Pam Reynolds: A Pre-emptive Takedown of NDE Skeptics

Question from Kamil:

Hey LX! Question about the famous Pam Reynolds NDE. On the awareofaware website, I found comments on the Pam Reynolds case where a few people who researched it called the science explanation BS because the skeptics lied. Here is a response from a guy who researched the case and found problems with Keith Augustine’s explanation:

“It’s a little bit irritating to read statements like that about the Pam Reynolds case! Meticulous researchers Smit and Rivas and myself (I’m not a researcher) studied this case in minute detail).

Her first veridical perception occurred when she was under burst suppression, a pattern of mostly flat brainwaves in which consciousness is categorically not possible. We have the clear statements from the surgeons who conducted the operation on this matter.

I doubt if you have any real conception of the brutality of the operation that Pam was subjected to. That’s not your fault of course; mischievous pseudo sceptics have been quite successful in spreading misinformation and downright lies about the case because they don’t like the obvious implications.

When surgeons are removing your eye socket (bone flap) to get into an area inside the skull so they can get down to the base of the brain in an area called the circle of Willis (apparently) they don’t want anyone to wake up… believe it or not. That is why they place you in the deepest anaesthetic state possible without killing the patient…burst suppression. Her EEG was monitored all the way through the operation and no brainwaves were detected at that time so it is impossible that she woke up.

However, even if she had been wide awake (as the sceptics prefer she still had
100 decibel clicking nodules (11 clicks per second) securely fixed in her ears which is comparable to hearing the sound of a pneumatic jack hammer several feet away. Pam would have heard these incredibly loud sounds in her ears if she had been awake but she never mentioned them.

Her second set of veridical observations occurred when she was not only without brainwaves, but her heart had stopped when they were starting the process of rewarming her on circulatory by pass. That occurred at 27 degrees C (I discovered that fact) a temperature at which consciousness is not possible. She was dead. And she still had the loud clicking nodules hammering away in her ear canals.

It was previously thought that this veridical observation occurred at 32 degrees C. Keith Augustine has it at 32 degrees C and refuses to change it. However even Gerry Woerlee had to admit that I was right.

So, the Pam Reynolds case is indeed absolutely solid (as it always was) but because there is no law to prevent people telling lies and spreading misinformation online, the popular misconceptions continue to this day.”

My question is, do you think it’s true that skeptics just lie, or hide the truth? Many people who believe in OBEs and NDEs say this. 

Also if it were true that we could not explain Pam Reynold’s case, would you then believe it was really her soul, or would you say we just cannot explain it? I am just really confused on what to believe. I have even heard of people who spoke with the doctor who performed the surgery saying there is no way she should have experienced this and gotten the details correct that she did, including the shaving of her head and the use of a tool with even the correct description (a saw that looked kind of like an electric toothbrush). Do you think this likely demonstrates truth in NDEs and souls?

Answer by SmartLX:

It’s rare that a near-death experience claim has a high enough profile to deserve its own Wikipedia page but here we are. To tackle the case point by point:

  • It is never possible to determine when during the entire period of consciousness a dream or hallucination has occurred, because the subject has no sense of time when unconscious. If there was a period during which the brain was not active enough to form such experiences, such as when super-chilled and bloodless, it probably happened either side of that. Reynolds was under for hours before the procedure.
  • From an NDE believer’s perspective, however, the timing is determined by what was “observed” in the outside world during the NDE. The one unique marker in this case was the use of an electric saw, but since it looked and sounded like a dentist’s drill this is hardly an outlandish guess to make, consciously or unconsciously. As for shaving her head…she woke up with a shaved head, didn’t she?
  • See one of the reference links here: it’s possible to hear through the sound coming from the earphones, and you can test it for yourself if you don’t mind an unpleasant experience. Reynolds was a musician with a trained “ear”, making it even easier to pick something out. If there was any anaesthesia awareness in play, the noise does not invalidate it.

