Pam Reynolds was a 35-year-old woman who came to Dr Sabom’s attention twenty years after an operation performed for a basilar artery aneurysm (a swelling due to a weakness in the arterial wall and likely to rupture, often with catastrophic results). We are not told what symptoms and over what timescale it had been troublesome. The basilar artery arises from the junction of the two vertebral arteries ascending within the cervical (neck) vertebrae, then continues its upward course on the under-surface of the lower brainstem (into the posterior cranial fossa) to supply the brainstem and posterior parts of the cerebral cortices. Surgical removal of this very large aneurysm was performed in Phoenix, Arizona, by an operative technique termed ‘hypother- mic [¼ below normal body temperature] cardiac arrest’.27
The procedure requires severe cooling of the patient to 60 F (normal 98.4F) during which procedure the electroencephalogram and electrocar- diogram become flat. While surgery to remove the aneurysm takes place, the cardio-pulmonary bypass machine is turned off so that all blood circulation to the body ceases, while the blood remaining within the brain is drained under gravity by putting the patient into a sitting-up position. From the operative surgeon’s notes, this critical phase in the surgical procedure was commenced at 11.25am. By 12 noon cardio-pulmonary bypass was being re- established, although the spontaneous return of the pulse was complicated by episodes of abnormal cardiac rhythm (ventricular fibrillation). A proper heart beat was eventually secured after application of two shocks from the cardiac defibrillator. At 12.32pm, cardio-pulmonary bypass was terminated, at which
27 Spetzler R, Hadley M, Rigamonti D, Carter P, Raudzens P, Shedd S et al, J Neurosurg 68:
868 879, 1988; Williams M, Rainer G, Fieger H, Murray I, Sanchez M, Ann Thoracic Surg 52: 1069 1075, 1991.
point her body temperature, although having risen to 89.6 F, was still significantly hypothermic.
The entire exercise was prolonged. It began at 7.15am when Pam was wheeled into the anaesthetic room, after which the surgeon began cutting out a right-sided posterior bone flap in her skull (around 9am). After 45 minutes he had assessed the aneurysm and decided to proceed with the standstill operation. At around 10.50am he gave the order for cardio-pulmo- nary bypass, and body cooling, to be commenced. Not until 2.10pm was the patient moved to the recovery room, still with an endotracheal tube in situ, although whether a ventilator was still being used to assist respiration is not given. If that had been the more likely case, then sedation would have been necessary to overcome the continued discomfort of the tube and the interfer- ence of the pump with her own respiratory efforts. The use of sedatives would have influenced her ultimate recall of events. At least she was conscious, speaking, and not demonstrating any obvious neurological deficit as a result of the procedure, a position confirmed twenty years later when recounting her story to Sabom. After that long interval, there was no evidence of any persistent brain damage caused either by the severe body cooling or the period of complete circulatory arrest during the operation. The operative details are those abridged by Sabom,28who obtained the surgical notes from Phoenix.
Pam’s case has become an icon for ECE phenomenologists. That is because she experienced OB/NDE during her operation, supposedly during the period when the EEG and ECG tracings were flat. It is considered remarkable that although her brain and heart monitoring records were those which normally would be ascribed to ‘dead’ persons, she was able to undergo such experi- ences, as she later recalled. Let us first observe Pam’s own verbal narrative which stands as the complete, unedited account of her experiences. We then consider how Sabom reacted to her story on hearing it several years later: his transcript starts at Pam’s first remembered recollection:
Pam’s near death experience began to unfold. She recalls her story in remarkable detail:
The next thing I recall was the sound: it was a natural D. As I listened to the sound, I felt it was pulling me out of the top of my head. The further out of my body I got, the more clear the tone became. I remember seeing several things in the operating theatre when I was looking down. It was the most aware that I think that I have ever been [sic] in my entire life. I was metaphorically sitting on [the surgeon’s] shoulder. It was not like normal vision. It was brighter and more focussed and clearer than normal vision.
28
Sabom 1998, 37 51, 184 191.
There was so much in the operating theatre that I didn’t recognize, and so many people.
I thought the way they had shaved my head was very peculiar. I expected them to take all of the hair, but they did not. The saw thing that I hated the sound of looked like an electric toothbrush and it had a dent in it, a groove at the top where the saw appeared to go into the handle, but it didn’t. And the saw had interchangeable blades, too, but these blades were in what looked like a socket wrench case. I heard the saw crank up. I didn’t see them use it on my head, but I think I heard it being used on something. It was humming at a relatively high pitch and then all of a sudden it went Brrrrrrrrrr! like that.
Someone said something about my veins and arteries being very small. I believe it was a female voice and that it was Dr [ ], but I’m not sure. She was the cardiologist [sic]. I remember thinking that I should have told her about that. I remember the heart lung machine. I didn’t like the respirator. I remember a lot of tools and instruments that I did not readily recognize.
There was a sensation like being pulled, but not against your will. I was going on my own accord because I wanted to go. I have different metaphors to try to explain this. It was like the Wizard of Oz being taken up into a tornado vortex, only you’re not spinning around like you’ve got vertigo. The feeling was like going up in an elevator real fast. And there was a sensation, but it wasn’t a bodily, physical sensation. It was like a tunnel but it wasn’t a tunnel.
