Erasing Death new book (NPR) Excellent “Science of After Death”

NEW BOOK:

Erasing Death: The Science That Is Rewriting the Boundaries Between Life
and Death
By Sam Parnia, Josh Young

……………….

‘ERASING DEATH’ EXPLORES THE SCIENCE OF RESUSCITATION
NPR
February 20, 2013

‘Erasing Death’ Explores The Science Of Resuscitation
February 20, 201312:03 PM

Listen to Terry Gross interview Dr. Sam Parnia here (MP3)
[audio src="http://nhne-pulse.org/wp-content/uploads/2013/02/erasing-death-npr-02.20.13.mp3" /]

http://www.npr.org/2013/02/21/172495667/resuscitation-experiences-and-erasing-death

What happens when we die? Wouldn’t we all like to know. We can’t bring
people back from the dead to tell us — but in some cases, we almost
can. Resuscitation medicine is now sometimes capable of reviving people
after their heart has stopped beating and their brain has flat-lined;
Dr. Sam Parnia, a critical care doctor and director of resuscitation
research at the Stony Brook University School of Medicine, studies what
these people experience in that period after their heart stops and
before they’re resuscitated. This includes visions such as bright lights
and out-of-body experiences.

Often described as near-death experiences, Parnia prefers the term
“after death.”

“What we study is not people who are near death,” Parnia tells Fresh
Air’s Terry Gross. “We study people who have objectively died. … And
therefore what we’ve understood is that the experience that these people
have of going beyond the threshold of death, entering the period after
death for the first few tens of minutes or hours of time, provides us
with an indication of what we’re all likely to experience when we go
through death.”

In his new book Erasing Death: The Science That Is Rewriting the
Boundaries Between Life and Death, Parnia examines the experiences
patients describe, but whereas much discussion around the experience of
death has been philosophical or personal, Parnia is looking at the
subject scientifically.

“One of the big problems that we have,” Parnia says, “is that because
we’ve never had a science, we’ve never had an objective method to go
beyond the threshold of death and study what happens both biologically
and from a mental and cognitive perspective. Therefore everything that
we deal with is basically hearsay and people’s own beliefs.”

He specializes in people who survive cardiac arrest. Eighty to 90
percent of these patients do not have stories of bright lights, tunnels,
out-of-body experiences and luminous beings. Parnia says this could be
related to the degree of damage and inflation that is occurring in the
brain and how this affects memory. Ultimately, Parnia’s concern is the
quality of care patients are receiving.

The question that drives his research, he says, is: “Is there a reason
why people are having these experiences? For instance, could it signify
that somehow these people had had better-quality resuscitation of the
brain?”

………………

TRANSCRIPT

http://nhne-pulse.org/new-book-erasing-death/

http://www.npr.org/templates/transcript/transcript.php?storyId=172495667

TERRY GROSS, HOST:

This is FRESH AIR. I’m Terry Gross. What happens when we die – wouldn’t
we all like to know? We can’t bring people back from the dead to tell us
but in some cases, we almost can. Resuscitation medicine is now
sometimes capable of reviving people after their hearts have stopped
beating and their brains have flat lined. And some of those people
report being conscious during the period after their heart stopped,
before they’ve been restarted.

These experiences are popularly known as near-death experiences. But my
guest, Dr. Sam Parnia, prefers to call them after-death experiences.
He’s a critical-care doctor who is the director of resuscitation
research at the Stony Brook University School of Medicine. He’s
conducting research into optimal cardiac arrest care, and into the
experiences some cardiac arrest patients report they have brought back
from the other side of death. He says whether these experiences are
psychological phenomena or actually happen, they’ve been reported so
routinely they warrant further study. Dr. Parnia is the author of the
new book “Erasing Death.”

Dr. Sam Parnia, welcome to FRESH AIR. As a doctor who specializes in
resuscitation research, what is your interest in what people have
experienced after they technically died; after cardiac arrest, when
their heart has stopped?

SAM PARNIA: Well, I’ve been interested in this field for many years now.
And the reason I got interested, really, was because I had a patient who
I had taken care of, who – when I was a medical student, many years ago,
now – who I saw essentially die; have a cardiac arrest in front of my
eyes, and nothing could be done to save this person. And I remember
thinking to myself, what is this person experiencing as they’re going
through this period of death?

Now, this was more than 15 years ago, and at that time there was very
little work carried out in this field. But as I have begun to grow in
this field myself, I have come to realize that we have a very strong
need to study what happens to the brain after people die, because
R-remed(ph) – a physician like myself, who specializes in resuscitation
science – R-remed is to bring people back to life after they’ve died.

And therefore, inadvertently, we have to study what happens to the brain
in the minutes to hours after someone’s dead but also, not forgetting
that there’s a human being in there; and that they have a consciousness,
they have a mind, what classically used to be called the psyche or the
soul. And what does that person experience, and what’s it like for them?
And that’s why we combine both together.

GROSS: So since we’re talking about what people experience after cardiac
arrest, after their heart has stopped, and then they are subsequently
revived – so what they experience between the time their heart has
stopped, and the time that they’re resuscitated – how has medicine
changed the length of time you can be technically dead after cardiac
arrest but still be resuscitated?

