NDE

Heart beat line end of life

Abstract
This paper speaks to multiple near-death experiences (NDE’s), the conversations we have with ourselves as well as with others, and the profound changes that can occur at the edges of that steep drop into unconsciousness. These are personal reflections that my supervisor encouraged me to write about that speak about the need for a vulnerable reciprocity in the way we have conversations about life and death, what I learned from a local cardiac team in Vancouver, and how taking notice can shape our thoughts and deeds.

NDE (Near Death Experiences)
My heart surgeon called to let me know that the team at St. Paul’s Hospital was ready to replace my aortic valve and perform a quadruple bypass. I’m not sure if that’s more about genetics or the wear and tear of a life well-lived, and simply the luck of the draw for having a childhood heart murmur. Regardless, for all the well-intentioned platitudes and reassurances from family and friends that all would be well, my stoicism only goes so far as I join a cohort of roughly 10,000 heart patients in BC annually. I’m not doing the happy dance, wondering if I’ll be returning to consciousness, anticipating the feeling of having been hit by a truck, and months, perhaps years of recovery, wondering what my new normal might look like. And this assumes that it will all go well. But what if doesn’t? Mourning the near-death of yourself seems like a journey without any direction. This paper speaks to multiple near-death experiences (NDE’s), the conversations we have with ourselves, and the profound changes that can occur at the edges of that steep drop.

We have a funny definition of death being when all your physical processes stop and your brain and heart flat line, then you are considered dead. The UDDA asserts that “an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” That is unless someone can revive them, and then I suppose they really weren’t “dead” after all. So, where did they go? Given that near-death experiences happen with limited warning, they seem almost impossible to test. Nevertheless, stories of remarkable experiences on the threshold of death have been reported since ancient times and described today by many people who have a traumatic, life-threatening event. My own experiences suggest that this is a vehicle for renewal and a stimulus to inner exploration and that our idea of death may be more of a journey than the end of the trip. Joseph Campbell may have said it best. “I think the idea of life after death is a bad idea. It distracts you from appreciating the uniqueness of the here and now, the moment you are living for.”

These near-death experiences occur when the body is injured by the blunt trauma of an accident, explosion, fall, heart attack, and other life-threatening events. Many of them impact how we perceive ourselves and the world around us. For those of us who have experienced various traumatic events, our brains and bodies may make some dramatic physical, psychological, and spiritual shifts. Kathy Briggs was the co-founder of the Myers-Briggs Personality Indicator and once said that the only thing that can shift or change our personality is a major traumatic event. Many who experience these events also share other commonalities, such as allowing the participant to eventually become pain-free, reunited with departed family and friends, seeing a bright light at the end of the tunnel, being detached from this physical world and in some other magical place. The stories are endless, and these occurrence’s almost always shift how we see and feel our way in the world. Joni Mitchel’s lyrics to “Both Sides Now” remind us of the many things that we know so little about and the self-doubt and insecurity that can be amplified from a traumatic experience. “I’ve looked at life from both sides now, from win and lose and still somehow, it’s life’s illusions I recall, I really don’t know life at all.”

The risk of not surviving open-heart surgery is small in the 21st century, as only 2% of heart surgeries are fatal. St. Paul’s does approximately 1,100 heart surgeries of the 10,000 performed in British Columbia annually. That means about 1,078 patients survived, and 22 or 200 in BC didn’t. Good odds, but try carrying that around with you for a while, knowing that you’re next and that your surgeon is going to disconnect your heart from your body! On the day of my surgery, I asked about these statistics and learned that most of those who didn’t make it were usually much older with recurring heart issues (I’m 74). They were having catastrophic complications that couldn’t be fixed. Of the 98% of us who make it, there are still ongoing complications that put pressure on these stats, and like every person who has had a near-death experience, there are countless questions about life and death and how they change us. Where one person may get up and dust themselves off and keep on going, others struggle with the fragility of life.

