Imagine a medical syndrome so common that as many as one in five patients who nearly die in a medical setting experience it. Also, imagine that this syndrome has a profound, lifelong effect on both the patient and their family. Finally, imagine that if this syndrome is mishandled by the patient’s physician, it may have major adverse consequences for the patient and their loved ones.

Sounds like something all physicians and medical personnel should be able to recognize and treat, doesn’t it? Sounds like something that should be inculcated in all medical training, beginning in medical school. But it’s not!

Incredibly, it isn’t included in medical curricula, so most physicians are clueless when they encounter this syndrome. I won’t drag this out any longer—I’m talking about near-death experiences (NDEs). Oh, are you unfamiliar? Let me present the essentials.

NDEs were first described by Raymond Moody, MD, PhD, who began his research in 1965. He developed an interest in people who almost died—some would say they did die—due to a grave medical problem, usually in a hospital setting. These experiencers often return, inexplicably, from the brink of irreversible death. They frequently report a life-changing experience during their time at the nexus between life as we know it and what’s next. In 1975, consolidating more than 150 cases of NDEs, Dr. Moody published Life After Life, a book that has remained a bestseller for almost half a century, with over 13 million copies sold. Dr. Moody coined the term “near-death experience”; it stuck, and he became known as “the father of NDEs.”

Like any medical syndrome, NDEs have a unified content, though not every episode includes all components. They may occur in the context of a medical setting (e.g., cardiac arrest or exsanguination in the ER or ICU) or a non-medical one (e.g., auto accidents or drowning). The patient is in extremis, and efforts are made to resuscitate them.

A complete NDE typically follows this sequence:

1. A strange sound. The individual hears a buzzing, ringing noise, or surreal, calming music. They sense they are dead but feel comfortable with it.

2. Peace and painlessness. As soon as they leave their body, their pain vanishes, and they experience peace.

3. Out-of-body experience. They rise up and float above the scene, seeing their body (autoscopy) but understanding that their spirit is their true essence. Their spiritual entity seems like a living energy field. Time and space become irrelevant.

4. The tunnel experience. Their spirit is drawn through a tunnel of light at extremely high speed, leading to a realm of radiant golden-white light, full of ineffable joy and love.

5. People of light. The dying person meets glowing individuals, often friends or relatives who have already died, greeting them joyfully.

6. The being of light. After meeting these figures, the experiencer encounters a powerful, loving deity, often seen through the lens of the person’s religious or cultural background. For example, Catholics may see the Virgin Mary, though Jews or Muslims do not.

7. The life review. The being of light presents a panoramic review of the person’s entire life. They relive every act they’ve committed, often realizing that love is the most important aspect of life.

8. Reluctance to return. The being of light sometimes tells the person they must return to life, or the individual may be given a choice to stay in this realm or return to Earth. They are often reluctant to leave but may return for the sake of loved ones they do not want to abandon.

Once back in their body, the experiencer returns to the earthly realm, where pain, fear, and dread reoccur. Medical personnel often cannot explain their return from the brink of death.

When systematically asked, “While you were unconscious, did anything unusual happen that you’d like to talk about?” about 20 percent of patients report having had a positive NDE. However, if not directly asked, only 2 percent spontaneously report it. Researchers estimate that as many as twenty million people in the U.S. may have had NDEs, most of which go unreported.

A positive NDE often leads individuals to live enriched lives, lose their fear of death, and believe in a loving, merciful deity. However, as the rock band Poison once said, “Every rose has its thorn.” About 10 percent of NDEs are distressing (dNDEs), with elements like fear, evil, solitude, pain, a sense of falling into a void, soul loss, and hellishness. These individuals often need their physicians’ assistance and support. People coping with dNDEs usually respond in one of three ways: 1) denial or minimization of the experience, 2) interpreting it as a call to live a better life, often becoming hyper-religious, or 3) struggling to cope, sometimes turning to drugs, alcohol, or psychiatric care, driven by the question, “What did I do to deserve this?”

Unlike many medical challenges, NDEs are easily diagnosed and treated. Once you understand the components of an NDE, you as a physician should have no trouble differentiating it from the many physical and mental conditions that cause altered mental states. Unfortunately, some unaware physicians attribute NDEs to psychosis or confabulation, telling patients, “You imagined it due to poor blood flow to your brain. Don’t talk about it, or people will think you’re demented.”

Treatment of NDEs

Physicians need to remember five key steps: ask, listen, validate, educate, and refer. Ask, “While you were unconscious, did anything unusual happen that you would like to talk about?” If the answer is “yes,” practice sympathetic listening. NDEs are among the most meaningful experiences for the person, affecting them and their family for life. Listen attentively and never suggest that the NDE was imagined. For the experiencer, it is often the most ‘real’ thing imaginable. Validate and educate by saying, “Many people experience what you did when they nearly die. We don’t fully understand these events, but most people live fuller, richer lives afterward. The most common term for what you experienced is a near-death experience.” Educate the family as well, as this is often a life-altering event that may affect relationships. Divorce or alienation is not rare, especially if the physician mishandles the diagnosis and treatment. Finally, refer patients to organizations like the International Association for Near-Death Studies, the Near-Death Research Foundation, or the University of Virginia School of Medicine Division of Perceptual Studies.

Bibliotherapy—using reading materials as a therapeutic aid in medicine and psychiatry—can also help. A plethora of books are available, including some written by physicians who have experienced NDEs. Other physicians have dedicated their careers to studying NDEs, focusing on their etiology and content validity. One particularly compelling account comes from Lloyd Rudy, MD, a cardiac surgeon and an unimpeachable witness, who described an NDE in a 12-minute video.

You might ask, “And how were you educated, oh enlightened one?” Short answer: by accident. A friend loaned me a book on NDEs, asking, “John, as a doctor, what do you think of them?” I was clueless, but I read the book with increasing fascination and then read more on the subject. Over time, I realized NDEs represent an untreated medical syndrome. As a physician, it’s not necessary for you to believe in the content of an NDE, just as you wouldn’t focus on the content of a patient’s delirium tremens hallucinations. Instead, recognize the syndrome and treat it accordingly.

The near-death experience is a common and important medical syndrome. Esteemed researchers believe NDEs offer unique insights into consciousness and mortality.

John C. Hagan III is an ophthalmologist.