140. Dr. Lakhmir Chawla Frustrates Near-Death Experience Researchers

George Washington University Medical Center Professor, Dr. Lakhmir Chawla, answers critics of his near-death experience research.

Join Skeptiko host Alex Tsakiris for an interview with Dr. Lakhmir Chawla.  During the interview Dr. Chawla discussed whether his discovery of a surge in the brain’s electrical activity seconds before death might, or might not, be related to near-death experience:

Alex Tsakiris: A moment ago you referenced the discovery of the first black swan as reminder of how science has to be prepared for unexpected discoveries.  Part of the frustration I hear from near-death experience researchers is, “hey, we keep finding all these black swans; where are the rest of you?”  They keep finding cases where patients report a near-death experience during a time when there’s no brain activity — that’s a black swan. Then they look at your finding, which is interesting and surprising, but is quite speculative as far as being related to near-death experience and they say, “where’s the balance?”

Dr. Lakhmir Chawla: I think that’s a very important point. At the end of the day, if near-death experience is going to enter a very durable research area it has to answer some of these questions.  Because right now we know that near-death experiences are very important to patients. So the stakeholders are very interested in it. So it will always have its relevant people who are very interested in it because it’s a big deal and it talks about the aspect of life when life potentially ends. What we’re suggesting in this paper is that we have an interesting finding at the time of death. It may have nothing to do with near-death experience, but the need to understand what this is or isn’t has a lot of value.

Now, I’ll tell you, the other important issue is that we have patients who we allow to pass away and then we take their organs. Currently we use EKG as the metric for when they’re dead. Some people have suggested that you should wait and see if they have this spike because that may, in fact, be the border. And this has real consequences for the quality of the organs that are taken from these patients if they’re allowed to sit for even a minute or two minutes longer. So, the implications are beyond the near-death experience.

Example of how Dr. Chawla’s finding was reported

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Alex Tsakiris: Today we welcome to Skeptiko  Associate Professor of Medicine at George Washington University Medical Center, Dr. Lakhmir Chawla.  Dr. Chawla, thank you so much for joining me today on Skeptiko.

Dr. Lakhmir Chawla: Delighted to be here.

Alex Tsakiris: So, Dr. Chawla, in 2009 you published a paper with the surprising discovery that some of your patients who were very close to death experienced a final surge in brain activity and the paper has gained quite a bit of traction, media attention, mainly because of this quote of yours:

“We think that near-death experiences could be caused by a surge of electrical energy as the brain runs out of oxygen.”

It‘s been a while since that paper was published.  So first I want to ask you, do you still think that what you saw has anything to do with near-death experience?

Dr. Lakhmir Chawla: Obviously all of the patients in our study passed away so there’s really no way for us to truly know if what these people were experiencing is, in fact had they survived, being the signature of a near-death experience. What we did notice which was very striking is that in all these patients–and in this study we reported on seven patients on which we had very good documentation. We’ve seen these electrical surges, EEG activity, at the end of life in over 100 patients and what we basically have, I hypothesize that when people pass away something occurs in their neural structure.

We have a hypothesis for why this may be happening, that causes this large intensity of electrical energy. What we basically hypothesize further and speculate is that if somebody within the field, someone who’s having a heart attack, for example, and their heart stops and the oxygen to their brain went down and they have this sort of terminal surge of energy and then they were resuscitated and brought back, it’s very likely that they would recall that electrical surge.

If they did recall that electrical surge, we hypothesize and speculate that that could be what people describe in their near-death experiences. The one thing that we’ve seen rather consistently when you read the literature of near-death experiences is that not everyone has the same imagery. Not everyone has the same experience.

But the one thing that they all have in common is that the experience is very intense and very vivid. People can usually recall many, many years later on with great detail what they experienced. So it would take something that would be a very durable electrical event of energy for someone to have that. So we put those notions together and arrived at that speculation.

