Vital Signs

St. Louis Nurse Leads Rare, Prospective Study

by Paul Bernstein, Ph.D.

Nurse Janet Schwaninger, coordinator of cardiology care at Barnes-Jewish Hospital, a teaching venue of the Washington University medical school (St. Louis, Missouri), this summer saw her three year study of near-death experiencers published in the Journal of Near-Death Studies. Her research is only the third prospective* study of cardiac-arrest neardeath experiencers published in the US, and the fifth ever in the world. Vital Signs is delighted to have had the opportunity to interview Nurse Schwaninger, to gain from her an inside view of the practical rigors of designing, conducting, and publishing such valuable research.


Photo by Linda Jacquin

Barnes Hospital
Cardiovascular Coordinator
—and NDE researcher—
Janet Schwaninger, RN, BSN

VS: What started you in this work?
JS: In 1989 I witnessed the cardiac arrest of a medical colleague, during his recovery after a heart-valve replacement. Many hospital personnel knew this physician, and a number of us were present at the time of his arrest. It took seven defibrillations before he was revived.

When he became conscious, he told us he had witnessed the entire arrest, from a vantage point to the left in the upper corner of the room. He described everything that we’d done, and knew exactly how many times we had defibrillated him. Then he told us that there was a spiritual entity with him during the entire arrest who was very reassuring to him, telling him that everything would be okay, no matter how things turned out—which surprised him very much. He had never heard of an NDE before. “I felt totally conscious and totally aware, and yet I know that medically I was virtually dead because you defibrillated me seven times.”

*Interviewing all revived patients in a hospital unit, before knowing which ones have had an NDE. 

I was very moved by how significantly this physician’s life changed the year following his experience: he became a happier person, he began enjoying his life, he made significant changes in his family and personal life, and in his medical practice. Several times he came back to us, wanting to discuss the experience. At that time, though I had heard of the near-death experience I really had not read much about it. So this event stimulated me to go to the library and do a computer search, trying to find out all I could about the experience, and to share that with him.

Then, within the year, we had a transplant patient who had a very profound near-death experience during a cardiac arrest, yet went through a lot of ridicule from a lot of medical professionals telling him that the experience didn’t mean anything, that it was a hallucination, a dream—all the typical things we were used to hearing. That showed me there was such a significant need to recognize and address these experiences. I decided they should become part of the management of patients who suffer cardiac arrest. Also, I wondered just how frequent these experiences really are.

So after spending a couple of years doing computer searches and reading all of the literature I could find, I drafted a research proposal and took it to the Chairman and Dean of our Washington University Human Studies Committee—and he was very interested and supportive.
VS: That surprised you a little?
JS: Yes. Because I really thought the Committee members might be skeptical about the worthiness of

Dr. Alan N. Weiss,Professor of Medicine (Cardiology) at Washington University

what I was trying to do. For example, one physician in the hospital who’d heard that I’d sent this proposal to the Human Studies Committee said, “Well, I guess you’re not going to hurt anybody.” But the official committee from the very beginning took the research very seriously, and before long gave me total approval to proceed. They were pleased that I had studied all the existing literature in the field; they definitely felt that it would be a worthwhile study. I think it also may have helped that Dr. Weiss and I are wellknown at the hospital; we had already worked there for 12 years, and we took care of a large number of patients. We’re on hospital rounds every day and also have contact with a wide variety of the staff.

VS: So you were already known and credible, and when you proposed something that stretched your colleagues’ beliefs, they thought, “Well, we’ll keep listening.”
JS: Yes, and they did keep listening. They were supportive and interested, wanting more information. Some others exhibited what I would call healthy skepticism but still were interested to the point where they would come to me and say, “Oh, look, I had a patient that went through this,

and I didn’t quite know what to say to them or how to handle it. Would you please come and talk to them?” I even had physicians come up to me and say, “You know, I had one of those experiences myself.”

So once I started the study, I was surprised at how much interest a variety of medical professionals had within the hospital and the university. As time went on, some personnel would ask, “How’s your study going, how many patients do you have? Tell me.” These people then told other professionals, and a number of their patients contacted me directly.

VS: The three other co-authors of your study—how did each of them get involved?

Dr. Paul R. Eisenberg,
Internal Medicine,
Lilly Laboratories

JS: Dr. Paul Eisenberg, Director of the Cardiac Intensive Care Unit at the time, heard of the study and became very interested. He helped track cardiac arrests with me in that unit, and told me that he would help when I got to the point of writing up the study. Even after he left as director of the unit [to join the Eli Lilly Research Laboratories in Indianapolis— Editor’s note], he followed the progress of our project.

