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CONTENTS – Proof of Heaven

Prologue

• The Pain
• The Hospital
• Out of Nowhere
• Eben IV
• Underworld
• An Anchor to Life
• The Spinning Melody and the Gateway
• Israel
• The Core
• What Counts
• An End to the Downward Spiral
• The Core
• Wednesday
• A Special Kind of NDE
• The Gift of Forgetting
• The Well
• To Forget, and to Remember
• Nowhere to Hide
• The Closing
• The Rainbow
• Six Faces
• Final Night, First Morning
• The Return
• Not There Yet
• Spreading the News
• 27. Homecoming

• The Ultra-Real
• A Common Experience
• Back from the Dead
• Three Camps
• A Visit to Church
• The Enigma of Consciousness
• A Final Dilemma
• The Photograph
• Eternea Acknowledgments
• Appendix A: Statement by Scott Wade, M.D.
• Appendix B: Neuroscientific Hypotheses I Considered to Explain My Experience
• Reading List Index

PROLOGUE

A man should look for what is, and not for what he thinks should be.

—ALBERT EINSTEIN (1879-1955)

When I was a kid, I would often dream of flying.

Most of the time I’d be standing out in my yard at night, looking up at the stars, when out of the blue I’d start floating upward. The first few inches happened automatically. But soon I’d notice that the higher I got, the more my progress depended on me—on what I did. If I got too excited, too swept away by the experience, I would plummet back to the ground . . . hard. But if I played it cool, took it all in stride, then off I would go, faster and faster, up into the starry sky.

Maybe those dreams were part of the reason why, as I got older, I fell in love with airplanes and rockets—with anything that might get me back up there in the world above this one. When our family flew, my face was pressed flat to the plane’s window from takeoff to landing. In the summer of 1968, when I was fourteen, I spent all the money I’d earned mowing lawns on a set of sailplane lessons with a guy named Gus Street at Strawberry Hill, a little grass strip “airport” just west of Winston-Salem, North Carolina, the town where I grew up.

I still remember the feeling of my heart pounding as I pulled the big cherry-red knob that unhooked the rope connecting me to the towplane and banked my sailplane toward the field. It was the first time I had ever felt truly alone and free. Most of my friends got that feeling in cars, but for my money being a thousand feet up in a sailplane beat that thrill a hundred times over.

In college in the 1970s I joined the University of North Carolina sport parachuting (or skydiving) team. It felt like a secret brotherhood—a group of people who knew about something special and magical. My first jump was terrifying, and the second even more so. But by my twelfth jump, when I stepped out the door and had to fall for more than a thousand feet before opening my parachute (my first “ten second delay”), I knew I was home.

I made 365 parachute jumps in college and logged more than three and a half hours in free fall, mainly in formations with up to twenty-five fellow jumpers. Although I stopped jumping in 1976, I continued to enjoy vivid dreams about skydiving, which were always pleasant.

The best jumps were often late in the afternoon, when the sun was starting to sink beneath the horizon. It’s hard to describe the feeling I would get on those jumps: a feeling of getting close to something that I could never quite name but that I knew I had to have more of. It wasn’t solitude exactly, because the way we dived actually wasn’t all that solitary.

We’d jump five, six, sometimes ten or twelve people at a time, building free-fall formations. The bigger and the more challenging, the better.

One beautiful autumn Saturday in 1975, the rest of the UNC jumpers and I teamed up with some of our friends at a paracenter in eastern North Carolina for some formations. On our penultimate jump of the day, out of a D18 Beechcraft at 10,500 feet, we made a ten-man snowflake.

We managed to get ourselves into complete formation before we passed 7,000 feet, and thus were able to enjoy a full eighteen seconds of flying the formation down a clear chasm between two towering cumulus clouds before breaking apart at 3,500 feet and tracking away from each other to open our chutes.

By the time we hit the ground, the sun was down. But by hustling into another plane and taking off again quickly, we managed to get back up into the last of the sun’s rays and do a second sunset jump. For this one, two junior members were getting their first shot at flying into formation—that is, joining it from the outside rather than being the base or pin man (which is easier because your job is essentially to fall straight down while everyone else maneuvers toward you).

It was exciting for the two junior members, but also for those of us who were more seasoned, because we were building the team, adding to the experience of jumpers who’d later be capable of joining us for even bigger formations.

I was to be the last man out in a six-man star attempt above the runways of the small airport just outside Roanoke Rapids, North Carolina. The guy directly in front of me was named Chuck. Chuck was fairly experienced at “relative work,” or RW—that is, building free-fall formations. We were still in sunshine at 7,500 feet, but a mile and a half below us the streetlights were blinking on. Twilight jumps were always sublime and this was clearly going to be a beautiful one.

Even though I’d be exiting the plane a mere second or so behind Chuck, I’d have to move fast to catch up with everyone. I’d rocket straight down headfirst for the first seven seconds or so. This would make me drop almost 100 miles per hour faster than my friends so that I could be right there with them after they had built the initial formation.

Normal procedure for RW jumps was for all jumpers to break apart at 3,500 feet and track away from the formation for maximum separation. Each would then “wave off” with his arms (signaling imminent deployment of his parachute), turn to look above to make sure no others were above him, then pull the rip cord.

“Three, two, one . . . go!”

