Two visitors from the nether world?

I discounted near-death experiences until 20 years ago when I cared for a 7-year-old boy with asthma. He was receiving maximal doses of steroids and salbutamol and we were poised to intubate, but his oxygen and carbon dioxide levels were reasonable and he was not acidotic. His blood pressure and electrolyte and blood sugar levels were normal and he was otherwise healthy, and not taking any other medications.

His condition teetered, then improved over a couple of hours during which a female nurse and I were the only people around. Two days later he was better and, when talking to him, I suggested he must have been very frightened when he had been so sick. However, he denied it, and with great conviction. I looked him in the eye and asked “really?” He returned the look and repeated his answer. Curious, I asked “why not?” He replied, “because there was a man there”.

I can still recall the flush of warmth I had begun to feel when I declared, “Of course there was a man there. It was me”, and then the let-down when he coolly replied, “No, it wasn’t”.

Skin beginning to creep, I asked “who was it?” He did not know. “What was he was like? Was he frightening?” “No”, he replied, “he was a friendly man”. “What did he look like?” There had been some “shininess” about him. “What did he want?” “He wanted me to go with him.” “Where to?” He didn’t know. “Were you frightened to go?” “No.” “Why didn’t you go?” “I did not want to leave Mummy and Daddy.”

Next day, I saw the boy before he went home with his parents, who had heard the story. Being of the Greek Orthodox faith, they were delighted that their son had been conversing with St George and considered it a miracle. But was it? Since the publication of a book on near-death experience by psychiatrist Raymond Moody in 1975,1 there have been sparse, rationalist explanations in mainstream medical literature about these experiences.2 These explanations have been opposed by profuse affirmation of the transcendental in alternative media, but both sides seem to agree the phenomenon exists.

This was my first case, and I acknowledge it may not fill the diagnostic near-death experience scale of Greyson, which includes cognitive changes of accelerated thought processes and reviews of the past, affective experiences of joy, “autoscopy” or viewing oneself from without, and the transcendental experience of recognising a spiritual being.3

Greyson’s scale, however, was constructed on the memories of adults, and cases of near-death experiences among children in medical literature are rare. However, one review of 11 paediatric patients reported “an absence of life review, time alteration, worldly detachment or transcendent feelings”.4 The handbook of near-death experiences claims that “several hundred” have been reported in children but laments imprecision.5

What might cause such a defined phenomenon? Some rationalists point to stimulation of the temporal lobe, others to the hallucinatory effects of various chemicals, including endorphins. Others blame hypoxia, and some, getting closer to home for my young patient, blame hypercapnia, but without giving the level of carbon dioxide necessary to produce the near-death experience. There is a hypothesis that noradrenaline may ultimately evoke positive hallucinatory experiences, and my patient was heavily dosed with sympathomimetic drugs.

I favoured the idea of some kind of endorphin effect in my young patient until I had my own kind of experience while recovering from intestinal thromboses from which I had been given a 50% chance of survival. I had turned the corner and was happy to be alive. I was clear-headed, not stressed, no longer under the influence of morphine and was beginning to walk.

I had not been thinking of my mother during that period. She had died 3 years before after a most unhappy life: bitter over abandonment as a baby, my father’s death in World War II, a failed second and tumultuous third marriage, and increasing physical debility.

During the closest thing to a near-death experience I have personally experienced, I entered a room where my mother was seated on the end of a sofa in front of a window through which streamed the only light. She was beautiful, youthful, radiant and happy. She was singing, and I remembered how she sang when I was very small. Despite a combative attitude to Christianity, she was singing a hymn! I was astonished, and sat down on the other end of the sofa in time to hear her stumble on the second verse. “I know that hymn”, I said, and reached for a hymnal among a pile of books on the table. But she reached across me and poked me, hard, in the right shoulder. She declared with a smile, “but I am not here”.

I was not unaccustomed to my mother not making sense, and reached again for the hymnal. She poked me again: “But I am not here”, she said again, this time with an edge of amusement in her voice. I stared, trying to understand, and as I stared, she faded from view. I woke searching for the poker. The room was empty.

I don’t understand the physiology of my two experiences, but I do recognise their effect. They both point to another dimension.