At some point very early in the tunnel vortex I became aware of my grandmother calling me. But I didn’t hear her call me with my ears. It was clearer hearing than with my ears. I trust that sense more than I trust my own ears. The feeling was that she wanted me to come to her, so I continued with no fear down the shaft. It’s a dark shaft that I went through, and at the very end there was this very little tiny pinpoint of light that kept getting bigger and bigger and bigger.
The light was incredibly bright, like sitting in the middle of a light bulb. It was so bright that I put my hands in front of my face fully expecting to see them and I could not. . . I noticed that as I began to discern different figures in the light and they were all covered with light, they were light, and had light permeating all around them they began to form shapes that I could recognize and understand. I could see that one of them was my grandmother. I don’t know if it was reality or projection, but I would know my grandmother, the sound of her, anywhere.
I recognized a lot of people. . . [various relatives] . . . they were specifically looking after me. They would not permit me to go further. . . it was communicated to me that’s the best way I know how to say it, because they didn’t speak like I’m speaking that if I went all the way into the light something would happen to me physically. They would be unable to put me back into the body, like I had gone too far and they couldn’t reconnect. I wanted to go into the light, but I also wanted to come back I had children to be reared.
Then they [deceased relatives] were feeding me. . . [but] not through my mouth . . . something sparkly. I definitely recall the sensation of being nurtured and being fed
and being made strong. I know it sounds funny, because obviously it wasn’t a physical thing, but inside the experience I felt physically strong, ready for whatever.
My grandmother didn’t take me back through the tunnel, or even send me back or ask me to go. . . I expected to go with her but it was communicated to me that she just didn’t think she should do that. My uncle said he would do it. . . back through the tunnel. I did want to go. But then I got to the end of it and saw the thing, my body. I didn’t want to get into it it looked terrible, like a train wreck. It looked like what it was: dead. I believe it was covered. It scared me and I didn’t want to look at it. It was communicated to me that it was like jumping into a swimming pool. No problem, just jump right into [it]. I didn’t want to [but my uncle] pushed me. I felt a definite repelling and at the same time a pulling from the body. The body was pulling and the tunnel was pushing. . . it was like diving into a pool of ice water. . . it hurt!
When I came back, they were playing ‘Hotel California’. . . When I regained con sciousness, I was still on the respirator.
Pam’s OBE occurred at points within the two-hours and ten-minutes interval (8.40–10.50am) during which the surgeon raised the rear, right-sided tem- poro-occipital bone-flap in order to inspect the aneurysm and assess the feasibility of removing it. Before continuing, we should note that Pam’s eyes were lubricated and the eyelids taped together, while special earplugs were inserted into her outer ears in order to transmit tones necessary for monitor- ing brainstem function. We are not told whether these plugs rendered Pam completely oblivious of all external adventitious sounds. The OBE concerns two aspects of the procedures undertaken during this two-hour period—the use of the saw in raising the bone flap, and the difficulties encountered in achieving satisfactory vascular access to her groins in order to establish cardio-pulmonary bypass.
With regard to the bone flap, I shall consider what Pam alleged she saw and heard: clearly, she was unable to use her eyes. She thought she was sitting on the surgeon’s shoulder and looking over him. Yet despite occupying this grandstand position, she provides no account of the cutting procedure, only surprise at the small area of hair that was shaved from her scalp: ‘I expected them to take all of the hair, but they did not’. That information, of course, was available to her after the operation and could have been subconsciously woven into her narrative at some later stage. Her description of the bone saw used was inaccurate and did not fit the model actually used in her operation. She heard the bone saw ‘crank up’ yet, despite being positioned by the surgeon’s shoulder, she (incredibly!) never observed it in use: ‘I didn’t see them use it on my head but I think I heard it being used somewhere’ (my emphases). That statement indicates, beyond any doubt whatsoever, that 22 Getting a Sense of the Other-Worldly Domain
she saw nothing of the saw in the theatre on that day, but was only aware of its sound.
The problem arises as to whether she actually did, or could, hear the saw, despite having her ears plugged. Against the possibility that she was unable to hear any externally produced sounds by air conduction, there is no doubt that she actually heard the saw internally, by means of bone conduction. Most of us are familiar with the analogous situation of the dentist’s drill whose sound is substantially transmitted through bone, in addition to external air conduction. Similarly, the internalized ‘body-image’ of the sound of our own voices is predominantly dependent on bone rather than air conduction, explaining why hearing a recording of our own voice seems so different from our inbuilt mental preconceptions of its varying timbres. We should also be aware that the bone flap was cut immediately around the site of her right ear, so that there was direct contact between the scalp bone being severed and her internal ear mechanism (for audition) within the adjacent (petrous temporal) bone on that side.
