AWAREness Beyond Death?

A critical care doctor and expert in the field of resuscitation, Sam Parnia has been fascinated with the question of what happens to consciousness at the moment of death since the time he lost a patient as a student doctor at the age of 22. Parnia’s joint fascination with resuscitation and the near-death experience (NDE) led him to establish the AWARE project, which is now a major collaboration between doctors and researchers in the coronary units of medical centers and hospitals across the globe. Dedicated to exploring and advancing our knowledge of these two inter-related areas, it began with an 18 month pilot study restricted to just a few hospitals in the United Kingdom, before the AWARE project proper launched on September 11, 2008 with the investigation extended to more locations, including some in Europe and the United States. To examine the veridical out-of-body experience component of near-death experiences, Parnia and his team installed approximately one thousand shelves high up on walls within rooms in the emergency, coronary and intensive care wards of participating hospitals, though they were unable to cover all beds due to time and financial constraints – with 25 participating hospitals, the total number of shelves they would have needed to install for full coverage would have been closer to 12,500. On these shelves they placed a hidden ‘target’, which they hoped patients who had OBEs might report back on after being successfully resuscitated. By targeting these specific wards they were hoping to cover some 80% of cardiac arrest events with their ‘shelf test’.

In the first four years of the study, AWARE has received a total of more than four thousand cardiac arrest event reports – some three per day. But while four thousand events may seem a good sample size for in-depth research into veridical NDEs, it must be remembered that these are cardiac arrests – not ‘heart attacks’, with which many people confuse the term, but cases in which the heart has completely stopped beating. As such, in only a third of those cases were medical staff able to resuscitate the patient – and then, only half of those critically-ill survivors remained alive to a point where they could be interviewed by the AWARE team. Further, those medical staff doing interviews on behalf of the AWARE study had to do so around their normal daily duties, and so not all patients were able to be interviewed post-resuscitation (especially so if they came in on the weekend). And, unfortunately, the team’s coverage of cardiac arrest events via shelf positioning was lower than hoped – only 50% occurred in a location with a shelf, rather than the hoped-for 80%.

Now, given that near-death experiences were only reported by 5% of survivors in the AWARE study, and that the out-of-body experience only occurs in a low percentage of NDEs, you might begin to see the problem. Out of some 4000 cardiac arrest events, the AWARE team was left with little more than a hundred cases in which a patient with a shelf in their room reported back after their resuscitation, and then only 5 to 10 of those actually had an NDE. In all, after four years, and four thousand recorded cardiac arrest events, the AWARE study has at this stage documented a grand total of just two out-of-body experience reports during cardiac arrest.

Nevertheless, the few NDEs recorded thus far very much conform to the archetypal experience. One of Parnia’s AWARE colleagues, Ken Spearpoint, recounted one patient’s experience:

His journey commenced by travelling through a tunnel towards a very strong light, which didn’t dazzle him or hurt his eyes. Interestingly, he said that there were other people in the tunnel, whom he did not recognize. When he emerged he described a very beautiful crystal city and I quote “I have seen nothing more beautiful.” He said there was a river that ran through. There were many people, without faces, who were washing in the waters. He said that when the people were washing it made their clothes very bright and shiny. He said the people were very beautiful and I asked him if he recalled hearing anything – he said that there was the most beautiful singing, which he described as a choral – as he described this he was very powerfully moved to tears. His next recollection was looking up at a doctor doing chest compressions!

For the patient this was a profound spiritual experience, and certainly powerful for me too…unfortunately the event was not in a research area [an area with a board].

The Deceased in the Afterlife Realm

It wasn’t until 2011 that the AWARE study had its first out-of-body experience report. A 57-year-old man had suffered a cardiac arrest in the cardiac catheterization laboratory in Southampton General Hospital (in the United Kingdom), but unfortunately, in the heads-or-tails odds of whether the patient was in a room with a shelf, Parnia called wrong: the out-of-body experience occurred in an area where there was no target for the patient to view. Nevertheless, the patient was keen to recount his story – despite his family having told him it was likely just an effect of the drugs used – saying he believed “it was important” to tell others about it.

The patient, ‘Mr. A’, had been at work, and started feeling a bit odd. Being a diabetic, he immediately checked his blood sugar level, but it was fine. He continued to feel increasingly unwell, until he finally asked his fellow office-workers for assistance when he started feeling short of air. They immediately phoned an ambulance, and when the paramedics arrived and hooked the patient up to an ECG, the gravity of the situation became apparent:

[T]hey wanted to whisk me off and not talk to me and just do it. Do you know what I mean, doctor? That unnerved me a little bit because I am not used to anything like that, so I said, “Hang on, what are you doing?” They said, “We need to get you to hospital.” Anyway, they did.

…I can remember coming into the [hospital bay] … and a nurse came on board. [The paramedics] had told me a nurse called Sarah would come to meet me when I arrived… She came on board the ambulance like they said she would and then she said, “Mr. A, I am the most important person in your life at the moment. I am going to ask you some questions and I want you to answer every one of them.” I said yes. I can remember that I wanted to sleep all the time at that stage and all she kept trying to do, it felt like, was to keep me awake and talk with her. Do you understand what I mean? And that’s how it was with her.

