by Sanjay Gupta
“ ‘Clinical death’ might be the loss of a heartbeat, and with those fish, I turn off the heartbeat so they are clinically dead. But I can bring them back. So they must not have been dead,” he chuckles. To even try this in humans, to push suspended animation to its limits, would require a wholesale change in how we view the practice of medicine. Imagine a patient with no heartbeat, no blood pressure, no vital signs. Is she dead? Who can say? What doctor would try that experiment?
“You have to think about separating the connection between life and animation, between death and deanimation,” says Roth. “We’ve put them together, but I think from these research studies, those are not reasonable connections to be drawing. Not always.”
Roth’s company Ikaria takes its name from an ancient Greek island renowned for its ancient, medicinal sulfur springs. The philosopher Herodotus was an early advocate, as was his pupil Hippocrates, the father of modern medicine. It’s not a stretch to say that Roth enjoys tempting fate. The island Ikaria takes its name from the famed Icarus of Greek mythology. Icarus flew on giant wings built by his father, the master craftsman Daedalus. Ignoring a warning not to soar too high, Icarus sailed toward the sun, only for its heat to melt the wax that held together his wings, which sent him plunging to his death in the sea below.
Mark Roth isn’t afraid to soar, but when he decided to “do it now,” his goals were pretty simple: Make a difference. Save lives. In his typically low-key way of talking, he told me, “If I was able to do something that helped someone out during a difficult moment, that would be good. I would be happy with that.” If it took starting a company to make it happen, well then, so be it. “It wasn’t going to be enough for me to just publish a paper suggesting the possibility. I wanted to actually do it.”
What we’ve seen, here in Seattle, may be the key to the whole puzzle—a way to dim the lights, slow the candle, stop time, cheat death. “I think the whole of emergency medicine is a time-dependent thing,” says Roth. “Someone either has time or they don’t. Ask a doctor, and it’s always a question of ‘I could have done this, if only I had the time to do it. If only I could have gotten him in the OR, and done this, and that.’ ” He’s getting pretty worked up, gesturing with his hands. “Can we fix anything? That might be going too far. But things that can’t be fixed now, we could fix with more time. There’s no question.”
CHAPTER FOUR
Beyond Death
The silver cord was not for ever loosed, nor the golden bowl irreparably broken. But where, meantime, was the soul?
—Edgar Allan Poe, “The Premature Burial”
THE SPARKLING SUMMER day was in sharp contrast to Duane Dupre’s mood as he trimmed back pine tree limbs in the backyard of his trim bungalow. 1 Dupre was forty years old with an eighteen-year-old daughter and a twelve-year-old son. Having a girl going off to college was stressful enough and so was managing three grocery stores. Doing yard work was usually a release. Today, it wasn’t. Texas-born and Texas-bred, Dupre was used to the heat, but this day he was feeling every ounce of the 240 pounds that he carried on his not quite six-foot frame. Sweat held his shirt to his chest and across his shoulders, and he could feel pangs of heartburn, or indigestion, shooting through his midsection. Once or twice he’d stopped to rest, but that just made the pain sharper. Oh well, he thought, better to work and distract myself.
Heaving a sigh, Dupre folded his ladder, packed his clippers, and moved on to the swimming pool. After just a few minutes of sweeping the bottom, he decided to call it a day. Damn, it was hot! Wiping his forehead, Dupre headed inside. The indigestion was really starting to burn, so over a cold glass of water, Dupre picked up the phone and called his doctor to ask if there was something he might do for the pain. He’d had a prescription before, no big deal. But when his doctor called back, it brought another headache—-telling him to go to the emergency room. Just a precaution, mind you.
He wouldn’t have gone, but it was too damn hot to do anything else. Dupre drove himself in ten minutes to the hospital and told his story at the desk. That’s when things started to move a bit faster. A concerned-looking nurse took him by the arm, ahead of the people waiting, through the door and down a dim hallway. Five minutes later, in an exam room, a young doctor was telling Dupre that there might be something happening with his heart. To make sure everything was okay, he ought to have an angiogram.
