ICU, Memory, NDE

It has been almost eighteen months since a hemorrhagic stroke in my right temporal lobe knocked me almost completely out of commission. From the very beginning, even the days of confusional mental states in ICU, a single ambition about recovery has been clear to me:  I will put up a blog post. An interesting blog post.

The prospects ranged from dire to unlikely. Tremors snarled my typing and my handwriting is illegible. Sitting up to work required a hoist; I could not stand or reach or lift even a small book. It was a struggle to read a simple mystery novel, much less think enough to write paragraphs. I could not think of a thing to say.

But “inch by inch, row by row,” and as I write this, 517 days of healing have happened and are continuing. I still cannot think of a thing to say on my own; but this past week an email brought a perspective so fascinating that it popped everything open. This morning I made it through a full session of physical therapy walking shakily but without a walker, and this afternoon, here we are, drafting that blog post. Obviously, beyond my own determination, it is the care of a raft of health professionals, therapists, helpers, and people who love me that has brought us all to this point. I am so grateful to them, and to the writer of the email that ignited today’s topic, and to you readers for coming back.

The email from “Ann”:

 My mother (over 80 years old retired teacher) told me that she remembered some things from her recent surgery. I started to look for references about near death experiences and found your article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173534/.

In January this year, my mother underwent an 8-hour-long abdominal surgery under general inhalational anesthesia [anesthetic gas] with endotracheal intubation [insertion of breathing tube] . She was septic, and she had a subileus [partial bowel obstruction] from extensive peritoneal adhesions [abdominal scar tissue] from prior surgeries.

She did not regain consciousness after her surgery and she stayed in the ICU for 45 days. During this time she was extubated, then she experienced hypoxia [low blood oxygen], reintubation, unstable SVT [very fast heart beat with low blood pressure] corrected by synchronized cardioversion, [electrical jolt to restore normal  heart rate] pneumonia, and tracheostomy [opening on of the neck to place a breathing tube].  She did have 2-5 day periods between these crises when she was under light sedation by propofol infusion or no sedation.

My mother is now recovering at a lower acuity unit and she told us that she remembered “things” from her OR and ICU stays:

1. First she saw amorphous, dark entities approaching her. She was afraid of them.
2. Then her field of vision brightened up and there was a pleasant light.
3. In the end she saw a friend, and she knew that she would be all right. The friend is a physician at the hospital where Mother is staying and the friend visits her daily.

My mother thinks it is a memory and it made her more reflective. She is asking questions she would have never asked before (Am I a good person?). Before her illness she never talked about death, the word was banned and her goal was to live to be 100. She was raised Catholic, but for her religion is more of remembering childhood and Latin rituals. She believes in God, though, without defined beliefs about what happens after death.

Do you think this might have been an NDE?  

Thank you so much for your time and consideration.

~ ~ ~

Other than that the writer is clearly medically sophisticated, did anything in the content strike your attention? What do you think it was that caught mine?

Here is an expanded version of my response:

Intensive care units are (understandably) notorious for their association with hard-to-explain states of consciousness. Given the seriousness of your [letter-writer] mother’s condition, her intermittent sedations, and the length of her stay in such high-stress surroundings, it is not surprising she has a blur to deal with.

Patients coming out of deep unconsciousness are like travelers returning home from abroad, though the ‘foreign country’ they describe is the unfamiliar territory of the deep unconscious. It is not unusual to hear of indistinct, shadowy figures such as those you mentioned. While many patients, like your mother, experience them as frightening, others find them non-threatening, even comforting presences. There is no “one explanation fits all” to identify them or their function.

Images have always been the language of disordered thinking—but they are also the vocabulary of art and spirituality, subject to much interpretation. The pleasant light your mom mentions is probably as close to having a universal meaning as any symbol, usually interpreted as having something to do with the sacred. The one anomalous element in her description is the presence of the physician friend, as it is not at all common for people who are still living to appear in these experiences.

The experiences are so different from everyday awareness! What are they, and how to interpret them? Given your mother’s situation, three explanations come immediately to mind: hallucination, ICU delirium/delusion, and anomalous experience (near-death experiences, for one).