As for your other question about the behaviour of skeptics, the idea that they lie and conceal the truth is something believers in the disputed phenomena often claim. An X-Files-esque conspiracy to suppress evidential support for one’s own beliefs is easier to accept than a simple lack of evidence, because it makes it seem far less likely that one is just wrong. Perhaps some skeptics have been deceitful (they’re only human), even in the particular case of Pam Reynolds, but even with the facts “corrected” to what the advocates would like, there is not enough evidence to suggest anything supernatural. It’s possible that these accusations have been leveled at Augustine et al not just to rebut specific points but to discredit anything else they’ve written about the case, and reassure believers that even the refutations that seem legitimate must have holes in them somewhere. Saves them thinking too hard about it.

25 thoughts on “Pam Reynolds: A Pre-emptive Takedown of NDE Skeptics”

  1. But. We dealing with the brain after all. And the brain is still uncharted territory, (at least as to its full capabilities). And so for one, because we have all heard about a supposedly dead loved one, after having been declared “brain dead”, after one and another scan, but then right before the disconnect, that person wakes up, we don’t really know what “brain dead” really is.

    That’s not to say that God is not speaking to a dying loved one. But that the loved one is going to heaven, (or hell), is a complete contradiction of what the Bible says. Please read Ecclesiastes 9:5-6

    But as that person is dying, God can and will be there, because He promises that He will never leave us or forsake us. And in Psalm 23 this is mad abundantly clear. “Even in the shadow of death”. At least for the Christian. We don’t have to fear death.

  2. Common sense and logic say that when we are countering something or/and somebody, in the court of justice or anywhere else, in a discussion, a dispute, in this case over the existence or not of ‘god’, then WE DO NOT USE OUR OWN ANYTHING, words, relatives, even friends, as our witnesses, our books, anything that the other party is contradicting.


    For a ‘god’ believer, a Christian theist,



    whenever we argue over the non/existence of ‘god’,

    The BIBLE is NOT a NEUTRAL source because it was written by people who claimed there is ‘god’, actually that some Jesus person was born of ‘god’



    The theists is due to use some OTHER sources as their proof that the bible is true, not the very same bible.

    Because the bible says there is ‘god’ so using the bible as proof that there is god is insane or very VERY .V E R Y…S T U P I D

    An issue of on’s I.Q.

    This is so COMMON SENSE that I cannot believe that this theist does over and over again, times and times again…


    This time he told LX to read ecclestiastes…FROM THE BIBLE…with threes numbers, in order that he, LX, sees that there is ‘god’ i.e. that the bible is true !!!



    My mum says I am the most beautiful girl in the world. Does what my mom says make it true. Everybody would say, ask OTHER people. Not her mum.

    Ask other books about the non/existence of ‘god’, not the bible.

    Ask ‘GOD DELUSION’ and all Richard Dawikns’ books, Stephen Hawking, Christopher Hitchens, Sam Harris, Dan Dennett



  3. (Ladies and gentlemen, Keith Augustine himself. His comment was marked as spam, probably because of all the links, so he asked me to post it. – SmartLX)

    “It’s possible that these accusations have been leveled at Augustine et al not just to rebut specific points but to discredit anything else they’ve written about the case, and reassure believers that even the refutations that seem legitimate must have holes in them somewhere. Saves them thinking too hard about it.”

    This guess is spot on.

    The idea that I’m a “mischievous pseudo sceptic” engaged “in spreading misinformation and downright lies” because of my reconstruction of the Pam Reynolds case is the kind of rhetoric without substance that I’ve come to expect from many survivalists. This is the sort of reaction that you invite when you provide a clearly reasoned, evidence-based analysis of “their Roswell,” the “smoking gun case” that true believers will cling to no matter what the evidence.