The medical team brought Mr. A into the catheterization laboratory in the hospital on a trolley, and placed a sterile drape across his upper body so that they could work on him without him seeing what was happening. As such, he didn’t notice when the doctor arrived, nor when the team gave him a local anaesthetic so that they could push a wire into the blood vessel in his groin to feed it up to the heart. At this stage, the patient said, he was still talking to the nurse Sarah, when “all of a sudden, I wasn’t”. Mr. A’s heart had stopped beating. But instead of blacking out, as should be the case once blood flow to the brain stops, the patient said he left his body:

I can remember vividly an automated voice saying, “Shock the patient, shock the patient,” and with that, up in that corner of the room [he pointed to the far corner of the room], there was a person beckoning me. I can see her now, and I can remember thinking (but not saying) to myself, “I can’t get up there.” The next second I was up there and I was looking down at me, the nurse Sarah, and another man who had a bald head… I didn’t even know there was another man standing there. I hadn’t seen him. Not until I went up in that corner – then I saw them. You understand what I am saying?

It’s interesting to note here that Mr. A seems to have had a cross-over between a death-bed vision and a near-death experience. A large number of death-bed vision reports discuss the apparition as being up in the corner of the room. Similarly, Mr. A initially saw a person in the corner of the room from his ‘death-bed’ perspective, and then in an instant he was ‘up there’ with them.

Mr A. went on, describing his view of the man with the bald head who was working on his body, whom he hadn’t noticed from his bodily view due to the sterile drape.

I could see all this side of them. [He pointed to the back.] As clear as the day I could see that. [He pointed to an object.] The next thing I remember is waking up on that bed. And these are the words that Sarah said to me: “Oh you nodded off then, Mr. A. You are back with us now.” Whether she said those words, whether that automated voice really happened, I don’t know—only you would know those things. I don’t know how to be able to confirm that those things did happen. I am only telling you what happened with me and what I experienced.

I couldn’t see his face but I could see the back of his body. He was quite a chunky fella, he was. He had blue scrubs on, and he had a blue hat, but I could tell he didn’t have any hair, because of where the hat was.

The robotic-sounding voice that Mr. A had heard initially was an automated external defibrillator (AED), an electronic system that can detect when the heart has stopped beating regularly and is fibrillating, and which issues feedback to the user if an electric shock needs to be administered to the heart. Despite being in cardiac arrest, Mr. A. was able to correctly describe the command given by the AED, as well as describe the doctor in attendance, even though he had not previously seen him due to the drape across his chest. Ultimately, however, to skeptics of the NDE this is yet another ‘anecdotal report’, inadmissible in the court of science. We will have to wait and see if the AWARE study is able to produce something more conclusive in the years ahead.

Though four years have elapsed since the AWARE study was set in motion, and the results so far have shown the difficulty in investigating the out-of-body experience component, Sam Parnia is as keen as ever to continue on with the research, and also to improve the procedures. For instance, he notes that in the case of Mr. A., a shelf in the room might not have made any difference, as the patient said he was floating in the opposite corner of the room, well away from where the shelf would have been placed. Perhaps a review of the most reported OBE viewing positions might allow for better targeting in future?

But this tail-chasing has some researchers more skeptical of the chances of the study finding evidence for veridical OBEs. Dr. Bruce Greyson of the Division of Perceptual Studies is associated with the AWARE study, but he holds doubts that it will yield any meaningful results when it comes to veridical OBEs. “If you were to ask travellers the name on the ID badge of the TSA agent who beckoned them through the metal detector on their last flight, it is highly unlikely any could identify that ‘target’,” Greyson explains to me. “The designated target – the TSA ID badge – was right in front of them to see, but they had no reason to pay attention to it, and no reason to remember it if they had seen it”. The problem with the experiment, he says, is in the design, which doesn’t include any reason to expect that experiencers would see or remember the designated target. “Patients who report leaving their bodies in the midst of a near-death crisis have no reason to notice a randomly-chosen target planted in a corner of the room that has no particular significance for them,” Greyson asserts, “and if they do happen to see it, they have no reason to remember it. So I do not expect meaningful data from the AWARE study, although it is better than not doing any research at all”.

Nevertheless, the AWARE study does survey a variety of aspects of the NDE beyond just veridical perception, allowing other possible insights into its mysteries. For instance, from the data so far Parnia has also been able to put forward a possible reason for why so many people that are resuscitated don’t remember having a near-death experience. Noticing a correlation between the length of cardiac arrest and whether an NDE was reported, Parnia suggests that “if a cardiac arrest event is relatively short, then the post-resuscitation inflammation and disease that normally engulf the brain and cause widespread damage (including damage to the memory circuits) are also relatively mild by comparison to someone with a prolonged cardiac arrest”. As such, says Parnia, those who report detailed near-death experiences may do so “simply because they had suffered less damage to their brains and specifically the memory circuits in the days and weeks after the cardiac arrest”.

For now though, Parnia and his colleagues are continuing to collate data from the cases on their files since 2008, and once finalized will publish their results in a reputable medical journal. They will then amend any problems with the study that they have noticed in this initial phase: for example, they hope to provide funding for a dedicated member of staff at each medical centre who can attend every single cardiac arrest, possibly with a tablet computer displaying a random target image that they can place in an elevated position in the room, and who would be able to follow up with each patient within days of their resuscitation.

For the rest of us, we’ll just have to wait and see if Sam Parnia and his AWARE colleagues can uncover evidence that the minds of those who die really do ‘leave’ their bodies. If they do, the discovery would perhaps rank among the greatest discoveries in science, up there with the paradigm-shattering ideas of Copernicus and Einstein. Mind would no longer be seen as arising from the brain, and our perception of ourselves and our part in the universe would be forever changed.