Dreams and other signs bring comfort to grieving people

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We’ve all had dreams. Some people dream vividly and often, some not as often. And there is the problem of forgetting the dream when you wake up, or shortly thereafter. I usually try to make a note to myself right away or when the dream wakes me up. I keep a bedside notebook for ideas, etc. Otherwise they are just forgotten.

And there are many types of dreams — happy and pleasant, wishful thinking, nightmares, anxiety dreams such as being lost, and, most difficult of all, distorted or mixed up dreams with the characters and events all combined and scrambled. There are many types of dream analysis, as well: ways to try to interpret the meaning of dreams. And we also have our own ideas about what a dream means.

But there is a special type of dream in grief, in which your loved one appears as if in life.

This can be very comforting. You are lucky to get one of these once in a while. I’ve had a few over the years and cherish them. They create a happy sensation, even after I wake. One vivid one I had a year or so ago was just a normal scene with my beloved Baheej’s arms around me. That was nice. A blessing. He appears in dreams occasionally but not very often.

There are lots of anxiety dreams in grief. Usually along the lines of being left alone, abandoned or other stressful scenes. Or danger where you can’t save the other. Or you can’t find him or her.

So dreams are a mixed bag. And they are different from “signs,” which are almost always pleasant and encouraging in my experience — and among people who’ve talked to me about signs. They are happenings/messages that serve as communication from lost loved ones, easily recognized by the bereaved, and very comforting.

The problem with signs is most people, unless it’s happened to them, think it’s just a person’s imagination, wishful thinking, or some fantasy because of grief. Or they think the sign is just a coincidence. But I continue to believe signs are a method of communication from the lost loved one. It’s a reassurance that they are still around and watching out for you.

Some people even experience a visual visit from a spirit, but this has never happened to me. It did happen to my sister and a couple of friends. I always hope my dear Baheej may appear someday, but not so far.

A while back, I got an email from a reader who described a sign he and his wife got from the adult son they lost. It was graphic and quite clear to them. How nice.

Last night I was talking with a close friend who had a huge sign from her father-in-law who died a few days ago. She went into the city alone to see a big art exhibit, and felt she was doing it not only because of her personal interest, but also in memory of her father-in-law, who loved art and would have enjoyed this exhibit.

Well, as she was walking around the gallery, there was a couple near her. From the back, the man looked like her father-in-law and seemed to be dressed like him. He turned around and looked just like him, but 10 years younger. He had on the same clothing, shirt and vest, of the same brand and style her father-in-law always wore.

My friend was surprised so she approached the couple and told them. They said to her, “Of course, he’s probably here with you now.” Wow. So I immediately said, “That’s a sign.”

This is how it happens, totally unexpected but clear as a bell.

My friend told me, “I think you have to be very open to recognize these signs when they happen.” I agree with her.

I’ve written about signs with lots of examples in earlier columns, so won’t repeat those. But here are a couple more examples:

Once I was at a swap shop in New Hampshire and I picked up (free) two darling flower watercolor drawings. Each is about 8 inches square, with matching frames. They now hanging in my dining room. One is the July water lily. It’s my husband Baheej’s favorite flower and his birthday month. The other is the December rose, my father’s birthday month. The two most important men in my life. My brother Nic had died shortly before. I expect to find the Nic’s April flower one of these days — my brother’s birthday month, and it’s also my mother’s.

Another sign is a feather. It’s widely thought to be a sign from a lost child or infant and, I think, could also be from someone young in spirit. Baheej was one of the latter; he had a really young joy of life. Well, in the first month or two after his death, I found many feathers around the yard, on the patio, even one in the house. My cats never go outside, so it wasn’t them. And I don’t have any pet birds.

I’ve only found one feather ever since. However, a friend who lost an infant found many, many feathers. Signs as far as I’m concerned.

So the point is: There are some extrasensory phenomena that happen in grief, chief among them dreams and signs. I think everyone agrees we all have dreams. So if you are lucky enough to have pleasant dreams of your lost loved one, whether spouse, partner, friend, child, parent or other, you are very fortunate.

Life is so complicated. And so is death. We just need to be as open as possible. Comfort comes in many forms.

Complete Article HERE!

He Was Already Sick.

Was His Life Worth Less Than Yours?

With the coronavirus upon us, Americans now must confront death up close.