PARNIA: Traditionally, when somebody died – and that’s true of today –
when somebody died it was really the point where the heart has stopped
beating. And as a consequence of the heart stopping beating, a person
would stop breathing immediately and would lose consciousness
immediately. And the reason for that was that there was no blood getting
to the brain, and the brain would stop functioning.

So today when we define someone as being dead, we look at those three
criteria – no heartbeat, no respirations, and we check the pupils of the
eye for a reflex that when it’s absent, it tells us that the brain stem
and the brain is no longer functioning. The person is motionless – and
they’re dead, and we define them as dead.

However, what we’ve now discovered – in the past decade or so – is that
actually, it’s only after a person dies. So in other words, when someone
has actually reached that point and they’ve become a corpse, that the
cells inside the body start to undergo their own process of death, and
that the period in which the cells die is variable depending on the
organs, but it certainly goes on to hours of time.

So for instance, brain cells will die at about eight hours; again, there
is some variation, but around eight hours after a person has died. And
therefore, our work in resuscitation science is to try to study the
processes that are going on in a person after they’ve died, but before
they’ve reached the point of complete, irreversible and irretrievable
cell damage such that no matter what we do, we can’t bring them back.

And if we manage to restore oxygen and nutrients back to those cells
before they’ve reached that point, we are able to successfully bring
someone back to life. And that’s why today, with numerous advances that
have taken place in the field of resuscitation science, we have managed
to push back that boundary to well beyond the 10-, 20-minute time frame
that had been perceived in the past, into many hours of death.

GROSS: So in resuscitation medicine, one of the goals, as you’re saying,
is to keep the cells alive while the doctors are trying to restart the
heart. And that’s why – and I guess I maybe should have known this, but
I didn’t – in a lot of resuscitation medicine, the person is put on ice,
or a technological version of chilling the body, while doctors try to
revive the heart.

PARNIA: That’s absolutely correct. One of the biggest discoveries in the
last 10 years has been that actually, if we cool people down by a number
of degrees Celsius that actually, we slow down the rate by which the
cells, particularly brain cells, are undergoing their own process of
death – because we have to remember that cell death takes place through
chemical steps. And so from our, you know, high school chemistry days,
we all know that chemical reactions need heat and if you take away the
heat, that slows down the chemical reactions. So actually, that is one
of the things that’s enabled us to prolong that gray zone after death
and bring people back many hours after they’ve died.

GROSS: So let’s talk about what most people describe as near-death
experiences, which is what you’ve been studying except you don’t think
of it that way; you think of it as actual death experiences. And why
don’t you explain the distinction.

PARNIA: Well, after physicians discovered CPR and were able to push back
the boundaries of death for the first time – in 1960, interestingly by
the mid-1970s, a book was published in which people’s accounts of having
had a critical illness and been close to death – including people who
survived cardiac arrest and essentially, had been brought back from
death – their experiences and their accounts were documented. And it was
found that people who’d been in that situation had these very unusual
but yet interesting experiences where they felt incredibly peaceful;
they weren’t afraid of death. They often described seeing a bright,
warm, welcoming light; going through a tunnel. Sometimes they described
a sensation of having a loving, compassionate being with them that would
guide them through the experience. Sometimes they described seeing
deceased relatives. Sometimes they described going to a point where, if
they’d gone beyond that, they couldn’t come back. And some of them
described getting to a place that was very beautiful.

Now, the most interesting aspect of what these people described was a
sensation of detaching from the body and looking down at resuscitation
efforts that had been ongoing. And these were termed near-death
experience, at that time. Now, they led to a lot of interest but also a
lot of skepticism. And one of the biggest problems with the term
near-death experience, which is why I don’t like to use it anymore, is
that it – from a scientific perspective, it is very vague. There is no
definition to what near-death really means, and that’s why it’s led to a
lot of controversy.

And the main reason for that is because what has happened is, different
people have lumped together experiences that were taking place under
very many different circumstances where the human body has a completely
different physiology, a different biological process that has been going
on. And therefore, people don’t agree, and they’ve been very emotional
about this, and it’s created a lot of debate – and in my opinion, not
necessary.

Now, what we study is not people who are near death. We study people who
have objectively died. These people have been dead for tens, sometimes
hours – tens of minutes and sometimes hours of time. And therefore, what
we’ve understood is that the experience that these people have of going
beyond the threshold of death, entering the period after death for the
first few minutes, tens of minutes or hours of time, provides us with an
indication of what we’re all likely to experience when we go through death.

And that’s why I call these an actual death experience, because the
physiology and the biology of the human brain is very well-studied, it’s
very well-understood, and it’s standardized, which means that we can
study it in a scientific fashion.

GROSS: What are some of the questions you’re asking?

PARNIA: Well, at one point, we’re simply interested in documenting what
people have experienced when they’ve gone beyond that threshold of
death. For us, it’s very much – we tend to like to use an analogy. It’s
a little bit like if you look back 100 years ago, and if someone had
said that one day we’ll be able to get into space, go to the moon and
come back, it would have seemed completely implausible. Yet somehow by,
you know, 1969, we were able to go to the moon and come back and tell us
– tell other people what it was like to look at Earth from space.

