The Witch in the Waiting Room: A Physician Investigates Paranormal Phenomena in Medicine

by Robert S. Bobrow M. D. M. D.

  • Loss of status or self-esteem. Deaths with loss of status or selfesteem included two men who were passed over for promotions they expected to get.

  • Emotional reunion or triumph. Although it may not be surprising that a negatively charged event (like the threat of danger) can kill, it seems that too much of a good thing can be fatal as well: For instance, Engel included examples of death after reunions with loved ones, and the winning of a very large bet.

  • During mourning or on an anniversary of a death. The examples Engel cited in this category included one of a man who dropped dead at the opening bars of a concert commemorating the death of his wife, a well-known piano teacher, five years earlier. The other was the case of' a seventeen-year-old boy who died of a massive brain hemorrhage one year to the day, and within forty-eight minutes, of his older brother's untimely death in a car accident.

  The age range of the people in Engel's examples spanned childhood through old age, but the majority were between fifty and eighty. The peak age of vulnerability was 45-55 for men, and 70-75 for women. Men were more likely to die in situations of danger; women's demises were more frequent after the loss of a loved one.

  Engel also cites examples of animals dying under stress. A female llama died within minutes of seeing her mate of thirteen years shot and killed. Rats have been known to die of fright. Even cockroaches-despicable creatures though they may be-can be done in by being rendered helpless (by being pinned to a board) while facing danger in the form of a nearby, threatening dominant roach (ironically, also pinned down).

  Engel references another author's work that included people who were convinced of the inevitability of their own deaths, "at a particular time or under particular circumstances, sometimes based on prediction made by fortune tellers years earlier." He feels that his data, although drawn from news reports, are reliable, as his cases are similar to others reported in the medical and lay literature. He believes that the common denominators are overwhelming excitation, loss of control, and giving up.

  The paper concludes with speculation as to the physiology of death by emotion. Stress hormones, including adrenalin, speed the heart and make it electrically irritable so that potentially fatal rhythms may occur. Conversely, inhibition via other nerve pathways can slow the heart and may underlie the phenomenon of giving up or letting go. Engel feels that some interplay between sympathetic (excitatory) and parasympathetic (inhibitory) nervous systems, as well as higher, cerebral control mechanisms, must be involved. In 1971, when the work was published, it was not well known that spasms of the coronary arteries could occur. These can be reversible, and can also be sufficient to shut off blood flow to heart muscle so that a heart attack results. This was the presumed fate of the forty-year-old woman described in the Lancet nine years later, when the existence of these spasms was better known.

  Oh, My Aching Heart

  A recent article in the Neu' Engbaud Journal of iJfeduwze (February 10, 2005) took a hard, clinical look at the effects of sudden emotional stress on the heart. Nineteen patients (eighteen of them women) who developed cardiac symptoms such as chest pain, very difficult breathing, or cardiogenic shock right after emotional stress were evaluated. Their median age was sixty-three. The initiating event was often a family death, but one sixty-yearold woman was stricken because of a surprise party, in her honor. (I remember my uncle's terrified pallor on his 65th birthday when the lights went on and 165 guests shouted "surprise." He had a heart condition, and didn't look far from keeling over. Thankfully, he survived the shock and a good time was had by all.)

  All of the nineteen patients in the article survived, and were studied in-hospital with coronary angiography (pictures of the heart-nourishing coronary arteries), echocardiography (an image of the heart made with sound waves), and, in some cases, blood levels of stress hormones like adrenalin; a few had biopsies of' the heart muscle itself' (known as myocardium). Only one of the patients actually had coronary artery disease-a predisposing condition. Adrenalin levels were much higher in these patients than in others admitted with actual heart attacks. The heart failed to pump adequately in all the patients, but this reversed in time. All these patients were still alive four years later. The authors call the condition "stress cardiomyopathy" or "myocardial stunning," but the exact mechanism remains unknown. Obviously the high adrenalin levels are involved, but we don't know precisely how.

  A Will to Die

  Besides deaths from sheer anxiety, Engel also is aware of' Cannon's work, which I mentioned in the chapter on witchcraft, whereby someone appears to die by just letting go. In 1973, a Lancet article, "Self-Willed Death or the Bone-Pointing Syndrome," puts the experience of a physician at a melanoma clinic in Sydney, Australia into a wider perspective. Melanoma is a particularly nasty form of skin cancer. Often the prognosis is poor, and this clinic dealt with many patients who would not survive their disease. The writer, G. W. Milton, finds that "there is a small group of' patients in whom the realization of' impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death." Milton describes this syndrome of self-willed death: A strong man, when first told of his malignancy, seems cavalier about it, but soon retreats. He loses interest in things, and while pulse, blood pressure, and respiration continue to be normal, he withdraws further and is dead within a month. Autopsy shows extensive cancer, but not sufficient to have killed the man at this time. Milton likens this to the bone-pointing voodoo deaths from the Australian outback, which I described in the witchcraft chapter (although these only took a few days for the patient to die).