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Before this novel coronavirus ever reached American shores, I heard dark tones of reassurance. Don’t worry, people said. It kills only the old and the sick. The thought, a temporary (and misleading) escape from rising panic, crossed my mind, and surfaced in conversation. When I spoke last week to Jessica Smietana, a 30-year-old doctoral student in French literature at New York University, she admitted the thought had occurred to her, too. “I remember saying, ‘Well, you know, when it’s reaching people that aren’t in vulnerable populations, that’s when I’ll worry about it.’”

And then, like many of our unsavory national tendencies, the sentiment took an exaggerated, grotesque form in the statements of President Trump. “We cannot let the cure be worse than the problem itself,” he tweeted in all-capital letters, signaling that he might urge states to lift protective restrictions on gatherings and businesses rather than continue to incur economic costs. In that calculus, the lives of the sick and dying became a mere data point in an actuarial account of the coronavirus pandemic’s economic impact. Mr. Trump has since changed his view, saying, “the economy is number two on my list. First, I want to save a lot of lives.”

Rightfully so. Such an easy dismissal of the sick and elderly is a ghastly indictment of one of our most cowardly cultural reflexes: an abandonment of the dying as a means of wishing away death.

It’s a weakness only the lucky can long afford, and in the midst of this pandemic, their numbers are swiftly shrinking. As coronavirus cases in the United States multiplied, Ms. Smietana, like many of us, found reason to reconsider her initial response. Her 63-year-old father, Bruce Smietana, began chemotherapy treatment for early-stage pancreatic cancer last month. “I realized what a terrible attitude this is,” she told me. “We shouldn’t think of that as an acceptable outcome — ‘Well, all these people were going to die soon enough.’”

In America, Ann Neumann writes in “The Good Death,” “death has been put off and professionalized to the point where we no longer have to dirty our hands with it.” But with the coronavirus, death has drawn too near to ignore. And this is a good thing. The dying, their value and their particular wisdom should never have been banished from our common life in the first place.

The physicians who accompany people as they face death have a unique perspective on mortality, perhaps thanks to the example of their remarkable patients. I spoke to Christopher D. Landry, a postgraduate trainee in the Columbia University psychiatry department, last month, during his emergency medicine rotation. “A lot of young people feel that life in the shadow of death is no life at all,” Dr. Landry said. “But everybody approaches that shadow eventually. And then, even people who were previously young and healthy learn to appreciate the many good things in life that they’re still able to have.”

The prospect of death also prompts a philosophical evaluation of life. These reckonings can bring the blur of ordinary life into sharp and brilliant focus.

At 19, Ms. Smietana lost her mother, and later, her older sister. From that point on, her family consisted of herself and her father, a stoic and steadfast garbage man who worked for the city of Chicago for some 30 years. Ms. Smietana told me that she had always been close with her father, but that their relationship became even more vital after the loss of her sister and mother. “That’s made this whole situation a little more intense,” she said.

The threat of the coronavirus kept Ms. Smietana from being with her ailing father.

Her father’s battle with a miserable disease has led her to contemplate justice, or the lack of it. He had already lost so much. Because the chemotherapy weakened his immune system, she wasn’t permitted to visit him during his treatment. He would be alone. As we spoke, her voice thinned with tears. “It feels tremendously unjust,” she said.

What Ms. Smietana saw was that the presumption of fulfillment — that the elderly have lived life, and can ask little more from it — is mistaken. As much as any young person can hope to feel more love, happiness, curiosity, satisfaction in the balance of life, so can the aged and the ill. In fact, they may experience those good things in life even more acutely for recognizing their scarcity.

In that respect, the dying may be more alive than any of us — more awake to the truths that emerge at the end of all things, and more aware of the elements of life that lend existence its meaning.

When I spoke to Mr. Smietana on the telephone, he was recovering from chemotherapy in the midst of a pandemic. But he didn’t ruminate on pain; instead, he talked about gratitude. He told me about Jessica, how she would be the first doctor in the family. He looked forward to her graduation, and to all of the other things he had no doubt she would accomplish; “she’s an amazing daughter,” he said.

And then he drew a labored breath, still exhausted from his treatment. “I’ve had a relatively great life,” he reflected. “I lost my wife, and I lost one of my daughters. But besides that, I’ve been pretty damn lucky.”