Dr. Alan Weiss and I had been working together in cardiology for many years, and he was very supportive of the study from the beginning. He came with me on a number of the interviews and helped organize the data.

 dr_kenneth_schechtmanDr. Kenneth Schechtman,
Director of Biostatistics
Consultation, Washington
University Medical School

And Dr. Kenneth Schechtman was recommended to me as an expert statistician by Dr. Eisenberg. Dr. Schechtman is associate professor of biostatistics at Washington University.
VS: Did you get help from any experienced NDE researchers, like the first person to publish a prospective study, Dr. Michael Sabom?
JS: I actually didn’t meet Dr. Sabom until he and Dr. Bruce Greyson came to St. Louis for the 1993 IANDS conference. That was two years after I’d begun the study. During that time I’d been in contact with Dr. Greyson, having sent him a copy of my research proposal at the beginning. So before contacting Dr. Greyson, it was only by reading the published literature that I knew how to design the study.

VS: What kinds of practical problems did you have to solve in order to accomplish the study?
JS: First, I hadn’t realized how difficult it would be to get a large enough sample of patients having a true cardiac arrest who could be interviewed right after their resuscitation. I started out thinking, “I’ll just follow everyone that has a code” [the hospital’s emergency call for resuscitation]. But when I checked their medical records, I realized that only 73% of those were true cardiac arrests, which was the group that I really wanted, and 68% did not revive, so only 17% could be interviewed.

We tracked every single code in the hospital for three years—I had it worked out so that every head nurse on every floor would report through the administrative office and record in a logbook at the end of every shift each person who arrested. I also carried a code beeper for those three years, twenty-four hours a day, so I would be alerted to every potential cardiac arrest in the hospital.

The only unit that I had trouble with was the surgical intensive care unit, because their codes did not go through the central paging system. After a number of unsuccessful tries at tracking their codes, we ended up excluding that unit —which was probably good for the study, because then we didn’t have to deal with patients who’d been given anesthesia, with all the issues of memory compromise that involves.

So over three years we tracked a total of 273 codes. I was doing almost all the interviewing and reviewing of medical records, at the end of working a 9- or 10-hour day.

Emergency ‘code’ patients tracked = 273 persons

   From that group, cardiac arrests = 73%

   From that cardiac arrest group, revived persons = 31%

   From that revived group, persons interviewable immediately = 17%

   From that interviewed group, NDEs = 23%

Consequences Six Months Later

Some of the 29 statistically significant differences found in the cardiacarrest survivors who’d had NDE as compared to the non-NDEsurvivors:

   Increased sense of sacredness of life, inner meaning, and purpose of life

   Increased intuitiveness

   Increased understanding of others, ability to listen to others, and
   ability to express love to others

   Increased feelings of self-worth

   Increased tendency to pray

   Increased belief in life after death

   Increased concern with political matters and social justice


VS: Did you think of persuading another nurse to help you with it?
JS: Well, actually, I didn’t. I kind of took it on myself, and felt that once I’d gotten the support of every head nurse and unit to help me track all the codes, that was about as much as I could ask for.

I did consider other types of patients as potential research subjects— those who were hypotensive [very low blood pressure], and those who had respiratory arrest—because they too could very well have had near-death experiences. But in order to make the study as scientifically rigorous as possible, I had to confine it and look only at the near-death experiences of people who had true cardiac arrest. I didn’t have the time nor the manpower to include the others.

Additionally, lots of people started sending me their neardeath experiences when they heard about the project through the media. Many local TV channels had called me for an interview, and several stations then sent their tapes to the national networks.

That’s when I got a little sidetracked dealing with the retrospective* group of individuals. I went back to the Human Studies Committee and asked if I could send this retrospective group the same follow-up form that I had sent to the prospective patients. They approved it. Some of those people had experiences dating back into the 1930s, yet they were still able to

give the same kind of clarity as the recent group. I spent a lot of time analyzing their experiences, and comparing them with my prospective group.

But when it came to writing up the paper for submission to the Journal of Near-Death Studies, its Editor, Dr. Greyson, urged me to set aside the retrospective cases and report them separately. I have a lot of data for 40 patients in that retrospective group. But I understood what Dr. Greyson and the other editor said, that they didn’t want to muddy the waters by mixing that retrospective group in with the prospective group, and I agreed with him. Unfortunately, I felt like those people had so much to say; it was hard to exclude them.