As a young kid, I never forgot the feeling of choosing a brick wall in a nearby driveway over an oncoming car in the soapbox the kids on our street made. Our homemade racer exploded when it hit the wall throwing me twenty feet into a neighbour’s yard. The world stopped as I regained consciousness, wondering where I was and how I got there waking up to the smiling faces of my friends. That time between impact and being back in the world is lost to me now. However, I have always wondered where I went and what the edges were between consciousness and unconsciousness.

The Oxford Dictionary defines the word “edge” as a noun or a verb and is often described as the outside limit of an object, area or surface. It’s that place next to the steep drop, the point before something unpleasant or momentous occurs, a thin linear thread or a thought that holds the edges of time between this and that, then and now. These edges are transitional or “liminal” spaces that exist in everything known. They occur every day and in every moment, and they have throughout time. They are often unannounced as they gently take shape around and within us, often unconscious as we don’t recognize them at first, sometimes for decades. Others make a momentous entrance defining the beginning or end of something such as a birth or death, a change of direction, the end of war, or hitting that wall in my soapbox.

I think consciousness is a state in which brain information processing is organized and coherent. Anything that disrupts the coherence of processing produces a state of altered consciousness or unconsciousness. I doubt there has ever been a time on our planet where there have been so many alternate realities for both. Allah knows I tried to alter my consciousness often in the ’60s, meditated with Baba Ramdas in the ’70s, and I’m still looking for the Buddha within. So, while some might argue that there is essentially only one type of fully conscious state, like an on or off switch, I believe that there are an enormous variety of possible conscious and unconscious places, depending on the nature of the disruption and the self-awareness of an individual. According to Freud, thoughts and emotions outside of our awareness continue to influence our behaviours, even though we are unaware of these underlying influences. Conscious is to be aware, intentional and responsive. Unconscious, on the other hand, refers to being unaware or doing something without realizing it.

Carl Jung believed that there are no such things as accidents, only patterns that we don’t yet recognize. This analysis followed my near-fatal “accident” in 2015 as a simple journey home became a life-changing experience that accelerated my exploration of self. If not an accident, this became an existential search for personal and spiritual meaning in life as my Jeep lost control in the mountains of British Columbia. In an instant, the icy highway let go of my vehicle as it rolled and flipped erratically out of control into oncoming traffic. In this dance with death, I was thrown unceremoniously to the back of the overturned wreck, unconscious to the world, bleeding profusely from shrapnel and glass. It would be ten minutes before I would hear the voice of a nurse speaking from a distant and surreal place with words of care and concern as she busily went about saving my life; “Don, can you hear me? You’ve been in an accident. You’re bleeding; please don’t move!”

I’ve never forgotten the kindness nor the seriousness of that distant, ethereal voice as she pulled me back to consciousness. I often wonder if I had a choice to stay or go somewhere else other than returning to this world. I’m sure I was with my daughter who left us a few years earlier, when she lost her fight with Cancer. Was there another reality or another path available? While trying to find a way back to the surface in this unfamiliar place, strangers went about choreographing how to save my life. With a head full of voices asking questions about why I was still here, Seneca’s words echoed in my head that death should have arrived, and yet it didn’t.

“No one will bring back the years; no one will restore you to yourself. Life will follow the path it began to take, and will neither reverse nor check its course. It will cause no commotion to remind you of its swiftness, but glide on quietly. It will not lengthen itself for a king’s command or a people’s favour. As it started out on its first day, so it will run on, nowhere pausing or turning aside. What will be the outcome? You have been preoccupied while life hastens on. Meanwhile, death will arrive, and you have no choice in making yourself available for it.”

I don’t have many soapbox memories from my youth and doubt that I could spell existential then anyway. For months after the Jeep accident, even now, I think about it as family and friends ask how I’m doing? I recognize their silent and unspoken request for a short and casual reply that many humans put out there when encountering uncomfortable conversations. I would politely respond then, as I do now, that “I’m fine” with an emphasis on a short and optimistic narrative. Few care to have a deeper conversation to learn the truth that is different and far more complex as the hangover from my concussion fades and the scars become less visible. Martha Nussbaum noted that we humans don’t like talking about these messy bits that force us to feel our way into conversations.