The first four jumpers exited, then Chuck and I followed close behind. Upside down in a full-head dive and approaching terminal velocity, I smiled as I saw the sun setting for the second time that day. After streaking down to the others, my plan was to slam on the air brakes by throwing out my arms (we had fabric wings from wrists to hips that gave tremendous resistance when fully inflated at high speed) and aiming my jumpsuit’s bell- bottomed sleeves and pant legs straight into the oncoming air.

But I never had the chance.

Plummeting toward the formation, I saw that one of the new guys had come in too fast. Maybe falling rapidly between nearby clouds had him a little spooked—it reminded him that he was moving about two hundred feet per second toward that giant planet below, partially shrouded in the gathering darkness. Rather than slowly joining the edge of the formation, he’d barreled in and knocked everybody loose. Now all five other jumpers were tumbling out of control.

They were also much too close together. A skydiver leaves a super- turbulent stream of low-pressure air behind him. If a jumper gets into that trail, he instantly speeds up and can crash into the person below him. That, in turn, can make both jumpers accelerate and slam into anyone who might be below them. In short, it’s a recipe for disaster.

I angled my body and tracked away from the group to avoid the tumbling mess. I maneuvered until I was falling right over “the spot,” a magical point on the ground above which we were to open our parachutes for the leisurely two-minute descent.

I looked over and was relieved to see that the disoriented jumpers were now also tracking away from each other, dispersing the deadly clump.

Chuck was there among them. To my surprise, he was coming straight in my direction. He stopped directly beneath me. With all of the group’s tumbling, we were passing through 2,000 feet elevation more quickly than Chuck had anticipated. Maybe he thought he was lucky and didn’t have to follow the rules—exactly.

He must not see me. The thought barely had time to go through my head before Chuck’s colorful pilot chute blossomed out of his backpack. His pilot chute caught the 120-mph breeze coming around him and shot straight toward me, pulling his main parachute in its sleeve right behind it.

From the instant I saw Chuck’s pilot chute emerge, I had a fraction of a second to react. For it would take less than a second to tumble through his deploying main parachute, and—quite likely—right into Chuck himself. At that speed, if I hit his arm or his leg I would take it right off, dealing myself a fatal blow in the process. If I hit him directly, both our bodies would essentially explode.

People say things move more slowly in situations like this, and they’re right. My mind watched the action in the microseconds that followed as if it were watching a movie in slow motion.

The instant I saw the pilot chute, my arms flew to my sides and I straightened my body into a head dive, bending ever so slightly at the hips. The verticality gave me increased speed, and the bend allowed my body to add first a little, then a blast of horizontal motion as my body became an efficient wing, sending me zipping past Chuck just in front of his colorful blossoming Para-Commander parachute.

I passed him going at over 150 miles per hour, or 220 feet per second. Given that speed, I doubt he saw the expression on my face. But if he had, he would have seen a look of sheer astonishment. Somehow I had reacted in microseconds to a situation that, had I actually had time to think about it, would have been much too complex for me to deal with.

And yet . . . I had dealt with it, and we both landed safely. It was as if, presented with a situation that required more than its usual ability to respond, my brain had become, for a moment, superpowered.

How had I done it? Over the course of my twenty-plus-year career in academic neurosurgery—of studying the brain, observing how it works, and operating on it—I have had plenty of opportunities to ponder this very question. I finally chalked it up to the fact that the brain is truly an extraordinary device: more extraordinary than we can even guess.

I realize now that the real answer to that question is much more profound. But I had to go through a complete metamorphosis of my life and worldview to glimpse that answer. This book is about the events that changed my mind on the matter. They convinced me that, as marvelous a mechanism as the brain is, it was not my brain that saved my life that day at all. What sprang into action the second Chuck’s chute started to open was another, much deeper part of me. A part that could move so fast because it was not stuck in time at all, the way the brain and body are.

This was the same part of me, in fact, that had made me so homesick for the skies as a kid. It’s not only the smartest part of us, but the deepest part as well, yet for most of my adult life I was unable to believe in it.

But I do believe now, and the pages that follow will tell you why.

I’m a neurosurgeon.

I graduated from the University of North Carolina at Chapel Hill in 1976 with a major in chemistry and earned my M.D. at Duke University Medical School in 1980. During my eleven years of medical school and residency training at Duke as well as Massachusetts General Hospital and Harvard, I focused on neuroendocrinology, the study of the interactions between the nervous system and the endocrine system—the series of glands that release the hormones that direct most of your body’s activities. I also spent two of those eleven years investigating how blood vessels in one area of the brain react pathologically when there is bleeding into it from an aneurysm—a syndrome known as cerebral vasospasm.

After completing a fellowship in cerebrovascular neurosurgery in Newcastle-Upon-Tyne in the United Kingdom, I spent fifteen years on the faculty of Harvard Medical School as an associate professor of surgery, with a specialization in neurosurgery. During those years I operated on countless patients, many of them with severe, life-threatening brain conditions.

Most of my research work involved the development of advanced technical procedures like stereotactic radiosurgery, a technique that allows surgeons to precisely guide beams of radiation to specific targets deep in the brain without affecting adjacent areas. I also helped develop magnetic resonance image-guided neurosurgical procedures instrumental in repairing hard-to-treat brain conditions like tumors and vascular disorders. During those  years  I  also  authored  or  coauthored  more  than  150  chapters  and papers for peer-reviewed medical journals and presented my findings at more than two hundred medical conferences around the world.