  Dr. Milton's depiction of self-willed death is very reminiscent of the patient, also in the witchcraft chapter, who seemed to be dying of cancer of the esophagus until his doctor convinced him, at least for the time being, that he was healthier than he realized. So ... he walked out of the hospital. Milton's melanoma clinic sees patients who know that their cancer cannot be cured and are beginning to show signs of what he believes is self-willed death. And he notes that as soon as such a patient can be shown that something can be done to help, rapid improvement ensues.

  The last angle from which the idea of self-willed death has been studied is statistical. It surprises me how many studies have been done that examined relationships, in retrospect, between when people die and when their birthdays are or which holidays were approaching or had passed; or relationships regarding other significant occasions. At least twenty publications address this, tabulating everything from birthdays to religious holidays to the harvest moon festival (older Chinese-American women were studied in that one). Many of the results are "positive," showing rises or dips before or after the symbolic event. But, like the studies on intercessory prayer, the data don't coincide very well. For instance, one examination of' mortality relative to day of birth found death rates to be lower in females before the birthday and higher afterward; another paper reported the opposite. Male deaths, relative to birthdays, were also up/down in one survey, down/up in another.

  A recent paper in the .Inurnal ~)/' the American AleSieal Aeeociatinu (December 2004) looked at holidays, birthdays, and postponement of cancer deaths. The study looked at death certificates of 300,000 people in Ohio who had died of cancer over an eleven-year period. No evidence was found that cancer patients postponed their deaths to see just one more big day, as previous studies had suggested.

  So where does this leave us with regard to the banker, the Spartan, and the mother of five whose stories I presented in detail? The forty-year-old mother managed to actually have a heart attack, unlike the suddenly frightened, myocardiallv "stunned" women who, like her, had normal coronary arteries. She timed her exit perfectly, just as she had predicted three days in advance. This doesn't quite fit the syndrome of self'-willed withdrawal or that of the hyperexcited collapse. But somehow, she knew. The bank vice-president, the Greek immigrant-they knew (God knows how). And without a single sign of deterioratio
n, anxiety, shock, or awe, they departed this world at precisely the right second, as if Struck Down.

  `Nine

  Moving Toward the Light:

  Near-Death Experiences

  Raymond Moody had a Ph.D. in philosophy and then went on to become a medical doctor and psychiatrist. His 1975 book Ltfe After Lit;' First used the term "near-death experience" (NDE) to describe a phenomenon sometimes seen in people who have almost, but not quite, died. Such experiences, typically described as going toward a bright light or coursing through a tunnel, are part of folklore, and have been depicted historically and across cultures. Swiss geologist Albert von St. Gallen Heim, an avid mountain climber, had some sort of "experience" after a bad fall in 1871. This prompted him to speak to other climbers, and in 1892 he published A tes on Death. from Fall. which contains accounts of nearly-fatal accidents that were somehow survived amid visions of enlightenment.

  "Near-death experience" must have been a good fit for the examples in Heim's anthology, because this term stuck. NDEs have been the subject of much study, and while their meaning is controversial, the number of people who believe they have had them makes it possible for statistics and data to be collected.

  A Wakening in the O.R.

  Let's begin with a well-documented and detailed account, written by Georgia cardiologist Dr. Michael Sabom in his 1998 book Light and Death: One Doctor's Fascinating Account of NearDeath Eiperiences.3 Sabom was rather skeptical at first about NDEs but, after many patient interviews, changed his mind. This patient was a thirty-five-year-old woman who was found to have a large aneurysm (a balloon-like swelling) in her brain; if it ruptured-a real possibility-she would almost certainly die. An "extraordinary" neurosurgical procedure was her only hope. This would involve diverting all blood away from her brain for about forty-five minutes, allowing the surgeons to make the repair. Since a brain cannot live without oxygen-supplying blood for more than a few minutes, something rather special had to be done. First, her body temperature had to be lowered to 60 degrees Fahrenheit, which isn't all that chilly ifyou're outside on a sunny spring day while you maintain the temperature inside the body at the usual 98.6 degrees-but this woman's body temperature was going to be 60 degrees. That freezes all bodily functions and all cellular activity, including brain cells.

  This was accomplished by a cardiopulmonary bypass machine, a mechanical heart and lung through which all the patient's blood was diverted. The blood was tapped from a large artery in the groin (the femoral artery) into the machine, where it was cooled to 60 degrees and then returned to the body through a vein. Ultimately, the body's "core" temperature became 60 degrees. Then all blood was drained from her head, collapsing the aneurysm so that it could be fixed without the bother of having blood rushing through. During this time, the patient was "clinically dead"; there was zero brain electrical activity (the EEG was a flat line), and her heart had stopped. Even the lowest centers of her brain (known as the brain stem) had ceased function. The only difference between this and really being dead is that this state was induced and reversible.

  The significance of this in the context of a discussion of near-death experience is that her physiologic state was carefully monitored, documenting known parameters of lifelessness. Many NDE reports lack this, allowing the possibility that the person wasn't as close to dying as it may have seemed. But this woman was clearly in a state in which she could not hear (the brain wouldn't respond), nor could she have had seizure activity (her EEG, which would register this if it happened, was flat). Whatever she perceived could not have come through the senses, or from nerve or cell activity, as there was none.

