge them when they were well enough to leave. I would take a history from the patient, do a physical exam and come up with a diagnosis and plan of action to present to my senior resident for approval. The medical wards at the VA seemed intentionally dull, with walls painted a strange, pallid color that quite possibly could be peach, although it was hard to say. The feeble, striped curtains of a similar hue separating the two beds in the semi-private room were equally uninspiring. It created an odd monotone effect

that perhaps had made sense to the creative minds of the 1960s, when this hospital was originally built, but now, some thirty years later, it seemed old and melancholy. There was nothing at all soothing or comforting about this environment. Even the pale-green hospital gown Samuel wore, faded from many years of use and reuse, appeared depressed and tired. But even in this austere environment, with its ambient smell an unpleasant mix of old linoleum and antiseptic, Samuel looked peaceful and at ease. Despite his physical discomfort, which would come and go in episodic spasms, he seemed totally unaffected by his rather insipid surroundings. What stood out to me, though, as I walked into his room to introduce myself, was his ability to smile with his eyes even while his mouth remained static. He came across as being completely at ease – naturally open and trusting. Although he had no idea who I was, his demeanor was inviting as he leaned toward me from his neck and shoulders only, so as to limit the movement of his painful abdomen. He offered a fully extended arm for a handshake before I could even say hello. I was there to do his initial intake and officially admit him to the internal medicine service. He was triaged to us from the emergency department earlier that morning, where he had come for help after several days of increasing abdominal pain and nausea. Because he had a known history of recurrent pancreatitis and the symptom constellation fit, that became his working diagnosis. The busy emergency staff had quickly directed Samuel to the on-call medical team for standard treatment of the presumed ailment without any further evaluation. It had become the routine anytime he came to the VA because they knew him so well. Knowing his history, anyone would have likely done the same. Even Samuel had assumed it was his chronic pancreatitis flaring up, which was why he had waited days before coming in, treating himself with bowel rest – no food, plenty of fluids – on his own. From personal experience of many previous hospital admissions for the same problem he knew what to do, but when the pain persisted he came in. Despite his discomfort, however, which was tolerable as long as he didn’t move, he was graceful in the art of conversation. I found I was enamored by how he talked and could have easily listened to him for hours. A simple question on my part evoked a lyrical and well-spoken response on his. And so we took our time delving into his history. I was even treated to a couple of

interesting war stories from his time in the military. Since we both thought it was pancreatitis, and with the treatment for it already underway while we waited for the definitive lab tests that we felt certain would confirm the diagnosis, there was no real sense of urgency. Several times during the interview, however, he would wince suddenly, then breathe forcefully through pursed lips with his arms extended to either side, palms down, as if he was trying to right himself within the waves of pain. It would subside then he would gracefully continue answering my questions. When I moved to examine him, asking if it was okay if I took a look at his abdomen, I was surprised that my pressing down on his belly didn’t elicit the same discomfort I had just witnessed moments earlier. Pancreatitis should have caused pain when I pressed down on his belly, but it didn’t. That immediately registered as a concern that what Samuel might be experiencing was ischemic bowel instead of pancreatitis. Pain from a lack of blood flow to the intestines – a “gut attack,” basically – can quite frequently manifest as horrible pain that is not necessarily reproduced during the physical exam. Immediate management of a bowel that is suspected of having insufficient blood flow due to clogged arteries involves turning up the rate of intravenous saline infusion in an effort to increase the flow through the calcified and narrowed vessels in the abdomen. By increasing perfusion you can often relieve the pain, and while I was waiting for the radiology tests to confirm my suspicions that Samuel had an ischemic bowel, this did seem to help. I was now very concerned that his gut was at risk of dying. Soon Samuel was on his way down to the radiology department for a specialized computerized tomography (CT) scan that would not only evaluate the bowel anatomy but also tell us about blood flow, or lack thereof. As soon as the scan was completed and Samuel was back in his room, I was in the radiology department looking at the films over the shoulder of the radiologist. My suspicions were confirmed. An extensive portion of his bowel seemed to not only be showing distinct signs of severely limited blood flow and possibly death, but there were also areas that were clearly twisted and obstructed. Samuel had had emergent abdominal surgery many years ago in an army hospital to repair a war injury. What we were looking at now, as we stared at the film displayed on the light board, were loops of bowel wrapping around

the scar tissue that had probably formed after that initial procedure. It happens – not commonly, but it’s not unheard of. In this setting the limited blood flow from narrow, calcified arteries had reached a crisis point and could no longer provide oxygen-rich blood to Samuel’s vulnerable intestines. This was not reversible and it needed surgical intervention. I immediately paged the senior surgery resident on call. Hearing the story, he came down to the radiology department right away and reviewed the films with us. I knew Brad as a friend outside of our training arena. He was respected as a talented surgery resident. He was handy with a scalpel, but he was also a kind and compassionate human being. I was relieved to discover he was on call. “This guy needs surgery now,” Brad said. “This can’t wait.” “Let me go tell him,” I said. “He knows me now.” “Great. Thanks,” he replied, patting me quickly on the back. “I’ll get the team ready and page you with a time to send him down. I’ll have to meet him in the operating room. Not a lot of time for social graces.” With a tight smile and a wave, trusting me to relay the details to the patient and obtain consent, he hurried out to arrange for the emergent surgery. Rushing back to Samuel’s room, I was relieved that we had a precise reason for his symptoms and a definitive path forward to resolve the issue. Brad and his team would remove the dead bowel, restore blood flow and all would be well. As I entered his room, however, I immediately noticed, in complete contrast to when I’d first met him, how very tired and drained he now looked. I imagined he was fairly exhausted from the long day and from the pain itself. He had certainly not slept much the night before his hospital admission. Appearing fatigued, he lifted a hand off the bed with a single arc of a wave and turned his head slightly to look at me. “Hey, Doc, what’s the situation?” he asked with much less energy than he’d had just a couple of hours ago. The midafternoon sun had shifted in the sky such that a single shard of light, broken oddly by the sagging curtains, deflected off the edge of the neonlight fixture on the ceiling and cut straight across the room. It appeared to slice through Samuel’s abdomen like a guillotine, which I thought was oddly prophetic. Peering to the other side of the curtain, I noticed that his roommate had been discharged. I pulled up a stark metal chair with a cracked and faded

green vinyl cushion and sat down beside him, grateful for the privacy. “Well, it’s not your usual pancreatitis,” I said, thinking it was a good place to start. “No?” he queried, although he didn’t sound surprised. “What is it then?” I noticed he wasn’t looking at me. He seemed oddly disengaged, in sharp contrast to his demeanor earlier in the day. Laying out the details of his new diagnosis and what needed to be done, I was pretty straightforward. I explained how it was likely an unfortunate combination of calcified arteries and scar tissue from his previous surgery during the Korean War some forty-plus years earlier. Turning down the corners of his mouth, he nodded knowingly. I doubted, though, that there was any way he could know. It seemed more of a gesture of processing the information than truly understanding it. He remained quiet. “You’ll need abdominal surgery to fix the problem,” I went on, then added, probably a bit too cheerfully, “but I have the best team available lined up for you.” Tapping his fist in a light rhythm on the bed, he continued nodding his head slowly, his frown deepening. Then shifting his head and his mood, he suddenly stared at me with narrowed eyes. If I was reading him correctly, his gaze contained a look of barely concealed fear. “Doc, I appreciate everything you’ve done for me, but I won’t be having surgery,” Samuel said. He then lowered his head and began fingering the folds of his blanket nervously, avoiding further eye contact with me. This was so different from the man I had met earlier. All the eloquence of his conversational style that had charmed me that morning was gone, replaced by a voice that was tremulous and soft. He was shutting me out. He was afraid. “I understand that this is different from what we thought was going on initially, Samuel,” I said, leaning into him and speaking softly. “But if you don’t have this surgery, you’ll likely die.” He shook his head no. “Why, Samuel?” I pleaded. “Can you help me understand why you won’t have surgery?” He took a deep, sucking breath, and jabbing the bed with his finger for emphasis, still looking down, he told me: “I will never have surgery again.” His voice started to crack. “Because the last time they did that to me, I saw everything! I saw them open me up and cut inside my belly. I tried to scream.” With the sudden appearance of tears, his voice fell to a whisper. “I tried to tell

them I wasn’t asleep – but they wouldn’t listen to me. They just kept right on cutting. Right on cutting.” I was stunned. Shocked and horrified by what Samuel had just shared with me, I didn’t know what to say, so for a while we sat in silence and I said nothing. Finally, afraid to ask but wanting to know, I inquired, “Did you feel any pain?” “No, I didn’t feel pain, but I could see my guts all laid out. I could see what they were doing when I looked down and it freaked me out!” He was clearly distressed, but I was confused. I knew that under general anesthesia he should not have been conscious for the procedure, let alone able to feel it. I had heard of rare cases where patients appeared to be unconscious during surgery and later reported feeling pain, but Samuel had seen his surgery in detail and felt nothing. I also knew there would have been a drape extending up from the sterile surgical field separating his head and upper chest from the abdomen where they were working, preventing him from being able to see what the surgeons were doing, even if he had been awake. Finally, I spoke. “I can only imagine how terrifying that must have been.” Not knowing how to respond exactly, I did my best to reassure him – but at the same time, I was stumped. In that moment, words failing me, I reached out and took his hand, gave it a gentle squeeze and then released it. We sat in silence. Both of us were absorbed in that moment for different reasons – Samuel unexpectedly reliving his trauma, me trying to sort it all out – when my pager suddenly rang out, startling us both. Glancing at the digital display, I knew it was going to be the surgery resident paging to inform me they were ready for Samuel. Patting Samuel’s arm and assuring him I would be right back, I excused myself to answer the page. The nurse’s station was just down the hall from his room, so it didn’t take me long to call Brad. It took me longer to explain what Samuel had just shared with me and why he was refusing surgery. I struggled to explain what he had told me, all the while knowing that it sounded crazy, and Brad’s silence on the other end of the line confirmed my suspicions. “Hmm,” he finally said, then “Hmm” again. Clearly, he didn’t know what to make of it. Patients always have the right of refusal, of course. We can’t, and shouldn’t, force them down any path of treatment they don’t want to take. With that, though, comes a responsibility to provide patients all of the information to make

the best possible choice that they feel is right for them. I wasn’t able to explain to Samuel what had happened to him. I had absolutely no idea what had happened to him, and neither did Brad, but at least my friend wasn’t totally dismissive. Maybe it was because he knew me and had reasonable evidence that I was of sound mind. But even when Brad went to Samuel’s bedside to explain the procedure and the devastating outcome if he didn’t have it, Samuel’s answer remained the same. Not knowing what else to do as my next step, since Samuel was refusing the necessary treatment to save his life, I sought out my senior resident. With some hesitation, I described what Samuel had shared with me. I distinctly recall him looking up from the chart he was writing in and staring at me blankly as if he was hearing gibberish from a total idiot. I was still new enough to the practical implementation of what I had learned in medical school that I didn’t know if what I had heard from Samuel wasn’t an odd fugue state of mind that I had not yet come across. Perhaps what he had experienced was unusual but perfectly natural. By the way my supervising resident was looking at me, however, I gathered this wasn’t one of those rare diagnoses that would earn me a pat on the back. “Whatever you do when you present that patient to Dr. Grunwald on rounds in the morning, I wouldn’t say that,” he finally said. Then, with the barely veiled impatience of an experienced physician guiding a novice, he got up and walked out of the workstation, expecting me to follow. “Come on,” he said without looking back. “Let’s go talk to him,” meaning I’ll show you how it’s done – so watch closely and learn. My senior resident was very professional at the bedside, hearing Samuel’s story and deftly examining him. He was much more tolerant of the patient than he was of me, but I knew enough about the old-school training hierarchy not to take it personally. He related everything to Samuel that I had already said, and still Samuel refused. Finally, sighing and placing his hands on his hips, he shook his head and said, “Well, sir, I wish you would make a different decision, because with surgery we can save your life. Without it, I’m afraid you’ll likely die.” “I understand,” Samuel replied gracefully, “and I thank you for your time – but I won’t be having surgery.” There was the kind of authority in that statement that left us both knowing it was pointless to pursue the matter any

further. My resident extended his hand to Samuel, who took it. With a handshake, a promise was made to honor his wishes and keep him comfortable as he continued to decline. Without treatment, we knew he certainly would. With that we left the room and my resident, rather detached I thought, excused himself to return to his work. But I was troubled. What had happened to Samuel during that surgery so long ago? What Samuel had experienced led him to decide to die rather than undergo lifesaving surgery – and I had to find out more. For the rest of the afternoon and evening I was busy admitting and discharging other patients from our service, but when I found a lull around midnight in our thirty-six hour shift, I finally had a chance to review Samuel’s old hospital charts. Earlier that day I had requested that they be delivered from the medical records department in the basement of the VA hospital to our workroom on the fourth floor. The resident workroom was as bland as the patient rooms. It was adjacent to a bunk room where our team would catch a few minutes of sleep whenever we could during the long shifts we took every fourth day, rotating with the other three teams of residents and medical students that made up the medicine service. It was here that I spent several hours poring over Samuel’s charts. This was before the day of the computerized medical record, so if I were to discover anything about Samuel’s original surgery, I would have to sort through the charts myself. What I was looking for specifically was the anesthesiologist’s report. I knew that this particular physician would have been positioned at the head of the patient during the surgery behind the drape. He would have been the first to recognize and respond to any signs of wakefulness or distress. According to his documentation, there were none. There was no mention of anything physically unusual that had occurred during the procedure. The anesthesiologist’s paperwork documented a typical course, and according to his report the patient was unconscious the whole time. Throughout the surgery the vital signs were recorded in detail and there was no indication that he had experienced any distress while under anesthesia. He was sedated throughout the entire surgery with no variation in blood pressure or heart rate that would have suggested the presence of stress or pain. The surgery apparently went off without a complication of any kind. Following the trail of that hospital stay, I read that Samuel recovered well

and was eventually discharged home. Now, several years later, he was facing a similar surgery that he flatly refused to have because he maintained that he had viewed the entire procedure from a vantage point above his physical body. Given the traditional setup of surgery and the report I had just read, it was a view I knew was impossible – physically, at least. The next morning on rounds, fueled by caffeine and an eagerness to be done with our shift and get some sleep, our team of several residents and medical students clustered around our attending physician outside of Samuel’s room. Before we went in, I presented his case and the plan of care. Dr. Grunwald listened carefully. When he asked me to explain why Samuel wouldn’t consent to surgery, I glanced at my senior resident, who tightened his lips and subtly shook his head. Taking my cue, I sidestepped bravery and fumbled a moment before saying, “Because the last time he had surgery it was such a traumatic experience for him.” My resident nodded his approval, but I felt dirty. I had intentionally omitted a key component of Samuel’s reason for refusing surgery. I had yielded to the pressure of medical convention. We all filed into Samuel’s room as the attending physician took charge. While I admired Dr. Grunwald’s bedside manner and his professionalism – he was kind and respectful – I was aware of a very different side to this story that, due to the reaction I had received from members of my team, I did not feel free to tell. I also felt that by not sharing the real reason he had declined surgery, I had let Samuel down. That said, as the primary doctor who had interacted with him the most, I refused to hide. I stepped to the other side of the bed opposite my attending, making a spontaneous decision that if Samuel chose to divulge the reasons behind his choice to decline care, I would stand beside him. But surrounded by an intimidating cloud of white-coats, Samuel didn’t seem motivated to further elaborate about his reasons for refusing surgery when Dr. Grunwald asked him. It was, after all, his story to tell if he so chose. But he didn’t. Samuel made clear that he would rather be made comfortable and let nature take its course than take a chance on repeating the frightening ordeal he had experienced some years earlier. His wife, who was present in the room when we invaded it, took her husband’s hand and tearfully nodded her support of his decision. Over the next few days, Samuel continued to decline and, agreeing to respect his wishes, his family gathered at his bedside. Eventually, enveloped in a

comfortable cloud of morphine to suppress his pain, Samuel passed away from complications of an ischemic bowel. I was on call the night he passed away, and ironically found myself in the position of being the physician who made the official pronouncement that he was indeed deceased. I was there when he came into the hospital; I was there when he left. I hadn’t been able to tell by my interactions with Samuel’s family before he died if they knew about his experience so many years ago – I didn’t ask and they didn’t say. I still felt that I had let Samuel down by not bearing adequate witness to his experience, primarily because I didn’t understand it. Walking into the dimly lit room after the nurse had notified me of his passing, I stood in silence at his bedside as his wife held his hand and cried softly to herself. Not wanting to disrupt the moment, I moved quietly to the opposite side of the bed across from her so that I could do the necessary physical assessment to confirm clinical death. She didn’t acknowledge me right away but eventually spoke in a voice that was soft and low. “Did Samuel ever tell you why he refused to have surgery?” she asked without looking at me. “Yes, ma’am, he did.” I kept my reply simple and she nodded, still not looking up. “Have you ever heard of anything like that before?” I could only assume we were talking about the same thing – about Samuel’s experience of witnessing his own surgery while the medical records seemed to confirm that nothing physical was amiss and that he was completely sedated and apparently unconscious the entire time. “To be honest, I haven’t, but that certainly doesn’t mean it hasn’t happened to other people. It probably has. Samuel was the first person to share anything like that with me. But,” I was quick to add, “just because I haven’t heard of it doesn’t mean it didn’t happen.” “True enough,” she continued. “Now that you know… maybe…” her voice trailed off. “Maybe I can help someone else?” I tried to guess at what she wanted to say. “Yes. Thank you for that. I hope you can. No one should be so afraid of something they don’t understand that it limits their choices.” How very wise that sounded to me in that moment.

“I agree with you. Samuel taught me something and I won’t waste it,” I promised her. Yes, I promised her that I wouldn’t waste the opportunity Samuel had afforded me when he trusted me with his experience, but I had no clue at the time what, if anything, I would do with that information for other people. What it had done for me, however, was clear. I started to allow a sense of mystery to be part of my work and allow me to explore things I had not previously considered. I also began to take seriously the role of listening to and respecting patients when they tell me about experiences for which the scientific side of medicine has no good explanation.

When I was taking care of Samuel, I had no frame of reference for what he had shared with me. His story was a bit of a shock to my carefully cultivated medical belief system, so when I heard it, I struggled to fit his experience into a framework I was familiar with. I had been offered nothing in my medical training to reference this interaction with my patient. At the time I had not even begun to assemble my own thoughts around such phenomena, so when confronted with it for the first time and not really knowing what to say, I said nothing. Dismissing something a patient shares with me, however, is just not within my nature. My instinct even as a resident was to discuss it with my colleagues to see if they had heard of anything similar to Samuel’s case. It quickly became clear to me, though, that it was not a safe topic and was roughly considered the equivalent of chatting with fairies. I realized that I had best keep quiet about things that veered too far from the scientific centerline, if I wanted to be taken seriously as a physician. The directive to stay within logical, scientifically comfortable boundaries was not only implied, but also, in many instances, spoken aloud. That’s when I learned to maintain silence about mystery, and I did so for many years, kept in check by the collective agreement of medical convention. It’s a powerful machine. On a certain level, I can understand how such a cautious culture has evolved. Until the Age of Enlightenment, around the turn of the eighteenth century in the Western world, medicine was largely a back-alley art. It was primarily administered by folk healers and barbers, and was frequently accompanied by muttered incantations and homemade potions. The

interpretation of physical observations were linked strongly to the spiritual influences of the day, and in some centuries were considered to be on the level of sorcery. With substantial effort since then, and often trudging uphill against society’s social gravity, medicine has deliberately distanced itself from its superstitious past when medical practice was not respected. With the advancement of science and our growing understanding of the human body, a deliberate effort was made to shed the Middle-Age image of medicine as boring holes in people’s heads (trephining) and selling snake oil, thereby upgrading its status and social esteem. Please understand that I am in awe of what science has revealed to us about the amazing human body – its function and dysfunction – and am thankful to have been informed by the knowledge from the great discoveries of my predecessors. I take pride in being able to use this information to treat disease and alleviate the discomfort of my patients. I wonder, though, if we’ve gone too far when we use science to distance ourselves from what we don’t understand. Even from a scientific perspective, it is hard to make the case that we are justified in denying or overlooking anything for which we don’t have a conventional explanation. Our indoctrination into the current medical culture occurs from day one of our training, and frankly, it’s an easy sell. When I started medical school, I was firmly engaged in left-brain mode, not only out of habit but also out of necessity. I had to be. There is a finite amount of time to absorb everything you need to learn in order to recognize disease and treat it competently. There is not a lot of room for philosophical musings about medical mystery when you are trying to digest and internalize the endless piles of facts required for proficiency. There are plenty of critics about the process and the structure of medical education, but I get it. I understand that its current structure exists in the way it does because there is a limited amount of time allotted to craft a capable medical detective and body mechanic. From the time that I started medical school until the time I finished my fellowship in critical care medicine, I had inhabited the medical establishment’s training grounds for ten years. That was certainly long enough for me to absorb the distinct cognitive and practice styles of those who trained me. There are attempts, however, to cultivate a more philosophical side to medical care. These feature special workshops and guest lecturers who try to

plant the seed of seeing things differently and learning to interact with patients on a more personal level, taking into account how they see the world. Mostly, though, we are left to draw our own conclusions, while working with the assumptions and priorities of our mentors and attending physicians, about how to understand the inevitable oddity we’ll encounter for which there is not a tidy explanation. I remember on the first day of medical school in July of 1992 filing into an enormous, steeply tiered auditorium that tapered sharply down to a platform and podium far below with a very large projector screen behind it. It seemed intentionally vast and intimidating, and as I made my way down to select a place somewhere along the edge (a fitting metaphor for what would become my unwitting journey along the fringes of patient experience), there was the uneasy feeling that the room was swallowing me whole. That would be the main lecture hall for our class of 170-plus medical students for the next two years. Placed on the long stretches of row desks in front of each swivel seat was a thick syllabus and a copy of a book entitled On Doctoring – an anthology of stories, poems and essays written about medicine compiled over several decades. I leafed through it curiously while waiting for our first class to begin, and the titles of some entries caught my attention and intrigued me, but that was as far as I got. Where it came from and what we were to do with it was never made clear. I set it aside when the first lecture began, and I didn’t pick it up again until many years later, when I would learn that it is a lovely philosophical and practical book filled with the musings of both patients and doctors who ask deep questions about life, existence and the complex and significant relationship that we have with each other. But not a word was said about it by our instructors, and under the weight of histology, pathology, pharmacology and every other “ology” I would encounter over the next few years, that book and other such attempts to incorporate a more philosophical, relationship-centered viewpoint into what we were learning was pushed aside out of a perceived necessity to make room for the hard sciences. What we learned on a given day, we studied well that night and often into early the next morning, because with the amount of material we were required to digest in that amount of time, we frequently did not have a chance to study it again before the test. We could literally have a college semester’s worth of

information in a week – or sometimes a day – that we were expected to not just study, but to own and be able to regurgitate back on a moment’s notice. It is super-human that medical students can achieve this. I’ve often asked myself, “Does a person really have to be that smart to be a doctor, or just have a good memory and unwavering endurance?” So yes, maybe there is a better model, but with the growing magnitude of medical knowledge, it is even harder to find a spare crevice and tuck some human communication skills and a more patient-centered way of thinking into it. At its core, medical training is a mental marathon requiring the logical left brain not only to be fully engaged, but also to function in overdrive most of the time. That’s how medical training leaves you. And I believe that this is due to no intended malice on the establishment’s part, but has emerged out of the very practical need to pack a lot of information and skill into a very limited span of time. It is up to us to navigate our way back to a sense of wonder and respect for patients’ experiences that cannot be easily explained by our medical training. That’s why, when I met Samuel, what he told me was so out of context to what I had learned. I literally could not see it any other way than a concrete, earthbound, physical-matter-reality occurrence. When what he told me did not compute, I didn’t know what to say or do. Apparently, neither did my colleagues, for they neatly sidestepped it – and I was encouraged to do the same. I’ve since learned that there are many other documented incidents of disassociation of consciousness from the human body, but at the time that I was first introduced to the possibility by Samuel, I did not know that. That was the first time that I had encountered a patient who had likely experienced the phenomenon. Now, nearly twenty years later, I am more firmly established in medical practice and have been privy to other such patient experiences, including out-of-body awareness during surgery, trauma and coma, as well as the classic near-death experiences during confirmed clinical death. I hold a specific gratitude for Samuel because of how that pivotal experience changed me, and how it made it clear how important it is to listen to and respect patient experiences, even those we don’t understand. Without knowing it, he opened up the dialogue between me and many other patients who would follow him about life, death and what may survive our death. I’ve often thought that perhaps that is what Samuel’s wife was alluding to when she suggested that I use

what her husband shared with me to help others having similar experiences. I am always a bit haunted by my experience with Samuel, though. Would the outcome have been different if I had been able to have an alternate conversation with him – if his fears had not informed his choices the way they did? At the time, I didn’t have the language or the framework to help him see things another way, but that is his gift to me now. His legacy is a door that is now opened for me to have a different interaction with patients around their anomalous experiences. Although there’s no certainty that talking to Samuel differently about what had happened to him would have led him to make a different choice about his treatment and improve his chances to live, it became clear to me that being able to talk with patients about these powerful and meaningful experiences can be a life-and-death matter. As a result of my interaction with Samuel, I became motivated to make it safe for patients to talk to me about things they encounter that don’t neatly fit the medical paradigm.

“Truth is stranger than fiction, but it is because fiction is obliged to stick to possibilities; truth isn’t.” – Mark Twain

one bright, autumn morning, I was walking the hall from the doctor’s E arly lounge to the ICU to start my morning rounds when I heard a Code Blue announced overhead. It was the signal that someone was in trouble and that death, if medical intervention did not alter the course, was likely imminent. In a voice that was a little too pleasant for the occasion, the female switchboard operator intoned three times in rapid succession the location (ICU) and the room number (218). As I flashed my name badge across the security pad, the ICU doors swished open and I could see the commotion straight ahead. I was the first doctor to arrive on the scene, which put me automatically in charge. I didn’t recognize the patient, but the abdominal dressing indicated that he was likely on the surgical service. Glancing up at the monitor I could see that the continuous EKG showed a dangerous heart rhythm. I knew that this particular rhythm was most commonly attributed to a very low magnesium level. Learning from the nurse that the patient was a chronic alcoholic, this made sense. Magnesium levels are frequently quite low in everyday, heavy drinkers. Calling for intravenous magnesium to be started right away, I asked for the chest compressions to stop so I could feel for a pulse. There wasn’t one. Chest compressions resumed, and I pressed the button on the defibrillator to start charging up the paddles. We would try to electrically shock the heart back into a safer rhythm. I grabbed the paddles from their holders when the charge was complete and, per protocol, firmly stated “everyone clear” so that our staff could step back from the bed and avoid being electrocuted. I delivered the shock. The patient’s body arched from the jolt of electricity I’d just sent

coursing through his chest, and we all watched the monitor to see if our intervention had worked. It hadn’t, so right away I said, “Let’s turn up the juice,” meaning we’d try a higher voltage this time. “Okay, charge.” “Charging,” the nurse replied, and I shocked him again, then again a third time, and finally a fourth. On the fourth time it took, and he was back in a normal rhythm, but there was still no pulse. I called for the nurse to continue giving compressions, and the patient received another push of IV medication to try to get the heart to do its job. Despite the fact that his heart now had a normal electrical rhythm, it wasn’t pumping blood with enough force to generate a pulse. It was likely that his stunned heart was sitting in his chest quivering rhythmically, trying to find a way back to normal function, but not succeeding. The nurses were well trained to keep track of the rhythm, pulse status and drugs given, and to keep verbal time for me. So I moved to the head of the bed and prepared to intubate the patient, meaning I would be putting a flexible tube into his throat to connect him to the ventilator. We needed to breathe for him. He wasn’t doing it well enough on his own, and because he was unconscious from his cardiac arrest, he couldn’t protect his airway. This would also ensure that he got the amount of oxygen he needed – the fuel for basic body function. I moved the patient’s head and neck into a position that would allow me to better visualize the vocal cords, where I would have to insert the plastic intubation tube. Lifting the jaw, I commented aloud that he had mucus in the back of his throat. It was obscuring my view, so I asked for the suction catheter to remove it. “Whoa, it’s really sticky! It’s fighting me a bit,” I exclaimed. After I had successfully cleared it away, I said, “Tube, please.” I passed the tube through the vocal cords into position in his trachea, turned to the respiratory therapist and asked, “You got this, Richard?” “Yep. Got it,” he replied, and quickly grabbed the tube that I was holding in place until he could secure it with a special clamp that was attached to a soft, foam collar that encircled the patient’s neck. Velcro straps looped through the clamp on either side to secure the collar, keeping one end of the tube in the patient’s throat and the other end connected to the ventilator. I moved back into my previous place at the side of the bed, carefully stepping over and under

tubing and wires that connected the patient to various life-sustaining drugs and devices. Once clear, I pivoted around to get a look at the monitor that was keeping track of his vital signs and crossed my arms to ponder what I was seeing. “Stop compressions, please,” I said. “Do we have a pulse?” “Yes, it’s there. Weak but present.” The blood pressure was a bit low, so I said, “Turn up the fluids and let’s see if the extra volume is enough, before we start meds. He may not need them.” After a few minutes I could see it was working. His blood pressure was improving, the magnesium was running in, the heart rate seemed steady and his oxygen levels were normal. He was heading in the right direction. “All right then, I think we’re done. Good work, everyone,” I said, and with that statement, the team took their cue and disbanded. They began cleaning and packing up the resuscitation equipment, and we concluded the successful code. I paged the surgeon listed as the attending physician on the patient’s chart and updated him about the cardiac arrest. I let him know that his patient was now successfully resuscitated, and that he appeared to be stabilizing. The patient’s nurse and I remained at his bedside, and he started telling me the patient’s story. Since my first introduction to this patient was his cardiac arrest, I didn’t know anything about him. And I needed to, now that he was on the vent. I ran the vents in the intensive care unit, so I was automatically invited to the party. Not only that, but once I became involved the attending doctors generally made a habit of leaving basic daily care of the patient to me. Since the ICU was my main hangout, I was usually there most of the day and I could address patient issues as they arose. He first told me the patient’s name (Howard) and how he had come in two days earlier to the emergency room with severe belly pain. He was discovered to have a segment of dead gut, probably due to diseased and clogged arteries. The blood supply had been cut off to that part of the bowel and it had to be removed. This had been the cause of his pain – much like blocked arteries in a heart would cause a heart attack, or in the head, a stroke. He was taken to the operating room and the damaged segment of intestine was removed. By all accounts, the surgery was a success and he was sent back to the intensive care unit to recover. His post-operative course had become complicated, though, when he started

going through vigorous alcohol withdrawal toward the end of the second day. He required heavier sedation to keep him calm and comfortable. As we took care of Howard for the next few days, he continued to improve. Due to his withdrawal, however, he required ventilator support longer than would normally be expected after a cardiac arrest or even after his surgery, but it was the humane thing to do – keep him comfortable until the withdrawal symptoms had resolved. On day five of his hospital stay, things seemed to be settling down and we were able to awaken him and start weaning him from the vent. He was pretty weak from lying in bed several days, and due to his history of smoking heavily we suspected he might have some underlying emphysema. Because of this, he didn’t advance off the ventilator as quickly as we would have liked. As we dialed back the amount of support he was getting from the vent, he would breathe very fast and shallow and we would have to increase the support to allow his respiratory muscles to rest and recuperate before trying again. To state the obvious, you can’t talk with a tube in your throat. It is even impossible to mouth words and have them understood, but there was one day in particular that Howard was really trying. On that day when he saw me come into his room, he became very animated. He was trying to communicate something important, but “yes/no” questions got us nowhere. He was too weak to write, and working with a letter board, we still couldn’t figure out what he was trying to say. Hovering over the letters arranged in rows and columns, he paused as if he was having trouble even putting into words what he so intently wanted to communicate. He finally pointed out letters to spell the words “green shirt” and then pointed to me. I was indeed wearing a green shirt, but the significance of this was lost on us. I assumed, actually, that perhaps he still had some lingering delirium from his withdrawal, since the context and importance of me wearing a green shirt just didn’t make sense at all. His wife and adult children tried to help, thinking that because they knew him so well perhaps they could try to decipher whatever had him so agitated, but even those familiar with him and his idiosyncrasies couldn’t figure it out. After fruitless attempts to communicate, he got frustrated, turned his head away and sank into the pillow in a gesture of defeat. “Hang in there, Howard. You are so close to getting off the vent, then you can tell us exactly what you want to say,” we tried to encourage him. “You’re

getting better every day.” But we could tell that he was frustrated. I’m sure it is tough lying in bed in the ICU with no sense of control, especially when you have something urgent to say, as we would later learn Howard did. When the day came that we could successfully remove him from the vent and he was finally able to talk, what he shared surprised us. Struggling for words to explain his experience, all he could say at first was, “Something happened to me.” “What do you mean?” I asked. “What happened to you?” I had no idea what Howard was going to say. I had not really thought much about his cardiac arrest since it happened. I had been more focused on his dayto-day clinical progress, but what followed as he began to share his experience brought me right back in a stunning way that warped reality, both his and mine. Howard not only remembered the events of his cardiac arrest – what was said, what people were wearing, who was present – but he recounted it in such detail that it was clear he was a witness to his own event, even though he was completely unconscious at the time. I could have rationalized some of his memories away by accepting that perhaps, while unconscious, he was able to hear on some level. It has happened that patients would recount bits and pieces of conversation while under sedation, even in some detail. It makes sense to me that parts of the brain remain active and able to incorporate environmental input despite sedation, much as it does when we’re asleep. But Howard was not only telling me what he had heard but also what he had seen with incredible accuracy. What’s more, he recalled seeing it from a vantage point above his physical body – far above those of us who were working on him that day. Howard started from the beginning and gave us a play-by-play of his experience. He recounted that at some point, he didn’t know when, he felt more than heard an intense, escalating buzzing. Not long afterward he experienced the sensation of shooting out of the top of his head with incredible speed. Hearing this, I was still interpreting it as the physical sensations of being unstable, but then he continued. “Next thing I know,” he said, “I’m looking down on my body and it feels like I’m bobbing and bouncing against the ceiling. I was too shocked to be scared! It occurred to me I might be dead, so I started to panic and, as crazy as it sounds, I tried swimming through the air to get back to my body. It didn’t work.

