Recovery may be predicted with a perception of the inner pulse

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An excerpt from The Inner Pulse: Unlocking the Secret Code of Sickness and Health.

by Marc Siegel, MD

The Pulse of Recovery

People are like stained-glass windows.  They sparkle and shine when the sun is out, but when the darkness sets in their true beauty is revealed only if there is light from within.
–Elisabeth Kübler-Ross

The inner pulse can keep beating—loudly—long after doctors, researchers, and their monitors predict a patient’s death. Believing in this essential force can keep you and your family from giving up hope too soon.

In 1985, when I was an intern rotating through the intensive care unit, one of my first patients was a man named James Gould, a forty-year-old restaurant manager and maître d’. Gould had suffered a cardiac arrest and just about died outside the hospital. As is typical for such a sudden and unwitnessed disaster, by the time his heart was brought back, his brain had practically suffocated from lack of oxygen. It’s a medical condition known as anoxia. Dr. George Anderson, the neurologist who visited Gould in the ICU, insisted that he would never recover. Yet Anderson couldn’t be certain because Gould still had brain function on his EEG, his eyes were still open, and he still responded slightly to pain. “The lights are on, but no one’s home,” Anderson said, as he wrote his brief, dismissive note in the chart. For some reason, I didn’t believe him. Even this early in my training, I accepted the inevitability of progressive sickness and death. I consigned many cases to failure and lack of recovery even before my supervisors did. But something about Gould was different, something I couldn’t put my finger on. Even though several weeks passed without a discernible change, I sensed a presence that defied the physical reality—Gould’s inner pulse.

As an intern, I tended to disbelieve my own perceptions and my developing intuition, especially when my higher-ups’ opinions differed from mine. But Gould was different. I considered him a viable patient, rather than someone in a deep coma with no prospect of regaining a good quality of life who was simply occupying one of our beds until he died.

This was 1985, five years before the Teri Schiavo case first hit the news, and cases like Gould’s were quickly dismissed by every doctor involved as unsalvageable. I was appalled when my supervising residents began to mock my continued need to present his case in great detail during daily rounds. There was a convention among residents that the less viable the patient was, the less time an intern spent poring over the details. Very little time was spent examining Gould at his bedside; discussions with the family were avoided entirely, unless they concerned a withdrawal of aggressive medical care; there was a quick consignment of Gould to the circling-the-drain group of patients.

Gould’s restaurant was a popular Italian eatery in southern Westchester, and I was able to surmise by speaking with his family that he had been popular there. He was divorced and lived alone, and at first there was no mention of his ex-wife or his only child. His sister, a large woman with long, untrimmed blonde hair, was his most frequent visitor. She often sat beside his bed for hours. She said she was certain that he could still hear and understand her. She clung to the fact that his heart rate and blood pressure always increased slightly when she came to visit. The notion of Gould being consciously aware inside the hard shell of his unnresponsive confinement was infectious—to family members, if not to doctors—and soon more relatives, including his ex-wife and his daughter, visited to see whether his vital signs would increase in their presence, too.

Gould’s ex-wife stood two feet from the bed and didn’t speak to him or touch him. She was very tall and thin, with large, inexpressive green eyes, which I imagined were masking the pain of the divorce. Her teenage daughter, on the other hand, came right up to the bed and took her father’s limp hand and squeezed it. She stared into his blinking, unsensing eyes as if she were looking into a mirror. She seemed like an incarnation of him, at least physically, with the same dark blue eyes, high forehead, and hair that was so blonde, it was almost white. Her passion for her father was clearly powerful, and I began to wonder whether it was possible that she could help will him back to consciousness. I knew this was an irrational thought, yet I was soon able to elicit a greater response from him. I pinched his nipple, as all doctors-in-training are taught to do, a primitive, yet effective gesture for gauging a pain response, and for the first time in many weeks of similar attempts, this time the maneuver elicited a small groan. “You’re hurting him,” his daughter objected and glared at me.

“Sorry, but it’s a miracle that he can feel pain at all,” I replied. “It’s a good sign.” And it was some kind of a miracle. Soon he was twitching his arms and shifting his feet. A day after I reported this on rounds and endured sarcastic looks and derisive comments, the nurses confirmed my observations, and all of the doubting Thomases who had previously written Gould off began to flock to his bedside.  He was still mainly a curiosity to these callous doctors, rather than a viable patient. But then he began to respond to pain and utter low moans.

My supervising resident now charted Gould’s every muscle twinge or bleep on the monitor and reported them to the critical-care specialists, as if he’d always believed in Gould’s recovery. Gould’s neurologist Dr. Anderson, who spoke in obscure Latinate phrases and wore the most expensive-appearing suits and the shiniest shoes that I’d ever seen in an ICU (and somehow never got them stained), was now examining Gould several times a day and proclaiming this the greatest brain recovery he’d ever witnessed in his twenty-five years of practice.

