Covert Cognition: My So-Called Near-Death Experience
A skeptic sees no light at the end of the tunnel when she falls into a six-week coma and nearly dies.
We often see and hear dramatic accounts of near-death experiences (NDEs) in books, in films, and on television. But where are the stories from skeptics who “returned” but not from The Other Side? After all, NDEs are generally accepted as a neurological phenomenon. Well, most people who have NDEs actually die. Among the survivors, many are severely brain-damaged. Of those who do recover, most are believers. As for the skeptical ones, how many of them are writers? Not many, probably, but I am one.
“It’s the profound brain damage again,” has become a running joke whenever I say something stupid, a fairly common occurrence long before the strokes that caused my coma. This wouldn’t be very funny if I weren’t fully conscious now—excluding mornings. I’m writing this article not long after the first anniversary of my awakening. My boyfriend calls it Coma Day, and he’s never forgotten the date. I’ve never forgotten that first conscious moment.
I thought I was suffering through a miserably sleepless night, a recurring theme in what I call my coma-dream. Every time I finally managed to drop off, something would wake me up again. Whenever doctors shined lights in my eyes looking for signs of consciousness, I would grumpily ask them to leave me alone so I could get back to sleep . . . in the coma-dream. My lack of response in the real world only added to their conviction that my brain was, as they said, profoundly damaged. My mother, boyfriend, and his mother, who had visited daily, noticed signs of my increasing awareness, but their observations were disregarded by the doctors.
When I finally awoke, I thought, “Goddammit, I just fell back asleep.” That’s when my mother told me I had actually been sleeping for six weeks, on the brink of death. I was shocked. “Seriously?” I mouthed. I had a tracheostomy, so I couldn’t speak—a fate worse than death for me.
However, the doctors’ conclusions weren’t groundless. My MRI showed that I had suffered a series of strokes on both sides of my brain when my blood pressure plummeted from septic shock. The sepsis was triggered by Legionnaires’ disease, a rare form of severe pneumonia discovered when it sickened attendees at a Legionnaires’ convention.
In the waning days of a vacation in Sicily with my boyfriend, Keith, I came down with what we thought was nothing more than a nasty chest cold. We joked about my case of “Mussolini’s Revenge,” but it was far more serious than that. A few days after we returned home, he rushed me to the emergency room. I was so delirious that when he asked why I hadn’t turned on the air conditioning, I said, “I like the heat.” It was 105° that day, and I hate the heat.
Most of the victims at the Legionnaires’ convention were elderly. I caught the disease because my immune system was weakened by prednisone, which I was taking for an obscure autoimmune disease called dermatomyositis. It’s uncommon enough that I’ve often seen the dermatomyositis Wikipedia page on the computer screen when seeing a new specialist. And, yes, it is disturbing that medical professionals are using a questionable information source popular with schoolchildren.
Though the doctors continued to dismiss suggestions of my improving wakefulness, much of what was going on around me was filtering into my coma-dream. I wasn’t aware that I was in a vegetative state, but I knew I had a “trach,” a term I had previously heard only in medical dramas. Encouraged by an imaginary doctor, I blew large bubbles out of my nose—as if I’d been snorting bubblegum—when I had a sinus infection from my feeding tube. The constant thrumming was the machinery keeping me alive.
Near death isn’t required for a near-death experience. They can be triggered by severe illness and even fainting (from lack of oxygen to the brain). Though my coma-dream shared many similarities with typical NDEs, my experience was different because I’m a skeptic. The reason I didn’t see dead relatives is I don’t believe in life after death. Likewise, I didn’t see Jesus’s rainbow-hued horse because I’m Jewish and not a four-year-old imagining Jesus with a gay Little Pony. I did, however, dream of ice cream. Indeed, while my life didn’t flash before my eyes, childhood elements figured prominently in the revolving segments of the coma-dream. On my Brain TV, some shows were repeats, while others had advancing plots like soap operas. I had a lot of time to kill.
One serial featured a low Big Wheel–like kid’s tricycle that churned ice cream in a cart attached to the back as it was peddled. Actually, burning the calories you’re about to consume isn’t such a bad idea. Sometimes when I peddled this ice cream–making Big Wheel, I was an anthropomorphic polar bear cub. While I saw no religious figures, I imagined miniaturized zoo animals right out of a 1950s sci-fi film. They were having a tea party, like poker-playing dogs except with tiny china cups. You can see why I call this a coma-dream. These surreal images may be akin to the spirits believers see in their NDEs.
