Tomorrow is promised to no one

I have always searched for deeper more meaningful purpose than simple success in my life. This has become more and more important over time, especially starting with my years as a medical student, when I first saw people departing their lives, like passengers on a journey that has come to an end. Seeing this has increasingly reminded me that my own voyage would inevitably dock for the last time. And as I depart from this journey, will I be wondering what it had all meant? 

This hit home for me during the challenging times where I – and thousands of other doctors and nurses – lived and experienced COVID-19 in New York. I was one of the intensive care physicians working on the front lines of the storm as it hit in March 2020. Very rapidly, we found ourselves short on time and running out of space. We were opening a new thirty-bed intensive care unit almost daily to try to deal with the influx of critically ill people. When all was said and done, we had a whole COVID-ICU building with almost three hundred ventilator beds because there were just so many patients flooding in on an hourly basis. Though we had been warned –by China, by Italy, by Spain – the whole city and state underestimated COVID's impact. We had known the storm was heading our way, but too many had simply hoped it would not come. 

We managed an unprecedented number of "crashing patients," people in severe distress, panting frenetically, breathing at a rate of sixty breaths a minute, or one breath every second. They were exhausted, shattered, and petrified, with eyes bulging through fear. They were unable to breathe any longer on their own. However, due to the sheer volume of cases, people were unfortunately forced to wait for available ventilators. Given the number of crashing patients and limited resources at our disposal, we did our best to save as many people as possible. We were sending emergency response teams to put out fires in every corner of the hospital. The emergency pager and overhead calls for help were going off incessantly. 

I can only compare the experience to a war zone. And like a war zone, we were making life-and-death choices throughout our thirteen-to fourteen-hour days, for days on end, with little to no breaks. 

It was disheartening to see rows and rows of people who looked like zombies hooked up to machines. I had to remind myself that they were indeed people – someone's child, father, mother, brother, sister, wife, husband, or friend. Though in reality they looked like husks of people. One out of five of the 5,000 people who came to us in that first wave succumbed to the devastating complications of their disease. 

Nurses and all medical ranks were asked to join what essentially became a quasi-national service. It was a conscription, plain and simple, just like the draft during a time of war. Staff members were notified where they would be needed, and they were expected to show up. Just like an Army draft, you had some people who had found reasons not to show up – because they were, understandably, scared to die. On the other hand, we also had people who voluntarily risked their lives to serve in any way they could. One of them, a world-renowned professor of ophthalmology in his sixties, showed up one day and after introducing himself said: "My wife thinks I am volunteering at a call center. She doesn't know that I have volunteered to be on the frontline of the ICU. She will kill me if she finds out." 

That was because many doctors and nurses had already died on the frontlines. Every time we treated a COVID-19 patient, we recognized that person could cause us to end up on a ventilator and die within weeks or months, like so many others. On more than one occasion, to preserve someone else's life, I and others had to expose ourselves to forceful gushes of COVID-19 infected air being blown directly into our faces, sometimes for up to an hour at a time, with just a mask as our sole line of defense. Imagine seeing all the complications – limbs turning into gangrene, blood clots, dialysis, sudden death – and then having to expose yourself to its cause. We didn't know how many of us might be alive in two months, but we certainly expected some not to be. 

These events caused my colleagues and I to look at life more existentially. We were asking ourselves deeper questions about our purpose, knowing that our time might come to an end soon. 

One explained, "[This] allowed me to ask myself, 'What is it that I genuinely needed to do? What is life about really?' Death is a completely normal process of life. The question is, what do you do in between?" Ah yes, the in between birth and death. This thing we call living. 

The global pandemic touched nearly every corner of the world. It inflicted untold suffering on countless families and upended the very fabric of daily life, from how we interact and work, to how we raise and educate our children. At the same time, it brought to the fore larger and more difficult questions: What is the ultimate meaning and purpose of our lives? Is there some deeper meaning to our existence that transcends our day-to-day existence? And what will become of us, and our loved ones, when we die? In that sense, the pandemic served as an existential wake-up call, causing individuals and communities of all backgrounds to seek a more complete paradigm, one that not only allows for a better understanding of the world around us, but also the world within and the possibility of an existence beyond this life. 