In short, I devoted myself to science. Using the tools of modern medicine to help and to heal people, and to learn more about the workings of the human body and brain, was my life’s calling. I felt immeasurably lucky to have found it. More important, I had a beautiful wife and two lovely children, and while I was in many ways married to my work, I did not neglect my family, which I considered the other great blessing in my life. On many counts I was a very lucky man, and I knew it.

On November 10, 2008, however, at age fifty-four, my luck seemed to run out. I was struck by a rare illness and thrown into a coma for seven days. During that time, my entire neocortex—the outer surface of the brain, the part that makes us human—was shut down. Inoperative. In essence, absent.

When your brain is absent, you are absent, too. As a neurosurgeon, I’d heard many stories over the years of people who had strange experiences, usually after suffering cardiac arrest: stories of traveling to mysterious, wonderful landscapes; of talking to dead relatives—even of meeting God Himself.

Wonderful stuff, no question. But all of it, in my opinion, was pure fantasy. What caused the otherworldly types of experiences that such people so often report? I didn’t claim to know, but I did know that they were brain- based. All of consciousness is. If you don’t have a working brain, you can’t be conscious.

This is because the brain is the machine that produces consciousness in the first place. When the machine breaks down, consciousness stops. As vastly complicated and mysterious as the actual mechanics of brain processes are, in essence the matter is as simple as that. Pull the plug and the TV goes dead. The show is over, no matter how much you might have been enjoying it.

Or so I would have told you before my own brain crashed.

During my coma my brain wasn’t working improperly—it wasn’t working at all. I now believe that this might have been what was responsible for the depth and intensity of the near-death experience (NDE) that I myself underwent during it. Many of the NDEs reported happen when a person’s heart has shut down for a while. In those cases, the neocortex is temporarily inactivated, but generally not too damaged, provided that the flow of oxygenated blood is restored through cardiopulmonary resuscitation or reactivation of cardiac function within four minutes or so. But in my case, the neocortex was out of the picture. I was encountering the reality of a world of consciousness that existed completely free of the limitations of my physical brain.

Mine was in some ways a perfect storm of near-death experiences. As a practicing neurosurgeon with decades of research and hands-on work in the operating room behind me, I was in a better-than-average position to judge not only the reality but also the implications of what happened to me.

Those implications are tremendous beyond description. My experience showed me that the death of the body and the brain are not the end of consciousness, that human experience continues beyond the grave. More important, it continues under the gaze of a God who loves and cares about each one of us and about where the universe itself and all the beings within it are ultimately going.

The place I went was real. Real in a way that makes the life we’re living here and now completely dreamlike by comparison. This doesn’t mean I don’t value the life I’m living now, however. In fact, I value it more than I ever did before. I do so because I now see it in its true context.

This life isn’t meaningless. But we can’t see that fact from here—at least most of the time. What happened to me while I was in that coma is hands- down the most important story I will ever tell. But it’s a tricky story to tell because it is so foreign to ordinary understanding. I can’t simply shout it from the rooftops. At the same time, my conclusions are based on a medical analysis of my experience, and on my familiarity with the most advanced concepts in brain science and consciousness studies. Once I realized the truth behind my journey, I knew I had to tell it. Doing so properly has become the chief task of my life.

That’s not to say I’ve abandoned my medical work and my life as a neurosurgeon. But now that I have been privileged to understand that our life does not end with the death of the body or the brain, I see it as my duty, my calling, to tell people about what I saw beyond the body and beyond this earth. I am especially eager to tell my story to the people who might have heard stories similar to mine before and wanted to believe them, but had not been able to fully do so.

It is to these people, more than any other, that I direct this book, and the message within it. What I have to tell you is as important as anything anyone will ever tell you, and it’s true.

The Pain

Lynchburg, Virginia—November 10, 2008

My eyes popped open. In the darkness of our bedroom, I focused on the red glow of the bedside clock: 4:30 A.M.—an hour before I’d usually wake up for the seventy-minute drive from our house in Lynchburg, Virginia, to the Focused Ultrasound Surgery Foundation in Charlottesville where I worked. My wife, Holley, was still sleeping soundly beside me.

After spending almost twenty years in academic neurosurgery in the greater Boston area, I’d moved with Holley and the rest of our family to the highlands of Virginia two years earlier, in 2006. Holley and I met in October 1977, two years after both of us had left college. Holley was working toward her masters in fine arts, and I was in medical school. She’d been on a couple of dates with my college roommate, Vic. One day, he brought her by to meet me—probably to show her off. As they were leaving, I told Holley to come back anytime, adding that she shouldn’t feel obliged to bring Vic.

On our first true date, we drove to a party in Charlotte, North Carolina, two and a half hours each way by car. Holley had laryngitis so I had to do 99 percent of the talking both ways. It was easy. We were married in June 1980 at St Thomas’s Episcopal Church in Windsor, North Carolina, and soon after moved into the Royal Oaks apartments in Durham, where I was a resident in surgery at Duke. Our place was far from royal, and I don’t recall spotting any oaks there, either. We had very little money but we were both so busy—and so happy to be together—that we didn’t care. One of our first vacations was a springtime camping tour of North Carolina’s beaches. Spring is no-see-um (the biting midge) bug season in the Carolinas, and our tent didn’t offer much protection from them. We had plenty of fun just the same. Swimming in the surf one afternoon at Ocracoke, I devised a way to catch the blue-shell crabs that were scuttling about at my feet. We took a big batch over to the Pony Island Motel, where some friends were staying,

and cooked them up on a grill. There was plenty to share with everyone. Despite all our cutting corners, it wasn’t long till we found ourselves distressingly low on cash. We were staying with our best friends Bill and Patty Wilson, and, on a whim, decided to accompany them to a night of bingo. Bill had been going every Thursday of every summer for ten years and he had never won. It was Holley’s first time playing bingo. Call it beginner’s luck, or divine intervention, but she won two hundred dollars— which felt like five thousand dollars to us. The cash extended our trip and made it much more relaxed.

