Keith Augustine interview

That paper is used by Tim to show the standstill procedure promoted by Spetzler for dealing with large or hard to get to aneurysms. It shows that Spetzler promoted burst surpression throughout the surgery. It’s method is to connect up bypass to the patients groin, then induce burst suppression for the rest of the surgical procedure.

But  Spetzler hadn’t decided what procedure to use on Pam. He opened up her skull and saw the size of the aneurysm, and then tells us he decided he would have to use the standstill procedure. Therefore it’s only after this descision that they connect up the bypass to Pams groin.

We can see the standstill procedure outlined In Spetzlers paper has not been followed. According to that paper it should be connect groin -> burst suppression-> open scull. But in Pams case it is open scull -> connect groin.

This is the wrong way round, but is completely understandable, because Spetzler tells us he only decided to use the standstill procedure after opening Pams scull and seeing the size of the Aneurysm. It seems Spetzler might have started Pams operation using a standard procedure, which for example, may only have induced burst suppression for the aneurysm clipping part of the operation. But upon seeing the size of the aneurysm, he decided a standstill procedure would be necessary, connected Pams groin for bypass and then induced burst suppression for the rest of the procedure, just like in Spetzlers standstill paper.

Although we know Pam would have been put into Burst Suppression during the procedure. At present no one here knows when during the procedure that was done. But we do have Spetzlers comments that say he opted for the standstill procedure only after seeing the size of the aneurysm. That suggests Pam may not have been induced into burst suppression until after her groin was connected up.

This changes nothing about the validity of Pams NDE OBE. But Tim is trying to muddy the waters prematurely, and using our knowledge that Pam was in burst suppression to imply that this means she was in burst suppression throughout the whole of her time in surgery. But Tim simply doesn’t know that. It’s attractive to him to try this, because people don’t have recollections like Pams under Burst Suppression. But he is overreaching himself here, and making claims when he doesn’t have hard evidence to back him up.

Disgraceful bullshit, Max. (again) You've excelled yourself !

Yep, I think I have, although in my defense it was not intentional... so I do owe you an apology Tim... Sorry.    

It is clear after rereading that paper again that I am getting the arterial lines muddled up with the femoral lines, and that you are quite correct, the femoral lines are only inserted after the scull has been opened and the aneurysm inspected. And that burst suppression is maintained throughout surgery.

This does seem to suggest to me that it is more likely that Pam was in burst suppression after all. I'm still unsure on this one though, I'd still want to see some hard evidence that this was the case during Pam's surgery.

I wonder why Spetzler never wrote this up as a short paper, if as you claim, he believes that Pam was definitely under burst suppression. Why on earth wouldn't he produce the recordings and notes to support the case? He seemed happy to go on TV and talk about it, and I can't believe Pam would have had any objections.

Max, thank you ! That's decent of you.

Yep, I think I have, although in my defense it was not intentional... so I do owe you an apology Tim... Sorry.    

It is clear after rereading that paper again that I am getting the arterial lines muddled up with the femoral lines, and that you are quite correct, the femoral lines are only inserted after the scull has been opened and the aneurysm inspected. And that burst suppression is maintained throughout surgery.

This does seem to suggest to me that it is more likely that Pam was in burst suppression after all. I'm still unsure on this one though, I'd still want to see some hard evidence that this was the case during Pam's surgery.

I wonder why Spetzler never wrote this up as a short paper, if as you claim, he believes that Pam was definitely under burst suppression. Why on earth wouldn't he produce the recordings and notes to support the case? He seemed happy to go on TV and talk about it, and I can't believe Pam would have had any objections.

Wait, now I'm confused. You now admit that you were mistaken and that Tim is correct, right? Yet you immediately do an about-face and say that you need hard evidence. Of what? 

Again, are you suggesting that Spetzler may have lied? Why would he? As I said above, this is not the kind of thing that medical professionals are in a hurry to be associated with. If he was "happy to go on TV" then surely that was a brave thing to do while expecting the inevitable backlash from a skeptical medical community. And doesn't Tim point out that his assistant, Dr Karl Greene, concurs?

Wait, now I'm confused. You now admit that you were mistaken and that Tim is correct, right? Yet you immediately do an about-face and say that you need hard evidence. Of what? 