“I always knew he had a chance,” he claimed.

What a hypocrite, I thought.

The narrow-minded views of doctors like Anderson were what kept my profession from acknowledging rare and uncanny recoveries until they were blatantly obvious. Anderson was one of the most rigid of them,  pompously adherent to his so-called scientific principles. Known as the grab-bag diagnostician, he was known for making his diagnosis after only a few minutes and then being unwilling to budge, no matter what further information or insights surfaced.

A few weeks later, Gould was sitting up in bed and straining to speak. His voice was high-pitched and squeaky, hoarse from the many weeks on the respirator, an incongruous sound when contrasted with his thick chest and large, manly jaw. He began to speak in sentences of only a few words, subject and verb, but enough for me to tell that he had maintained his intelligence. Another neurologist, Dr. Allen, who was covering one weekend for Anderson, told me that he’d never seen this significant a recovery from the anoxic encephalopathy (shut off of oxygen to the brain) that had accompanied Gould’s cardiac arrest. Allen, a gentle old neurologist with soft hands and a large, bald head, was one of the few attending doctors who bothered to speak directly to interns. I could tell that he wasn’t a fan of Anderson’s.

“When he can speak, ask Mr. Gould what he remembers,” Allen said. “Might his drive to survive, combined with his family’s support, have helped him recover?” I asked. “Hard to prove,” the wise old doctor said. “But I do believe it.”

I believe it was his inner pulse. As Gould began to sit up in his bed, his recovery stretched on over several more weeks, and I had him to myself again, as the residents and the attendants forgot about the miracle and focused on what was needed to get him transferred out of the ICU. Now he was simply a slow-thinking, slow-to-speak patient who was taking up a bed. Even when I was a more seasoned physician, I could still never understand this common urge among doctors to free the ICU of patients as soon as they stabilized, when there were many more gains still to be made. Why was the staff so eager to free up his bed when it would instantly be refilled by a patient who required far more work and had much less of a chance to recover?

By not learning from this man’s unexpected recovery, a staff wearing blinders would make the same mistakes over and over again and would overlook many unexpected cures. I was searching for something specific that might account for the miracle. As Gould regained his ability to think and reason, I began to ask him what he remembered. He had a memory hole where the last three months should have been. I spoke to him about his near-death experience, but he said he didn’t remember anything beyond flashing lights and blurry images. He did recall several out-of-body moments—feeling as if he were looking down at himself from the heart monitor over his bed. Gould told me that he was the kind of person who never gave up, and his entire family reinforced this view. His sister, daughter, and ex-wife all commented on this vital force; they all said they could still feel his inner pulse even when he was deep in a coma.

His daughter told me that she never doubted that her father would recover. “I could feel it,” she said, “long before I could see it.” I wondered whether having his daughter and his ex-wife around and feeling their energy had actually helped Gould recover and return from the long deep tunnel of his coma, had enabled him to infuse his pulse with healing energy.

It was clear to me that the divorce from his ex-wife had hit him very hard. She was the first person he asked for when he awoke. He was clearly pleased to hear that she had been coming to see him. He told me that he still hoped to convince her to come back to him. When I first mentioned his daughter, I could see his passion for her in his expression, and I had a stronger view of the love/courage/will that had enabled him to defy science. Anderson had been ready to pull the plug when the EEG showed minimal upper-brain function, but Gould had defeated the wisdom of the grab-bag neurologist.

Gould is not alone, although his recovery was certainly quite rare. Other recoveries from comas have been even more dramatic. The year before I was an intern treating Gould, in 1984, nineteen-year-old Terry Wallis survived a motor vehicle accident after the pickup truck he was in plunged twenty-five feet into a ravine. He was left paralyzed and comatose for nineteen years before suddenly returning to consciousness one day and blurting out “Mom” when his mother came to visit. Wallis’s doctors commented that they believed constant talks from his mother elicited his emotions and helped gradually pull him from his coma. In fact, he awoke on Friday the 13th, nineteen years after the accident, which had also occurred on Friday the 13th.

According to neurological studies, the longer a coma lasts, the less chance a patient has of regaining independent function. When a coma lasts more than a week, the likelihood of achieving a good recovery within a year declines to 7 percent. Patients with a choked-off oxygen supply to the brain (hypoxic encephalopathy such as Gould’s) have a 58 percent chance of awakening from a coma and a 12 percent chance of making a good recovery. Yet the vast majority of the patients who recover from this kind of coma do so within the first week, and Gould was in his coma for more than three weeks.