People questioned their priorities, and people reeling from loss, changed. Even in the media, suddenly, the world of celebrity and gossip had taken a back seat to the world of altruism and selflessness. In my experience, for every one person who acted more selfishly, many more acted selflessly. People did whatever they could to serve others, with humanity and understanding, even if all they could do was offer a simple gesture of gratitude. It was extremely heartwarming to see people come out at 7 p.m. to cheer us on and show their appreciation. It was surreal and touching that even the police and fire crews, who had put themselves at risk for years, were standing outside hospitals and saluting those working inside. 

As one of my nursing colleagues said, "[COVID-19] challenged our prevailing view of being self-focused, seeking comfort and simply following pleasure – with little attention to the world of hardship and difficulty beyond – even though we all learn through hardship." After all, as she put it, during the first wave of the pandemic we all learned that "tomorrow is promised to no one." 

Flight of life

What is it about loss that brings out such beautiful human qualities: humanity, comradery, kindness, understanding, and empathy, and what is it about loss that makes us stand back and question our purpose? Why does it take a natural disaster to shake us into thinking more deeply? 

The pandemic brought home the importance of seeking answers to our seemingly existential questions, as well as the relevance and importance of the scientific research we had been engaged with. This had been clear from the perspective of the scientist and doctor in me to save the "lives and brains" of people. Now I felt it on a deep personal level from the perspective of a person who had faced the reality that my own time is limited and may end abruptly. It focused my mind on how our research may help people like myself find meaning and optimize life. This is why knowing what happens with death is important for life as it helps direct what to prioritize and how to live. Knowing the purpose directs the process. 

Imagine being on a fifteen-to twenty-hour flight from New York to Singapore. During the flight everyone is naturally fretting about what seat to sit in, or what snack or meal they will be handed. They engage themselves with the immediate matters that might maximize their comfort on what may be an otherwise uncomfortable flight, by virtue of being so long. They are concerned with the quality of the food, where to stow their bag, who they are sitting next to, the entertainment, movies, and so on. Of course, a flight is finite and either way, those fifteen to twenty hours, whether comfortable or uncomfortable, will pale into insignificance compared with the reality that awaits them in the new destination. There you will be concerned with things like finding suitable accommodation, a new occupation, a new livelihood, learning to deal with cultural nuances, rules, regulations, and so on. What had preoccupied you on the plane itself (the food, snacks, and so on) will seem completely meaningless by comparison. 

Now imagine that while you are on the flight, you realize there is a risk that the plane could crash on landing. How would your priorities change on the flight? What would you be focused on? Logic would dictate that everyone should prioritize doing whatever is necessary to ensure the plane will land optimally. That means finding someone to steer the plane safely, while there is still time. After all, what really matters for everyone is to arrive at the destination and pursue their life in that reality. The flight itself is nothing more than the means or the process by which to get to the destination. However, the ultimate purpose is to arrive safely and pursue a new life. Suppose your fellow passengers ignore you? They are more interested in their movie or flagging down a flight attendant for another drink. Their actions and behavior continue as if the airplane is somehow going to be their home forever. They acknowledge the plane has to land, but to them, that can all be dealt with when the time comes. For now, they are too busy with other, more pressing issues. Some are watching their favorite movie, others picking out their meal. No matter how much you try to explain that it will be too late to deal with the landing later, they ignore you. Or if they look at you, they look at you as if you have two heads. You ask yourself, "Am I the one who is illogical and crazy, or is it the other 500 or so people who have become so preoccupied with their immediate comforts that it has made them oblivious to the far more significant reality and purpose that lies ahead?" 

I know this sounds extreme. Obviously, in this hypothetical situation, everyone would have prioritized the landing. But put this analogy into the context of how most people and society prioritize and deal with various matters in life – not just the question of what happens with death – and you will see it resonates. We saw the devastating consequences of putting off preparations for COVID-19 in terms of the sheer numbers of lives lost, families destroyed, and economies devastated. Even though many had warned against putting off dealing with the inevitability of the pandemic, those responsible were unprepared and uninterested. Even as China was being engulfed, many continued to convince themselves that it would just be another cold or flu. They were unwilling to plan, because they were too preoccupied with other things, until it was too late.

In my experience, when it comes to the question of what happens when we die, there are two types of people. The first are those who are completely uninterested, would rather ignore death outright and bury their head in the sand, hoping it's just never going to happen. They keep themselves preoccupied with everything else in life, until it's too late, instead of facing this question up front. 