“How about Wednesday?” asked Dupre.
The doctor smiled for some reason and said that Wednesday wouldn’t do. “You need to understand something, Mr. Dupre. You may be having a heart attack.”
Dupre was dubious, but his chest was really hurting. On a hospital phone, he called his sister, who happened to be the head nurse in the hospital’s cardiac unit. She sounded worried and told her brother to get moving.
At least it was cool in the hospital, but Dupre could still feel sweat as he wiped his brow. Two cardiologists came in and started filling out forms. By that point, Dupre was rattled. He knew he had a belly, didn’t exercise much, and could stand to eat a whole lot better, but was he really having a heart attack? His esophagus was on fire; the flames were shooting right up his gullet now. To try and ease the pain, he recalls, “I leaned back on the gurney. And I was gone.”
Now, the medical records tell a pretty clear story of what happened next. For the next twenty-eight minutes, Duane Dupre was in a fight for his life. He’d been felled by a massive heart attack, a 100 percent blockage in his right ventricle. Only a trickle of blood pumped through his veins, and a team of nurses and cardiologists went through every trick in the book to get it moving again. They started CPR straight away, pressing down so hard that they cracked three of Dupre’s ribs. They grabbed defibrillator pads and shocked him six times in those twenty-eight minutes until a heartbeat meekly returned.
At that point, the team threw Dupre on a stretcher, wheeled him to the cath lab, and did an angioplasty. The doctor threaded a tiny balloon through an incision and snaked it through the blood vessels to Dupre’s heart, where he slowly inflated the balloon to open the dam of plaque that blocked the artery. The trickle turned into a normal flow, and pink returned to the patient’s cheeks. “They saved my life,” Dupre says now. He was able to relay that story with such stunning detail that I felt like I had gotten a real glimpse of that fine line between life and death.
But that wasn’t all. Dupre told me there was in fact more to the story. In his telling, something happened in those twenty-eight minutes that the doctors and nurses and medical technicians in the room weren’t even faintly aware of. As the ribs were cracking, as the frantic medical team called out marching orders, Dupre felt himself watching from a perch a few feet above them, surrounded by a warm and blissful feeling.
Dupre struggles for the words to explain what it was like. “It’s complicated, but it was the calmest, the most peaceful, the most relaxing, the most safe place I’ve ever been.” While the doctors struggled over his body, the medical bay slipped away. Dupre found himself in a huge, old-fashioned waiting room full of wooden tables and chairs. “Have you ever seen the old black-and-white pictures of Ellis Island? Big, massive windows, high up, with lots of light coming in?” Like the Great Hall at Ellis Island, there were rows and rows of old tables, but there was also a row of lamps hanging from long cords. The lights were off, except for a single lamp about three-quarters of the way through the room.
“I was the only person there. I was dressed for work. I knew exactly what I was doing there, so I sat and waited,” said Dupre. “I wasn’t scared or apprehensive. It was a very natural place to be. I kept sitting, even though my name was called two or three times. And then I woke up, and there were people running down the hall, sitting on my chest, banging on me.”
What Dupre went through is usually called a near-death experience, or NDE. If death is a tenuous line in the sand, NDEers are people who seemingly were swept away by the tide—only to emerge alive from the pounding surf. Going by the published research it seems that anywhere from
10 to 20 percent of Americans say they’ve had a near-death experience. Casual surveys put the number much higher.