    On the website that Kamil quotes, Tim writes: “It was previously thought that this veridical observation occurred at 32 degrees C. Keith Augustine has it at 32 degrees C and refuses to change it.” First of all, the only temperature I ever mention in the text of my critique is 60°F. Search for the degree symbol ° yourself in the online version:

    Then there’s the timeline of the events in the case, which also never goes lower than 60°F:

    And of course there’s the original source of all this information about exactly what happened, when–Michael Sabom:

    Since I merely use survivalist Sabom’s information, if that information is in fact inaccurate, it is Michael Sabom who is doing all the things that “Tim” accuses me of, and in his print books and journal articles at that! Since Sabom is the one with the access to the unpublished medical records, I can hardly be faulted for not checking Sabom’s facts against those records for accuracy, if for some reason Sabom reported the facts inaccurately–something that I have no reason to believe, and which “Tim” only suggests because he pretends that those facts come from nefarious “pseudoskeptic” me rather than from survivalist Michael Sabom (and of course if I’m not in “Tim’s” tribe, I must by definition be a liar and propagandist).

    Second, in order to “refuse to change” the text/graphic to reflect some new temperature, I would have to be ASKED to change the text/graphic to display a some new temperature. No one has ever asked me to do this.

    Third, I have not modified my online Secular Web critique of the case AT ALL since 2008, right after my three 2007 exchanges in the Journal of Near-Death Studies were published, the first of which concerned the Pam Reynolds case (in part). (And you can find links to PDFs of the print exchanges on my Secular Web bio page, but the online material is more or less identical to the print material.) So my online critique has not been updated to discuss new material EITHER “disproving” my case or supporting it, such as the supporting evidence that SmartLX linked to showing that it was indeed possible for Pam Reynolds to hear when the bone saw started up early in her operation, which is really the only truly veridical observation claimed in the case. Compare my 2008 comments about whether Pam Reynold could ear at this location:

    With the results of Gerald Woerlee’s published direct test of whether she could hear:

    You be the judge of who is spreading “misinformation and downright lies” now.

    Incidentally, in their own published work (The Self Does Not Die), the researchers that this pseudonymous troll “Tim” (whose real name is Stephen) cites try to refute the centerpiece of my book, The Myth of an Afterlife, without ever even looking at it! This is immediately evident to anyone who actually does look at it in two ways.

    First, the authors of The Self Does Not Die attribute my coauthored chapter, “The Dualist’s Dilemma,” to the editors of the entire volume, Michael Martin and Keith Augustine, when in fact that specific chapter was written by Keith Augustine and Yonatan I. Fishman.

    Second, they clearly refute the abstract of the chapter only (which they lifted from rather than the chapter itself because they never bothered to skim, let alone read, the chapter that they were criticizing. (No one ever accused them of role modelling the pinnacle of scholarship.) This is evident because they simply cite a quotation by Neal Grossman as the last word on the subject without any further comment, when in fact 7 pages into the chapter that they are criticizing, that VERY SAME quotation is quoted verbatim and responded to in depth. Why aren’t those responses mentioned at all? Because they would actually have to have skimmed the chapter to know that they were there. (The only alternative is that they knew those responses were there, but dishonestly omitted them so that their readers would get the impression that their point was never answered. But I’m interpreting them charitably here, and the charitable interpretation is more consistent with the fact that they mixed up the names of the authors of the chapter, which are shown in headers at the top of every other page of a 90-some page chapter when you look at the actual book.)

    See for yourself:

    Then Search Inside’s page for The Self Does Not Die for “Neal Grossman” on p. 225:

    Since these researchers know that their readers comfortably reside in an echo chamber where they will never bother to check The Myth of an Afterlife themselves (even though all you have to do is click the links above), they can get away with the very things that they project on to skeptics.

    1. Hello Keith,

      thanks for your response. Now that I have seen what you have to say, I have indeed decided not to take that side seriously in terms of the PR case. I was merely asking for a skeptic’s opinion on some of the things I have seen the Pro NDE community say because I am not very knowledgeable in these debates, so I am not always sure which side to take. However, since you have provided evidence and shown how dishonest the other side has been, I fully accept your analysis of the case. Thanks!