Mr. Smietana died a week later, on a cold Sunday morning in Chicago. He awoke that day with breathing trouble, and passed shortly thereafter. When I spoke with Ms. Smietana, she was still thinking about justice, or the lack of it. “Coronavirus is the reason I didn’t get to see my dad during what turned out to be the last week of his life,” she said. “It was the right thing to do. But I will regret it forever.”

Complete Article HERE!

We can’t be squeamish about death. We need to confront our worst fears

Patients, their families and their doctors need to be open about the inevitable as the virus sweeps through our population

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As the coronavirus spreads through the population, there is one fact we can all agree on. Whether we like it or not, society’s greatest taboo – death and dying – has been thrust unequivocally centre stage.

How could it not, when government strategy is to allow the virus to infect huge swathes of the country in the hope of building sufficient “herd immunity” to protect from future harm? The virus has killed an estimated 3.4% of those it has infected, according to the World Health Organization, although this figure is expected to decline as the true number of people infected becomes apparent. Herd immunity, according to Downing Street’s chief scientific adviser, requires a minimum infection rate of 60% of the population. Thus we may face a potential early and unexpected death toll of hundreds of thousands of Britons.

There is, therefore, a glaring imperative to confront the topic so many of us long to squirm away from: the inescapable fact of mortality. As a palliative care doctor, I am intimately acquainted with our reluctance to square up to dying, and with the unintended harms of such squeamishness. Advance care planning – the phrase doctors use to describe proactively how much medical intervention you would wish for in extremis – is too frequently neglected, by patients and doctors alike.

Sometimes, for example, if an oncologist is less than candid about a patient’s frailty precluding any further rounds of chemotherapy, a family may be unaware that time is running out. Profound and vital conversations between family members never happen. Final messages hang in the air, forever unsaid.

Suddenly, the patient is comatose and fading. And no one has sought to find out if they would like heroic efforts at prolonging life – or if, perhaps, their final wish is to die at home, neither gowned nor tubed, with no machines and only loved ones at their side.

We are fast approaching a crunch time. NHS intensive care beds will be imminently overwhelmed with patients in dire need of mechanical ventilation. Italy’s experience has shown all too graphically that peak infection rates demand draconian rationing of health resources. In Lombardy, for example, some beleaguered hospitals have been forced to impose bans on ventilators for coronavirus sufferers aged over 60 – this despite knowing that it is predominantly the elderly who will die.

As Britain approaches peak infection, we therefore owe it to each other to start talking now. Would your mother, approaching 80, even wish for an intensive care bed? Do you, her anxious offspring, even feel able to find out? No one can pretend these discussions are easy. Our dearly beloved mums and dads are no less loved for their years; how on earth do we begin to broach the prospect of each other’s deaths?

If there is one thing I have learned from my time in a hospice, it is that these conversations rarely measure up to the degree with which we dread them. Indeed, for some elderly patients – conscious of their frailty – a little candour about the future can bring immense relief. It is fine to stumble, feel awkward, grope your way, get the words out wrong. In the end, all that matters is motive: the sincerity of your fumbled aim to tease out your loved one’s views.

Two medical truths may help you find the strength to talk and listen. First, every medical intervention has cons as well as pros. Even for young and healthy patients, intensive care is a gruelling experience that can leave serious, long-term medical problems. For the elderly, survival is more doubtful, let alone full restoration to good health.

Second, not every problem can be fixed. Sometimes, a disease is so aggressive that intensive care cannot cure, but only harm. When doctors conclude intensive care is not an option, it is not discrimination but a weighing-up of what might work, the sober balancing of benefits and risks.

In the end, an advance care plan need be nothing more technical than a chat over a cuppa. Steel yourself. Find out your loved ones’ wishes and tell them yours at the same time. There is kindness in being informed and prepared.

And – please – know that however besieged the health service becomes, we will never stop caring for every patient. You may be young, you may be old, but we will always do our best. How much you matter to us will never, ever run dry.

Complete Article HERE!

Getting Familiar with Life’s Certainty: The D-Word

“I’m gonna die, you’re gonna die. So is everyone we’ve ever loved and hated. And that’s OK.”

By Molly Marco

When I thought about what to write for my End Well blog post, I struggled to think of something different than what I submitted last year. The story I share in last year’s piece is one I’ve now told a million times. I know it well — where to put the emphasis (“Ever onward!”) and what will get the audience’s applause. Conversely, I know what parts of my story people may want to deny or avoid: Death. Dying. Fears and deficits that come with a brain cancer diagnosis.