VS: You spent three years gathering the data?
JS: Right. We tracked and interviewed patients from 1991 to 1994. Originally, I’d thought it would take me only 6 to 9 months to identify and interview 30 people who’d survived a cardiac arrest.

VS: Why did it take so much longer?
JS: Because not all the persons who had “coded” turned out to have had a true cardiac arrest. And of those, not all could be interviewed—because some had suffered nervous system damage, and others were being sustained on a respirator immediately following their resuscitation, when our study protocol required us to interview them. If I would have acquired 30 patients within the first 6 months, I probably would have gone on for 60 patients or more. But after 3 years I felt that when we finally reached the 30 patient mark, that’s where I had to stop.

VS: And since 1994, has it been—or could it still be—feasible for you, or perhaps for some colleagues or graduate students, to see what the longerterm consequences have been for those people?
JS: Well, it would be possible. However, I wonder how many patients are still alive. Two of them had already died even at our 6-month mark. After that time I did run into several patients in the hospital, and they were so appreciative of the time we’d spent with them and told us what a significant difference it made in their lives.

I could also go back to the patients’ medical records, to look at what their blood gasses were, etc. I know in one British

study, Dr. Parnia and his colleagues looked at that and didn’t see any differences between the NDEr and non-NDEr groups in carbon dioxide levels; they were within the normal range for both groups. The NDErs even had higher oxygen levels than the non-NDErs, suggesting that these experiences don’t happen just when oxygen levels are low.

The thing that I find so interesting is that it makes you wonder if consciousness may continue after the brain has stopped functioning. I wish an MRI could have been done during the arrest. I know that EEGs have been done on patients during cardiac arrest, as the Dutch team under Dr. van Lommel reported. They stated that patients were flat-lined; there was no EEG response. Yet so many times when talking with these NDE patients I saw how lucid their thought processes had been during the time of their cardiac arrest, how structured they were; there was an element of intelligence and reasoning going on there. Normally you would expect that there would be no memory at all from such periods of “unconsciousness”. A lot of patients will tell you after a traumatic event, “I remember going into it, but I don’t remember anything from the next several days.” What’s so amazing about these neardeath patients is that they obviously remember well enough to tell us what they experienced, from a time when you wouldn’t think that they’d be having memory formation, or any kind of mental experience.

VS: Yes. If the body’s in crisis with cardiac arrest, you’d think that if there’s any mental activity at all it would have to do with fear, panic, or trauma.
JS: Right. Which no one reported, not one single patient. All just the opposite. Three patients told me they recovered more quickly. This was not even a question we asked them—they just told me. Obviously, this is an area that I think really needs further research: that it’s such a brief experience yet it so powerfully and significantly changes the individual.

A lot of the patients tell me that during the experience there was a functioning of their consciousness beyond the timespace boundary. 82% of our subjects told me there was no sense of time or space. That was very consistent: ‘I was aware.’ ‘I was conscious, yet I was definitely not in any kind of time-space framework’—which was very interesting to me. Basically they were telling me that their awareness was present within the moment. And they perceive this moment as being eternal, also.

And then they all said there was some kind of survival of their soul or consciousness beyond the physical. They kept telling me, “Well, you’re not going to be able to explain this in psychological or physiological terms.” So you wonder if this doesn’t shed some light on consciousness working independently of the brain itself. Of course there very well could be an area of the brain that helps us make that transition, or that’s involved in the separation of consciousness from the physical organism. Or a particular awareness comes about when certain areas of

the brain are not functioning, having possibly been shut down as a consequence of the cardiac arrest.

VS: Was the process of analyzing and writing up the data at all problematic?
JS: We had a long process of editing, during which Dr. Greyson was very helpful. I had one person who’d had an OBE only: ‘I was up there, and I could see everything that was going on.’ But that’s as far as it went. So he didn’t really classify as a core NDEr. Then I had two others who had some memory flashbacks that were not NDEs, and I was advised to put them in with those who did not have an NDE, instead of treating them statistically as a separate group. And that resulted in a recalculation of the statistics, which required a number of months.
VS: Did you think of having a different periodical publish your study other than the Journal of Near-Death Studies, or was that always your first choice?
JS: Personally, that was always my goal, that’s where I wanted it. But Dr. Weiss wanted me to send it to JAMA*, and also to the American Journal of Psychiatry and the American Journal of Psychology. And actually, I was very surprised at how complimentary they were. The problem they all had came down to the small sample size on which we had run a large number of simultaneous and interdependent statistical tests. The editors wrote that it was a significant study that has great implications for humanity, for religion, for spirituality. “Unfortunately,” they continued, “your study doesn’t exactly fit our format for the next year.”

