What Happens When We Die?

By Sam Parnia, M.D.

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Scientific mysteries sometimes take centuries to solve, and it can be like putting together a very complicated jigsaw puzzle. Initially it seems to be a haphazard mess, but you look for clues, lay a few pieces, and then, as a picture starts to form, you lay more pieces until the complete picture appears. In science, the final picture can be revealed through the contribution of many individuals who have each laid down a small piece of the puzzle.

     In this age, perhaps the most fascinating unsolved scientific mystery is the puzzle of life itself, of how it begins and how it ends. Although some of the mysteries surrounding the beginning of life have been explored, what happens at the end still remains an enigma. Yet this is one of the few subjects being explored by science today that is relevant to us all.

     As I sit here comfortably writing this book, I’m aware that with every passing second somebody somewhere in the world is faced with the question of what happens at the end of life, perhaps through simple curiosity, the loss of a loved one, news of a terminal illness, or maybe even a close personal brush with death.

     Very recently my wife, Lisa, and I were going on vacation and were driving to our hotel. We’d just turned off the main road and were chatting and enjoying the warm summer afternoon. Traffic was moving steadily when suddenly the car in front of us stopped sharply. I was sure that Lisa had noticed this, but she seemed slow to react, so I nudged her to stop. She tried to, but the brakes failed. As we sped toward the stationary vehicle, I just pushed myself back into the seat, put my arm across Lisa, and waited for our fate. I had no control over what was about to happen and knew that in a split second we could be seriously hurt, or even dead.

     We smashed into the car in front at full speed—and then there was silence. I opened my eyes and looked across at Lisa. She appeared well. I moved my arms and legs. They were all fine. I called to Lisa, “Are you all right?” “Yes,” she replied. She was visibly shaken but otherwise okay. So were the passengers in the other vehicle. In fact, the only damage was to the cars.

     Later that evening, once we were over the shock, I sat and thought about what had happened. What if the brakes had failed half an hour earlier when we had been on the main road, driving at an even greater speed? Surely we would not have been so lucky. It had all taken place so quickly, in just a few seconds. The border between life and death had been just an instant. Thankfully we’d been on the right side on this occasion, but I was all too aware that death can come to any of us at any time, without warning.

My own interest in understanding what happens at the end of life began a long time before our accident. In fact, it started almost ten years earlier when I was studying medicine in London. Training as a doctor provided me with a unique opportunity to not only learn the science of medicine, but also to share many of the most intimate moments in people’s lives. The insights I gained taught me so much about life itself.

     I clearly remember the first time I witnessed life at the beginning. I was in the delivery suite of St. Thomas’s Hospital in London, assisting the birth of a young woman’s baby. After hours of pain, tension, and sweat, suddenly a tiny head emerged, and a small baby slid out of his mother’s womb. For a split second, the minuscule body was blue and lifeless, and then suddenly it took its first breath, turned pink, and started screaming, as if to say, “Well, here I am!” There it was, the beginning of life, and the beginning of consciousness, too—that unique sense of self-awareness and thought that accompanies us all throughout our lives. As I watched, I wondered how this had come about. How had a single cell in its mother’s womb transformed into a conscious being with its own thoughts and emotions?

     No one really knows exactly when consciousness begins, or what it is that makes each of us so unique. During my years as a medical student, I became fascinated by these questions. I knew that the simple answer was essentially our thoughts. But I wanted to know the answer to a far more difficult question—namely, how do our thoughts actually come to exist in the first place? And I soon found that the answer was not so readily available. In fact, I realized that the nature of the mind was a truly undiscovered area of science, one that many consider to be the final, completely untraveled frontier of the biological sciences.

     During the clinical years of medical training, like most medical students I began to deal with dying patients and soon discovered that the issue of life and death confronts most doctors on an almost daily basis. Yet what happens to the mind during the dying process still remains largely a philosophical concern rather than a medical one. I came to realize that we know very little about death, and what we do know tends to be based more on personal opinion than verifiable reality.

     Perhaps the most profound event that went on to shape my thoughts and to lead me to study the nature of consciousness at the end of life was witnessing the passing away of a man named Desmond Smith in New York. Desmond was a tall, thin man of West Indian origin with a distinct Harlem accent. He was a bright, bubbly, and charming individual who lived on the outskirts of New York with his family, who had recently organized a surprise party for his 62nd birthday. One early morning, Desmond began his day with what had become an inevitable bout of coughing. Carrying his breakfast tray to the bedroom, he recalled his doctor’s original comment: “It’s a smoker’s cough.” But that day, for the first time, Desmond coughed up blood.

