Thursday, March 31, 2016

Death and Dying - Some Reflections

Read the deeply affecting "When Breath Becomes Air" by the late Dr. Paul Kalanithi recently; it is a small yet powerful book, not just because the book appears like a deeply thoughtful and smart man talking to you from beyond the grave, but the contents are especially affecting for us doctors who has to deal with death and dying on a daily basis. As an Oncologist I could empathize with his Oncologist, whom he trusts and adores, but could see through her at times - times when the relationship is no longer just a bland and emotionless "Doctor-Patient relationship", but as he wrote beautifully "it is the relationship of two people huddled together, with one of them facing the abyss" and how he forgives his Oncologist's sunny - and eventually wrong - prognostications with the saying "some time Doctors needs hope too". 

With his deep and vast knowledge including a PhD in English Literature, formal training in Philosophy, a stint at History of Medicine, Neuroscience and of course as a promising Neurosurgeon, all at some of the world’s best institutions, even without his untimely death and this book, it is fairly certain he would have become famous, a future Oliver Sachs. Or may be like many doctors, his profession would have swallowed him whole and the wider world would never have heard of him. Medicine is indeed like a possessive wife, often causing other passions to die. So in one way, even though he died at age 37, he has become now immortalized by his book, which I suspect could become a "required reading material" for many future students of Medicine. I often tell patients with terminal cancers "to live one day at a time" which is really a cop-out - as Dr. Paul Kalanithi writes "I would like to know; because if I have only few months I want to write a book; if I have few years I want to pursue Neuroscience". But nothing is harder than prognostication, especially with newer treatments for previously incurable cancers. It is easier in some cases, but often it is not. Anyway I would strongly recommend this remarkable book; short book which can be finished in one sitting yet powerful. 

So the book, an examination of death, reminded me of something I read couple of years back and wanted to share this with readers. This is a remarkable idea on death and afterlife that most people have not heard of. The two traditional and competing theories of afterlife are 1) An Eternal Heaven/Hell 2) Nothingness. But there is a third alternative: The term for this is "Near Death Experience leading to Never Ending Dream" or NDE to NED. NDEs are well documented phenomenon and reported across various cultures. In many NDEs, individuals describe intense dreams of being drawn through a tunnel toward a bright light into a celestial realm and of feeling wonder, love, and contentment.  The NED theory of heaven suggests that NDEs provide evidence of a “natural afterlife” and thus perhaps a heaven which exist in the person's mind; etched forever in the brain of the dying person. The NED theory suggests those describing NDE are indeed experiencing "heaven". But then they awake and return to consciousness. That is, the NDE doesn’t become their NED and natural afterlife, though it very well could have.

To better grasp this, imagine what it’s like to never wake up from a dream, something none of us have experienced. You’re having your NDE. Effectively, you’re in heaven. But then you die, and so you never become consciously aware that your dream ends. It’s not like the dream screen displays "The End" or even goes blank! Thus, as far as you know, you’re in heaven forever. And reality is what ever our brain makes of this world. So to an out side observer you are dead; but as far as the dead person is concerned, his last experience is the vivid dreams of a Near Death Experience - which thus becoming a Never Ending Dream as the person never wakes up from this dream. 

Most people would find it hard to swallow, as we are chained by our ideas of time. So the first question when some one hears of NED is "what happens when the person dies"? This question forgets the intensively subjective nature of time as well as consciousness and sense of self. But what is time anyway? Time may be only a human illusion. It’s relative to perceived events and when we begin to perceive none—e.g., when falling into a dreamless sleep or passing out under general anesthesia (or in dying!)—our self, or our spirit (or soul?), doesn’t cease but time ceases and we simply enter a timeless state. The universe itself may be fundamentally timeless as Einstein himself believed.

