I’m a palliative care physician,” explains Christopher Kerr, “and all my patients are dying. Yet there is a strong light in this darkness of death. Indeed, many patients have end-of-life experiences: dreams or visions. They help them stay or reconnect with the love they have given and received, and with the relationships they cherished.
End-of-life experiences are real
These end-of-life experiences are not delirium. These are powerful, moving experiences that occur in the last days or hours of life. They often mark a clear transition from distress to acceptance, a sense of tranquility and fulfillment for the dying person. Patients regularly describe them as “more real than real”, and they are as unique as the individual experiencing them. They are, indeed, profoundly real and transform those who experience them, their loved ones and caregivers.
These end-of-life experiences focus on the person’s history, relationships and significant life events. Long-dead loved ones return to reassure. Past wounds are healed, lifelong conflicts are re-examined, and forgiveness is given and received.
They give meaning to the end of life
End-of-life experiences help bring peace to those who are dying. They also benefit those who stay. They are relieved to see their loved ones die with a sense of peace and reassurance.
Herein lies the paradox of death: patients are often emotionally and spiritually alive, even enlightened, despite profound physical deterioration. The physical and psychological burden of death is undeniable. But this is also why the emotional and spiritual changes brought about by end-of-life experiences are sometimes so rapid and spectacular, bordering on the miraculous.
Death is not a failure, it’s a moment of profound life.
The prejudices of current medical training have led to an inability to consider death as anything other than a failure. They compromise the calming power of end-of-life experiences. Doctors often consider that end-of-life experiences have nothing to do with their profession.
And yet, when we don’t over-medicalize the process, death becomes less a question of death than of life.
End-of-life experiences bear witness to our greatest needs: to love and be loved, to be nurtured emotionally and feel connected, to remember, remain in the memory of others and be forgiven. They ensure continuity between lives and from one life to the next.
When patients see their pre-death dreams and visions validated by those around them and their caregivers, the end of life can become a journey to newfound fulfillment. Our study confirmed that end-of-life experiences help patients to (re)connect with who they are and with those they have loved and who have loved them.
Comfort from those who have already left
End-of-life experiences involving deceased relatives and friends are the most comforting for our patients.
Many patients have described deceased friends and relatives in their dreams as “waiting for them”, in a silent, loving presence. There was no judgment, just pure love and comfort.
Death as a journey to an unknown destination
Over a third of the participants in our study identified travel or preparation for departure as a common theme in their dreams and visions. Paradoxically, the lack of a destination for this trip is usually a source of peace, not anxiety. Patients described themselves boarding planes and trains, cars and buses. They said they were comforted by this preparation for departure.
Virtually all our patients have said of their end-of-life experiences that they are categorically distinct from “normal” dreams. They explain: “I don’t usually remember my dreams, but these were different”; “they seemed more real than reality” and “it was as if it had really happened”. Patients insisted that their dreams were not only realistic, but that they were actually being experienced.
What we call “dreams”, because they occur during sleep, patients call “visions”.
End-of-life experiences can heal very old wounds
Initially, we thought that the therapeutic value of end-of-life experiences lay in their facilitation of the dying process. We had no idea that their power extends to even the oldest wounds. End-of-life experiences are not just about the end of life. They concern life as a whole.
Eddie, who was so anxious about how his sins would affect his status in the afterlife, suddenly found himself, as death approached, prioritizing the needs of others over his own. Instead of worrying about the possibility of hell, he reached out to his loved ones, told them of his love and wished them good luck.
More importantly, he came out of the experience a better man. All the powers and wonders of medicine couldn’t have turned a patient like Eddie from deep, bitter despair to euphoric serenity as his inner life did, just hours before his death. No antidepressant or talk therapy can match the amazing capacity of the human soul to heal and find forgiveness and peace at the end of life.
It’s always love that counts
What happens at the end of life is a process that repeats itself over and over again, whatever the cultural, racial, sexual, educational, national, economic or spiritual contexts that seem to separate the dying. It’s a universal phenomenon. And it’s always about love.
Again and again, our patients demonstrate what the dying process really is: the resurrection of our deepest bonds and the reaffirmation of love, both given and received. During their end-of-life experience, dying people often reconnect with those who meant the most to them. In these moments, even patients whose lives are fragmented and broken find their way back to connection and belonging.
To love is to reach God
“To love is to reach God” said Rumi, the 13th-century Persian poet. Many people at the end of life reach that state in which love is the only reality.
We often assume that accepting the end of life means accepting one’s own death. Many people think that my job as a palliative care physician is to guide dying patients to the point where they can accept the idea of their finitude. But that’s not always the case. The knowledge of death is never the end of the discussion in palliative care. It is the beginning. Patients’ end-of-life dreams play an important role in this progression. They are neither the end nor the goal. They are the tools we use even if, or rather precisely because, they are not of our making.
Here is the testimony left by a teenager on her Facebook page a few days before she died. She announced to her friends that this would be her last message “for a while”. Then she wrote: “It’s true that I’m still too young to talk about my life experience, but through my illness I feel I’ve gained a lot of maturity. I have learned that we must all do our best to spread joy, even if we are suffering or unhappy. Don’t think, plan or work for the future. Live from day to day. Live for the moment. Because these moments won’t come back, and because God’s plan for you will come true no matter what”.
End-of-life experiences also help those who remain
In one of our studies, more than half the participants whose loved ones had had dreams and visions before death confirmed that it had helped them too. One of them said: “we both believed from the start that he would be in a better place and that our love would remain alive”. Another said: “My mother’s vision was happy and peaceful. She was happy and welcoming to anyone she interacted with. I knew she was leaving us and that she was happy to do so. Her visions were very comforting for her and for us.