  4. Hi

    I would like to add some points why I also do not believe that the Pam Reynolds case is proof of a afterlife. There are others problems with the Pam Reynolds case:

    1. There are many cases of stand still operations and yet no one reported a similar case like in the Pam Reynolds case in years after this. If the Pam Reynolds case is proof of it then other operations of this kind would have resulted in the same result. However we do not hear any other remarkable case like this one.

    2. We do not know what Pam Reynolds knew about the operation before it. Have one thing in mind she had a dangerous operation before her, so I believe she was told a lot of details what will happen during it. This is at least a normal procedure in many countries. So its not hard for her to make the rest up.

    These are two of my cents to this NDE.

  5. Just because your mom tells you something positive, even if it does not make it true, it does not make it not true because it comes from your mother. And you need to remember that beauty is subjective.

    So just because some do not accept the Bible as the last say, that does not, not make it the last say so.

    The Bible has been used by thousands of people in different disciplines, and it has been shown to be unlike any other book.

    Go ahead and show me another book that has been more accepted and verified.

    1. Gerald writes: [Go ahead and show me another book that has been more accepted and verified.]

      “On The Origin of Species”. It’s way more accepted in non-Christian countries and cultures than the Bible. In fact, just about every science book ever written is more accepted than the Bible. And they sure as hell are more verified than the Christian tome of tales too.

      That was an easy question.

  6. You do realize I am talking about the Bible. It is a well documented validated historical document. A book that was written hundreds of years ago and still being used to teach from. A book that millions of people have found a wealth of help from. And that is thousands of scientists as well as millions of others. There is no other book like the Bible.

    You are allowing your prejudices to influence your good judgement.

    1. Gerald, I know exactly what book you are talking about. And since it means nothing to the majority of the world, whilst Darwin’s book is accepted by people around the globe, it’s obvious that Darwin’s book is much more accepted. Darwin’s book (and other science books for that matter) contain data and empirical evidence that can be verified and validated by any person on Earth. It’s not even close which is more widely accepted.

      No legitimate educator teaches from the Bible, Gerald.

      You’ll have to excuse me if I let my good judgement get in the way of your prejudices…

      1. Tim, you are always saying things that you must know are not true. Or you really don’t know what a real scientist is. Why do you keep denying that there are Christians who are scientists who are just as scientific as any of the atheists who you think are scientists. The only thing is, you and they don’t have proof for evolution. It is just hearsay. And the design of life bespeaks of God.

        1. Gerald writes: [Tim, you are always saying things that you must know are not true.]

          Like what? As usual you don’t list any details or specifics about your claim, which is par for the course with you. As it relates to this particular thread, I’ve said nothing that is false. Obviously more people except Darwin’s book than the Bible, given that evolution is accepted by the vast majority of people on Earth, while less than 50% of the world is Christian. There’s nothing controversial or debatable about that statement.

          [Or you really don’t know what a real scientist is.]

          This is a hilarious statement from you Preacher, given the countless times you’ve been unable to understand the difference between a theory and a scientific theory, or what empirical means, or verifiable, etc. A real scientist uses the scientific method to discover and explain things, even if those discoveries and explanations go against their world view.

          [ Why do you keep denying that there are Christians who are scientists who are just as scientific as any of the atheists who you think are scientists.]

          Check every single thing I have ever written Gerald. I have never said a Christian cannot be just as “scientific”. In fact I have often stated that, based on survey data, the majority of scientists in the U.S. are religious and/or believe in a personal god. Yet the vast majority of those scientists (talking 99% here) accept the theory of evolution as a valid explanation for the diversity of life on Earth. In other words, there is no prerequisite for a person’s belief system in order for them to follow the scientific method and do good scientific work. Christians can be just as good at science as an atheist.

