Two weeks ago, I listened to an interesting interview on a NYT podcast with a doctor who had worked in hospice and had amassed data about end-of-life experiences. During the last few weeks of life, the vast majority (88%) of hospice patients experience talking to loved ones who have died before them. Sometimes they interact with deceased pets. These experiences are often (but not always) very peaceful and comforting as they enter the final phase of life, death.

This weekend, the interview really hit home as my mother, who lives across the country from me, has begun experiencing this phenomenon, according to two of my siblings who are with her. I tweeted about it, and there were many, many responses from others sharing the exact same experiences when their loved ones were in hospice. (Go to the link to read some of their stories.)

Someone recommended a book called The In Between: Unforgettable Encounters During Life’s Final Moments by Hadley Vlahos, a young hospice nurse in New Orleans. I’ve only begun reading it. Often caregiver family members are frightened when they see their parent or loved one conversing calmly with thin air, clearly seeing someone who can’t be seen by others. Sometimes they assume their relative is delusional or that pain medications are the cause, but Hadley and other hospice doctors and nurses debunk this, stating that it is the norm at this phase of life, that it occurs regardless of medications and treatments, and across different cultural and religious backgrounds.

Chris Kerr was 12 years old when he witnessed his dying father have a deathbed vision. He reached out to his son and said with a peaceful smile that they needed to catch their flight for a fishing trip in the Canadian wilderness, an annual event that brought them together despite his father’s busy schedule as a surgeon. A hospital priest led Chris away from his father protectively, telling him his father was delusional, dismissing the experience as the raving of a dying man. When Chris grew up, he became a doctor and eventually worked with hospice patients. His years of working with those who were no longer fighting to stay alive, but who were instead preparing for death, led to him doing a TED Talk on this topic. Immediately, caregivers approached him, thanking him for finally validating what they had all witnessed, that nearly all hospice patients went through this phase, and that it was a positive, often healing experience, even addressing trauma they had carried with them through their lives and bringing them peace in their final moments.

Do these experiences feel religious to you? No, and that was one of the most convincing things for me. It does not matter what their background is — if they believe in nothing, if they are the most religious person, if they grew up in a different country, rich or poor. They all tell me the same things. And it’s not like a dream, which is what I think a lot of people think it is. Like, Oh, I went to sleep, and I had a dream. What it is instead is this overwhelming sense of peace. People feel this peace, and they will talk to me, just like you and I are talking, and then they will also talk to their deceased loved ones. I see that over and over again: They are not confused; there’s no change in their medications. Other hospice nurses, people who have been doing this longer than me, or physicians, we all believe in this. – Hadley Vlahos

Vlahos also observed that when she did her residency working in Emergency Rooms, that the nurse she shadowed said that nobody who works in the emergency room believes in an afterlife. (I’m pretty sure that’s not accurate as I know a former bishop who is an ER doc, but it could be a majority opinion of those in the ER based on the experience of watching people die under those circumstances). Hospice is a somewhat unique death experience in that one is expecting to die and is now focused on comfort and acceptance, not on fighting to live. The ER is all about preserving life, dealing with (sometimes) life-threatening emergency situations that nobody is ready to accept or give into. These deaths are not as peaceful or contemplative. Hospice is kind of the opposite of the ER.

So what are these experiences like?

They can occur while patients are asleep or fully conscious. Dead family members figure most prominently, and by contrast, visions involving religious themes are exceedingly rare. Patients often relive seminal moments from their lives, including joyful experiences of falling in love and painful ones of rejection. Some dream of the unresolved tasks of daily life, like paying bills or raising children. Visions also entail past or imagined journeys — whether long car trips or short walks to school. Regardless of the subject matter, the visions, patients say, feel real and entirely unique compared with anything else they’ve ever experienced. They can begin days, even weeks, before death. Most significant, as people near the end of their lives, the frequency of visions increases, further centering on deceased people or pets. It is these final visions that provide patients, and their loved ones, with profound meaning and solace. – NYT article

My mother used to share a family story with me from her childhood. When her grandfather died, her aunt was so distraught that she wouldn’t eat and she cried in her room all day. One night, her aunt’s deceased father came to the end of her bed and told her she had to stop grieving because she was making herself sick, and he was fine, and she needed to stop worrying. My mother’s aunt did not want another visit from her dead father, so she stopped grieving. (They were all Lutherans.)

The religious interpretation of these experiences might be that the “veil is thin” and that dead relatives are actually present, and only the dying person, the one who is ready to “join” them, is able to see them, that these are visits, not visions, that they originate outside the dying person, not from within. A non-religious interpretation might be that there is much we don’t know about the mind’s ability to process memories and to shut down as the body dies.

There is another end of life phenomenon that often occurs that doctors call “the surge.” It’s similar to “nesting” during the last phase of pregnancy. The body is suddenly more energetic. Patients who were bed-ridden suddenly get out of their bed and move throughout the house, doing activities they haven’t felt up to in a long time. While someone new to the hospice experience, particularly family members who aren’t ready to say goodbye, might interpret this as the person being “healed” or no longer dying, hospice doctors have seen it happen enough that they know it usually signals that the final 24-48 hours of life has arrived.

Hadley Vlahos also talks about the fact that many of her patients are ready to die. This is something that my mother has expressed at times as well. She’s 97. She’s had a good run. There’s almost more going wrong than going right with your body at some point, and these things add up on your mental state and endurance.

Personally, I’ve never met someone 100 or older who still wants to be alive. – Hadley Vlahos

Of course feeling old and ready to die is always going to be relative to both mental and physical health factors, so it varies from person to person. Hadley explains that most of her patients feel more of a pull toward those who have already died than they do toward the living, and this is one reason that their focus is on those who’ve died.

  • Do you know anyone who has experienced this phenomenon? Have you been present when someone had a deathbed experience like this?
  • Do you find this compelling evidence of an afterlife, or do you see it as unrelated?
  • Is the mind providing healing and comfort as it shuts down, helping the person feel wholeness and well-being that the worries and cares of life prevent? Or are dead people actually visiting them from beyond, urging them to join them in the afterlife?

Discuss.