When the doctors declare you dead, you will hear them. Quite often, you may see them, too, from a coign of vantage, if you are lucky enough to number among the 0.4 per cent of cardiac arrest patients who return from the dead with their memories intact. That’s the substance of early leaks from the second report of the AWARE (AWAreness during REsuscitation) project, which sparked off a rash of media stories last week in the UK and US. Led by Dr Sam Parnia, it is the world’s biggest scientific study of the mind and awareness during clinical death, when respiration and the pulse cease and the brain stem shuts down.
While preparing for his MRCP 20 years ago, Parnia, then at Southampton General Hospital in the UK, was drawn to a rather obscure field of research: near-death experiences. The unusual inclination has turned him into a cult figure closely watched by everyone interested in the first and last questions: where do we come from, and where do we go after the last breath? The stars, Carl Sagan had affirmed in Cosmos — deep within, we know that we came from the gulfs of space, and long to return. But these questions are of wide ambit, and they have preoccupied philosophers, religious thinkers and shamans for millennia. They offer many answers, while science offers none. That is the void that Parnia hopes to fill, using the precision tools of science.
Medical doctors are trained to focus on the preservation and prolongation of life. Death signifies failure, and yet Parnia found the community helpful from the word go. He got first aid from the legendary cardiologist Douglas Chamberlain, whose rules for ECG analysis are still in use, and who made paramedics — the preclinical specialists who care for patients during the “golden hour” — the pivot of emergency care by suggesting that they should be taught resuscitation.
Chamberlain told Parnia of his own experience in resuscitating a cardiac arrest patient, by fairly primitive means, way back in 1960, who later claimed that he had been watching the procedure from a point near the ceiling. He was apparently not very grateful, because he had not wished to come back to life.
Parnia is one of very few researchers in this area who writes for the lay public. In 2005, he published What Happens When We Die (Indian edition 2008, Hay House), an account of the methods he developed at Southampton General. He chose patients with cardiac arrest, a condition in which the notion of clinical death is clearly defined and universally accepted. And since resuscitated patients frequently report a disembodied state in which they watch the efforts of the emergency crew from up above, he suspended boards horizontally from the ceiling, bearing different markings above and below. It was a simple stratagem for winnowing truth from imagination — if you were really hovering near the ceiling and it wasn’t just your brain on a hypoxia high, you should know what was on the top side of the board.
The paradox of near-death experiences is that, clinically, a person with cardiac arrest should be in an acute confusional state as the terminal moment approaches, and yet patients who come back from the dead often report their experiences with astonishing lucidity — such as a feeling of joy, and of traversing a tunnel towards a light. If they saw what was written on a board that they could not possibly be seen from the emergency room gurney they lay on, they would let you know.
It is reported that the second phase of the study, which is in progress now, has added a new trigger: the name of a world capital is spoken out loud during resuscitation. It is a bit weird to imagine doctors and nurses in a tearing rush yelling, “Tehran!” and “Tokyo!” amidst the customary calls to, “Stand back!” and “Cannulate!” and “One mg adrenaline stat!” But that seems to be going on in several hospitals, and patients who recover after flatlining are apparently recalling the names of capitals in a statistically significant manner.
Parnia, now at New York University’s Langone School of Medicine, has taken care to keep his study apart from the mysticism and religious doctrine associated with death. The focus is the relationship between consciousness and the brain — the mind-body interface, between the biological hardware and the abstraction layer which rides on it, in which reside our loves and hatreds, knowns and unknowns, the Dancing Girl of Mohenjodaro and tensor algebra, Nostradamus and Einstein, Mona Lisa and Inanna, and, most significantly, our hopes and fears. Including the fear of death.
Parnia is one of dozens of researchers who have been fascinated by the moment of death, but one of a very few who connects with laypersons. That’s a vast community — anyone who is old enough to have shed the exuberance of childhood and to be conscious of their own mortality. Readers who have had near-death experiences can connect with him at www.horizonresearch.org.