Review of "Proof of Heaven"

Here on this blog and recently, at a medical appointment, while speaking to another patient, the book, "Proof of Heaven" by Eben Alexander was mentioned. Dr. Alexander is a fellow neurosurgeon who has experienced being a patient.

His illness, from which he has made an excellent recovery, was meningitis. He was in coma for about a week. He describes his memories of the experience interspersed with the medical events that were happening. While, this is an excellent technique for telling his story and making sense of his experiences, I wonder if the timing was really as he described. The experience of time when one is unconscious is likely very different than when awake. Recently, there has been research that suggest that there is a burst of electrical activity in the brain just before death (http://www.telegraph.co.uk/health/healthnews/7785944/A-cascade-of-brain-activity-as-people-die-could-explain-near-death-experiences.html). So, I wonder if many of his memories are either from the time that he was just lapsing into coma or emerging from it. But, even so, one has to discuss the issue of what he experienced.

Clearly, many people have electrical activity of the brain when they are dying or almost dying. It is from this latter group, the survivors, that we hear about near death experiences. For Dr. Alexander, they involve two major groups of images, first that of a soup in which he sees faces, first grotesque animal faces and later recognizable human faces; and second that of riding on a butterfly with a woman who is acting as his guide of heaven. Only after his recovery does he learn that this woman appeared to be his biological sister who had died, though he had never met her since he had been given up for adoption as an infant. By the time of his illness, he had met other biological relatives.

Many other survivors of near death experiences have reported a light filled tunnel or images of a deity. Others report a sensation of floating above their physical body. It seems probable that prior life experience and belief systems may influence the near death experience. For example, Dr. Alexander mentioned his love of  skydiving, describing two sunset dives, including one where his quick reactions saved another skydiver. While there are similarities in some near death experiences, there are also differences suggesting that something more individual influences the experience as well.

As people are dying, there is also a surge in endorphins (natural opiates in the body) which helps to make people feel more at peace. This has been proposed to be a way that animals developed to lose connection to the pain of being attacked by a predator. No matter the reason, it does seem that as death nears, both humans and other animals seem to become more peaceful. To me this is a suggestion of a kindness of nature or a creator.

I have never had a near death experience, though I have experienced things I cannot explain. The first was many years ago when I was struggling with life choices. I felt a presence and a light and a peacefulness telling me that I would know what to do. At that time, my mother was recovering from cancer surgery nearly ten years before her death due to another cause. The second was in the months leading up to my mother's death. I would rehearse running a code (resuscitation) nightly in my dreams, knowing that I was running it on someone I knew and loved, though I never saw the face. These dreams ended abruptly after I ran the code on my mother in a Spanish hospital since they routinely did not resuscitate patients there who were dying. After her death, I have felt her presence many times. (Much of this experience was described in an article I wrote a couple years ago: http://www.physicianspractice.com/work-life-balance/content/article/1462168/2041808.)  For me, the  rehearsal dreams are the most difficult to explain. They started several months before her death. How could I know that I would need to run a code on my own mother? We were living on separate continents at the time. She had recently been given a clean bill of health by her oncologist with respect to her breast cancer. Why did I know to memorize doses of medications which are usually ordered as "an amp(ule) of ..." in the US during code situations? Yet somehow I did know those details.

While I find Dr. Alexander's book to be an interesting read and I have learned more about him as a person, I am still left with the sense that the interpretation is dependent on a belief system. For me, this is better as I think the mystical is not fully knowable or provable. Yet, for those of us who have experienced it in some way, it is certainly real.

Death

There is a common joke among physicians, "No one gets out of this life alive." This joke hints at the discomfort many physicians feel about death. Being a patient or a family member of a patient helps us to be better physicians. Because of going through the experience of suffering helps us to learn to be more empathetic. Unfortunately, too often, being a physician does not prepare us to be either patients or family of patients.

A few weeks ago a friend died after a brief illness. Because he had been relatively well until a few days earlier, it was unexpected. Even, once he was admitted, I was hopeful that he would recover. But as I was considering going to the hospital to visit, I learned that he had died. This death, like each other, reminds me of the deaths of my parents and my own mortality. And it is that personal connection that helps us to feel empathy for our patients.

As physicians, we must shield ourselves from becoming too connected since it would be difficult to continue to function if we become overwhelmed with grief. Rather, we must continue to be rational in the care of patients, rather than becoming lost in our own emotions. Otherwise we would not be able to be good physicians and provide the best care we can for our patients. But we must allow the human connection to be seen by the patient and their family. That human connection is empathy. A few tears (at least from a female physician, though I think this may play differently for a male physician in American culture) or a touch can help to convey that connection. I think this connection can help heal both the family and the physician.

During my last year of medical school, my mother died very unexpectedly while we were on vacation. It was very traumatic for me, but also helped me to become more empathetic.  I even had to learn again to shield myself, as I began to cry when I had to run a code a few months after her death. The emotions were still too raw. Fortunately, the patient was one who had no chance of survival, so my emotions did not alter the outcome. A couple years ago I wrote about my mother's death. Here is the link:  http://www.physicianspractice.com/work-life-balance/content/article/1462168/2041808 Even all these years later, it was a difficult and painful experience to write about since the emotions again resurfaced.

As physicians we see death far more often than the average person, yet we are affected in similar, human ways. Yet, we must both control our emotions and show our empathy. That is a very difficult balance, but one I hope more physicians strive to achieve.