Alex Tsakiris: Okay. I just wanted to confirm that and it’s interesting that you reference the near-death experience literature. I’ve had a chance to interview some of the world’s leading near-death experience researchers and gosh, I even went back and talked to some of them about this. I couldn’t find any of them that would even seriously entertain that kind of speculation.

As a matter of fact, privately one of them told me, and this is pretty harsh, but he said, “It’s one of the dumbest explanations for near-death experience yet published.” So I guess I was really wondering exactly where you’re coming from, exactly what near-death experience research you’ve dug into that makes you feel like the speculation that you’re talking about would fit the broader research that’s been done into near-death experience.

Dr. Lakhmir Chawla: No, I mean I’m not a researcher in near-death experience. That’s not my primary scientific interest. We are basically at the bedside taking care of very sick patients in the intense care unit. I don’t pretend to have any incredible insight into what these are or are not. All we are saying from our group’s scientific standpoint is that we see a very consistent signature for patients when they’re passing away. We are not the only investigators to report this; it’s now been investigated and reported by multiple investigators.

This is not artifact. This is real electrical activity. It’s high-frequency gamma wave activity at the minimum. It could be higher frequency than that. And the one thing which is abundantly clear is that this level of activity is coherent electrical activity. This is not sort of slow beta wave activity. It is not nothing, sort of dying brain variance or whatever. So I don’t know what’s causing it. We’ve speculated what might be the cause.

I don’t know if this is a near-death experience or not. I’m not saying it is or it isn’t. But I do believe that it’s plausible that if someone has a very large coherent amount of activity and they are then awoken or awakened, they’re going to have a memory of that. That memory could be what people believe to be is a near-death experience.

The one thing which we find rather consistent is that the level of energy associated with this is very high frequency and it’s very intense. If you look at the BIS monitor and SEDline monitors for which these are measured, it pretty much goes to the top of the scale. It goes beyond or very close to the maximum capacity that the device can measure.

So I don’t know what it is but I do think it’s plausible that if someone has this and they recall it, that they would recall a vivid memory. Whether that’s a near-death experience or not, I don’t know.

Alex Tsakiris: Right. Let’s just push that a little bit further. I appreciate where you’re coming from that near-death experience is a hot topic. Something happens at the final stages of life. I think it’s easy to make that connection.

The pushback I hear from the near-death experience researchers and why they say, “Wow, that just doesn’t really fit and we’ve been down that path before,” there’s a couple reasons. But the main one is the timing. You know, the first thing they’ll tell you is that while near-death experience has certainly been studied a lot in cardiac arrest patients because it eliminates a lot of the other variables, it’s not the only place where near-death experiences are reported.

The first thing that I heard back from the near-death experience researchers I talked to about your work is most people who report a near-death experience aren’t that bad off. They’re not in that much of a medical emergency, final stages kind of situation that you talk about. Heck, there’s even people who jump off the Golden Gate Bridge and don’t have any real physical trauma going on that have a near-death experience. Or people who are in the middle of a plane crash scenario that have a near-death experience. So the literature, when you get into near-death experience, goes way beyond people in this medical situation.

But moreover, this issue with the EEG becomes very interesting because we also have people in the near-death experience literature, case studies published in placed like the New England Journal of Medicine, all the right places to publish case studies, where they’ve induced cardiac arrest and they know there’s no EEG, and yet there’s the report of a near-death experience.

Dr. Lakhmir Chawla: Right. So I guess it really comes down to your definition of what a near-death experience is or isn’t. Is it driving a car and having a Mack truck come and nearly crush you and you avoid it? That’s a near-death experience because you nearly died. I think that it all depends on what near-death means and your definition of what near-death is. I think that’s an important distinction. I think that when we talk about near-death, what we’re talking about can vary.