But I have to say that the version we submitted to those other journals was not nearly as refined as it turned out to be after I incorporated the suggestions of Dr. Greyson and the other reviewers. They’re the ones who really fine-tuned the paper for me and brought out some of the important material that I had gathered but hadn’t included in my original draft. For example, the experiential and physical changes that are in the last two tables. And the specifics on the code data. Both made the article better, but I had not had them in the original draft I’d sent to JAMA, the American Journal of Psychiatry and the American Journal of Psychology.

So as it turned out, it was published exactly where I’d wanted it to be. Because Dr. Greyson had been behind me and supportive from the very beginning, and I really wanted him to have this study to publish.

But I have to tell you, one interesting thing about the study is that from the beginning it had a mind and a time of its own. No matter how much I tried to speed it up or to get it done, there was always something that just kept it right on its own time. People said, “Why are you doing this? Why are you putting in so many hours—and years—of your time?” And I couldn’t really tell them, other than it was just something I knew was very important, that was meant to be done. Re-organizing the data and fine-tuning the statistical operations went on year after year. I felt, this will be done when it’s meant to be

done; this will be published when it’s meant to be. It was interesting because recently studies began to be published on prayer in coronary units and alternative medical therapies, so it really was good timing. I think it meant more to the public that it came out now than if it would have come out perhaps several years ago.

When I think of how long it took to complete the paper, I also recall the obstacles that I had to overcome. But never once did I say that I was going to give up. No matter how gloomy it looked, no matter how difficult it was, I just felt that I needed to do this. The study did not receive any funding, no one received any payment, no compensation—it just wasn’t about that.

VS: Have you seen that there has been progress at Barnes Hospital because of this? And even if there’s been progress, are there still obstacles by people who should know better but still refuse to pay attention?
JS: One of my goals was to increase the awareness of medical professionals. I gave talks to all different groups in the hospital— everybody was asking me, “Please come talk about your research!” They were begging me, from the operating room personnel to neurology. And people said, “Oh, my gosh, I never thought about when I said things while the patients were supposedly unconscious, that maybe they could hear what I was saying.”

So there’s this whole new awareness of how we treat patients when we think they’re unconscious. That’s one awareness.

Now medical professionals ask how can they intelligently discuss such experiences when they have a patient that tells them they’ve had one. They now have avenues for providing the patient with support. There is an IANDS support group in the St. Louis area.

I had a lot of interest from the psychiatrists and psychologists. One who was particularly responsive said, “I would be very happy to see any of your patients who need extra psychological support. I’ll be happy to take on those patients.” So I was able to establish a psychiatric and psychology referral involving a number of support systems within Barnes Hospital. It increased awareness. Most people didn’t even know what a near-death experience was when the study began. Now most medical professionals know what they are, and their significance. They all use their knowledge in the management of patients now, from the coronary care unit to the neurological intensive care unit.

VS: Has any of this experience become part of anyone’s teaching inside the University’s medical school?
JS: I don’t know. I gave talks throughout the hospital on NDEs and our study until about 4 years ago. By then I’d talked to every area. Medical students did attend. I don’t know what actual teaching is going on within the university’s medical school program, except that students hear about NDEs when they take the cardiology course that Alan Weiss teaches one month each year.

When the study was published this summer, Washington University and Barnes Hospital were so supportive. The University put out press releases, both in the print media and in radio across the country. And I’ve been contacted by local TV

stations wanting me to appear on more shows. The international issue of the Miami Herald put out a story on our study. From that I got responses from scientists and other individuals in Costa Rica, Ecuador and Peru. People were so pleased that we had done the study, and thought it was significant, expressing their interest, a lot of physicians and medical professionals just contacting me, being in support, and sharing their experiences or those of their patients or their personal loved ones.
VS: If somebody fairly new in nursing or cardiology, perhaps even a medical or nursing student, were leaning towards doing such a prospective study, what kind of advice would you give them?
JS: Not to give up! Because it’s so significant, and there’s something so important that’s being said by the patients, significant information that’s being given to humanity. And not just the message is important, but how we see that such a brief experience can so profoundly change a person’s life. How important it is to recognize and address these experiences in the management and care of patients.

Paul Bernstein is on the editorial team of Vital Signs. He is very grateful to Melissa Fellows for transcribing the original interview.

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