One of the most tragic consequences of the COVID pandemic was the inability for loved ones to be at the bedside of the dying to comfort them as they took their final breaths. Many people have expressed deep anguish that a beloved family member died alone, afraid, or in the company of strangers in medical hazmat suits. Now more than ever, it is critical that grieving survivors know that a vast majority of people will experience profound end-of-life dreams and visions (ELDVs) that can transform a scary, lonely death into one of peace and acceptance. In the final weeks and hours before death, as countless hospice workers and caregivers report, the dying will meet a special someone – in a dream or through a vision – who has arrived to accompany the dying peacefully through their transition. Through their experiences, we are reassured that no one dies alone. If the living cannot be at the bedside of their loved one, most assuredly, the dead will be.

We are all just walking each other home.

Ram Dass

In the first part of a series of posts entitled ‘What’s New in Survival Research’, I’d like to highlight the on-going work of Dr. Christopher Kerr, a palliative care physician, CEO and Chief Medical Officer of Hospice & Palliative Care Buffalo. The publication of his 2020 book, Death is but a Dream: Finding Hope and Meaning at Life’s End and a 2021 documentary of the same title shares the stories and experiences of patients and their extraordinary end-of-life experiences (ELEs). Dr. Kerr’s has recently published new quantitative and qualitative data about ELEs, which can be reviewed at the links below. Thanatos TV EN, an excellent YouTube channel that publishes interviews on the topic of life after death, published an in-depth interview with Dr. Kerr about his book in 2021. This week, Thanatos published an hour-long documentary on ELDVs which features Dr. Kerr extensively. Both videos are embedded in the references section at the end of the post.

End-of-Life Dreams and Visions

Dr. Christopher Kerr, Journal of Palliative Medicine

• End-of-Life Dreams and Visions and Posttraumatic Growth: A Comparison Study, February 2020
• End-of-Life Dreams and Visions in Pediatric Patients: A Case Study, October, 2020
• Expanding the Understanding of Content of End-of-Life Dreams and Visions: A Consensual Qualitative Research Analysis, July 2020

See more of Dr. Christopher Kerr’s research at https://www.drchristopherkerr.com/research

“Death is a miracle.” This was the statement made by a hospice nurse that I was fortunate to meet. It is a sentiment echoed by many hospice nurses and caregivers who believe that the process of dying can be a deeply meaningful and life-affirming experience for the patient and their loved ones. Doctors, who may visit a hospice patient only long enough to write out a prescription, too often see the dying patient as a failure of medical intervention; a body in terminal decline and not much else. This misguided thinking has become pervasive in western culture that champions life-extending medicine at any cost. As Dr. Kerr himself would discover, doctors have a lot to learn about what it means to die well.

In the introduction of his book, Dr. Kerr describes his first brush with end-of-life experiences. A 30-year-old doctor finishing his cardiology training, he took a weekend job at Hospice Buffalo to pay the bills. There he met Nancy, a no-nonsense veteran nurse who had “little patience with young and idealistic doctors”. When discussing a young man in his 40s with AIDs, Dr. Kerr approached Nancy with the recommendation that his life could be prolonged by further treatment. Nurse Nancy did not ‘mince words’. She explained to Dr. Kerr that it was too late because the man was already dreaming of his dead mother. Dr. Kerr responded in “equal parts disbelief and defensiveness” and replied, “I don’t remember that class in medical school.” “Son”, Nancy said, “you must have missed a lot of classes.” Nancy was, of course, correct about the young man. And Dr. Kerr would wonder why the subjective experience of dying had anything to do with his role as a doctor. As it turned out, quite a lot. As Dr. Kerr explains:

In the evolution from treating illness to caring for the dying, medical staff should lead the way instead of denying or merely medicating these powerful end-of-life experiences. Patients and their families should be encouraged to speak about them openly with their medical care providers. This helps enhance patients’ mental well-being, and it helps doctors dispense better care. Managing symptoms medically should include promoting dying patients’ psychological and spiritual well-being, as well as preserving patient dignity at life’s end.

Kerr, Christopher; Mardorossian, Carine. Death Is But a Dream (p. 7). Penguin Publishing Group. Kindle Edition.

End-of-life experiences (ELEs) are a collection of phenomena experienced in the weeks and months before death. They are intensely personal experiences that manifest through ultra-real dreams and visions (ELDVs). How a patient interprets an ELDV may differ based on their personal beliefs, culture and the nature of the experience, but Kerr’s research has shown that ELDVs take on important significance to the dying, with themes of forgiveness, redemption, and reunion with pre-deceased family members. As Dr. Kerr puts it in his book, “Long-lost loved ones come back to reassure; past wounds are healed; loose ends are tied; lifelong conflicts are revisited; forgiveness is achieved (page 4).

End-of-life experiences are one of the most common spiritually-transformative experiences, occurring in 88% percent of dying patients. Like near-death experiences, ELDVs seem to be a universal human phenomenon and occur independently of religious affiliation, culture, age, medical diagnosis, and medical treatment. Ninety-nine (99%) percent of ELDV experiencers will insist that their experience was real, and psychiatric evaluations confirm that experiencers are not delusional, confused, or otherwise hallucinating.

ELDVs by their nature are not as objectively veridical as other life after death phenomena but there are instances where a dying person sees a family member or friend in their ELDV that was believed to be alive. Later, it is verified that the person has recently died. There’s a famous case where the parents of a terminally-ill boy are told by their son that his older sister has arrived to help him go to heaven. The parents discount the child’s vision until they learn that their daughter, away at college, has died in a car accident. Another case involved two young friends who both fell ill. After one of the children died, the fact was kept from the other child. When the second child was near death herself, she exclaimed, “Oh, Anne is here! Why did you not tell me she had died?”