That convinced me I must be dead, so I just watched and listened. I started thinking that maybe I was supposed to go somewhere or maybe someone was supposed to come get me. With that thought, I felt myself rising up through the ceiling and it was like I was going through the structure of the building. I could feel the different densities of passing through insulation. I saw wiring, some pipes and then I was in this other room. “It looked like a hospital but it was different,” he said pensively. “It was very quiet and it seemed like no one was there. There were individual rooms all around the edge and on some of the beds were these people, except they were not people, exactly. They looked like mannequins and they had IVs hooked up to them but they didn’t look real. In the center was an open area that looked like a collection of work stations with computers,” he said. That’s when my jaw really dropped. I stole a look at the nurse who looked equally surprised. What we knew, that Howard didn’t, is that right above the ICU is a nurse-training center where new hires spend a few days rotating through different scenarios. There are simulated hospital rooms around the perimeter with medical mannequins on some of the beds. In the center there is indeed a collection of workspaces with computers. I was amazed, but I was all in and wanted to hear more. “What else did you experience, Howard?” I inquired. Bolstered by our interest and reassured that we seemed to believe him, he continued. “I wasn’t there long before I got jerked back to my body with a jolt and then floated up again. As I floated up this time I heard someone say, ‘Turn up the juice’ and then, ‘Okay, charge.’ I didn’t know what that meant, so I just watched. I didn’t know what was happening, but then I saw the things they put on your chest to shock you like you see on TV, and I saw my body jump right after someone said, ‘Everybody clear.’” I was amazed. He had actually heard our conversations while unconscious, was able to recount it with great detail and correlate the words with visual events that he could accurately describe! Howard went on to relate how he had watched me step carefully over wires and under tubing to get to the head of the bed and then back out again after I had intubated him. He also told me how he watched a “hose” being put into his throat right after he heard the comments of there being “mucus in his throat that was really sticky and fighting me.” But what he remembered most was my shirt.

I have a lime-green blouse that I had apparently worn the day Howard’s heart stopped. That he would comment on that specifically, when I knew with certainty that he was unconscious, was remarkable. He noted that it was bright green and looked to him like it was a glowing wedge peeking out from my button-down, white physician coat. It caught his attention and he locked in on it. He said it seemed brighter than everything else in the room and that the hue appeared to vibrate and stretch so that somehow it looked like it was moving separate from my body. He recalled filaments that seemed to stream out from the color and cast off in all directions whenever I moved. He became mesmerized because the color seemed alive. Apparently, on the day that Howard was really starting to clear from his withdrawal, a few days after his cardiac arrest, I had come into his room wearing that same blouse. That was the day, he said, that he became so agitated trying to communicate that it was me he had seen at his code and that I was wearing the same blouse he saw when he was floating up above his body. I agreed that it was unmistakable. “How do you explain that with a letter board?” Howard mused. “Yeah, you’re right. You were so frustrated,” I affirmed. “And we could not, for the life of us, figure out what you were trying to say.” We continued talking for the next half hour or so, pondering what had occurred and what it could mean. Nothing like that had ever happened to Howard or to anyone he knew. Being a very practical man with a distinct, earthbound philosophy and a literal interpretation of the world, he had not ever really heard about near-death or out-of-body experiences during moments of physical crisis, but I had. I told him there are documented accounts of other patients who have had similar experiences and that he was not alone. He had some insights of his own, and as is often the case, his experience of conscious awareness separating itself from his body had a powerful, lifeaffirming impact on him. Howard was not only fascinated by what had happened to him, he was transformed. What he experienced so vividly on the day his heart stopped, affected him in a powerful and lasting way. His interpretation of what had happened to him was that he had been offered a unique opportunity to step outside of himself and look at the unfortunate state his unhealthy habits had left him in. He had been warned by his primary care physician that, with his family history of heart and vascular

disease, if he continued to smoke and drink heavily he would have a devastating event, as had many of his relatives preceding him – a stroke, a heart attack, or in his case, a “gut attack” – where part of his intestine actually died due to a lack of blood supply from a clogged artery in his abdomen. As a result, he was shocked into a new awareness. He had not really believed before that he was at risk, but he did now, and he was changed by understanding the impact of his habits and experiencing the outcome in such a dramatic way. I was able to see him in follow-up for his newly diagnosed emphysema some months after his cardiac arrest and he still maintained his abstinence from alcohol and tobacco. The pivotal event of a near-death experience during extreme illness had motivated him to make immediate and lasting changes in his lifestyle.

Over the years, I’ve had other patients share their experiences of observing what was happening to them from a perspective of being outside of their bodies. Often, though not always, it seems to occur from a perspective above their bodies. I don’t know what that means and I certainly don’t know how it happens, but based on the events shared with me and documented by others, it is clear that it does happen. It is especially remarkable when people are able to report specific details about what transpired – what was said, what they saw – while they were known to be unconscious, or even clinically dead. The amount of detail some patients report is stunning. When we are able to correlate those details with what we know happened, it is pretty convincing that the patient has experienced something out of the ordinary. One may be tempted to say that these experiences are simply a kind of dream, but for those having them, they are more real than dreams and more vivid than imagination. In ways we don’t yet understand, those who experience these events often find themselves perceiving and interacting with what is around them in a very real and life-like way. But whatever they are, the fact that these remarkable phenomena of consciousness occur in an extreme, stressinduced state where vital brain and cardiac function are frequently taken completely offline makes them mysterious, fascinating and worthy of serious study.

“Reality is what you see. When what you see shifts, departing from anyone else’s reality, it’s still reality to you.” – Marva Hornbacher

all of the near-death encounters I’ve been fortunate enough to have O fpatients share with me through the years, I am continually amazed when someone comes back from a state of confirmed clinical death to relate otherwise unknowable details about the physical environment or tell of encounters with deceased loved ones. This is especially remarkable when they report information that they could not have possibly known or events that will occur that haven’t yet happened. Such was the case with Marlene. Marlene was a young Native American mother who was pregnant with her second child. It had been a routine pregnancy and she progressed without difficulty to labor and then delivery of a healthy baby boy. The problem occurred when she suddenly became unstable with what was later surmised to have been an amniotic fluid embolism. This occurs when a bolus of amniotic fluid enters blood vessels that are perhaps torn or otherwise compromised during childbirth. It goes to the lungs through the right side of the heart and, like air injected into veins, obstructs vital blood flow, causes instability, and not infrequently leads to cardiac arrest. This is precisely what happened to Marlene. Her resuscitation was prolonged, with several periods where she had flat-lined and didn’t have a heart beat or pulse at all. After nearly an hour, the code was deemed unsuccessful and she was pronounced dead. After several minutes, as the doctor was removing his surgical gown and gloves and preparing for the grave task of having to inform the family of the tragedy, the nurse announced with alarm, “She has a heartbeat! And a pulse!”

Resuscitation efforts resumed and this time were successful, but because she had been clinically dead for several minutes, her medical team warned the family that she would most certainly have anoxic brain injury due to the prolonged time that her brain had no blood or oxygen supply – at best they could expect her to be in a persistent vegetative state. But fortunately for both Marlene and her family, that was not the case. She awakened nearly four days later, as her worried family held vigil at her bedside, and shared an incredible story. She recalled being in labor and giving birth to her child. Not long after that, though, she related experiencing the feeling of an incredibly warm wave washing over her while her point of view sped swiftly backward to the corner of the delivery room, up and to the left of her body. From there she observed the team panicking, starting to do chest compressions and concerning themselves with the business of trying to save her. She heard shouts and orders from the staff below, but felt strangely calm and detached as she observed them. She soon became distracted by the presence of a soft blue orb of light that came into view on the opposite side of the room. She watched as it began to move slowly toward her the moment she had noticed it. How long it had been there hovering, watching before she had actually seen it, she could not say, but it seemed that the mere engagement of her attention drew it forward. While the orb was slowly approaching, she noticed that the voices below became thinner and more distant while the visual scene grew ever smaller and more remote, as if she were looking through the wrong end of a telescope. As the orb, about the size of a beach ball, came to rest in front of her, she felt overwhelmed with emotion and intense feelings of peace, love and complete safety. While nothing particular was said, the thought came to her that she was going to be okay but that something was going to happen first. This was confusing to her, but she did not feel afraid or threatened. For some time, she and the blue orb lingered in the corner of the room where she had been after she had left her body. While she was still aware on some level of what was happening below her, it seemed to recede farther and farther away and she began to have a sensation of ascending. Just as Howard had experienced, she felt a density difference as she moved through the ceiling of the delivery room. She saw large silver pipes and industrial wiring as she moved through the spaces in between floors then briefly paused in another patient’s room. There she saw a man sitting up in his hospital bed. He

was eating a meal from a narrow, wheeled tray table while a woman, reclining in a chair beside the bed, was reading a magazine. She noted a couple of vases of flowers on the windowsill and perceived, more than actually smelled, their intoxicating fragrance. The flowers were the most vivid colors she had ever seen and the petals, stems and leaves all seemed to be made up of tiny particles that vibrated very fast. Remarkably, there was a palpable, humming energy emanating from the flowers that vibrated across the atmosphere, entered into her body, if she could call it that, and presented itself in such a way that she could feel the flowers. After lingering in the room for just a few seconds, she and her amorphous companion began to move again through other floors and finally to the roof. She saw the flat, pebbled surface and the tar patching that reached out in streaks and twists along seams and in circles around pipes and supporting structures. There was a three-dimensional effect where the pebbles seemed to loom toward her with incredible detail while the black tar appeared to deepen and recede. She saw the parking lot several stories below and was aware of a delivery truck, with caution lights flashing, where it was temporarily parked for unloading. Again she homed in on the blinking lights, noticing that the colors and motion of the illuminated blinkers were so intense. Once more, she perceived the sound a blinker would make even though she was too far away to actually hear it. She observed that when she looked at the blinkers she could hear them and when she looked away the sound faded. She saw the deliveryman come back to the truck and, when she looked at him, she could hear his padding footsteps on the pavement. When she looked away, the sound was gone. So it would seem that whatever she visually locked in on – from the hospital room where she had seen the flowers, to the roof and then the parking lot below – she gained an instant awareness of the sounds, smells and colors in hyper-sensory detail from a great distance. Her guide, if that is what it was, seemed in no hurry to move her along, allowing Marlene to marvel and observe with this phenomenal skill. Marlene shared with me how, caught up in the fascination of these new experiences, she became totally detached from her physical existence and less aware of the drama happening to her body in the delivery room. Every now and then she would hear the faint, distant cry of a baby that she understood to be hers. Even the random, chaotic commands of resuscitation in progress would

occasionally bleed through to her awareness. For the most part, however, these sounds concerned her less and less. In fact, she found that her new nonphysical reality didn’t seem new at all but that the longer she was in her now state, as she put it, she seemed to be more who she really was than when she was in her then state, when she was in the physical. As her attention drifted from the visual scene below her, she continued to rise above the point of view of the roof and in a distinct shift in perspective, recalled a specific moment when she was no longer moving from but going toward. She felt that the blue orb, with unspoken permission, had let her make that decision, letting her untangle physical ties at whatever pace she chose. Moving into lighter space, she was aware that the orb was less dense as well. Looking to her right as they moved along, she realized that her companion was actually no longer an orb but seemed to have stretched out to a filmier smudge of an elongated, cloud-like substance. She wondered why the orb had changed like that – dense and round in physical space but lighter and less formed in a more ethereal atmosphere. As she was contemplating the changing nature of her new guide, she noticed suddenly that they seemed to be moving very fast; it was intoxicating. She had an urge to giggle and felt the distinct vibrations of actually laughing. Soon she noticed a shift in the environment and could see that they were skimming a vast body of water. She could even feel the briny spray coming up from what seemed to be a slowly roiling ocean. It was real water, real ocean. She was fascinated, but at the same time, puzzled by how they got there. Tossing these questions around, she heard a reply from her guide to her internal question. “We thought ourselves here,” she was informed. “In this reality, we are not limited by physical matter. See?” With that query, they were instantly skimming across a rippling field of golden grain, moving at incredible speed across the top of a wheat field. To Marlene, it was very real. She could smell the sweet, dusty aroma of wheat and hear the soft, shucking whispers as the heads of grain whipped and twisted against each other under the influence of their travel. Glancing behind her, she saw the turbulent depressions in the vast grain field in the wake that their movement seemed to create, and how the motion of the wheat slowed to a gentle wave as they moved on. Here, as Marlene shared her experience with me, I was instantly taken back

to my childhood when, staring across vast cotton fields on my grandfather’s Southern farm, we would see a sudden eddy on top of the crop on an otherwise windless day. I remember my grandfather saying, “Angels checking on my cotton, I reckon.” As a child, my imagination took off, thinking about spirits swooping down and moving through the soft, pillowy cotton plants. But now, hearing Marlene’s account, I found myself wondering if my family’s land was training ground for some newly deceased personality learning to manipulate their environment under the tutelage of a supportive guide. Marlene continued. Suddenly, she reported, they came to an instant stop with absolutely no sense of deceleration into a vast void that was incredibly silent. But even the silence seemed to have texture. After a brief pause of floating in this splendid quiet, the environment took on more density, with subtle shifts in color and hue. At this point, Marlene really struggled to explain this to me, saying that it was like a cloud, but not really – like a mist, but not exactly. She described the feeling of silk or soft fog settling around her while, at the same time, muted colors of blues, grays, and faint pinks and greens fluctuated in and out. With the color there was a faint sound that had a somewhat musical quality, but there were no specific tones that she could identify. It was more vibrational than anything, she recounted, much like the connection she had felt from the vase of flowers she had encountered in the hospital room where she had paused briefly on her ascent. Suddenly and without warning, Marlene felt overcome with emotion without really understanding why. Then her awareness shifted, as if of its own volition, and she looked up to see her deceased grandmother, mother and a favorite uncle moving toward her. Oddly, a man with a severe limp came forward next. At first she didn’t recognize him, but then remembered he had lived in the same neighborhood where she had lived as a newlywed. She was surprised to see him because she didn’t necessarily feel a particular connection with him. She recalled helping him occasionally when he needed a ride, some yard work or a few groceries. But that was her nature with anyone she encountered who was in need of assistance. Why he was there, she couldn’t imagine, but in a brief flicker of infiltrating thought, she understood that the help she had offered had meant so much to him when he was alive. The deep gratitude he had held for her actions all those years ago had caused him to show up in this moment. But her attention quickly returned to her dear loved ones.

Weeping as she embraced them, she was astonished at how real they seemed. She recalled her mother smiling as she gently wiped tears from her face, and the love in her eyes was overwhelming. Then her mother uttered three words that ripped the moment apart. “You can’t stay.” “What? But why?” Marlene exclaimed through choking sobs. Even in nonphysical space, she felt the crash of being at the top of unspeakable joy then plummeting into an abyss of despair. She began crying harder and, gasping for breath, pleaded, “But I have to stay. I have to! I want to be here with you. I don’t remember what I left behind.” “You will,” came the reply. From whom specifically, she could not say. “But why?” Marlene asked. “You were allowed to come here to learn, to perceive things differently and understand. You will be different when you return,” she was informed. It was then that a small female child was brought forward by two beings that she, as a Native American, perceived to be Elders. As she was shown the child, who was about four or five years old, she was told, “This one is special and she will need you.” Marlene couldn’t say why or how she knew, but she could sense there was a problem with this child. Physically, the child looked beautiful, but it was more the essence of a mental struggle she seemed destined for. She was told that the child would be named Crystal and would come to teach those near her about love and acceptance. The young girl seemed excited about the task. She was informed, again through a thought that seemed to be deposited in her mind, that this was a preordained task agreed upon by the young child and her guides. It was then that Marlene perceived herself beginning to move slowly backward as the gathering of loved ones and Elders faded away. Her loved ones waved to her and smiled gently, even as they receded further and further into the ether that surrounded them. Then, with incredible speed, she was hurled back into her body. She had survived the grueling mechanics of resuscitation from death, felt the wrenching pain of broken ribs from chest compressions and the limp exhaustion of having given birth. She lay there, feeling sad and helpless that she had been made to return. She could hear the hurried excitement of the medical team around her, but could not bring herself to respond. For the next few days she faded in and out of awareness. When she finally came to full consciousness, she saw her family

surrounding her. They were obviously very concerned and were overcome with tears when she was able to engage with what was going on around her. She appeared to have come through her ordeal relatively unscathed, and mentally intact. After a few days of assimilating her experience and gaining strength, she dared to share her story. While her family was fascinated and even felt encouraged to hope that loved ones live on, the response she received from her physician was lukewarm and dismissive. “The brain can do funny things when it doesn’t have oxygen,” her doctor remarked, insinuating that this vastly rich journey beyond the physical had all been a hallucination. That was the last she spoke of it to anyone outside of her family until years later when she was working with me as a staff nurse in an outlying clinic. A few of us had gathered in a break room over lunch, and when the discussion somehow drifted toward near-death anomalies, she entrusted us with her spectacular story. She also shared that, twenty-one years later, her daughter had a child. Her journey into the afterlife, long buried in the activities of daily living, came rushing back to her the moment she learned that her daughter was pregnant, knew from ultrasound it was a girl and her name would be Crystal. This was part of her near-death experience that she had deliberately not shared with anyone – not even her family. The sobering memory of being informed by those she had encountered during her journey that the child would likely have a disability of some kind was suddenly a possibility. She kept this information to herself, hoping that she was wrong, but as time would reveal, Crystal struggled with autism and a profound dysfunction of sensory integration. She was extremely sensitive to sound and other stimuli, and would go through years of occupational and physical therapy to learn to turn the volume down on her hyperactive response to sensory triggers in order to function relatively normally in a physical environment. It wasn’t easy. Crystal required a lot of work and attention but her ready smile, infectious humor and unqualified affection more than compensated for it. Her characteristic gesture when someone was angry or frustrated, especially with her, was to take their face between her hands, bring it close to hers, look into their eyes with extreme ease and calmly say, “Love, love!” No one could resist that, and they would collapse into a hug with this special child.

Marlene and Crystal had a particularly special connection, a bond that was instant and strong. They spent hours together and, living close by, Crystal often stayed the night with Marlene while her mother worked third shift at a local factory. Once when Crystal was about four years old, as Marlene was tucking her into bed for the evening, she looked peacefully up at her grandmother and, lost in a soft gaze that connected her to something far away, said, “I saw you before, Grammy, remember?” “What do you mean, Sweetheart?” Marlene did not immediately understand. “When you died before, and came to Heaven. I saw you there. Remember?” With a shiver of excitement, Marlene leaned in toward her granddaughter and replied softly through instant tears, “Yes, Crystal, I remember.” Marlene’s death and return to life so long ago was now a distant memory. It was something she rarely talked about, and certainly not with Crystal. There was no way that this child could have known what she seemed to know about what had happened over twenty years earlier. “You were sad that you had to go back in your body,” Crystal became pensive as tears poured down Marlene’s cheeks. “Are you still sad?” “No, Crystal, I’m not sad. I’m very happy to be here with you.” She gave her granddaughter a light kiss on the forehead and tousled her dark curls. With a giggle and a brilliant smile, Crystal leaned forward and, taking Marlene’s face in her two small hands, brought her close and said brightly, “Love, love!” Marlene thought back to the day she had shared her story with her physician and how, with one sentence, he had cast doubt on an experience that had been so vivid and life-changing – for her and now for Crystal. Under the weighty opinion of an authority figure, she had begun to second-guess what had happened to her when she had died. Was it even real? Bolstered now by Crystal’s inexplicable, spontaneous memory of a moment that they had apparently shared in that space-in-between, she found renewed affirmation that, despite what others may say, what she had experienced was real to her. Sharing this experience now with her granddaughter, and hearing details that would have been impossible for Crystal to know except if she had been there, Marlene understood that her reality was most important in relation to her own personal experience and not to the perspective of an outside observer who can neither confirm nor refute such a personal encounter. Whether or not it can be associated with physical metrics becomes unimportant in the face of the power

of these moments to inspire change and strengthen relationships, as it did with Marlene and Crystal. That often seems to be the mystery and the gift of a neardeath experience.

A word about near-death experiences and how we explain them. I recently read an article penned by a science writer stating definitively that near-death experiences were unquestionably caused by naturally occurring brain events. He based the claim on his exhaustive review of available research, as well as having read over twenty books about near-death experiences claiming to be visits to Heaven. He concluded that the evidence pointed overwhelmingly to a neurological event where consciousness is able to retain a sense of self and also perceive information outside of the physical body. Maybe he’s right, maybe he’s not; his certainty is perhaps a bit premature. But what really jumped out at me was that the writer acknowledged that the research revealed that consciousness could apparently retain a sense of self and perceive information outside of the unconscious, physical body. Perceiving one’s self from a vantage point above the body and being able to recount visual details with stunning accuracy is not trivial. Even if it is nothing but an aberrant brain event, it is rather astounding, and is not explained by what we currently understand about how our senses experience the world. What is perhaps more important, though, given the significance of these events to those who experience them, is that discounting them as exclusively neurological phenomena with no further meaning is blatantly disrespectful. It is like dismissing a person’s dream, insightful breakthrough, or creative thought as a mere neurological phenomenon, with the implication that they should make nothing more of it. On what authority can we tell a patient that a highly meaningful personal experience they have during a medical crisis when their body is clinically dead or near-death should be ignored or dismissed as an entirely physical phenomenon? I was once listening to a physician being interviewed on a radio show on the topic of medicine and spirit. During the question-and-answer segment of the broadcast, someone called in to share in considerable detail his near-death experience during a severe, life-threatening illness. After listening to the caller’s story, the physician said, “Well, it certainly sounds like you were very sick, and in

times of extreme illness, hallucinations are quite common. That is most likely what you experienced.” He had shut down the caller and denied the personal meaning of the caller’s story with flagrant disrespect cloaked in a veil of authority – and I was deeply troubled by what I’d heard. Should a physician (or anyone else) ever interpret or dismiss a patient’s personal experience? Based on our personal philosophy or professional training, would we be justified in calling someone out as delusional for praying, or weak and dependent when they look for love and support from another person at a time of crisis? Of course, a few might do that – or might think those things, even if they don’t say them. There are those who on principle dismiss personal subjective experience as unimportant and untrue, only taking into account what is physically visible, measurable and understood. But that is not a good approach for someone in a helping profession – one in which the fundamental work is about relieving suffering. You can’t prove or disprove that a person is in pain, nauseated or fatigued, and to deny that a person has a subjective symptom when (as is often the case) a physical cause for it cannot be identified is a violation of the trust patients place in us. We take patients at their word and set about offering relief of their discomfort. Likewise, with a subjective near-death experience, our job is to listen respectfully and respond in ways that do as little harm and as much good as possible. I don’t think at this point in human evolution we have the scientific theory, language, or methodology to untangle and understand consciousness phenomena. We simply don’t know what is happening when patients perceive themselves to be floating outside of their bodies and can then later relate details to us with astonishing accuracy. Maybe, though, one day we will, and the explanation of how it occurs will probably seem incredibly simple and logical. Perhaps conscious perception from outside our body travels a ribbon of energy particles that is still connected to our physical self – a phenomenon that could possibly be scientifically detected and verified. In times of crisis, maybe consciousness can protectively hold our perception at a distance in such a way that we can witness what is happening to our physical body safely and remotely – a function that may have some survival benefit and be part of the process of natural selection and evolution. At present, we simply don’t know. All we can do is observe the phenomena and try to understand them as best we can. We once thought of the earth as flat. It was by the power of the cumulative

observations of inquisitive scientists that we eventually made a shift and came to the understanding that our planet is round. It is a perspective that we now collectively embrace, and in retrospect we find it odd that we could have ever thought otherwise. This discovery is an elegant illustration of what human imagination does best – regard mystery with reverence while exploring possible explanations until the answer to the question, “How is this even possible?” becomes clear. That is why being able to say you don’t know how to explain a phenomenon is at the heart of being a scientist. To say, “It reminds me of something I’ve dismissed before, therefore I dismiss it,” is actually not scientific, but a dogmatic imposition of personal belief. The more valid, scientific and respectable thing to say would be, “I don’t know” – and keep searching for the answer. And we don’t know – yet. Perhaps, at some point in the future, we will have the capacity to understand and even reproduce these phenomena of consciousness and be able to explain them in a manner that will make perfect sense. Until that time, holding them in curious regard, rather than dismissing them as preposterous impossibilities, will better facilitate both an eventual understanding of these events and a supportive relationship with those who have them.

“The impossible could not have happened, therefore the impossible must be possible in spite of appearances.” – Agatha Christie

is a friend I had known for many years before he shared with me the F red impossible thing that had happened to him – an out-of-body experience during surgery. We had been to meetings and workshops together and over the years had shared some personal stories, but his experience never came up in conversation until I published an essay on the topic. In the article I related an account of a patient seeing his own surgery while under general anesthesia and mused about its cause and significance. Fred contacted me after he read it and told me the same thing had happened to him. Of course, I was fascinated by what he shared, but what really stood out for me was his physician’s response to his experience, and how, because of it, Fred didn’t feel confident in sharing what had happened to him for many years. In 1973, at age twenty, Fred was a university student and a member of the wrestling team. During an intramural competition that autumn, his opponent accidentally fell on his left knee, causing instant and searing pain. Fred tried to resume the competition after a timeout, but clearly something was wrong. He was unable to return to the mat and had to forfeit the match. Although he was sore for days afterward, with rest and elevation things improved somewhat. Being in the middle of a busy semester and feeling he could tolerate the remaining discomfort well enough, he did not seek immediate medical attention. However, his knee continued to give out on him, especially when negotiating stairs, so by late January, he thought it wise to finally seek medical help. Working through the student health center, he was referred to the

Department of Orthopedics at the university’s medical school. He was evaluated by the head of the program, Dr. Davis, as a team of residents looked on. The doctor diagnosed him with a badly torn ligament and recommended surgery to repair the injury. After discussing it with Fred, he decided the procedure could wait until spring break in order to minimize the impact on Fred’s busy academic schedule while allowing adequate time for healing. He had managed with the injury to this point, and a couple of months more with a splint for support would not impact the outcome. Fred was young and healthy, so when the time for surgery arrived, he breezed through the preoperative assessment. There were no particular concerns or hesitations on the part of the physicians involved in his care. Although Fred had never had surgery before or even been hospitalized, Dr. Davis’s manner reassured him. Fred was feeling confident that he was in good hands. He knew the surgeon had a reputation for being very capable and his bedside manner immediately put Fred at ease. The physician was personable and sincere, and came across as very caring. Dr. Davis spent unhurried time addressing his concerns and provided an explicit, technical overview of the procedure he planned to do that was easy to understand. Fred wasn’t worried. As during his initial evaluation in January, there were surgery residents present for the intake in March, but this time there were different ones. One stood out in particular in Fred’s memory because of his rectangular, silverrimmed glasses, ginger hair and the fact that he actively participated in asking Fred questions about his medical history and the incident that had resulted in the injury. He also took time to examine Fred’s knee and to review the radiographic images with particular interest, more so than the other residents present. It was never discussed how, if at all, the physicians in training would be involved in his care. Because of how the attending physician presented the information, Fred had assumed Dr. Davis would be the one performing the surgery, a fact that would later help validate certain details of his unusual experience while under anesthesia. When the day of surgery arrived in March of 1974, Fred was feeling confident and relaxed. He placed total trust in Dr. Davis, based solely on his interaction with him leading up to the procedure. After being wheeled into the operating suite, he was transferred to the narrow, elevated operating table and

instructed to just lie back and relax. Lying down on the flat surface, he patiently waited as the surgical team shifted him into position, elevated his injured knee into the proper position for repair and began the process of creating a sterile field. As they raised a sterile drape to sequester the surgical arena, Fred exchanged a few words with the anesthesiologist, who briefed him on what would happen as they put him to sleep for the surgery. He then placed a mask lightly over Fred’s mouth and nose and asked him to count backwards from one hundred as he inhaled the gases that would gently induce a state of unconsciousness for the procedure. Fred could vividly smell, but could not see, the antibacterial solution the surgeon was smearing on his knee to kill any germs that could potentially infect the surgical site. It was pungent and made him feel a little queasy. He felt the tiny circles of the sponge on his skin as they grew wider and wider and strangely, as he inhaled the anesthetic gases deeply, the sensation of the circular motions from the sponge on his knee made him feel dizzy. He was hyperaware of the movement, as if he was traveling along with the sponge as it sterilized his knee. The last thing Fred recalled was staring at the ceiling above him, breathing in and out, counting backwards and starting to feel drowsy. At some point he became lost in the numbers but vividly aware of everything else going on around him, yet it was somehow very different. He struggled briefly to figure it out when it occurred to him – it was the vantage point that had changed. Instead of lying flat on the operating table, with his head and torso separated from the sterile surgical field by a drape, his consciousness somehow seemed to be above his physical body. Not having a context for what he was experiencing, he assumed that he had been repositioned, the anesthetic had worn off, and now he was awake and aware of what was going on. Although he was looking down on his body, seeing the whole surgical scene laid out below him, he still did not conceive that anything particularly out of the ordinary was happening. He noticed how brown his knee looked from what he presumed to be the sterilizing solution he had smelled earlier as it peeked through a small hole in the sterile sheet that had been laid out across his abdomen and legs. It looked strange to see the small mound of his knee rising up through a sea of blue sterile draping, and he had the amusing thought that it looked like a desert island in a vast expanse of ocean.