The second group of people are those who can't help but contemplate death and can't live without knowing what happens after we die. They believe there's a higher purpose to living, and they're constantly striving to gain those answers. They just can't live without it, and they feel that it is vital to know the answer because those answers will fuel the way they're going to plan and execute their life in a more meaningful way. I am in the latter group. I categorize these people as well as myself as "the planners." We recognize the importance of planning for a different eventuality, in the same way someone in their twenties or thirties is working but is fully focused on the inevitability of their retirement and is planning for it in advance. 

Considering how long the Earth has been turning, is there any real difference between a fifteen-or twenty-hour journey on a flight, and a journey lasting eighty years, which is the expected length of our own flight of life? In relative terms, they are both transient flashes in time. As with the passengers on the hypothetical flight, it is natural to seek ways to optimize what may be relevant and important at different stages in life. Nobody on the plane would have been comfortable cramped between others. It is natural to try to optimize our situation as best we can. But do we become so engaged as to forget the overall purpose, or do we recognize the process for what it truly is: a means to optimize the purpose? 

The main issue to try to determine in life is what is the real "signal" and what is the "noise"? For those who may be less familiar, in scientific language the signal is the meaningful information scientists are trying to detect in their studies. The noise is the unwanted variation or fluctuation arising from other less important phenomena that interferes with the signal. To get a sense of this, imagine trying to tune into a radio station. As you move the dial you pick up white "noise" and after a few minutes, you may pick up the real "signal" and tune into a station.

Purpose 

Like many of us, I have tried to detect the signal from the noise in life. Of course, there are many places for people to turn to for answers. As discussed, these are not new questions. People have faced them throughout time. The question I faced was: Where can I find answers that are compatible with a rational mind? Do we turn to others, our friends and family, society, or maybe religion, or perhaps the ever-increasing groups of people who purport to help with spiritual well-being? Or do we maybe turn to science? Where does one find help to optimize life for the signal and purpose we have talked about? 

Society has its own measures of success, but it never made sense to me to limit the deeper purpose of life to these things, which, beyond a certain level of necessity, rarely aid genuine fulfilment or happiness. Wealth is a prime example. Psychologists have shown that beyond a certain threshold, getting richer is not associated with greater happiness or satisfaction; in fact, it may have a detrimental effect on well-being. Yet paradoxically, society cherishes and promotes wealth and the lives of the wealthy. 

Psychologists call this phenomenon of chasing pleasure the "hedonic treadmill." You know you are on it if you are pursuing one activity after the next to feel the transient sensations of pleasure, power, or status. The problem with this pursuit, however, is once we become accustomed to a pleasant sensation, we naturally want more of it. So, in effect, we are constantly increasing what we think we need to be happy or to feel pleasant or satisfied. Of course, what we desire can seem benign – such as tastier food, better vacations, better cars, better promotions, etc. On the face of it, each desire may seem harmless, but if these desires drive our lives and become our purpose, we are walking along that hedonic treadmill, filling our lives with limited pursuits that distract us from what may be more meaningful. Ironically, science has shown that the more self-centered we are, the less happy we are. By contrast, researchers, such as Dr. Sonja Lyubomorsky of the University of California, Riverside, and author of The Myths of Happiness: What Should Make You Happy but Doesn't, What Shouldn't Make You Happy But Does, have discovered that it is resiliency and growth in the face of hardship and the selfless ability to help others that leads to greater happiness and fulfilment. 

The passengers ignoring the impending crash are like all of us, in denial about the ultimate fact of our life: its end. Most people keep themselves so engaged in the minutiae of how to optimize their comfort and well- being in our brief hours of life, like those passengers, that they forgo any need to think beyond. These distractions manifest as concerns about status, wealth, career, beauty, relationships. Some of these are necessary rungs on the ladder of life, some distractions that masquerade as the goal or purpose of life and become part of the hedonic treadmill of life. Once on that treadmill, we run faster and faster toward our superficial goals of more, bigger, better, faster, all the while staying firmly in place. We may feel like we are moving forward, but we're not really going anywhere significant. 

