You awaken to cold darkness and inexplicable silence. Confused, you attempt to get up, and realize you’re lying inside some sort of rectangular box. As panic begins to set in, you start screaming for help, pounding relentlessly on the walls of the rectangular prison. And then suddenly you realize what’s happened — you’ve been buried alive. Although this may sound like the plot for a low-budget horror film, it’s been a macabre reality for countless individuals.

Called Out In The Dark

This week, a story from North Rhine-Westphalia, Germany, reminded us just how real these occurrences are. In March, a seriously ill 92-year-old woman was found unresponsive and without a pulse inside her nursing home room, The Associated Press reported, without specifying her condition. A doctor came and pronounced the woman dead. Relatives were called to say their final goodbyes before the woman’s body was brought to a local funeral home. But later that evening, the woman, who was still alive, awoke inside of the undertaker’s refrigerated room. Alarmed, she began to cry for help and was quickly discovered and taken to a local hospital. She died two days after the incident, although her cause of death is believed to be unrelated to her harrowing experience.

On Tuesday, however, the doctor who wrongly pronounced her dead was charged with bodily harm caused by negligence and will be due to appear in a German court, the date of which hasn’t yet been set.

A Brief History Of Being Buried Alive

Taphephobia, or the fear of being buried alive is far from irrational. In a 1905 report covered in the book Premature Burial: How It May Be Prevented, co-author William Tebb, founder of the London Association for Prevention of Premature Burial, recorded 219 instances of narrow escape from premature burial. Of these cases, 149 were of actual premature burial, 10 described bodies that were accidentally dissected before death, and two involved embalming the still-living people.

Let’s say that you’re one of the unlucky ones who actually makes it to the grave without doctors detecting your beating heart. What happens then? How long you’d survive in the coffin is largely dependent on both the coffin size and your body size. Popular Science reported that a normal, healthy person might have 10 minutes to an hour, or six hours to 36 hours, depending on who you ask. Thankfully, the buildup of carbon dioxide in the coffin will likely knock you out before you have the chance to suffocate. So while death from burial is guaranteed, at least it’ll be relatively painless.

Oftentimes, diseases that cause the heart to slow down to a near-undetectable beat are cited as the root cause of live burials. Decreased heart rate is a rare but well known symptom of epilepsy. African sleeping sickness, an infectious disease that causes uncontrollable abnormal sleeping patterns, has also been cited as a medical cause for a number of cases of premature burial. Considering the early 1900s was a time when medicine wasn’t as advanced, it’s easy to see how doctors could misinterpret these conditions for death.

But disease is not the only way for individuals to be mistakenly perceived as dead. According to the 1994 book The Serpent and the Rainbow, written by Harvard scientist Wade Davis, high doses of the toxin tetrodotoxin, which is produced by the pufferfish, can cause death by paralysis. In low doses, however, the toxin induces a death-like state. According to Davis, witch doctors in Haiti have used the toxin to turn their victims into “zombies” — days after burial, the witch doctors would dig them out of their graves and use them as slaves.

Infectious disease, however, is responsible for the highest number of premature burials, Maxim reported. During time periods before the discovery of the germ theory, people believed they would catch infections from the bodies of the deceased. Because of this, it became common practice to bury the bodies of the dead as soon as possible. In periods of mass outbreaks, it was quite common for the “not-quite-dead” to be tossed into graves along with their corpse companions.

Thankfully, these stories don’t always have such gruesome endings — such as the 6-year-old boy who was accidentally buried in a sand dune for two days after accidentally falling into a sinkhole. He made a full recovery. Regardless of the many near-premature burials, just the thought of being buried alive is enough to make anyone panic. In the past, people have gone to great lengths to ensure this didn’t happen.

Preventing Premature Burials

Rumors of people accidentally being buried alive during the 18th century cholera outbreak spurred the design of “safety coffins,” according to io9. The sale of these safety coffins soon became a booming industry. Coffins were being sold with escape hatches that could only be opened from the inside, that were linked to the surface to ring for help, and periscopes that gravediggers could occasionally look through to monitor any possible changes in the corpse.

According to legend, George Washington requested that his body not be buried until two days after his death, just to ensure that he was in fact truly dead. Legend even says that the tradition of holding a two-day wake in which the body can be viewed before being buried came about as a way to ensure that the cadaver did not suddenly wake up.

Today, the chances of being buried alive are very small — but not impossible, as exemplified by the German woman. When an individual dies in a hospital they are usually attached to a machine that reads their brain waves, heartbeat, and respiration. If activity in all of these stops, the patient is considered dead and sent to a funeral home, Time reported. In the U.S., it's illegal for a person to be buried without a medical professional pronouncing them deceased, making the chances of someone bypassing these tests very slim.