He saw Dr. Davis on one side of the operating table and heard him talking to another surgeon across from him. Fred recognized the other doctor by the glasses he wore and his ginger eyebrows, visible above the rims, as one of the residents who had been present at the preoperative appointment. Because they were concealed in surgical garb, he knew them primarily by their voices and the parts of their faces he could see that weren’t covered by a mask and hat. He watched as the team sorted the instruments and listened as they talked through the surgical steps before beginning. Fred noticed right away that Dr. Davis was not the one holding the scalpel. At that moment, it registered with him that the physician in training would be the one performing the surgery under the attending physician’s direction. He knew this was a teaching institution, but this surprised him and he felt a little alarmed. He did not try to say anything, though, until the surgery resident took the scalpel and began to make the initial incision in his knee. What probably happened in only a brief moment seemed to play out in slow motion as he braced himself for the pain he was certain to feel. Fred tried to scream, but no sound came out of his mouth. He tried to yell “I’m still awake!” but no one seemed to hear him. When he saw the knife begin to sink into his knee, he was shocked that he felt nothing – nothing at all. Realizing this, his initial panic subsided as his fear turned into curiosity. It fascinated him. Why did he perceive himself talking, but they couldn’t hear him? Why could he see every detail of the surgery, as they splayed open his knee and repaired his tendon, but he could feel no pain? How was he able to hear wordfor-word every bit of the conversation as the lead physician supervised the surgery? How was it even possible that he seemed to be viewing the whole scene from above his body in vivid and stunning detail? Fred became so enrapt watching the surgical repair of his knee that the passage of time held no meaning. He was so engrossed in the wonder of how he was able to be fully aware of what was happening, despite visually appreciating that he was hooked up to the breathing machine by a tube in his mouth and his body seemed to be unconscious. Then he was suddenly awake in the recovery room with his surgery successfully completed. As the fog of anesthesia wore off, his unusual experience came back into vivid view in his mind’s eye. He knew it wasn’t a dream – it had been too real. He was intrigued. He was excited. He had to tell someone.

When Dr. Davis came around with his team later to see how he was doing and to inform him that the surgery went well, Fred was eager to share with him what had happened. Recalling how personable and receptive Dr. Davis had been in the preoperative office visits, Fred had no reservations about telling him what had happened during surgery, so he was surprised and promptly deflated by the response he received from the surgeon after sharing his experience. “That didn’t happen,” Dr. Davis replied crisply. “We were all there,” he gestured with a commanding sweep of his hand to his collection of residents, “and you were completely unresponsive under anesthesia for the entire time. What you experienced must have been a dream. You couldn’t possibly have seen the surgery.” He was adamant and completely discounted an experience that had been very real to Fred. Fred was confused. He lay there thinking about it for a while as the team continued to discuss his case and how postoperative care would proceed. He wondered if Dr. Davis was right and that perhaps he had been dreaming after all. But it had been so real and he had seen the surgery despite the fact that there was a sterile drape obscuring the actual procedure from his field of vision. Then he remembered a key piece of information. “Dr. Davis, you didn’t do the surgery. He did.” Fred pointed to the resident with the square, silver-rimmed glasses and ginger hair who had actually done the procedure. “How could I have known that if I hadn’t seen the surgery, which we both know should not have been possible with the drape blocking my view?” Fred entered boldly back into the arena after essentially being knocked down for the count. There was silence as they looked at each other. Finally, his jaw subtly clenching and unclenching, Dr. Davis spoke. “Lucky guess,” he smiled tightly, tilting his head stiffly forward, assuming the stance of claiming the final word. Gesturing to the resident, whom he referred to as Dr. Morrison, he confirmed that this young man had indeed performed the surgery. Perhaps feeling he needed to defend the lack of disclosure from the outset, Dr. Davis was quick to emphasize that Dr. Morrison had done an excellent job and that his knee would be fine. He also took a final opportunity to reiterate that he thought what Fred had experienced was impossible because he and his team, including the anesthesiologist, had observed him throughout the entire surgery and could attest that he was completely unconscious – out cold; end of story. But Fred knew what he had experienced and was convinced it was not a

dream. Although he did not understand it, the clarity with which he had heard and observed the surgery, coupled with the fact that he had witnessed someone other than Dr. Davis performing the procedure and that this was later confirmed, told him that what he had experienced was real. It was too real to have been a dream. Reluctant to discuss it further, however, he filed it away for fear of being considered crazy. Fred told me that even in a follow-up appointment, while Dr. Davis remained very professional and personable, when Fred tried to broach the subject once more, the doctor was no closer to an open mind about the unusual experience. What stood out to Fred was how, despite his very clear and accurate account of details that he couldn’t have possibly known except to witness them directly, Dr. Davis remained not only unconvinced, he had seemed annoyed and somewhat defensive. He placed his own belief stamp firmly on Fred’s experience: “That didn’t happen.” It’s not often that I have the opportunity to discuss the fallout of someone’s unusual experience so long after the initial event, but with Fred, I did, and I am so grateful for the insight our exchange offered. It has helped to shape how I interact with patients. Fred told me he felt not only shut down but also disrespected. He even experienced feelings of isolation and depression. What had happened to him? Had it ever happened to anyone else? He needed to know. Only years later would he learn that other patients have experienced similar phenomena, but at the time, except for the ability to voice what had happened to him to his wife, he felt quite lonely in his experience. Furthermore, when he was told by an authority figure that his subjective experience did not happen, it was not unlike being told he was making it up and making a big deal out of a lucky guess. I wonder what would have happened if Dr. Davis, instead of telling Fred his subjective experience didn’t happen, had left the door open to explore the possibility of what seemed to be, by our current understanding of physics, impossible. Clearly, Fred had experienced something, but the physician’s response left no room for any type of connection between them to foster exploration of what had occurred – dream, imagination, or otherwise. I told Fred I thought it was actually quite brave of him to dive back in and point out the fact that he had witnessed someone other than Dr. Davis doing the surgery.

And I had to wonder, what if the doctor had said, “That’s certainly an unusual experience” or even “Hmm…interesting” and left it at that? That is still not very invitational, but neither is it dismissive.

Occasionally, a patient will experience a side effect I’ve not heard of from a medication I have prescribed or an intervention I’ve recommended. Rather than tell them it’s not possible simply because I’ve not heard of it, I tell them it is not a reaction I am familiar with, but clearly it is something that happened to them. If it catches their attention as something out of the ordinary, I feel I at least owe them the courtesy of considering it even if I have no ready explanation. I have no other respectful option but to take them seriously. “Let me look into it, and I’ll get back to you,” I often say. I’ve had patients tell me they appreciate that I’m willing to consider the possibility of their unique experience, and acknowledge that while I may not be aware of a particular side effect or reaction, I believe their experience was real to them. Too often, medical professionals tell patients “that’s impossible” or “what you experienced doesn’t happen.” I wish I could say that I’m exaggerating but, unfortunately, based on my own observations of many of my peers interacting with patients, I am not. I once had to take an antibiotic four times a day for ten days to treat an abscessed tooth. Within thirty minutes of taking the medication, I would become profoundly tired and weak. This would last about an hour or so, then gradually subside. It was not a side effect I had encountered before, even though I had prescribed the medication myself for nearly twenty years. I had never had a patient complain to me of similar symptoms while on the medication, but I was clearly experiencing them and the pattern remained predictable and significant throughout the entire course of the medication. Using the professional medical websites I have access to, I did an exhaustive research of the medication and its side-effect profile. I found that this transient reaction of extreme fatigue and weakness within half an hour of taking the pill had never been documented or reported in mainstream journals or data banks. But there was no question that my experience was real to me. By the timing of each dose response, and the cessation of this cycling fatigue and actual physical weakness when my treatment was complete, it was clear to me that my

symptoms were associated with the medication I was taking. My curiosity was intense, so I went beyond the professional sites and did a general search across the Internet. Finally, after several attempts I happened upon an obscure reference by a European physician some nine years earlier who reported the same symptoms from a patient in response to the very antibiotic I had taken. Only one (two, counting me) out of hundreds of thousands who likely receive this antibiotic routinely each year had experienced this odd effect. To my dentist’s credit, when I told him about my experience his response was more welcoming than Dr. Davis’ remark. “Wow, that’s pretty crazy!” I recall him saying. “I’ve never heard of that, but thanks for telling me. If another patient ever experiences that, I’ll look a little smarter,” he joked. It was, in my opinion, the perfect response. It struck me that my reaction to the antibiotic, and the extreme rarity of my response, was not so dissimilar to scattered case reports of near-death and outof-body experiences seemingly triggered by a physical event. The phenomenon is not on most physicians’ radars, so when they do encounter such reports they either don’t recognize them because they are so unfamiliar or they dismiss them for the same reasons. I realize, of course, that the perfect response to anything not well understood almost never happens. But maintaining an open and curious mind to experiences that don’t fit neatly into a familiar frame of reference, instead of shutting them down, seems like a generous approach to the unfamiliar. Acknowledging the authenticity of someone else’s personal experience certainly doesn’t compromise the listener’s own belief system. Besides, as Agatha Christie so astutely observed, however strange or impossible a phenomenon may seem, it must in some way be possible – despite appearances to the contrary.

“Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?” – J. K. Rowling

every patient spontaneously mentions to a healthcare provider an N otunusual experience they have during an altered state of consciousness, natural or induced, as Fred did with Dr. Davis. In fact, very few do. But sometimes when they are asked directly, they will have an astounding experience to share. I didn’t always know how to approach patients about whether or not they’d had a near-death or out-of-body experience during severe illness, trauma or documented clinical death, but I really wanted to know. More importantly, I wanted them to know that it was safe to share with me anything they had experienced without fear that I would think it strange or be dismissive. Certainly not in the way Fred and Marlene had experienced. Intensely curious, but not wanting to be pushy, I gave some deep thought to how I might ask patients if they’d had anomalous consciousness experiences during extreme stress events. Eventually I settled upon a simple question – the unusual question. Did anything unusual happen when you experienced cardiac death? Did anything unusual happen when your heart stopped? Did anything unusual happen during your accident or surgery? It seemed a straightforward enough inquiry that if nothing out of the ordinary had occurred, it wouldn’t necessarily register as odd or intrusive. I felt that asking “Did anything unusual happen that you would like to talk about?” encompassed both the inquiry and the invitation, and that both elements were important. My hope was that if something strange had happened, the question would register with them as a safe invitation to share whatever they had

experienced without fear of judgment or worse, being considered a nut job. The first time I had the courage to inquire, it was to a lady in the ICU named Cora who’d had a cardiac arrest and survived a prolonged resuscitation. Thinking she was as likely as anyone to have had a near-death experience, I posed the question. “Did anything unusual happen when you had your cardiac arrest that you would like to talk about?” Without hesitation she raised her eyebrows and with wide-open eyes and a twisted mouth, erupted with some frustration. Letting her fist fall heavily on the bed, she said, “No, and I was so disappointed!” I couldn’t help but chuckle at her animated response, and she laughed too. As it turned out, Cora was an avid reader about near-death experiences and other such phenomena. After learning she had recovered not only from a cardiac arrest but that she had actually experienced documented, clinical death, she was truly disappointed that she had not had a personal near-death experience. She had met the criteria – no spontaneous respirations or heartbeat of her own without the aid of CPR (cardiopulmonary resuscitation) for nearly half an hour – and nothing unusual had occurred that she could recall. Here was a perfect physiologic setup for her to have her own peek into that mysterious space beyond death, and it hadn’t happened. Cora’s experience – or lack thereof – ran counter to the presumption of critics who maintain that such things happen when people believe they will. True, belief may predispose you to an experience, but that isn’t always a necessary part of it – quite the contrary. Most people I’ve encountered who have had near-death or out-of-body experiences had no particular frontloading belief system that would set them up for what they experienced. In fact, one patient who shared his near-death encounter with me was an atheist, believed nothing existed beyond the physical, and had his worldview turned upside down by what had happened to him. So, not having the classic near-death experience within the context of her belief construct, of course Cora was disappointed. But we went on to have a very rich discussion, and she arrived at a conclusion that sat well with her. Perhaps because she had no doubts about the soul surviving beyond the physical, she didn’t need a transformative near-death experience – an experience that often flips a person’s conception about life and death on its head and leads

them to reconsider the possibilities. The second time I tentatively floated the unusual question, it was to Diane, a lady who had again been admitted to our ICU after a prolonged resuscitation from sudden cardiac death due to a massive heart attack. Her heart catheterization revealed severe coronary artery disease, and she proceeded quickly to open-heart surgery for bypass of the multiple occluded vessels. Her post-operative course was tenuous and prolonged. When she had recovered enough to be able to converse and I asked her the unusual question, it quickly became clear to me that she didn’t need the near-death experience as much as she needed me to ask her about it. When I asked the question, I was surprised to see her face crumple briefly before she burst into tears, sobbing uncontrollably. I offered her my hand, which she grasped tightly, and waited as her weeping slowly receded. With my free hand I reached behind me for the box of tissues, which I have learned from my psychologist husband is a universal symbol for “I care, I’m listening, tell me more.” Releasing my hand, she took a tissue that, after wiping her eyes, she proceeded to twist and knead until she could find her voice. Uncertain why she was crying, my fear was that I had upset her in some way by asking the question. All I could do was wait for her to speak. When she was finally able to talk, she shared an incredibly beautiful neardeath experience. Before that, though, she prefaced it by saying, “I’m so glad you asked, because my family won’t believe me. Something incredible did happen to me and I know my family will not accept it well.” I tried to reassure her by saying, “Diane, I will believe whatever you want to tell me happened to you. It is your story to tell and it is not my place to judge if it did or did not happen – or what it even means. But I will tell you that I have talked with other patients who have had near-death experiences and nothing you can say will shock or surprise me.” With that invitation she began to talk. About ten years earlier, she’d had a severe head injury during an automobile accident, and at the scene, during her prolonged extrication from the car, something very unusual had happened. When she shared what had happened to her with her care team at the time, she was told that the records indicated she was totally unconscious at the scene and not breathing. She had to have a tube inserted into her trachea before being transported by helicopter to the hospital. The rescue workers had to deliver the life-sustaining breaths to her that she

could not take on her own, because her head injury had temporarily wiped out her innate drive to breathe. Her own experience at the accident scene, however, had been of standing off to the side of the mangled car, watching the rescue workers struggle to get the tube into her throat due to the hunched-over position she was in. She heard frustrated expletives from the two-person rescue team trying to help her, and one worker specifically pleading, “Come on, lady, don’t you die on us.” As she watched the slow and complex exercise of the rescue team removing her body from the twisted metal that was once her vehicle, she lost focus and was suddenly aware of two large, amorphous luminous beings approaching her. Her recollection was that they were very tall, perhaps seven or eight feet, and intensely bright. The overwhelming feeling of love, peace and complete familiarity they exuded still moved her to tears as she was telling me the story in her hospital room a decade later. They assured her, through thought more than words, that she wasn’t going to die and that she would be okay. Nothing more. The next thing she recalled was waking up, the breathing tube being removed from her throat and the beginning of a long road to full recovery. But something was different. It didn’t take her long to make the very unusual observation that she “knew things” in a way she didn’t before her accident. She knew what a nurse was going to say before it was said, that a janitor would enter her room moments before doing so or a favorite family member was flying in from out of town to visit her before she was told. “Aunt Judy is coming to visit me today,” she had said, as her family looked at her in shock. It was supposed to be a surprise. A secret. How did she know? “No one told me,” she replied. “I just know. I don’t know how I know, I just do.” Incredibly, she had even foretold her own follow-up testing. “What time am I getting the MRI of my head today?” she had asked a nurse who had replied that there were no studies ordered for that day. The nurse came back into her room a few moments later in a state of disbelief, and said that Diane’s doctor had just placed an order for an MRI of her head. It would have to take place later that evening since she had already eaten lunch, and at least six hours after a meal were required before they would do the scan. “But I didn’t eat my lunch,” Diane replied, “because I knew I was having an MRI today and they don’t want me to eat until after the test is done.” The nurse,

disbelieving, glanced at the untouched food tray at her bedside. “How did you know?” the nurse inquired. “Did the doctor come by and tell you? “No,” came Diane’s reply. “No one told me. I just knew.” Pausing to marvel at the phenomenon, she continued, “I can’t explain it, but I just had the overwhelming thought come into my mind when they brought my lunch tray that I shouldn’t eat it because I was having an MRI soon.” They were able to move her test up by several hours, simply because Diane had somehow known the test would be done – and had not eaten. As time progressed her intuitive abilities continued, but her family didn’t like this at all. It bumped uncomfortably against their well-constructed, conservative belief system of what is possible and what is not. The fact that she had awakened from her head injury with what some would call psychic abilities left her family extremely unsettled. Not understanding it, they feared it. They told her to stop it and emphasized a need to protect herself, hinting at a potential sinister origin. But the suggestion that this new intuitive ability was malevolent made her angry, because it didn’t feel that way to her. The gift of knowing continued, but it was a part of her that she could not reveal to her family, and their insistence that she shut it down created a rift in her relationships. While her abilities didn’t stop, her sharing them did, resulting in her feeling lonely and alienated. Not being able to talk about what was going on inside of her, she became withdrawn and depressed. Feeling their mission to silence her claims of heightened intuition was accomplished, Diane’s family moved on, but she did not. She felt that ever since her abilities had emerged after her head injury, she had become more separated from those around her. Sometimes, she would have an overwhelming intuition and try to warn someone. Then when the event would happen, they would become angry with her as if she had caused it. Such was the disbelief, fear, and intense suspicion surrounding this ability she hadn’t asked for and didn’t necessarily enjoy having. She felt misunderstood and devalued. Remarkably, with her intuitive abilities present since her head injury so long ago, she knew something was going to happen to her before she had her heart attack. She didn’t initially know exactly what would happen, but about two weeks before it did, she began to have vivid dreams of lying in a hospital bed. In her dream she kept falling out of the bed into a dark abyss, and she would

awaken panicked, in a cold sweat, with her heart beating fast. Sometimes in her dream, as she was falling through the bed into darkness, a large, loving hand would reach down, break her fall and then, cradling her in very large arms, would gently lay her back in the bed, assuring her she was safe and would be okay. Two days before her heart attack, she experienced an intense sense of knowing that she would have one soon. So she waited, and tried to be ready. It happened in the chilly, predawn hours of a dark February morning. She was awakened by a brief but intense, transient pain in the center of her chest. Because it had come and gone so quickly, she began to wonder if this was nothing or even if she had dreamed it, since the sensation had awakened her from a deep sleep. She lay there quietly, with an uneasy feeling that the other shoe was about to fall, when the pain seized her again like a vise, and she couldn’t breathe. The last thing she recalled was waking her husband, but she was unable to utter a word to tell him that something was wrong. Just as it had been ten years earlier, her next awareness was that she was suddenly standing beside her bed, watching emergency workers doing chest compressions on her body that was now lying on the floor – the place where they had apparently moved her when they arrived. She saw them placing pads on her with cables attached to a machine. She watched as they paused to look at her heart rhythm on a monitor, and then saw her body jolt as they pushed a button that sent a shock through her heart. Still, she remained standing there, watching from a place outside of her body. During her car accident she had been able to hear the conversations around her; strangely, this time everything was intensely silent as she looked on. She couldn’t hear anything, but she saw it all very clearly. Suddenly she was aware, as before, that she was not alone. There was a single bright presence standing with her and, once more, it communicated that she would not die; it was not her time. Several times throughout her instability – from the ER to the cardiac catheterization lab, to the operating room and in the ICU – she floated in and out of her body to observe what was happening. Each time she was accompanied by one or two of these bright, loving beings. They assured her that she would be fine and would survive this ordeal. The feelings of love, peace and reassurance she felt were immense, and as Diane put it, she felt as if she was in the presence of something sacred, holy, and very familiar to her.

Now she was here telling me about it – able to relate openly her near-death events and residual intuitive abilities – around which her family relationships had deteriorated over the past decade. I found it heartbreaking, knowing how meaningful these experiences were to Diane. There had been no room within the framework of her family’s conservatism to respect her experience. It seemed to be a threat to their beliefs. I wondered what the outcome would have been for Diane if her family had been able to focus on her and not the thing. Focusing on the thing – the events that made them uncomfortable – instead of embracing her with love and acceptance, left her feeling devastated and alone. So Diane needed the question. She needed me to honor her experience for what it was, whatever it was, and her for having it. She needed someone to provide her an opportunity to process it. The purpose of the unusual question had been served.

Telling someone that you believe them is a generous act of grace. At its best, it is empowering; at the very least, it is respectful. Do you have to personally believe in what has happened to someone in order to bear supportive witness to their experience and acknowledge that it is real for them? I don’t think so. In fact, you don’t actually have to evaluate it or have a personal opinion about it at all. But to discount someone’s experience just because you can’t grasp it is not unlike saying, “You are not in pain. I can’t possibly fathom how you would be. I have run extensive tests and can’t find a reason for your pain, so I don’t believe you have any.” Caregivers wouldn’t tell a person they didn’t have pain (or rather, we shouldn’t) any more than you would tell someone they didn’t dream a dream just because you couldn’t see them dreaming it. Unfortunately, we shut people down every day in ways both obvious and subtle, and often we’re not even aware of it. My husband shares an account of a patient with heart failure he was counseling when he was working as a clinical health psychologist in a Chicago medical center. To support her in dealing with her anxiety, he accompanied the patient to the cardiac lab for the placement of a specialized catheter to measure pressures inside the heart. It was floated through a large vein under her clavicle into the right side of her heart in order to reach her pulmonary artery. The area of insertion had been liberally numbed with lidocaine, and she didn’t flinch at all

when the needle pierced her skin and the catheter was introduced. There was no apparent discomfort. The local anesthetic seemed to be working. It was when the catheter with a tiny balloon on the tip was being threaded through her vein into the right side of her heart that her face clenched and she suddenly said, “Ouch, that hurts,” to which the doctor responded abruptly and unsympathetically, “That’s not possible.” Stunned, the patient became instantly stone-faced, withdrawing into the uncomfortable event that she was now experiencing alone. A physician, an intimidating authority figure just inches from her face, had emphatically shut her down. When a person shares a symptom or an experience and they are told by a person of authority – medical, religious or otherwise – that they aren’t believed, what they hear is: “I deny you. I deny you your right to say what you experienced and I refuse to believe that it happened.” On the flip side, to say, “I believe you experienced something,” when someone reports something out of the ordinary, is affirming to that person, whether you personally understand what happened to them or not. It is not sacrificing your own point of view to support someone in their belief that something outside of ordinary experience occurred. Initially, when I began asking the unusual question, I distinctly recall feeling a heightened sense of restraint. Perhaps I shouldn’t ask the question. Maybe patients would take offense at my intrusion or find the inquiry somehow weird or off-putting. Would I lose credibility? Was it even any of my business? I certainly did not want to undermine their trust in me as a capable physician caring for them in their extreme state of need. I also had some reservations about asking, because it might risk my professional reputation. Fundamentally, though, I felt reasonably confident that I was far enough along in my career, with enough professional credibility, that my peers wouldn’t consider me a flake. It didn’t take me long to realize that the question is actually quite welcomed, and, as Diane showed me, often sorely needed for healing the whole person, not just the body. So to ask the question is actually a gift. It is an entry point into honoring a person’s experience, however unusual that experience may seem. Also, the unusual question is often a comfortable entry into a conversation that can help patients understand how whatever happened can inform their lives, their choices and the way they move forward from their pivotal event. In some professions the unusual question seems to be implied. When I began

to broach the subject of near-death experiences with my friends at the hospital who are chaplains and counselors, they responded, “Of course, we hear about these experiences quite frequently.” One chaplain even shared with me that a former colleague, now working in another city, had been a businessman and became a hospital chaplain after having a dramatic near-death experience during a life-threatening illness. Another chaplain contacted me to say there was a patient who had shared a near-death experience with him, and upon mentioning to the patient that there was a physician who was interested in these phenomena, the patient wanted to talk to me. I no longer have reservations about asking if anything unusual happened during a time of imminent death, severe illness or trauma. I have also found that patients respect and respond to the inquiry and don’t find it disappointing at all when I say, “I don’t know what it was exactly that happened to you, but I believe you when you say you experienced it and that it was real to you.” More and more, though, it seems that people spontaneously share their experiences with me without the question. Is it possible that I’ve asked, “Did anything unusual happen?” long enough that I now carry the intention of the inquiry as an unspoken invitation? I like to think that within the space of intention the question has created over time, patients somehow know they can tell me their experiences without being judged or considered crazy. Perhaps on some level they perceive an unspoken invitation to share their stories and know I will believe that what they experienced is real to them. I love the quote from Albus Dumbledore in J.K. Rowling’s Harry Potter and the Deathly Hallows when Harry asks, “Is this real or happening in my head?” to which Dumbledore exclaims, “Well, of course it is all happening inside your head, Harry, but why on earth should that mean that it isn’t real?” Asking the question is affirming the personal reality of someone’s unusual experience if they choose to share it. Still, even when I ask, what I encounter more frequently is that patients are reluctant to open up. In a culture where unusual personal experiences are often dismissed, most people are uncomfortable coming forward. They are afraid that what they experienced, something that seemed so profound to them, may simply be an illusion conjured from their illness and not be real. Or even if they think it is real, they may be concerned that if they tell their story, they will be doubted and dismissed.

That is why I think being the one to take that first step – to ask the unusual question – has been the best way to open the door for patients to share what has happened to them. It creates more safety in my relationship with patients. What if relationships with all physicians, like relationships with chaplains and counselors, are assumed by patients to be safe? The unusual question promises to do more than satisfy curiosity. If widely adopted – and if the question’s premises of openness and acceptance are present in all patient-physician interactions – patients could assume that sharing any experience with their physician would be safe and supported, whatever they might report happening to them.

“I believe death is only a door. One closes, and another opens.” – David Mitchell, Cloud Atlas

began to wonder if the unusual question was starting to automatically I first extend a silent invitation when I met Henry. He was admitted to me through the emergency department after he was brought to the hospital by ambulance in respiratory arrest from his severe emphysema. His son, Patrick, whom he had called earlier to say he was having trouble breathing, found him unresponsive in his home. Patrick had told his dad he was coming right over to take him to the doctor, and to just sit down and try to relax. He lived twenty minutes away. By the time his son arrived and let himself in, Henry was slumped over in the chair. The cordless phone was resting on his lap along with his inhaler. Rushing to his side, Patrick found his father unresponsive. He shook his dad and called out, but there was no answer. He dialed 911 right away. Trying to keep his panic under control, he answered their questions and did everything they told him. “Is he breathing?” He was not. “Does he have a pulse at the side of his neck right beside his windpipe?” It was faint and very slow. “How slow? Count it out over fifteen seconds and tell me.” Only twenty or so beats a minute. “Do you know how to do CPR?” He thought so. Pulling his dad to the floor, he did as the dispatcher asked. He began CPR by pumping up and down on his chest to help the heart deliver blood to vital organs – twenty beats per minute is too slow – and then mouth-to-mouth breaths since Henry wasn’t breathing at all. According to the records, it was only six minutes from the time that Patrick called 911 until their arrival at Henry’s

home, but he would later report that it seemed eternal. I’m sure it did. The paramedics arrived on the scene and took over. They placed a breathing tube in Henry’s throat and began the artificial breaths given by a special squeeze-bag device that took air from the atmosphere and delivered it to his lungs while a one-way valve allowed the carbon dioxide to escape to the environment. With appropriate oxygen delivery, his pulse picked up and his dusky gray color began to improve. Slipping a backboard underneath him and strapping him down, they hoisted him up and carried him to the ambulance for transport to the nearest hospital. Although his color was improving and he now had a better pulse, he was still unresponsive and Patrick could only look on helplessly as his father was carried away. I had admitted Henry to the ICU from the emergency department, and over the course of a couple of days I was able to wean him off the ventilator so that he could breathe on his own. As soon as we removed the tube from his throat, he looked at me and, like an excited kid, spontaneously announced, “I saw my brother!” Being in a very literal state of mind at that moment, I looked behind me thinking perhaps his brother had walked by the sliding glass doors of his room, looking for Henry. The patient was quick to interpret my actions and said, “No, you don’t understand. I saw my brother when I died.” Quickly recalibrating, I understood the context and was all in. “Tell me,” I offered. “My brother died six years ago,” he continued, “and I have missed him terribly. We were very close.” He went on to tell me how his older brother Dennis, eight years his senior and someone he always looked up to, had only had his diagnosis of widely metastatic pancreatic cancer for a few short weeks before passing away. It was a swift and uncomfortable process, leaving his family stunned and grieving for their previously healthy and very vital loved one. Dennis had been the rock of the family, according to Henry. He was always the one to offer an encouraging word or make light of a tense situation with his robust sense of humor. With Dennis gone they had all felt as if a bit of soul had leaked from the family. Henry felt it most of all. “Hardly a day goes by that I don’t think of him,” he managed to choke out through tears. Then he composed himself in the silence I offered him before he

continued. “I remember having a hard time breathing,” he said, taking us back to the day of his respiratory arrest. “I had been having some trouble for a couple of days, but I knew I had an appointment with my doctor coming up so I tried to hold on. The day I went down, though, I knew I was in trouble, so I called my son Patrick. I remember talking to him and him telling me, ‘If you can just get to the chair and sit down, Dad, I’ll be right there.’ That’s the last thing I remember until I saw Dennis.” Henry went on to say that right before he saw Dennis, he felt light and had a sensation of floating. It was very dark, but a soft, comfortable darkness – so silent and still. From a distance he could hear someone saying, “Dad, Dad, wake up” in a frantic voice, as if someone was trying to get him to respond. At the same time, a faint, yellow smudge of light had caught his attention and distracted him. Mesmerized, he watched the light grow larger as it continued to emerge from the darkness surrounding him, and he heard his name being repeated. The light looked fuzzy at first, but the more he focused on it, the clearer and closer it became. It was then that he could hear a voice calling him by his name, and that, too, was growing clearer and more familiar. “Suddenly I was looking at my brother,” Henry said excitedly. “He was standing right there in front of me, and he looked fantastic: healthy and strong like he used to. I was so happy to see him that I just ran to him and hugged him. He seemed so real, like this bed here,” Henry said, tapping the bed rail beside him with the back of his hand. “I could actually feel him! I held onto him and didn’t want to let go,” he went on with tears streaming down his face, “and he hugged me back. It was so good to see him and know he was okay. He seemed totally okay – perfectly healthy just like he used to be.” Henry couldn’t recall how long they stood there together, but at some point, Dennis pulled him gently away and stepped back, with both hands on his arms, just looking at him and smiling. “He had such a nice look in his eyes. A very kind look,” Henry recalled. “He was always, you know, very kind. Everybody thought so. He looked at me as he always did, smiled and told me we would see each other again but not right now. I had to go back because we both had our work to do before we would be together again. I didn’t know what he meant by that.