Many of the foundations of my life were moved in that near-death experience, and I’ve been busy reshaping them since in a search for meaning and purpose. I can hear my father telling me to “suck it up and get on with it,” but who’s lurking in the shadows of this entity known as self? Was I a fraud at the crossroads of a profoundly personal and spiritual discovery? Was this a second chance to undo those wrongs and say the things I needed to the people I love? Was a second chance gifted to revisit and improve those parts of myself that deserved attention that I had sent away years earlier, or was this an opportunity to ensure that I would be ready the next time death arrives? The task of transformation upon re-entry into life and society has been an unexpected process of vulnerable rediscovery.

In Trauma and Recovery, Judith Herman presents a classic model which describes the healing process of people who struggle with traumatic experiences of all types. Stage one is about finding treatment, understanding and how to manage suffering. Establishing safety and a path for healing is then put in place. Stage two is often referred to as remembrance and mourning and involves working through the experience to lessen its emotional intensity and find meaning in one’s life. Working through and understanding grief is a large part of this process. Stage three focuses on reconnecting with people, activities and other aspects of life. While there are three stages, they are seldom linear, and they often overlap. Throughout all of these stages, there are numerous psychological themes and dynamics that address various issues such as helplessness, powerlessness, anger, regret, loss, dissociation and guilt. Where one person may show initial symptoms that diminish naturally over time, another may have long-lasting symptoms that make it difficult to carry out everyday activities.

With my share of traumatic events and an awareness of having passed my best before date years earlier, it’s not lost on me that the front of the line is getting closer. That is, I still have “stuff” to work on and preparing for heart surgery was less about booking three or four months off and getting on with life, as it was another opportunity to prepare for a deeper understanding of life and death and finding peace just in case the odds weren’t in my favour. I recall that Ernest Hemingway sent a letter to his parents when he was severely injured in World War I and wrote, “Dying is a very simple thing. I’ve looked at death, and really, I know. If I should have died it would have been very easy for me. Quite the easiest thing I ever did.”

Confronting our own mortality is the origin of philosophical reflection dating back to Plato. In the Hagakure, an 18th-century samurai manual, Yamamoto Tusunetomo writes about how a warrior should live consciously, ethically, and with an awareness in life. Tusunetomo advocates that the samurai should meditate on death every day and imagine being ripped apart by dogs, pierced by arrows, dying of disease, falling from a thousand-foot cliff, and committing seppuku at the death of one’s master. He believed that by meditating, on one’s death, by acting as if one is dead, by accepting that and moving into it, then you can act with freedom because you’re no longer beholden to fear.

Unlike my previous skirmishes with unconsciousness, my heart surgery was premeditated and purposeful! No dogs, arrows, or the need to jump off a thousand-foot cliff. No traumatic injury of a stressed heart – only a surgical date subject to change due to Covid 19, the best science of the 21st century, the friendliness of a caring cardiac team, and the knowledge that if I passed that near-death threshold, I would never know that I’d hit another wall, or hear the screams tumbling across the highway. Hemingway may have had a point that dying is a very simple thing!

Strangely, I remember a gentle return to consciousness following heart surgery and the realization that I hadn’t passed that threshold. There was only a soft, warm welcome from the intensive care nurse at my side and the team around me in what appeared a space-age cocoon, all abuzz with technology, tubes, and wires. This was one of those surreal moments where my body, perceptions, thoughts and feelings felt alien to me, yet somehow, I felt safe, alive, and very much in the moment. I remember being wheeled into surgery and struck by the warmth and care the surgical team created. We shared stories about our families, school, good books, how much they are appreciated as they prepared me for my journey, explaining what to expect on the other side while gently easing me into that unconscious place again. I think it was Propofol, a fast-acting anesthetic that works by slowing brain wave activity and induces a deep level of sleep and sedation. It allows a patient to wake up calm and alert, unlike old school anesthetics, which left patients feeling disoriented, worn out, scared and often screaming.

