[RADIOLAB INTRO]

JAD ABUMRAD: One.

ROBERT KRULWICH: When you die—we can all agree on this—something changes. You get the feeling that something that was there isn't there or leaves. But what leaves?

LEE SILVER: One, two, three can you hear me?

ROBERT: We talked to a biologist at Princeton University, Lee Silver, who told us a story about a guy back in 1907 who did a very interesting experiment. His name was Duncan MacDougall.

ROBERT: I don't remember exactly who he was, what's his ...?

LEE SILVER: He was a doctor.

ROBERT: A doctor.

LEE SILVER: A physician, yes.

ROBERT: Mm-hmm. And what's his story?

LEE SILVER: He wanted to prove that the soul exited the body after death. He thought the soul had a certain amount of weight, that it was a substance. And so what he did was he had these people who were dying from tuberculosis, and they were lying on beds on this gigantic scale.

ROBERT: He literally put people almost dying onto a scale?

LEE SILVER: Yes.

ROBERT: So imagine how a patient on one side of the scale, and on the other side are weights, and they're there in perfect balance.

LEE SILVER: And then at the moment of death ...

ROBERT: Right at the last breath.

LEE SILVER: ... he tried to determine whether or not the scale changed.

ROBERT: So did they lose weight when they died? That was the question?

LEE SILVER: Right. And he claimed that on average they lost 21 grams the instant they died.

ROBERT: Oh.

JAD: Does he describe the moment that suddenly the scales shift one way or the other?

LEE SILVER: Yeah, the moment—I mean, death was easy in those days because you stopped breathing, you were dead. I mean, they weren't hooked up to machines.

ROBERT: Didn't do brain scans or stuff, yeah.

LEE SILVER: Right. So it's the last breath.

JAD: The last breath.

LEE SILVER: Yes.

ROBERT: And the New York Times headline was "Soul Has Weight, Physician Thinks."

LEE SILVER: Right. great headline, right? [laughs]

ROBERT: Yeah pretty good.

LEE SILVER: And this is the beginning of the 20th century. We're not talking about medieval times. You have to remember that.

ROBERT: What did he conclude from this?

LEE SILVER: Soul has weight, okay? And ...

ROBERT: I've seen a soul. It was there when he was alive and it flew off and it weighs 21 grams.

LEE SILVER: Yes. Now there was one person whose weight didn't change immediately. It changed a minute later. And so his hypothesis was that this was a very kind of dumb guy, and the soul was—didn't realize it was free, and so it took a minute after the death before the soul realized it was free and it flew out of the body.

ROBERT: So a true idiot would be hanging out for five minutes while the soul doesn't know where to go. [laughs]

LEE SILVER: Now this was very serious, of course.

ROBERT: Yeah.

JAD: How would you explain what he saw, or thought he saw? The 21 grams, I'm still stuck on that. I mean ...

LEE SILVER: Oh, the 21 grams, it's statistically insignificant. I mean, three-quarters of an ounce compared to the weight of a body is a minuscule amount.

JAD: Particularly, says Lee, when you consider how crude the scales were at the time, almost anything could have swayed them, a breeze, a pressure. Anything really.

LEE SILVER: Today he would be laughed out of the Academy.

ROBERT: Have you ever seen someone die or ever seen a dead person?

LEE SILVER: I've seen dead people. I mean, I've seen dead bodies.

ROBERT: Uh-huh. I mean, I saw my mom just before she died and just after she died. And I thought to myself, "There's a real difference here." It's beyond pallor, or it's a very noticeable, deep absence of something.

LEE SILVER: Mm-hmm.

ROBERT: And it does make you think that something—and I'll use the word carefully—vital has gone away suddenly.

LEE SILVER: Mm-hmm. We have to be very careful about the words. I mean, something has gone away, the brain has ceased to function. And therefore, I would say there is no person.

JAD: But still, the unanswered question is what really happens in that moment when a person is suddenly gone to ...