“I’ll be honest with you,” Henry confided, “I wasn’t too happy about it – coming back, that is, to this.” His hand made a sweeping gesture from the top of his head toward his legs. “My health hasn’t been that good and every day is a struggle, so when I thought I had died, I was actually relieved. When I heard I had to go back, I was very disappointed and pretty upset, actually. I wasn’t having any of the trouble breathing there that I have been having here, and I wanted to stay with Dennis. I’ve missed him so much and I didn’t want to leave him. But, he said I had to go back, so I knew that was that. “I always did do what Dennis told me,” Henry laughed, and then was silent for a long time. “Anyway,” he said, taking a deep breath and trying to cheer up, “here I am.” He shrugged, with his hands splayed out on either side of him. “I’m definitely not afraid to die now,” he continued, “and I’m fairly certain that whatever waits for me on the other side is pretty good, because Dennis looked so great and happy. I guess I just need to figure out why I had to come back.” Then he chuckled, “It’ll give me something to do, right?” When it seemed he had nothing more to say, I confirmed what a beautiful experience that was and thanked him for sharing it with me. Moving closer toward the bed, I gestured for him to lean forward as I pulled my stethoscope out of my coat pocket and placed the earpieces in my ears, preparing to examine him. “I know what happens next,” he said. Thinking he meant he knew what would happen when he died, I offered, “You’re going to see your brother.” “No,” he corrected and grinned, pointing to my stethoscope, “You want me to take a deep breath!” We both laughed at that. It was the perfect comic relief to his very emotional recounting of his encounter with his deceased brother. But it also seemed to signal that he was finished talking about his experience for the moment and ready to move on, so we did. I continue to be amazed at what patients take away from these mysterious encounters. For some it is a reckoning of how they have lived their lives to that point compared to what they think they should have done, and an opportunity to move forward from the event with lasting behavior change. For others it is a life-affirming moment to realize that after death they may be reunited with those they loved.

I am still awed when I don’t even have to ask the question. Some patients emerge from their near-death experience and simply have to tell about it, without restraint – much as Henry did, and as Fred did after his surgery. It cannot be contained. Something happened that was incredibly vivid, profound and life changing. They have to tell someone, because it just will not stay inside them.

Naomi had come to the hospital by ambulance in full-blown cardiac arrest from a heart attack. She had awakened in the middle of the night with crushing chest pain and shortness of breath. Her panicked husband had called 911. When the emergency service arrived, they recognized she was having a heart attack and called ahead to the hospital for the cardiac catheterization team to be mobilized. They would meet her in the heart catheterization lab so they could open up whatever occluded vessel had cut off valuable blood supply to her heart muscle. They would have trouble getting her there, however, because no sooner had she arrived in the emergency department than she went into full-blown cardiac arrest once again. She required aggressive resuscitation (including CPR), needed to be placed on a ventilator and her unstable heart rhythm had to be shocked several times. It took a while for her to stabilize enough to be wheeled to the catheterization suite one floor above. Several shocks later, and after nearly twenty minutes of continuous CPR, there appeared a window of opportunity where things were relatively stable. While she seemed to be holding her own, she was whisked away. With several medication drips now hanging from her IV pole to try and quell the electrical storm threatening her heart rhythm, while bolstering the pump function of the heart, the team held their breath, hoping that she could keep it together long enough for them to open up the blocked coronary artery. Not long after she arrived in the cardiac special procedures lab, though, she decompensated into cardiac arrest again. With her heart muscle having been terribly insulted by the lack of blood flow, it wasn’t pumping well at all. As a result, fluid backed up in her lungs, and it rapidly became difficult for the ventilator to get enough oxygen across her soggy lung tissue. Her oxygen levels began to drop. Reacting quickly, the respiratory therapist removed her from the vent and started delivering breaths

with a hand-held ventilation device, but it was a challenge. The fluid from her flooded lungs kept backing up into the tubing. He would have to pause to suction it out as best he could before continuing the manual ventilation. Alternating between chest compressions, helping her breathe and getting the life-saving catheterization procedure going, eventually the cardiologist was able to identify and open up the offending occlusion that was responsible for the assault. Still, the heart had been stunned into suboptimal function and required a pump-assist device. The machine, called a balloon pump, was a special device inserted through an artery in her leg near the groin area that was threaded up to the aorta in her chest, the main large vessel arcing up off of and then descending from the heart. It inflated and deflated in synchrony with her weakened heart muscle to help carry the oxygen-rich blood to the rest of her body, where it could supply her starving vital organs. These organs, the kidneys being the most vulnerable among them, were no doubt protesting their starvation and threatening severe dysfunction, or death, if their needs were not immediately met. I was on call that night, and the cardiologist paged me around 1:00 in the morning to come in and assist with Naomi’s care in the ICU. He had another heart patient who was being flown in right on her heels, so he was not immediately available and needed my help. When I arrived some minutes later, her situation seemed dire. She appeared very pale, and there was no urine at all in the bag connected to the tube entering her bladder. Glancing at the heart monitor above her bed, I saw irregular, ominous-looking beats flicking in and out of her baseline heart rhythm, which didn’t look too healthy to begin with. She needed more medication to stabilize her heart and blood pressure, and for that she had to have better access than the single arterial line in her leg, which remained from her recent procedure, or the IVs in her arm. Some of the medications she required to keep her blood pressure up are caustic to the small, peripheral veins in the arm, which was where her two IVs were. So I needed to place a special device called a central line into her chest – a long catheter, passed under the clavicle, into a large vein going directly into the right side of the heart. Placing a central line is a sterile procedure, so I was completely gowned, gloved and hatted, prepped as one would be for surgery – sterile field and all. The central line is essentially a very long IV, about twenty centimeters in length.

Although she was unresponsive from her cardiac arrest, I numbed the area anyway just to be sure she would have no pain. I injected a generous dose of lidocaine all around the sterile area of skin where I intended to place the catheter, especially up against the sensitive clavicle, otherwise known as the collarbone. I then inserted a needle underneath the collarbone and carefully advanced it at a nearly flat angle toward the sternum (breastbone), while retracting the syringe’s plunger. I was hoping to hit the vein without collapsing the lung, which is uncommon but can happen. If you place enough central lines, you will eventually collapse a lung when a patient’s anatomy doesn’t line up neatly with what you expect it to be. I felt relief as I always do when, under the vacuum of the retracted syringe, I felt the soft pop and saw dark venous blood come shooting back into the syringe. Bright red and you’ve hit the artery, air and you’ve hit the lung – neither of which you want to happen. It’s the vein you want to access. Cardiac arrest is rarely convenient and the heart, not in the least concerned with whatever you’re about, will act out whenever it feels like it. It doesn’t ask permission, and you can’t say, “I’m in the middle of a sterile procedure, so if you could hold off a minute I would really appreciate it.” So of course, that’s what happened. Naomi’s heart, not caring one whit that I was trying to place a sterile line to help her, began acting up. The ominous extra beats that had been threatening to break through like nasty weather suddenly unleashed themselves in a full-on storm of ventricular tachycardia, and her blood pressure disappeared. We had to start chest compressions, we had to shock her, and we had to finish placing her central line – all at the same time. We couldn’t continue to run the medications through her tiny peripheral IVs at the rates Naomi’s flailing hemodynamic system required. Thinking quickly, I had one person lift up the edge of the drape opposite me and stand on a stool to hold it vertically to the sterile field I had established. From the other side of the bed, a nurse began CPR under the drape, and the respiratory therapist disconnected the vent and connected a hand-operated bellow to better control the delivery of life-saving breaths. Feeling I had little choice, I continued placing the line while navigating around the movement of the chest from the CPR. I had already established,

with no small measure of relief, that I was in the vein, so I kept going, threading a flexible wire through the hollow needle to hold my place. Removing the syringe and needle and knowing I had left a trail of sorts to guide me back to the vein along that wire, I told them to shock her. Once, twice – finally her baseline rhythm returned, but its permanence was not assured, based on the frequent abnormal heartbeats. After a quick nick in the skin with a scalpel, I hurriedly slipped a dilator over the wire to widen the pathway into the vein. Her heart faltered again despite the medications that were infusing into her, and she once more surrendered her blood pressure to a malicious heart rhythm. “Resume CPR and charge the paddles,” I uttered quietly but intently. Stepping back and leaving the dilator there to hold my place I said, “Okay, shock.” The shock was delivered, but there was no response from Naomi’s flailing heart. “Again,” I said, “and turn it up,” meaning the energy of the electrical shock would be increased to the next level by several units of energy. The second shock took, but the oppressive feeling that this cardiac calm was only temporary was pervasive, so I worked quickly to remove the dilator, slip the line into the vein, remove the guide wire, flush the catheter with a sterile saline solution and sew it into place. I snatched up pieces of numbed flesh on either side of the device to secure it so it wouldn’t slip out. Finally, placing a sterile dressing over the entrance of the line through the chest to protect her from infection, I broke down the sterile field and stepped back to survey the situation. She was showing attempts to stabilize. Her heart was displaying a more reliable rhythm and her blood pressure was improving with the medications we were now able to give her at a higher rate through her new central line. Several hours later her thirsty vital organs began to respond, and we were all happy to see urine in the bag that was hanging beside her bed – a reassuring sign that her kidneys were starting to work. Her blood pressure was normalizing and her heart was having fewer and fewer threatening beats break through. By the time the cardiologist was able to return, the drama had died down and Naomi was stable. Despite what I’ve documented here, I really don’t live my professional life day to day in a state of vigilance for the next great near-death experience. Amidst the intense business of caring for very ill patients, I can often forget about “the unusual question” and my desire to provide safe space for patients to

share their mystical experiences. So even now, this far along the path of championing a way for people to feel comfortable talking to me about whatever has happened to them in that space-in-between, it can easily fall off my radar. That’s when I am especially grateful that my intention around the unusual question seems to have taken up quiet but permanent residence in whatever unspoken invitation to share that patients perceive in me. Many times there are days or even weeks that pass before the patient regains consciousness and is able to communicate with us. By then there is much water under the bridge, and the intensity of the event that rendered them fragile and incapacitated is so remote that the care team has moved on to keep up with the patient’s ongoing issues. As such, we may be a bit disconnected from the hours when the patient first crashed onto our doorstep, but the patient is not. If they remember it, it can be very fresh for them the moment they wake up. Almost two weeks passed before Naomi’s body had begun to recover enough that she started to respond. In fact, because so much time had gone by, and she remained comatose without sedation, we feared permanent anoxic brain injury from her cardiac arrest and prepared her family for that possibility. Despite her lack of responsiveness, the electroencephalogram (EEG), which mapped her neurological response, showed normal brainwaves. We remained hopeful. As she improved, we were able to remove many of the support devices that had taken over some of the work of breathing and other functions that her body was too weak and worn-out to do on its own. When her breathing tube was removed, it was a very busy day in the ICU, and at that time she was not my sickest patient. The fact that she might have had a near-death experience that she would want to share with me was not on my mind at all. I had assessed Naomi earlier that morning, made the decision that the breathing tube could be taken out in order to liberate her from the ventilator, reviewed her labs, adjusted some medications and moved on to the other fifteen or so ICU patients in my care. Now, later in the day, with everyone else tucked in for the evening, I swung back by her room to see how she was doing. Despite the busy day, a certain calm had settled across the ICU as the night moved in, so when I walked in, her sparkle seemed to especially stand out against the contrasting backdrop. “You seem to be in fine spirits,” I smiled. “Having the ventilator removed

suits you.” “I’m feeling good,” she said. Then I noticed it. She had that look – the look of someone who has something pressing on their mind they can barely contain. I had begun to recognize that appearance in some patients who had experienced near-death or out-of-body moments during their extreme clinical distress. As the residue of the day settled, seeing her now brought me right back to the question. “Is there anything on your mind you want to talk about…” that happened during your cardiac arrest, I was about to say, but she beat me to it. The first part of my sentence was all I got out before she blurted, “Yes! Can I tell you?” “Of course,” I said. I found a rolling stool nearby and pulled it up beside her bed. Activating a button, I lowered the bed and raised the head of it to more of a sitting position so that we were on the same level, eye to eye. “Tell me what happened.” “Well,” she began. “I saw everything. I saw it all. I saw my mom who died, I saw angels, saw you working on me, all the other doctors, me in the ER.” She could barely contain herself. Recognizing this, she put her hands out to slow herself then took a deep breath and said, “Okay. Let me start over at the beginning. “On the night it happened, I wasn’t feeling well,” she began. “I was tired and nauseated. I also felt a bit light-headed. I thought I was coming down with something, so I took some Tylenol and went to bed early. Then I woke up in the pitch darkness feeling like something was squeezing the life out of my chest, and it was hard to breathe. I knew what was going on. I knew I was having a heart attack, so I woke my husband up and, as calmly as I could, told him what I thought was happening and to call the ambulance. Then I started fading in and out. The next thing I remember, the ambulance people were there, hooking me up and telling me I was having a heart attack and that they were taking me to the hospital. “I’m a little bit of a smarty pants, so when they told me I was having a heart attack I tried to say, ‘Do you think!’ But nothing came out. I could hardly breathe, and I realized then, when I tried to talk, how bad it was and that I was probably in a lot of trouble. That’s the last thing I remember until I was in the emergency room. I remember seeing my husband’s face at home, though, and how scared he looked – and then everything blanked out. “In the ER,” she went on, “I was aware again, but this time it seemed

different. I couldn’t figure it out at first, then I realized I was up above my body watching everyone rush around. I saw them pumping up and down on my chest and putting a breathing tube in my mouth. I saw my closed eyes and how limp I was with one arm hanging off the bed. I actually thought it was kind of funny how my arm was bobbing up and down when they were doing CPR. It’s crazy that I would find that amusing, considering the situation, but hey, I did. “I felt so peaceful and detached, though, floating up above my body, so I thought I must have died. And you want to know what’s strange?” she asked. I nodded my head, certain that I did want to know what she considered strange, given that she had found it amusing so far. “I didn’t feel bad about it – about being dead. I thought I felt pretty good for being dead. No pain, very light and kind of floaty. It was so peaceful. “What happened next was a big surprise, and that’s when I knew I must have died. I became distracted by a growing, bright light to my left, and when I turned my attention to it, it became bigger and brighter. It seemed like it should have been a blinding light, that’s how bright it was, but it wasn’t hard to look at, even though it was so intense. The more attention I gave to it, the closer it came and then, suddenly, I wasn’t concerned at all about what was going on with my body in the ER. Not one bit. In fact, in an instant, I forgot all about it. In just a blink, it was all about that incredible light for me. “It was coming closer and I wanted it to, because the closer it came, the more intense love I felt.” Naomi paused for a moment and looked away as if she were trying to find the right words. Then I realized she was starting to tear up. Her animated voice became soft and frail. I waited and eventually she continued. “It’s so hard to explain that kind of love. It was very intense and so real. More real than this,” she made a sweeping gesture of the room. “And this,” she picked up her blanket in one hand then let it fall. “Whatever it was I wanted more of it, so I moved toward it and was suddenly drawn into it so fast. Lightning fast, like that.” She snapped her fingers. “I went with that light, that love, and I wanted to. I never wanted to leave it. “It felt like I was moving fast and standing still at the same time. Oh, it’s so hard to explain,” she said, clearly flustered, “but that’s how it felt. And I didn’t have a life review like you hear people talk about, but I did see random flashes of scenes from my life. Then I realized, by the sequence of things, that I was traveling backwards – in time, that is – because the scenes and snippets of

conversation were of me getting younger and younger. “Then it got a bit weird. Suddenly I was back in my mother’s womb. I could feel the warmth, I could hear her heartbeat – or mine, I couldn’t tell – and a distant muffled voice and laugh. Funny, but I knew it was my mother’s laugh, her voice, and that I was hearing it from inside of her. When she would laugh I would feel it like a vibration. I remembered that. I remembered all of a sudden that I would feel sound-like vibrations before I was born. I didn’t know that – or didn’t remember it – until that moment. “Then I felt myself floating in a void of sorts, and there was no more sound. There was only intense silence, and I knew I was somewhere else. I didn’t know what to do, so I just waited. Eventually, the darkness around me started to fade. Then far away, or at least it felt like it, I saw something growing closer. I had no idea what it was, so I just watched. Then I was aware that as it moved toward me, just like before, I started moving toward it. Then I was running, because all of a sudden I was aware that it was my mother, who had passed away. I couldn’t get to her fast enough. “When I got to her, I hugged her so tight.” Naomi choked on her tears, barely able to get her words out. She continued hesitantly, “And there were others. Smudges of light that seemed to be moving but they weren’t as clear as my mother. I guess they were angels. I’m not sure, but they didn’t seem human. At least, they weren’t as clear as my mother was, so I’m thinking they were angels, or something. Oh, it’s so hard to explain.” “You’re doing fine,” I encouraged her. “There were others there, too. People who seemed familiar, but I couldn’t quite place them. I saw their faces and felt like I should know them, and they certainly seemed to know me, but I just couldn’t remember who they were or how I knew them. Maybe I was just so happy to see my mother that I wasn’t concerned with them. But it seemed no sooner than I’d arrived there that she told me I couldn’t stay, that I had to go back. “That really upset me. You wouldn’t know it by how I’m always joking about things, but my life is not that easy. My husband, he’s a good man, but he’s not always an easy man to live with. He’s pretty hard to please, so I really didn’t want to come back, quite honestly. I don’t want him to know that, but it would have been so much easier to stay there where I was, with my mother. So I was not happy at all when she told me I had to go back. I was pretty sad really.

“I even tried pleading with her to let me stay. I told her, ‘It’s my life, I should get to choose. I should have a say-so.’ Then she told me, ‘It’s not that you don’t get to choose. Part of you, in fact, is choosing and participating in this decision. It would be easy for you to choose to stay here, but you understand on a level you can’t quite comprehend just now that there is more from your family relationships you need to experience and learn. And more they need to learn from you. When choosing is not an act of escape but an act of completion, then you will stay.’ I knew what she said was true, but in that moment, it didn’t make it any easier.” Naomi paused to reflect then continued, “So I came back.” “What do you think it means?” I asked. After a brief, contemplative silence, she replied softly, “That I can leave this body when I’m not looking at death as a way out of personal pain but as my natural next step – when I’ve completed whatever it is I’m supposed to do here. That’s why I had to come back.” Naomi went on to tell me that once the decision was made for her to return, she was suddenly unaware. The visit just stopped without any fanfare, goodbyes or further instructions. It was just over. Naomi took a deep breath and, with an intention of brightening the mood settling on her face, she smiled before continuing. Her next awareness was when she was in the catheterization lab. She said it was no longer the ER and that it looked like an operating room. There was a large light overhead and different medical personnel than she had seen in the ER. I explained briefly that that’s where the cardiologist found her clogged coronary artery and opened it up. Again she was outside her body, looking on. What was distinctly different this time, though, is that she knew she was about to have another cardiac arrest. She knew it was coming. She felt a subtle buzzing sensation then perceived a voice saying, “Get ready for it. Here it comes. It’s going to happen again.” Strangely, she said it sounded like her voice, as if she could hear aloud the thought she had spoken internally. Very much aware of her surroundings, as what seemed to be a distinct consciousness separate from her physical body, she even experimented with the phenomenon at one point. Having the notion that the voice she heard was actually her own thoughts audibly manifesting so she could perceive them, she decided, in her disembodied state, to test her hypothesis and found her suspicions were correct. True to her self-professed, smarty-pants nature, she tossed out random words – butter, ping pong, tacos – and heard these very words echo aloud, although she was looking

at her physical body that was unconscious, mouth unmoving, and clearly in distress. But she wasn’t in distress, not in the least. Rather, it fascinated her. She knew by now that she wasn’t dead, because she had just been told it wasn’t her time. But she wasn’t exactly sure what this in-between state was, where she had been told she had to come back to, but still she wasn’t inside her body. And she was glad for that at the moment, given how uncomfortable and tenuous her body appeared just now. So after noticing her unusual situation and not really understanding how it was possible, she decided all she could do was settle in and observe until it became clear to her that she should do something different. In the cardiac procedure lab, after hearing her own voice warning her that her heart was going to stop again, she then curiously observed it happening. Not too long after having that thought, she heard a nurse say, “We’re losing her” and the cardiologist say, “Start chest compressions.” He then muttered to himself, “I just want to get that vessel opened up.” Because the tone was so different, she wondered when she heard him if he had said it aloud or if she had read his thoughts. She couldn’t tell, but faded out into unawareness before she could test that theory. Naomi’s experience was certainly a curious one. It fascinated me that she had the presence of mind to sort out that she was hearing her own thoughts and then proceed to do a silly experiment while her consciousness seemed to be separate from her struggling body – and that she was even somewhat entertained by it. Apparently a sense of humor can be well preserved out-ofbody. The third time she had a cardiac arrest was in the ICU while I was placing her central line. She described it to me and, astonishingly, even reminded me of something I had forgotten. She was watching us from a position in middle space – not exactly floating above and not entirely standing; rather, she was somewhere in between. After having the thought, “Your heart is going to stop again,” and feeling the soft buzzing sensation tingle through her once more, she then saw the blue drape being lifted up and the nurse reaching under it to start chest compressions. Then she mentioned something I had forgotten entirely. She saw members of the resuscitation team try to tilt her whole body sideways to put a long, flat board under her and me saying, “Whoa, whoa, whoa, my stuff,” as I grabbed the

things I had set on top of the sterile field to prevent them from falling onto the floor. She couldn’t understand the long plank, so I explained to her that it is called a backboard. “It helps us do more effective chest compressions to circulate blood if there is a hard surface under the body as we press down,” I went on to explain. “Otherwise, your body would sink into the soft mattress and the pumping wouldn’t be nearly as effective.” She nodded that this made sense to her, but I remained amazed that she had been aware of that happening and saw me reacting to the shifting field by grabbing my supplies to keep them from falling off the bed when I knew, for a fact, that she was totally unconscious. After that, Naomi’s conversation began to wind down. She seemed tired, and it was getting late. A bit of her excitement had settled from when I had first walked in, and she seemed peaceful. Reaching out for my hand to give it a gentle squeeze, she expressed gratitude at being able to share what had been a lifechanging experience for her. She finished up by saying, “Now that I know what’s coming, because I’ve experienced it first hand, I’m not afraid to die. Even though it causes me a bit of heartache to have to come back, I know it’s because I have some important work to do – and trying to figure out what it is will keep me busy,” she laughed. “Although it’s a little disappointing, to be honest, my heart can wait.”

There is often a distinct sense of patience and ease that descends upon those I have met who’ve encountered loved ones during a near-death experience, along with a loss of the fear of death. Although some express disappointment at having to return to their physical body after being reunited with loved ones they have lost and hold so dear, once they feel reassured that at some point in time and space they will reconnect with them, not only are they not afraid to die, they are also comforted by the promise of reunion. For some the sadness lingers, and they can become fixated on the notion that they don’t want to be here; they’d rather be there. Their disappointed rumination can bind them so tightly that they can become stuck. They become unable to reintegrate into the life and relationships they enjoyed before because they remain in a permanent state of mourning for the near-death encounter they left behind when they returned to their physical bodies.

However, for many, there is acceptance. They feel motivated to integrate their experience and actively seek the purpose and reason behind why it was not their time to die and they needed to return. That purpose is so personal, so individual – and not always obvious. For those who are able to discover and connect with it, however, they are able to embrace what happened and understand that, in the vast expanse of eternity, during this brief incarnation, the heart can wait.

“Everything we see is a perspective, not the truth.” – Marcus Aurelius

me when patients return from a near-death experience and profess I ta intrigues heightened sense of perception for things going on around them – intuitive, sensory or otherwise. It seems to happen more than you would think, and I’ve heard a handful of patient accounts that would support this. One of the most fascinating accounts was from Chester. Chester was a retired foundry worker who’d had a heart attack. At age seventy-four, he arrived in our ICU after resuscitation in the emergency department from his initial cardiac arrest. Following a detour through the heart lab that found his coronary arteries were completely clean and that pump function of the heart was normal, he proceeded to have three more cardiac arrests over the next two days. These events were all triggered by ventricular tachycardia, an often-fatal heart rhythm when it cannot be interrupted and controlled. An extensive workup revealed that he had a diseased and faulty cardiac electrical system. Despite the exhaustive evaluation, a specific trigger – such as abnormal blood chemistry or an enhanced vulnerability from a prolonged part of his normal electrical rhythm – could not be identified. Any attempt to arouse him from sedation would result in an electrical storm of the life-threatening dysrhythmia leading to a cardiac arrest requiring large doses of medications and several shocks to rein the twitchy heart back in. So we took precautions. Eventually, after thoroughly marinating Chester in drugs to blunt the bad rhythm and implanting a defibrillator to shock his heart in the event of its return, we were able to waken him to relative cardiac calm so that he could go

about his life without fear of a fatal cardiac arrest. It was discovered in the hospital that Chester had some pulmonary fibrosis (a thickening of the lung tissue that affects breathing), most likely due to his years of working in the local steel foundry. I saw him in our office in follow-up for this to set up a plan for monitoring the disease progression of his lungs. It was during one of these outpatient visits that he volunteered his very unusual near-death experience. He shared with me that at one point he was aware that he could separate his consciousness from his body at will. He also made the stunning discovery upon awakening that he had perfect hearing and sight, which he had lost years before. It was disappointing for Chester, though, that these changes would prove to be temporary. He recalled a vivid moment in the emergency department during his first cardiac arrest when he had the sensation of his awareness shooting out of the top of his head, and then observed the resuscitation team from above as they worked on his body. Simultaneously, he was aware of a pastoral scene coming into view with a rolling grassy field and large, gently swaying trees that seemed transparently superimposed upon the emergency room scene. One appeared to be bleeding through the other, leaving him with the feeling of being in both places at the same time. As he focused on the field scene with fascination, it became clearer; not long after, he saw a filmy representation of a human, who seemed to be male by his build and gait walking quickly toward him. The image of the man was blurred by a very bright aura of light surrounding him. The aura was moving and stretching in cadence with the man’s movements, and as he approached Chester, he said, “Whoa, buddy, not so fast. It’s not your time, so you need to get back down there.” Chester was returned to his body without further recollection or awareness until he was in the intensive care unit. “Really?” I asked. “That’s what he said, ‘Whoa, buddy’?” “Yeah,” Chester replied, laughing. “Funny, isn’t it?” I thought so. Chester did too. Once in the ICU, he seemed to have trouble staying inside his body. He shared with me that he would come into awareness only to find his consciousness in different positions around his body – up above looking down, beside the bed, even upside down. It was very disorienting. After a few occurrences, he found he could control it. It started with him wondering what

was outside his room, and then suddenly he found himself actually outside his room. Fascinated, he thought himself to the window, then to the foot of his bed. Once when he saw a nurse come into his room, he quickly thought himself back into the bed, figuring that’s where he should probably be while she tried to take care of him. He was aware that this movement was quite separate from his body, because he could visualize his physical self lying sedated in bed, connected to a ventilator, while his conscious self was observing it all from afar. One time he blinked into awareness and found himself wandering along the counter at the nurse’s station. He only had a fleeting moment of trying to wrap his consciousness around how he got there when he heard a loud bang and found himself suddenly back in his body and waking up. He was very much in his body and aware that he was connected to tubing and machines. He had no idea what the noise was, and whether it was an external sound or something he heard within himself. We mused together about the ICU patients who are so sick and lying in bed, so hooked up to IVs and ventilators they can’t possibly get up. Maybe they perceive themselves wandering around, killing time and goofing off until their bodies recover. Chester and I laughed at the thought, but he confirmed that while he perceived himself disconnected from his own body, he saw no other discarnates. But it made us wonder about the possibility, which remains intriguing to me. If Chester could perceive his environment from outside himself while we saw his body lying in bed, were there others who could do the same? Does it always have to be a traumatic event that frees consciousness so that it separates from the physical body in such a way that it can roam as Chester did? Hearing accounts of out-of-body perceptions during surgery, and knowing we use some of these same anesthetic medications in the ICU to sedate patients, it’s a fascinating thought. Equally curious, Chester found he could also perceive thought and hear conversations between loved ones from a great distance away. He recalled a distinct conversation between his wife and daughter that was later corroborated to have been held down the hall in the family waiting room, well out of earshot of the ICU. They were discussing an unusual tree just beyond the waiting room window – its odd shape, fringy foliage, and distinct reddish color. I told Chester that I know that tree and it is a strange one, but he never saw it visually, and

there is really no way he could have from where he was in the ICU or where he was when he left the hospital. It is only visible from a certain waiting room courtyard – one he’s never been to. He heard them discussing the possibility of taking some leaves from the tree to try to identify it. He also heard them laughing about whether or not it would be considered theft of hospital property if they just took a small cutting. His wife and daughter were shocked when he recounted the conversation to them. How could he possibly have known about that? He had also heard his two-year-old grandson fussing and crying, then laughing and talking about a green tractor knocking down a wall he had assembled from a set of blocks. His daughter confirmed she had bought the tractor for him in the hospital gift shop to keep him entertained while they waited and that he had been using it to knock over blocks. Again, this all took place in the waiting room, far removed from where Chester lay tenuously trying to stay in a normal heart rhythm. He could hear the conversations clearly, hear his grandson playing with the tractor and blocks, even though he had never seen them and had no way of knowing at the time about these new toys. But what really stunned Chester was that, upon his recovery, he could see without his glasses and hear without his hearing aid. And not only somewhat better, but really well. Better than he probably ever had. Having worn glasses for all of his adult life and hearing aids for the past ten years, he was amazed to discover that now he didn’t need either. He related how wonderful it was, and that his enhanced perception was intense. Colors seemed alive, as if they were glowing and vibrating. Sound had more dimension, as if every noise, spoken word and musical note had tones that he had never heard before. Then to his disappointment, his sensory acuity slowly began to fade away. Three weeks after his discharge from the hospital, he finally returned to his previous baseline. Once more he needed the help of his prescription glasses and hearing aids in order to see and hear tolerably well. Still, all of these experiences remained vivid in his memory and served to change his perception of reality. It jump-started his journey of discovery into exploring the meaning of life, death and what may come after. It’s always fun to see him in clinic for his annual visits, where we manage to sneak in a few moments to reminisce and ponder what he’s been thinking about the nature of reality. Fortunately for him, unlike some of my other patients who’ve experienced near-death oddities we can’t

explain, his family was equally fascinated and have embarked on the journey of exploration with him.