Patients who undergo anesthesia and who have very bad events or are getting psychoactive medications, which is a part of critical care and a part of being in the operating room, they can all have near-death experiences and they could have had a very traumatic case in which the heart’s never stopped. So think there is going to be an enormous amount of heterogeneity of what a near-death experience is or isn’t.

In those cases, I certainly agree that people can have things that they recall from the events but it’s very hard because it’s very rare for a person to die or nearly die and then be awoken within 15 to 20 minutes and you can say to them, “Hey, do you remember anything?” It’s not the nature of the recovery of a very severe near-death event. So there’s a lot of things that can go on between an event and the actual recall and I think that it’s very hard to ascertain in any given individual if this electrical spike that we’re describing speaks to a very particular type of recollection versus a more generic near-death experience.

I think that this is a testable hypothesis, in fact, but I do think that it’s very hard because what one’s definition of a near-death experience varies from investigator to investigator.

Alex Tsakiris: Not really. Not all that much. Again, this is NDE Research 101. Everyone nowadays uses something called the Greyson Scale, invented by Bruce Greyson. It’s in a series of 7 or 12 questions and they rate how “deep” the near-death experience is. So when we throw around the term, “near-death experience,” it really has at this point in the stage of the research, a very specific set of features. It’s not really all over the board kind of like you’re saying. So I’m not really sure that there is that much discrepancy in what is or what isn’t a near-death experience in terms of the near-death experience literature.

Dr. Lakhmir Chawla: I’m not referring to the literature and what the case definition is or isn’t. I mean, the case definition is that they all agree on what they’re using to describe it. What I’m saying is that everyone in our study died. They all died. And they all had this electrical spike. And all we’re suggesting is that people who survive who had this are likely to recall whatever that electrical energy is. That individual may recall that as an experience or as a memory that occurred as they died or nearly died. That’s all we’re saying.

I’m not suggesting that every person who has a near-death experience has to have this spike. Nor am I suggesting that this spike is the signature for all near-death experiences. All we’re proposing is that if this is recalled, this could form a very strong memory and so it may represent a specific subtype of people’s near-death experiences. I’m not suggesting that this is the end-all, be-all. We don’t have any kind of evidence to make that determination but I do think it’s very interesting that people have this.

What I find further interesting is that animals, when they’re killed, also have this electrical spike about 45 seconds to 60 seconds after death.

Alex Tsakiris: Uh-huh (Yes). It is a surprising finding and it’s an interesting finding. It’s also interesting to me though how the story kind of runs way ahead of itself. As you say, I think you’re being very straightforward and I appreciate you putting the spikes in the ground in terms of what you would sign up for and what you wouldn’t.

The story has kind of taken on a life of its own and it seems like this happens over and over again when near-death experience is thrown into the mix and we have some kind of conventional explanation for it. We get a lot of traction behind those ideas even if they haven’t been, I don’t know, researched quite as fully as we’d all like. Any thoughts on that?

Dr. Lakhmir Chawla: Well, I’ve been interviewed and have spoken to many people about this and I think it dramatically determines what the person’s previous position is. If I have this conversation with an Atheist, the Atheist tells me that you have proven that the near-death experiences are not divine intervention and you have given evidence for the fact that there is no God. And when I speak to very religious people they tell me that I have measured the soul leaving the body and it’s a divine event that we are capturing and experiencing and being able to observe.

And I think that those two assessments are wildly off base and you have two sets of people looking at the exact same data, creating these exact opposite conclusions. All we can say is that we have an interesting finding. We don’t know what it is, but we strongly believe that when people pass away there is little to no research in this arena as compared to, let’s say, molecular biology. We simply don’t study it in a very forceful fashion because this is a time where it’s usually reserved for hospice and families and comfort care.

What we’re suggesting is that there be something to be learned at the end of life and it may shine a light on something that is very important to the stakeholders, which are our patients. Our patients care very deeply about what happens when they die, as I would argue most people do. What this is or isn’t I don’t know but I do know that the finding is intriguing. It may explain some patients’ recollections but I certainly don’t suggest that it explains everyone’s.

