Night Shift Revelations From the Hospitals of Puerto Limón

Costa Rica has achieved remarkable health outcomes that place it among the healthiest nations in the Americas, often compared favorably with countries of far greater wealth. The Caja Costarricense de Seguro Social (CCSS), established in 1941, provides universal healthcare to all citizens and legal residents, and has been instrumental in achieving a life expectancy of approximately 80 years — comparable to the United States and higher than many European nations. Costa Rica abolished its military in 1948 and redirected military spending to education and healthcare, a decision that profoundly shaped the country's health outcomes.

The University of Costa Rica's Faculty of Medicine, founded in 1961, trains the majority of the country's physicians. Costa Rica's community-based healthcare model, featuring EBAIS (Equipos Básicos de Atención Integral en Salud) primary care teams deployed throughout the country, has been praised by the WHO and World Bank as a model for developing nations. The Hospital Nacional de Niños (National Children's Hospital) in San José has achieved internationally recognized outcomes in pediatric care. Costa Rica's Nicoya Peninsula is one of the world's five Blue Zones — regions where people live unusually long, healthy lives — making it a subject of intense longevity research.

Costa Rica's ghost traditions are rooted in a blend of Indigenous Bribri and Cabécar spiritual beliefs, Spanish colonial Catholicism, and Afro-Caribbean traditions from the Limón coast. The Bribri people of the Talamanca region believe in Sibö, the creator god, and maintain a complex cosmology where the dead travel to a place below the earth. Bribri shamans (awá) serve as spiritual intermediaries and healers, communicating with spirits through sacred cacao ceremonies — cacao being considered the sacred blood of the divine.

Costa Rican mestizo folklore includes several iconic supernatural figures. La Llorona, the weeping woman searching for her drowned children, is heard near rivers and streams throughout the Central Valley. La Segua (or Cegua), a beautiful woman who appears to unfaithful men on horseback and reveals a horse's skull face when approached, is one of Costa Rica's most distinctive ghost legends. El Cadejos, a large supernatural dog (appearing as either a white protective spirit or a black malevolent one), accompanies travelers at night. La Tulevieja, a woman cursed for abandoning her child and transformed into a hideous creature with a leaf-like face, haunts forests and waterways.

The Afro-Caribbean community of Limón province, descended from Jamaican workers who built the Atlantic railroad in the late 19th century, brought obeah spiritual practices and Caribbean ghost beliefs, including duppies (ghosts) and spirit communication traditions. These coastal traditions add a distinct layer to Costa Rica's supernatural folklore, creating a ghost culture that varies significantly between the Hispanic highlands and the Caribbean lowlands.

Costa Rica's miracle traditions center on its patron saint, the Virgen de los Ángeles (Our Lady of the Angels), whose small stone statue was reportedly found by a mestiza girl named Juana Pereira on August 2, 1635, on a rock in Cartago. According to tradition, the statue repeatedly returned to the rock after being moved, and a spring that emerged beneath the rock is believed to have healing properties. The Basílica de Nuestra Señora de los Ángeles in Cartago is Costa Rica's most important pilgrimage site, and every August 2, approximately two million Costa Ricans (nearly half the population) participate in the Romería — a pilgrimage walk to the basilica, many on their knees, seeking healing or giving thanks. The basilica's collection of milagros (small metal charms representing healed body parts) and ex-votos testifies to centuries of claimed miraculous healings. Bribri healing traditions, centered on the awá shamans who use medicinal plants and spiritual rituals, document healings attributed to spiritual intervention.

Cardiac rehabilitation programs near Puerto Limón, Caribbean Coast are discovering that NDE experiencers exhibit different recovery trajectories than non-experiencers. These patients often show higher motivation for lifestyle change, lower rates of depression, and—paradoxically—reduced fear of a second cardiac event. Understanding why NDEs produce these benefits could improve cardiac rehab outcomes for all patients, not just those who've had the experience.

The Midwest's volunteer EMS corps near Puerto Limón, Caribbean Coast—farmers, teachers, and retirees who respond to cardiac arrests in their communities—are among the most underutilized witnesses to NDE phenomena. These volunteers are present during the resuscitation, often know the patient personally, and can provide context that hospital-based researchers lack. Training volunteer EMS workers to recognize and document NDE reports would dramatically expand the research dataset.

The Midwest's public health nurses near Puerto Limón, Caribbean Coast cover territories measured in counties, not city blocks. These nurses drive hundreds of miles weekly to check on homebound patients, conduct well-baby visits in mobile homes, and administer flu shots in township halls. Their healing isn't dramatic—it's persistent, reliable, and so woven into the community that its absence would be catastrophic.

The Midwest's tornado recovery efforts near Puerto Limón, Caribbean Coast demonstrate a healing capacity that extends beyond individual patients to entire communities. When a tornado destroys a town, the rebuilding process—coordinated through churches, schools, and civic organizations—becomes a communal therapy that treats collective trauma through collective action. The community that rebuilds together heals together. The hammer is medicine.

Hutterite colonies near Puerto Limón, Caribbean Coast practice a communal lifestyle that produces remarkable health outcomes: lower rates of stress-related disease, higher life expectancy, and a mental health profile that confounds psychologists. Whether these outcomes reflect the colony's faith, its social structure, or its agricultural diet is unclear—but the data suggests that communal religious life, whatever its mechanism, is good medicine.

Sunday morning hospital rounds near Puerto Limón, Caribbean Coast have a different quality than weekday rounds. The pace is slower, the conversations longer, the white coats softer. Some Midwest physicians use Sunday rounds to ask the questions weekdays don't allow: 'How are you really doing? What are you afraid of? Is there someone you'd like me to call?' The Sabbath tradition of rest and reflection permeates the hospital, creating space for the kind of honest exchange that healing requires.