In a famous case in 1989, Trisha Meili, jogging in Central Park in New York City, was brutally attacked. She ended up in a coma in the hospital, where Dr. Mary Ann Cohen used a technique on her known as “the running commentary.” It was similar to the method that as an intern I had used intuitively with Gould. Dr. Cohen talked to Meili on a daily basis, in the hope that this would establish a connection that would help draw the patient out of her comatose shell. Like me, Dr. Cohen had a deep intuition that her patient would be one of the rare ones to survive. Cohen was quoted in Meili’s book The Central Park Jogger, “When I first saw you, in a coma and in need of resuscitation, it didn’t look good, but my intuition sensed you were going to be fine. I wasn’t sure you could get all your mental function back, but I was positive you’d get most of it.”

In January 2009 in the UK, a thirty-four-year-old woman named Emma Ray suffered a heart attack and went into a coma nearly two weeks after giving birth. As reported in the Daily Mail, she remained in the coma until a kiss from her husband, Andrew, appeared to revive her. Her condition was quite similar to Gould’s, in that her brain had been starved of needed oxygen (hypoxic encephalopathy). After Emma’s two weeks of not responding, Andrew’s sudden kiss provoked a return kiss. This was the beginning of a miraculous recovery, which, like Gould’s, appeared to be a result of her will to survive and the love of her family.

Paulette Demato, the program coordinator for the Coma Recovery Association, has complained that all too often, families aren’t given the opportunity to “wait and see what happens,” that the medical community will try to force a family’s hand to get them to withdraw treatment from a comatose patient. This was the pressure I felt with Gould, but luckily, he had already begun to recover by the time Anderson was ready to turn off the machines.

Gould’s out-of-body experience was an indication of the close tie between his flickering physical life and the larger spiritual world it clung to by his inner pulse. There are many well-known cases of this, perhaps none more famous than the experience of Carl Jung, who wrote about his experience in his autobiography, Memories, Dreams, and Reflections:

It seemed to me that I was high up in space. Far below I saw the globe of the earth, bathed in a gloriously blue light. I saw the deep blue sea and the continents. Far below my feet lay Ceylon, and in the distance ahead of me the subcontinent of India. My field of vision did not include the whole earth, but its global shape was plainly distinguishable and its outlines shone with a silvery gleam through that wonderful blue light. In many places the globe seemed colored, or spotted dark green like oxidized silver. Far away to the left lay a broad expanse—the reddish-yellow desert of Arabia; it was as though the silver of the earth had there assumed a reddish-gold hue.

Then came the Red Sea, and far, far back—as if in the upper left of a map—I could just make out a bit of the Mediterranean. My gaze was directed chiefly toward that. Everything else appeared indistinct. I could also see the snow-covered Himalayas, but in that direction it was foggy or cloudy. I did not look to the right at all. I knew that I was on the point of departing from the earth. Later I discovered how high in space one would have to be to have so extensive a view—approximately a thousand miles!

 

Jung’s-out-of-body experience occurred in 1944, but the first satellite photo of the Earth wasn’t taken until 1959. Amazingly, Jung’s “mental map” conformed to later photos.

Most out-of-body experiences occur while a patient is losing consciousness, often due to exhaustion or physical paralysis. I believe that these experiences demonstrate the mind’s connection with the spiritual world, especially when unfettered by the body’s usual daily demands.

These experiences and sensations can be reproduced, to some extent. Susan Blackmore, a psychologist in Bristol, England, who herself had an out-of-body experience in the 1970s, was later able to induce these perceptions in subjects by stimulating the temporal lobes of the brain. In 2002, neurologists at Geneva Hospital in Switzerland triggered out-of-body sensations in epileptics by stimulating the angular gyrus of the right cortex of the brain.

In a study published in the August 2007 issue of the journal Science, scientists tried to induce out-of-body experiences in healthy people. The research, conducted by neuroscientist Dr. Olaf Blanke at the Ecole Polytechnique Federale in Lausanne, was combined with separate experiments carried out by neuroscientist Henrik Ehrson at the Karolinska Institute in Stockholm. Blanke, in his experiments, stroked a fake hand and the subject’s real hand simultaneously, until the subject had the sense that the fake hand being stroked was his or her actual hand. Ehrson also used video equipment to allow subjects to see their own backs. He simultaneously stroked a subject’s real back while appearing to stroke the image that the person saw. The out-of-body type experience that resulted could be explained by the decoupling of sight and touch.

Dr. Jeffrey P. Long, a radiation oncologist and a world expert in near-death experiences (NDEs), considers out-of-body experiences to be proof of our inner connections to the spiritual world. “About half of near-death experiences involve a separation of consciousness,” Long said to me in an interview. He pointed to the seminal research of Dr. Michael B. Sabon, which showed that those who had a near-death experience following a cardiac arrest had a clear recollection of the details of the resuscitation. Additional research by Janice Holden and others have found an accuracy of recollection of more than 90 percent.