There is a very wide group of people who have, a lot of them, a huge set of conclusions on a 7-person case study that I think is highly premature. So our view is that we have an interesting finding and whenever we have an interesting observation generally what we do is scientists study it in more detail to understand what it is and what it isn’t. And I think that for the near-death experience researchers who are looking at these data and saying, “Oh, everyone’s saying it’s this, that, or the other,” I would say, “Let’s study it.”

Alex Tsakiris: Right. But I’m not sure that they’re saying this that or the other. They’re saying, “Okay, let’s take your finding and let’s take your data and very logically try and fit it into the rest of the data that we have.” They’re saying, “You know what? This doesn’t really add much to the story that we already have, because we have so many cases that would contradict the kind of conclusion that you’re coming to that this is somehow a near-death experience.”

And the contradiction is that we have too many people that have this continuous memory of their entire process of being in the hospital, of going under then leaving their body. I don’t want to get into too many of the details of the near-death experience research because I know that’s not your thing. But the most profound part of the near-death experience research is this out-of-body experience, this ability to see things from a vantage point outside their body, to hear things from a vantage point outside of their body.

Of course, this has been reported repeatedly in case studies and they’ve tried to replicate it in other work. But there’s no way to connect that OBE part of the near-death experience to your data. There’s also no way to connect the EEG data that they have to your research. So I don’t think it’s a lot of people coming to conclusions; they’re just saying like they’ve said in the past when people have come up with, “Oh, it’s probably a lack of oxygen. It’s probably fear of death.”

And then they’ve gone and done the work and said, “You know, that doesn’t really fit.” And that’s what I’m hearing them say again—“You know what? This is an interesting, surprising finding, but it doesn’t really add much to the research we’ve already done in near-death experience.”

Dr. Lakhmir Chawla: I can’t say looking at the end total conclusion idea that people have about NDEs and what this adds or subtracts. I certainly wouldn’t want to say that this is something that—the only point that I would make is that this is an imminently testable hypothesis.

It’s testable to see what percentage of patients actually develop this spike who are then revived and do it in a very large series of patients and look at those who have it and don’t have it and look back on a case definition and see if there is a difference. If there is a difference, then I think you would argue that it does add because these folks have a different type of experience or they describe a particular kind of experience. Or it may add nothing…

Alex Tsakiris: That’s certainly a good point.

Dr. Lakhmir Chawla: …I don’t know. But I think that just to dismiss it and say, “It doesn’t fit my theory. It has no place,” I find that to be problematic not just for this science but all science. It only takes a single observation that contradicts the theory to bring it down.

The classic example of this is the White Swan. When European explorers were traveling around looking at swans, every swan they saw was white. So after 100 observations they said, “Ah, most swans are white.” After 1,000 observations they concluded that 99% of swans must be white. After 1 million observations, these investigators concluded that all swans were white. And then they went to Australia and they found a single black swan and 300 years of observational theory was thrown underwater.

Now, I’m not suggesting that my spike is a black swan. But I am suggesting that just because something doesn’t fit your notion it shouldn’t be thrown away. It should be tested. That is what good scientific theory usually does.

Alex Tsakiris: I think you make a good point and I think your outline for an experiment sounds very reasonable. You know, I think part of the frustration from the near-death experience researchers is they say, “Hey, we keep finding all these black swans. Where are the rest of you? We keep finding these cases where people have no EEG and they report a near-death experience. That’s a black swan. Where is everybody?” Then they compare that to your finding which is interesting and surprising but isn’t yet the black swan and they go, “Hey, where’s the balance here? How do we get to some sort of balance in making these leaps forward in new understandings?”