I earned my M.D. in 1980, just as Holley earned her degree and began a career as an artist and teacher. I performed my first solo brain surgery at Duke in 1981. Our firstborn, Eben IV,  was born in 1987 at the Princess Mary Maternity Hospital in Newcastle-Upon-Tyne in northern England during my cerebrovascular fellowship, and our younger son, Bond, was born at the Brigham & Women’s Hospital in Boston in 1998.

I loved my fifteen years working at Harvard Medical School and Brigham & Women’s Hospital. Our family treasured those years in the Greater Boston area. But, in 2005 Holley and I agreed it was time to move back to the South. We wanted to be closer to our families, and I saw it as an opportunity to have a bit more autonomy than I’d had at Harvard. So in the spring of 2006, we started anew in Lynchburg, in the highlands of Virginia. It didn’t take long for us to settle back into the more relaxed life we’d both enjoyed growing up in the South.

For a moment I just lay there, vaguely trying to zero in on what had awakened me. The previous day—a Sunday—had been sunny, clear, and just a little crisp—classic late autumn Virginia weather. Holley, Bond (ten years old at the time), and I had gone to a barbecue at the home of a neighbor. In the evening we had spoken by phone to our son Eben IV (then twenty), who was a junior at the University of Delaware. The only hitch in the day had been the mild respiratory virus that Holley, Bond, and I were all still dragging around from the previous week. My back had started aching just before bedtime, so I’d taken a quick bath, which seemed to drive the pain into submission. I wondered if I had awakened so early this morning because the virus was still lurking in my body.

I shifted slightly in bed and a wave of pain shot down my spine—far more intense than the night before. Clearly the flu virus was still hanging on, and then some. The more I awoke, the worse the pain became. Since I wasn’t able to fall back to sleep and had an hour to spend before my workday started, I decided on another warm bath. I sat up in bed, swung my feet to the floor, and stood up.

Instantly the pain ratcheted up another notch—a dull, punishing throb penetrating deeply at the base of my spine. Leaving Holley asleep, I padded gingerly down the hall to the main upstairs bathroom.

I ran some water and eased myself into the tub, pretty certain that the warmth would instantly do some good. Wrong. By the time the tub was half full, I knew that I’d made a mistake. Not only was the pain getting worse, but it was also so intense now that I feared I might have to shout for Holley to help me get out of the tub.

Thinking how ridiculous the situation had become, I reached up and grabbed a towel hanging from a rack directly above me. I edged the towel over to the side of the rack so that the rack would be less likely to break loose from the wall and gently pulled myself up.

Another jolt of pain shot down my back, so intense that I gasped. This was definitely not the flu. But what else could it be? After struggling out of the slippery tub and into my scarlet terry-cloth bathrobe, I slowly made my way back to our bedroom and flopped down on our bed. My body was already damp again from cold sweat.

Holley stirred and turned over. “What’s going on? What time is it?”

“I don’t know,” I said. “My back. I am in serious pain.”

Holley began rubbing my back. To my surprise it made me feel a little better. Doctors, by and large, don’t take kindly to being sick. I’m no exception. For a moment I was convinced the pain—and whatever was causing it—would finally start to recede. But by 6:30 A.M., the time I usually left for work, I was still in agony and virtually paralyzed.

Bond came into our bedroom at 7:30, curious as to why I was still at home.

“What’s going on?”

“Your father doesn’t feel well, honey,” Holley said.

I was still lying on the bed with my head propped up on a pillow. Bond came over, reached out, and began to massage my temples gently.

His touch sent what felt like a lightning bolt through my head—the worst pain yet. I screamed. Surprised by my reaction, Bond jumped back.

“It’s okay,” Holley said to Bond, clearly thinking otherwise. “It’s nothing you did. Dad has a horrible headache.” Then I heard her say, more to herself than to me: “I wonder if I should call an ambulance.”

If there’s one thing doctors hate even more than being sick, it’s being in the emergency room as a patient. I pictured the house filling up with EMTs, the retinue of stock questions, the ride to the hospital, the paperwork . . . I thought at some point I would begin to feel better and regret calling an ambulance in the first place.

“No, it’s okay,” I said. “It’s bad now but it’s bound to get better soon.

You should probably help Bond get ready for school.” “Eben, I really think—”

“I’ll be fine,” I interrupted, my face still buried in the pillow. I was still paralyzed by the pain. “Seriously, do not call nine-one-one. I’m not that sick. It’s just a muscle spasm in my lower back, and a headache.”

Reluctantly, Holley took Bond downstairs and fed him some breakfast before sending him up the street to a friend’s house to catch a ride to school. As Bond was going out the front door, the thought occurred to me that if this was something serious and I did end up in the hospital, I might not see him after school that afternoon. I mustered all my energy and croaked out, “Have a good day at school, Bond.”