Swiss-American psychiatrist Elisabeth Kubler-Ross was a pioneer of research in death and dying and and advocate of palliative care. She was quite interested in deathbed visions of children and often sat by the bedside of critically injured children whose families had been in vehicle accidents. As was the usual case, the children would not have been told which family members had already died. But the children always knew who would be waiting for them. Kubler-Ross was quoted as saying, “In thirteen years of studying children near death I have never had one child who has made a single mistake when it came to identifying — in this way — family members who have preceded them in death.”

Research of ELEs in pediatric patients is of critical importance for children and their families who may be facing a terminal diagnosis. ELEs are associated with more positive outcomes in terminally-ill children and bereaved caregivers, particularly when doctors and nurses support rather than dismiss their experiences. This is illustrated through a case study published by Dr. Kerr of a 15-year old girl receiving palliative care for glioblastoma (a type of brain tumor). Ginny (a pseudonym) began to experience ELDVs soon after her terminal diagnosis. A notable experience occurred after falling into a deep sleep during an MRI. Ginny awoke with a newfound sense of acceptance, peace and hope. She explained to her mother (and later to Dr. Kerr) that she had found herself in a castle with her pre-deceased great aunt and many of her family’s deceased pets (Similar to adult ELDVs, the living almost never appear in these visions). The castle is described as a ‘safe place’ filled with warmth and sunlight. Ginny and her aunt (who was elderly and sick when Ginny knew her) are both hale and healthy.

Four days before Ginny passed away, her mother describes a remarkable experience that would “profoundly influence how she [Ginny] and her loved ones would experience her dying process.” From here, I will directly quote Dr. Kerr’s research abstract to describe the event.

On what had been a quiet afternoon, Michele [Ginny’s mother] heard an animated conversation through a baby monitor that was kept beside Ginny’s bed. When Michele asked Ginny who she was talking to, Ginny responded, “I was talking to God.” She added “He’s old, but he’s kinda cute.” She said to her mother, “I’m not going to be sick, you know… where I’m going. You know… to the castle.” Ginny’s conversation with God also addressed her concern as to whether her family would be able to join her when their time came. She was especially worried about her father, who had denounced God and Catholicism in light of his daughter’s terminal diagnosis. These deep fears were relieved as Ginny relayed that God had assured her that, when it was time, her whole family would be able to come to the castle, including her father. In the days before this experience, Ginny had been agitated and calling for her mother multiple times an hour. After sharing her ELDV, Ginny calmly asked her mother to paint her nails and toenails to match her “goodbye” dress. Subsequently, Ginny drifted comfortably asleep until death.

https://www.liebertpub.com/doi/10.1089/jpm.2019.0547

Dr. Kerr has supplied videos of Ginny discussing her dreams of the castle as well as her mother discussing Ginny’s conversation with God four days before her death. I have linked both in the references section at the end of the post. Please be warned that the videos may be difficult for some viewers to watch.

Dr. Kerr is careful not to speculate on what ELDVs may mean as evidence for life after death. He is quick to stress that the focus should be on the positive impact ELDVs have for the dying and their family, regardless of their origin. This distinction is essential to gain support with medical professionals who may feel uncomfortable by speculation that ELDVs are evidence of survival. With further awareness of the positive outcomes that ELDVs can provide, doctors and nurses may be less likely to dismiss them as unimportant or something to medicate away. End-of-life dreams and visions undeniably comfort the dying who take such dreams and visions at face value, but just as importantly, they comfort the living.

I’d like to end this post by sharing my own experience witnessing my grandmother’s remarkable transformation as a result of an ELDV. Soon after she arrived in the hospital and several weeks before her death, she was experiencing severe paranoia as a result of late-stage dementia. As I sat with her, she would grasp my hand in terror, sure that the hospital staff were trying to kill her. She was delusional; speaking of aliens and monsters trying to steal her away. I was unsure if she knew who I was. I was unsure she knew who she was.

Shortly before my grandmother died, I visited her for the last time. When I entered the room, I could tell immediately that something had changed. She was peaceful, rested and coherent. She recognized me and welcomed me by name. The paranoia was gone, replaced by a dreamy, enigmatic smile. She explained in a hushed voice that her father and brother had been to visit her the night before. With childlike wonder, my grandmother described that her father and brother were singing old songs from their youth and reciting poetry for her. Her father had been part of a barbershop quartet and she herself was a talented pianist, so this was very likely an activity that she enjoyed with her family as a young woman. My grandmother was utterly delighted. She never questioned the logic of being visited by two people who died decades before. She was just overjoyed to see them. I was only 19 at the time and knew nothing of end-of-life dreams and visions. Thankfully, I was wise enough not to dismiss her experience. Instead, I shared in her joy and told her that I was sure that they would be back. She died soon after, presumably in the company of the two people she had loved most.

If I had not been there to witness my grandmother’s profound transformation, I would have believed that she died in terror. I can’t imagine how distressing it would have been to live the rest of my life with that belief. That’s why it’s so important that doctors and nurses support end-of-life experiences and share ELDVs with family members, especially in cases where family could not be at the bedside of the dying. It doesn’t matter if the doctor believes in the reality of what the dying see and hear as death approaches. It matters only that at the appointed hour, someone whom they loved was there to walk them home.

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References and Sources for Further Research

Dr. Kerr’s Case Study “Ginny” Supplemental Videos (content warning: may be disturbing for some viewers)

• Ginny describes her dreams of visiting her aunt and deceased pets in a castle
• Ginny’s Mother describes Ginny’s talk with God four days before her death

Dr. Christopher Kerr – End of Life Research

Kerr, Christopher; Mardorossian, Carine. Death Is But a Dream (p. 4). Penguin Publishing Group

The Visions of Dying Children Seem to Bring God Alive, LA Times, 1990