ROBERT: The other side.

JAD: ... the other side? Those of us with the benefit of being alive cannot help but ask this question. It's like a curse. We want to know, but obviously it's not something we can know. Because this will just always be one of those domains ...

DAVID EAGLEMAN: Where the tools of science just can't be used.

JAD: Alas. But then there are those folks like neuroscientist David Eagleman who say, "Screw it. We're gonna ask, we're gonna wonder because that's just what we do."

DAVID EAGLEMAN: When you walk to the end of the pier of science, you look out and you've got everything beyond that, you've got the whole ocean of what we don't know past the end of the pier. What a scientist does is sort of leap out on to different islands and just try things out.

JAD: I'm Jad Abumrad.

ROBERT: And I'm Robert Krulwich.

JAD: Today on Radiolab, we're gonna do what David Eagleman suggests, we're just gonna hop around.

ROBERT: This is unusual for us, but what the heck. We're going to look at different aspects of death and the other side in no particular order.

JAD: But here's what we can tell you, we're gonna make 11 stops. Eleven meditations shall we call them. On various questions relating to ...

ROBERT: Death and dying.

JAD: And what happens after. But it won't be depressing.

ROBERT: No.

JAD: You just heard the first one, soul has weight, physician thinks.

ROBERT: Here's our second.

JAD: It comes to us from the guy you just heard David Eagleman, who is a neuroscientist but wrote a book called Some.

DAVID EAGLEMAN: Yeah.

JAD: Which is very not neuroscience-y at all.

DAVID EAGLEMAN: The truth is I haven't talked about this book with any of my science colleagues.

JAD: Why not?

DAVID EAGLEMAN: I have reasons why, but I'm not sure I want to say them on the radio.

ROBERT: [laughs] Okay.

JAD: In any case, the book consists of 40 different versions of the afterlife, and here's one. It's called "Metamorphosis." Written by David Eagleman and read by Jeffrey Tambor.

ROBERT: The actor.

JAD: Right.

JEFFREY TAMBOR: There are three deaths. Now the first is when the body ceases to function, of course. And the second is when the body is consigned or, you know, put in a grave. The third is that moment sometime in the future when your name is spoken for the last time.

JEFFREY TAMBOR: So you wait in this lobby until the third death. And there are long tables with coffee and tea—cookies. You can help yourself, and there are people here from all around the world, and with a little effort you can strike up some convivial small talk. Just be aware that your conversation could be interrupted at any moment by a—well, we call them the callers.

[VOICE: Thompson Harris. Miyuki Himoto.]

JEFFREY TAMBOR: And what they do is they broadcast your new friend's name to indicate that there will never again be another remembrance of him by anyone on the Earth. Your friend slumps, saddened even though the callers, they tell him kindly, "Look, you're off to a better place." The thing is, no one knows where that better place is or what it offers because no one exiting through that door has returned to tell us.

[VOICE: Alex Gonzales.]

JEFFREY TAMBOR: And tragically, many people leave just as their loved ones arrive, since the loved ones were the only ones doing the remembering, and we all wag our heads at that typical timing. Now not everyone is sad when the callers shout out the next list of names. On the contrary, some people beg and they plead. These are generally the guys who've been here a long time—too long.

JEFFREY TAMBOR: Now take that farmer over there who drowned in this small river 200 years ago. Now get this, his farm is the site of a small college now, and the tour guides each week tell his story, so he's stuck. He's miserable. The more his story is told the more the details drift. He's utterly alienated from his name, it's no longer identical with him, but it continues to bind. And that cheerless woman across the way is praised as a saint even though the roads in her heart, believe me, are complicated. And I guess that is the curse of this room. Because since we live in the heads of those who remember us, we lose control of our lives and become who they want us to be.

JAD: What gave you the idea for that story?