I first heard the term near-death experience in the 1990s, during my neurosurgery training at the university hospital in Ann Arbor, Michigan, but the term long predates that. It was originally coined by Dr. Raymond Moody in his best-selling 1975 exploration Life After Life. Moody became interested in the topic while he was an undergraduate philosophy student at the University of Virginia. In an interview he said he first heard of NDEs from the psychiatrist George Ritchie, who had a near-death experience when suffering severe pneumonia as an army private during World War II. 2 Moody soon met several other people who told him about their near-death experiences. For example, a patient who suffered cardiac arrest said that as doctors and nurses were pounding on his chest, he tried to tell them, “Leave me alone. All I want is to be left alone… . I tried to move their hands to keep them from beating on my body, but nothing would happen. I couldn’t get anywhere. It was like—I don’t really know what happened, but I couldn’t move their hands. It looked like I was touching their hands and I tried to move them.”
Moody, who wrote his best seller while still a medical student at the University of Georgia, identified several consistent characteristics in the stories people told about what happened when they died. 3 Not every experience includes each one of the signature traits, but Moody noticed several common features. The first signal of death, he wrote, is usually a loud, unpleasant noise:
A man is dying and, as he reaches the point of greatest physical distress, he hears himself pronounced dead by his doctor. He begins to hear an uncomfortable noise, a loud ringing or buzzing, and at the same time feels himself moving very rapidly through a long, dark tunnel. After this, he suddenly finds himself outside of his own physical body, but still in the immediate physical environment, and he sees his own body from a distance, as though he is a spectator. He watches the resuscitation attempt from this unusual vantage point and is in a state of emotional upheaval.
After a while, he collects himself and becomes more accustomed to his odd condition. He notices that he still has a “body,” but one of a very different nature and with very different powers from the physical body he has left behind. Soon other things begin to happen. Others come to meet and to help him. He glimpses the spirits of relatives and friends who have already died, and a warm, loving spirit of a kind he has encountered before—a being of light—appears before him. This being asks him a question, nonverbally, to make him evaluate his life and helps him along by showing him a panoramic, instantaneous playback of the major events of his life. At some point he finds himself approaching some kind of barrier or border, apparently representing the limit between earthly life and the next life. Yet, he finds that he must go back to the earth, that the time for his death had not yet come. At this point he resists, by now he is taken up with his experiences in the afterlife and does not want to return. He is overwhelmed by intense feelings of joy, love and peace. Despite his attitude, though, he somehow reunites with his physical body and lives.
AS A DOCTOR, it is somewhat chilling to hear this described so vividly, but the notion of a soul as separate from the body is as ancient as humankind, part and parcel of nearly every religion, from the Tibetan Book of the Dead to the ancient Hindu Upanishads to the prophet Isaiah in the Old Testament: “Thy dead men shall live, together with my dead body shall they arise” (Isaiah 26:19).
In Phaedo, Plato weighs whether “the body comes to be separated by itself apart from the soul, and the soul comes to be separated from itself” or if the soul simply dissolves. In The Republic, he recounts the near-death experience of Er, a soldier, who is apparently slain on the battlefield but later makes a return.
For all the mentions in religion and philosophy, it’s Moody’s description of life after death that holds sway. The near-death experience, as he describes it, is deeply embedded in our popular culture—from new age books about angels to sophisticated films like All That Jazz. Who can forget the climactic song-and-dance number? Choreographer and director Bob Fosse made this autobiographical film about his own hard-driving life and near-fatal heart attack. In the film, Fosse’s alter ego, played by Roy Scheider, does not make it out of the hospital, but before he dies he gets the full near-death treatment—a soft-voiced, white-robed woman; a long white tunnel (looking much like an MRI machine); even a full “life review” in the form of stage patter by Ben Vereen (“A so-so entertainer. Not much of a humanitarian. And this cat wasn’t never nobody’s friend”)… and Vereen’s thrilling song-and dance-number, “Bye, Bye Life.”
TO BE SURE, most people who “die,” who suffer cardiac arrest even for a few minutes, do not remember anything at all of the experience. For Zeyad Barazanji, there’s a completely blank space from the moment he stepped off the treadmill until he woke up in the hospital two weeks later. And yet, whether it’s the one in six from controlled studies or the 42 percent of adults in one physician’s widely read survey, millions of Americans have experienced NDEs. What happened to them?