• Hallucinations are sensory perceptions, often chaotic, illogical, and emotionally charged, which are not shared in consensual reality. They may be vivid but do not ordinarily carry much in the way of deeper meaning (simply forms). Although a patient’s interpretation of a hallucination may endure and be troublesome, they are not known for creating life-changing aftereffects such as overturned values or sudden psychic abilities.
• ICU delirium/delusion is a complex quick-onset confusional state, described by DSM-5 as involving attention deficits, disorientation and perceptual disturbances. Delirium, according to PubMed (https://pubmed.ncbi.nlm.nih.gov/32644706/) is “the most common clinical manifestation of acute brain dysfunction in ICU,” especially for patients on mechanical ventilation. It may have long-lasting effects such as PTSD.
• NDEs also present as emotionally charged images, often about movement through space and entering what feels like a profoundly meaningful environment. They tend to be more highly structured than hallucinations and can fall easily into a logical narrative form. They are known for their durability in memory and the pervasiveness of their effects on people’s lives.

So—NDE or not? Many people are powerfully affected by having to think of themselves as dead. If the “near-death” aspect is alarming, there may be comfort in knowing that in any sizable collection of these accounts, the majority are from people who were not medically declared dead (clinically dead), though as many as seventy-five per cent “had a sense of being close to death, were in a life-threatening situation, or believed they were clinically dead” [emphasis added]. (www.iands.org/ndes/about-ndes/key-nde-facts21.html) In other words, although the experiencers felt death, their physicians would not have confirmed it.

That is perhaps the greatest mystery of these experiences: if most do not originate in actual death, what is their source? The fault of the common confusion lies in the “near-death” name, which was accurate for the original study sample, all of whom had been in cardiac arrest; but that uniformity does not hold up in the general population of experiencers. In fact, many accounts featuring elements such as presences and a memorably pleasant light, like your mother’s report, have not explicitly mentioned death at all. The “non-death accounts” are called by many names–mystical experiences, exceptional human experiences, spiritually transformative experiences–there are dozens of terms and acronyms for them—but all may include the familiar NDE reports of out-of-body events, movement through space, encounter with presences, a sense of place and of being at home, emotions, profound life changes. Like death-related NDEs, they rarely speak to the beliefs and dogmas of any specific religion, though there is affirmation for love, compassion, fair play, and a sense of what I will call reverence.

Your mother’s circumstances certainly put her experience within the NDE type of non-pathological event. Coming from the confusing swirl of post-ICU images, as you and your mother are now discovering, the label of the incident is likely less important than the living of the experience’s beneficial psychological and spiritual effects. They are all full of mystery, whatever biological specifics may contribute to understanding them and by whatever name we call them.

The most striking observation to me is this:

“She thinks it is a memory and it made her more reflective. She is asking questions she would have never asked before.”

I have been fascinated by that: “She thinks it is a memory.” I wonder, a memory as opposed to…what? Perhaps a memory, in her terms, is more closely aligned with a physical experience than merely a glimpse of something? I am hearing it as perhaps an instance of our Enlightenment thinking: in Newtonian terms, does a memory originate somewhere tangible, as in a place? (Is this a restatement of the “hallucination vs NDE” question again?

Most NDE accounts are structured like stories, tangibly, with a sequence of incidents, one or more settings, characters—overall, becoming like a location for the memory. Otherwise, the happening might seem like something of no substance, something nonexistent. It’s a fascinating question! Is it perhaps the narrative sense which gives an NDE its feel of stability and being “realer than real”? Is memory simply a perspective?

I am aware that this exploration of things non-physical is likely to be unsatisfying for those grounded in the hard sciences. In terms of consciousness, though, there is no material substance, no physicality. What the writer’s mother remembers is a genuine memory of an experience of consciousness. This seemingly flimsy, invisible reality is actually so powerful that it is launching her, over 80, into asking the kinds of self-reflective questions maturity demands. She has been able to refuse them house-room before this hospitalization, but is now asking developmentally and morally imperative questions about herself and her life.

It is not easy, encountering whatever it is that lives, at least in part, in images across time and cultures and, at least in another part, in our individual heads. Socrates would be pleased that her life is being so carefully examined.

Please share your thoughts!  And “Ann”,  thank you for sharing your question!