DAVID EAGLEMAN: This actually, I should say came out of my work as a neuroscientist, because what happens in the brain is you make models of other people when you think, "Well, what would my friends such as such, say? Or what would my wife say?" You're actually running a little simulation of that person in your head. Well, what happens when somebody dies is then they exist only in the scattered heads around the globe of people who knew them. They exist in some way as these algorithms that continue to run. But through time your model of somebody might drift.

ROBERT: Are we ready?

JAD: Mm-hmm.

ROBERT: Number three.

JAD: We're gonna change up the question a bit.

ROBERT: When am I dead?

JAD: How do you decide if somebody is alive or dead? If you take it as your starting point King Lear from Shakespeare, when Cordelia his daughter dies.

[ARCHIVE CLIP, King Lear: How? How?]

JAD: Lear takes out a mirror.

[ARCHIVE CLIP, King Lear: Lend me a looking glass.]

JAD: And puts it right under her nose to see if there is some breath there.

[ARCHIVE CLIP, King Lear: If that her breath were mist or stain ...]

JAD: And he takes out a feather.

[ARCHIVE CLIP, King Lear: This feather.]

JAD: And does the same thing, and that is how he decides if she's on or off.

GARY GREENBERG: Yes. And it's really one of the most beautiful scenes in Shakespeare.

JAD: That's Gary Greenberg. He wrote a book called The Noble Lie.

GARY GREENBERG: When it's done right, it's impossible not to weep ...

[ARCHIVE CLIP, King Lear: She's gone forever.]

GARY GREENBERG: ... at that scene.

[ARCHIVE CLIP, King Lear: Cordelia.

GARY GREENBERG: And the intimacy of that moment.

JAD: But if you fast forward a few hundred years, things change. All right, it's 1816. There's a fat lady in a hospital—we're in France. And in walks a guy by the—what was his name?

ROBERT: Theophile Hyacinthe Laënnec.

GARY GREENBERG: Laënnec.

ROBERT: Yeah.

JAD: He's a doctor? This fellow?

GARY GREENBERG: He's a doctor, yes. And he is called in to consult with a patient who is obese.

JAD: Obese and ill. He says to this lady, "Please, may I see your wrist so that I can feel your pulse."

GARY GREENBERG: But this woman had so much flesh on her that the only way he could imagine to do it was to put his ear on her chest, which would have been indecent.

JAD: So he came up with an idea.

GARY GREENBERG: He fabricated quite quickly a device—rolled up paper, really—and fashioned it into a tube. Put one end of the tube on the woman's chest and his year on the other end.

ROBERT: Oh, how very decent of him. So he doesn't have to touch her flesh.

GARY GREENBERG: He doesn't have to even really look at her chest. And his head is actually turned away from the patient.

JAD: And so what we've got here in 1816 is the world's first stethoscope. And a very unintimate but increasingly precise and technological approach to defining death, which now is all about the heart.

GARY GREENBERG: Up until then, death was heart death. People were dead when their heart stops beating.

JAD: But if you fast forward again, things take another turn. Just imagine—thought experiment. If King Lear had been written, not in 1604, but 1968. LBJ administration, okay? Cordelia would die.

[ARCHIVE CLIP, King Lear: How?]

JAD: Lear would be distraught, but instead of doing the mirror thing again, he would call a doctor, who would rush her to the hospital, shock her heart, resuscitate her, hook her up to a ventilator and a feeding tube, and there she would be alive again—sort of. I mean, technically yes, she'd be alive because her heart would be. But the Cordelia that he knew, his daughter, would be gone. And this was the problem in 1968. With all this new technology, ICU units were filling up with these purgatorial Cordelias who floated somewhere in a comatose state between life and death.

GARY GREENBERG: You could minister to these people, you could feed them, you could clear their infections, but you could not restore their consciousness. What are you going to do with these people?

JAD: In walks a physician.

GARY GREENBERG: A very prominent American physician named Henry Beecher.

JAD: And he decided that the time had come to ...

GARY GREENBERG: Acknowledge the obvious, which to him was ...

