Waking up is hard to do

It is sometimes suggested that near-death experiences in the operating room are the result of incomplete anesthesia, which can allow for some degree of patient awareness. This phenomenon gained some national recognition lately when the movie Awake came out. Though the movie bombed, it probably did give some people the idea that waking up during surgery is fairly common, and one natural conclusion would be that operating-room NDEs can be explained in this way.

A closer look at "patient awareness under general anesthesia," the technical term for this condition, makes any connection to NDEs doubtful. Here is what one document, prepared by an organization devoted to patient safety, has to say on the topic.

Under general anesthesia, a patient is given medications that are expected to relieve the pain of surgery and prevent consciousness. If either of these fails, the patient may awaken and be aware of the procedure.

Although the incidence of anesthesia awareness is relatively low, at about 0.1% to 0.2%, that percentage translates to 20,000 to 40,000 incidences a year in the United States.

The first thing to note is that this condition is estimated to occur, at most, only 0.2% of the time. NDE researchers who have interviewed postoperative patients have found a much higher percentage of cases. For instance, Dr. Pim Van Lommel conducted a study of cardiac surgery patients. Here is what he found:

We performed our prospective study in 344 survivors of cardiac arrest to study the frequency, the cause and the content of near-death experience (NDE). A near-death experience is the reported memory of all impressions during a special state of consciousness, including specific elements such as out-of-body experience, pleasant feelings, and seeing a tunnel, a light, deceased relatives, or a life review. In our study 282 patients (82%) did not have any memory of the period of unconsciousness, 62 patients (18%) however reported a NDE with all the “classical” elements. [The quoted article, "Medical Evidence for NDEs - A Reply to Shermer," is found here, 2/3 of the way down the page.]

Van Lommel, then, found that 18% of the patients he surveyed had experienced an NDE - not 0.2%, as we would expect if incomplete anesthesia were the explanation. The rate of NDEs in this study is nearly 100 times (10,000%) greater than the estimated rate of anesthesia-related awakenings.

The near-death experience is also markedly different from the experience reported by patients who wake up during surgery. The medical document cited above tells us:

For the patient, awareness is frightening and can lead to debilitating emotional injury. For anesthesiologists, it ranks second only to death as a dreaded complication. ...

Auditory perceptions and being unable to move or breathe are the most commonly described sensations. Patients also report feeling (1) anxiety or stress, pain, (2) the endotracheal tube, and (3) surgery without pain. Implicit recall emerges indirectly through painful, often inexplicable, psychological difficulties that appear following surgery, including sleep disturbances, dreams and nightmares, flashbacks, and anxiety. Explicit recall is responsible for the most traumatic and horrific incidents of anesthetic awareness and may, in rare cases, lead to post-traumatic stress disorder.

These symptoms bear almost no resemblance to those of near-death experiences. NDErs do not report "being unable to move or breathe." On the contrary, they report floating outside their body and feeling a wonderful sensation of freedom. It seems clear that patients who wake up during surgery still feel very much "in" their bodies; they can feel the endotracheal tube, the pain of surgery, and the paralysis of their limbs. Conversely, NDErs report being out of their bodies; they do not report feeling the endotracheal tube, nor do they report pain (except after they have reentered the body at the conclusion of the experience).

In fact, NDEs are noteworthy precisely because the experiencers feel no pain, and normally no anxiety or stress whatsoever. Typically, the NDEr finds himself looking down on the surgical procedure and wondering why the medical team are making such strenuous efforts to revive his body. The emotion most often reported is one of relief at being free of the burdens of the body, and extreme reluctance to reoccupy it.

Of course, NDEs also involve the tunnel phenomenon, the life review, reunions with dead loved ones, a sense of mystical oneness with the universe, etc., none of which appear to be part of the incomplete anesthesia experience. 

The long-term effects are also different. NDErs usually lose their fear of death and find themselves more loving, nonjudgmental, and serene. They are not typically burdened by "sleep disturbances, dreams and nightmares, flashbacks and anxiety" or "post-traumatic stress disorder." They do not regard their experience as "traumatic and horrific." The exceptions are the apparently rare cases when NDErs find themselves in a hellish environment, but this environment is not the operating room; it is perceived as some other dimension.

The actual characteristics of NDEs, then, are quite different from those ascribed to patient awakenings. And given that awakenings seem to occur in only 0.2% of surgeries, while NDEs apparently occur far more often, there is no reason whatsoever to think that patient awareness under general anesthesia can explain the NDE phenomenon.

Two other points: First, NDEs are hardly limited to the operating room. People have had these experiences in circumstances where anesthesia was never applied and couldn't have been a factor. Second, even in operating-room NDEs, the experience often starts just when the patient's heart has stopped. How could the patient "wake up" at the very moment when he is clinically dead?

Comments

[Mickey D]

I note VZ has just updated his Michael Pisspot article :-). If he actually read all your blog (not just the articles that mention his name)he might just understand that you agree on most things, apart from DT.

[Cyrus]

I scolded VZ about his character attacks recently. I was really sad to see none of that stuck even after he wrote me a semi-thoughtful reply. Ugh... That guy.

Anyway, being awake under anaesthesia is obviously different. It could, in some conditions, explain somebody who became awake in the theater and observed the doctors. But, when dead relatives start coming into the room, or they find themselves walking around in a big, green forest and being told the secrets of reality, I'm inclined to believe it's something a little different.

[Michael H]

Anyone claiming that an NDE is related to awareness during anesthesia is engaging in one of the weakest arguments available, and hasn't spent a moment's time investigating either phenomenon.

Those who put forth this argument would be better off pointing to electrically induced OBE's or Persinger's God Helmet, though both of those arguments are flawed as well. See this link for the IANDS response to the induced OBE:

http://www.iands.org/research/important_studies/
out-of-body_experiences_all_in_the_brain.html

The Dawkins', Pinker's, Dennett's and Blackmore's of the world will consider anything at all, except the possibility that consciousness is not dependent on brain activity.

Even proposing the hypothesis threatens their carefully constructed and heavily invested worldview, and is likely to cause them to lash out in an outburst worthy of Victor.

[Kevin]

Here's hoping that those people mentioned in Michael H's response can restrain themselves from using "Victor-isms" as a rhetorical devise. More likely they would "cherry-pick" their data references and attempt to deflect attention from their "straw man" dismissal ("Pay no attention to that man behind the curtain!!"). In other words, the same old "Same Old".

[Kevin]

"Oz"-bodkins!!

[Art]

The only thing I love reading about more than near death experiences is reading about death bed visions.

Current NDERF NDE's:
http://nderf.org/NDERF_NDEs.htm

Death Bed Visions by Sir William Barrett
http://www.survivalafterdeath.org/books/barrett/dbv/contents.htm