A 2023 Best of the Net nominee, Keith Hoerner’s work has been anthologized frequently—as well as featured in 100+ literary journals across five continents. He is the founding editor of the Webby Award recognized Dribble Drabble Review, in addition to a Best Book and American Writing Award Finalist.
Then Sings My Soul
Verses from the old hymn rise harmoniously. First faint. “O Lord, my God…” Then increasingly louder. “When I in awesome wonder…” As shadow people circle Ann in undulating shades of grey. She feels the deepest, purest sense of serenity. Love, indefinable, wraps her in its comforting weave as the music crescendos, and the light grows blinding. She does not, cannot raise her head: out of sincere humility. For Ann recognizes she stands in the presence of God.
On April 28, 2008, Ann Thomas, then 46-years old, flat lined on the operating table at a premier St. Louis hospital, after being given an overdose of the narcotic painkiller: Dilaudid. It is in these moments — suspended between life and death — that this account of her being in the presence of God, and conversing with Him, originates.
“I was having a procedure,” Ann explains, “called… now let me say this slowly, and forgive me; I can sound like a doctor after all these years… endo-scopic retro-grade cholan-gio-panc-rea-tography or ERCP… a process to detect blockage in the bile ducts leading to the pancreas.”
Pancreas Divisum, a congenital birth defect of the pancreatic bile duct, is the cause of Ann’s living daily with severe abdominal pain for over 14 years. “It’s less than it was since… the experience,” Ann answers, when asked what level of pain she lives with — on a level of 1 to 10 — with 10 being the worst. “But it still floats somewhere between five and seven.”
“How do you cope with it?” I ask.
“How do I not?” she asks in return, “You just accept it.”
This seems remarkable, in that Ann is vivacious, hardworking, successful, and rarely without a smile. I picture myself wincing and ouching all day long.
A homemaker for 18 years after high school and a rising star in real estate for eight years, Ann is a fast-paced woman. Her shoulder-length blonde hair crowns a fit frame dressed with a discerning sense of style. She is put together as one might say. Not stand-offish, her green eyes invite you in without question. She is accessible, wanting to help you in any way possible. Ann attracts those that meet her effortlessly by offering something that can’t quite be pinpointed: a knowledge, a secret known.
The ERCP procedure, done through an endoscope, was to seek out blockage and place a stent in Ann’s biliary tree — if necessary — to drain the pancreas, complicated by severe scaring and hardening, due to chronic pancreatitis. This operation’s goals were simple: 1) relieve the years of unrelenting pain in her upper abdomen and accompanying migraine headaches, while 2) stopping the degenerative process.
Upon flat lining, her mother, Patti (allowed in the operating room against protocol) begins rubbing Ann’s feet frantically, whimpering, “Please God, we need her; don’t take her now.” Patti cries out repeatedly for Ann to wake, unaware that her daughter no longer lies before her, but rather inhabits a place of no pain and no suffering. How glorious this feels to Ann. Beyond the scurrying of mortals in an operating room; beyond the whizzing, whooshing and whistling of man-made machines; beyond the walls of a world, of galaxies we think we know; is a perfect place suspended between space and time. Ann stands with head bowed. Not unable, but unwilling to look upward. She acclimates herself to what she believes is happening, when God speaks.
“I have called you, Ann.”
“I am not deserving,” she says softly without moving her lips; the thought alone transferring… for she has no physical form as we know it. She is more a mass of energy, beautiful translucence, having shed her human husk to allow the dormant seed of her soul, nurtured from childhood, to now blossom in unfathomable beauty.
“You are now rooted where you belong. You have suffered enough,” God tells her.
Within her being, the chorus of Ann’s favorite childhood hymn, “How Great Thou Art,“ rises from within her. Ann’s soul intermingles with the insurmountable energy of the angelical shadows that surround her, sometimes moving through her: loved ones like her grandparents, aunts and uncles. “Now sings my soul, my savior God to Thee / How great Thou art / How great Thou art.” The music is barely audible; the music is deafening.
“Think of pancreatitis as a ruthless eating disorder,” Ann says. “It’s when your pancreas gets inflamed,” she explains further. Positioned in the upper part of the abdomen, behind the stomach, it plays a vital role in digestion: producing necessary digestive secretions and hormones. These include enzymes and bicarbonate, which travel through a tiny tube called the pancreatic duct to the small intestine. There, they break down proteins and fats in foods allowing nutrients to be absorbed. Digestive hormones, primarily insulin and glucagon, release into the bloodstream, controlling the body’s blood sugar: a major source of energy.