I always thought that the answer would come from the realm of religion or philosophy, so I was a little surprised to meet people who are confident that science, traditional medical science, can explain the phenomenon. We were introduced to Duane Dupre by one of these scientists, an emergency physician named Sam Parnia, whose research passion is the study of near-death experience. You might picture someone whose office is full of crystals or who lives in a yurt, but we found Parnia roaming the halls of New York-Presbyterian Hospital/Weill Cornell Medical Center, one of the premier centers of academic medicine in the country.
“What is death? What do we experience? Ultimately, whether we like it or not, all of us will be confronted with this eventually.” Parnia went on, bursting with boyish enthusiasm. “What is it likely to be for us? Maybe some old-school types say it should be left to philosophy. I disagree. I say everything should be studied by science.”
An emergency physician by training, Parnia grew interested in death while he was still a medical student in Southampton, England. “For some reason, I became fascinated with the whole mind-body problem. What makes me, me? You, you? What makes the self?” As he watched newborn babies enter the world, Parnia became interested in the question of when consciousness begins and how thought arises from brain cells. As a young medical student on other hospital rotations, he found himself confronted with death on a regular basis for the first time. 4
“I started to see people die in front of me,” Parnia said. “Hospitals were very used to the idea, but I was very much affected by the fact that we would make decisions about how to proceed, how aggressive to be [with dying patients]—without any real science about what death meant or any input from these people.”
I think most doctors don’t take enough time to reflect on death. No doubt, as members of a profession dedicated to preserving life, death can be viewed simply as a failure, not doing the job we hoped we could. It is more than that, though. Anytime I see a patient die, I’m reminded again of just how large the stakes are when you’re a neurosurgeon. I’m reminded, too, of what the future holds for all of us. On the rare occasion that I have more than a few minutes to think about the patient who has just passed on, I also think about how that person reminds me of a family member or close friend.
In his final year of training, now abroad for a stint at New York-Presbyterian Hospital/Weill Cornell Medical Center, Parnia met a man whose death left an especially deep impression on him. Desmond Smith was a cheerful, gregarious West Indian immigrant, celebrating his sixty-second birthday at home just outside New York City. Despite a lifelong smoking habit, Smith was in good health and full of energy, until he began coughing up blood while preparing a big birthday breakfast. In the emergency room, he was still in good spirits, telling the twenty-two-year-old British medical student to cheer up, that everything would be fine. Smith did not seem gravely ill, so while they waited for a few test results, Parnia moved on to oth
er patients.
Thirty minutes later, his pager was blaring the code for a cardiac arrest. Rushing back to the ER, he saw the tall figure of Desmond Smith sprawled on the floor, surrounded by a bustle of white coats. Smith never took another breath. Parnia was devastated and couldn’t shake the questions that filled his head: How could a man so full of life be suddenly gone? What did gone really mean? Where was he now? Was this truly the end?
“I was left with the question of what did this person experience? Was he still with us in some way, or was he completely annihilated? I was fascinated, but I knew there was a science,” said Parnia. “These questions in my mind made me want to investigate it myself.” 5
That hunger to understand never left, but Parnia’s next three years were consumed with the grueling training of a medical residency. There was no time to pursue his curiosity about the possibility of life after death. So it was that three years went by until, the week after emerging as a newly minted, fully credentialed physician, Parnia sought out a doctor named Peter Fenwick, who was at the time perhaps the world’s leading authority on near-death experience.
Fenwick is a neuropsychiatrist and neurophysiologist at King’s College Hospital in London. In 1995, he had just published The Truth in the Light, an evaluation of more than three hundred near-death experiences. To some it might have seemed an odd obsession, but Parnia was fascinated. With Fenwick’s encouragement, the young doctor started reading the scientific literature on near death. By 1997, he had landed a job at Southampton General Hospital in southern England, and he was ready to launch his own experiment.