Now, if you look at death, it’s very similar. Throughout history,
humankind has never perceived it possible to go beyond the threshold of
death. And that’s why if you look at every discussion that takes place
about death, it tends to be philosophical or personal. So we find that
we have a unique set of patients who have actually, by analogy, gone to
the moon and come back and were able to document what they’ve
experienced. And that’s the first level of what we do, is just document
that.

The second level, though, it looking to see – is there a relationship,
is there a reason why people are having these experiences? For instance,
could it signify that somehow these people had had better quality
resuscitation of the brain? Was it something that was going onto their
brain at that time that may be indicative of these, and so on and so forth.

GROSS: So for people who have had these actual death experiences, what
are some of the themes that you’ve heard, experiences that are similar
in many patients?

PARNIA: Well, I think that interestingly, although – as I describe – the
limitation or the problem with the term near-death experience is that
it’s too vague, that in general, people who have undergone cardiac
arrest and a period of death and been brought back to life, actually
have very similar experiences. And what I find most fascinating about
the experiences are the cases where people have come back and described
to their physicians, with astonishing detail, of what had been going on.
And they described watching things, and described hearing conversations
– and recalling them incredibly accurately.

GROSS: When you say what had been going on, you mean going on in the
hospital room after the patient’s heart had stopped, while doctors were
trying to resuscitate them?

PARNIA: Absolutely. So they may describe events that were going on while
they were being resuscitated. They may describe events that were going
on outside their room, family members’ conversations that were going on
that were not even in the room they were in, but things that have been
verified.

And although a lot of people had traditionally tended to discard these
experiences – and possibly for the right reasons because we didn’t have
a science to explain it. But if you look at it scientifically, there are
now millions and millions of people around the world who have had these
experiences, sometimes children less than 3 years old, who have had very
accurate descriptions of what was going on that were similar to what
adults have described. And therefore, it’s important for scientists like
ourselves to bring them into the mainstream and study these objectively.

The general trend of what they describe, aside from the sensation of
being very peaceful, is seeing a bright light; sometimes a very warm,
welcoming, loving being that they describe as being full of compassion,
that guides them through their lives.They often describe having a review
of their lives, everything that they had done from early childhood to
that point. And interestingly, the way they describe their review is
very much like they experience, sometimes, everything that they had
done. So for instance, if they had hurt somebody’s feelings, even
inadvertently, without purpose, they feel the pain that they had given
somebody else. And therefore, they judge themselves, in effect, and
their actions. And that’s why when they come back, many of them are
motivated to lead their lives in a completely different way. I remember
one person who said that, I particularly wanted to make sure that I
don’t fail again; and I want to make sure that I at least end up with a
C, when I get back there again.

GROSS: So I have like, two opposite reactions to these stories. One is
they sound like theatrical cliches; you know what it sounds like? The
Rogers and Hammerstein musical “Carousel,” in which the main character
is dead and comes back to Earth with his angel, who shows him everything
that’s happening and reviews his life. It sounds like a lot of – like a
lot of the more simplistic visions of heaven. But the other side of that
is maybe some of these things have emerged because people have
experienced this, like maybe there’s a reason that there are those kinds
of themes. And also, how do you argue with people who say that they’ve
experienced this?

PARNIA: Well, I mean, this is a wonderful point that you’ve brought up
because if you think about it – and we touched on this earlier – one of
the big problems that we have is that because we’ve never had a science,
we’ve never had an objective method to go beyond the threshold of death
and study what happens both biologically and from a mental and cognitive
perspective. Therefore, everything that we deal with is basically
hearsay and people’s own beliefs. And that’s why if you were to poll,
I’m sure, 1,000 people, you may get up to 1,000 different opinions, but
possibly even – maybe a slight exaggeration, but you may well get many
different opinions.

Some people have actually suggested that it may be that our perceptions
of what it’s like to die may be related to people who come close to
death and been – somehow come back to life and told others. For
instance, there’s a very interesting painting by Hieronymus Bosch, from
the 15th century, where he’s actually painted what looks like a
classical near-death experience. But in reality, people didn’t know
about near-death experiences at that time, and it certainly isn’t what
classical Christianity would have taught of what people would have
experienced when they’ve died. So what we’re doing is, really, going
through and systematically and scientifically studying what people
experience. And what we’re hoping to do is to enable science to guide
our opinions and belief systems, as it’s done with other aspects of
human knowledge in the past.

GROSS: If you’re just joining us, my guest is Dr. Sam Parnia. We’re
talking about his new book “Erasing Death: The Science that is Rewriting
the Boundaries Between Life and Death.” And he’s the director of
resuscitation medicine at the Stony Brook University School of Medicine.
Let’s take a short break here, and then we’ll talk some more. This is
FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: My guest is critical care doctor Sam Parnia, author of the new
book “Erasing Death.” We’ll get back to the research he’s conducting
into the so-called near-death experiences some cardiac arrest patients
report. But first, some more about state-of-the-art resuscitation medicine.

So what is the most technologically advanced and effective way of
restarting a heart?

PARNIA: Well, traditionally, what doctors have been doing since the
1960s and ’70s is essentially, doing chest compressions and providing
breaths to a person; that’s what we call CPR. But really, we’ve now
advanced beyond that and therefore, there are various other technologies
available, which include automated CPR machines that will deliver both
breaths and chest compressions at the correct depth.