JAD: These people weren't just dying.

GARY GREENBERG: They were dead. He'd convened a committee at Harvard, and he simply move the line that divides life from death back a little bit toward what most people would consider life.

JAD: And so you get, in that moment, the concept of brain death. A person is really dead, really dead not when they stop breathing, not when their heart stops beating, but when their brain winks out. That now is when a person really dies.

GARY GREENBERG: Exactly.

JAD: Totally invented concept, but it stuck.

GARY GREENBERG: One way to argue it was that the brain was considered to be sort of the maestro, the coordinating organ that made all of the rest of the body work. And that without it, the center no longer holds and things fall apart.

JAD: Nowadays, most people go with this brain dead definition of death. But where it gets weird is that there are some holdouts. Just a few. For instance, some sects of Orthodox Judaism will say that if the heart is beating, the lungs are still filling with air, and if the lungs are still feeling with air ...

GARY GREENBERG: There's still a soul. The Spirit of God is in you, and you certainly can't be said to be dead.

JOHN TROYER: Well, I'll give you another example ...

JAD: That's John Troyer associate of death and dying practices at the University of Bath.

JOHN TROYER: For example, Italy they use the brain death criteria. The Vatican, however, its own city state within the country of Italy does not. The Vatican goes only by heart death.

JAD: So technically, according to John, it's possible that if I were brain dead in Italy and the doctor wanted to pull my plug but my family didn't, they could just wheel me down the street into the Vatican and—voink! I'd be alive again.

JOHN TROYER: Yeah. I mean, you'd need a really long extension cord probably because of course, these are all—I mean, you'd be on machines and devices that require power. So it would be a laborious process, to say the least.

JAD: Nonetheless, the real question here, the deeper one, isn't when do you die? Is it brain versus heart? It's when are you gone? Like, when is a father, a son, a daughter really gone to us? And who gets to decide that?

JOHN TROYER: And that's—therein lies the rub. Dead to family can be very different than dead to an institution that might be caring for that body.

GARY GREENBERG: You know, that that scene of Lear with the mirror and the feather ...

[ARCHIVE CLIP, King Lear: She's gone!]

GARY GREENBERG: ... it's not a medical diagnosis. It's a diagnosis about love and loss.

[ARCHIVE CLIP, King Lear: Cordelia, stay a little.]

ROBERT: And number four.

JAD: Tennis anyone?

ROBERT: Let me tell you about a woman.

ADRIAN OWEN: She was the victim of a road traffic accident.

ROBERT: That's Dr. Adrian Owen. He's a neuroscientist at the University of Cambridge, and he told me about this patient he had.

ADRIAN OWEN: A patient who's in her 30s, and she came to us after five months in a vegetative state following a blow to her head.

ROBERT: So for five months she'd been lying in the hospital ...

ADRIAN OWEN: Couldn't talk or couldn't move.

ROBERT: She could breathe but ...

ADRIAN OWEN: No evidence of any awareness.

ROBERT: You could shine light in her eyes, she wouldn't have the normal response. In effect, that woman was gone.

ADRIAN OWEN: That's right.

ROBERT: But in spite of the fact that she was giving the world nothing back, Dr. Owen wondered would it just be possible that there was somebody in there?

ADRIAN OWEN: So we tried a new kind of approach with her.

ROBERT: Because they had a new and sophisticated tool that previous scientists had never had.

JAD: You mean, a brain scanner?

ROBERT: Yeah, this is a stethoscope for the brain. Dr. Owen stood by her bedside and said, "I'll tell you what, in a few minutes, we're going to take you to a machine."

ROBERT: You chat with her? You say, "Hey?"

ADRIAN OWEN: Well, that's exactly how it's done. Yes, is it sounds a little bit bizarre because of course you don't get any responses back from these patients. You don't even know whether they can hear you. But we make the instructions very clear.

ROBERT: And he says, "Now when we put you in the machine, there's going to be a click, and I'm gonna say into your ear, please begin ..."