          Let’s get down to brass tacks here. You are specifically talking about the “creationist scientists” that I regularly and thoroughly debunk every single time you bring their garbage claims to these discussions. You think because they call themselves scientists that their claims must have merit. The problem here Gerald, which I have explained before and will patiently do so again, is that they don’t follow the scientific method. Therefore, they are not scientists. I don’t care if they wear lab coats or have PhD’s, if they don’t gather evidence and test it, they aren’t conducting science. If their claims aren’t verifiable and repeatable, they aren’t doing science. There are plenty of Christians who do great scientific work every day, but none of those Christians are in the false field of creationism. There is zero empirical evidence supporting their pseudo nonsense.

          [The only thing is, you and they don’t have proof for evolution. It is just hearsay. And the design of life bespeaks of God.]

          I was going to ask you if you’ve read any of the scientific books I’ve asked you to, or had any discussions with any biologists or paleontologists or morphologists or geneticists or geologists at your local university, but then I remembered that you’ve ignored those requests for years now. You’d rather stay purposefully ignorant for some strange reason. That’s on you preacher…

  7. Hi

    Found another problem with this case: Pam Reynolds case happened in 1991 but it was recorded in 1994. Pam had 3 years to get additional information about her operation and I strongly believe she did who would not want to know what happened to you after such a difficult medical operation? Here are the information I found:

    [quote]In 1991, at the age of 35, Reynolds underwent a rare operation to remove a giant basilar artery aneurysm in her brain that threatened her life.[/quote]


    The study began in 1994:

    [quote]Begun in 1994, The Atlanta Study is the first comprehensive investigation of its kind into near-death experiences (NDEs).[/quote]


    1. Not with love, but only to show that as much as Mr. Dawkins has said, he still has not proven anything. All you have to do is look at the debates he has attended and you can see how uncomfortable and unsure he is. Speaking without saying anything.

      1. You are judging what Dawkins says in debates based on….your perception of how comfortable he looks? That’s like judging the words of Martin Luther King by whether or not it’s cloudy outside. You make zero sense sometimes….

        Listen to what he states, and research it to see if he is right or not. (I write that like there’s a snowball’s chance in hell you would even bother to do that Gerald, when I know full well you aren’t interested in learning about the other side of the argument…I guess I can still dream, eh?)

  8. Gerald has not enough scientific education nor i.q., but, instead, as if to compensate for these two lacking of his, he has a magical prone character, which is possible only with 1. uneducated scientifically people with at the same time low i.q. and with 2. not enough intelligent and free of magical thinking ‘scientists’.

    Which, all, prevents both him and these ‘scientists’ to see that


  9. Well seeing as you nor anyone else who may not agree with me are unable to provide any evidence to support your views, then what reason it there to believe what you say?

    And remember you don’t want me to talk about you, so why press me to answer you. I will only do this when I think you are not correct. Better for you if you don’t talk about what you don’t know, then to have someone show you that you don’t know.

    1. Don’t be so dishonest, that kind of behavior is beneath you. I’ve mentioned books you can read, I’ve asked you to go talk to people at universities, and I’ve listed web sites. You’ve been given the information and the sources for some of the mountain of evidence that supports the theory of evolution, but you’ve made zero effort to read and pursue that. It’s rather embarrassing that you think you would get away with stating that no one has provided you with data and evidence (as if Google is broken on your computer). You sure seem adept at finding creationist crap all the time to post on this website though….

  10. oh shut up you ignoramus even if i have to go from here i will say what you are no one say anything to you because no one takes you seriously

    1. Niki. I’m sorry. If you don’t want me to be here, and you would prefer to have someone tell you only what you prefer to hear. I’m gone. I’ll be praying for you.

      1. Clasping your hands together and talking to no one doesn’t accomplish anything…

  11. No, I am judging on all that I have taken in. He is not making any sense, and failing to provide what little he has said, with any kind of demonstrable evidence. He has said that life only looked like it was designed. But the inference is still that life looks designed. And this coupled with the fact that none of the different kinds of lifeforms have ever been seen to evolve into another form of life.
    Make it very clear that he is lost. Hemming and hawing his way through a meeting that he really wants to be finished with. Because he has nothing to supply that can ever stop the plunge of the hypothesis of evolution from the skies, to prevent it from burning up.