     I was 22 and in New York as part of my final year of medical studies on a clinical attachment at Mount Sinai Hospital. It was an exciting time for me. I was at one of the finest medical institutions in the world, going through my medical adolescence into adulthood. I was attached to the pulmonary team when Desmond was rushed into the hospital. My pager went off and I hurried to the emergency room, picked up the notes from the nurse, and read: “Desmond Smith, hemoptysis”—a medical term for coughing up blood.

     Desmond was optimistic. “That’s what I coughed up. Never mind. I’ll live, doc!”

     I began to examine him. There were signs of fluid surrounding the lung, and I ran through a mental list of possible diseases. The most common cause of coughing up blood is a simple upper-respiratory tract infection—a flu-like illness. But this didn’t seem right in Desmond’s case. I knew he was a lifelong smoker. Perhaps lung cancer, I thought. His vital signs were strong, so I decided to order further tests. But whatever Desmond had, it didn’t seem to be a life-threatening emergency.

     I left the emergency room. No more than 30 minutes later, my pager went off again.

     “Cardiac arrest: Emergency area. Cardiac arrest: Emergency area.”

     This was real medicine, real life-and-death stuff. Adrenaline rushed through me. As I ran down to the emergency area, I was thinking, What kind of emergency could this be?

     A bay had been curtained off, and nurses were rushing about. I pulled the curtains aside to see a team of doctors frantically working. One was kneeling by the man’s head, hurriedly trying to secure his airway, and there was blood everywhere. Time sped up for me as I realized that I knew this man—he was my patient.

     “Pulse check, rhythm check ... VF ... shock ... stand clear. Oxygen away!” I barked, joining the other doctors. “Get intravenous access, 1 mg epinephrine stat. Continue with CPR. Start a bag of gelofusin. Blood’s pouring out of his mouth, he’s bleeding extensively .... Suction, quick! Get the double lumen endobronchial tube and the emergency bronchoscope. We’ve got to find the bleeding vessel ... 1 mg epinephrine stat. Cross match. Universal blood stat. Squeeze the bag of fluids ... asystole ... flatline ... 1 mg epinephrine, 3 mg atropine stat. Continue resuscitation. I can’t see anything—it’s just a red sea of blood down here .... It’s impossible to resuscitate him; he’s clotted up his airways.”                          

     Desmond was dead: One minute here—the next, nothing. What had happened to the person I was talking to an hour ago? All that was left of him was a lifeless body. The interval between life and death had been so quick that questions buzzed around my head. What had Desmond experienced when he’d died? Had he been able to see us trying to resuscitate him? What had happened to him now? Could he have retained some form of consciousness, or was that the end?

     I didn’t know the answers ....

     I stayed in New York for a few more months, but the death of Desmond had a deep impact on my life. So deep in fact that in the coming months I decided to pursue the answers to my questions through the tool I had begun to learn and could rely on the most: science.

     Since then, I’ve spent much of my time trying to understand what happens when we die. Although I realize that traditionally this has been considered to lie in the realms of religion and philosophy, I believe that everything, including the question of what happens to us at the end of life, can be studied through the objectivity of science. Indeed, in only the last few years, mainstream science has shown an interest in investigating these very issues. This is a very new area of science and may at first appear somewhat unconventional, yet I genuinely think that there’s no other area of research as potentially rewarding for all of humankind.

     After I started my research, I found to my surprise that many more people than I had ever imagined were interested in the subject. These included people of all medical backgrounds—medical colleagues, nurses, pharmacists, physiotherapists, dietitians, and many more—and from all walks of life. In fact, it seemed to be a subject that drew almost universal interest. Perhaps this is because one day it will touch us all at a very personal level.

     What has been discovered so far is perhaps just the tip of an iceberg, but it has huge implications for humanity. It may even hold the key to the nature of human consciousness itself. Although the story is still not complete, this is a very exciting era. We are now at the point where we have both the tools and the means to scientifically answer the age-old question: What happens when we die?

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Excerpted from the Introduction to What Happens When We Die? A Groundbreaking Study Into the Nature of Life and Death by Sam Parnia, M.D. Published by Hay House, it is available at retail and online bookstores.

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