by Pam Kircher, M.D.

Note that this is a presentation made by individuals at an IANDS conference, and does not necessarily represent the views of the IANDS organization.

General ways to be helpful

1. Anticipate possible NDEs in post-CPR situations and in the last days of life in a terminally-ill person.
2. Ask open-ended questions such as "Do you wonder about anything that occurred during your CPR?"  and then be guided by their responses to your question.  Merely asking the question initially may be what they need at that time to know that you are available for discussions when they feel ready.
3. Be alert for changes in the patient after a CPR such as withdrawn behavior, increased sensitivity to noise or violence (such as an aversion to watching violent television programs or the news.)  If you notice those behaviors, establishing general rapport with them and sitting in silence are often helpful in assisting a person in opening up in sensitive situations.
4. In the hospice setting in particular, be aware of signs that a person is conversing with someone that you don't see.  Don't interrupt them at the time, but ask an open-ended question about it later.
5. Have a strong base of information so that you can answer their questions in a matter-of-fact and factual way.
   1. NDEs are extremely common.  In a Gallup poll in 1982, 5% of adult Americans had experienced a NDE.  That extrapolates to about 8,000,000 people in America in 1982.  In people who had undergone CPRs, 35% of those people reported a NDE.  Since our resuscitative attempts are continuing to be more successful with advanced technology and the increased knowledge of basic CPR in the general population that has led to an increased success rate for witnessed cardiac arrests, we can expect that the number of people that have undergone a NDE will continue to rise.
   2. Melvin Morse who reviewed the records from Operation Airlift Northwest on successful pediatric resuscitations confirmed these statistics.  He noted that about 35% of the children remembered NDEs and, furthermore, that they were more likely to remember a NDE if they had received fewer medications during the resuscitation attempt.
   3. In Michael Sabom's study of successful CPRs in consecutive resuscitations in the Atlanta Emergency Room, he discovered that some 43% of people reported NDEs when they were interviewed within a few days of the CPR.  He is a cardiologist who had resuscitated many people without hearing about a NDE until he began to sit with people and ask them open-ended questions.
   4. Numerous studies have now shown that these experiences are equal for both sexes, all age groups, and all belief systems.  Statistically speaking, there is no difference whether or not people expect to have a NDE.
   5. "Visitations" with deceased relatives are extremely common in terminally-ill patients in the last few days of life and are differentiated from hallucinations in that the patient may be interrupted during the "visit" with the deceased relative and will give perfectly coherent answers whereas the patient having a hallucination cannot be brought back to reality to answer questions.
   6. It is becoming increasingly common for people to be aware of the possibility of NDEs, largely because of the media such as books, television shows, and even movies.  As people become aware of the frequency of NDEs, it is becoming increasingly easy to talk about them with family and friends -- and even health care professionals, especially nurses!!
6. Discuss with NDErs the common after-effects.  They may not experience them all, but it is comforting to know that these effects are secondary to the NDE if they do occur.
   1. Immediately after the NDE, there may be a strong sense of unreality about everything.  It may seem that the reality of the NDE is so powerful and so in contrast to everything that is going on in the hospital setting that the hospital setting has a strong sense of unreality about it.
   2. There are common changes in values experienced by those who have had a NDE:
      1. There is no longer a fear of death, but there is often lingering fear about the dying process, especially fear of pain.
      2. There is an increase in spiritual interests.  While NDErs may not become more religious, they certainly do have a profound increased interest in spiritual matters.
      3. There is an understanding that our main purpose on Earth is to learn how to love better.  Thus, there is an increase in universal non-specific love.
      4. An increased feeling of connection with nature and an increase in the desire to be in nature is very common.
      5. There is often an increased interest in learning just for the sake of learning.
      6. A decreased interest in materialism is usually seen.
      7. There is a decreased interest in success, especially in the form of fame.
   3. Other changes may be noted by the person who has had the NDE:
      1. An increased sensitivity to violence may make watching the news and "action" movies intolerable.
      2. Sensitivity to other people's emotions is often enhanced, making it difficult to be in crowds such as in the mall and at large parties as the emotions are experienced as a "bombardment."
      3. Psychic abilities may be enhanced which is often experienced as very disconcerting, especially at first.
   4. Common problems that occur after a NDE:
      1. Readjustment to the "real world" often takes months and even years.
      2. The understanding that we are here to learn to love well may not mesh with the NDEr's previous lifestyle.  His friends and/or occupation may no longer be appropriate for him.
      3. The increased sensitivity to emotions and violence may create great tension in situations that were previously interpreted as pleasant.
      4. There may be difficulties within the family as family members try to adjust to the changes in the NDEr and the NDEr tries to find his place in the family with his new values and sensitivities.
      5. The NDE generally occurs in the setting of severe medical illness or a trauma and the physical aspects of that need to be dealt with simultaneously with the adjustments after a NDE.
7. Other assistance that might be useful
   1. Many NDErs find great comfort and assistance from meeting other people who have had NDEs.  This can be done on an individual basis or in a support group setting.  Follow this link for information on local support groups.
   2. Brief counseling with a minister or psychotherapist that is familiar with the after-effects of NDEs is often quite helpful.  It is crucial to avoid therapists and counselors who themselves are not well versed in NDEs.
   3. Books that might be useful include:
      1. Callanan, Maggie and Patricia Kelley.  Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying.
      2. Kircher, Pamela M., M.D.  Love is the Link: A Hospice Doctor Shares Her Experience of Near-Death and Dying.
      3. Morse, Melvin, M.D.  Closer to the Light.
      4. Ring, Kenneth, Ph.D.  Heading Toward Omega.