Dr. Lakhmir Chawla: I think that’s a very important point. I know that Sam Parnia is doing some interesting work on this and doing these photos in trauma bays and whatnot and trying to see if they can get some sort of information about this. I think that it’s an honest attempt to try and test a hypothesis. I think that’s a very good start. At the end of the day, if near-death experience is going to enter a very durable research area, because right now we know that near-death experiences are very important to patients. Right? If you ask a person who’s had one they will tell you nine out of ten times that it was a life changing event.

Alex Tsakiris: Right. Moreover, more than just if we ask them. If we study the long-term psychological effects like Bruce Greyson at the University of Virginia did, it’s highly statistically significant in any way that we’d measure it. So it’s more than anecdotal. I’m agreeing with your point. Go ahead.

Dr. Lakhmir Chawla: So the stakeholders are very interested in it. So it will always have its relevant people who are very interested in it because it’s a big deal and it talks about the aspect of life when life potentially ends. What we’re suggesting in this paper is that we have an interesting finding at the time of death. It may have nothing to do with near-death experience, but the need to understand what this is or isn’t has a lot of value.

Now, I’ll tell you, the other important issue is that we have patients who we allow to pass away and then we take their organs. Currently we use EKG as the metric for when they’re dead. Some people have suggested that you should wait and see if they have this spike because that may, in fact, be the border. And this has real consequences for the quality of the organs that are taken from these patients if they’re allowed to sit for even a minute or two minutes longer. So what this spike represents and what it is or isn’t very much is in the we don’t know arena.

I think it has implications that are beyond the near-death experience and I think it may have significant implications for near-death experiences. I don’t think all near-death experiences are created equal in the sense that some patients may actually have their heart stop and they have a different recall. It would be interesting to see if patients who have a near-death experience that’s associated with an electrical spike at the time of death versus a near-death experience that’s not associated with it have different psychological impacts and different experiential impacts.

There may be differences. All these things are not necessarily created equal. I don’t think that when someone has a near-death experience that for each individual it’s the same each time, nor is it in intensity or necessarily duration. I think that qualitatively and quantitatively understanding and cataloging this has tremendous value. I think it has value for the stakeholders, which are the patients because if you can go back to them and say, “This is what we’ve learned about this and this informs what you actually experienced in a scientific way,” you’re able to bring the two areas together. I think that has merit.

Alex Tsakiris: It’s certainly been great chatting with you. What’s coming up for you? I know you’re going to explore this topic with Dr. Peter Fenwick at the Consciousness Conference, right, over in Europe.

Dr. Lakhmir Chawla: Yeah, that’s right. I’ll present the data that we show in the paper. I’ll present some of the animal data that other investigators have reported. I’ll basically propose, I think, what a potential study might look like that could actually assess this.

For our future research, we’re going to continue to try and understand what this is. The devices that we’re using from an EEG standpoint are rather crude. So what we aspire to do is use higher fidelity electrical encephalogram monitoring systems to try and understand what this is and isn’t. Is it coming from a certain part of the brain? Is it cascading from one place in the brain to another? Or does it happen all at once?

I think that these are very important things because we want to understand what it is from a physiologic standpoint that we’re dealing with. From an aspect of near-death experiences, I think you’re going to have to develop a very large size study that’s going to have to have folks involved who have expertise in psychology and psychiatry to understand what this is, develop case report tools, to understand if people are recalling things that are related to something from the hospital stay, or psychotropic drugs or a combination thereof. Or something that actually happened to them.

And you’re going to have to do something which doesn’t fit well with most spiritualists which is to use statistics to try and get some understanding of the probability or improbability of what we’re describing having any connection to what other folks are describing. These single cases, though compelling on the individual basis, make it very hard to convince scientists at large.

And if this is going to enter the field of true research, meaning with true financial support and using cutting-edge technology to understand, like CAT scanning and MRI, then you’ve got to have a significant buy-in from the neurology and neuroscience community. They’re not going to step up in my opinion unless you can show them some hard data that they can get their head around.

