Going Gentle into That Good Night

By Claudia Wallis

A doctor studies patients recollections of dying

Owen Thomas appeared dead on arrival at the New York Infirmary last December. His heart, liver, intestines and a lung had been slashed in a knife fight. The 20-year-old fish-market laborer had no pulse, no blood pressure and no breath left in a body that was already "very cold to touch," according to Dr. Daryl Isaacs, who was in charge of the emergency room. Yet five minutes later, Thomas' heartbeat was restored, a recovery that Isaacs described as "the most wondrous thing we've ever experienced."

After awakening from eight hours of surgery, Thomas told a story about his "death" that was no less wondrous. The normally down-to-earth Brooklyn youth remembered floating into a dark void. "I was going some place, and then I saw my brother," says Thomas, meaning his brother Christopher, who had died in a 1979 car accident. "He put his two big hands on my shoulders and pushed me back, saying, 'You can't come here; there's no room.' "

Owen Thomas had lived through what is sometimes called a near death experience (NDE), a vivid, memorable sense of sights, sounds and events that occur while an individual is clinically dead or very close to the point of no return. Discussion of this phenomenon and other aspects of dying achieved an almost faddish popularity in the early and mid-1970s, following the publication of two bestsellers: On Death and Dying, a study of terminally ill patients, by Psychiatrist Elisabeth Kuebler-Ross, and Life After Life, by Psychiatrist Raymond Moody.

Neither author took a particularly scientific approach to NDEs. Moody's style was anecdotal. Kuebler-Ross did not actually write about NDEs, but lectured on the subject. Now comes a new book, Recollections of Death: A Medical Investigation (Harper & Row; $13.50). The author is Dr. Michael Sabom, 37, a cardiologist at Atlanta VA Medical Center and assistant professor of medicine at Emory University. Like most doctors, he was initially skeptical about " 'far-out' descriptions of afterlife spirits and such." When asked to help lead a church-group discussion of Moody's book, he decided to do a little research with his own critically ill patients. "Five years and 116 interviews later," he says, "I am convinced that my original suspicions were wrong."

In approaching his far-out subject, Sabom was determined to be "objective and systematic. Patients were asked standardized questions and did not at first know the purpose of his study. Rather than limiting it to people claiming to have had an NDE, as Moody did, Sabom questioned a random sample of patients who had suffered near fatal medical crises, defined as any unconscious bodily state that "would be expected to result in irreversible biological death in the majority of instances." Three-quarters had been in cardiac arrest. A few had already been given up for dead. One soldier, for instance, was discovered to be alive only when a mortician saw blood flowing from a vein into which he was about to inject embalming fluid.

Sabom found that 40% of his random sample had vivid memories of their brush with death. A third had what he calls purely "autoscopic" experiences, in which they remember floating at ceiling height above the operating table (or battlefield) and looking down on their own lifeless bodies. About half had "transcendental" experiences, in which they recall traveling through a dark tunnel toward a bright light. Some, like Owen Thomas, encountered other figures or entered unearthly landscapes like those painted by Hieronymus Bosch. Several patients reported both autoscopic and transcendental elements.

What astonished Sabom was the uniformity of the patients' accounts. All recalled a sense of timelessness, an awareness of their own deaths, and a strong sense of reality. (It was "realer than here," said one man.) Patients remembered an absence of physical pain, a feeling of tranquillity and even delight ("That was the most beautiful instant in the whole world when I came out of that body!").

Sabom could discern no religious or other differences between patients who had NDEs and those who did not. The two groups contained roughly equal numbers of atheists and frequent churchgoers, college grads and high school dropouts. Even prior awareness of the existence of near death experiences did not predispose patients to have them. Nor did race, occupation or sex, though, curiously, women who had NDEs were more likely to recall seeing their loved ones.

What was a serious scientist to make of such findings? Could the recollections be nothing more than dreams or hallucinations induced, perhaps, by drugs, lack of oxygen or brain seizures? Could they have been triggered by beta-endorphin, the body's naturally occurring opiate, which, Biologist-Author Lewis Thomas has suggested, may be released at the moment of death to "ensure that dying is a painless and conceivably pleasant experience"?

Sabom does not think so. As evidence, he cites patients who had extremely sharp autoscopic memories. They were often able to describe the minutiae of their own cardiopulmonary resuscitation: readings on a monitor, the color of an oxygen mask, the number of electric shocks administered, the exact position of doctors around the table and what they talked about (in one case, golf). These memories, Sabom found, conformed precisely with doctors' accounts. Was it possible that some chronic cardiac patients were simply familiar enough with CPR procedures (from experience and television) to fantasize accurately about what took place? Sabom put this to the test by asking longtime heart patients who had not had NDEs to describe such procedures. Twenty out of 23 made major errors in their accounts.

Kuebler-Ross jeopardized her standing in the medical profession by asserting that she knew "beyond a shadow of a doubt" that there was life after death. Sabom is more cautious. "Personally, I believe in life after death," he says. "But I do not believe the work I have done proves life after death." What it does suggest, he thinks, is that dying brings about a "splitting apart of the nonphysical part of our being from the physical part." How this split occurs and the nature of the nonphysical part are, of course, elusive matters. Many of the patients in the study, notes Sabom, have died since he spoke to them. "It's an eerie feeling to know that now they may know, while I'm still here wondering about what they said."

--By Claudia Wallis

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