Proof of Heaven Page 2

  1. 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.

  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.