ADRIAN OWEN: To imagine playing a vigorous game of tennis.

JAD: What?

ADRIAN OWEN: We said imagine that you're standing there at the baseline of Wimbledon carrying out the movements.

JAD: Tennis? Why?

ROBERT: See, because here's the thing we now know enough about brains to know that if you are imagining tennis ...

ADRIAN OWEN: That will produce activity in your motor cortex, very similar to the activity that you would see if you could scan somebody when they were actually playing a game of tennis.

ROBERT: And this is true of all healthy people.

ADRIAN OWEN: That's right.

JAD: Always the same pattern?

ROBERT: Yeah.

ADRIAN OWEN: It lights up very reliably.

JAD: Okay. So he puts this patient into a brain scanner, then what?

ROBERT: He rolls her into the machine.

ADRIAN OWEN: And we say "Right, play tennis. Now relax. Play tennis. Now relax."

JAD: And he said this woman's been vacant for five months?

ROBERT: Yeah.

JAD: I gotta say this seems quite literally a shot—or a forehand in the dark.

ROBERT: [laughs] This was his first patient.

JAD: Really?

ROBERT: He does this. He says "Play. Stop. Play. Stop." She hadn't spoken or shown any sense of awareness or any interior life at all for months and months and months and months.

JAD: And?

ADRIAN OWEN: Play tennis.

ROBERT: On the screen, there's a tennis game.

ADRIAN OWEN: What we saw is exactly what we see in healthy volunteers. And her pre-motor cortex was turning on and turning off when we asked her to relax, turning on when we asked her to do the task, and it would stop when we asked her to relax.

JAD: So she's in there.

ROBERT: She's in there.

ROBERT: Were you amazed, or were you expecting—what happened to you?

ADRIAN OWEN: Well, I mean, it was pretty exciting. I mean, I have to say the fact that it was the first person we tried it in was perhaps the biggest surprise. And we've scanned about 20 patients since then doing the same thing, and we've seen three so far who showed clear signs of being aware.

ROBERT: See, that's the thing that sort of frightens me about what you've done. It seems to me you've discovered that there may have been and there may be lots of people in this world who are somehow aware but who are invisible to the rest of us, whom we could in effect murder by mistake.

ADRIAN OWEN: Yeah. Well, that's obviously a very loaded question. I mean, I think we have to face the fact that historically we haven't always had the tools that we have today that can help us to make complex decisions. But we're at very early stages of this. And there are some also very technical reasons why one needs to be extremely cautious about drawing conclusions from this. For example, we could tell with this patient that she was aware, but what we can't do is to conclude that the rest of them were definitely unaware.

ADRIAN OWEN: Imagine if you were stone deaf. You appeared to be in a vegetative state. Now in that situation, we wouldn't necessarily know that you were stone deaf because you've had a major brain injury and we can't talk to you and find out, so we don't know that you're stone deaf. We put you in the scanner and we ask you to imagine playing tennis, but you can't even hear the instructions. Now clearly, that patient wouldn't imagine playing tennis, they wouldn't activate their pre-motor cortex. But it wouldn't be because they weren't aware, it will be because they were deaf.

ROBERT: Oh dear!

ADRIAN OWEN: So even though we can tell when a patient is aware, we can't tell when a patient is unaware. And that's a very, very important distinction.

JAD: But if you can't really know that someone is unaware, then you can't actually ever really know if they're gone.

ROBERT: We've entered into this very difficult space, where we have learned enough to know that we know much less than we thought.

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[GARY GREENBERG: Hi, this is Gary Greenberg. Radiolab is funded in part by the Alfred P. Sloan Foundation, the Corporation for Public Broadcasting and the National Science Foundation.]

[ANSWERING MACHINE: Message two.]

[KEN BALDWIN: This is Ken Baldwin. Radiolab is produced by WNYC and distributed by National Public Radio.]

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