Often what patients share with me seems so inconceivable – even to them – but keeping to my commitment of honoring their experience, I try to listen without judgment or interpretation. This takes practiced intention, because I admit that sometimes what I hear is pretty mind-boggling. It is sometimes difficult to grasp how something so far removed from our understanding of reality could actually happen. But even if it turns out that there is eventually discovered a logical neuroscientific explanation for the phenomenon, I honestly don’t care. Who am I to deny the meaning of their experience? What qualifies me to tell them it’s not possible or real – especially if something positive, lifechanging and meaningful emerges from their experience that compels them to live their lives differently? Such was the case for Alan. Alan had come in for an outpatient nuclear-medicine cardiac stress test for some atypical chest pain he had been having. He had all of the risk factors for cardiac disease, but his arthritis prohibited a traditional treadmill stress test. Patients undergoing this version of the test are injected with a specially formulated liquid that will allow the heart to be imaged both at rest and when the heart is stressed. If a patient cannot walk on a treadmill to stress the heart, a medication will be given during the stress portion of the study to increase the heart rate. During this stress period, the doctor can then observe if adequate blood flow is delivered to all regions of the heart. If the scan shows areas of low or no uptake of the nuclear solution, this suggests an area of narrowing or blockage of a coronary artery. So wherever the solution doesn’t go and is not taken up by the heart muscle, you can assume there is probably a blockage. Further evaluation and intervention is then required to open up that vessel. I’ve had two people in twenty years tell me of having a sensation of shooting out of their bodies when injected with the liquid that allows the heart to be scanned for blockages. Both of these patients described being able to observe the whole scene from up above their bodies. They shared in great detail what they observed that they couldn’t possibly have seen unless they were watching from above – details that were later confirmed. But for Alan it was different. When Alan was injected with the liquid that would travel to his heart and be

taken up by the muscle, not only did he have the sensation of shooting out of his body through the top of his head, he also heard the doctor call for a code blue because he was experiencing a cardiac arrest. Soon after hearing this, there was a brief moment where he observed a vast field beyond the wall of the room where the test was taking place. He briefly saw what he perceived to be a large, luminous being, and then it disappeared. He went on to describe feeling tethered to his body by a cord like a bungee, and bobbing up and down for a short while like a giant balloon before flying off into space at a great rate of speed. With his consciousness still attached to his body by what felt like a stretchy elastic cord, he was propelled up and away from his body into what seemed like outer space. He could see stars whipping by him. After what felt like just a flash of a moment, he saw a tiny dot of light ahead of him. He watched this bright light grow from the size of a tiny pinhole far away in the darkness to a rapidly expanding brilliant white light rushing toward him, growing larger by the millisecond. He had the distinct sensation that as it moved quickly toward him, he was moving equally as fast toward this light. He also perceived that it was growing in the warmth and intensity it radiated. For a very brief instant, he came to an abrupt halt as he merged completely with the light. In that moment he felt intense, almost unbearable, peace and love. The radiance was all encompassing. He was consumed by it. In that brief moment, which he described as “infinity in a second,” he felt an overwhelming sense of unity with everything – he was a part of the All and the All was a part of him. There was no distinction. No feeling of separateness, only complete connectedness with everything. Although he himself didn’t fully understand it, he said this was the best he could do to put an indescribable experience into words. In that brief moment, which was simultaneously vastly endless and briefly finite, he also perceived an instant download of knowledge and information, as if a giant droplet of thought content had been infused throughout his entire being. In ways that he struggled to convey, he felt that he had been shown everything and understood it all – existence, how the universe worked, how and why we were here. Everything. He recalled thinking that it all made perfect sense. Shortly thereafter – after he had come to an abrupt halt, after he had connected with pure love, after he felt completely one with all that is, after his

instant download of infinite knowledge – whatever it was that had held him briefly in that timeless space suddenly ended. Just as quickly as he had been propelled into communion with the intense light, he was sent hurtling back into his body, with a mighty slam and a total assault on his senses. Sound and light were so intense they were almost unbearable. Slowly over several hours the hypersensitivity faded, and while he surmised that perhaps this heightened discomfort with sensory input may have been a side effect of the medication, the experience of total immersion into pure love and the complete sense of connection and oneness with everything in the universe was not. That brief moment, so unexpected and so inexplicable – he still struggles to find words adequate to explain it – changed his entire life. All of his priorities shifted, and how he regarded life and existence changed significantly. As a result of his stress test, he received not only restored health but had also experienced a total personal transformation. Now that he reflected back on the experience, he couldn’t recall anything that had been shared with him, and it was frustrating. To be given an immense download of information, only to remember none of it, was a huge letdown. Not knowing how to respond, the best I could come up with was that perhaps it would be revealed to him over time as it became necessary or important for him to recall whatever knowledge had been imparted. That seemed to resonate with him, and he said, “You know, now that you say that, I think it has happened already.” He went on to describe how he’d had this knowing that his daughter, who was currently in college in another state, would be unhappy to discover that she was pregnant. He shared this with his wife, and so they were not entirely surprised when their tearful daughter shared the news with them that she was going to have a baby. They had already had a chance to talk about how they would respond and convey their support if Alan’s premonition came true, which, as it turns out, it did. Although some of his abilities faded over time, others did not, and a certain unique capacity remained that he initially had no context for understanding at all. After returning from his cosmic adventure and recovering from cardiac arrest, he noticed that he was able to see color surrounding people. It wasn’t all the time, and it wasn’t something he could predict. The hues varied, as did the size and intensity of the color field. Eventually learning that some people refer to this color field as an aura, he studied more about the phenomenon and

eventually formed his own opinion about how to interpret it. For instance, when he was sharing this part of his story, he pointed out that the field of color he saw around me was predominantly pink and orange with streaks of green scattered throughout and indigo closer to my body. I didn’t exactly know how to take this information, but the way he interpreted what he saw seemed like a compliment, so I certainly didn’t decline the gesture. Alan is a perfect example of how a near-death experience can have a positive impact on someone’s life, and how radically and quickly they can experience change. Suspending belief or disbelief for the sake of the person who sits before you, daring to share something so personal, can be profoundly meaningful to that person. What is often most valuable about our willingness to listen is the positive, life-altering inspiration the person is able to accept and incorporate from their experience.

In a field of research like the study of near-death phenomena, none of us is an expert. We can’t generate randomized, controlled double-blind studies to collect data to prove or disprove the occurrence of the experience itself. We have no choice except to either choose to believe the person experiencing the event or not, and collect our data – their stories – where we find them. Yet there are those who claim to be an authority on the nature of these experiences, and interpret them with a certainty that I believe is currently not justified. Not long ago I had the opportunity to attend a meeting where an acclaimed author of many books on the subject of near-death experiences was speaking. I thought it would be helpful to my work to hear the presentation and hopefully have a chance to personally visit with her afterward to ask her opinion on some of the curious cases patients had shared with me. What struck me during her presentation, which was based on her interviews of hundreds of subjects over many decades, was the certainty with which the subjective data of near-death stories was presented as facts and perceptions that proved a particular version of reality. Also, the information she had collected from people across a broad array of cultures and societies was further distilled through the lens of her own personal spiritual belief system. The end result was a stiff and unyielding interpretation of an afterlife that slanted heavily toward her beliefs about what might lie beyond death.

She also took liberties in interpreting what her subjects had experienced in order to support her description of a specific structure of the afterlife. I had a hard time hearing the theories she extrapolated from the stories she shared. Her take on what these experiences meant, and the fact that she interpreted other people’s experiences so definitively, left me feeling uncomfortable. In closing her talk, she shifted the topic toward the anomaly of obtaining heightened sensory abilities, such as clairvoyance and intuitive skill, after a neardeath experience. I wanted to talk with her about Chester’s experience and those of others I had observed who had emerged from their brush with death demonstrating similar abilities. After she had finished her presentation and was mingling with the attendees, I had the opportunity to share with her how, after his consciousness had returned to a waking state following his cardiac arrests, Chester seemed to have the capacity to tune into the thoughts and conversations of loved ones over a great distance. I also shared his observation that, for a period of about three weeks, he experienced the dramatic return of his hearing and sight that then slowly faded to his baseline deficits. “I don’t think that’s possible,” she said. “I’ve never heard of that. Enhanced sensory and perceptive abilities after a near-death experience are permanent.” I was more than a little taken aback. I am used to, and prepared for, the dismissal of patient’s experiences by those taking a hard-line, traditionally scientific stance about the unexplainable. But it surprised me that someone who is actually open to such phenomena and had dedicated her entire adult career to investigating and documenting people’s near-death experiences would be so immediately dismissive and manipulative of others’ experiences to fit her own worldview. “Well,” I remember responding, “that is what my patient reported, and I won’t deny him that personal experience.” After offering my concern about rigid interpretations of subjective experiences that are specific to the individual, I thanked her for her time and walked away. But I was rattled. I realized that bias exists within the very field dedicated to gathering and investigating valuable anecdotal evidence about peoples’ experiences during moments of extreme physiologic stress. We are far from being able to describe with any certainty exactly how or why these experiences happen, and forcefeeding the accounts through the narrow lens of our own point of view seems unfair to the individuals who offer them for our consideration. Furthermore, it

is a disservice to the overall goal of trying to advance our understanding of these phenomena. I’m reminded of an Indian folk tale about a group of blind men trying to identify the nature of an elephant through touch alone. Blind since birth, they have never seen an elephant and they have no reference as to the true nature and appearance of this great beast. As a result, upon their first encounter, being unable to take in the whole truth of the animal, they each respond only to the part they can perceive through touch from where they stand. The blind man touching the ear is convinced that the elephant is like a great fan – sometimes limp and still, sometimes waving back and forth to stir the air around it. The blind man who feels the leg maintains that the elephant is like a giant pillar, tall and stout with a broad base at the foot, and he holds firm to his theory based on his personal experience. The blind man who feels the tail cannot believe that the elephant is anything other than a rope, and the blind man exploring the side is absolutely certain the elephant is like a vast wall. Touching the tusk, the final blind man informs the others with authority that they are all certainly wrong, because based on the information available to him, the elephant is like a great spear. Hearing the elephant’s loud bellow, they all agree that the fan, pillar, rope, wall, and spear are certainly mighty and fearsome, but that is as close as they come to agreeing on the true nature of the animal. Of course, they are all correct based on their unique perspective. However, limited as they are by their physical deficit and by being able to take in only a small part of the whole, they are incapable of appreciating the true nature of the elephant. It strikes me as an apt analogy to our understanding of the subjective near-death experience. There are, undoubtedly, many ways to think about this personal experience. But its many aspects and possible interpretations are perhaps best considered as contributing to a growing understanding of a larger truth that none of us are yet capable of fully understanding – at least not at this point in our human history.

“The Universe is under no obligation to make sense to you.” – Neil deGrasse Tyson

was unconscious when she was brought to the emergency room by C arlita ambulance. A youthful Latina woman of thirty-eight, she had felt ill for a week prior to her admission. According to her husband, she’d had a cough and fever that lingered for several days, and when she didn’t get better, he began to worry. He took her to the doctor. A chest X-ray revealed a small area that looked like pneumonia, so she was placed on antibiotics and sent home. She continued to get worse, though, and over the twenty-four hours leading up to her admission she was increasingly listless and less responsive. On the morning she was brought to the hospital, her husband had gone in to check on her and found her jerking strangely in the odd posture of a seizure. How long that had been going on, he could not say, because she had been in the room alone for a couple of hours. He could not rouse her, and her seizures showed no sign of stopping. Realizing this was a dangerous situation, he wisely called 911. Sitting beside her on the bed, he was paralyzed with fear in the minutes it took the ambulance to arrive. He felt helpless as he watched her twitch violently, then go still, off and on in sequence. When the paramedics arrived, they were able to start an IV and give her some medication to stop the seizure. En route to the hospital, she began seizing again, this time so violently that she was not breathing well and her oxygen levels started to drop. Within a few short minutes they were wheeling her into the emergency department where the doctor was able to administer paralytics just so he could relax her clenched teeth and insert a breathing tube. Noticing her neck was very stiff when he intubated her, the doctor suspected meningitis. After giving her more medication to stop the seizure, he

quickly set up to do a lumbar puncture, where he would insert a large needle between two vertebrae directly into the spinal column to withdraw fluid for testing. He advanced the needle until he felt the soft pop that told him he was in the right place. Cloudy fluid flowed from the needle where it should have been clear; turbid and slow where it should have run freely and been less viscous. He sent the fluid off to confirm what he already knew – she had meningitis. For a brain to have been bathing in that much pus for as long as she likely had been, and with her persistent seizures, he feared her outcome might not be good. He knew her best chance of survival was to start the antibiotics right away and to control her seizures. After the antibiotics were started, she was wheeled to the ICU and I took over. By the time I received her, she was no longer seizing but her fever was quite high and her failing blood pressure indicated the presence of septic shock. It didn’t take long to identify the offender, and within hours we knew she had both streptococcal pneumonia and meningitis. She also had a raging sinusitis as well, which was the suspected source of all her troubles. All we could do now was support her with medication and wait for her body to fight off the intruders and heal. She slowly improved, but even days later after we stopped the sedation, she still didn’t wake up. She was attached to a continuous seizure monitor during the first few days of her admission, and we knew from that that she had not had any further seizure activity. Unbroken seizures beyond an hour or so can have devastating results, causing permanent brain damage, even death. The neurologist did another series of EEGs (electroencephalograms) to study brainwaves. Special scans of the head were done. Everything came back unremarkable. There did not seem to be any continued neuropathology to explain why she wasn’t waking up. In the ICU, nurses will do regular neurological exams as part of their routine to see if a response can be elicited. There are various maneuvers used to evaluate the unresponsive patient. Rubbing the sternum hard with the knuckles, and bearing down on the nail beds with a fingernail and running a blunt object, such as a tongue depressor, up the bottom of the foot are all part of the repertoire. This may seem barbaric, but far from being abusive, these intense stimuli, intended for patients under the weight of a coma or other neurologic insult, are meant to elicit a “stop-doing-that-to-me” response indicating that the lights may

be off but somebody’s probably home. While uncomfortable, patients aren’t harmed, and if they do respond it is reassuring that perhaps they are starting to come around. If they don’t, it’s worrisome. Approaching Carlita’s bedside one morning, I stood there looking at her, wondering what, if anything, she was experiencing deep in her coma state. I maintain with staff and families that we never really know what patients may be thinking or feeling, so I’m always an advocate of taking great care in how we communicate with unresponsive patients and what we say around them. Families will often ask, “Can they hear me?” and my response is always the same, “Assume they can.” I looked up at the monitors to contemplate whatever information about Carlita they would reveal to me. Her heart rate and rhythm were steady, blood pressure looked normal and oxygen levels were just right. I inspected her various tubes and catheters as they entered her skin, and they all looked good. There were no signs of irritation or infection. Walking around the bed, I leaned down to look at the urine emptying from the catheter exiting her bladder into the bag attached to it – clear and not too concentrated, as it should be. Nothing obvious indicated any type of physiologic distress. I moved over to the ventilator and pressed a few buttons. Bringing up a summary screen, I could see she was maintaining a steady drive to breathe and seemed to be doing most of the work on her own, requiring less and less support from the machine that was helping her breathe. Why wasn’t she waking up? I picked up her flaccid hand and with my thumbnail pressed down firmly on her nail bed at the cuticle – no response. Carlita’s nurse walked in as I was doing this and said, “I know. I don’t get a response either.” I laid her limp hand back down on the bed. Grabbing a wooden tongue depressor from a nearby drawer, the nurse unwrapped it then ran the blunt end firmly up the bottom of each foot. This should have caused her to curl her toes, but nothing happened. She bore her knuckles down onto the sternum and gave it a vigorous rub. Again nothing. On the opposite side of the bed from me she grasped Carlita’s right index finger and gave it a good pinch with her own fingernail. “She’s just not waking up,” the nurse said. “Not a very good sign is it?” she continued. I shook my head. Reaching into my pocket for a pen light, I raised both of Carlita’s eyelids, swung the thin beam from the side to the center of each eye and watched the

pupils contract briskly and equally in response to the bright light. I rolled her head from side to side while holding open her eyelids and watched the movement of her eyes. With the gentle rocking motion, her unseeing eyes stayed centered on the ceiling above her, as they should. It indicated that the muscles controlling the eye movements were responding to feedback from the brain to stay centered when her head moved. “Doll’s eyes,” I said to the nurse, which is what we call that maneuver. The absence of doll’s eyes suggests brainstem dysfunction in the comatose patient. Her reflex appeared to be intact – good news. “Yep,” she replied. All of our exams and tests showed that nothing major was amiss neurologically. Every vital function seemed to be working, but she just wasn’t waking up. Several days now since her initial presentation, it was worrisome. Usually what I tell the family when patients take such a long time to come around after a neurological insult, be it infection or injury, is that the brain has had quite a shock and it may take a while for it to get back on line. The best we can do is to provide the most favorable environment medically possible to allow the body to heal. While this may not give them an exact timeline, I think it helps them to know we are not giving up. Several more days passed without a flicker until finally, on day thirteen, she began to respond – slowly at first, then eventually with spontaneous, intentional movement. She was waking up. Her family was very excited, of course, but they were appropriately cautious. She still could have some brain damage from the initial storm of seizures before she came to the hospital. If there is more than an hour of seizing, the chances of escaping without some type of injury to the brain becomes less likely. But with each passing day she improved, showing signs of coming around. I was actually on vacation when she became fully awake and the breathing tube was able to come out. When I returned a week later, she had improved substantially and had been moved out of the ICU to a regular room on the neurology ward. I went to see her and, through the open door I could tell she was alone in the room. Staring out of the window, she appeared to be deep in thought. I knocked softly on the door so I wouldn’t startle her. Hearing the light rapping of knuckles on wood, she turned around and flashed a brilliant smile. She looked so much better than when I had last seen her over a week ago. With

her smile and the back lighting from the window casting a small halo, it occurred to me that she looked angelic. “Wow,” I said, “You look fantastic.” I reached for her hand and shook it, introducing myself because, of course, she wouldn’t remember me, since she had been in a coma the whole time I had cared for her. I had held grave concern about what her neurologic function would be once she woke up, but based on our brief exchange thus far, she seemed perfectly fine. “I took care of you when you were so sick in the ICU,” I explained. “Oh, yes, I remember you,” she replied. “You remember me?” I asked, knowing she had been unconscious most of the time and only minimally responsive when I left for some time off with my family. “Yes,” she said in a lovely, musical Colombian accent, “I remember you checking on me.” “Can you tell me what you remember specifically?” I ventured. She then proceeded to relate a very accurate and detailed account of me examining her. “Well, it started with me becoming aware that my body was buzzing,” she said, then with a shy, dismissive shake of her head, went on to say, “I know that sounds weird.” “I assure you, Carlita, nothing really sounds too weird to me,” I told her, and I meant it. “I’ve heard a lot of interesting things that have happened to my patients over the years that I really can’t explain.” Seeming to be bolstered by what I said, she went on. “Okay, so I felt this buzzing in my whole body, right, like a vibration kind of feeling. Then I became aware that I felt like I was moving backward very slowly. I could feel it but I could also see it. I could see that it looked like I was moving up and away from my body to the side of the hospital bed near my head. And I actually felt like I was standing at the head of my bed looking at my body. I could see my body and I could see the room pretty clearly. It was startling, but I was more surprised than afraid. I really had no fear, just curiosity. “I didn’t know what was happening and, honestly, I thought I might be dying, but I wasn’t scared. I actually felt,” she paused, searching for the right word, “detached. No sadness or fear. I was purely a curious observer. I felt really peaceful, actually. I remember looking at my body lying in the bed and feeling sorry for it. I saw all kinds of tubes and wires and things coming out of

me and I thought this looks like what you see on television when people are hooked up to machines to keep them alive. I remember thinking I must really be sick, you know, to be all hooked up like that. But, I couldn’t remember why I was there or what illness I had. I was trying to remember as I was standing there looking at my body, but I just couldn’t.” I pulled up a chair and sat down to listen. I was fascinated as I always am when people share these stories with me. Understanding my gesture, she continued. With a faraway look in her eyes, as if she was going back to that moment, she spoke. “You know what was really weird was right above my body I saw this round ball of soft, blue light just floating there in the air. It wasn’t totally still. I could tell it was moving very slightly, but it stayed in the same place right above my belly. It was about this big,” and with her hands she indicated the size to be a bit bigger than a basketball. She went on: “I wondered to myself, ‘What is that thing?’ I thought, ‘Maybe it’s my spirit that left my body.’ That didn’t make sense, though, because I was aware of myself being separate from this blue ball. I didn’t feel like it was me. I was looking at it from that space at the head of the bed where I seemed to be standing. I know I was standing in that place because I could see my body lying there separate from my awareness and that was strange. It was all very strange. What was that, do you think?” she asked me. I responded honestly, “I don’t know. I have no idea what that was.” I told her briefly about Marlene’s blue orb escort during her near-death experience following the birth of her child. “So I’ve heard it described,” I went on, “but I have no idea what it is exactly.” “Maybe it’s an angel,” she mused. A soft smile settled easily on her face, indicating that she liked the idea. “Maybe,” I concurred. Carlita talked a bit more about the orb of blue light, describing how any movement was subtle. At one point, she watched it slowly move up to rest above her chest then back down to her abdomen again. “Then I saw you come into my room,” she abruptly shifted gears. “I saw you come in and stand at the side of the bed looking at me. I wondered what you were thinking as you stood there looking at me.” “I was probably wondering what you were thinking,” I said, and we both

laughed. “Then you looked up at the screens and stared at them for a long time,” she continued. “That’s when I figured you were probably seeing how I was doing. You came around to the same side of the bed where I seemed to be standing and started pushing buttons on a large machine. Then I watched you pick up my hand and pinch my finger. I thought it was strange and wondered why you would do that.” “We usually do that when a patient is in a coma like you were. We’re not being mean, but just trying to get a response – to see if you’re in there somewhere,” I explained. “Yeah, I finally figured it out when the nurse came in and did the same thing. I remember her saying that she couldn’t get a response either and that I just wasn’t waking up. That’s when I thought for sure maybe I wasn’t dead but maybe in a coma or something like you said,” she surmised. “You were,” I told her. “I saw all the things the nurse did to me – tickling the bottoms of my feet with a stick and rubbing my chest with her knuckles. Then I saw you shine a light in my eyes and move my head from side to side while you held my eyes open.” Carlita laughed, “It was very strange watching the two of you do those things to me and I didn’t feel a thing. I saw you shine the light but, from where I was standing, I didn’t see a bright light shining in my eyes. It was like I was watching these things being done to another person, but I knew it was me.” I explained to Carlita what those tests were and what we were checking for. She also shared several other times during her ICU stay that she seemed to be outside of her body observing, but it was never as clear or for as long as the day she had just described. We chatted on for quite a while, especially about the blue orb. That was what fascinated her the most. She continued to ponder what it was, as we each tossed about our own theories of what it could possibly be. I rarely spontaneously share things about myself with patients across that invisible, professional line we’ve been taught not to cross. I may share something if they specifically ask or if there is a similar experience I have had that might offer them comfort or help them not feel so alone around an event or situation they are having difficulty accepting. While Carlita did not seem to be having any trouble integrating her unusual experience, she was musing so intently about the nature of the blue orb she had seen, that it seemed fitting to

tell her of a similar encounter I’d had nearly two decades earlier. I told her that several years earlier I had seen two soft blue orbs during a very difficult time. I did not share with her the details of my circumstances surrounding the sighting – it didn’t seem appropriate. All I told her was that I saw two blue orbs, with no obvious light source outside of their own internal illumination, hovering up in the corner of my room during a time of intense personal pain. That’s all of the detail I shared with Carlita, but to understand the impact that the appearance of this light phenomenon had on me, it may be helpful now to tell the rest of the story. When I was entering my fourth year of medical school, two weeks away from taking the second part of the three-step licensing exam, my then-husband of nearly five years asked for a divorce. I was devastated but not entirely surprised, having seen the relationships of some of my friends and classmates buckle under the strain of medical school. It was certainly not unheard of. It was terribly painful, of course, and the timing was so ill conceived. Two weeks before one of the most important exams of the whole four years of medical school, I was given notice that my first marriage was over. Cycling rapidly through the stages of grief, I finally settled on just feeling like a failure. Plus, sinking under the weight of the rapidly approaching exam, I was totally overwhelmed. Paralyzed, I couldn’t study. I couldn’t concentrate. Drawing more inward in an act of self-preservation, I became depressed – quite profoundly – and braced myself for the head-on impact of failing a pivotal exam. I could see no other outcome. I wasn’t prepared. I couldn’t prepare. Every attempt to study resulted in my sitting limply at my desk staring at my study materials, totally unseeing. I was emotionally exhausted and, because I had not had enough sleep due to my hectic schedule, physically spent. All I wanted to do was sleep. I couldn’t determine what was the bigger dragon, a pending divorce or a looming exam. I must have looked as bad as I felt, but with the selfcentered tunnel vision you develop as a medical student in order to survive the process, I was reasonably certain that no one noticed. If they did, my pallor and signs of strain could have easily been written off to the wear and tear of medical school. We all looked a little unwell. I moved blindly through my final two weeks in a surgery rotation that I hated, in no small part due to a caustic attending physician who seemed to enjoy making medical students miserable. But for once, I was grateful for the rotation.

After doing rounds on my patients with the team, I would check the schedule to see which surgical case I had been assigned to, scrub in, and then slink out of sight behind a surgical gown and mask. Holding a retractor for hours on end is usually the undesirable job assigned to a medical student. I had typically disliked it but now found that it was a great place to hide. With not a lot of effort, I was successful at making myself invisible, and that’s all I had the inner strength to do at the time. On the day of the exam, the surgery rotation finally behind me, I got ready with a crushing sense of doom. Driving to the testing center, I was vaguely aware that I was functioning numbly on autopilot, and in that fuzzy state, ran through a stop sign. I recall that the horns bearing down on me sounded so far away. It is no small wonder that I arrived at the center without getting into an accident. Looking back, it’s even amazing that I made it to the center at all. I barely remember sitting at the table, moving through the test booklet and filling in the answer bubbles with my number-two pencil. I only half-heartedly made an attempt to read the questions and try to answer correctly. It seemed pointless. I knew I had failed the exam. I was living in a tiny, two-story guesthouse that I had shared with my husband up until two weeks earlier. It was on an estate in what was once the outskirts of the city but was now sandwiched between downtown, where the medical school was located, and the expanse of sprawling suburbs beyond. This old, midtown portion of the city housed a smattering of five- to ten-acre estates that had been held by private families across multiple generations. It preserved a cloud of quiet Southern style nestled in the midst of an otherwise-bustling urban thrall. Two weeks before it had been charming – but now it felt like a grave. It was dark with the curtains pulled, and after returning from the test center, I stood in the shadows of the tiled foyer for a long time deciding whether or not to make myself eat something. In the deafening silence, I finally dropped my keys and backpack where I stood, turned to my right and climbed the tiny staircase to the bedroom on the second floor. I crawled into bed without even changing clothes, and promptly fell asleep. When I awoke several hours later, it was pitch black. Having no idea what time it was, I just lay there staring into the darkness. Then something caught my attention. Looking up at the ceiling where it joined the wall, about halfway

between the two corners opposite where I lay, I saw two soft blue orbs of light. I could see them clearly, but when I looked askance, I saw them in better detail. The outer edges seemed blurred while the color was more pronounced toward the center. Propping up on my elbow to get a better look, I blinked several times and turned my head from side to side, but they didn’t change in their position or appearance. My initial thought was that there was a light shining through the bathroom window, projecting its glare to the ceiling. Peeling away the covers, I moved to the bathroom and looked out the small window that had a view of the large estate that sloped gently toward a tiny stream lined with tiger lilies along the back of the property. For being in town, it was incredibly dark and quiet, owing to an ancient, thick line of tall evergreens and hardwoods skirting the perimeter. All I saw as I looked out of the small bathroom window was a dark, moonless sky and the faint shadows of landscaping below that I could only barely make out. There was no light source. Hugging my arms around my waist and pulling my sweatshirt close, I turned around and leaned against the doorjamb, resting my head on the worn wood. Peering into the bedroom, I puzzled over the two orbs that I could still see at the ceiling’s edge. From that angle, I could tell one was slightly bigger and a bit more forward and away from the wall than the other. The smaller one was just a little below the bigger one and seemed to be touching the wall. I walked closer to them, and amazingly I could still see them. As I walked under them they seemed very close and far away at the same time. To this day I don’t know why I didn’t grab a chair and climb up to get a better look or try to touch them, but it didn’t occur to me. Walking back over to the bed, I glanced at my wind-up alarm clock and saw the faint green glow of the hands pointing to 2:30 in the morning. I sank onto the edge of the bed and looked up to notice that the orbs were just a little further apart from each other than they had been earlier. I watched with fascination as the larger orb, about the size of a large grapefruit, started to very slowly move to the left, increasing the distance between the two even more. Inexplicably, I started to cry. Big, silent streams of tears poured down my face and landed on my hands that rested limply in my lap. Not even bothering to wipe them away, I crawled back beneath the covers and continued to shed tears that blurred the orbs into blue smudges that would clear when I blinked.