  12. In response to Keith Augustine’s rather surly and inaccurate post, accusing me of being a “troll”, whilst at the same time reiterating the same incorrect “facts” around the Pam Reynolds case he has been peddling for years, I would like to add this.

    Everything pertaining to the Pam Reynolds case in the book “The Self Does not die”, is factual. We checked with the surgeons who conducted the operation (not Gerry Woerlee who wasn’t there), the definitive source…and we also examined Spetzler’s published paper on hypothermic cardiac standstill.

    The facts are that when Pam heard the conversation about her femoral arteries being too small for cannulation and ‘observed’ the bone saw (amongst other things), she was under burst suppression, a pattern of mostly flat brainwaves in which consciousness is not possible.

    We have the written statements from Spetzler himself and his assistant Karl Greene. Spetzler’s paper also makes it clear that the protocol of the operation at that time (in the early nineties) was to achieve burst suppression early, well before standstill. Remember that Spetzler pioneered this operation. Subsequent surgeons who have also utilised hypothermic cardiac standstill, seek burst suppression later, but Spetzler did not.

    The second set of anomalous observations around Pam’s operation occurred when she was being rewarmed after standstill. When her temperature reached 27 degrees C, her heart went into ventricular fibrillation ie stopped pumping). This is the time when she (somehow) observed her body jump from the first defibrillation and then entered her body and felt the second jump (the second defibrillation).

    It isn’t possible to be conscious at 27 degrees C when coming up from a lower temperature. Leaving her extreme hypothermia aside, her heart was stopped anyway and she was still
    full of barbiturates, so it is literally impossible that she could have woken up. We have the written statements from the surgeons that conducted the operation. What more could we have done ?
    Has Keith Augustine ever contacted the surgeons, the definitive source for clarification ? No, never. Why not, I wonder ? Surely he’s not going to try and tell us that they don’t know what they’re talking about ? That would be rather silly, wouldn’t it. My guess would be that it’s because they would only tell him exactly the same things they told us, and Keith obviously doesn’t want to hear that.

    With reference to Michael Sabom, unfortunately he did get a couple of points wrong, so what ? Why does Keith Augustine insist on not correcting these errors ? Is he not interested in the facts or is it because he is a committed materialist with an agenda ? Understandably, it makes me suspect it’s the latter.

    (NB. Gerry Woerlee, who I have had many discussions with and who I informed about the new fact of Pam being defibrillated at 27 degrees C, accepted it; why hasn’t Keith ? )

    Lastly, a word about my name. “tim” with a small “t” is an abbreviation of my old nickname from decades ago. That is why I use a small “t”. My real name, Stephen is published in the book referred to above for anyone interested. However, as I’m not notable, it makes no sense to use my real name on line, it would be quite pretentious. However, there is no attempt from me to stop anyone finding out my real identity. Go ahead !

    If you ever come over to England, (you have my email) come and look me up, I’ll do the same if I ever get over to where you are. We’ll have an interesting discussion, for sure. I am fascinated by your determined resistance to what you clearly perceive as a threat to your world view. (all these unexplainable veridical OBE cases make you feel slightly unwell, no doubt, I get that!).

    Keep up the good fight, Keith. regards “tim”

  13. I have no knowledge of the Pam Reynolds case but I am familiar with the phenomenon of burst suppression (BSP). Two claims made about this are wrong:

    (i) It is not characterised by mostly flat brainwaves
    (ii) It does not necessarily preclude processing of sensory information

    BSP is a highly variable EEG pattern found in controlled anaesthesia and also brain pathology characterised by alternate periods of high amplitude electrical activity (burst waves) and depressed (though not necessarily completely flat) waves.