There are many ways a pancreas becomes inflamed. Once inflammation occurs, the condition progresses to swelling of the gland and the surrounding blood vessels, bleeding, infection, and permanent damage. This is when digestive secretions become trapped and begin digesting the actual pancreas itself. Scarring occurs, such that it cannot return to its original state, worsening over time.
“No blockage was found in my pancreatic duct,” says Ann. “But it was so inflamed that the doctors agreed that I needed a stent to open the duct wall wider, allowing the proper drainage. It is while putting in the stent that I flat lined.”
She goes on to explain that the average dosage of Dilaudid is one-half a milligram every two hours, though her level of pain required one- to two-milligrams every two hours (anywhere from twice to four times the average dosage). “That day, April 24, 2008, I was given four milligrams at 7:20 a.m. when the day nurse came on shift, four more two hours later, and then an additional four more two hours later, still.”
An egregious oversight, Ann explains how she was taken into surgery that afternoon regardless of the fatal amount of Dilaudid in her bloodstream. Upon making an incision on the bottom left of her back, respiratory depression set in and her peripheral vision caught sight of the oxygen monitor plummeting to a dangerously low 39. Then everything went black. Then everything went white.
“As a real-estate agent, I’ve been opening doors to new homes for people for eight years. Now, a door pushed open for me. I somehow realized I was being given a gift, the greatest gift of all; but I worried for my children.”
“You are not pleased, Ann,” God says, in a voice masculine, yet feminine; commanding, yet comforting; comprehensible, yet coded. The revelation of these contradictions are the beginning of the answers, celestial knowledge infusing her being as promised in the scriptures.
“I am, so very pleased. But I worry for my children.”
“You have fulfilled your duty; they do not need you any longer, Ann.”
Ann is not sad at this comment or even startled by its bluntness; the comment’s pure truth is relayed with such an undercurrent of kindness, it is simply heard. She thinks quickly of her daughter, Sarah (then 26-years old) and son, Mark (29); Sarah’s impending marriage… John’s recent graduation from the Police Academy and his new career. She can’t imagine not guiding them. And then, there is her mother and father. But all of them are adults, she could hear herself think. God’s wisdom is so simple; God’s wisdom is so profound. Ann notes the dichotomy and in this realm: understands.
The action in the operating room is feverish. Mere seconds pass, but time as we know it is irrelevant as Ann feels she has been with her Maker for some time now. Pondering her quandary, she senses her human foolishness. Leave a perfect state of perfection for the flawed world of the living? How absurd, she thinks. But a mother has binds that are difficult to sever with her children. She reflects on a line from the hymn, which she realizes is being generated from deep inside her: “When I in awesome wonder / considered all / the worlds Thy hands have made.” Why did it strike her as a child and even more so as a young adult and beyond?
Ann remembers studying it in books and on the Internet. “How Great Thou Art” dates back to 1885 and is based on a poem by Swedish minister Carl Boberg. It celebrates the many worlds of God’s creation. Ann’s profound appreciation of God’s supreme miraculous power surges through her. “Then sings my soul,” bursts forth from deep within her core, light in every shade melds to create an incomprehensible visual palette. Then her voice suddenly soars with the others. She sings unlike ever before. Perfectly intonated. Resonating. Notes traveling light years and beyond. Without any sense of ego or pride, she recognizes it to be one of the most beautiful voices she has ever heard.
“While I was in the presence of God, they worked diligently to revive me. Records were quickly accessed, and the unusually lethal dose of Dilaudid was identified,” Ann says. “What seemed like hours passing was still seconds.” Medicines countering the Dilaudid and its respiratory depression were dispensed, as pulmonary respiratory maneuvers were performed. “They were doing everything they could within their human capability,” Ann says.
“My mother stood back away from me now, against the moss-green wall of the OR, praying for my return. How often we pray for things counter to God’s will,” Ann adds.
“It seemed God’s will was for me to stay, to stop suffering, to live a serenely eternal life with Him. But I felt my business on earth, with my children, with my parents was unfinished. God tells me: ‘You can go back,’ ” Ann says. “ ‘But on two conditions.