After the awakening, I felt like Dorothy waking up in bed after her journey down the Yellow Brick Road. So many of the things in the coma-dream suddenly made sense—except for the cub-powered ice cream Big Wheel and toy-sized elephant. The pachyderm held the teapot with its trunk.
Oh, that’s the reason snippets of The Hitchhiker’s Guide to the Galaxy, one of my favorite books, kept wafting into unrelated storylines. My boyfriend had read to me from the book, while my mother had played the original BBC radio series. I don’t believe the incursions always occurred when I heard them, though. My mother also used her e-reader to play some recent David Attenborough nature documentaries, including one on Charles Darwin. (As a former future-paleontologist, evolution has long been a special interest of mine.) Sometimes sections would repeat. I thought I was rewinding the program because my mind wandered (something I do frequently). My Brain TV had a DVR.
Ah, so that’s why they kept asking me to stop biting the hose delivering Hi-C to my mouth as if from a beer hat. They weren’t risking cavities by giving me a sugary fruit-flavored drink; they were preventing them by cleaning my mouth with a citrus-flavored swab. If I had stopped biting the swab, I wouldn’t have had so much plaque on my teeth, the reason I was running my tongue over my teeth in both the coma-dream and in reality. I couldn’t understand how my teeth could’ve gotten that coated overnight. But then, the tooth-licking was one of the signs of recovering awareness that gave my loved ones hope, even if the doctors wouldn’t acknowledge it as such.
And my new boyfriend in the dream, the one who looked and sounded exactly like Keith in every way except his beard, actually was Keith, who had grown a full beard while I was in the coma. I wondered why his glasses had been repaired with the same kludge Keith devised in Sicily—with the sticky part of a clear Band-Aid. What a weird coincidence. Since this was a form of dream, that wasn’t a tipoff, even when I slipped and called him Keith.
But for most people in a vegetative state, they’re more likely to hear prayers and the Bible than Hitchhiker’s Guide. That must affect what they visualize in their NDEs. Indeed, the content of NDEs varies among cultures. I was raised without religion, but the disembodied voices I heard were not unlike spirit voices. My brain didn’t supply images of the afterlife because I believe life after death is a fantasy. Resistance to being awakened is similar to reluctance to return from The Other Side. Using Occam’s razor, which is more likely to be true?
If I had been a New Ager, seeing myself being turned over to prevent bedsores would’ve seemed like an out-of-body experience (OBE). But how many times have I watched myself from outside my body in an ordinary dream? Oh, wait—some people believe those are OBEs too. I once dreamed that a lion put its paw on my hand, only to wake up with my cat’s paw on my hand. It doesn’t take a genius to figure that one out. There’s nothing supernatural about that; it’s just sensory information mixed with imagination. Besides, my eyes were sometimes open, so my perceptions weren’t always imaginary. That’s how I knew Keith had grown a full beard.
According to the Merck Manual:
A vegetative state is absence of responsiveness and awareness due to overwhelming dysfunction of the cerebral hemispheres, with sufficient sparing of the diencephalon and brain stem to preserve autonomic and motor reflexes and sleep-wake cycles. Patients may have complex reflexes, including eye movements, yawning, and involuntary movements to noxious stimuli, but show no awareness of self or environment. (Maiese 2014)
Yet, there is growing empirical evidence of covert cognition in people who have been in a persistent vegetative state (PVS) for years. Using functional magnetic resonance imaging (fMRI), which determines brain activity by displaying blood-flow patterns, researchers from Cambridge University, including pioneering researcher Dr. Adrian Owen, were able to communicate with five patients with consciousness disorders by asking them to imagine one of two activities (Owen et al. 2006). In the motor task, they were instructed to imagine playing tennis. In the spatial task, they were asked to navigate familiar locations. The images lit up different brain regions. Four patients were able to answer yes or no questions with this technique (Monti et al. 2010). One answered five of six correctly. His “do not resuscitate” order was rescinded. The results were repeatable and corresponded closely to those of the healthy controls.