The phenomenon of 'shared grief' — grief experienced collectively by communities affected by mass loss events — has received increased attention in the wake of the COVID-19 pandemic, which caused an estimated 18 million excess deaths worldwide. Research published in The Lancet found that for every COVID-19 death, approximately nine bereaved family members experienced significant grief reactions, producing a 'grief pandemic' that affected over 150 million individuals globally. For communities like Puerto Limón, where the pandemic claimed lives and disrupted every aspect of communal life, the collective grief remains a significant psychological burden. Dr. Kolbaba's book, while written before the pandemic, addresses the universal themes of loss, hope, and continued consciousness that are directly relevant to the pandemic grief experience.

The anthropology of death—studied by researchers including Philippe Ariès ("The Hour of Our Death"), Ernest Becker ("The Denial of Death"), and Allan Kellehear ("A Social History of Dying")—reveals that the modern Western experience of death as a medicalized, hidden, and feared event is historically anomalous. For most of human history, death was a public, communal, and ritually rich experience. Physicians' Untold Stories, by describing what happens at the bedside when physicians witness transcendent moments, partially restores this older relationship with death for readers in Puerto Limón, Caribbean Coast.

Kellehear's research is particularly relevant: he has documented that deathbed visions and social-spiritual experiences of dying are consistent features across cultures and historical periods—features that modern medicine has marginalized but not eliminated. The physician accounts in Dr. Kolbaba's collection represent contemporary observations of these perennial phenomena, described in the language of modern medicine but recognizable to any student of the history of dying. For readers in Puerto Limón who sense that our culture's relationship with death has become impoverished, the book provides a corrective—a window into the richer, more mysterious experience of dying that our ancestors knew and that medicine, despite its best efforts, has not fully suppressed.

The dual process model of grief, developed by Stroebe and Schut (1999), proposes that healthy bereavement involves oscillation between 'loss-oriented' coping (processing the emotional pain of the loss) and 'restoration-oriented' coping (adjusting to the practical changes created by the loss). Research published in Death Studies has confirmed that this oscillation pattern is associated with better psychological outcomes than either constant focus on loss or constant avoidance of loss. Dr. Kolbaba's book facilitates both types of coping simultaneously: the physician accounts of death and dying engage the reader's loss-oriented processing, while the evidence of continued consciousness and ongoing connection supports restoration-oriented coping by providing a framework for a changed but continuing relationship with the deceased. For grief counselors in Puerto Limón, the dual process model provides a theoretical rationale for recommending the book to bereaved clients.

The AWARE (AWAreness during REsuscitation) study, led by Dr. Sam Parnia at the University of Southampton, represented the most ambitious scientific investigation of near-death experiences ever conducted. Spanning 15 hospitals in three countries over four years, the study placed hidden visual targets on shelves in resuscitation bays — targets visible only from the ceiling — to test whether patients reporting out-of-body experiences during cardiac arrest could accurately identify them.

While the study's results were mixed — only one patient was able to describe verifiable events from the out-of-body perspective, though his account was strikingly accurate — the study's significance lies in its methodology. For the first time, NDEs were investigated using the tools of prospective clinical research rather than retrospective interviews. For physicians in Puerto Limón, the AWARE study signals that the medical establishment is taking NDEs seriously enough to invest major research resources in their investigation.

Near-death experiences in children deserve special attention because children lack the cultural conditioning, religious education, and media exposure that skeptics often cite as the source of adult NDE narratives. Dr. Melvin Morse's research, published in Closer to the Light (1990), documented NDEs in children as young as three years old — children who described tunnels, lights, deceased relatives, and angelic beings with a clarity and conviction that astonished their parents and physicians. The children's accounts matched the core features of adult NDEs despite the children having no knowledge of these features prior to their experience.

For physicians in Puerto Limón who work with pediatric patients, children's NDEs present a uniquely compelling data set. When a four-year-old describes meeting "the shining man" who told her she had to go back to her mommy, the child is not drawing on cultural expectations or religious instruction — she is reporting what she perceived. Physicians' Untold Stories includes accounts from physicians who cared for pediatric NDE experiencers, and these accounts are among the book's most moving. For Puerto Limón families who have children, these stories offer the reassurance that whatever awaits us beyond death, it is perceived as welcoming and loving even by the youngest and most innocent among us.

Dr. Pim van Lommel's prospective study of near-death experiences, published in The Lancet in December 2001, remains the gold standard of NDE research. The study followed 344 consecutive cardiac arrest patients across ten Dutch hospitals over a four-year period. Of the survivors who could be interviewed, 18% reported an NDE, with 12% reporting a "core" NDE that included multiple classic elements. The study's prospective design was crucial: by interviewing patients within days of their cardiac arrest rather than months or years later, van Lommel minimized the risk of confabulation and memory distortion. The study also controlled for a wide range of physiological and psychological variables, including the duration of cardiac arrest, the medications administered, the patient's prior knowledge of NDEs, and their religious beliefs. None of these variables correlated with NDE occurrence, challenging the standard physiological and psychological explanations. Van Lommel's follow-up interviews at two and eight years after the arrest demonstrated that the NDE had lasting transformative effects on experiencers — effects that were not observed in non-NDE cardiac arrest survivors. For physicians in Puerto Limón and the broader medical community, the van Lommel study represents a paradigm-shifting piece of research that demands engagement from anyone seriously interested in the nature of consciousness.