In July 2016, my brain tumor was discovered after I fainted off a bar stool at a downtown Detroit coffee shop. Turns out, it wasn’t just a simple faint: I had a grade 3 anaplastic astrocytoma. A grade 3 astrocytoma is a junior glioblastoma (or, more accurately, a glioblastoma is a grade 4 astrocytoma). It is incurable and considered a terminal diagnosis, though many patients prefer to call it a chronic illness. That doesn’t mean I’m dying tomorrow — unless, as my neuro-oncologist once told me, I get hit by a car or something like that — it just means we don’t have a fix.

We expect my tumor to, maybe, charge up and for those rogue astrocytes to return — either as anaplastic astrocytoma again, or GBM. One or the other, no lesser. I won’t get better, we just hope that we can hold it off as long as possible before its encore performance. Worse than reoccurrence or GBM? There’s not really anything worse. It’s a turd sandwich.

Though come to think of it, there is worse. Worse is denying that reoccurrence is possible. Worse is convincing myself that I am cured and “cancer-free” (no brain cancer patient should ever be told that falsity) only to crumble and fall to pieces when new growth appears on a future MRI.

After Molly finished her chemotherapy, she got this tattoo. | Memento Mori: Remember you must die. Amor Fati: Love your fate

Worse is not mentally planning for future treatment, including palliative and end-of-life care. When to demand my off-switch to be clicked, so my family isn’t left making the difficult choice for me.

There may come a time when I can’t write and I can’t speak, so I plan to make these decisions while I’m still in control of my think-box.

Losing my mom last year and my aunt recently brings certain things to the forefront of my now with urgency: Death is guaranteed. Death will happen. I want to be ready. Not because I’m morbid or depressed, but the opposite of that. The thought of leaving this world — everyone and everything I love — scares me. The thought of the act of dying scares me more than death itself, to be honest. I need to be on better terms with death and dying.

If death is anything like falling off a barstool and passing out, I can handle that. The thought of an eternal afterlife I can’t even comprehend, but that sounds cool, too. But dying in pain and afraid? That is what I fear. I don’t want that. However, I choose to talk about it so I am as familiar with death and dying as I am with my own name. It’s not because I crave death, it’s because I love being alive with every fiber of my being. I love life so much.

And if we’re honest with ourselves, we can admit that in loving life — truly loving life — we can accept death as a thing we all do. There should be no stigma attached to something absolutely guaranteed from the moment we come into existence: I’m gonna die, you’re gonna die. So is everyone we’ve ever loved and hated. WE ARE ALL GOING TO DIE. That’s that. And that’s OK.

Last year, I suggested we live our best lives and live them right now. This year? Live our best lives, live them right now, because one day — you are going to die. Learn to let it be OK. And be ready.

Complete Article HERE!

I’m Going to Die.

I May as Well Be Cheerful About It.

By Mary Pipher

While death is inevitable, our attitude about it is not.

Generally, I don’t think about death during the day. My schedule is full, and I focus on what is right before my eyes. It’s usually only when I go to funerals that I reflect upon deaths past, present and future; most of the time I think about life. Still, about once a month I wake in the night and know with absolute clarity that I will soon be gone.

I have always felt my own finitude. My father had his first stroke at 45 and died at 54. My mother died of diabetes at 74. I am 72. I would like to attend my last grandchild’s high school graduation and meet at least one great-grandchild. However, with my family history, that is unlikely. Now, with the news filled with stories of the coronavirus, I am reminded of the many random diseases that can strike suddenly and lethally.

Like almost all my peers, I want to die young as late as possible. I don’t want to live beyond my energy level. I don’t want to suffer dementia or lie helpless in a hospital. I want to die while I still believe that others love me and that I am useful.

I have done what I can to prepare for my death. I have a will, a health care proxy and medical directives. I’ve had many conversations with my family and my doctor about end-of-life decisions. My mnemonic device for all of them is, “If in doubt, snuff me out.”

While death is inevitable, our attitudes about it are not. We can be sanguine or gloomy, solicitous of others or self-absorbed. We can approach our deaths with fear and resistance or with curiosity and a sense of mission.

Facing death offers us an opportunity to work with everything we have within us and everything we know about the world. If we have been resilient most of our lives, most likely we will cope well with our own dying. It is frightening, of course, but it is our last chance to be a role model, even a hero.