But also, more advanced systems are in place, which are particularly
prominent and used commonly in Southeast Asia, in Japan, South Korea,
where they actually will take a person who’s been found dead,
effectively, brought to the emergency room; and attach them to a type of
bypass machine that takes the blood out of the body, provides oxygen
into it, and then circulates it and pumps it around the body again. And
that way, they give the doctors number of hours of time to try to figure
out what caused the person to die, and fix the underlying problem before
restarting the heart and bringing the person back to life again.

GROSS: So while we’re talking about resuscitation medicine – which is
your specialty – you’ve said that death isn’t a moment; it’s more like a
process in which the heart stops and then slowly, the cells die. And you
say resuscitation isn’t like, a 10-minute process. It’s something that
goes on even after – like, resuscitation medicine continues even after a
person’s heart has begun beating again. Tell us a little bit about that
process of resuscitation medicine.

PARNIA: Well, after CPR was discovered, there was a lot of excitement
because for the first time, physicians could actually bring back someone
who died. However, after this was put into practice and it was spread
around the world, it became very clear that even though physicians were
getting better at restarting the heart in people who’d died, most of the
people whose heart had been started once would die again in the
subsequent hours to days, such that the overall ability to have survival
– and ensure patients go home and remain without brain injury – remained
very, very low.

And the discovery that really has helped us to shift that balance was
the understanding that actually, the fact that someone has died once and
been brought back to life, is a completely unnatural state. And it leads
to a number of complications in the brain, in particular, but also other
organs; where the brain becomes inflamed and swollen and acidic and
damaged. And therefore today, the way that we have tried to function is
to also optimize resuscitation for the subsequent 72 hours after we’ve
even restarted the heart, to ensure that people don’t end up
brain-damaged and can get home safely.

GROSS: And just tell us, briefly, what are some of the things you can do
to try to prevent that brain damage.

PARNIA: Well, one of the biggest discoveries has been that if we cool
the brain, we slow down the rate by which brain cells require oxygen.
Because one of the biggest difficulties is that after you restart the
heart, the brain starts to swell up. There is – no matter – even if the
heart’s beating, we can’t get quite enough blood and oxygen into the
brain. So that while there is a deficit in the amount of oxygen getting
into the brain, the brain cells continue to undergo damage and
eventually, will lead to severe disability. By cooling the brain down,
we essentially slow down the rate of their activity and therefore, they
need less oxygen. So we try to match the amount of oxygen to what they need.

Furthermore, we also take away the swelling itself by cooling the brain.
And then other things that we have to do, which are very important – is
to regulate the correct level of blood pressure, which traditionally has
been too low. And we found that actually, by making sure the patient has
a higher blood pressure, we can get more blood into the brain. We need
to regulate the oxygen very closely, the carbon dioxide; and there are a
number of other nuances that we have to work on. But it’s by putting
together these multiple, intricate links, into the chain of
resuscitation that we can ensure that things that are potentially toxic
are removed.

For instance, another important point is that we’ve discovered recently
that actually, oxygen itself, if in excess, is toxic to brain cells; and
it causes them to die. And so that’s why it’s very subtle, and very
important, to manipulate these different parameters.

GROSS: Dr. Sam Parnia will be back in the second half of the show. He’s
the author of the new book “Erasing Death,” and is the director of
resuscitation research at the Stony Brook University School of Medicine.
I’m Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I’m Terry Gross, back with Dr. Sam Parnia, the
director of resuscitation research at the Stony Brook University School
of Medicine, and the author of the new book “Erasing Death.” He’s a
critical care doctor who is researching optimal ways of caring for
cardiac arrest patients and restarting their hearts. He’s also
researching the experiences some of these research patients report
having in the period after their hearts stopped, before they’ve been
restarted; what is popularly known as near-death experiences, but which
he describes as after death experiences. These patients sometimes report
having seen a bright light or a luminous being, or having had a review
of their life.

Now, although you specialize in resuscitation medicine, you know few
people who have actually reported these kinds of experiences – people
who have been your patients. And you write in your book that 80 to 90
percent of people who survive cardiac arrest don’t have these
recollections. So the overwhelming number of people who have these
actual death experiences, don’t tell stories about bright lights and
tunnels and out-of-body experiences and luminous beings – and
everything. So what do you make of that; that the people who do report
that are really, in a minority?

PARNIA: Well, you see, it’s important to remember that people who’ve
died – as I said, even when they’re getting CPR, their brain is
completely flat lined. The brain does not function, which is why they
are in a complete coma. That’s why if you test their reflexes, their
brain reflexes are absent and therefore, we would expect there to be no
memories whatsoever from anybody because even if you were to have some
sort of experience, you don’t have the apparatus to carry the experience
back and allow you to describe it to other people – because that
apparatus is completely nonfunctional. So what we don’t understand is,
why is it that 10 to 20 percent of people do somehow, paradoxically,
despite a non-functioning brain and going through the process of death,
recall these incredibly vivid experiences.