By the time Holley came back upstairs to check on me, I was slipping into unconsciousness. Thinking I was napping, she left me to rest and went downstairs to call some of my colleagues, hoping to get their opinions on what might be happening.

Two hours later, feeling she’d let me rest long enough, she came back to check on me. Pushing open our bedroom door, she saw me lying in bed just as before. But looking closer, she saw that my body wasn’t relaxed as it had been, but rigid as a board. She turned on the light and saw that I was jerking violently. My lower jaw was jutting forward unnaturally, and my eyes were open and rolling back in my head.

“Eben, say something!” Holley screamed. When I didn’t respond, she called nine-one-one. It took the EMTs less than ten minutes to arrive, and they quickly loaded me into an ambulance bound for the Lynchburg General Hospital emergency room.

Had I been conscious, I could have told Holley exactly what I was undergoing there on the bed during those terrifying moments she spent waiting for the ambulance: a full grand mal seizure, brought on, no doubt, by some kind of extremely severe shock to my brain.

But of course, I was not able to do that.

For the next seven days, I would be present to Holley and the rest of my family in body alone. I remember nothing of this world during that week and have had to glean from others those parts of this story that occurred during the time I was unconscious. My mind, my spirit—whatever you may choose to call the central, human part of me—was gone.

The Hospital

The Lynchburg General Hospital emergency room is the second-busiest ER in the state of Virginia and is typically in full swing by 9:30 on a weekday morning. That Monday was no exception. Though I spent most of my workdays in Charlottesville, I’d logged plenty of operating time at Lynchburg General, and I knew just about everyone there.

Laura Potter, an ER physician I’d known and worked with closely for almost two years, received the call from the ambulance that a fifty-four- year-old Caucasian male, in status epilepticus, was about to arrive in her ER. As she headed down to the ambulance entrance, she ran over the list of possible causes for the incoming patient’s condition. It was the same list that I’d have come up with if I had been in her shoes: alcohol withdrawal; drug overdose; hyponatremia (abnormally low sodium level in the blood); stroke; metastatic or primary brain tumor; intraparenchymal hemorrhage (bleeding into the substance of the brain); brain abscess . . . and meningitis.

When the EMTs wheeled me into Major Bay 1 of the ER, I was still convulsing violently, while intermittently groaning and flailing my arms and legs.

It was obvious to Dr. Potter from the way I was raving and writhing around that my brain was under heavy attack. A nurse brought over a crash cart, another drew blood, and a third replaced the first, now empty, intravenous bag that the EMTs had set up at our house before loading me into the ambulance. As they went to work on me, I was squirming like a six-foot fish pulled out of the water. I spouted bursts of garbled, nonsensical sounds and animal-like cries. Just as troubling to Laura as the seizures was that I seemed to show an asymmetry in the motor control of my body. That could mean that not only was my brain under attack but that serious and possibly irreversible brain damage was already under way.

The sight of any patient in such a state takes getting used to, but Laura had seen it all in her many years in the ER. She had never seen one of her fellow physicians delivered into the ER in this condition, however, and looking closer at the contorted, shouting patient on the gurney, she said, almost to herself, “Eben.”

Then, more loudly, alerting the other doctors and nurses in the area: “This is Eben Alexander.”

Nearby staff who heard her gathered around my stretcher. Holley, who’d been following the ambulance, joined the crowd while Laura reeled off the obligatory questions about the most obvious possible causes for someone in my condition. Was I withdrawing from alcohol? Had I recently ingested any strong hallucinogenic street drugs? Then she went to work trying to bring my seizures to a halt.

In recent months, Eben IV had been putting me through a vigorous conditioning program for a planned father-son climb up Ecuador’s 19,300- foot Mount Cotopaxi, which he had climbed the previous February. The program had increased my strength considerably, making it that much more difficult for the orderlies trying to hold me down. Five minutes and 15 milligrams of intravenous diazepam later, I was still delirious and still trying to fight everyone off, but to Dr. Potter’s relief I was at least now fighting with both sides of my body. Holley told Laura about the severe headache I’d been having before I went into seizure, which prompted Dr. Potter to perform a lumbar puncture—a procedure in which a small amount of cerebrospinal fluid is extracted from the base of the spine.

Cerebrospinal fluid is a clear, watery substance that runs along the surface of the spinal cord and coats the brain, cushioning it from impacts. A normal, healthy human body produces about a pint of it a day, and any diminishment in the clarity of the fluid indicates that an infection or hemorrhage has occurred.

Such an infection is called meningitis: the swelling of the meninges, the membranes that line the inside of the spine and skull and that are in direct contact with the cerebrospinal fluid. In four cases out of five a virus causes the disease. Viral meningitis can make a patient quite ill, but it is only fatal in approximately 1 percent of cases. In one case out of five, however, bacteria cause meningitis. Bacteria, being more primitive than viruses, can be a more dangerous foe. Cases of bacterial meningitis are uniformly fatal if untreated. Even when treated rapidly with the appropriate antibiotics, the mortality rate ranges from 15 to 40 percent. One of the least likely culprits for bacterial meningitis in adults is a very old and very tough bacteria named Escherichia coli—better known simply as E. coli. No one knows how old E. coli is precisely, but estimates hover between three and four billion years. The organism has no nucleus and reproduces by the primitive but extremely efficient process known as asexual binary fission (in other words, by splitting in two). Imagine a cell filled, essentially, with DNA, that can take in nutrients (usually from other cells that it attacks and absorbs) directly through its cellular wall. Then imagine that it can simultaneously copy several strands of DNA and split into two daughter cells every twenty minutes or so. In an hour, you’ll have 8 of them. In twelve hours, 69 billion. By hour fifteen, you’ll have 35 trillion. This explosive growth only slows when its food begins to run out.