I’d like to face death with the courage of my grandmother. The last time I visited her, she was recently widowed and dying from leukemia. She lay in bed in her small home in eastern Colorado. I could see she was in pain and could barely move, but when I asked about her health, she replied: “Let’s talk about you. How is college going this year?”

When I complimented her on her courage, she said simply, “I am going to be in pain and die soon no matter how I behave, so I might as well be cheerful.”

By the time we are in our 70s, we are likely to have witnessed many people dying. I’ve seen my parents and my husband’s parents die “bad deaths” with months of suffering and too much medical intervention, and I’ve witnessed peaceful deaths in rooms filled with love. Most of us boomers know how to behave at a bedside and have a sense of how we want to act when it’s our turn to be the one in bed.

We also have had decades of observing the rituals of death — hospitals and hospice, funerals, burials and the communal meals afterward. From these experiences, we have learned what we do and don’t want when it’s our turn. We may continue some of these traditions, but we will also design our own. Some of my friends with terminal illnesses have hosted goodbye parties in parks or at our local blues bar. Wakes with dancing, music and storytelling are back in style. Many of us want pine box coffins, green burials or cremations with our ashes tossed in beautiful places.

What happens after death is a popular topic among people I know. Opinions range from, “We turn into dirt,” to “I will see the face of God.” My writer friends want heaven to have a good library. One friend believes we will return to the place we were before we were born.

Jean Nordhaus wrote, “The dead are all around us / feathering the air with their wings.” A therapist who lost her young, cello-playing husband told me she feels his presence and knows they are still deeply connected in spirit. She finds that many people are afraid to die because they have no language for the numinous; however, she is certain that neither life nor relationships end with death.

I feel death may not be as big a change as we suppose. Rather, it might be like crossing a river.

I like to think that my relatives and friends will be waiting for me on the other side. I like to imagine grassy banks and flower-filled pastures shining in the sun. I like to think a lot of things, but I don’t know for sure.

I am not a particularly mystical person, but I have had mystifying experiences. When my Aunt Grace died, I drove to the Ozarks for her funeral. Her little house was surrounded by pink surprise lilies — what my cousins called “naked ladies.” The next spring, even though I had not planted them and they had never come up before, surprise lilies popped up in my garden. The year after that they popped up again but in different places. I concluded that Aunt Grace was greeting me. If I wanted to send a message after death, I would do it with flowers, too.

I love the world but I cannot stay. Death is democratic and we will all participate in its enactment. I will miss the beauty all around me. I have taken so much pleasure in the natural world, in people and books, in music and art, in cups of coffee and lolling cats. If I knew that I had a month left to live, I wouldn’t spend my time much differently than I do now.

All of my life I have loved snow.

When I was a girl in the 1950s, snow fell often in the long winters of western Nebraska. I remember one winter when, after the streets were plowed, mountains of snow 10 feet tall stood in the middle of the streets. As a young mother, my favorite days were snow days when our family could stay home and play board games. I would make soup and popcorn. I relished taking my children outside to do the things that I had done in the snow as a girl. I loved falling asleep with my family safe on a blizzardy night when the streets were impassable and a blanket of peace covered our town.

Now, snow has become a profoundly spiritual experience. When it snows, I sit by my window and watch it fall. I go deep into its purity and softness.

Snow falls inside and outside of me. It settles my brain and calms my body.

I hope death feels like watching the snow grow thicker and thicker. Doctors call dying of a morphine overdose being “snowed.” I would not mind that at all. I would like to disappear in a whiteout.

Complete Article HERE!

On Why We Should Talk More About End-Of-Life Experiences

By Christopher Kerr, M.D., Ph.D.

In many ways, the end-of-life journey is a culmination of an integrative process that distills life into its finest moments. It is about revisiting and rewriting the life scripts we have been handed, whether by chance or by design. That said, the voices and experiences of dying patients matter. 

Dying is more than the suffering we either observe or experience. Within the obvious tragedy of dying are unseen processes that hold meaning. Dying is a time of transition that triggers a transformation of perspective and perception.

If those who are dying struggle to find words to capture their inner experiences, it is not because language fails them but because it falls short of the sense of awe and wonder that overcomes them. They experience a growing sense of connectedness and belonging. They begin to see not with their eyes but with their unlocked souls.