I don’t recall anything in that liminal space between leaving and returning, however, in the eight days before discharge, I ran the gamut of behavioural, cognitive, and emotional changes as my body adjusted to the feeling of having been run over by that truck. St. Paul’s cardiac team carefully eased me through my roller coaster ride of depression, fear, anxiety, loneliness, helplessness and anger. They kept me moving, comfortable, fed, and cared for. The level of care was profound, palpable, and it seems a non-negotiable component of healing. In the backdrop of a pandemic and global chaos, this was a life-changing experience to observe firsthand front-line medical staff and workers providing an intimate and more personal approach to health care. I watched their actions and conversations reduce trauma, ease suffering, and contribute to healing. I’m reminded that these life-changing events almost always shift how we see and feel our way in the world, and I am struck by how they provided a new lens for me to consider of how we can change our conversations simply by caring.

Discourse theory proposes that the way we speak with each other in our daily activities is shaped by the structures of power in our society. Because our society is defined by struggle and conflict, our discourses reflect and create these conflicts. This has never seemed more evident in our daily news, social media doom scrolling, and many daily conversations that family and friends are shutting down. Yet, considering the growing polarization all around us, few conversations would appear to have adopted a lens of caring, such as the one at St. Paul’s Hospital. I’m reminded that language is a powerful tool when we’re not arguing and actually listening to each other as it allows us to influence, regulate, persuade, and learn how to trust each other. Their cardiac team seems to have perfected the science of caring by listening with child-like curiosity and the ability to ask generous questions that allow for multiple outcomes bringing out the best in them and their patients. This science of caring offers a unique holistic approach to healthcare and the mindful delivery of authentic patient-centred care. From what I learned, this is an interdisciplinary approach that incorporates both the art and science of nursing and frequently utilizes concepts from the fields of philosophy, ethics, ecology and mind-body-spirit medicine.

I’ve been having conversations with people for over five decades on and off the air. As a broadcaster and now as one of the older students on campus, I’ve become intrigued by the science, psychology, and cultural and emotional components of conversation. I’m curious what they have in common to improve on our existing knowledge of how we engage with each other, whether about climate, race, gender, culture, politics, or social justice issues. I observed firsthand how this diverse team can move patients from the edges of death and helplessness. By listening and changing the way we think about ourselves and the world we live in. Their practice of care is transformational and changes outcomes and, no doubt, futures! I’m grateful to still be on the other side of that steep drop, to work on my many insecurities and questions about life and death, and to approach more questions and the conversations that I have with greater care.

The range of what we think and do is limited by what we fail to notice. And because we fail to notice that we fail to notice, there is little we can do to change; until we notice how failing to notice shapes our thoughts and deeds.
R. D. Laing

[1] St Paul’s is an acute care, teaching and research hospital located in downtown Vancouver home to many world-class medical and surgical programs that had to make way for Covid as our world changed.
[2] The Uniform Determination of Death Act (UDDA) is a piece of model legislation (non-binding statutory text meant to serve as a guide for lawmakers) which provides a more concrete definition of death for legal purposes.
[3] Joseph Campbell. Companion: Reflections on the Art of Living. Harper Perennial, 1995. (pg 104)
[4] Kathy Briggs was the co-founder of the MBTI Personality test. https://www.myersbriggs.org/my-mbti-personality-type/mbti-basics/
[5] Joni Mitchell. Both Sides Now. https://jonimitchell.com/music/song.cfm?id=83
[6] Seneca On the Shortness of Life, Fragments of Words and Thoughts. Penguin Books, 2013 (p13).
[7] Ernst Hemingway. Letters Home. http://roadstothegreatwar-ww1.blogspot.com/2015/06/a-wounded-ernest-hemingways-letter-home.html
[8] Yamamoto Tsunetomo. Hagakure, The Secret Wisdom of the Samurai. Tuttle Publishing, 2014.