At some point I fell asleep, and when I woke up again it was almost 5:00 a.m. It was still very dark in my room, but outside I could see that the darkness was starting to soften in the predawn hours. Looking up, I didn’t see the orbs. I thought they were gone, but as I scanned the edge of the ceiling, I saw them once more but in a different place, now on the adjacent wall. This time, the small one had moved to the other side of its larger companion. Once more I fell deeply asleep. When I awoke it was almost 1:00 in the afternoon. Rolling over, I glanced up at the ceiling where I had seen the orbs of soft blue light the night before. The space was empty and all I saw was the crown molding where the pale yellow wall joined the white ceiling. Nothing more. Lying there reflecting, I noticed that I felt lighter. The heavy curtain of depression that had suffocated me for the past weeks was gone. I didn’t feel jubilant, but I didn’t feel low either. I was quite comfortably neutral, even peaceful. Curiously, thinking about the strange light anomalies from the night before, I didn’t feel alone. For me, that night seemed to be a turning point in ways I still can’t explain. For the remaining time I had off until the start of my next six-week rotation, I engaged in some major self-care, taking long showers, enjoying quiet walks, watching silly movies and cooking myself fabulous meals. Heading off to a different department of the hospital three days later, I felt like I was starting a new life. Several weeks after seeing the orbs, I walked into my house after a busy day on the medical wards and began sorting through the mail I had collected on my way in. My heart stopped when I saw the distinctive envelope with the United States Medical Licensing Exam address in the upper left corner. Inside, I knew, were my test results. Moving into the living room, I sat on the edge of the couch and stared at the envelope for a long time before opening it. That dark day seemed so long ago. Knowing I would have to face my results at some point, I turned the envelope over and slowly started to slide my finger under the flap, while in my head I began planning my strategy to take the test again. Opening the letter, all I read was “Dear Laurin, We would like to congratulate you…” I couldn’t read any further before choking back sobs of relief. I had passed my exam. I have no idea how I passed that test. I didn’t even remember it. Not a single question. Again, I thought of the orbs and made up my own mind. In my darkest hour I’d

had help. I thought of those orbs and knew that no matter what – or who – they were, I had not been alone. Which made me wonder, are we ever really alone? Do we always have help? I decided right then and there – and still I feel this way – that probably we do.

It has always been interesting to me how people will say with certainty and authority exactly what unusual and unexplained phenomena are, what they mean, where they originate and what their purpose is. I regard absolute answers about the nature of anomalous experiences with absolute suspicion – especially when everyone has a different answer, usually reflective of their underlying belief system. As a child of ten, I remember observing three high-level church members (one of them being my father, the pastor) disagreeing strongly about a theological issue. They each thought they were absolutely right and that the other two were certainly wrong. Furthermore, what stood out to me was their staunch refusal to try to see things from another perspective. I could see each of their points of view, and I remember thinking that they all sounded both reasonable and ludicrous at the same time. The conversational space was filled with auto-cycling recitations of their own viewpoints, and it was obvious that none of them was interested in seeing things another way. Rather than distress me to see three grown men strongly argue a nonprovable, philosophical position, it fascinated me. It set into motion an inner curiosity about personal truth that guides me to this day. Even at that young age I was thinking, “Wait a minute. If all three are saying that they know the truth, then who is actually right?” This led me to think that maybe in some way they all were right – or perhaps none of them were. Maybe they were just defending what seemed true to them. Wheels were turning, and my concept of personal opinion was born. Lying on the grass in my yard later that same afternoon, staring up through a giant, fragrant magnolia tree, I remember watching shifting clouds take different forms as they moved out from land toward the Gulf of Mexico. I was keenly aware that, as the fluffy white matter assumed different shapes, they were at their very essence still clouds – one hundred percent. Just because their forms shifted and morphed, they were no less clouds, I reasoned. The absolute truth was that they

were clouds. The relative truth, however, was that their outer form in that moment took on different expressions and manifestations of what they were, based on the atmospheric conditions and the observer’s interpretation. Staring into the sky, I saw turtles shifting into cars then twisting into castles, ice cream cones and dragons, all while remaining clouds. Perhaps that is the case with encounters with blue orbs of light that patients have shared with me and that I have experienced myself. Maybe, like clouds, they are centrally the same in content, with the relative truth of what they are emerging out of particular situations and specific need. I don’t know with certainty what these orbs are, and I’m not sure I really need to. Perhaps their magic lies in the fact that they may be whatever is needed at the time – an angel for Carlita, a healer, a comforter, the essence of a deceased relative, or in my case, a couple of compassionate companions who knew enough about medicine to help me pass that test and keep me company during a very dark hour.

“Reality is merely an illusion, albeit a very persistent one.” – Albert Einstein

care providers I have known – from hospice workers to nurses and M any palliative care physicians to family members – convey a rich repertoire of patient experiences of purported visits from the unseen shortly before the moment of death. These reports of visitors range from relatives to beings that some in our culture would call angels. I’ve even had the privilege, on rare occasions, of being present in a patient’s room near to the time of their passing as they report strange things that defy explanation and that they themselves, even while still quite coherent, struggled to describe. Interestingly, many healthcare providers will more readily talk about bedside visitations in extreme illness or at the end of life where death is imminent, even if they don’t believe in near-death experiences. I suspect that the need to explain buckles under the weight of the frequency of occurrence. Providers, especially nurses, are exposed to it so often that even the doubters have to acknowledge that something mysterious and inexplicable is happening. It’s not very often that I have personally witnessed patients experiencing bedside visitations – apparent interactions with entities we can’t see that clearly they can – but it has happened. More often I’ve been privy to family member accounts (even my own) as they share with me in awe and soft whispers what they’ve observed as they hold vigil, awaiting their loved one’s passing. “He’s been having a conversation with Mom,” they might say. Or, “Can’t you see him? He’s right there waiting for me,” a patient may muse in wonder. What seems different about these events in particular, setting them apart from hallucinations or delirium, is that patients are often very coherent with family and staff. They don’t seem delusional or even subject to confusion in

these moments. Perhaps they are having hallucinations of some kind, but it is hard to discount what they report while they simultaneously interact in a normal way with us. Having witnessed lucid and oriented patients interact with something or someone that’s not visible to us makes it difficult for me to pass it off as a misfiring of a dying synapse. It quickly becomes clear to all involved that they can see something we can’t. Often there is an expression of wonder from the patient and the families when it occurs. Of course, not all patients are clear and coherent so close to death. I have also observed patients who, after hours or days of being unresponsive, suddenly become acutely aware of their surroundings in a way that totally excludes those of us bearing witness. Having someone emerge acutely from a state of not responding at all to seeing and interacting with something they apparently see that’s so important to them that they actually ignore us, certainly stands out! One of my most memorable encounters with the mystery of bedside visitations happened when I was an internal medicine resident doing a required oncology rotation. The cancer ward also served as an inpatient hospice, and we took call for both. When you are a resident physician in training, you usually are on call overnight in the hospital. You can sleep there during your shift if it’s not busy, but the accommodations are not exactly luxe. The oncology ward where I trained was a separate wing set apart from the rest of the hospital and, oddly enough, connected to the Children’s Hospital, although we only cared for adult patients there. The isolated call room where we slept when we could was literally nothing more than a closet with a bed wedged into it. It was quite drab, with no window, and the lighting was either blaring or pitch black, so I spent as little time in there as possible. I preferred hanging out in the nurses’ work area in the early evening until I was tired enough to become blind to the claustrophobic feel of the tiny room. If the overnight workload permitted and admissions had slowed, it was a good idea to catch at least a couple of hours of sleep in order to make it coherently through the next day. One of the hospice patients on our service at that time was a 63-year-old woman with breast cancer that had metastasized to her brain, lungs and bones. Her body was wracked with pain, and as her condition deteriorated and her body continued to waste away, she became so weak she could not move of her own accord. It took generous doses of morphine and several nurses to be able to move her for her daily care needs without causing considerable discomfort.

Earlier in the week, there had been a family meeting that resulted in a shift in her treatment goals toward palliative care. It was the pivotal point where we all understood that we were at the stage where we were no longer prolonging her life but prolonging her death, so we all agreed to keep her comfortable until she passed away. There would be no more chemotherapy, no more radiation. In keeping with the patient’s wishes, she was placed on pure comfort care, and nothing other than those measures necessary to relieve pain and suffering would be administered until she died. For the next few days, family members and friends drifted in and out to pay their respects and hold vigil. One particular evening when I had the overnight duty, I was heading to a small workroom near the nurses’ station to catch up on some of my documentation. As I passed the patient’s open door, I noticed a woman whom I recognized from the family meeting earlier in the week sitting at her mother’s bedside. The overhead lights had been turned off for the evening, except for a small bank of track lighting above the bed casting an indirect glow toward the ceiling. It was comfortably dim. I leaned into the room to ask quietly how things were going. The daughter seemed in a mood to talk, so with nothing much else happening on the ward, I pulled up a chair in the room’s soft light and we began chatting quietly. It was an easy conversation and seemed to be a comfort to her. As my eyes adjusted to the low light of the room, I could see the patient lying there more clearly. She appeared weak and her breathing was so shallow as to be barely perceptible. It wouldn’t be long now until she passed, I surmised, and I could certainly understand why her daughter was reluctant to leave her side. We had been sitting there a few minutes, talking about nothing in particular, when we began to hear murmuring coming from the patient’s direction. Turning our attention to her, we noticed that she appeared to be having a conversation. This seemed odd to both of us because she had not been responsive at all for the past two days, and even before that had not done much more than utter moans or random single sounds. Although her body hadn’t moved on its own for several days, she then began to add subtle hand movements as one would in the course of normal conversation. It seemed absolutely conversational, complete with pauses and subtle head gestures, suggesting that she was listening when she wasn’t talking. Her daughter and I fell into silence watching her, leaning in to try to make out

what she was saying. But despite the conversational cadence, it was only distinguishable as mumbles. This went on for about ten minutes, when she suddenly opened her eyes and seemed to focus intently on something in middle space. Her daughter tried to speak with her, but there was no recognition or acknowledgement. Her mother’s eyes looked past her and up, toward the corner of the room. Then her attention shifted to an area of the ceiling above, requiring her to turn her head from where she had lain for the past few hours on her right side. Her daughter moved forward in fascination to observe her mother, but said nothing. After staring into the area above her bed for several moments, she began to make movements, attempting to sit up. Her daughter looked at me and we both exchanged amazed glances at what we were seeing. We understood that we were witnessing something quite extraordinary. This woman had not moved for days, and certainly not without complete help or immense pain, but now she was moving with relative ease and gave no indication of any discomfort. She seemed to be engaged in a process that clearly did not involve us, so we simply watched in awe and let it unfold. Then in one deft movement, she pushed herself up to a near-sitting position, leaned forward and lifted her hand up as if reaching for something. She then said very clearly and with obvious surprise, “You’re here!” I heard her daughter begin to softly cry, and I sat back just to be present to whatever was happening. The patient maintained this position for thirty seconds or so, and then, as if being lowered by unseen hands, slowly lay back down on the pillow. With eyes closed, she exhaled deeply her last breath – and died. We sat in silence for a long time, neither of us knowing what to say but clearly aware that something mysterious and wonderful had just taken place. Finally, with tears streaming down her face and her voice trembling, her daughter said, “I’m so grateful I was here to witness that.” I was too. I think that was the moment that I fell in love with the mystery that surrounds death and dying. Since then, I have had other occasions to marvel at things that neither I nor anyone else can adequately explain. Although it seems to be our default setting to be dismissive of things we don’t understand, reason them away as a neurological phenomenon or a second wind a patient captures after adequate rest or appropriate pain control, or avoid dealing with them entirely, I believe there needs to be more room to acknowledge – and appreciate – things that lie

beyond what we intellectually grasp. It can be enough just to enjoy the mystery and observe something in reverent awe without fully understanding it. And being able simply to greet mystery, without demanding that it explain itself, often invites more. Just as with any friend, a gracious welcome may open the door for more frequent visits.

I had my own strange experience of observing what seemed to be a bedside visitation when my grandmother was dying. She’d had a gradual descent into vascular dementia over the years leading up to her passing, and was nearly totally withdrawn toward the end. She wouldn’t interact, she wouldn’t eat, and with her increasing failure to thrive, she was clearly dying. A few weeks before my grandmother’s death at age ninety-one, hospice became involved and spent a great deal of time in her home, both caring for her and comforting my grandfather. When her decline accelerated, I flew in from my home in the upper Midwest to spend whatever time I could with her. I remember my grandfather, knowing I was a physician, sitting at her bedside when I arrived at the house, looking at me helplessly and saying through thick tears, “Is there anything you can do to save her?” “No, Grandpa,” I replied. “It’s her time.” He nodded sadly and turned his attention back to her wrinkled hand, which he held and caressed with such love and tenderness that it broke my heart. By this time she was totally unresponsive, and it was not clear to us what she did and did not understand. Could she hear us when we told her we loved her? Was she suffering in ways she couldn’t tell us? With the help of the hospice nurses, we gave her morphine under her tongue if she moaned, and we repositioned her periodically, trying to guess at what would make her most comfortable – but we couldn’t know for sure, and we frequently found ourselves feeling quite helpless to meet her unspoken needs. One night I was up late with one of the hospice nurses, who were by now staying in shifts around the clock. We chatted quietly now and then, but mostly we sat in the dim silence of my grandparents’ old Southern farm home, not saying a word. Suddenly, my grandmother began talking. It was hard to understand, but it seemed as if she was carrying on a conversation. All that we could understand was when she gazed softly with a faraway look in her eye and

said, “Almost there. Almost.” “She must be getting close,” the hospice nurse said. “She’s starting to talk.” I knew what she meant, having had patients of my own who had apparent discourse with a presence none of us could see. It was tough seeing my grandmother dying. Although by all appearances a simple farmer’s wife, she was one of the most naturally elegant people I knew, and I had always admired her for her calmness and grace. Even with drama erupting all around her, she seemed to maintain a cool and centered calm – one I sought to emulate but never quite succeeded in doing. Not the way she did, anyway. Having witnessed my patients’ beside visitations, I was deeply moved to be able to experience this with someone I was so close to. What happened next was strange. Had I not experienced it first hand, I would have harbored skepticism, but because I was witness to it, I can only report my experience. At the risk of reading meaning into something that was a natural occurrence and strictly coincidental, I chose then to embrace a way of understanding it that brought me the most comfort. In doing so, I gained insight into why my patients and their families might do the same, believing with their whole heart that what they experienced was real. What happened was meaningful and real to me. I now understand that similar events are meaningful and real to them. A day before my grandmother died, we noticed two doves right outside her window, perched on the back of the pale green metal glider that had been on their front porch for years and was now partly rusted from the ever-present humidity of the deep South. Those doves never left. More often than not, they were looking at the window of my grandmother’s bedroom, seeming to try to peer through it from time to time. Occasionally there was a soft peck at the window, and we would look up to see one or both of the gray birds ruffling their feathers and pacing back and forth along the back of the glider. Glancing through the window and cooing softly, they seemed to be watching her. After a day of tending their perch outside my grandmother’s window, just hours before she died they became very agitated, pacing up and down along the back of the settee – roosting, fluffing, then settling over and over. They seemed restless. Around the same time, my grandmother’s conversations seemed to pick up. She talked and gestured with her eyes closed, quietly, but very purposefully. Occasionally, we would understand a word here and there, especially on the

occasion that she would reach her hand out and say, “Almost. Almost.” We would also hear her talking about roses. “Oh, look, a rose,” she would say, or “A rose, so beautiful.” My grandmother loved her roses and tended to them faithfully. It seemed so fitting that in her dying moments she would somehow be presented with the image of roses, and it was a great comfort to us. Moments before she took her last breath, the doves became especially active. One in particular kept flying off a short distance, and then coming back. We were fascinated. Aunts, uncles, cousins, my mom and grandfather all took notice. Once, when my grandmother had a very long pause in her breathing, both doves flew away a short distance, only to return when her breathing resumed. Then after several moments of her taking long pauses, stopping breathing, then starting again, she took her final breath. At that moment, when it was certain she would not breathe again, the two doves took off in a flurry and flew away. We never saw them again, and my grandmother never took another breath. She was clearly gone, and we mused among ourselves that perhaps she’d had company on her way – escorted by two gray doves that had kept vigil for those long hours. It comforted us to think so. None of us had ever seen doves there before – not the children of my grandparents who had grown up in that house, nor the grandchildren who had spent many lazy summer days playing on that front porch. And since my grandmother’s passing, we’ve not seen them again. Ever. What happened next, though, truly defies logic. Keep in mind that my grandparents were farmers, as were their parents and ancestors before them. They were intimately familiar with their land. In fact, my grandfather inherited the land from his father, and had been farming it since his father’s death when he had to drop out of the small grade school not far down the red dirt road to support his family. There wasn’t an inch of that eighty-acre plot of land my grandparents and our entire family weren’t familiar with – an area in northern Florida where generations of Registers, Carswells and Outlaws had farmed peanuts, cotton and occasionally sugar cane. In fact, tucked right up against the borders of Alabama and Georgia, along a vast network of winding red dirt roads, they knew every sound and wind shift that occurred on that land. So it amazed us that a few moments after my grandmother died and the doves had flown away, we all heard what sounded like a horn play several sweet

notes in the field right behind the house. The field was totally empty for the season – the bare cotton stalks had only a smattering of white cotton remnants still lingering in the few pods that had resisted the harvester several weeks earlier – but the sound of the trumpet-like horn was very close. Even younger cousins who had been playing in the back yard came running in to tell us they had heard a horn playing in the field near them but couldn’t see anyone. No one could explain it. There were no radios or televisions on. We had all been quiet and reverent before and at the time of my grandmother’s passing. No vehicle had passed the remote dirt road outside their modest farmhouse. It’s the kind of story that had I not experienced it personally, I would be tempted to discount it as made up, thinking that “you hear what you want to hear.” Yet we had all heard the horn, and we could only just stare quizzically at one another and contemplate what had just happened – the doves, the horn sounding. No one said a word. Finally, it was a hospice nurse, a gentle black woman, who broke the silence and said, “Now that is only the second or third time in all my years that I have heard that trumpet right after somebody died.” She was so matter of fact about it. I admit it was comforting to have her validate our experience, her simple words reinforcing its meaning for us. I can’t logically explain what happened, and I don’t really feel a need to. Whether or not it was a totally random, collective auditory hallucination misinterpreted from another perfectly natural sound or not, I can’t say. But it happened. All of us who were gathered at my dying grandmother’s bedside – both inside and outside of the house – experienced it. Bearing mutual witness to this thing that we can’t explain during a moment of shared grief still holds deep meaning for our family. That is all the explanation I need, and it brings me comfort. I have wondered since then, though, if meaningful moments are delivered to us in our time of need through the filter of our mutually agreed-upon belief systems. In the biblical South, doves and trumpets hold deep symbolic significance around death. Psychiatrist Carl Jung wrote about the collective unconscious of the human species and the power of deeply embedded symbols to impact our perceptions. I would imagine that our unconscious selves also inform how we interpret a shared experience that cannot be readily explained. If we were an Asian family, would our attention have been drawn to events and objects in groups of four – a number symbolically associated with death in

many Asian cultures? If we were a Muslim family, would we have heard an unseen horse whinnying with hooves pounding, ready to escort our loved one’s spirit across the divide of conscious and unconscious existence? I don’t know, but because culture deeply influences our experience of life, it makes complete sense to me that it would also influence our experience of death. These powerful images are part of our rituals of shared grief, and may be part of our collective experience that can comfort us at the passing of our loved ones.

One of the most memorable bedside encounters I’ve had the privilege of hearing was that of a woman named Alice. She was gravely sick, but despite the touch-and-go course of her illness, she ultimately did not die. She did, however, experience a visitation. Alice had a teenage nephew, Corbin, with whom she shared a special bond. She had watched over him during his early years before he started school while his parents both worked. During his elementary and junior high school years, the bus would pick him up and drop him off at her house until his parents could collect him after work. He was not an only child, but he was the youngest, being born much later than his older brothers and sisters. The sibling next in age to him was still sixteen years his elder, so he seemed like an only child and received a lot of love and attention from his parents, his brothers and sisters and his favorite Aunt Alice. Corbin was one of those easy-going kids who was easy to like, at home and at school. He was popular and had a lot of friends. Good at sports and especially adept at math, he had plans of seeking a baseball scholarship for college and coming back to his hometown to be a teacher and a coach at the high school from which he would soon graduate. Shortly after his aunt was admitted to the hospital with severe pneumonia and respiratory failure, Corbin was driving home from a school event one evening when a drunk driver veered into his lane, hitting him head on and killing them both. Everyone was devastated at this senseless loss of such a promising young life. When the accident happened, his aunt was probably at her sickest and it was at a point in her illness when we were not certain whether she would recover or not. She had severe lung injury from her pneumonia, and her kidneys, which were not in the best shape before her hospitalization, had

become further impaired from her critical illness and she now required dialysis. As she started to show signs of improvement and it looked as though she would survive, they decided not to tell her about Corbin’s death. They feared that because she and Corbin had been so close, she would lose the will to live. They were a close family and just didn’t feel they could handle another loss. They knew they would have to tell her eventually, but for now they decided to let her get further down the road in her own recovery before sharing the sad news. When she finally turned the corner, she was awakened from her medically induced coma and removed from the ventilator that was supporting her breathing. Much of her family was there for the occasion. When she was able to talk, she looked at them all with so much sadness and love and said, “I know about Corbin.” There were gasps and murmurs of “who told you” and “we told the staff not to tell you.” They even looked at each other with misgiving, thinking that perhaps one of their own had divulged the devastating news. Her explanation shocked them all but also quickly righted an unsteady ship of suspicion of betrayal. With incredible love and gentleness, looking into her loved one’s faces and weighing her words, she softly said, “Corbin told me.” She let that information hang there a moment before she continued. “He came to me when I was so sick and he told me what happened. He told me about the accident and that it happened so suddenly. He assured me he didn’t suffer in the least. He saw bright lights, and then felt total peace. “He also told me I would get better because my family needed me. He wanted me to tell every one of you how much he loves you and how grateful he is for the good life you provided for him. He said he is in a beautiful place, and that he will never be that far away from us but that he will be busy now.” She continued, “When I asked him what he would be busy doing, he shrugged and laughed, saying he really didn’t know yet, but he was just told by a beautiful being of light, who met him when he left his physical body, to get some rest, because soon he was going to be very busy.” Even though the loss of Corbin was so unbelievably sad and heartbreaking, this unexpected visitation provided incredible healing for the family. And while it didn’t totally erase their grief or their sense of loss, it did provide immeasurable comfort and softened the pain. It offered peace to learn that Corbin was okay and gave them a healing topic of conversation as they laughed

and speculated about what new work was keeping him so busy. I sometimes wonder if those who say there’s no evidence of something beyond this existence perhaps aren’t really looking for it. I once had a colleague say that in all his years of patient care, he had never once had a patient describe a near-death encounter and he had never seen evidence of bedside visitations. “Did you ever ask patients about those experiences?” I inquired. He had not. It took a softened gaze through the lens of curiosity and awareness to open my own medically-trained eyes in order to catch the occasional glimpse of something more. Since becoming more open, I’ve experienced many things through the years that I can’t explain, and I honestly don’t feel a strong need to. As an occasional witness to things that defy our known physical laws and biomedical mechanisms, I’m quite comfortable marveling at the mystery without an incessant need to understand the how of it all, or to deny that it happened, just because I can’t fit it neatly into a scientific framework. The fact remains that we can’t explain everything with our current science, and we need to be able to live with that. Astronomer Carl Sagan was critical of scientists who couldn’t tolerate ambiguity, and he reminded them that the “absence of evidence is not evidence of absence.” I agree with him. But even though we don’t have a biomedical model and physical evidence for these experiences, the personal evidence I have witnessed during my years in medicine has only served to strengthen my suspicion that there is likely more to us than just this physical, earth-plane existence.

“Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened.” – Winston Churchill

one thing when other people don’t believe that something unusual I t’shappened to you. That is potentially negotiable. When you don’t believe an experience yourself, that is much more challenging to sort out. We all have our own beliefs about reality, often evolved out of cultural convention, and these constructs are in many ways quite helpful. They can provide a useful context and frame of reference that allow us to better understand information and relationships. Supported by the scaffolding of our belief system, incoming data more easily makes sense, and dialogue around new content within that agreed-upon framework can help us more quickly assimilate novel information in a manner that is comfortable and familiar. But occasionally something so dramatic and unusual happens that it can take a while for our understanding of reality to catch up with perception, or perception to integrate with our reality – and sometimes it never does. Thomas was seeing me in the clinic for a follow-up visit after a cardiac arrest that had landed him in the ICU. As critical care physicians, our team is frequently involved with caring for patients in the intensive care unit, regardless of their reason for being there – cardiac, surgical, injury or otherwise – especially if being supported by mechanical ventilation is part of the care plan. As such, when necessary, we will schedule a follow-up visit after they leave the hospital to make sure that any loose ends around their illness, as they pertain to our specialty, are tied up. It is often during these office appointments that I have more time to hear

what patients may want to tell me about their experiences, whatever they may be. After we had confirmed that he was doing well and having no lingering physical fallout from his illness as it related to pulmonary or critical care issues, almost as an afterthought, Thomas asked, “Can I tell you something strange that happened to me when my heart stopped? I’m not sure what to think about it.” “Of course,” I said. More frequently these days, for reasons not entirely clear, I find patients spontaneously sharing their deep and unusual experiences with me, unprompted by any inquiry on my part. “Well, on the day I had my heart attack,” said Thomas, “everyone was over at our house for a barbeque – the kids, the grandkids. Everybody. I was chasing the little ones around and apparently collapsed, although I didn’t feel a thing. Strangely, what I remember was laughing and running around after them and then suddenly hearing everything go quiet. Sounds were very far off, like a distant echo. I remember losing sight of the grandkids, but I was still running around the yard looking for them, wondering where they had gone. “I circled on around the house and eventually came back to where folks were hanging out in the backyard on the patio. I saw that everyone was gathered around, looking at something on the ground. I saw my wife crying, and the grandkids seemed startled by something. I wondered what was going on. I called out, ‘Hey, what’s happening?’ but no one responded. It was like they didn’t even hear me. I walked closer and realized that they were leaning over a person on the ground, and my son-in-law was doing CPR. He’s an emergency medical technician, you know, working on an ambulance, so he knew how to do that. I walked closer and realized that the person lying on the ground was me. My sonin-law was doing CPR on me! “I can’t tell you how strange that was, looking at a person on the ground that I recognized as myself. Apparently when I collapsed and my heart stopped, I just kept on running right out of my body! I could not wrap my head around it, especially when I was trying to talk to them, and no one answered me. I thought that I must be dead. For being dead, though, it sure felt so real to be standing there. I could hear and see everything so clearly. In fact, I felt very much like myself in every way. I just could not pull together an explanation for the weird experience I was having. I was standing there, watching my family gathered around a body that I knew to physically be me, but my awareness – or whatever it was – felt more like the real me than what I was witnessing. It was

pretty strange. “Not knowing what else to do, I just stood there watching: watching my wife and daughter crying, and watching my grandkids staring and looking so afraid. That’s when I saw Lexy, my two-year-old granddaughter, come toddling toward me with her hands stretched out, babbling, ‘Papa, Papa!’ That’s what she calls me. She was looking right at me and I knew she could see me. Why else would she be walking toward me calling my name? I was really curious about that. “She could see me, but she seemed to be the only one. I knelt down as she came toward me and she was almost there when her dad, my son, scooped her up. Clearly, my son didn’t see me. I still wonder what would have happened if she had actually made her way to me. Would she have been able to touch me, or would her hand have gone right through? I don’t know how long I stood there, but the next thing I knew, I was waking up in a hospital room a day or so later. It left me thinking I might be crazy, to be honest.” I know what it’s like to doubt your own experience, so, I made a point of affirming him. “I don’t think you’re crazy – in fact, I’ve heard of similar experiences during life-threatening events. It is incredibly intriguing and certainly invites you to rethink reality,” I suggested. “What has it meant to you to have that experience?” As our conversation continued, I realized that the more of them that I hear, the less crazy these expressions of altered consciousness outside of the physical body sound to me. But patients have only their own past experience and understanding to go on, and they are inclined to label themselves in negative ways for having these experiences. I hope that my curiosity and acceptance, and my giving them permission to tell their stories, helps them to accept what happened and try to make sense of what it means to them in a deeper way.

On a beautiful summer day in the upper Midwest, a deep, freshwater lake left over from ancient glacial melt was alive with recreation. High above the water, a parasail drifted behind a motorboat that pulled it along in sweeping, lazy arcs. The red and yellow silk of the parasail snapped crisply in the wind above Carl as he floated behind the boat, catching the lift-and-tug of random gusts of wind.