What it all means is that the best parts of living are never truly lost. I am reminded of this when elderly patients experience the return of the mother or father they lost in childhood; when soldiers speak of haunting battles; when children talk of dead animals returning to comfort them; and when women cradle babies long lost to their touch. This is when caution vanishes and courage prevails.

What matters is not so much what is seen but what is felt.

As poets and writers have reminded us throughout history, love endures. When the end draws near, time, age, and debility vanish to give way to an incredible affirmation of life. Dying is an experience that pulls us together by binding us to those who loved us from the start, those we lost along the way, and those who are returned to us in the end.

In the words of Thomas Jefferson, “I find that as I grow older, I love those most, whom I loved first.” The dying most often embark on a hopeful journey in which they are embraced one more time by those who once gave their lives meaning, while those who hurt them drift away. Death is also a form of final justice, one in which the scales are balanced by love and forgiveness.

Having witnessed so much death as a hospice doctor, I can’t say that I fully embrace the notion of a “good” death. There is no such thing as a good death, only good people. Death and dying are merely extensions of what came before; we die as we lived. This cannot always be reconciled with happiness or goodness, particularly if the balance of one’s life had little to do with either.

Despite the tragedy, being a hospice doctor is uplifting.

Although I am often saddened by the tragedy and trauma that so many have endured, I remain amazed by the strength of the human spirit in its endless quest to heal what’s harmed or broken. For those denied fulfillment and happiness in life, it may be in that struggle that hope and grace reside.

Dying may be isolating and even lonely, but patients often find comfort in spaces where they can continue to express themselves, connect with others, and still matter. Long after the battle to overcome illness is lost, the dying continue to fight, but they are not fighting against, only for and toward. They fight to have relevance, to find meaning—right up until their very last breath.

Why else would people, bedridden and fading, find it in themselves to share their stories? Not the embellished versions we typically tell, but the real stuff that comes from having lived and mattered—from hard-felt pains, deep secrets, and distant losses to enduring love and wisdom regained. These moments, measured in days and hours, are not motivated by the possibility of future gain. They constitute a wished-for and self-generated ending.

Illness and tragedy naturally demand that we look inward, an artifact of our fight for survival and our innate resistance against mortality. As sickness begins to overtake the drive to live, there is a shift. The dying continue to cherish life, but not for themselves—for others. They express concern for loved ones, in gestures of kindness and hope, even as they say goodbye. Buried within their stories is the same awe-inspiring message, repeated again and again.

During the end of life, people have faith that their voices, softened or at times silent, mattered. And that they would still be heard.

Complete Article HERE!

Working in Hospice Changed My Perspective on Death

“Like many physicians, I’d never considered that there might be more to death than an enemy to be fought.”

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Tom was only forty when he arrived at Hospice Buffalo with end-stage AIDS. Unlike most of my patients, he was not surrounded by loved ones. Not a soul came to visit, ever. He was rather stoic, so I wondered if the absence of visitors was his choice rather than an indicator of his loneliness. Maybe that was his way of refusing to give death an audience.

I was puzzled but, wanting to respect his privacy, did not inquire. Tom’s emaciated body showed traces of once-chiseled muscles. He had kept fit and was still quite young, which gave me hope. In light of his age and physical conditioning, I thought that his body would be more likely to respond positively to life-prolonging treatment. Not long after he was admitted, I went to the nurse’s station and decreed, “I think we can buy Tom some time. IV antibiotics and fluids should do it.”

The charge nurse, Nancy, had been at Hospice Buffalo for much longer than I had. She knew her job, and everyone looked up to her. She was also not one to mince words. Still, her response took me by surprise: “Too late. He’s dying.”

I said, “Oh really?”

She replied, “Yep. He’s been dreaming about his dead mother.” I chuckled awkwardly—equal parts disbelief and defensiveness. “I don’t remember that class from medical school,” I said.

Nancy did not miss a beat. “Son, you must have missed a lot of classes.”

I was a thirty-year-old cardiology fellow finishing my specialty training while working weekends at Hospice Buffalo to pay the bills. Nancy was an exceptional veteran nurse who had limited patience for young, idealistic doctors. She did what she always did when someone was out of their depth—she rolled her eyes.

I went about my business, mentally running through all the ways modern medicine could give Tom another few weeks or even months. He was riddled with infection, so we administered antibiotics. Because he was also severely dehydrated, I asked for a saline drip. I did all I could do as a doctor to prolong his life, but within forty-eight hours, Tom was dead.