What we do believe, though, is that it may be related to the degree of
damage and inflammation that is occurring in the brain afterwards. So,
for instance, if I were to resuscitate a patient now, after an hour of
chest compressions, and bring them back to life again, we realize that
that’s not the end. They still have significant swelling of the brain,
inflammation, damage ongoing to the memory circuits as well as other
parts of the brain for the subsequent 24, 48, even 72 hours. So now, if
I were to get this person back to life and they can fully become
conversant and try to remember their experiences, it may be that the
swelling has actually erased their memory from that time.

And I think there’s some evidence to support that. What we’ve certainly
found, in our studies, is that if we manage to get to patients
immediately after waking up – which is not easy, at times – and talk to
them, they tend to remember more. And if you go back and re-interview
them within a couple of days, they tend to have forgotten their
experiences, possibly. So we think that probably, many more people have
these experiences, if perhaps not – even everyone; but somehow, their
memories get wiped in the same way that most of us, if not all of us,
dream every night but somehow, there’s a disruption to the memory
circuits that allow us to recall our dreams the following day. And some
people certainly are more vivid dreamers; they can recall more of their
dreams than others. And that somehow – to do with the circuitry of their
memory recall.

GROSS: I’m glad you bought up dreams because I’m sure a lot of skeptics
say what people are experiencing with the luminous being and the light,
and the out-of- body experience is basically a chemically induced dream;
a hallucination of some sort, induced by a chemical. What’s your answer
to that?

PARNIA: Well, essentially, what you’re referring to is broadly talked
about, and considered, as the dying brain hypothesis; and that being
that essentially, as a person is dying, there are various chemical
changes going on in the brain, and there may be activation of certain
parts of the brain that can lead to hallucinations – for instance, the
same parts of the brain that say, LSD or other drugs may act upon. The
problem with this theory is that one, there is no scientific evidence to
support it. There have been numerous studies carried out looking at very
– oxygen levels, carbon dioxide levels, drugs, etc.; and there is no
relationship that has ever been discovered with any such factor and
people having experiences.

But the more important point that we need to highlight is that when
we’re studying people who’ve had a cardiac arrest – which is why I like
to separate them out from the vague entity of near-death experience, is
that we understand the physiology of what happens to the brain in very
precise detail. After someone dies and the heart stops, the brain stops
functioning within moments. And you have a complete flat-lined state.
There is inadequate blood getting into the brain, so the brain circuits
can no longer function. And therefore, there should be no memories. So
in order for someone to even hallucinate, they have to have a normally
functioning brain. And so what our discoveries have started to do is to
question the way we consider the relationship between the human mind,
what has classically been called the psyche or the soul, and the brain
itself. And it may be that the human mind, consciousness or soul may be
able to function when there is no brain function at all.

GROSS: Well, that leads to the question that so many people have asked,
and failed to answer; which is, where is the seat of consciousness?

PARNIA: Well, obviously that question goes back many centuries and
millennia before our time. And certainly, the classical Greeks had
addressed this and tried to address this in detail. Plato and many
others considered that the human mind, the psyche or the soul is an
entity that is separate from the body whereas others, such as Aristotle,
considered that it must be produced from the body – somehow, the soul is
a product of bodily processes. And if you now fast forward to modern-day
science, in a sense we have no answers, either. There is not a single
shred of scientific evidence that shows us how a brain or a brain cell
could generate thoughts, consciousness, feelings, emotions, everything
that makes us into who we are.

And therefore, scientists have also been broadly divided into two
opinions. Some tend to follow Aristotle’s belief system; that although
we have no idea how consciousness, the psyche, the soul may come to be,
it must somehow be generated by bodily processes and particularly, in
the brain. And there are others who think that perhaps no matter what we
do, we will never be able to explain the entity of the human mind
through activity of electrical and chemical processes in the brain and
therefore, that entity that we consider the soul or the psyche or the
self is a separate, undiscovered scientific entity that works with the
brain but is not manufactured by brain cells.

GROSS: You write in your book that because of what you’ve learned about
people’s actual death experiences – and you’ve learned this from them,
after they’ve been resuscitated – you say we can be certain that we
humans no longer need to fear death. And granted, a lot of people have
been telling these stories. But a lot of people don’t have these stories
to tell. A lot of people who have been resuscitated, we don’t know what
they’ve experienced. Do we know what people experience when they
knowingly commit suicide, or when they’ve been the victim of a terrible
crash or a bomb blast, or a murder or something, where there is no hope
of, you know, restarting the heart because the body is just so
shattered? Like, we have no idea what that experience would be like even
if we believe the testimonies by those who say they’ve seen – you know,
a beautiful light or a luminous being.

PARNIA: Well, I think this is a point that is definitely worth, you
know, thinking about a little bit more. Obviously, as you said, we have
certain limitations at any time where there are some people that we
cannot bring back. I mean, if someone’s been a victim of a bomb blast
and – as horrific as it sounds, you know – because we don’t have a body
to bring someone back to, then we simply, we can’t work miracles today.
Maybe in the future, things will be different. However, what is
interesting though, is that generally – and the reason why I think we
can draw some conclusions that are applicable to all of us – is that the
experiences where people have looked – have described when they’ve gone
through death, the initiating factors have been variable and different
amongst the people. And in other words, what I mean, the thing that
caused them to die hasn’t been the same. It’s been very different.