E. coli are also highly promiscuous. They can trade genes with other bacterial species through a process called bacterial conjugation, which allows an E. coli cell to rapidly pick up new traits (such as resistance to a new antibiotic) when needed. This basic recipe for success has kept E. coli on the planet since the earliest days of unicellular life. We all have E. coli bacteria residing within us—mostly in our gastrointestinal tract. Under normal conditions, this poses no threat to us. But when varieties of E. coli that have picked up DNA strands that make them especially aggressive invade the cerebrospinal fluid around the spinal cord and brain, the primitive cells immediately begin devouring the glucose in the fluid, and whatever else is available to consume, including the brain itself.

No one in the ER, at that point, thought I had E. coli meningitis. They had no reason to suspect it. The disease is astronomically rare in adults. Newborns are the most common victims, but cases of babies any older than three months having it are exceedingly uncommon. Fewer than one in 10 million adults contract it spontaneously each year.

In cases of bacterial meningitis, the bacteria attack the outer layer of the brain, or cortex, first. The word cortex derives from a Latin word meaning “rind” or “bark.” If you picture an orange, its rind is a pretty good model for the way the cortex surrounds the more primitive sections of the brain. The cortex is responsible for memory, language, emotion, visual and auditory awareness, and logic. So when an organism like E. coli attacks the brain, the initial damage is to the areas that perform the functions most crucial to maintaining our human qualities. Many victims of bacterial meningitis die in the first several days of their illness. Of those who arrive in an emergency room with a rapid downward spiral in neurologic function, as I did, only 10 percent are lucky enough to survive. However, their luck is limited, as many of them will spend the rest of their lives in a vegetative state.

Though she didn’t suspect E. coli meningitis, Dr. Potter thought I might have some kind of brain infection, which is why she decided on the lumbar puncture. Just as she was telling one of the nurses to bring her a lumbar puncture tray and prepare me for the procedure, my body surged up as if my gurney had been electrified. With a fresh blast of energy, I let out a long, agonized groan, arched my back, and flailed my arms at the air. My face was red, and the veins in my neck bulged out crazily. Laura shouted for more help, and soon two, then four, and finally six attendants were struggling to hold me down for the procedure. They forced my body into a fetal position while Laura administered more sedatives. Finally, they were able to make me still enough for the needle to penetrate the base of my spine.

When bacteria attack, the body goes immediately into defense mode, sending shock troops of white blood cells from their barracks in the spleen and bone marrow to fight off the invaders. They’re the first casualties in the massive cellular war that happens whenever a foreign biological agent invades the body, and Dr. Potter knew that any lack of clarity in my cerebrospinal fluid would be caused by my white blood cells.

Dr. Potter bent over and focused on the manometer, the transparent vertical tube into which the cerebrospinal fluid would emerge. Laura’s first surprise was that the fluid didn’t drip but gushed out—due to dangerously high pressure.

Her second surprise was the fluid’s appearance. The slightest opacity would tell her I was in deep trouble. What shot out into the manometer was viscous and white, with a subtle tinge of green.

My spinal fluid was full of pus.

Out of Nowhere

Dr. Potter paged Dr. Robert Brennan, one of her associates at Lynchburg General and a specialist in infectious disease. While they waited for more test results to come from the adjacent labs, they considered all of the diagnostic possibilities and therapeutic options.

Minute by minute, as the test results came back, I continued to groan and squirm beneath the straps on my gurney. An ever more baffling picture was emerging. The Gram’s stain (a chemical test, named after a Danish physician who invented the method, that allows doctors to classify an invading bacteria as either gram-negative or gram-positive) came back indicating gram-negative rods—which was highly unusual.

Meanwhile a computerized tomography (CT) scan of my head showed that the meningeal lining of my brain was dangerously swollen and inflamed. A breathing tube was put into my trachea, allowing a ventilator to take over the job of breathing for me—twelve breaths a minute, exactly— and a battery of monitors was set up around my bed to record every movement within my body and my now all-but-destroyed brain.

Of the very few adults who contract spontaneous E. coli bacterial meningitis (that is, without brain surgery or penetrating head trauma) each year, most do so because of some tangible cause, such as a deficiency in their immune system (often caused by HIV or AIDS). But I had no such factor that would have made me susceptible to the disease. Other bacteria might cause  meningitis  by  invading  from  the  adjacent  nasal  sinuses  or middle ear, but not E. coli. The cerebrospinal space is too well sealed off from the rest of the body for that to happen. Unless the spine or skull is punctured (by a contaminated deep brain stimulator or a shunt installed by a neurosurgeon, for example), bacteria like E. coli that usually reside in the gut simply have no access to that area. I had installed hundreds of shunts and stimulators in the brains of patients myself, and had I been able to discuss the matter, I would have agreed with my stumped doctors that, to put it simply, I had a disease that was virtually impossible for me to have.