Immersed in the thrill of gliding, he was totally wrapped up in feeling vital and alive, especially when the distraction of a couple of attractive, bikini-clad young ladies, lounging on the hull of a boat far below him, captured his attention. Flirting began, and each time he circled around, there was more interaction. On his final time gliding by them, a strong crosswind caught him and sent him shooting laterally toward some utility wires, high on a bluff above the lake. He became entangled in the lines before falling out of his harness toward the water far below him. There are two versions to this story – our version and Carl’s version. In our version, established by witnesses to the accident, the parasail became entangled in the utility wires. Not being firmly secured in the parasail’s harness, Carl broke free from its straps with the force of the impact and plummeted into the water far below. He hit the water with tremendous force and apparently became unconscious. During the time it took the nearest boat to reach him, he began to drown. Ironically, the two women Carl had been flirting with arrived on the scene first and became his rescuers. Shocked and panicked to see him fall, they motored over to him as quickly as they could. They pulled him out of the water into the boat and, fortunately for Carl, one of the women was a nurse. When she found no pulse or spontaneous breathing, she began CPR while her friend called emergency services from her cell phone. Carl started regaining consciousness as they were heading to the landing where the ambulance would meet them. Not knowing the extent of his injuries, the rescue team stabilized him at the scene with a backboard and a cervical collar around his neck before transporting him to the trauma center where we became part of his care team. Carl’s version: “I was watching these two babes sunning on the their boat when this gust of wind caught me and hauled me over toward the bluff. I remember hitting the utility wires, then immediately floating up. I thought I had caught another gust of wind that freed me from the wires, but I was confused because I saw a red and yellow parasail still caught in the wires down below me. Then something moving caught my attention, and I was stunned to see a guy falling into the water. I remember thinking, ‘This is not going to be good when he hits the water,’ because he was flat out and not diving, you know. “The next thing I know, I’m staring up into the faces of these two lovely ladies and wondering how I got there. One of them told me I had almost

drowned when my parasail was caught in the wires and I fell into the water. It took me a while to figure it out, but, putting it together, I realized I saw my own parasail tangled in the wires and was watching my own body fall into the water below me! I have no idea how that is even possible. I must be a bit insane, right?” Carl said that last line lightheartedly, but he was looking at me intently to see how I’d respond. Did I agree with his assessment or perhaps think that something else was wrong with him? After I reassured him that his experience put him in good company and he wasn’t crazy, he relaxed. He became completely fascinated by what had happened to him. The fact that he was able to view his own near-drowning from a vantage point outside of himself was far removed from anything he had ever experienced or even thought about before, and the whole experience transformed what he knew about life, existence and the ability of consciousness to function separately from our physical bodies. And so it is for many people who have a near-death experience. Rather than gradually shifting from non-believer status to wondering if perhaps there is something to existence that we can’t explain, they are fast-tracked from notbelieving to knowing, bypassing skepticism altogether. They’ve suddenly been prompted to retract the anchor of limiting beliefs that they had previously firmly set down as to the nature of reality. Direct personal experience has gifted them the knowledge that there is an as yet undefined but real part of us that is susceptible to being unfettered from our physical bodies during moments of trauma, severe illness and extreme fear. Separation of consciousness from the physical body doesn’t always seem to require an event charged with fear, trauma or illness, however. Numerous people have reported spontaneous out-of-body experiences not preceded by a traumatic event. Lacking an easy explanation for why these are happening, those experiencing them often regard these events as confusing curiosities. I was dating a guy once who shared with me an incident that had occurred when he was a teenager as he slept late one weekend at home. Awakening with the awareness of lying sprawled out on his stomach atop his covers, his eyes still closed, he had the odd feeling that he was gently bobbing up and down with something tapping against his back when he would bob up. Confused by the sensation, he opened his eyes to find that his conscious awareness was bumping up against the ceiling of his room. Below him on the bed he saw his body

splayed out on its stomach in the same position he perceived himself to be in up against the ceiling. Understandably he was a bit freaked out, and the moment he began to panic – thinking that perhaps he was dead – he plummeted back toward his body. Feeling a swish and a pop, he turned over quickly, staring at the ceiling from where he had apparently just fallen. All he remembered thinking as he lay there on his back trying to wrap his mind around what had just happened was, “Man, that was trippy!” For a seventeen-year-old, that was probably a pretty good explanation.

Over the years I’ve had the opportunity to hear many other instances of spontaneous out-of-body experiences, not only from patients but also from friends and acquaintances. Most of them realize, at some point, that something unusual is happening and eventually piece together that they seemed to have experienced their mind being aware outside of their physical body. What is curious to me, though, is when they don’t have that realization. There are times when they believe that an experience they had out of their body was an absolutely real experience they had in their body, and they can’t conceive of it having any other explanation. Their anchor of belief is firmly out and securely planted. Don was a trauma patient in traction who was convinced that during a time when he was physically unable to move, he got out of bed and walked around. He had entered the ICU a few days earlier through the emergency department, where he had been delivered by helicopter from the scene of a terrible accident. He had multiple broken bones requiring complex splinting and immobilization, badly bruised lungs and a twitchy heart rhythm problem from a severe cardiac contusion, which he had sustained when his chest hit the steering wheel with considerable force. With a head injury that rendered him unconscious, beat-up lungs, and broken ribs that left him needing a ventilator to breathe, Don was totally immobile. Days later when he regained consciousness and was liberated from the ventilator, he told us about a very unhappy night when he was trying to get the nurse’s attention because he needed to go to the bathroom. He was apparently unaware in that moment that he had tubes in every orifice to take care of basic

body functions, and that because he was connected to the vent and had his badly broken leg suspended in traction, it was not possible for him to move on his own. He tried pushing the call light, but couldn’t make it work. He yelled out for his nurse, but no one came. When his nurse did come in several minutes later to do routine vital checks and administer his medication, he started talking to her, but she did not respond. From his perspective, she carried on quietly with her assessment and care, while totally ignoring the fact that he was talking to her, and then left without saying a word. He perceived that his nurse was purposefully ignoring him. Nonplussed and totally frustrated, he got out of bed and headed out of his room, intent on giving the nurse a piece of his mind. In our physical reality, though, Don was so hooked up that he couldn’t possibly turn over, let alone get out of bed and search for his nurse. Furthermore, we know exactly what night this happened, because the red-headed woman he was looking for was a visiting nurse who had finished her two-month stint with us by working a night shift – that night shift – before moving on to her next assignment in another city. Don described getting out of bed and leaving his ICU room through its sliding-glass doors. Not seeing anyone, he followed the sound of voices around the corner until he found a group of nurses sitting at a central station, chatting and working on the computers. It was a work center he couldn’t see from his room that he later described in perfect detail. Walking up to them, he spotted his nurse and started talking to her, but she did not even acknowledge his presence. He tapped her on the shoulder. Still nothing. By this point he was pretty irate at being ignored, so he turned around and leaned against the counter where the computers were as his nurse continued to work on her charting. He crossed his arms and stared at her, thinking, “I’m going to stay right here until she notices me.” She never did. Finally, exasperated, he gave up. Harboring thoughts of how rude his nurse was, he stomped back to bed and went to sleep. A couple of weeks later, his complex orthopedic procedures behind him and his internal organs nearly back to baseline, he was weaned off sedation and disconnected from the ventilator. As the respiratory therapist removed the vent tubing, he was bursting to tell those of us gathered at his bedside what had happened the night he perceived himself getting out of bed to find help. It

wasn’t due to his realization that something extraordinary had happened, however. He was still incensed by the perceived unprofessional behavior his nurse had demonstrated by totally ignoring him. I asked him to give me details, and he did. Suspecting he’d perhaps had an out-of-body experience, I asked for as much information about what he perceived had happened to him as I could. Feeling pretty frustrated, he was happy to share. I asked him to tell me more about the area he had observed and who he had seen. He described the nursing station perfectly, even down to the ice machine, blanket warmer, and supply cart, though it would have been impossible for him to physically see those things from the bed he occupied – or any ICU bed, for that matter. He also described the nurse with the short, wavy red hair who had already moved on to another hospital long before he’d been awakened from sedation and removed from the vent. When I brought up the possibility that perhaps this could have been an outof-body experience, he just stared at me blankly for several seconds, appearing a bit dumbfounded, as if he was processing what I had said. Finally, seeming to make an internal decision that what I had suggested did not compute, he moved on with the conversation from where he had left off, maintaining that the nurse was out of line for not attending to him and should be reported. We could do nothing more than apologize for the unfortunate experience that had clearly caused him so much distress and reassure him that it would be looked into. It didn’t seem to occur to him that something other than a physical experience had likely happened to him that night, despite the fact that he was in traction and totally immobilized. I could tell by how he was responding to me that what I had suggested made no sense to him at all and was so foreign to what he believed to be true about reality that he tossed it out as extraneous noise and moved on. So I moved on with him, dropping the topic as if I had never raised it. Recalibrating and back on track, Don continued to focus on his disappointing experience that night. I simply said, “I’m so sorry that happened to you. I will have a word with the night shift manager.” To which he responded, “Good!” The nurse even told him that she would provide him the avenues to register a formal complaint if he chose to. Apparently satisfied with the outcome, he was done and moved on to other topics. But knowing that he had been immobile and unconscious, and knowing the level of professionalism and the attentive care provided by our

nurses, I concluded that he had more than likely had the unusual experience of his consciousness exploring his surroundings on its own while his physical body lay firmly sedated in the bed, unable to move. We have all had dreams that are so vivid, so real, that it is hard to tell if what we dreamt really happened or not. Certainly it is possible that Don had had a very vivid dream. But even though he was clinically unconscious, he was describing specific details about his nurse and the station where she was working that he couldn’t possibly have known, except to have witnessed it first hand. Even after waking up and being taken off the ventilator the day I visited with him about his experience, he was still bed-bound and unable to walk. There is no way he could have physically seen the area he described so accurately. Something similar happened to Carole, an elderly lady who was very sick with many of her vital organs struggling under the assault of a serious infection that was causing septic shock. The illness had originated from a severe urinary tract infection that had spread throughout her whole body, inflicting widespread damage. Although she was seriously ill in the beginning, we were able to stabilize her, and it became clear that she would likely survive although she had a long way to go before she would leave the ICU. Her kidneys had been particularly affected and she had even spent a brief time on dialysis before her renal function began to improve. Part of her kidney injury syndrome, called acute tubular necrosis, involved what is referred to as a diuretic phase, meaning kidneys that have been stunned, injured, and shut down are back on line and suddenly making a lot of very dilute urine. In this stage of recovery, the kidneys are trying to work their way back to their functional baseline. Even though the kidneys are making a lot of urine, they are still not able to concentrate it very well. Because the bladder is distended if urine is being made faster than it can be drained, it can cause the patient to feel they have to go to the bathroom. If they are awake and have that feeling, you can remind them that they have a tube in their bladder and that they don’t have to hold it. Then they relax, urinate into the tubing, and the feeling usually goes away. But Carole was not awake on the day she perceived she had to go to the bathroom. Based on the description she gave us later of the staff that she had tried to interact with, we knew roughly what day her unusual event had occurred, and that she had been fully sedated and was not conscious at the time. Just like Don, Carole was so

hooked up and plugged in that she could not have possibly left her bed in the way she was convinced she had. She recalled seeing a nurse in her room entering data into a computer that was mounted on the wall. She told the nurse she had to go to the bathroom, but got no response. “I tried to get her attention,” Carole told me, “but she just ignored me. I called to her several times, but she didn’t respond. She kept her back to me the whole time, and I’m sure she could hear me. Then she turned around and started listening to me with her stethoscope and did not even acknowledge me even when she was this far from my face,” Carole said, emphatically slicing the air with upright hands that she held about a foot apart. “She pretended that she couldn’t hear me talking to her. Unbelievable! “I finally got so frustrated,” Carole recalled, “that I got out of bed to go find a bathroom myself. It was clear I was going to have to take care of the problem on my own, because my nurse was ignoring me.” And so she did, or thought she did, anyway. “I got up and went to ask someone else where the bathroom was. I saw a receptionist and asked her for directions, but she ignored me, too. I got her name though,” she said, tapping her temple with a forefinger to indicate it was stored securely in her memory. She grinned briefly at her own cleverness, but there was absolutely no mirth reflected in her eyes. Carole was mad. “It was Meg, and she had short, spiky blond hair with dark roots.” Now I was really intrigued. Meg only worked part time, and the last time I had seen her working was a couple of days prior to the patient’s waking to tell me about her experience. She wasn’t working the day Carole and I talked. In the days before she was removed from the ventilator and able to converse with me, Carole was still under deep sedation with a tube in her bladder. Plus she was on the vent at the time and would not have been able to talk in the way that she was describing. There would have been no possible way for her to climb out of bed and leave her room in order to converse with the secretary she described so accurately. Curiously, she perceived herself as not only observing the actions of people we could confirm were there, but actually communicating verbally and walking around. Carole continued her story. “When that Meg lady ignored me too, I thought, ‘Fine! I’ll just go find the bathroom myself,’ so I left the ICU to look for a bathroom.” Knowing she would have had to pass through hydraulic double

doors that can only be opened by pushing a button on the wall several feet before reaching them, I was tempted to ask her if she had actually opened the doors or gone through them. She didn’t mention trying to push open the door, which would have been difficult to do manually, or pressing the button to activate them. I restrained myself and just listened, offering sympathy for her frustrating experience where it seemed appropriate. She went on to explain, “I walked around the halls and could not find a bathroom anywhere, so I said, ‘Who cares! I’ll just get back in bed, lie down and pee. I guess they will notice I had to go to the bathroom when they have to clean up the bed.’ And that’s what I did.” Now, I don’t know if her collecting bag had an influx of urine associated with her perception of letting loose, but that is certainly interesting to think about. I suggested to her in the most straightforward way I could that perhaps she’d had a nonphysical experience – an out-of-body event – but that concept did not fly. She was firmly convinced that what she experienced had physically happened. In fact, she seemed on the verge of being insulted that I would even insinuate otherwise – that perhaps I thought she was lying or that I was making excuses for the staff. I quickly switched gears, affirming that I certainly believed her and tried to be supportive. Even so, she was mad enough that she said she was going to file a complaint with management – and she did. Her firmly anchored interpretation of reality was not budging, and she was convinced that what she had perceived was real enough to put pen to paper in order to tell us how inattentive and rude our staff had been.

I often wonder about the power of limiting beliefs to obscure our ability to see things a different way. So firmly rooted are our tightly knit convictions that sometimes, when something occurs that is beyond our understanding of reality, we instinctively set about gathering up those bits that have escaped the confines of what we think is possible and try to neatly tuck them back into the framework we recognize and are comfortable with. I imagine that our psyche, faced with the temporary fallout of a shattered reality, quickly and deftly reframes incoming anomalous information into a pattern that we understand, no matter how poorly that framework may fit the data. It may well be a process so automatic that we don’t even realize it is happening – and so, we stealthily

sidestep the challenge of having to develop alternate explanations for the strange things that cross our path. Usually when people recount an experience to me where it seems their consciousness was clearly separated from their physical body, they realize it, as did Thomas and Carl. At some point during the event, they become aware that something unusual is happening, even though it may take them a while to realize that what they perceive doesn’t quite add up to their understanding of reality. Although they might be distressed by it initially, most seem to shift their understanding pretty quickly. They are able to recognize that something out of the ordinary realm of experience happened to them, even if those around them don’t believe it. But sometimes the opposite happens, as with Don and Carole, and they themselves can’t accept that something quite extraordinary occurred, even while those around them strongly suspect it did. Working in a trauma ICU, I frequently see patients who have been in very bad accidents. Most of those we treat don’t recall anything at all about the accident. There seems to be a protective veil of forgetfulness that descends, and the last thing they may remember is, “I was slamming on the brakes” or “Something was coming at me before I blacked out.” Then there are those individuals who recount experiencing a distinct out-of-body event where they seem to be able to consciously view and recall the scene from a vantage point outside of themselves. Perhaps both mechanisms – the lack of recall at the moment of trauma as well as the ability to witness our surroundings and our injured body from outside of it – are natural phenomena that evolved to protect us from the vivid impact of trauma and also help us cope. Maybe they are simply natural tools we all possess at varying levels of manifestation when we need them. But the lack of recall is more accepted, because it more readily fits our understanding about how we cope with trauma. Witnessing our surroundings from outside our body is less likely to be recognized by us if we are experiencing it ourselves, and less likely to be part of our inquiry if we are caregivers. Due to our limiting beliefs that anchor us about how the mind and body react during trauma and illness, it doesn’t occur to us to ask about those experiences – and as I noted earlier, one reason people don’t hear about them is because they don’t ask. We can easily not perceive something blaringly obvious that is right in front of us if we don’t ask about it or are not looking for it. A good example of this is

the short film many of us have seen, courtesy of our Human Resources departments during team-building events, where we are asked to watch a group of people wearing two different colored shirts pass a basketball back and forth and keep track of how many times each team possesses the ball. In doing so, many of us don’t even notice the person in a gorilla suit walking into frame from stage right, pausing halfway to wave to the camera before wandering casually off the screen in the opposite direction. Only when we are asked to watch the film again, with the specific intention of spotting the gorilla, do we actually see it – and we are mystified by how we could have possibly missed something so obvious. Similarly, we need to let ourselves see what’s going on beyond the medical task at hand. Scientific progress starts with observations we can’t explain – and perhaps even more importantly, it starts with our belief that those observations are potentially significant. Alexander Fleming’s response when he returned to London from vacation in September of 1928 was not that his petri dishes cultivating Staphylococcus aureus – a common bacterial source of human infection – were contaminated and needed to be discarded, but that they were contaminated and needed to be investigated. Under the microscope, he found that a mold had inhibited the growth of the bacteria colonies, and he concluded that the mold might be valuable in treating infections. The work that followed in understanding antibiotics and applying them to disease states resulted from his not dismissing his initial observation, but being willing to investigate and try to explain it. Adopting this perspective, I believe that our observations of near-death and out-of-body experiences are simply the beginning of developing a scientific understanding of them. At some point, these phenomena will be much better understood than they are at present. In fact, we do understand some states of consciousness far better now than we did even a century ago. Sleep states and psychiatric disorders are classic examples. How were we to know then that serotonin, dopamine, and norepinephrine play such direct roles in mood and sleep regulation until someone discovered they did – and in doing so, let us move beyond our previous explanations for these events? Clearly, we don’t know yet how or why a separation of human consciousness from the physical body happens. It is likely that our growing understanding will move it from the realm of mystical experiences to something

explainable, adhering to the laws of our physical universe that our current beliefs about what is possible prohibit us from seeing clearly. Just as we have learned that the brain is not composed of sharply demarcated phrenologic modules, as we previously believed with our rudimentary seventeenth-century understanding, we now know that brain function is a complex network of electrochemical communication, rapidly coursing back and forth along neurons and synaptic spaces. In the same way, one day we will no longer be restricted by our limited understanding of human existence as merely a function of what we currently understand of biochemistry and physiology. There is still so much we don’t know and can’t explain. With the weighty anchor of constricting beliefs lifted, we may eventually be able to peer beyond our current scientific limitations and understand phenomena of consciousness that we presently consider strange and unbelievable.

“There is no point in using the word ‘impossible’ to describe something that has clearly happened.” – Douglas Adams

recently sent me an article about post-traumatic stress disorder A colleague (PTSD) in ICU patients. It was stunning to me on reading it that, after so many years of caring for the severely ill, I could have overlooked something so fundamental that makes so much sense: critically ill patients are at risk for posttraumatic stress disorder. In the haze of a drug-induced coma, where we are regularly manipulating the patient and their environment, their battered consciousness struggles to make sense of the tactile and auditory input it receives through the weighty filter of illness and medication. That much psychic stress, no doubt, takes its toll, and the emotional fallout certainly has the potential to leave a mark. I’ve had the direct experience of patients misinterpreting an external stimulus as something other than what those of us caring for them knew it to be. There was the man with a breathing tube down his throat who thought he was drowning, a teenager who swore he was in police custody against his will due to the soft restraints we used to keep him from tearing away his surgical dressing, and, sadly, a woman who was having a catheter inserted into her bladder so she wouldn’t wet her bed who was convinced she had been sexually assaulted. The list of incidents of patient distress I’d encountered unfolded rapidly across my memory as I read the studies that identified post-traumatic stress in critically ill patients and how to help them cope. It troubled me and immediately evoked the question, “What is there to be done to help these patients process and correctly interpret what is happening to them so that they can move

forward from their trauma in a healthy and integrated way?” The current understanding is that, just as with military personnel dealing with a traumatic combat experience on their own, patients left to struggle alone with the memories of their illness and recovery often carry forward deep-seated emotional scars and all of the classic signs of PTSD – recurrent and uninvited memories that are distressing, all-too-real flashbacks to traumatic events, and severe emotional distress (or even physical reactions) when they are reminded of the event. As I followed the trail of available data and initiatives aimed at helping patients better cope with the outcomes of their hospitalization, I couldn’t help but wonder how near-death experiences entered into this concept. It is not a stretch to compare the denial or dismissal of a patient’s misinterpretation of actual documented events of medical care with the denial or dismissal of a powerful and significant perceptual experience along the spectrum of consciousness. Clearly, patients often have increased emotional distress when medical professionals, or even their family and friends, tell them that a deeply personal near-death experience they’ve had during a medical crisis couldn’t possibly have happened – that it was a dream or a medically associated hallucination. By now, it should be obvious that telling them it didn’t really happen is not helpful. It also stands to reason that extending the courtesy of supporting a patient’s reality for which we have no ready explanation – without judgment or interpretation – would be very helpful.

Helen had been in a very bad car accident. She had broken both of her ankles and had to be extricated from her car through a long and tedious process. The first responder’s documentation of the accident indicated she was unconscious at the scene the entire time, and our hospital records revealed she didn’t begin to awaken from the fallout of her injuries until several hours after the crash. Yet she recalled the scene of the collision clearly and vividly, including an experience our carefully recorded medical records did not document. She didn’t remember the actual impact that crumpled four vehicles at an intersection. What she did remember, however, was shortly after the crash, getting out of her car in somewhat of a panic, with the intention of surveying the damage and making sure everyone was all right. She knew how many vehicles were involved – there were four – and that one was a gray floral-

delivery van with company decals on the side, composed of blue writing superimposed on a spray of red roses. That was correct. This was also something she shouldn’t have actually known because she was unconscious at the time. She described walking over to a dark-green, four-door sedan that was smashed against her hood at a sharp angle where it had hit her from the left side after running a stop sign. She described the dark-haired man with a beard, slumping over the steering wheel, moaning. She correctly concluded that the impact of the two vehicles – her car and the bearded man’s – had been the initial catalyst that had created a pileup when the delivery van that was behind her and the white SUV behind it couldn’t stop in time. She noted that the van had slammed into the back of her car, causing it to be wedged like an accordion between the green vehicle and the van. This left her pinned in and unable to move – physically, that is. The white SUV merely rear-ended the delivery van behind Helen, and the woman driving seemed none the worse for wear. Helen pointed out that it was this driver she had heard making the call on her cell phone to emergency services, as clearly as if she were right beside her. This was also correct. The driver of the least damaged vehicle, the white SUV, had indeed made the initial call for help. Helen was unresponsive and trapped in her car, according to the paperwork. Her consciousness, however, seemed to have surveyed the scene and remembered it accurately from a vantage point not just outside of her vehicle, but also actually outside of her physical body itself, which was still trapped in the car. She knew the driver of the delivery van was relatively unharmed but unable to open his door, which was rendered unusable by the impact. She also knew that after placing the 911 call, the driver of the white SUV was rushing frantically from vehicle to vehicle to survey the damage. She saw her reach into the green sedan, weaving her arm underneath the injured driver, to turn off the engine that was starting to generate billowing smoke from underneath the wrinkled hood. Hearing him groan, she then leaned in to comfort him, rubbing his back in a soothing gesture. Helen heard the lady trying to reassure him that he would be okay and help was on its way. She also saw the woman in the passenger’s seat beside the bearded man, crying, obviously upset. Seeing that the owner of the white SUV was focused on

the driver, Helen walked over to the passenger side of the car and tried to offer comfort and support to the crying woman through the shattered window, but she didn’t answer. She didn’t even seem to notice her. Helen assumed it was because the lady was so upset. She thought this was understandable, and in that context didn’t think it strange that the woman didn’t answer back or even take notice of her. It was then that she heard the wailing sirens of approaching police cars and ambulances. She took that as a cue to get back to her own vehicle so that they could all be properly cared for. Walking back to her own car, a sudden realization stopped her in her tracks – she was looking at a woman, apparently unresponsive, in the driver’s seat of her car and realized that she was that woman. She was standing outside of her own car, looking at what appeared to be her body trapped in the driver’s seat of a very damaged vehicle. It took her a while to orient to the fact that she was looking at her own body while somehow being separate from it. In doing so, she eventually came to the sobering conclusion that if she was outside of her body looking at herself trapped in the heap of mangled metal, then she must be dead. Nothing else made sense. The official police report indicated that Helen was quite entangled in the debris of her car, and that it took nearly thirty minutes to extricate her. It was unclear at the time exactly what was injured or broken, but soon enough, the odd angles of her ankles revealed the truth of her injuries and that information was called in to the hospital ahead of her arrival. Not only was she trapped in the rubble of the car, both of her ankles were clearly broken and she was observed by experienced rescue workers to be unconscious at the scene. There is no physical way that she would have been able to get out of her vehicle, let alone walk around and report with such great accuracy what she later described. That wasn’t the end of Helen’s tumultuous experience, however. When the ICU staff saw that she was starting to wake up several hours later and knowing she still had complex surgery coming up to repair her broken ankles, the nurse administered medication to sedate her and pain medication to keep her comfortable. From Helen’s perspective, as we would learn after the fact, this very act of what we perceived to be a humane gesture provoked extreme inner terror. She would later report to us a sense that she was being choked (there was a tube in her throat connecting her to the ventilator) and held down (soft

restraints kept her from pulling the life-saving tube out of her throat). Her last thought before she sank into oblivion from the medicine we were giving her for comfort was that she was being held down while she drowned. Terrifying, to be sure. Once she was awakened after the surgery on her ankles and had recovered from her other injuries and begun following commands, we were able to take her off of the ventilator fairly quickly. Not too long afterward, she told us that someone had been trying to drown her. Exploring this with her, we were able to help her associate her interpretation of events with what had really happened – ventilator tube, soft restraints, medication. Talking with her about what had actually occurred in her care seemed to ease her anxiety around the events and helped her move forward. Behavioral research tells us that by talking through a traumatic ICU experience with a patient as soon after the event as possible, letting them describe their experience in a safe and supportive context and offering the documented medical explanations that are likely responsible for their troubling experiences, we can ease their stress around these events and diminish the likelihood that they will go on to experience PTSD related to being in the ICU. For Helen that was fine, up to a point. She recognized that the cloudy memories of being held down and drowning correlated well with the documented medical interventions we showed her in her chart. She seemed to make her peace with that part of her experience and move on. What she couldn’t reconcile, however, was the extraordinary experience she’d had outside of her car at the scene of the accident. The more she realized how extraordinary it was to have experienced a specific and detailed view of the events of the accident from outside of her body, the more excited she became. She would tell anyone who would listen. Her nurse and I were a willing audience, and we hung on intently to everything she wanted to share. Having heard other such accounts and never tiring of them, I listened to her tell her intriguing version of what we knew about her accident. She told us details she couldn’t possibly have been aware of unless she’d been awake and walking around, observing from the specific angles she described – especially when she saw her own body in the driver’s seat of her car. Some weeks later, I saw Helen in the office for follow-up. She arrived in the company of her two adult children who, I soon discovered, did not share her

enthusiasm for her apparent out-of-body experience at the site of the accident. Her son and daughter had insisted on accompanying their mother to the appointment and came in with an agenda. They were concerned about their mother telling fantastical tales of walking around the scene of the accident, when clearly it was impossible. She was trapped in her car with broken ankles, so how could she have possibly walked around the crash site? It didn’t take me long to realize that her children hoped that I, as a medical professional, would tell their mother that what she claimed to have experienced was impossible, hadn’t happened, and couldn’t possibly have happened. They wanted me to set her straight. When I realized her children wanted me to inform Helen that her unusual experience hadn’t happened, my first temptation was to say, “You’ve picked the wrong doctor!” But of course I didn’t. As I watched my patient hang her head, obviously dejected and a bit beaten down by the naysayers who should have been her natural allies, I chose my words carefully. “You don’t believe her?” I ventured. “She was trapped in the car with broken ankles. How could she have been walking around? It’s impossible!” “It seems to be such a strange thing, I admit.” I was trying to navigate the conversation in a way that would address their objections while helping their mother. Cautiously, I suggested a compromise. “We’re talking about something that your mom can’t prove to you did happen and you can’t prove did not happen, so is there a way that you can meet in the middle? Is it possible for you to honor her truth about what she genuinely believes occurred?” They were quiet but seemed to be contemplating my proposal. I waded in a little further. “Honestly, I don’t see the harm in it,” I continued, feeling there was potential space among us for agreement. “It’s her story to tell – her truth. Does it really matter if we believe it or not? I’m wondering if we can let her have her truth about what happened. Can we agree on that?” Silence ensued, but there seemed to be a shift on the part of Helen’s children as they exchanged glances and shrugs with each other before tossing a cursory nod my direction. The atmosphere eased, so I continued. “You know, your mom is not alone in her experience.” I recounted how over several years of medical practice, I’d had other patients share with me similar accounts of apparent separation of consciousness from the physical body during times of trauma. “I know how unbelievable your mom’s experience may

sound to you. But she was able to confirm details about her accident that we know to be true that she couldn’t possibly have known except to witness them first hand from a vantage point outside of her car. Personally, I believe her,” I said. Helen visibly relaxed as she looked up and met my eyes with a weak but thankful smile. I went on to share with them that I don’t pretend to know what it is that happens or what triggers these experiences, but that I’ve heard it often enough from a wide cross-section of the population across multiple belief systems to know that something happens. And it usually is a pivotal moment in a person’s life, holding great meaning for the experiencer. We left it at that. I haven’t seen Helen or her children since that visit some eight or so years ago. That is typically the case, since my encounters with patients in the ICU are usually transient and pertain to a specific illness or injury. But I’m nonetheless hopeful that the conversations I have with them and their families around these incredible experiences can help shift the focus away from trying to determine whether or not something actually happened to a more supportive position in which we let the person who has an anomalous experience also have their truth about it, without judgment or interpretation.