This is where the human side of the scientific study of recalled experiences of death comes in. We've learned from thousands of testimonies that in death we learn how to live. No one comes back from the grey zone determined to upgrade their car, or buy that bigger house, or overhaul their wardrobe, or regret missing out on a promotion. Instead, they come back with a determination to simply live with a higher purpose. In 2020 I felt that firsthand. During that first wave of the pandemic, the loudest noise from my own conscience was: How much effort did you make to become a better human being? What have you learned from your errors? What did you accomplish as a human being? My career was important inasmuch as it allowed me and my family to live, and to the extent that it may have been of help to others. What had I accomplished as a father, as a son, as a husband, and so on? Had I gone out of my way to assist others? Whose lives had I helped to improve? Importantly, what were the opportunities where I could have done more for others, but decided not to? This was like a powerful driving thought in my mind. Many other aspects of my life seemed to pale in comparison. 

There is also the reality that everyone's life and needs are different, and even the same person has different needs and priorities at different stages of life: my twenty-five-year-old self had to work and study hard to overcome many challenges in order to lay the foundations for the security of my current, fifty-year-old self. I, in turn, now need to think about what will be relevant and meaningful to my future seventy-five-year-old self. If am financially secure, then what is worthwhile and meaningful may be to spend more time to help others, without any expectation of reward, rather than getting stuck on the hedonic treadmill. Each person's life, their own calling, personal pursuits, and what is worthwhile will probably vary depending on their life circumstances. However, the need to find the "signal" from the "noise" and what has meaning is critical and relative to the endgame. Given what we know is going to be the endgame in the grey zone of death, I need to engage with my life in a manner today that is going to also be optimal for the reality that I will face in death. 

To answer their questions, people have traditionally turned to religion. However, there are so many contradictions among the beliefs put forth by different religions that they often leave people with many unanswered questions. Nonetheless, at the heart of most religions there is an emphasis on becoming a better human being and respecting the rights of others, even if some supposedly devout religious people don't follow these basic fundamental principles. It is also interesting that this is the only component of religions that stands out for people in death. In the grey zone, people don't focus or highlight the ritualistic aspects of religion, or its sociocultural aspects, just the application of their core moral principles. This is the main common unifying ground between all true religions. 

However, when it comes to helping people make sense of what happens after death, there are multiple permutations and contradictions for each faith. The beliefs are often based on stories first told thousands of years ago. Often these stories are told in a manner that would help people of a particular society and time period understand them – using depictions that were familiar to people then. However, these depictions and rituals may not resonate now. For instance, as discussed, many religions describe a hell of burning fire and despair, or heaven as an everlasting beautiful place of happiness and joy. Yet during the recalled experience of death, people come to understand that such depictions are overly simplistic. Instead, they report a hierarchy of knowledge and truths, like an educational curriculum covering the different facets and levels of humanity. It is the purpose for which they may return back to life while recognizing that one life may not be sufficient to achieve all the necessary levels of knowledge. The only "hell" they come across represents the painful consequences of their own actions, and the only "heaven" also represents the consequence of their own actions. 

Some people try to disembark the hedonistic treadmill by turning to contemporary spirituality. Spirituality originally meant the search for higher meaning in life, moral and ethical growth, and a desire to draw closer to "God," meaning development of ethical and moral virtues. Today, this term is increasingly used to refer to a group of diverse activities, ranging from altered states of consciousness, inner peace, harmonious relationships, music, chanting, contemplative practices, psychic powers, astrology, and even the use of hallucinogenic drugs in search of so- called "spiritual awakening." 

However, these activities are heavily focused on inducing certain emotional states in people, not developing our humanity through rationality and reason. It is also hard to see how they can lead to greater knowledge in line with what people report with their experience of death. Nor can they clearly answer questions about purpose or meaning in life. During the recalled experience of death, none of these increasingly popular practices are highlighted or stand out as having had meaningful value either (as we saw with traditional religious ritualistic practices). 

If we take what is understood to be meaningful and the signal in life based on what people come to understand during their recalled experience of death, then an "authentic" form of spirituality would have to be defined very differently from what is being labeled as "spirituality" in our times. Such an authentic spirituality should represent a universally applicable rational method, which when applied would lead a person to develop their humanity and increase their cognitive understanding of real truths, as reflected in the layers and hierarchy of knowledge and understanding that survivors experience in the grey zone. 

Before I address what has resonated with me in my own journey of life, let me address what I think will be the solution for the future – namely, that science and the scientific method need to help us address our deepest existential questions, including what is authentic spirituality, in an impartial manner.

Lucid Dying: The New Science Revolutionizing How We Understand Life and Death by Sam Parnia (£28, Hachette Books), is published on 29^th August