Kate Bainbridge, the first vegetative person Dr. Owen tested with positron emission tomography (PET), eventually recovered her mental faculties. “I was unresponsive and looked hopeless,” she later told him in a note, “but the scan showed people I was in there. It was like magic, it found me.” Today, she’s angry at the doctors who ignored her discomfort because they assumed she wasn’t feeling anything. The reason I was dreaming about ice cream—another serialized dream also involved ice cream—is probably because I was left uncovered in a frigid room.
Now at Canada’s Western University, Dr. Owen and his team recently conducted an fMRI study in which a man who had been vegetative for sixteen years responded with nearly identical brain patterns as the study’s healthy controls while watching “Bang! You’re Dead,” an episode of Alfred Hitchcock Presents (Naci et al. 2014). This indicated that he was following the suspenseful plot. Regarding the subject, Jeff Tremblay, Dr. Naci said, “For the first time, we show that a patient with unknown levels of consciousness can monitor and analyze information from their environment, in the same way as healthy individuals. We already know that up to one in five of these patients are misdiagnosed as being unconscious and this new technique may reveal that that number is even higher.” Since the Hitchcock experiment, they have tested patients using Charlie Chaplin’s Modern Times and The Lion’s Cage, which, according to Dr. Naci, have shown similar results.
If Mr. Tremblay is watching his own Brain TV, is he now seeing images of a little boy with a gun? Are the subjects of the Chaplin study imagining themselves caught in the cogs of a giant machine? Perhaps someday, through fMRI or emerging treatments, they will be able to tell us. When that day comes, what are the odds that they will report seeing the afterlife after all those years? You’d think their dead relatives would eventually return to the light so they can find something better to do.
Though many of these patients are misdiagnosed, without proper screening it’s impossible to know which ones. In my case, the minute the doctors saw the stroke damage they assumed I was beyond hope. The Glasgow Coma Scale wasn’t even performed, and it’s just a low-tech behavioral checklist. I was in a state-of-the-art hospital; imagine a patient in a less advanced facility.
My neurologist told me that the reasons I’ve recovered so well are that I was younger than the average stroke victim and most of my brain damage was in the watershed areas. Watershed areas lie between two major arteries. By the time blood reaches these sections, there’s less oxygen in it. It’s a bit like a wetland fed by two trickling tributaries. Together, they provide just enough water, but when the flow diminishes, the land between the tributaries dries up. As she explained, watershed areas don’t generally control vital functions. They die more quickly than more important regions, but they also spring back faster after damage has occurred. Ain’t evolution grand?
The “string of pearls” pattern of my watershed-area stroke damage should’ve been obvious to the neurologists examining my MRI. I can’t say why they didn’t add that evidence to my relative youth when predicting my chance of recovery. They did perform an electroencephalogram (EEG), which showed, not surprisingly, that I still had brain activity. Again, I don’t know why that didn’t figure into their evaluation. Perhaps they didn’t consider the mounting evidence that there is more awareness in the comatose and nearly—but not most sincerely—dead than previously realized.
Regarding the tennis study, “In the Blink of the Mind’s Eye” states, “This technology does more than open up the possibility of communicating with people thought to be unconscious and unreachable. It also suggests that neuroimaging must eventually be integrated into the clinical assessment of many patients who are vegetative or minimally conscious. This is a dramatic finding and a potential game-changer for clinical practice” (Finns and Schiff 2010). If that happens, there will be fewer seemingly miraculous recoveries because they won’t be such a surprise.
The perceptions of stricken brains are hardly inexplicable if awareness is more like a dimmer than an on/off switch. Moreover, NDEs can’t be proof of mind/brain separation if the brains of those experiencing them are still active. Covert cognition fills many blanks.
My OBEs felt like imagined perspective shifts, but the sensation of floating outside your body can be electrically stimulated in the brain (Blanke and Arzy 2005). Furthermore, REM intrusion, which causes blended dream states like lucid dreaming, may be responsible for the fantastical qualities of NDEs (Nelson et al. 2006). “I see it [the NDE] as an activation of certain brain regions that are also active during the dream state,” said Nelson. The study adds, “Under circumstances of peril, an NDE is more likely in those with previous REM intrusion.” I sometimes lucid dream spontaneously, as I did in the coma-dream. The hallucinations James Randi has reported seeing while awakening from surgery were probably due to REM intrusion.