And furthermore, these experiences have been described from all over the
world; people with different cultures, different backgrounds – whether
they be atheists, whether they have a particular religious faith, or
somewhere in between – and even children who are sometimes too young to
have any concept of what – or understanding of, you know, the concepts
of an afterlife or what happens when we die, etc. Yet the message of the
experience is remarkably universal, and it tends not to be frightening
to people. It tends to be very positive and upbeat, certainly for those
who’ve gone through a natural process of death.

Now, where I do like to definitely highlight caution is in the case of
people who’ve tried to commit suicide who somehow, we’ve managed to
bring back – and believe me, we get those. Those people tended to have
had, in my experience, very frightening and disturbing experiences that
I would definitely warn people off doing that. But those, at least,
who’ve died through natural causes, they – I don’t think they should be
afraid of death. We understand what happens when people die, and that’s
the one conclusion that I think we can make.

GROSS: So you’ve said that you think that the positive feelings, the
luminous beings, the sense of light and peace that some people report
having experienced after their heart has stopped during that period of
resuscitation, that you don’t think that that would be true of people
who commit suicide. Why would suicide be different?

PARNIA: I couldn’t tell you why suicide should be different. I can
simply tell you that from my experience of talking to people and
interviewing people who have gone through suicide, that the experiences
have been universally painful and distressing and certainly, they
wouldn’t want to go through it again. And therefore, I’m simply sharing
that observation. I don’t know what the processes could be, but I
certainly would not suggest someone to try that.

GROSS: My guest is Dr. Sam Parnia, author of the new book “Erasing
Death.” He’s the director of resuscitation research at the Stony Brook
University School of Medicine. More after a break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: If you’re just joining us, my guest is Dr. Sam Parnia, and he is
the director of resuscitation research at the Stony Brook University
School of Medicine; and is the author of the new book “Erasing Death:
The Science That Is Rewriting the Boundaries Between Life and Death.”

So one of the things you’re trying to empirically test is, you know,
when people say they’ve had an out-of-body experience, can you actually
prove that. And so you’re trying to study that. How are you trying to
study that?

PARNIA: The whole – sort of experience that people have had has really
fascinated many of us, for many years. And one of the things we have to
remember – and you actually highlighted this in one of the questions you
asked me, but I didn’t address it – is that the experience that people
have is very personal, and it’s very real to them. So for most people
who’ve gone through these experiences, as far as they’re concerned, what
they’ve experience is absolutely real. They’ve described and seen
something of the other side. Now, for those of us who haven’t had the
experience, it’s impossible to verify that. But in the same way that,
for instance, if a patient comes to me and says, I have depression, it
would be completely unacceptable for me as a physician to simply discard
that experience and say, well, I don’t think you – you know, you may
feel that you’re depressed but actually, it’s an illusion of having
depression; or, you’re hallucinating your depression, it’s not really
real. So we have to remember that to the people who’ve had the
experience, it’s real to them.

Now, how can we scientifically test these experiences? Well, most of
what they describe is very subjective. You know, if they describe seeing
a being of light or a tunnel, I can’t test that. But if they do come
back and describe in specific details watching me or my colleagues
working on them, recalling their conversations, then that is potentially
more objectively testable. And so what we have done as part of our work
is to try to install images that are only visible from a point above –
at the ceiling, in areas where patients are getting resuscitated in
order to see if they also can describe seeing this – images that they
would not have known about beforehand.

And obviously, if we can get, you know, a series of hundreds of people
who claim to have been at the ceiling looking down, and they do describe
the images, then we have to probably accept that what they say is real.
If, on the other hand, none of them describe seeing the images, then we
have to perhaps question their perception of what they’re seeing.

GROSS: So have you tried that yet, and what have the results been?

PARNIA: We have been trying it. We started a very small, pilot study at
my hospital in England a number of years ago. However, what we’ve come
to realize – and that’s ongoing – what we’ve come to realize is that we
have numerous challenges. The first challenge is that most of the
patients who get resuscitated, unfortunately, don’t live long enough to
talk to us. So this is one of the big problems we have – is that the
standard of care for resuscitation is not universal, and people don’t
all receive the best level of care so as a result, we may be lucky if
only 10 or 15 percent of people who go through resuscitation actually
come back and can then talk to us. And of these people, most of them
have had their memories completely wiped out. And only about 10 percent
will actually have any memories whatsoever. But the occurrence of the
out-of-body experience is even more rare. So we found that actually,
only about 1 percent of patients who survive a cardiac arrest actually
have any memories that are consistent with an out-of-body experience.

So that means if you start out with a thousand cardiac arrest events,
you may end up with one person who has – who’s lived long enough to also
have an out-of-body experience and therefore, as the data is now coming
through – and I’ve tried to describe some of these in our book because
people are fascinated by it, and we get numerous requests for updates,
etc. They don’t realize how challenging this is. We’ve had a number of
people who’ve had out-of-body experiences, but their out-of-body
experiences have occurred in areas where they actually did not have
images installed. And they’ve tended to recall looking at the events
from a different angle to where the images have been installed

So for instance, we have started out by putting images at the head of
the bed. But the patients come back and told us that, you know, I was
looking from the foot of the bed; and then goes through and describes
all kinds of accurate details. So we’re having to readdress – and as we
learned, we’re having to adjust the study, to incorporate the realities
of what’s happening on the ground.