“You will remember only a measure of the divine knowledge you have acquired. And, Ann, if you choose to return, you will continue to live in constant pain.”
Then the lack of physical suffering fills Ann’s recollection. She feels perfectly balanced in this place. It would change if she returns. Suspended between the world of human wants — and this place — of divine perfection, she is confused. And she has milliseconds to decide.
A recent Gallop Poll shows 5% of the U.S. population of 260 million has similar out-of-body experiences, many of which present the opposite, harrowing account of going to hell. Could this be a glimpse into the future state of our souls?
The concept of a human double has a lengthy and colorful legacy. According to Plato, what we experience in this life is only a dim reflection of what our spirits can see if released from the physical. Imprisoned in the body, the spirit is restricted; separated from the physical, it is able to converse freely with the spirits of the deceased and in many cases, one’s Higher Power itself. Theoretical posturing on this topic, from then to today, varies little.
“I was brought-up a Christian and remain a Christian,” Ann says. So, finding myself in this state of being was at first a shock but not unbelievable to me. It’s my faith. The desire for eternal life with God is my goal.”
With head still bowed, the aura of people known and unknown comforted her, while the light’s intense warmth kept her in its rapture. Ann’s being called out, “Oh, loving God, I wish to return to my family.”
“We will await your return, Ann. Prepare to bare your physical pain with the grace you have previously shown Me,” God says.
A sudden backward pull finds Ann moving from the light, the warmth, the supreme ecstasy of God’s direct presence. Is she making a grave mistake?
The heart monitor begins to beep.
“Immediately, I have great regret. The pain is so great, and the difficulty of getting through it in that moment is so overwhelming, I wish I had stayed in that perfect place, where no pain and no sorrow exists,” Ann says. “The music is gone. Only beeping, buzzing, and the rustling of hurried hands and feet can be heard,” she continues. “To experience perfection… absolute perfection… and then to return to such imperfection is wrenching.”
Ann pauses, looking momentarily in the distance, pushing back her hair and a tear, she does not think I notice.
We agree to meet on another day. “Keith,” she says, showing a more reflective manner than I have ever seen with Ann. “He is an awesome wonder.” Squeezing her hand and smiling, I turn to leave, my eyes catching a tattered old hymnal on the corner of her desk, open to the song, “How Great Thou Art,” and bookmarked with a daily list of things to do.
I come by Ann’s office at 8:30 a.m. on Tuesday of the following week. She looks wonderful. There’s a spring in her step. A sweet, endearing smile on her face. How? How do you do it? I ask myself.
We walk to her office when I notice the bulletin board around the corner of the front desk. It posts a list of the top-10 selling real-estate agents for the month of August (out of 62 in the office). Ann Thomas is listed first. “Congratulations on your August performance,” I say. “Thank you,” says Ann with the smile of a conqueror.
Sitting down, I add, “I don’t know how you do it.”
She looks at me, unsure of my meaning.
“Successful at work, living… loving life, but always in constant pain,” I try to explain. Ann looks me square in the eyes. I sense she has something serious she wants to say.
“Coffee?” she asks. I laugh, because she laughs. I’ve been trumped.
While she is gone, I look around. Her desk is messy. Probably one of those she-still-knows-where-everything-is things. Order in the chaos.
Returning around the corner, coffee in hand, Ann says, “I hope I didn’t give the wrong impression last week. Today, I do not regret returning. It was just in those moments directly upon being revived.”
“I understand… I think,” I say.
“I am grateful for the opportunity to still be with my children, mom and dad, family and friends. To be with you, Keith.”
She radiates a palpable warmth seldom felt. “But the… pain,” I stammer.
“The suffering is lessened by the joy I carry in knowing where I will go someday. I carry it for Him as he carried it for me.”
“I notice you carry your hymnal with a list of things to do each day,” I say.
“OK, the book is something dear to me that I keep at my side; the other is a to-do list. Quit trying to make everything symbolic,” she laughs.
“I have to ask,” I say.
“The answer is no.”
“But I haven’t asked the question.”
“The questions,” she rebuts. “You have two.”
“No, it is not a dream,” she says taking my hand.
I sit dumbfounded.
“And no. I could never sue someone: who opens the door, who allows my soul to sing — in the presence of God.”