Nancy had been right in her estimation of where he was on the downward slope. But how could she have known? Was it just pessimism, the numbing effect of having watched so many people die? Was she truly using a patient’s dream as a predictor of life-span? Nancy had worked in hospice for more than two decades. She was tuned in to aspects of dying I knew nothing about: its subjective dimensions. How patients experienced illness, particularly dying, had mostly been ignored throughout my training as a doctor.

Like many physicians, I’d never considered that there might be more to death than an enemy to be fought. I knew about blind intervention—doing everything possible to keep people conscious and breathing—but had little regard for the way any given individual might wish to die, or for the unavoidable truth that ultimately death is inevitable. Because it had not been part of my medical education, I failed to see how the subjective experience of dying could be relevant to my role as a doctor.

It was ultimately the remarkable incidence of pre-death dreams and visions among my dying patients that made me realize how significant a phenomenon this was, both at a clinical and a human level. As a hospice doctor, I have been at the bedsides of thousands of patients who, in the face of death, speak of love, meaning, and grace. They reveal that there is often hope beyond cure as they transition from a focus on treatment to notions of personal meaning. As illness advances, grace and grit collide and bring new insight to those dying and their loved ones, insight that is often paradoxically life-affirming. This experience includes pre-death dreams and visions that are manifestations of this time of integration and coming into oneself. These are powerful and stirring experiences that occur in the last days or hours of life and that constitute moments of genuine insight and vivid re-centering for patients. They often mark a clear transition from distress to acceptance, a sense of tranquility and wholeness for the dying. Patients consistently describe them as “more real than real,” and they are each as unique as the individual having them.

These end-of-life experiences are centered on personal histories, self-understanding, concrete relationships, and singular events. They are made of images and vignettes that emanate from each person’s life experiences rather than from abstract preoccupations with the great beyond. They are about a walk in the woods relived alongside a loving parent, car rides or fishing trips taken with close family members, or seemingly insignificant details such as the texture or color of a loved one’s dress, the feel of a horse’s velvety muzzle, or the rustling sound of a cottonwood’s shimmering leaves in the backyard of a childhood home. Long-lost loved ones come back to reassure; past wounds are healed; loose ends are tied; lifelong conflicts are revisited; forgiveness is achieved.

Doctors owe it to their patients to incorporate this awareness into our practice. End-of-life experiences ought to be recognized as evidence of the life-affirming and inspiring resilience of the human spirit that drives them. They are proof of humanity’s built-in, natural, and profoundly spiritual capacity for self-sustenance and self-healing, grace and hope. They help restore meaning at end of life and assist in reclaiming dying as a process in which patients have a say. They also benefit those left behind, the bereaved, who get relief from seeing their loved ones die with a sense of peace and closure.

This subjective experience of dying is also a powerful reminder that beauty and love in human existence often manifest themselves when we least expect it. The patients who summon up comforting processes at life’s end are beset by symptoms of a failing body over which they have limited control. They are at their most frail and vulnerable, existing within suffering states of aching bones and hunger for air. Catheters, IVs, and pills may now be part of their every day, sometimes literally functioning as extensions of their bodies under the daily medical management that is their new and irreversible lot. They may experience various degrees of cognitive, psychological, and spiritual dissonance. Yet even as the inexorable march of time is taking its toll on their bodies and minds, many also have pre-death dreams and visions in the context of which they display remarkable awareness and mental sharpness.

Herein truly lies the paradox of dying: patients are often emotionally and spiritually alive, even enlightened, despite a precipitous physical deterioration. The physical and psychological toll of dying may be undeniable, but it is also what makes the emotional and spiritual changes brought about by end-of-life experiences border on the miraculous. Doing justice to end-of-life experiences means accounting for this paradox, one in which death and dying transcend physical decline and sadness to include spiritual awakening, beauty, and grace. Or, as the title character in the acclaimed Tuesdays with Morrie puts it, “Aging is not just decay, you know. It’s growth. It’s more than the negative that you’re going to die.” This is also true of the dying process, which often functions as a summing up, culmination, and capstone, an opportunity to recognize and celebrate our humanity in all its complexity and dignity rather than just as an ending.

Excerpted from DEATH IS BUT A DREAM by Christopher Kerr, MD, PhD and Carine Mardorossian, PhD. Published on February 11, 2020 by Avery, and imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2020 by William Hudson, LLC

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