by Pam Kircher, M.D. 

Van Lommel's article in Lancet is a landmark that should be read by every doctor.  It reports on the largest prospective study to ask people about NDEs after a cardiac arrest.  Its results show that NDEs are a significant phenomenon in the setting of cardiac arrest.  Equally important, the study followed people for eight years after their NDE.  The observations gleaned from that follow-up demonstrate that NDEs really are life transforming, and that the transformation in values is consistent over time.  The study showed that NDEs create much greater changes in a person's life than does simply having a cardiac arrest or being near death.

Family doctors may not be the physicians present at the time of cardiac arrest, but they are the doctors people usually talk to the most, because they are the doctors people go to most often for a variety of problems.  I would encourage Vital Signs readers to obtain the complete Lancet article to share with your doctor.  You will be doing your family doctor a great favor.  Basically, we doctors change our minds about diagnoses and treatments because of articles in medical journals.

When people read van Lommel's article, they are often drawn to one or two items in his vast array of findings.  I have mentioned the major ones in my first paragraph.  Near the end of the summary on this page, Dr. Greyson addresses the question of false memories, which the Lancet commentary brought up regarding patients who later recalled an NDE they hadn't initially reported on.  For me, the most fascinating statistic in van Lommel's article has to do with predictors of death in the 30 days following cardiac arrest.  Each person in the study was very ill or they would not have had a cardiac arrest.  Statistically, it is quite common to die soon after a cardiac arrest, particularly if it occurred as the result of a chronic medical condition.  In his study, Dr.  van Lommel measured the depth of the NDE by using Kenneth Ring's scale.  People who had more of certain aspects of the NDE (e.g., tunnels, light, life reviews) were labeled core experiencers.  Having a core experience was a predictor of death over the next 30 days at a probability of .0001.  That means that there is a 1-in-10,000 chance that those results would have occurred by chance alone.  Why would that be?

Two very different hypotheses come to mind.  One is that people with very deep experiences might be so taken with the experience that they simply allowed themselves to slip over to the other side.  (The will to live is crucial in people who are extremely ill.  Though it doesn't predict whether or not the person will die, it can have a bearing on when their death occurs.  For example, people who are terminally ill frequently put off their own deaths until after they have finished waiting for an important day such as their daughter's wedding.)  The sense of what lies ahead of NDErs may be so peaceful, that they simply complete unfinished business here and then let go into death.  Another possible interpretation of the data, however, is that the depth of the NDE may be related to the severity of the illness of the person.  In a statistically precise study of NDErs, Dr.  Bruce Greyson found that psychic abilities are more common after a core NDE (Theta, 11:26-29, 1983).  Since we have not had studies until now that interviewed large numbers of people within 30 days of their NDEs, the reasons for the relationship between the depth of the NDE and impending death have not yet been identified.

I believe that the findings in van Lommel's study challenge hospitals to ask people about their NDEs after a cardiac arrest.  As it becomes common practice to invite resuscitated people to discuss their NDEs with health care personnel in the hospital, the relationship between having a core NDE and dying a short time later will become clearer.  In addition, NDEs in resuscitated persons will be seen as a normal concomitant of the experience.  Finally, I believe that people with NDEs will be able to adjust more easily to the changes that occur in their values, if they have some assistance with that from immediate caregivers while still in the hospital setting.

Colorado physician Pam Kircher is board certified in both hospice care and family practice.  She has taught at Baylor College of Medicine, and was Chief of Family Medicine at Memorial Southwest Hospital in Houston, Texas.