Proof of Heaven: A Neurosurgeon's Journey into the Afterlife

2. 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.