Alex Tsakiris: You just opened up about five other topics we could go into but let’s leave it there because I think you’ve made so many points and given us so many things to think about. Dr. Chawla, your research sounds fascinating. We wish you the best of luck with it. Thanks so much for joining me today.

Dr. Lakhmir Chawla: You bet.

Alex Tsakiris: Thanks a lot. That was great.

Dr. Lakhmir Chawla: Okay. So I’m interested—I didn’t know other people were so bothered by it. That’s interesting.

Alex Tsakiris: Bothered by your research?

Dr. Lakhmir Chawla: Yeah, because it’s not like I get feedback from anyone else. I mean, it’s out there and I get occasionally blasted about it but that’s about it.

Alex Tsakiris: Well, you know the main thing—and I was kind of driving towards this—I tell you, if you publish something about near-death experience that gives it any kind of conventional explanation the amount of traction you get is just unbelievable. And I think there’s a certain feeling among near-death experience researchers that like, “What the hell is going on?” I mean, it’s a surprising finding, what you have, and it’s fascinating. I think the way you’re talking about researching it makes a ton of sense.

You’re going to speak with Peter Fenwick when you do the Consciousness Conference. Those guys have gotten down and dirty with hundreds of these cases and done the statistics, done all that, and he’d say, “Aren’t we kind of burying the lead to use a newspaper story that consciousness seems to survive death?” So how it survives it in your case versus someone else’s case is interesting but we’re still burying the lead that consciousness seems to survive death.

Dr. Lakhmir Chawla: I know. I think as I’ve learned more about this, because obviously we started with our observation and moved from there, is the variability on people’s view of this and what the various research shows and doesn’t show. Deepak Chopra and Stu Hammerhoff’s article in The Huntington Post arrived at a completely different conclusion than I had even considered. They were really moving towards a sort of spirituality, potential consciousness of the soul kind of explanation, which I hadn’t even—I mean, we talked about it sort of as an aside but I never really considered putting that into a framework because it’s not testable.

Alex Tsakiris: I think it’s too far out there. I mean, I would take the Black Swan thing you said. Just come back to that and say we have so many good cases where people are having these verifiable experiences outside of their body when they have a flat EEG. I don’t know why we have to dig a lot further before we answer that.

We should say, “Hey, how is that possible? We had this person monitored. We were monitoring their EEG the whole time and yet they come back and tell the nurses and doctors stuff that we’re able to verify that they shouldn’t be able to know.” I don’t know why we have to say, “Well, let’s ignore that for a minute and look over here.” That’s what seems to be going on and I can’t quite make that connection.

Dr. Lakhmir Chawla: Yeah, I think that people have a hard time with the plausibility of it and so they just discount it, right? I think that’s just people.

Alex Tsakiris: Right. Exactly.

Dr. Lakhmir Chawla: I think they don’t want…

Alex Tsakiris: It’s very, very challenging to some basic paradigms so it’s not going to get a lot of traction.

Dr. Lakhmir Chawla: No, I think that like I said, being very new to this and not really having a vested interest in it, this is not my primary research area. I don’t have a grant that rides on someone’s view of this one way or the other. I’m just very struck by how strongly the belief structures are around this. I kind of imagined that would be the case but I’ve been very struck by what people have concluded on a very, very preliminary report. You know?

Alex Tsakiris: Yeah.

Dr. Lakhmir Chawla: This is essentially a study where we said, “Hey, we saw something really neat and we have some information on what it might be.” What I was looking for was a lot of back-and-forth on what this might be, you know? People saying, “Hey, we’ve seen this. We’ve done studies. It looks like it probably is this. We’re looking at the physiological process of what you’re picking up.” I’ve gotten none of that. All I get is this very sort of strident views on either side of the fence, which is not what I expected.

Alex Tsakiris: Interesting. Hey, welcome to the culture war, right?