While I was comatose, Keith told me about his future plans for us, most of which I remembered when I awoke. He would start telling them again, and I would say, basically, “Been there; heard that,” albeit through his doppelganger. Yet, at the same time Keith was telling me these things, the doctors were advising him to give up hope that I would ever fully recover. Indeed, they said rehabilitation of any sort would be futile, despite the fact that every time I experienced a new stimulus my wakefulness improved. I can’t help wondering if medically supervised stimulation might have helped me emerge from the PVS sooner—as happened with Kate Bainbridge after she was “found.” It would’ve certainly shortened my recovery. Instead, I was written off as a basket case after the MRI, which, ironically, may have jumpstarted my awareness like a dead car battery. It’s the earliest event that appeared in the coma-dream, and after the stress of the scan, I displayed new hints of arousal.
Today, I have no signs of cognitive impairment, nor have I since that first conscious moment. How embarrassing for the doctors who wrote me off. Indeed, I don’t believe I was even in a coma when I regained consciousness. The comatose don’t have sleep-wake cycles, which is why their eyes remain closed. So, I was vegetative, but not under the restrictive Merck Manual definition. Ms. Bainbridge wasn’t misdiagnosed; she fit the criteria for PVS. It’s the term that needs revision.
I used to feel sorry for people clinging to the desperate hope that their vegetative loved ones would recover. I still feel sorry for them, but their hope no longer seems so hopeless to me. I worry that life-and-death decisions are being made based on inadequate testing and incomplete knowledge. Ms. Bainbridge and others who were in the same situation have expressed similar concerns. Nurses gently suggested to my mother that my quality of life was poor, which she took as a hint that I should eventually be taken off life support.
Vegetables rarely write articles, however. My recovery is still ongoing—I was so deconditioned after the long period of complete inactivity I could barely lift my head—but my quality of life is excellent. In fact, I feel an increased sense of purpose and self-confidence. Though I don’t believe my recovery was a gift from God, I do view my second chance as a gift.
And speaking of gifts, last Christmas, Keith and I walked into the ICU with a gift basket to thank the medical personnel who saved my life. Some of them didn’t recognize me upright. On the basket, we taped a collage of pictures taken during our strength-building walks. Many of the ICU workers cried; some said my recovery was a miracle. But it was no act of God that saved my life—it was science. Massive doses of antibiotics scrubbed the Legionella from my system like an antivirus program (or should I say antibacterial program?), halting my septic shock. A respirator and dialysis bought my failing organs time, and they gradually came back online. And, after six weeks, my brain finally rebooted. The human body is a marvelously evolved machine, even though, with my bad back, I often wonder if bipedalism was such a good idea.
The doctors and nurses taking care of me were responsible for giving me this second chance, and for that I’m obviously grateful. But maybe we should be giving more respect to the amazing resilience of the human brain and be more humble about the limits of our knowledge about it. And while we’re at it, let’s not underestimate the boundless powers of imagination, where polar bear cubs churn ice cream with Big Wheels and where flying somewhere over the rainbow doesn’t require an out-of-body experience.
Blanke, Olaf, and Shahar Arzy. 2005. The out-of-body experience: Disturbed self-processing at the temporo-parietal junction. Neuroscientist 11(1): 16–24.
Finns, Joseph J., and Nicolas D. Schiff. 2010. In the blink of the mind’s eye. Hastings Center Report 40(3): 21–23.
Maiese, Kenneth. 2014. Vegetative state and minimally conscious state. Merck Manual Professional Version. Online at http://www.merckmanuals.com/professional/neurologic-disorders/coma-and-impaired-consciousness/vegetative-state-and-minimally-conscious-state.
Monti, Martin M., Audrey Vanhaudenhuyse, Martin R. Coleman, et al. 2010. Willful modulation of brain activity in disorders of consciousness. New England Journal of Medicine 362: 579–589.
Naci, Lorina, Rhondri Cusack, Mimma Anello, et al. 2014. A common neural code for similar conscious experiences in different individuals. Proceedings of the National Academy of Sciences of the United States of America 111(39): 14277–14282.
Nelson, Kevin R., Michelle Mattingly, Sherman A. Lee, et al. 2006. Does the arousal system contribute to near death experience? Neurology 66(7): 1003–1009.
Owen, Adrian M., Martin R. Coleman, M. Boly, et al. 2006. Detecting awareness in the vegetative state. Science 313(5792): 1402.