From my own experience and the stories I’ve uncovered for this book, I believe he is right. Near-death experiences  can be analyzed by science, but they frequently go beyond it. Long said that people may experience a renewed sense of life from a near-death experience: “Having a NDE is life enhancing. NDErs usually no longer fear death. It gives them courage to live life to the fullest. They become aware that life is purposeful, meaningful; they learn lessons, especially lessons of love. An NDE gives them the will to live and to live with love.”

This renewal of the life force seemed to be the case for my patient Gould. Although I hadn’t known him before his cardiac arrest, everyone in his family said that he seemed happier and more content after his recovery.  After a long stint in the ICU, he was finally transferred out and two weeks later was discharged to go back home. He returned to work at the same restaurant. The only residual sign that he had of a mild deterioration of mental acuity was that he now worked as a waiter, rather than as maître d’ and restaurant manager. Outside the restaurant, he performed better than ever; he saw his daughter far more often, and he once again began to date his ex-wife.

Neither Gould’s neurologist Anderson nor his critical-care specialist could explain why he had been spared the usual tragic outcome of an anoxic victim. Why had his brain recovered, when so many other people’s brains had not? Had his daughter helped reinfuse him with a life force? A probabilities expert might suggest that Gould was simply the rare case that survived. The vast majority don’t recover from this degree of brain injury, but a few, mainly those who have a strong inner pulse, do.

My medical training focused on the pathology of how Gould’s brain had strangled without its needed blood and oxygen supply, but this science did not prepare me to consider the power of his emotions and his drive to survive. Yet these intangible forces were crucial to his recovery.

In medical school, I learned about empirical “facts,” the logic of cause and effect, and the world of evidence-based medicine. Penicillin cures a sore throat, blood pressure responds to antihypertensives, surgery removes an infected or a cancerous organ, and people get better. It takes a special kind of learning to consider the effect of the spirit on healing.

Can strong passions directly alter the metabolic potential of the body? The brain, after all, is a soup of chemicals, and in response to the mind’s entreaties, the body either speeds up or slows down, sweats, urinates, or dries up like a prune. There is a growing body of medical literature that examines this connection, studies that show the exact effect of personality on hormones, emotion on body chemistry, thinking on the actual nerves themselves. Yet no matter how science maps the exact pathways, I am certain that the effect of the mind on health goes beyond the physical and verges on the metaphysical. I believe strongly that a powerful intuition-based response may be working to protect a patient long before a test or a finding brings an illness to a doctor’s attention. Doctors may also be guided by intuition, but this intuition evolves during a career, as cardiologist Dr. Sandeep Jahuar wrote in the New York Times: “When we talk about instinct in medicine, we usually talk about expert clinicians grasping diagnoses in ways that seem to defy analytical explanation. These doctors appear to know almost intuitively which data to focus on and which to ignore. Of course, their decision-making is based on experience and deductive reasoning (and perhaps on evidence, too), yet it seems almost mystical.”

This doctorly intuition may grow from a direct connection with patients’ intuition. Unfortunately, this kind of connection seems to be rarer than ever before. Overdependence on tests and their misleading sense of precision has lulled many a doctor such as Anderson into a false sense of security that blunts instinct. One antidote for this kind of reductionist thinking is to be found in the patient’s story itself. Narratives introduce quirky, yet illustrative examples that cut against the grain of accepted medical mantras. For Gould, it was the day-to-day narrative that added up to recovery. The monitor continued to beep on, and each day revealed a patient who was slightly more responsive than the day before. The days accumulated until a miracle was acknowledged by all. Anne Harrington believes that the power of suggestion has a great capacity to heal and maintains “a powerful hold on the contemporary imagination.” Today’s doctors tend to place too much stock on direct physical evidence. We doctors, as well as our patients, need a more expansive way of thinking that includes an emotional and intuitive narrative that our patients can relate to.

Too many patients are frustrated by a medical system in which test results are the primary focus, answers are often impersonal, and emotions are disregarded. Patients are in revolt these days against such attempts to write them off too soon, to peg them into pre-decided diseases and prognoses based on the symptoms of disease alone.

Their rebellion is justified. The solution is to broaden our perspective, to consider the emotional, as well as the physical, and to examine the spiritual tie that binds them together. Many sick patients know when they are going to die or perhaps survive against the odds before any test or doctor-messenger tells them. We can all learn from this knowledge.

Recovery may be predicted when a patient or a healer has a galvanizing moment that is infused with a deep perception of the inner pulse.

Marc Siegel is an Associate Professor of Medicine at New York University School of Medicine and author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.

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