Dr. Lakhmir Chawla: Yeah, I guess. You’re exactly right. I guess I’ve been sitting it out and didn’t really realize that it had reached this level. But I think that the folks who are studying this in a systematic way are to be congratulated. I think it’s really important to try and get your head around it.

I think the reason why it cannot and should not be discounted is because the patients care so much about it. And in my opinion, if people are having life changing events for the better we need to understand that because that’s a big deal, right? You have people who quit drinking. They stop doing drugs based on these experiences. So that suggests that something is going on.

My personal view is that I think that for people who have this variety of different experiences, I think there’s this sort of classic one of this leaving the body and looking down on yourself. This is sort of the experience that many people think is the classic near-death experience. But in talking with my patients and people who describe what they had as a near-death experience to me, and reading a lot about it as well, not just in the literature but in the lay literature of people describing their own personal experiences, it’s been my take that there’s a huge variety in what people experience. And I think that the conditions upon which they experience it probably influence it.

Alex Tsakiris: Yeah, maybe, but again, I’d go back to your Black Swan thing. Okay, so there’s a variety of different experiences and you can categorize them a bunch of different ways. But what about the Black Swans? Those are the ones where we just have to stop and say, “Wait a minute. Is consciousness, you know, consciousness? Is consciousness fundamental? Are we looking at the whole thing backwards in that we’re looking at brain causing/creating/secreting consciousness? Do we have it backwards? Is it consciousness that then reflects onto the brain?”

It’s a fundamental shift in things but if you just take the Black Swan and try and include the Black Swan in your explanation, you’ve got to come up with something like that. I think that goes even further than Hammerhoff will allow but it’s where a lot of people–some researchers are there and saying, “Hey, maybe consciousness is fundamental and we’re looking at the whole thing backwards.”

Dr. Lakhmir Chawla: Yeah, I think that’s an interesting point and I think that for most people who really look at this, they’ll tell you that if you actually want to explain consciousness and try and explain how the brain does it, you simply cannot put the physics together.

Alex Tsakiris: Exactly.

Dr. Lakhmir Chawla: Right?

Alex Tsakiris:   Right.

Dr. Lakhmir Chawla: The brain is not 32:45 by any reasonable metric. And the number of items that need to be processed per second to explain what a normal human brain does is totally not explainable.

Alex Tsakiris: Right. And then we have the whole timing problem, right? Where we can see physiologically that you’re acting before you’re thinking kind of thing. We can repeat that over and over again. We don’t have a way to explain that, either. And we extrapolate that out and go, “What is going on here?”

Dr. Lakhmir Chawla: Well, I am glad I spoke with you because I don’t know many of these researchers very well. I know some of their work and I’m glad to know that they have certain views that concern them so I can try to address them. I’m sure they’ll come up.

Alex Tsakiris: Well, I think the way that you did it here is incredibly—I don’t know how anyone could find fault with that. I think the way that you’ve laid out a way to test it and add it to the body of research going forward, hey, that’s super.

Dr. Lakhmir Chawla: We tried very hard not to do anything beyond what we were able to say. We were very clear in the paper. I’m sure you saw that. It’s just a paragraph that’s 100% purely speculative. This is what we saw; this is what we can show. And this is the part where we can say, “Look, we really don’t know what this is but it could be this or it may play a part in this.” We’ll let people who really focus and make a career out of looking at this answer better than we can because the ICU is not the place to actually study this in a longitudinal fashion.

Alex Tsakiris: Right. You’ve got to worry about people keeping people alive or helping them transition to death, right?

Dr. Lakhmir Chawla: Yeah, our immediate concerns are a little more basic.

Alex Tsakiris: Hey, thanks a lot for your time. If it’s okay with you I’m going to use some of this stuff afterwards. I think it’s really good stuff. We’ll throw that in there.

Dr. Lakhmir Chawla: Yeah, that’s fine. Good luck with it.

Alex Tsakiris: Hey, thanks a lot.

Dr. Lakhmir Chawla: All right. Take care.