Sabom alleges during his interview with Pam that she did not perceive anything before hearing the bone saw. He also states that the craniotomy was begun at the same time as the groin incisions were being made in prepara- tion for the bypass procedure. Thus Pam’s OBE does correspond with the timing of the saw and the alleged conversation about the smallness of her femoral (groin) vessels. However, her account is sequential: Pam clearly derived no information during the operation that the events were contem- poraneous. ‘I believe it was Dr [][speaking] but I’m not sure’ (my em- phases). We note the complete uncertainty here regarding her testimony. It is as vague as her remarks about the use of the bone saw ‘somewhere’ although she was supposedly looking over the surgeon’s shoulder and directly into the field of surgery ‘with heightened visual acuity ’ at the time. The likelihood is that her impression about the conversation could have been inferred post-operatively, relayed to her directly through nursing or medical staff. She would naturally have enquired why both groins had been opened when perhaps she only expected one to have been used. Reynolds may have picked up conversations by the same female doctor when she and other members of the surgical team handed over responsibility to the personnel in the recovery suite, while their patient was still sedated, drowsy and possibly cool (her last stated temperature still being in the moderately severe hypothermic range). My own conclusion is that Pam could not have heard the conversation in theatre with earplugs in her ears: her information must have come from another source and those which I have indicated seem to be the most likely.
Finally, some comments on time and timings. We can relate Pam’s OBE account to the initial operative procedures when her head and groins were opened: her experiences, however much she was conscious or unconscious, correspond. Yet we should be aware that Pam’s account of this phase in her ECE is contained within 325 words for a period exceeding two hours in real time, as documented in the surgical notes. Her account is extremely mini- malist and signally fails to provide a proper commentary on the events as they evolved—only fleeting and inaccurate perceptions of two alleged, and impor- tantly, non-sequential happenings, as reported. I conclude that Pam did have an OBE, but it is by no means as impressive as the many others recorded in the literature, and that it clearly occurred well before body cooling was initiated. Pam notes that she did not like the respirator, suggesting that her levels of anaesthesia and sedation were shallow and that she may therefore have consciously been aware of some sounds during the early stages of the opera- tion. Her visual record is unimpressive. She neither saw her head being opened, nor did she competently report the most crucial detail of the opera- tive technique employed: that is, her head was turned sharply to her left and held there rigidly by a robust, mechanical three-point pin head-holder, in order to allow the surgeon to proceed. That militates impressively against claims that veridical experiences of external reality occur during OBE (I make more general observations on this point in Chapter 6). All we can be sure about is that during these initial stages of the operative inspection, Pam reported having evanescent glimpses of herself ‘looking’ over the surgeon’s shoulder, giving a puzzling description of the saw which she ‘heard’ but clearly did not actually ‘see’ or ‘know’ where it was being used, and of ‘recalling’ fragmentary items of conversation about her groin vessels which could have been incorporated into her memory after she had come out of theatre. The operation was planned to get her through a technically very difficult piece of neurosur- gery, not designed to answer questions about ECE. As a result, the issues become very unclear and indecisive when employed critically as proof of extra-corporeal existence.
Sabom continues his account of Pam’s operation and ECE. He arrives at the stage when her body core temperature had been lowered by almost 40F. During this stage, bypass having been terminated, there was no measurable blood pressure, pulse, cardiac activity, electrical brain activity or brainstem activity, as assessed through the special earplug monitoring devices. Pam was now in a state popularly known as ‘suspended animation’. Yet at this critical juncture in his text, and presumably without intended deception, Sabom offers the following unbelievable comment: ‘sometime during this period Pam’s near-death experience progressed’ (emphases mine). Sabom therefore 24 Getting a Sense of the Other-Worldly Domain
implies that Pam experienced the next (NDE) stage in her recorded narrative comprising ascending vortex, expanding light and sight of many deceased relatives, when all bodily function had ceased. That is, when cardio-pulmo- nary bypass was stopped, her brain had been drained of blood, and her core body temperature had been markedly depressed to 60 F. That, of course, is impossible, viewed from any physiological perspective. Because her brain (as the ‘flat’ EEG was taken to indicate) was dormant, it obviously lacked the ability to activate the cerebral processes associated with sensory perception and, importantly, with memory, an essentially necessary function if Pam was ever to recall any of these perceived events at a later time. Thus, to indicate that Pam’s NDE commenced during that particular stage of the operation is absurd, as it is likewise for others to believe and transmit, as true fact, what Sabom, without any warrant, is alleging here. Yet Sabom persists: ‘During “standstill” Pam’s brain was found to be “dead” by all three clinical tests— her EEG was silent, her brainstem responses were absent, and no blood flowed through her brain. Interestingly, while in this state, she encountered the “deepest” near-death experience of all [his previously reported] Atlanta Study participants’ (my emphases). ‘Had the surgeons brought her back from the dead?’, he asks. The answer is clearly no, for the additional reason not included by Sabom is that Pam was markedly hypothermic as intended by the procedure, thus protecting her from the prolonged metabolic sequel- ae of having no functional circulation during that critical period of the operation.
After the aneurysm was clipped, Pam’s body was rewarmed through the re- establishment of cardio-pulmonary bypass (between 11.25 am and 12 noon). Here Sabom adds: ‘Pam’s body appeared to be waking up, perhaps at a time during her near-death experience when she was being strengthened’. The