Sandy was thrown from her car and landed several feet away. She had rounded a corner on a rural road late one cloudy summer afternoon and met an unexpected gathering of deer standing on the road in her lane. Both she and the deer were surprised by each other and neither had time to react. She couldn’t avoid the sudden impact. Frequently a veil of amnesia descends over victims of a violent accident and the details are forgotten, but Sandy remembered it all. Brakes squealed, several deer were instantly airborne from the impact, and the car skidded and rolled before landing upside down in a deep ditch beside the road. As the car flipped, Sandy was tossed out through the driver’s door, which had sprung open from the impact. She was propelled to the opposite side of the ditch into a dense tangle of shrubs, never touching the ground, and had sunk deeply into the bushes when she landed. With her arms and legs spread out at odd angles and held tightly by the twisting branches, she was stuck. The animals that had not been hit immediately scattered in all directions, and she could hear them frantically scrambling away from her through the

woods on either side of the road. The snapping of twigs and scuffle of dead leaves on the forest floor became fainter as they hurried away. No doubt they were struggling to make sense of what had happened, just as she was. Then it was over as quickly as it had begun. Silence descended, and except for the soft trickle of a nearby creek, the slowing breath of two deer that lay dying in the road, and the ticking of cooling metal from the damaged car, all was quiet. Sandy had remained fully conscious throughout the accident, but because everything had happened so fast, she couldn’t completely follow the chain of events that had ejected her from her vehicle and placed her in the nearby bushes. Trying to sort it all out, her gaze settled upon the car a few feet in front of her. With alarm she looked at the buckled roof that now dove deeply into the front seats and the large shards of glass from the windshield that jutted into the space she had just evacuated. She realized with chilling clarity that had she not been thrown from the car, she would likely be dead. Difficulty breathing, however, and searing pain in her chest and limbs informed her that she had not avoided injury. Unable to move, all she could do was wait. The back road was remote and not frequently traveled, so how long it would be before someone arrived was impossible to predict. It could be minutes or hours, but there was nothing she could do to speed up the arrival of help. She watched the drifting clouds darken and blur through the tree branches above her, and eventually she closed her eyes against the soft drizzle of rain that had begun to fall. She must have passed out, she reasoned, because the next thing she recalled was the echo of voices surrounding her. Opening her eyes, Sandy struggled to bring the scene into focus. There was a police car parked behind her upturned vehicle with its red and blue lights flashing. Orange traffic cones had been set out, and two men were dragging the dead deer out of the way. She also noticed a large silver pickup truck parked along the opposite side of the road. Perhaps its driver was the first one who had found her, but she didn’t remember it stopping or the arrival of the police car, so she couldn’t say. A soft voice caught her attention and she looked up into the face of a police officer leaning over her where she was still resting in the bushes. He laid a hand on her shoulder and was talking to her in such a way that she presumed he was trying to assess her injuries and state of consciousness. Her suspicions were

confirmed when he pressed a button on a device hooked to his shoulder and, turning his head, spoke into it. “She’s awake but not talking. Seems dazed and is looking around, but not following any commands. Has a pulse, but it’s weak and irregular. Looks to have some bad cuts on her and probably some broken bones. Breathing is shallow and fast.” She struggled to focus her attention on him as he reassured her she was okay and that an ambulance was on its way. But as she tried to reorient to the environment around her, something else caught her attention. A familiarlooking older woman was approaching her from a distance and smiling at her as she lifted a hand in a friendly wave. As she drew closer, Sandy’s face crumpled, and tears starting streaming down her face as she recognized the gentle figure approaching her. Her mother, who had passed away several years earlier, was as clear and real as the officer who leaned over her. Seeing her distress, the policeman leaned closer and crooned, “Shhh, it’s okay. You’re going to be all right, ma’am.” Misunderstanding her tears, he assumed she was frightened and upset, and he was attempting to comfort and reassure her. But Sandy cried harder as she focused on her mother drawing closer. “Mom,” Sandy sobbed. “You’re here!” Reaching out her hand, she felt her mom take it, and as Sandy would later relate, it was all so very real – just as real as the police officer’s voice telling her that her mother wasn’t there but that she herself was fine and that help was on its way. She could feel the warmth of her mother’s hand as she held it and the gentle sweep of her fingers as her mother brushed tears from Sandy’s face, but she never spoke. All she could hear was the policeman’s voice saying, “There is no one here but us, ma’am,” as he responded to her attempts to converse with her mother. Her mother stayed there with her, unspeaking but present. Later, as Sandy was placed in a cervical collar to protect her neck, she saw her mother step back but continue watching from a distance. When Sandy cried out in pain as the emergency crew lifted her from the shrubs and placed her on a backboard, she saw her mother move further away and fold her arms across the top of her stomach, as she always used to do. Still, she remained silent. As Sandy was moved to the ambulance, she began to cry harder as she watched her mother wave one final time before the ambulance doors were closed, and they drove away. By the time we heard Sandy’s story, she was waking up in the ICU from the

surgeries she had undergone to repair her injuries. She had sustained several broken ribs that resulted in a punctured and collapsed lung, as well as a ruptured spleen and torn liver that had caused a great deal of internal blood loss. How she had managed to remain conscious at the scene was remarkable, but she was able to recount the details of the accident with astounding clarity. As she continued to improve, she also began to share with us, with all of the raw emotion and tears one would expect, about the mysterious encounter with her long-deceased mother. I thought it was an amazing story and I told her so, but not everyone shared my enthusiasm. Her son in particular was incensed. “That never happened,” he stated bluntly when she began to share her experience. Understandably, Sandy was surprised and hurt by his response. Each time she tried to open up with her family about what she had experienced at the scene of the accident, she was met with resistance. Her son was especially irritated with her for reasons that remained unclear. He was surprisingly emphatic, saying, “Cut it out, Mom. That didn’t happen.” But she was convinced it did, so she wasn’t backing down. I stopped by her room a couple of days later on my daily rounds and found them in the midst of a heated discussion about her experience. “Talking about what happened to you after your accident?” I asked casually. She hung her head and nodded quietly but said nothing. She seemed defeated. Honestly, I was a bit surprised they were still discussing it, but grateful in retrospect that I had walked into the middle of their conversation. As I finished examining Sandy, I motioned to her son to step outside of her room with me, indicating I’d like to speak with him. Thinking about how I was going to broach the subject as we walked out, he provided the opening. “She’s talking nonsense again about seeing Grandma after the accident,” he said, sounding exasperated. “Maybe it really happened,” I said in what I hoped was a matter-of-fact manner. “You don’t really believe that, do you,” he said. It was a statement, not a question. “It’s not my place to say what she did or did not experience,” I countered. “Why does it upset you so much?” “Because it’s not real!” he replied emphatically. His hands were resting on

his hips, emphasizing his firm stance. Redirecting, I ventured, “What is the most important thing here?” “That my mom stop talking nonsense.” He wasn’t budging. “We should be orienting her to what really happened,” he continued, “not encouraging her to keep babbling on about something that’s impossible.” He clearly believed this was the right way to address what he perceived to be his mother’s delusional thinking. I could see in his face that his concern was genuine. “I just want my mom to get better,” he finally said. “That’s the most important thing.” “What if being able to tell her story the way she experienced it, and have it heard without judgment, is part of her getting better?” I offered. “She believes it happened. It’s real to her, and frankly, none of us are in a position to argue otherwise. Can we let her have that experience? It seems important to her.” “Have you ever heard anyone else talking like that?” Sandy’s son seemed to be fighting back tears, and for the first time I felt that his defensiveness might be centered in concern for his mother’s sanity. “Actually, I have,” I said. “There’s a lot I’ve heard from patients that I am in no position to dispute, and the longer I am a doctor, the more persuaded I am that something happens when patients are traumatized and so close to death. It’s become my personal practice to provide a safe space for them to talk about it.” He said nothing, so I continued. “What if part of her getting better is being able to tell and relive a very unusual experience that she believes happened to her? Whether or not it did or didn’t happen doesn’t seem to matter much, in my opinion. She’s experienced enough trauma from the accident alone, don’t you think? Telling her that we don’t believe something that was so real to her may actually hinder her improvement. What about just letting her tell her story? Are you okay with that?” He let his hands slowly drop to his sides as he lowered his head and offered a brief nod indicating his agreement. I don’t know what happened after our conversation. Encouraging him to accept his mom’s experience in whatever way he could seemed to be all I could do at the time. The rest was up to Sandy and her son to work through. But each passing day that I saw Sandy after my chat with her son, she seemed lighter, more cheerful and more interactive. I thought that if she wanted to share anything more about her experience at the accident scene with me, she would, but she never did. The day she left to go to a nursing home to convalesce before returning home, her son was there to

drive her. As I was walking away after wishing her good luck with her continued recovery, he stepped out into the hall with me. He shook my hand and said, “Thank you for what you said. It really meant a lot.” That was enough.

PTSD research recognizes the importance of talking about a traumatic event in a safe, supportive setting as soon as possible after it occurs. This approach seems to move the traumatized person a long way down the road toward neutralizing negative emotions before they can solidify into a set of emotional triggers and behavioral reactions. Processing a difficult experience when the feelings around it are still fluid and malleable creates an opportunity to reshape and inform the memory of it before it takes up permanent residence. Older traumatic memories seem to be harder to untangle and integrate in a way that is helpful. The intense work of peeling away the deep, protective layers that have helped us cope with a damaging event for so long becomes more difficult as time goes by – sometimes too difficult. And so they stay, embedded and unprocessed, becoming obstructive roadblocks to complete healing. I’ve also had patients share with me that being told that a positive experience wasn’t true and didn’t really happen can have damaging results as well, as they push that potentially helpful, healing memory further into the recesses of their mind. There is no benefit in being pressured or forced to disbelieve your own experience. From this perspective, it seems not only reasonable but absolutely essential to remain open to the truth of a patient’s experience, exploring its meaning and usefulness for them – whatever that may be. Whether or not we can correlate it convincingly with something we have documented to have actually happened doesn’t matter. Our ability to prove that something they experience did or did not occur is so completely irrelevant, and even our own personal beliefs about such experiences don’t have a starring role in these conversations. If it’s real to that person, then it’s real. Period. The same principles apply when assisting a patient in processing tangible and intangible experiences. By making sure that patients are respected and believed, defusing their fear of not being taken seriously, and creating a more accepting, invitational moment for people to share their stories, we’ve done something important and of service to them. Making room for a person’s

experience to be accepted as their own personal truth, safe from our own imposing interpretation, is as important in helping them integrate their neardeath or out-of-body experience as it is in helping them understand their misinterpreted physical stimuli while they are sick and sedated in the ICU. By honoring someone’s truth, we facilitate their processing of any intense emotions they may have around their experiences, whether negative or positive.

“Life can only be understood backwards; but it must be lived forwards.” – Søren Kierkegaard

on call one night during the final weeks of bringing this book to a close. I was Around three o’clock in the morning my pager went off, and waking from a deep sleep, I struggled to bring the numbers on the digital display into focus. I recognized it as a phone on a general ward at one of the two hospitals I was covering that night. I dialed the number and heard it ring several times with no answer. Thinking I might have called the wrong number and would possibly waken someone by mistake, I was preparing to hang up when a very worriedsounding nurse answered. “Oh, doctor, thank you for calling back.” She sounded frantic. “This is Leisha, the nurse taking care of Edith in room 542. There’s a problem.” She was clearly concerned. “What’s up, Leisha?” I was moving through the list of patients in my head trying to recall exactly who Edith was. Then I remembered. She was an unfortunate seventy-eight-year-old lady who had been admitted to our ICU four days earlier. Edith’s daughter had brought her to the Emergency Room when she began coughing up a lot of blood. Her blood loss was so profound that she was unstable and pale. We had to transfuse several units of donor blood and place a breathing tube into her throat to protect her airway and try to control the bleeding. I was on duty when she came into the hospital and a CT scan of her chest revealed that her right lung was almost totally obstructed, both with the blood that was filling it up and by what appeared to be a large mass that was likely the cause of the bleeding in the first place. The mass was obstructing the exchange of air and as a result, large portions of the involved lung had collapsed. Once

she was heavily sedated, we had placed her on her right side, stuffing pillows behind her back so that her bleeding lung was lower and her healthy lung was positioned higher. By keeping her bleeding lung low, we would stop the blood from spilling over into the good lung – the one that still had open passageways to deliver oxygen to all of her vital organs. Once the situation was under control, I advanced a flexible scope down through the breathing tube into her lung to take a look around and try to see what was causing so much bleeding. It didn’t take me long to find out. There, just beyond the entry to her right lung, was a bulky, fleshy-appearing mass that was most certainly cancer. Slipping a special wire through the scope that had tiny pincers on the end, I grabbed several pieces of the mass and sent them off to the lab for identification. I knew it was cancer, but what kind? That was the question. “Large-cell lung cancer,” said the pathologist when she called me. That was the answer. It was lung cancer, and a rather fast-growing one. Once we knew the diagnosis, we continued our workup and found that it was widely metastatic. We brought in an oncologist who presented her family with all of the treatment options. As the cancer doctor indicated clearly, treatment would be purely palliative at this point. The chemotherapy would make her sick and not cure her cancer. Radiation could shrink it and perhaps prevent more bleeding, but the news was not good. Ultimately, this cancer was not survivable. As Edith stabilized, we were able to wake her up, take her off the ventilator and inform her of the diagnosis. She was presented with her options. Remarkably, she took the news rather calmly. In fact, I can’t say she seemed too surprised by the information. She told us of a dream she’d had two weeks earlier where her deceased husband had come to her in a very vivid way, and after a long conversation – most of which she couldn’t recall – he smiled broadly, kissed her sweetly and said, “So I’ll be seeing you real soon, okay?” Although Edith had not said anything to anyone about that dream, she told us all now – the staff, her family and her friends who visited. It seemed that she was sharing her story more for the benefit of those around her than anything else, and it did bring them comfort – especially to her four children who liked the thought that their dad was quite possibly waiting on the other side for their mother. Edith seemed at ease with the diagnosis and even a bit giddy about the prospect of being reunited with her husband.

She opted not to receive treatment. “At my age? Pshaw!” she said, and waved the options away as if they were the most ludicrous of suggestions. “I’ve lived a full life and I’m ready to go. I know what chemotherapy can do and I don’t want any part of it. Just keep me comfortable and let me go.” And that’s what we did. Edith didn’t want to die at home, where she had lived for several years by herself. She didn’t want to be a burden to her children and seemed to enjoy the attentions of our staff. Her preference was to stay in the hospital, knowing the end was near. Moving her out of the intensive care unit, we transferred her to the floor where she was admitted to the hospice service. Over the next couple of days, as if she had made up her mind and set her course, she began to slip away. That’s when Leisha paged me in the early hours of the morning. “Edith is hallucinating. I was wondering if you could order some medication to make her stop. Maybe some Haldol or another antipsychotic?” Leisha suggested. She was serious. I’ve made an intentional habit of not medicating the patient in order to treat the staff’s discomfort, so I inquired further. “Is she distressed by the hallucinations?” I asked. “She doesn’t seem to be. But she’s talking to people who aren’t there, and she’s laughing.” Leisha was genuinely concerned, and I can’t fault her for that, but it sounded to me as if Edith was actually having fun. After the stressful days of nearly bleeding to death and learning she had cancer, this seemed a welcome change. “Well, if she’s laughing, it sounds like she might be having a good visit with somebody she’s about to meet when she dies. Maybe it’s someone she knows,” I offered. I was fully awake now. There was silence on the other end of the line followed by an eventual, “Huh?” I was pretty sure that Leisha was also thinking the patient wasn’t the only one needing an antipsychotic. Dealing with a tired doctor from a nurse’s standpoint can certainly pose its challenges. But here was a young nurse who, I’m sure, was feeling a bit adrift and hadn’t yet accumulated the experience that many older nurses have of witnessing bedside visitations of patients close to death. “Leisha, I’m quite serious.” I had interacted with Leisha here and there during the months since she’d begun her nursing career and felt she respected my opinion, so despite the dark hour I thought the moment opportune. I

proceeded to share with her that it is not unusual to observe patients who are close to dying have conversations with those we cannot see but that they apparently can. “Frequently,” I continued, “you’ll find that the nearer they are to death, the more often they seem to be more there than here. And in those moments it’s not so unusual to hear them speaking with loved ones who’ve passed on. If Edith doesn’t appear distressed then I wouldn’t worry about it. If she seems troubled, call me back.” She never did. Lying back down, I couldn’t sleep. My memory took me back to the first moments, so long ago, when I had first encountered patient experiences that I couldn’t explain and certainly didn’t understand. I thought about Samuel and his fear of surgery because of having an out-of-body experience that no one had helped him process. I remembered Alice who had seen her nephew Corbin at her bedside, which was how she knew he had died. The many near-death stories I had heard over the years drifted into my awareness as I lay staring into the darkness. I marveled that what had seemed so strange to me then was now so comfortable. But I could still recall that feeling of being lost and not being able to wrap my head around what I was hearing from patients. I mused that quite likely this young nurse on the other end of the phone I’d just hung up was having the same experience I’d had. Leisha had just been introduced to mystery.

Our ability to be open to the existence of things we can’t currently explain hinges on our capacity to regard their mystery with reverence and an open mind. There are still so many things about this strange life that we just don’t know. There are anomalies we don’t understand yet – and quite possibly can’t understand. But I think that we can still marvel and wonder at how consciousness might work without having to understand everything about it first. In fact, it is our unique capacity as a species to speculate and ponder the unknown that holds the door open for eventual discovery and understanding. Dismissing something we can’t quite grasp keeps that door firmly shut, and if we refuse to consider the what-ifs and how-comes, we may never unravel the mystery in a way that we can eventually understand. For five thousand years, the fermentation of malted beverages and rising bread was thought to be due to a visit from spirits. It was so mysterious – and considered nothing short of miraculous, really – that some food items left out in

the open air would eventually start to bubble or rise. It wasn’t until the mideighteen hundreds when Louis Pasteur discovered that it was actually tiny, hungry yeast spores settling randomly on the surface that turned the starch in barley liquid into beer and caused bread to be lighter and taste better. Pasteur parted the veil of mystery for us so that we could finally understand that, no, it was not the hands of angels that brought the gift of fermentation to us but a naturally occurring process that was just not understood before. Now that we know and understand, it makes perfect sense. Perhaps it is the same with our understanding of consciousness and what happens as we approach death. At some point in our collective future, a bright individual will make the connection. A gifted brain will have that “Aha!” moment that weaves together the intricate fibers and filaments that hold a whole theory of consciousness together. But continuing to deny or dismiss the mysterious parts of ourselves increases the likelihood that we will never understand them. Lending our attention to the mystery of near-death and outof-body experiences – mulling them over, contemplating their structure, turning them around to look at all angles – greatly increases our chances of eventual understanding. An inquisitive, curious regard for a mystery is the pathway to understanding it. Denying that it exists is an obstruction to eventual revelation. It is not unlike love, really, or fear, or any other emotion. We all experience emotions, and neuroscience has helped us track their generation to the ancient limbic part of our brains. Yet for all we know about emotion, the role and magic of it in our lives remain deep and meaningful to each of us individually. We don’t doubt that feeling and emotion exist, even though we can never know exactly what another person feels. What we can do is accept our own feelings and respect the feelings of others, acknowledging that emotional experiences are a significant part of ourselves and our relationships with each other. Together in that awareness, we then support each other in facing our emotional challenges, whether they involve reining in anxiety or unfolding ourselves to love and trust. Similarly, we don’t have to understand novel experiences to be in relationship with them and create safe space for those who have them. When I first tuned in to patients’ stories of mysterious encounters, I didn’t know what to think or even what to say. I’ve come to realize, though, that I don’t have to be able to explain something in order to acknowledge it and support the person reporting it. All I need to do is offer my ability to listen and be present with an

intent to accept whatever someone wants to share with me that has particular meaning for them. For someone who has experienced an anomaly of consciousness such as a near-death experience, the most important thing we can do is bear witness to their personal truth – what is true for them. More often than not, that is simply the best and most respectful thing to do. Not long ago, my husband and I sat down to dinner with a fellow physician and his wife. After a couple of drinks, the conversation mellowed and turned to more contemplative matters. Unprompted and quite unaware of my own interest in the topic, my colleague shared how many years ago, when his father was visiting from out of town, he collapsed in their home from a massive cardiac arrest. After being resuscitated from sudden cardiac death, he was surprised to hear him report a classic near-death experience – being surrounded by white light, greeted by benevolent beings, talking to deceased loved ones – the whole bit. “I don’t know what I believe about all that,” he said. “But you know what? After having that experience, my father said he was not afraid to die. When he did finally did pass away years later, I remembered that moment and knew he was okay.” Despite being a practitioner of medicine deeply rooted in science, he didn’t have to understand the how of a phenomenon to straightforwardly understand its power for someone he loved deeply. The more I encounter mystery, the more comfortable I am accepting that there are things that exist with or without our understanding them – and with or without our belief in them. Fortunately, their existence and their truth is not dependent upon our understanding or belief. It reminds me once more of Shakespeare’s wisdom in recognizing that there are realities beyond what we have dreamt of in our current philosophies and theories. At least for now.

with his book Life After Life, psychiatrist Raymond Moody introduced I nthe1975, public and most professionals to a phenomenon he called near-death experience (NDE). Forty years later, virtually everything he presented in that book has been corroborated by numerous research studies involving thousands of experiencers (NDErs). As a long-time researcher of NDEs and based on my knowledge of that literature, I found that the features of these experiences and several of their aftereffects were accurately presented in Dr. Bellg’s excellent book. There she recounted several of her professional experiences as an ICU physician—and, courageously, even some personal experiences—with these and similar phenomena—and the conclusions she has drawn from them. NDEs belong to a category of experiences sometimes termed “transpersonal” because they transcend the usual personal limits of space, time, and/or identity. In addition to NDEs, many transpersonal experiences surround death, including premonitions of death, nearing-death awareness of individuals on their deathbeds—seeing and often conversing with deceased loved ones and/or spiritual entities, and after-death communication. Dr. Bellg has included descriptions of cases involving these phenomena, as well. As Dr. Bellg revealed, people who disclose transpersonal experiences are sometimes stigmatized. The prevailing Western scientific worldview (some would say scientistic, to imply orthodoxy) is philosophical materialism, which is based on the assumption that everything arises from the physical, material world. From this perspective, human consciousness is a product of brain function; when the brain dies, consciousness dies. But this viewpoint is hard to square with many significant human experiences. Here is an example from my own life. I am sitting at work one afternoon answering email. Suddenly, completely unrelated to the task in which I’m involved, a “knowing” washes over me: that my husband, Gary,

will be in a serious accident, but he will be okay—no death or even disability. I sit with this knowing for perhaps 45 seconds, at which point it fades away. I take note. My husband’s and my schedules that day don’t allow for us to communicate. After his workday, he goes on his weekly night bicycle ride with his bike club. I work late, then go to the mall to pick up a coat for my out-of-town trip the next day. As I pull into a mall parking space, my cell phone rings: a call from my husband’s phone. But when I answer, a Hispanic male asks me if I am Gary’s wife. I reply in the affirmative, and he proceeds to tell me he is an emergency room attendant calling from a hospital. Gary was in a bicycle accident in which he was thrown over his bicycle handlebars and hit the pavement. After a couple of minutes of unconsciousness, followed by a brief period of disorientation, he is now conscious and stable. I am alarmed—but not panicked, because I know, from my transpersonal experience that afternoon, he will be okay. Indeed, he was. How could I have known of this accident and its outcome? Gary had been going on this Wednesday night ride—as well as Saturday and Sunday morning rides—with his club for years. I had never had such an experience before—nor have I had it since. I had it only on the day of the one serious bicycle accident he has ever had. I received the information neither from sensory information nor from rational deduction. But because of other transpersonal experiences I have had, I have come to accept these experiences—and benefit from them— even though they occur by some process other than what we know of how the brain and senses function. Unfortunately, though, in the materialist climate of Western culture, when people disclose transpersonal experiences, they are sometimes met with stigmatizing and harmful responses. My colleagues and I recently published a study of NDErs’ most noteworthy experiences of disclosing their NDEs to healthcare professionals—medical (physicians, nurses, EMTs), mental (psychologists, counselors, social workers), and spiritual/religious (chaplains, religious officials)—as well as family and friends. Interestingly, NDErs reported both wonderful and horrible disclosure experiences in each of the four categories of confidant, and no category was significantly better or worse. There were at least four features of the confidant’s response that these NDErs found negative, emotionally distressing, and harmful: failing to recognize and name the NDE; failing to consider that the NDE was or, at least, could have been real— including labeling it a dream or hallucination; pathologizing the experience or experiencer, that is, considered one or both “crazy”; and demonizing the

experience, that is, attributing it to a malevolent source. None of these responses is supported by research. Rather, NDEs are an established phenomenon; considerable evidence indicates that they are qualitatively different than hallucinations or dreams and that they often are veridical (that is, what the experiencer reports having perceived during the NDE is later affirmed as accurate); there is no relationship between NDEs and mental disorder (that is, just like the general public, most NDErs are mentally healthy); and the effects of NDEs tend to propel people toward values and actions that would be considered spiritual by any major spiritual or religious system—less materialistic, more concerned about others, etc. We also found that the deeper the NDE—the more features it contained and the more intense it was—the more likely it was to elicit a harmful response. But most surprising to us was the finding that NDErs who had their NDEs in any decade from the 1930s to the 2000s were just as likely to report a harmful disclosure experience. We thought that with the increase over the last few decades of availability of information about NDEs, at least health professionals, if not family and friends, would respond increasingly helpfully—but that was not our research participants’ perception. Dr. Bellg affirmed this finding with her description of her interaction with a young nurse just weeks before she completed her book. These results bring us to the need for and timeliness of Dr. Bellg’s book. Both the public and health professionals need to be better prepared to respond helpfully to people who report NDEs (and, as some of Dr. Bellg’s cases show, other transpersonal experience). Healthcare providers, in particular, all function under the ethical imperative of nonmaleficence: to do no harm. In addition, considering the non-materialistic scientific and philosophical issues that are implicit in NDEs—specifically, the possibility that consciousness is primary, that the brain is not a producer but a receiver/transmitter of consciousness, and that consciousness may have preceded the formation and may survive the demise of the brain—preparation to respond helpfully to NDE disclosure is also a matter of being open to the possibility of something other than an exclusively biomedical interpretation of what is going on. Dr. Bellg’s book addressed both of these crucial aspects. She is a model of a healthcare practitioner who, rather than being threatened by the prospect of revising her philosophical assumptions and fearing that doing so would

undermine her competence and effectiveness, is open to considering alternative perspectives and has become a more effective practitioner for it. Following the evolution in her thinking that she described in her book may help others evolve, as well. One would think that someone like me, who has been researching NDEs since the mid-1980s, would find a book like Dr. Bellg’s ho-hum. Not so. Prior to receiving the manuscript, my only knowledge of Dr. Bellg was having seen her featured in the educational video, Near-death Experience: What Medical Professionals Need to Know,* in which I also appear. Upon receiving her manuscript and beginning to read it, I was captivated and proceeded to complete it in the course of one day. To my knowledge, no one has addressed so well the need to offer a helpful response to those reporting an NDE and the process of reconsidering one’s belief system in light of evidence from NDEs. As a complement to my research on NDE disclosure, which I consider the “head” of the matter, her book addresses the “heart” of the matter. I can only hope that in the future, in addition to this book being read by the general public, whom Dr. Bellg primarily addressed, it also becomes required reading for students in every health profession preparation program and a staple of continuing education for healthcare professionals already in practice. Janice Holden, Ed.D., LPC-S, LMFT, NCC, ACMHP Professor, Counseling Program Chair, Department of Counseling and Higher Education University of North Texas Denton, TX *http://ndevideo.com/caregivers/

I first met Dr. John, I had no idea that he would provide the spark to W hen ignite this book. I owe him an immeasurable debt of gratitude for the final gift he offered me in courageously sharing his story. Little did I imagine that his initial fear to reveal his truth would meld so easily with my own desire to honor it. His own near-death experience – and the personal tragedy of him being unable to talk about it with his patients and family – provided the power and forward propulsion to move this book to completion. He let me clearly see the need for physicians and other medical caregivers to no longer hide in the shadows to preserve our professional reputations when doing so silences the voices of patients and others who have powerful and personally meaningful near-death experiences that they need to share. I also wish to thank my writing mentors Tom Bird and RamaJon Cogan. Their unique approach is unmatched and as a team they are supremely qualified to help writers empower their Inner Author and birth a book. Equally, I appreciate good style, content and copy editors, and certainly want to acknowledge mine – Idony Lisle, A. J. James and Rosina Wilson. I marvel at their ability to find inconsistences in my literary voice, identify places where I confounded the reader, and help me reorder, rewrite or extract whole passages and chapters from this book that just simply did not work. Their skill made the whole work a tighter, more elegant read with a better arc and progression than I would have been able to achieve alone. I’d especially like to thank my proofreaders, Candie Sanderson and Roberta Moore, who reviewed the manuscript multiple times. They are nothing short of grammatical phenoms. Misplace a semicolon and they will find it. Wayward commas will be identified, guaranteed. What’s even more mysterious to me is that they find it an enjoyable adventure – taking a romp through a manuscript to pick out misspellings and grammatical stumbles and setting them upright. (Any errors that remain, of course, are my own doing.)

I offer a special hats-off to Denise Cassino, a top-notch publicist. Her ability to guide authors through that strange land of social media and help them understand its importance is both educational and illuminating. That I even have FaceBook and Twitter followers is primarily her doing. Her understanding of the Amazon machine and how not only to offer your book there but also have it noticed is remarkable. I could not have done it without her. I wish to thank my mother who so generously, without one single word of complaint, took care of my children when I needed to write. I am reassured that she appeared to be having great fun with her granddaughters while doing it. I also now believe in the power of the arcade to assist adolescent children in holding space for their mother who was always “writing again.” Somehow, scoring the jackpot on Slam-O-Winner went a long way toward making it all okay. Typing furiously on my keyboard at a remote corner table while my daughters plunked tokens into pinball machines helped get it done. Were it not for my husband, this book simply would not be. I thank him for his steady and unwavering belief in not only my ability as a writer but also as a bearer of the vision when I could no longer see it. When I felt I’d waded into murky waters and become entangled in a point I was trying to make or a story I was trying to tell, he provided just the insight and feedback I needed to find my way out and produce good writing. He is a health psychologist and writer, having earned a living for many years as a poet, author, speechwriter and ghostwriter. So when he told me with no hesitation I could do this, I had to believe it was so. In too many ways to count he simply makes my life better and more enjoyable, and for that I thank him and love him. Finally, I need to express deep gratitude to the people who shared their stories with me. Their decision to bravely trust that I would take them seriously and honor their truth is remarkable. It is because of them and for them that this book was written.

Near-death experiences are often profoundly meaningful, yet when they are reported, they are frequently met with skepticism and dismissal by medical caregivers and family members. But do we have to fully understand these events to honor the transformative role they often play in the lives of those who experience them? Do we need to prove they are something more than the result of illness, medication or a dying brain to acknowledge their power to impact lives in a positive way? For nearly twenty years, Dr. Laurin Bellg has been present at the bedside of critically ill and dying patients. As she has worked to create an accepting and supportive relationship with them, her patients have shared with her the mysterious experiences they sometimes have during moments of crisis of apparently seeing beyond our physical world. In telling their engaging, powerful and sometimes humorous stories, Dr. Bellg invites the reader to consider that bearing witness to a patient’s near-death experience is a respectful and meaningful part of medical care, a way for families to support their loved ones, and an important part of the patient’s healing. “No one has addressed so well the need to offer a helpful response to those reporting a neardeath experience and the process of reconsidering one s belief system in light of evidence from those experiences ...Dr. Bellg s book addresses the heart of the matter.” -Janice Holden, Ed.D., Chair, Department of Counseling and Higher Education, University of North Texas, Editor of Journal of Near-Death Studies “My time with Dr. Bellg s book was profound: inspiring, comforting, and a gentle reminder of so much that I can easily forget. Also, it helped me to pause, for reflection, on some of my own personal journey. ” - Patricia A. Muehsam, M.D., Founder of Transformational Medicine™

Laurin Bellg, MD is a board-certified critical care physician, Chair of Medicine and ICU director for two busy intensive care units in the Upper Midwest. In addition to caring for her patients, she is involved in training medical residents and teaching others how to care for the critically ill. She has contributed to other publications about near-death studies and is an invited speaker throughout the United States on the topic. She also blogs about her experience as an ICU physician. Visit her at www.laurinbellg.com.