    While EEG measurements have very good temporal resolution, they exhibit poor spatial resolution and it is difficult (and rarely done) to measure BSP simultaneously at all possible brain locations. We cannot assume (as suggested above) that BSPs are always homogenous and occur globally throughout the brain. For example, we know that BSP can be localised with asynchronous (differing) ratios measured between cortical brain regions. Strong burst suppression can also occur in one cortical brain region while being absent in a neighbouring region.

    When we are conscious, auditory sensory information is conveyed to cortex via the thalamus. During BSP coherent activity has been registered in the thalamus and thalmocortical connections to both frontal and parietal cortical regions. The activity is related to the strength of the burst phase. BSP suppression phases need to be especially long before all thalamic neurons go flat. Hippocampal-cortical interactions (important to consolidate short-term to long-term memory) are also preserved during BSP and, paradoxically, some activity appears to increase during anaesthesia. Similarly, the BSP suppression phase does not completely silence brain stem cells.

    BSP states are common in healthy neonates when they are conscious yet drowsy and asleep, so we can be certain that BSP per se does not preclude auditory information reaching the cortex. Experiments have also demonstrated that auditory (and even visual) stimuli presented during deep BSP during anaesthesia invoke coherent cortical electrical activity (i.e., somatosensory evoked potentials that are distinct, such as in response to a familiar voice and an unfamiliar voice). In other words, sensory information appears to reach and be processed (to some degree) by the cortex. Postoperative recall of sensory information during anaesthesia is reliably found in approx 2 per 1000 patients of all ages and is a recognised medical phenomenon.

    TL:DR If the evidence presented in the Pam Reynolds case evidence relies primarily on the claimed impossibility of auditory information being processed during BSP and/or deep anaesthesia then that evidence is either not particularly strong and/or is misleading.

    1. Gary,
      I’m not sure why you’ve decided to enter the debate with that rather odd ‘composition’ above, but I’m afraid it’s mostly incorrect. What I’m stating here is not my opinion; it’s an accepted medical fact. I’m a layperson, I don’t claim expertise. I listen very carefully to what the medical experts themselves know or profess to know.

      Burst suppression flattens brainwaves. That’s simply a fact. The ratio of burst to suppression, varies according to the dosage of barbiturates (then). See here in the paragraph below.

      Therapy (barbiturate, propofol, or halogenated anesthetic) is titrated to an electroencephalographic (cEEG) endpoint. Complete pharmacologic suppression results in a flat-line EEG. Typically, a 1:10 burst to suppression ratio is chosen as an arbitrary endpoint, but this is neither evidence based nor a universal practice. In other words, a 10 second screen of EEG would have 1 second of burst activity and 9 seconds of flat-line EEG. Optimal dosing is unknown and there is no evidence base to guide therapy (6).

      I don’t know if you are familiar with some of the arguments around this case? Dr Gerry Woerlee, who is a very accomplished anaesthesiologist (it has to be said) has ‘weighed in’ on the case many times. He is a hard-line sceptic and believes that Pam had anaesthesia awareness (which explained her observations) even though the surgeons themselves have repeatedly denied this.

      Leaving that aside, I can tell you categorically that Dr Woerlee also accepts burst suppression eliminates any possibility of consciousness. He confirmed that for me via email. Woerlee actually asserts that burst suppression was achieved later in the operation, just before standstill, to be clear.

      However, Dr Spetzler and his colleagues sought burst suppression early because they had found that it offered better “protection” (barbiturate protection) for the brain cells while they are starved of oxygen and glucose, during the time when there was no blood flow into the brain (standstill). Indeed no blood in the brain at all.

      Pam Reynolds clearly heard a conversation (and somehow remembered it) at the same time that she observed the bone saw that was being used to take the roof of her eye socket off. At that time she was under burst suppression, which is, as I said, a pattern of mostly flat brainwaves which eliminates any possibility of consciousness (apparently).

      That’s why the case is so fascinating and that’s why it remains unexplained. Best regards

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