I'm not sure what to make of this book (although realistically it's more like 2 1/2 stars than 3). Part physicians guide to the physiology of death and resuscitation science, part mystical exploration of near death experiences and part consideration of the existence of self/soul independent of the brain, it isn't entirely clear what the author wants this book to be.
There are times when the Parnia's ponderous writing (page long paragraphs, run-on sentences, etc.) and his discussions of strange efforts to scientifically study near death experiences, make the book downright uncomfortable to read. On the other hand, there is deep insight here on the tremendous advances in "resuscitation science" - the emergency medical procedures taken to preserve brain function and restart the heart during cardiac arrest.
The author is at his best when reviewing the physiology of death and the relatively recent understanding that even after the heart stops and brain activity ceases, "brain cells, liver cells, and muscle cells all have a period of time after the heart stops and a person dies before they become irreversibly damaged." The period before irreversible damage, the author notes, is much longer than originally thought and therefore the long held belief that there is no way back from a cessation of respiration and brain activity is simply not true - that for some period of time, death is fully reversible. Underlying this reality is the truth that "contrary to common understanding, death is not a moment, it's a process - a process that can be interrupted well after it has begun."
Parnia is quick to point out that if there is an chronic, unresolved medical issue that has caused the heart to stop, resuscitating an individual is fruitless without a resolution to the underlying problem. Yet, for many who have suffered heart failure due to accident or injury who are otherwise healthy, resuscitation (even after long periods) can occur without permanent brain damage if managed with the right medical protocols.
The book is at its most compelling when it sticks to science and health policy. For example, the commentary about global systems failure when it comes to emergency cardiac care - in particular the lack of universal acceptance of cooling body temperature as an essential element to prolonging life - is a powerful criticism of our global health care systems and their standards. The evidence that the simple act of cooling the body of someone who has experienced cardiac arrest could literally save thousands of lives across the globe is startling and disconcerting.
With one exception, the book goes off course when it delves into mystical explorations of "near death experiences" and philosophical debate about the existence of an independent self (or soul) beyond the brain. The author's strong suit is not philosophy and the book can veer from rigorously scientific and lucid to downright mystical and bizarre.
The one "aha" moment for me in the independent soul debate came when Parnia pointed out the scientific conundrum related to how a biological structures like brain cells could create human consciousness. "In science, we have not been able to come up with a plausible biological mechanism to account for how a cell or groups of cells working together (i.e. the brain) could possibly generate a thought or collection of thoughts and hence ultimately the entity we call human consciousness. We know how cells make electricity through the movement of chemical molecules, but we just don't know how they could also make thoughts from electricity or chemicals."
Here then, is the miracle of human thought. How do we go from electricity and chemical interactions to human consciousness?
At times rigorous and scientific at others uncomfortably mystical and even odd, this book is a conundrum. I found it worth the effort for the physiology, not the philosophy.