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Long didn’t really convince me that NDEs are evidence of another world. After all, my dreams can seem pretty realistic; often
the only reason I know it was a dream is because when I wake up in bed the three-headed alligator or the tropical beach or
the supermodel isn’t there. But Long also raises another important point. REM intrusion—whether sleep paralysis or hallucinations—tends
to be frightening or deeply unsettling. By contrast, most people who go through an NDE say the experience is almost supernaturally
calm and peaceful, even joyful. Not only anecdotes, but real evidence does support this. In a 2001 study in the medical journal
The Lancet
, of sixty-two cardiac arrest patients who reported a near-death experience, more than half said the main emotions they experienced
were “positive.”
22
Long says these distinctive, positive emotions are powerful evidence that a near-death experience is not just REM intrusion
in disguise.

An even fiercer critic of scientific NDE explanations is Dutch cardiologist Dr. Pim van Lommel—the author of that
Lancet
study. Now in his late sixties, van Lommel has the graying hair and kindly smile of a beloved family doctor. When he opens
his mouth, though, he sounds like the commanding medical general who ran the cardiology ward of a major hospital in his native
Holland. Even in English, his tone is clipped and certain. Like most physicians who study near-death experience, van Lommel
traces his interest to an early patient—in his case, a man who was bitterly disappointed to be back among the living. Van
Lommel says, “He told me about the tunnel, and the light, and music, and a beautiful landscape so beautiful that he was unhappy
to be back in his body.”
23

Intrigued by the vivid story, van Lommel started asking his patients who survived a cardiac arrest if they remembered anything
from the period of unconsciousness. Many did, and he began to analyze their accounts. His
Lancet
study looked at 344 cardiac arrest patients, only sixty-two of whom had what van Lommel categorized as a near-death experience.
To van Lommel, this was proof that something was going on
outside
the body. “Our results show that medical factors cannot account for occurrence of NDE,” he wrote. “Although all patients
had been clinically dead, most did not have NDE. Furthermore, seriousness of the [physical] crisis was not related to occurrence
or depth of the experience. If purely physiological factors caused NDE, most of our patients should have had this experience.”

In the
Lancet
, van Lommel describes a signature case—a forty-four-year-old man, cyanotic and comatose, who had been discovered an hour
earlier, lying unconscious in a meadow. He had no detectable heartbeat. To insert a breathing tube, van Lommel had to remove
the man’s dentures, which he placed on the crash cart in the medical bay. Only after defibrillation, “extensive” CPR, and
ninety minutes of touch-and-go waiting was the patient stable enough to transfer to an intensive care unit.

A week later, the man was recuperating in the cardiac ward when van Lommel found him awake for the first time.

The moment he sees me he says: “Oh, that man knows where my dentures are.” I am very surprised. Then he elucidates. “Yes,
you were there when I was brought into hospital, and you took my dentures out of my mouth and put them onto that cart; it
had all these bottles on it and there was this sliding drawer underneath and there you put my teeth.” I was especially amazed
because I remembered this happening while the man was in deep coma and in the process of CPR. When I asked further, it appeared
the man had seen himself lying in bed, that he had perceived from above how nurses and doctors had been busy with CPR. He
was also able to describe correctly and in detail the small room in which he had been resuscitated as well as the appearance
of those present like myself. At the time that he observed the situation he had been very much afraid that we would stop CPR
and that he would die.

Despite the man’s poor initial prognosis, he was able to leave the hospital a month later. Wrote van Lommel, “He is deeply
impressed by his experience and says he is no longer afraid of death.”

Van Lommel argues forcefully for the view that NDEs prove the existence of an unseen world, a level of consciousness beyond
the confines of the brain. In a 2007 article, he writes, “Because of the occasional and verifiable out-of-body experiences,
like the one involving the dentures in our study, we know that the NDE must happen
during
the period of unconsciousness, and
not
in the first or last seconds of cardiac arrest. So we have to come to the
surprising conclusion
that during cardiac arrest NDE is experienced during a loss of all functions of the cortex and of the brainstem.”
24
(van Lommel’s italics)

A lot of people find this convincing. It certainly tackles a question that arises from the most dramatic stories, where a
patient seems to have accurate memories from a time when he or she was measurably, clinically dead. There are thousands of
stories like this, but it’s extremely rare to find one that comes with medical documentation. Probably the best-known case
involves a woman named Pam Reynolds, a Juilliard-trained singer and songwriter who lives just outside Atlanta. In 1991, Reynolds
was working with her family’s record business, writing her own songs and also raising five children when she received alarming
news—she’d been diagnosed with an aneurysm of the basilar artery, a major blood vessel in the brain. Doctors told Reynolds
it could rupture at any time and advised surgery to fix the damaged artery.
25

Because of the aneurysm’s size and location, the operation would be unusually complicated. The aneurysm was large and fragile,
on a major artery, pulsing with blood every second. Any repair work would run an extremely high risk of popping the artery
open by mistake; the blood loss would likely be immediate, massive, and fatal. Given the danger, Reynolds’ doctors planned
a relatively new type of operation, cooling her body from its normal temperature of 98.6 degrees Fahrenheit to just 60 degrees.
Her breathing would stop. Blood flow would slow to a trickle. Brain activity—on a standard EEG monitor—would be unnoticeable.
To the casual eye, she would be dead.