GROSS: So if I may ask, what do you ultimately hope to learn before you die?

PARNIA: Well, I’d like to rephrase that and say, what would I like to
achieve?

GROSS: (LAUGHTER) OK.

PARNIA: (LAUGHTER) If I may. And what I’d like to achieve – and this is
what really drives me on; and we haven’t talked a lot about that, but it
really does drive me on, and it really is something that bothers me – is
that there is enormous, enormous variation in the quality of care that
our patients receive, across the country and in different countries. And
the reason for that is because there is no – absolutely no regulation on
the quality of care that our patients receive. And therefore, at the
same institution, doctors may provide care completely differently. And
therefore, your chance of coming back from a cardiac arrest is
completely potluck. And more importantly, that means that your chance of
ending up with brain damage is also completely potluck.

Now, we have to remember that cardiac arrest is the only condition that
will affect every single one of us. I will definitely have a cardiac
arrest in my lifetime. You, unfortunately, will definitely have a
cardiac arrest, and so will everybody who’s listening to your show. And
so do we want to have the best level of care provided for us so that we
can be brought back without brain damage? Or are we willing to just take
a pot chance? So that’s my overall goal and ambition.

Now, an inadvertent consequence of that work is that we’ve – constantly
pushing back the boundaries. And what we’re beginning to learn
scientifically, which is what I’d like to continue to learn – to address
your actual question – is, what does happen to us when we die? What is
the relationship between the human mind, the psyche, consciousness, or
what people have classically called the soul? And I use that term on
purpose because I want people to understand what it really means. It’s
the self. What happens to it, and how does that interact with the brain?
And what does that tell us, and how can we use that to better our lives
while we’re on Earth? Inadvertently, through science, we’re starting to
answer questions about what is life, what is death, what is the real
afterlife that people have talked about; does it really exist. And I
think we’ll continue to have more answers in the coming years.

GROSS: So this might be too personal, but are you giving this a
religious interpretation?

PARNIA: Not at all. You know, I didn’t come from religion; I don’t
particularly have a religion. So I just want to be clear about that. I
came to this – again – for some crazy reason. I was a 19-year-old who
was fascinated by what makes us into who we are, and then I started to
see people being resuscitated in hospitals. And I began to see that we
don’t have the right standards of care, there’s enormous variation in
care; and that really provoked me into getting involved in this field.

And as now – you know, many years have gone by, and I’m still interested
in this, and I continue to push forward. I’m beginning to learn things
that I’m simply sharing with others – because we have to remember that,
you know, until a few hundred years ago, everything that was “known” –
and I say in quotation marks, “known” – was described to us by
philosophers or theologians, OK? But it was only through the advent of
the scientific method, which is, in essence, the objective method of
learning about the world around ourselves, that gradually, things
started to fall out of philosophy or theology, and into the realm of
science. So for instance, you know, astronomy, the idea of the stars,
was always a religious thing. And now, it’s science. Well, I believe
that death should also be studied by science, and that’s what I do.

GROSS: Well, thank you so much for talking with us.

PARNIA: It’s been a pleasure, and I’ve really enjoyed being on the show.

GROSS: Dr. Sam Parnia is the director of resuscitation research at the
Stony Brook University School of Medicine. His new book is called
“Erasing Death.” You can read an excerpt on our website,
freshair.npr.org. This is FRESH AIR.

………………

Excerpt from ‘Erasing Death’
Chapter 1
Amazing Things Are Happening Here

http://nhne-pulse.org/new-book-erasing-death/

http://www.npr.org/books/titles/172494833/erasing-death-the-science-that-is-rewriting-the-boundaries-between-life-and-deat?tab=excerpt#excerpt

Joe Tiralosi began to feel ill shortly after leaving a Manhattan car
wash. He was a little nauseated, somehow off, and was glad his shift had
ended. A chauffeur, Tiralosi spent his workdays driving legendary stock
trader E. E. “Buzzy” Geduld around New York City. But on this August
afternoon in 2009, a few minutes after he had begun his drive home to
Brooklyn, he couldn’t stop perspiring. He cranked up the air conditioner
in his car, but he continued to sweat profusely.

Tiralosi was a practical man, a married father of two, and not given to
panic. So he planned to push through with the rest of his day, figuring
his ill feelings would pass. But an hour later, it was unbearable. He
called his wife.

Don’t take any chances, she told him. Go to the hospital.

But he couldn’t drive another block. His wife immediately called a
coworker, who found Tiralosi pulled over at the corner of Eightieth
Street and Second Avenue in Manhattan and rushed him to the emergency
room at New York Presbyterian Hospital.

Tiralosi was helped into the ER by his coworker. The color had drained
from his face. He began explaining to a nurse what was wrong, but before
he could finish, he collapsed. A Code Blue, meaning cardiac arrest, was
called. Tiralosi’s heart stopped. He was dead.