In fact, the more caregivers see that pre-death dreams and visions are comforting to their dying loved ones, the more they feel soothed by their own loss, both in the short and long term. Comfort for the dying person systematically translates into comfort and peace for caregivers. The grieving process experienced by the patient’s family is facilitated by their loved one’s end-of-life experiences.
A patient’s husband, Paul, finds great comfort in realizing that the dreams of his dying wife, Joyce, have helped him resurrect the love that sustained her most as a child: that of her father. He then realized that she was finally at peace, and was able to let her go.
They also help them when it’s their turn to leave.
Years later, when Paul in turn became one of our patients, this knowledge still resonated with him, helping him to approach his own death with serenity. He was at peace even before he started having visions of his dead wife. Her most recurring dream was of Joyce, in her favorite blue dress, waving at her. He told me that she had given him “a little sign” that she was fine and that he would be too.
Paul loved to share his experiences, and his daughter Diane, a nurse, was encouraged to hear him talk about his end-of-life dreams. She says: “We all enjoyed hearing about Dad’s dreams. If Dad was comforted by those dreams, that’s what I was looking for. His last days on earth were his last gift to us as a father.
It’s the experience that counts, more than the meaning we give it
Many bereaved family members make sense of their dying relative’s end-of-life dreams and visions, drawing on beliefs in God, angels, the afterlife and heaven. But how each family chooses to understand the meaning of their loved ones’ end-of-life dreams and visions matters little.
What’s remarkable is how simply witnessing these experiences helps the bereaved overcome the pain of loss and accept the reality of separation.
Even when patients are looking for an explanation, the interpretation of their end-of-life experiences is not the main thing. What’s important is what they feel, what they see and how they are transported to a place of unconditional love and support. End-of-life dreams and visions offer a path to peace, however they are interpreted. What counts is that they are experienced, not explained.
The spiritual dimension is essential
However, it’s important to recognize that the process of dying brings a form of spiritual and emotional comfort that implies a form of connection with a spiritual world. As death approaches, the boundaries between the experiential and the spiritual, the body and the mind, the present and the past, seem to dissolve into a sense of connection to a place of happiness and serenity.
Dying is much more than a physical event. And dying with dignity, like living with dignity, is more a spiritual process than a biomedical one.
The approach of death often allows us to rediscover our depths
It’s at the hour of death that people are able to free themselves from old fears and find the path of unconditional love for themselves and others. Often, we’ve lost touch with our inner selves through years of stress, disappointed expectations, mishaps and negative emotions. Yet it is this Being that resurfaces in full force at the end of life. During the profound advances made possible by the dying process, patients reconnect with themselves and with those they have loved and sometimes lost. They relive the unconditional nature of love, especially family love.
At Hospice de Buffalo, the medical team knows that close collaboration with our chaplains and religious representatives is essential to the well-being and happiness of our patients. It is now universally accepted that body and mind influence each other. At the end of life, a compartmentalized vision of healthcare is simply untenable. The spiritual and the physical go hand in hand as we seek to ease our patients’ transition to their final resting place.
Love is the bridge between worlds
Religious references are rarely found in the dreams and visions of people at the end of life. Yet spirituality is very much present, if we understand it as the search for the greatest love. The writings of Kerry Egan, a hospice chaplain in Massachusetts, illustrate this point well. She explains that she is regularly called to the bedside of dying patients who wish to talk, not about God or great spiritual questions, but about their families and “the love they felt, and the love they gave [ou] did not receive, or the love they did not know how to offer, the love they withheld, or perhaps never felt for those they should have loved unconditionally … People talk to the chaplain about their family because that’s how we talk about God and the meaning of our lives. We live our lives in our families: the families we are born into, the families we create, the families we form through the people we choose as friends.”
God is Love
In a world where one’s success is often measured by the number of relationships one sacrifices along the way, the dreams of the dying help us see a world where human relationships define our purpose and true fulfillment. Kerry Egan recognizes God and the teachings of his religion in the love exchanged by family members at the moment of death: “God is love, and we come to know God when we come to know love. The first, and usually last, class of love is the family. We don’t need to use the words of theology to talk about God. People close to death almost never do. We should learn from those who are dying that the best way to teach God to our children is to love and forgive each other fully, just as each of us longs to be loved and forgiven by our mothers and fathers, sons and daughters.”
A profound renewal of our being
If end-of-life dreams are spiritual, it’s not so much in their content as in their experience. They are spiritual in the way they alter perception, and in the sense of well-being they provide. These dreams are spiritual because they trigger a process of profound renewal in the deepest recesses of our being. They are also spiritual in that they free us from fear and pain and connect us to one another.
Death is a period of transition that transforms our way of seeing and living. If dying people struggle to find the words to describe their inner experiences, it’s not because language fails them, but because it doesn’t match the wonder that overwhelms them. They feel a growing sense of connection and belonging. They begin to see not with their eyes, but with their liberated souls.
When illness begins to take precedence over the will to live, a change takes place. The dying continue to cherish life, but not for themselves, for others.
For a more in-depth look, I invite you to read Christopher Kerr’s book: Death is but a Dream – Hope and meaning at Life’s end
You can also watch his fascinating TEDx talk, with French subtitles.
To find out more, see the article on IMEs, a message of joy and peace and the article on Sylvie Cafardy’s book and her work with people at the end of life.