The operation in August 1991 went as planned—a perfect success. But when Reynolds awoke, she had an amazing story to tell.
While not in pain, she had been conscious during every step of the procedure. She had felt surgeons drill through her skull
with an electric saw (“The noise was awful, like the drill in a dentist’s office”), then floated out of her head and watched
the operation from above.
26

She found herself in the presence of her late grandmother. There was no sound, but Reynolds knew somehow that her grandmother
was calling her—down a tunnel that wasn’t quite a tunnel, toward a pinprick of light that kept getting bigger and bigger.
In that place of light, she found herself surrounded by deceased relatives, who fed and nurtured her. She was warned not to
go farther, because she wouldn’t have a way to get back. Though drawn by the light, Reynolds thought of her family at home
and agreed to return. Her late uncle led her back to the tunnel, and she found herself looking down once more at:

… the thing—my body. It looked terrible, like a train wreck. It looked like what it was: dead… . It scared me and I didn’t
want to look at it.

It was communicated to me that it was like jumping into a swimming pool. No problem, just jump right into the swimming pool.
I didn’t want to, but I guess I was late or something because he [the uncle] pushed me. I felt a definite repelling and at
the same time a pulling from the body. The body was pulling and the tunnel was pushing… . It was like diving into a pool of
ice water… . It hurt!

When I came back, they were playing “Hotel California” and the line was “You can check out anytime you like, but you can never
leave.”

Michael Sabom, the researcher who first inspired Jeffrey Long, wrote an account of Reynolds’ case, which became a sensation.
She’s easily the most-cited example of a person having memories at a time when they were “clinically dead.” The thing is,
even the term clinically dead is open to interpretation. In the United States, we use EEG or brain monitoring to declare there
is no brain activity—that someone is dead. Transplant surgeons wait for this proof before removing organs, but to an extent,
that’s arbitrary. In Japan, it’s only after heart activity is stopped on an EKG that someone is considered dead. Brain death
versus cardiac death. Nelson, who has not reviewed Reynolds’ medical records, seriously doubts that she truly had no electrical
brain activity throughout the operation.

Nelson speculates that Reynolds might have been partially awake for at least part of the operation, despite the anesthesia.
So-called “anesthesia awareness” isn’t as rare as you might think. According to the American College of Anesthesiologists,
1 or 2 percent of all surgical patients experience at least partial awareness during their operation. This number is for surgeries
where the patient is actually supposed to be knocked out; it doesn’t include operations done under local anesthesia or other
cases where the patient is intentionally left conscious. Here’s an interesting aside: the brain is totally free of pain receptors.
In fact, in certain brain operations the patient is left awake so he or she can communicate with surgeons during the operation
to ensure that no tissue is removed that would affect the patient’s ability to talk or other skills. Of course, it may be
that none of this is relevant to the case of Pam Reynolds or any NDEer, but it’s not far-fetched to think that a patient might
be partially conscious even during an invasive brain operation.

Some cases of anesthesia awareness are horror stories where the patient suffers intense pain from the surgeon’s knife but
is paralyzed and can’t cry out. This version was dramatized in the 2007 Hollywood thriller
Awake
; its publicists said it would do for anesthesia what
Jaws
did for sharks. In other cases, the pain medication portion of the cocktail does work, leaving the patient calm and numb—but
still aware, at least partially aware, of their surroundings. Nelson started thinking about a connection between anesthesia
awareness and NDEs because of a quirk in his survey results: four of the fifty-five subjects who reported near-death experiences
also said they were awake during surgery.
27

As I continued my discussions with experts around the world, I realized a possibility: that it all comes down to memory. Biologically
there’s no physical difference between “real” memories and memories of something that never actually happened. Listening to
Nelson, I was reminded of research done by Harvard psychologist Richard McNally and his students. McNally’s specialty is memory,
especially the way it can be distorted. He’s done extensive work on false memories, and his work on how easy it is to produce
false memories—through suggestion—has strongly influenced the way that courts handle testimony about old, supposedly repressed
memories.

One big question is whether the brain forms and stores false memories any differently from the way it handles real memories.
To try and answer this, McNally’s then-student Susan Clancy wanted to examine memories that almost certainly were not based
in reality. She decided to interview people who claimed to have been abducted by space aliens. Their stories were eerily alike,
full of gray-headed aliens with big eyes, taking people aboard spacecraft for medical or sexually themed experiments. Clancy
came to an interesting conclusion: she decided that the memories were real, even if the abductions were not. The mechanism
for producing these memories, in Clancy’s view, was sleep paralysis. The people had only dreamed about being abducted, but
the dreams were so vivid—complete with an intense physical feeling of being unable to move while being examined by aliens—that
they were convinced it really happened.
28

Kevin Nelson says the same about near-death experience. “I don’t think it’s inaccurate recall, although I do think that recall
and memory at a time when your brain is potentially impaired by low oxygen or low blood sugar might be called into question,”
he says. “When we’re dreaming, the fascinating thing is we don’t know we’re dreaming. There are rare exceptions called lucid
dreams, but for the vast majority of people, we don’t have that insight. The brain turns it off normally.”

There’s reason to think that memory of NDEs is even less reliable than memories of a dream. For one thing, memory is often
the first thing to go when the brain is running out of oxygen. The seat of memory is the CA1 region of a brain structure called
the hippocampus. According to Larry Squire of the University of California at San Diego, a neuroscientist and expert on memory,
when cells of the CA1 region are deprived of oxygen, they go into an overwrought metabolic state, burning energy at a frantic
pace.
29
“They basically fire themselves to death over a period of a few days,” explains Squire. “These patients end up with memory
loss.” To be blunt, you can’t trust the memory of someone whose brain was oxygen deprived, even for a short time.

Less obvious but equally true is the fact that memory is distorted by stress. Under stress, the body releases certain hormones,
like cortisol, which trigger activity in the amygdala. The amygdala is about the size and shape of an almond. It plays a vital
role in transforming short-term memories into long-term ones. When there’s too much activity, the process is impaired. This
means that under stressful conditions, people are far less likely to recall the details occurring around them. This has major
real-world implications. For example, memory experts say that eyewitness testimony is extremely unreliable, even if courts
and juries have been slow to recognize this.

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