Still unable to completely accept the evidence being presented from the test results, the two doctors placed calls to experts in infectious disease at major academic medical centers. Everyone agreed that the results pointed to only one possible diagnosis.

But contracting a case of severe E. coli bacterial meningitis out of thin air was not the only strange medical feat I performed that first day in the hospital. In the final moments before leaving the emergency room, and after two straight hours of guttural animal wails and groaning, I became quiet. Then, out of nowhere, I shouted three words. They were crystal clear, and heard by all the doctors and nurses present, as well as by Holley, who stood a few paces away, just on the other side of the curtain.

“God, help me!”

Everyone rushed over to the stretcher. By the time they got to me, I was completely unresponsive.

I have no memory of my time in the ER, including those three words I shouted out. But they were the last I would speak for the next seven days.

Once in Major Bay 1, I continued to decline. The cerebrospinal fluid (CSF) glucose level of a normal healthy person is around 80 milligrams per deciliter. An extremely sick person in imminent danger of dying from bacterial meningitis can have a level as low as 20 mg/dl.

I had a CSF glucose level of 1. My Glasgow Coma Scale was eight out of fifteen, indicative of a severe brain illness, and declined further over the next few days. My APACHE II score (Acute Physiology and Chronic Health Evaluation) in the ER was 18 out of a possible 71, indicating that the chances of my dying during that hospitalization were about 30 percent. More specifically, given my diagnosis of acute gram-negative bacterial meningitis and rapid neurological decline at the outset, I’d had, at best, only about a 10 percent chance of surviving my illness when I was admitted to the ER. If the antibiotics didn’t kick in, the risk of mortality would rise steadily over the next few days—till it hit a nonnegotiable 100 percent.

The doctors loaded my body with three powerful intravenous antibiotics before sending me up to my new home: a large private room, number 10, in the Medical Intensive Care Unit, one floor above the ER.

I’d been in these ICUs many times as a surgeon. They are where the absolute sickest patients, people just inches from death, are placed, so that several medical personnel can work on them simultaneously. A team like that, fighting in complete coordination to keep a patient alive when all the odds are against them, is an awesome sight. I had felt both enormous pride and brutal disappointment in those rooms, depending on whether the patient we were struggling to save either made it or slipped from our fingers.

Dr. Brennan and the rest of the doctors stayed as upbeat with Holley as they could, given the circumstances. This didn’t allow for their being at all upbeat. The truth was that I was at significant risk of dying, very soon. Even if I didn’t die, the bacteria attacking my brain had probably already devoured enough of my cortex to compromise any higher-brain activity.

The longer I stayed in coma, the more likely it became that I would spend the rest of my life in a chronic vegetative state.

Fortunately, not only the staff of Lynchburg General but other people, too, were already gathering to help. Michael Sullivan, our neighbor and the rector in our Episcopal church, arrived at the ER about an hour after Holley. Just as Holley had run out the door to follow the ambulance, her cell phone had buzzed. It was her longtime friend Sylvia White. Sylvia always had an uncanny way of reaching out precisely when important things were happening. Holley was convinced she was psychic. (I had opted for the safer and more sensible explanation that she was just a very good guesser.) Holley briefed Sylvia on what was happening, and between them they made calls to my immediate family: my younger sister, Betsy, who lived nearby, my sister Phyllis, at forty-eight the youngest of us, who was living in Boston, and Jean, the oldest.

That Monday morning Jean was driving south through Virginia from her home in Delaware. Fortuitously, she was on her way to help our mother, who lived in Winston-Salem. Jean’s cell phone rang. It was her husband, David.

“Have you gone through Richmond yet?” he asked. “No,” Jean said. “I’m just north of it on I-95.”

“Get onto route 60 West, then route 24 down to Lynchburg. Holley just called. Eben’s in the emergency room there. He had a seizure this morning and isn’t responding.”

“Oh, my God! Do they have any idea why?” “They’re not sure, but it might be meningitis.”

Jean made the turn just in time and followed the undulating two-lane blacktop of 60 West through low, scudding clouds, toward Route 24 and Lynchburg.

It was Phyllis who, at three o’clock that first afternoon of the emergency, called Eben IV at his apartment at the University of Delaware. Eben was outside on his porch doing some science homework (my own dad had been a neurosurgeon, and Eben was interested in that career now as well) when his phone rang. Phyllis gave him a quick rundown of the situation and told him not to worry—that the doctors had everything under control.

“Do they have any idea what it might be?” Eben asked.

“Well, they did mention gram-negative bacteria and meningitis.”

“I have two exams in the next few days, so I’m going to leave some quick messages with my teachers,” said Eben.

Eben later told me that, initially, he was hesitant to believe that I was in as grave danger as Phyllis had indicated, since she and Holley always “blew things out of proportion”—and I never got sick. But when Michael Sullivan called him on the phone an hour later, he realized that he needed to make the drive down—immediately.

As Eben drove toward Virginia, an icy pelting rain started up. Phyllis had left Boston at six o’clock, and as Eben headed toward the I-495 bridge over the Potomac River into Virginia, she was passing through the clouds overhead. She landed at Richmond, rented a car, and got onto Route 60 herself.

When he was just a few miles outside Lynchburg, Eben called Holley. “How’s Bond?” he asked.

“Asleep,” Holley said.

“I’m going to go straight to the hospital then,” Eben said. “You sure you don’t want to come home first?”

