Mona Simpson, Steve Jobs’ sister, wrote a touching eulogy of her brother (NYT, 10/30/2011). She closes by describing his last moments:

He seemed to be climbing.

But with that will, that work ethic, that strength, there was also sweet Steve’s capacity for wonderment, the artist’s belief in the ideal, the still-more-beautiful-later.

Steve’s final words, hours earlier, were monosyllables, repeated three times. Before embarking, he’d looked at his sister Patty, then for a long time at his children, then at his life’s partner, Laurene, and then over their shoulders past them. Steve’s final words were:

OH WOW. OH WOW. OH WOW. “

So what was that “still more beautiful later” that elicited this child-like wonderment of his as he lay dying? His last words will forever reside in the pantheon of ‘famous last words’, and will undoubtedly generate endless speculation as to what the words meant.

So let’s take a stab at it.

Was it a lucid dream?

The capacity to dream is not restricted to humans. Just like humans who can laugh or cry out loud in their sleep animals do it as well. My dog would bark softly, his eyelids fluttering   suggesting REM sleep. What invaders was he chasing? (Which raises the question: since dreaming is ubiquitous in the mammalian world, it must have some physiological function – what is it?)

But the neurobiological question begged by dreams is how do they form in the brain? Are they just random, disorganized activity of the brain,
getting rid of stored junk, as some researchers have theorized, or is there method to the chaos? There is a state of dreaming called lucid dreaming, in which the dreamer is aware that he is dreaming and can intervene in the dream narrative and change it. Could Steve Jobs be
having a lucid dream? Did he see yet another beautiful gadget that we mortals desperately need but we don’t know it yet? As Mona Simpson writes:

“On Steve’s better days, even in the last year, he embarked upon projects and elicited promises from his friends at Apple to finish them”.

Scientists of the Max Planck Institute in Germany used subjects who were lucid dreamers and therefore could manipulate the content of their dreams. They hooked them up to an fMRI machine and when they were having a lucid dream they instructed them to clench their fists. Amazingly, the brain motor area of the hands lit up, just like it did in a state of wakefulness. In other words, dreams are not random and chaotic
activities –they use the very same circuits and centers that are in charge of those activities. So it is not far-fetched to speculate that Steve was “dreaming up” a beautiful new thing. Except that it doesn’t perfectly fit with his last hours and minutes.

A left hemisphere stroke

Dr. Jill Bolte Taylor, a Harvard-trained neuroanatomist, awoke one morning having a strange feeling of being not quite right. She tried to work
out on her exercise machine but was progressively unable to do it. Over the next four hours she lost her language capacity and progressively lost the sense of boundaries between her body and the environment; she felt herself as one with the universe, at complete and profound peace; she was in a state of nirvana, as she later put it. Could this sensation elicit the WOW exclamation of wonderment? It could, but there was no other sign of a stroke-in-evolution in Mona Simpson’s description of the last hours. But there is one feature of Dr. Taylor’s stroke that fits Steve Jobs’ last days: brain hypoxia.

The wonderful brain tricks hypoxia plays

Did Steve Jobs experience hypoxia? Mona Simpson’s description is revealing:

“His breathing changed. It became severe, deliberate, purposeful. I could feel him counting his steps again, pushing farther than before.”

And then:

“He made it through the night, Laurene next to him on the bed sometimes jerked up when there was a longer pause between his breaths. She and I looked at each other, then he would heave a deep breath and begin again.”

This is a classic description of Cheyne-Stokes breathing, which is a pattern of shallow breathing, progressing to outright apnea ( when breathing stops altogether), punctuated by a few very deep breaths, and the cycles repeats. Result: blood and tissue hypoxia, including the brain. It apparently is a result of damage to the brain respiratory center, and it typically precedes the final demise.

People who had a near-death experience and were resuscitated describe several common sensations: out-of body experience and feelings
of levitation; total serenity, security, or warmth; the experience of absolute dissolution. Reminiscent of the right-hemisphere stroke described by Dr. Jill Bolte Taylor’s dissolution of her body boundaries, merging with the environment, entering the state of nirvana. The most striking sensation described by people who experience near death is a tunnel and a bright light at its end. The adjective they use to describe it are “awesome, overwhelming, otherworldly”.

Or “OH WOW. OH WOW. OH WOW”.

 

 

 

 

 

 

 

Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.

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