Again, are you suggesting that Spetzler may have lied? Why would he? As I said above, this is not the kind of thing that medical professionals are in a hurry to be associated with. If he was "happy to go on TV" then surely that was a brave thing to do while expecting the inevitable backlash from a skeptical medical community. And doesn't Tim point out that his assistant, Dr Karl Greene, concurs?

Yes, that's a fair point, Dave. Considering Max's apology I am happy to let it go now. She was in burst suppression when she heard the conversation, there's no doubt about it. Maybe Max will just make that step a bit later..or maybe not.

Just to add, the case was so remarkable that the medical profession descended on Barrow Institute to discuss it with Spetzler. Allan Hamilton told us this.
There has never been a satisfactory explanation for it. Gerry Woerlee only got involved because he knew the implications of it and has basically been telling downright lies for years.

Yep, I think I have, although in my defense it was not intentional... so I do owe you an apology Tim... Sorry.    

It is clear after rereading that paper again that I am getting the arterial lines muddled up with the femoral lines, and that you are quite correct, the femoral lines are only inserted after the scull has been opened and the aneurysm inspected. And that burst suppression is maintained throughout surgery.

This does seem to suggest to me that it is more likely that Pam was in burst suppression after all. I'm still unsure on this one though, I'd still want to see some hard evidence that this was the case during Pam's surgery.

I wonder why Spetzler never wrote this up as a short paper, if as you claim, he believes that Pam was definitely under burst suppression. Why on earth wouldn't he produce the recordings and notes to support the case? He seemed happy to go on TV and talk about it, and I can't believe Pam would have had any objections.

Okay! That's the right attitude, Max.
I am happy that you are able to admit mistakes, something diehard skeptics never ever do (in my experience).

The reason why Spetzler never wrote this up in a short paper?
Let me guess: Most likely he would have become the laughing stock of his profession, certainly in the early days of his pioneering work.

Smithy

Yes, that's a fair point, Dave. Considering Max's apology I am happy to let it go now. She was in burst suppression when she heard the conversation, there's no doubt about it. Maybe Max will just make that step a bit later..or maybe not.

Just to add, the case was so remarkable that the medical profession descended on Barrow Institute to discuss it with Spetzler. Allan Hamilton told us this.
There has never been a satisfactory explanation for it. Gerry Woerlee only got involved because he knew the implications of it and has basically been telling downright lies for years.

I can only concur as regards Woerlee. I told all of you in the long interview of Vortex with Titus and me, that I have debated this case with Woerlee for a number of years, resulting in a very thick document (over 170 A4 sheets).
The man drove me almost nuts. But when you visit his site, you will find out that he still sticks to his ideas which have been completely overruled since then.

Smithy

Yes, that's a fair point, Dave. Considering Max's apology I am happy to let it go now. She was in burst suppression when she heard the conversation, there's no doubt about it. Maybe Max will just make that step a bit later..or maybe not.

Just to add, the case was so remarkable that the medical profession descended on Barrow Institute to discuss it with Spetzler. Allan Hamilton told us this.
There has never been a satisfactory explanation for it. Gerry Woerlee only got involved because he knew the implications of it and has basically been telling downright lies for years.

Yes, agreed. I added my own comment about why Woerlee got involved above and I think the quote of his that I posted says it all.

Yes, I was mistaken on my interpretation of the paper, and also that Spetzler was following his own procedure by inspecting the Aneurysm before deciding whether standstill was necessary.  

But because it is so unusual (AFAIK unheard of) for a patient to have veridical recall of a sentence spoken by a member of the surgical team whilst the patient is in burst suppression, it would seem reasonable to want to see the monitoring/measurement records from Pam's procedure.

Because awareness during anesthetic is a major issue in medical procedures, and may be responsible for many more cases of PTSD-like symptoms than is currently known, it would also have been useful for Spetzler to publish Pam's case for future reference in the medical literature. You know, something like... "Anesthetic awareness with accurate recall from a neurosurgical patient in burst suppression using x anesthetics".

Understood, Max. After all, someone like Pim van Lommel did take that course and dedicate part of his career to writing papers and further investigating the phenomena. Perhaps Spetzler didn't see that as a desired direction; maybe he was busy with other things. I'm guessing that a formal paper would need accompanying research into other possible cases and causes.