“No,” Eben said. “I just want to see Dad.”

Eben pulled up at the Medical Intensive Care Unit at 11:15 P.M. The walkway into the hospital was starting to ice over, and when he came into the bright lights of the reception area he saw only a night reception nurse. She led him to my ICU bed.

By that point, everyone who had been there earlier had finally gone home. The only sounds in the large, dimly lit room were the quiet beeps and hisses of the machines keeping my body going.

Eben froze in the doorway when he saw me. In his twenty years, he’d never seen me with more than a cold. Now, in spite of all the machines doing their best to make it seem otherwise, he was looking at what he knew was, essentially, a corpse. My physical body was there in front of him, but the dad he knew was gone.

Or perhaps a better word to use is: elsewhere.

5.

Underworld

Darkness, but a visible darkness—like being submerged in mud yet also being able to see through it. Or maybe dirty Jell-O describes it better. Transparent, but in a bleary, blurry, claustrophobic, suffocating kind of way. Consciousness, but consciousness without memory or identity—like a dream where you know what’s going on around you, but have no real idea

of who, or what, you are.

Sound, too: a deep, rhythmic pounding, distant yet strong, so that each pulse of it goes right through you. Like a heartbeat? A little, but darker, more mechanical—like the sound of metal against metal, as if a giant, subterranean blacksmith is pounding an anvil somewhere off in the distance: pounding it so hard that the sound vibrates through the earth, or the mud, or wherever it is that you are.

I didn’t have a body—not one that I was aware of anyway. I was simply . . . there, in this place of pulsing, pounding darkness. At the time, I might have called it “primordial.” But at the time it was going on, I didn’t know this word. In fact, I didn’t know any words at all. The words used here registered much later, when, back in the world, I was writing down my recollections. Language, emotion, logic: these were all gone, as if I had regressed back to some state of being from the very beginnings of life, as far back, perhaps, as the primitive bacteria that, unbeknownst to me, had taken over my brain and shut it down.

How long did I reside in this world? I have no idea. When you go to a place where there’s no sense of time as we experience it in the ordinary world, accurately describing the way it feels is next to impossible. When it was happening, when I was there, I felt like I (whatever “I” was) had always been there and would always continue to be.

Nor, initially at least, did I mind this. Why would I, after all, since this state of being was the only one I’d ever known? Having no memory of anything better, I was not particularly bothered by where I was. I do recall conceptualizing that I might or might not survive, but my indifference as to

whether I did or not only gave me a greater feeling of invulnerability. I was clueless as to the rules that governed this world I was in, but I was in no hurry to learn them. After all, why bother?

I can’t say exactly when it happened, but at a certain point I became aware of some objects around me. They were a little like roots, and a little like blood vessels in a vast, muddy womb. Glowing a dark, dirty red, they reached down from some place far above to some other place equally far below. In retrospect, looking at them was like being a mole or earthworm, buried deep in the ground yet somehow able to see the tangled matrixes of roots and trees surrounding it.

That’s why, thinking back to this place later, I came to call it the Realm of the Earthworm’s-Eye View. For a long time, I suspected it might have been some kind of memory of what my brain felt like during the period when the bacteria were originally overrunning it.

But the more I thought about this explanation (and again, this was all much, much later), the less sense it made. Because—hard as this is to picture if you haven’t been to this place yourself—my consciousness wasn’t foggy or distorted when I was there. It was just . . . limited. I wasn’t human while I was in this place. I wasn’t even animal. I was something before, and below, all that. I was simply a lone point of awareness in a timeless red- brown sea.

The longer I stayed in this place, the less comfortable I became. At first I was so deeply immersed in it that there was no difference between “me” and the half-creepy, half-familiar element that surrounded me. But gradually this sense of deep, timeless, and boundaryless immersion gave way to something else: a feeling like I wasn’t really part of this subterranean world at all, but trapped in it.

Grotesque animal faces bubbled out of the muck, groaned or screeched, and then were gone again. I heard an occasional dull roar. Sometimes these roars changed to dim, rhythmic chants, chants that were both terrifying and weirdly familiar—as if at some point I’d known and uttered them all myself.

As I had no memory of prior existence, my time in this realm stretched way, way out. Months? Years? Eternity? Regardless of the answer, I eventually got to a point where the creepy-crawly feeling totally outweighed the homey, familiar feeling. The more I began to feel like a me

—like something separate from the cold and wet and dark around me—the

 more the faces that bubbled up out of that darkness became ugly and threatening. The rhythmic pounding off in the distance sharpened and intensified as well—became the work-beat for some army of troll-like underground laborers, performing some endless, brutally monotonous task. The movement around me became less visual and more tactile, as if reptilian, wormlike creatures were crowding past, occasionally rubbing up against me with their smooth or spiky skins.

Then I became aware of a smell: a little like feces, a little like blood, and a little like vomit. A biological smell, in other words, but of biological death, not of biological life. As my awareness sharpened more and more, I edged ever closer to panic. Whoever or whatever I was, I did not belong here. I needed to get out.

But where would I go?

Even as I asked that question, something new emerged from the darkness above: something that wasn’t cold, or dead, or dark, but the exact opposite of all those things. If I tried for the rest of my life, I would never be able to do justice to this entity that now approached me . . . to come anywhere close to describing how beautiful it was.

But I’m going to try.

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