  Here is what this clinically dead woman reported: The noise of the saw used to cut through her skull awakened her from the anesthesia. She felt herself pulled out of her body through the hole in her head, and could watch the proceedings from a vantage point above the neurosurgeon's shoulder. She supplied details about the pneumatic saw used for cutting, and knew of a problem the cardiac surgeon had had in finding an appropriate vessel for the shunting procedure. She knew what music was being played in the operating room. At the juncture when her heart stopped, she passed through a tunnel toward a brilliant light. There she met several deceased relatives who advised her to go back, lest she not survive the surgery.

  NDE Analysis

  Enough people have recounted stories like this so that common features can be tabulated for comparison. Remembrances are similar but not identical. Moody originally listed fifteen elements of NDEs, including seeing a dark tunnel, feeling out of one's body, meeting spiritual beings, experiencing a bright light, and a sense of returning to the body.

  Dr. Moody began his residency training in psychiatry at the University of Virginia during the 1970s, just as his book became popular. He promptly received enough letters from readers who had had NDEs to fill a box, and he showed these to a junior faculty member, Bruce Greyson, who then became interested in the phenomenon.

  Dr. Greyson, currently a professor of psychiatry at UVA, published a "near-death experience scale" in a 1983 paper in the Journal of Nervous and Mental Dweaee. Previous observers like Moody had listed what seemed like consistent, crucial elements of NDEs, but Greyson wanted a scientific tool that could be easily administered by clinicians.

  So he took sixty-seven subjects who claimed to have had NDEs and gave them an eighty-item questionnaire. Responses were then culled down to sixteen items felt to be the most clinically meaningful. These final sixteen questions were those most often answered affirmatively, and where responses were consistent when the test was given a second time a few months later. The questionnaire consisted of four headings with four questions within each category:

  Cognitive

  • Did time seem to speed up?

  • Were your thoughts speeded up?

  • Did scenes from your past come back to you?

  • Did you suddenly seem to understand everything?

  Affective

  • Did you have a feeling of peace and pleasantness?

  • Did you have a feeling of joy?

  • Did you feel a sense of unity or harmony with the universe?

  • Did you see, or feel surrounded by, a brilliant light?

  Paranormal

  • Were your senses more vivid than usual?

  • Did you seem to be aware of things going on elsewhere (ESP)?

  • Did scenes from the future come to you?

  • Did you feel separated from your physical body?

  Transcendental

  • Did you seem to enter some other, unearthly world?

  • Did you seem to encounter a mystical being or presence?

  • Did you see deceased spirits or religious figures?

  • Did you come to a border or point of no return?

  Answers were weighted 0, 1, or 2, depending on degree of concurrence. A score of 7 or more was considered significant for research purposes. The subject's age, sex, and amount of time elapsed since the NDE event had no effect on responses. Of note, the passage through a tunnel, frequently an NDE component, was not used, as Greyson found that it did not correlate well with the other parameters. He did feel that this final sixteen-piece scale was reliable and could differentiate true NDEs from brain damage or diseases and from stress reactions following recovery from a dangerous situation.

  Two years later, Greyson published a "typology" of NDEs. Having developed a scale that simply identified an event as an NDE, he now wanted to see if there were differing NDE types. Greyson analyzed eighty-nine claimed NDEs, using his sixteen-part instrument as described above, and was able to "cluster" the responses into three types. Forty-three percent scored highest on the transcendental component, 42 percent emerged as affective, and the remaining 15 percent were predominantly cognitive. Neither age nor gender seemed to make a difference, nor did the medical specifics of the near-death event itself. What did seem to matter was whether the "death" was sudden and unexpected (accident, cardiac arrest), or anticipated (terminal i
llness, surgery). Cognitive features, like seeing one's entire life in a flash, seemed to accompany the former, but were lacking from the latter, as if death's slower approach had already allowed time for life-review.

  Michael Sabom, the cardiologist who reported the aneurysm case, reviewed a series of NUEs and categorized them as "autoscopic," meaning a sense of looking down at oneself from above, and transcendental (see above). About a third were autoscopic, slightly more than half were transcendental, and the rest had features of both.

  NDEs in the Not-Near-Dead

  What happens if someone thinks they are close to death, but they really aren't? This was the question posed by Ph.D. psychologist Justine Owens and colleagues at the University of Virginia in their 1990 publication in Lancet. "Features of NDE in Relation to Whether or Not Patients Were Near Death" examined the medical records of fifty-eight patients, twenty-eight of whom were judged to have been so close to death that they would have died without medical intervention. The other thirty were not in danger of dying, although they believed they were.

  What were the differences? Seventy-five percent of the truly near-death patients experienced a bright light; forty percent of those not actually near death did as well. These differences are significant, statistically speaking. Also significant (i.e., unlikely to have occurred by chance) was enhanced cognitive function in the nearly-dead group. Not measurably different were the tunnel experience, a sense of having exited the body and viewing it from above, and life-review. The authors note that the enhancement of thought processes (cognitive function) was greater in the people really near-death, who would have had diminished brain function. Those who only thought they were having a close brush, who would have had normal brain function, were less likely to have had clear, comprehensive thinking.