But fortunately for him, he had died in a hospital where a team of
people specially trained in resuscitation was on duty. Doctors and
nurses came racing over from every direction and immediately started
CPR. They are accomplished professionals whom I have worked with many
times, including Dr. Rahul Sharma and Dr. Flavio Gaudio, both very
diligent emergency physicians. They were part of the team that lifted
Tiralosi onto a gurney, tore open his shirt, and cut off his pants with
scissors. They attached the circular electrodes of a defibrillator
machine to the skin of his chest. They moved rolling carts lined with
medicines into the cramped space around him.

Despite all the modern technology available to them, the medical team
also scrambled over him with an everyday item — plastic bags, loaded
with ice. They positioned the bags along his sides, under his armpits,
and on either side of his neck. They injected his veins with chilled
saline. The team did all this in about one minute. His body temperature
quickly began to drop. Then they settled into a rhythm: CPR, accompanied
by occasional injections of adrenaline and defibrillator shocks.

Joe Tiralosi was now surrounded by some of the best medical personnel,
technology, and thinking that modern science has to offer. But he was,
with no heartbeat and insufficient oxygen and nutrients feeding the
cells of his brain and body, already dead.

Don’t take any chances, his wife said. Go to the hospital. Could these
or any other words recur to Tiralosi as he lay flat on the table and
slipped further into the process of death? Was he aware of anythingat
all? The dominant, scientific view of the brain is that such a thing
would be impossible. The gag reflex and other functions of his brain
stem had ceased, meaning his brain had stopped functioning entirely. All
the conversations he had with his wife were now seemingly lost to him,
and the odds were against him ever seeing his family again.

Seconds passed to the steady rhythm of chest compressions. Minutes
passed. They stopped compressions and hit Tiralosi’s body with an
electric shock. Still, no heartbeat. After ten minutes of continuous
chest compressions, the medical and nursing staff was starting to lose hope.

Ten minutes without a heartbeat has long been considered a kind of
dividing line in resuscitation science. It has long been thought that
after ten minutes without a heartbeat, damage to the brain from a lack
of oxygen starts to become permanent. Of course, without a properly
functioning brain, Joe Tiralosi would no longer be Joe Tiralosi at all.
His memories, his personality, what we might call his “Joeisms” would be
gone forever, and only his body would still be here. His wife could hold
the hand of the man she had shared her life with, yet they would not
really be together.

So ten minutes passed, fifteen minutes passed. Doctors worked well past
the old markers; the ticktock rhythm of chest compressions was
punctuated by an occasional defibrillator shock.

Twenty minutes.

The call to cease resuscitation attempts in this circumstance belongs to
the doctor in charge. But he kept going.

Thirty minutes.

By now, Tiralosi had received thousands of chest compressions and had
his heart shocked a half-dozen times. The room was looking more and more
like a war zone. Traces of blood and medical debris lay around the
gurney. Empty vials of adrenaline littered the floor, like spent gun
cartridges on a battlefield. The nurses and doctors providing chest
compressions were sweating, consuming their own stored-up energy.

Forty minutes.

Ten years ago, continuing to try and save him at this point would have
been considered a tremendous risk — for both Tiralosi and his family.
In the best-case scenario, even if Tiralosi’s heartbeat was restored,
his mind would be a mess — a CT scan likely revealing multiple small
and large plumes of damaged, black spaces where functioning neural cells
once held his thoughts. But technology and medical understanding have
advanced with the years, and so the doctors pressed on because they knew
there was a possibility, however remote, that Tiralosi could be saved
and returned to his normal life.

Finally, something incredible happened to break the exhausting monotony
— someone screamed with excitement: “I feel a pulse, I think we’ve got
him back.” Suddenly, in one moment, all those clouds of despair were
replaced by a sense of elation in the room.

The exhausted staff had a new wind of energy and, more important, after
having had more than forty-five hundred chest compressions and having
his heart shocked with a defibrillator eight times, and being given
countless vials of adrenaline, Joe Tiralosi’s heart had started to
flicker again.

Ten years ago, a man saved after that length of time would most likely
have been a kind of living husk — his body present, his mind gone. But
today, Joe Tiralosi is a smiling, vibrant man. His face is long and lean
with the shade of a well-groomed mustache and goatee covering his lips
and chin. He is back at home with his children and the wife whose advice
helped to save him, and back at work, continuing his life. The
newspapers and television stations that reported on his resuscitation
all called his recovery a miracle. If so, Tiralosi and his family were
the beneficiaries of a medical miracle — delivered through medical science.

…

Throughout history, death has loomed as the ultimate downer of a
subject. The ultimate defeat. But recent scientific advances have
produced a seismic shift in our understanding of death — challenging
our perceptions of death as being absolutely implacable and final — and
have thus rendered many of our strongest-held views regarding death as
outdated and old-fashioned. In fact, where death is concerned, two major
revolutions have already begun — one of accomplishment, and another of
understanding. In short, medical science is rendering previously
unthinkable outcomes entirely plausible. We may soon be rescuing people
from death’s clutches hours, or even longer, after they had actually died.

But as an unintended consequence of developing these new lifesaving
measures, science is also expanding our knowledge of death. By finding
new means to save lives, we are also inadvertently finding new ways to
investigate and answer fundamental questions about what happens to human
consciousness, to what we might call the mind, the “self,” or even
“soul,” during and after death — questions that, until recently, were
considered subjects better suited to theology, philosophy, or maybe even
science fiction.

.