The concept of time here is like that which we have “experienced” before-life, i.e., before we were born. Timeless! Billions of years pass by in no time at all, literally. The big difference, however, is that our “afterlife” begins at death enjoyably immersed in a glorious dream. While this dream physically ends, from our mind’s perspective it is now an NED. After a billion years have passed by, for instance, we are still unaware that we are dead.

Why this third way, the so called “Never Ending Dream” could be true? Because of the following three features 

1) Our ability to dream—specifically, to have an NDE, there are so many well documented evidence of this across varying cultures; there is an excellent book written by Neurosurgeon Dr. Eben Alexander who almost died from a severe case of meningitis (“Proof of Heaven”); All these NDEs are very similar, and some as in Dr. Eben Alexander’s case could be extremely elaborate 
2) Our perception of time as a perceived ordering of events is illusory 
3) Our inability to realize the moment of death, i.e., our imperceptible death.

Based on research, some scientists believe that common NDE features may be induced, possibly as a defense mechanism, by psychological and physiological processes occurring in the brain as it senses doom or shuts down. For instance, chemicals are released as a protective mechanism when the brain is traumatized. These chemicals have been shown to trigger intense hallucinations with features like those of NDEs. While such science is used to explain NDEs as just natural phenomena mistaken for a supernatural heaven, it also shows the natural ability and propensity of the brain to trigger vivid NEDs.

More support for the NED theory comes from our dreaming experiences. I for one believe that despite numerous studies and publications about dreaming, it hasn’t been given the prominence it deserves. When inside our dreams, we can’t distinguish them from real-life. Also, when dreams are pleasant, real-life worries are left behind, as in heaven. Our dreams are truly another dimension of being, like another universe.

And why do we possess this amazing ability to dream? Some scientists believe that dreaming evolved to better prepare us to face life’s crises, though this theory seems to apply only to nightmares and doesn’t seem to explain most of my dreams. The NED theory provides another purpose: a potentially satisfying, evolved and/or God-given, afterlife experience.

And who or what controls our dreams? I certainly don’t control mine. Some scientists speculate they’re brain-controlled processes that assimilate and store recently accrued knowledge. However, many of my dreams are weird, unrelated to recent experience, and so don’t appear to fit this explanation at all. Dreaming seems a realm within our universe yet out of this universe.

The NED theory facilitates a distributive heaven rather than a centralized one. So, heaven could be whatever one believes and dreams. Suppose one doesn’t believe in heaven? Then maybe there’s no NED and one’s afterlife will be just like one’s before-life.

Can an NED be "hell"? Studies based on NDE reports vary much but show that on average about 15% of NDEs are reported as hellish experiences. So yes, I guess NED could be like a nightmare that never ends.

Will someone be denied an NED if they are “blown to bits” in an instant? As indicated before, the brain can likely paint a heavenly landscape almost instantaneously. Also, if the brain can, as reported, make life flash before one’s eyes in the moments before pending disaster, maybe it can execute an NED in nanoseconds before shutting down.


Why this is important? Whether one agrees with the idea of NED or not, as far as I know, this idea of “Never Ending Dream” ties together lots of loose ends, and could answer one of the most fundamental questions humanity ever faced. I would even go on to say that, if there is even a tiny possibility of NED, then we should develop techniques and medications (like endogenous hallucinogen dimethyltryptamine) to help dying patients to have vivid and happy dreams; which would become his/her “Never Ending Dream”. While waiting for such technology to evolve, I guess the next best thing is to live a good life; from Dr. Kalanithi’s book, and the description of how he died surrounded by so much love, it is quite possible that Paul is now in a heavenly state of Never Ending Dream. Research also shows that what we dream can be influenced somewhat by heavy concentration on a topic just before falling asleep. So what is one’s final dream after fixating the mind on death and its meaning? A life well lived without too many regrets could indeed be the way to heaven; so one's Near Death Experience is a pleasant and even heavenly one. and if it indeed ends up as death, then one has the possibility of entering an eternal world of heavenly "Never Ending Dream" state.