Dead relatives filling his room: Kerr excerpt #9

Dr. Christopher Kerr writes of dying patients having dreams of renewing friendships with deceased friends and relatives:

Frank had been admitted to the Hospice Inpatient Unit with severe congestive heart failure. At 95, he was still completely aware of his surroundings and loved a good conversation. He had collected encyclopedic bits of baseball lore the way others do treasured objects and could talk the game like no one else. Yet, despite his recall and engagement, when Frank closed his eyes to rest, his room became crowded with dead relatives. One of them was Uncle Harry who had been dead for 46 years and who “wouldn’t shut up.” This was a recurring phenomenon I now knew better than to mistake for the manifestation of a broken mind.

Like for so many of our dying patients, time was now inconsequential and what was before was now in the present while realities, whether current or past, living or dead, merged. His body was shutting down, but his mind had not lost its foothold in consciousness. In truth, he had a foot in two worlds, only one of which we shared.

Over time, Frank’s inner-world experiences returned him to what he treasured most in life, his wife’s love. The more he dreamt of her, the more he felt her presence and the more peaceful he became. He finally requested that we discontinue treatment. His decision to decline care was medically appropriate. As is so often the case, patients recognize medical futility before their physician and, in a sense, release the doctor from an obligation that can no longer be honored. Frank wanted to join “Ruthie in heaven”. We helped him reach comfort for this much-awaited reunion, and he died with the beauty and grace he had lived and created. As his organs failed, his senses, perceptions and awareness did not. In fact, they were telling Frank that his soul was in fact very much alive. In contrast to the notion of “raging against the dying of the light”, Frank, like most of our patients, was fighting towards not against. The “towards’ he was drawn to resided within his ELDV, a renewed consciousness warmed in familiar love. This was where he was now experiencing “life”, beyond his physical boundaries. 

Christopher Kerr, “Experiences of the Dying: Evidence of Survival of Human Consciousness,” an essay written for the 2021 Bigelow Institute for Consciousness Studies in response to the question: “What is the best evidence for survival of consciousness after bodily death?” Dr. Kerr, MD, PhD, is the Chief Medical Officer and Chief Executive Officer for Hospice & Palliative Care Buffalo. The full text with notes is available at https://bigelowinstitute.org/contest_winners3.php.

Consciousness awakened in dying patient: Kerr excerpt #8

Dr. Christopher Kerr writes of dying patients having dreams of renewing friendships with deceased friends and relatives: Ryan, a fifty-one-year-old Protestant with metastatic colorectal cancer, initially worried “am I losing my mind? I haven’t seen some of these people in years.” But when his dreams and visions ceased in correlation with clinical improvement, he sighed: “I am back... I miss the other stuff.”

Ryan had never married, and never moved out of the neighborhood in which he had been raised. By any measure, he had experienced limited success in his career but found tremendous joy in life’s simple pleasures and dependable affections. He had a loyal group of friends, most of whom he knew from childhood. He loved the 1970’s, the music and culture that had shaped his youth, and he had shown no inclination to move beyond that decade. His point of reference had remained safely anchored in a past of rock and roll--a virtual time capsule.

Now dying, he dreamed of deceased friends with whom he was going to concerts; he revisited the weekly garage sales through which they had casually roamed, mostly looking for old record albums; they went fishing in the local river. At other times, he “traveled with relatives”, although he never knew where they were going. In these moments, he felt alive, unburdened by the limitations of his illness. The physical complications that came with dying had been an affront to Ryan because they had compromised his socially active lifestyle. It took re-experiencing freedom in his end-of-life dreams for him to reach acceptance. Now, despite his physical decline, he again felt the warmth of familiarity and cheerful living that had defined his social life, one rich with friends, music, and small adventures.

This was Ryan’s consciousness awakened, his awareness and perceptions heightened through the connectivity he was re-experiencing. Now his acuity was sharpened and centered on what had defined his existence in health, his relationships. This was no memory or nostalgia for times gone by, but rather a satisfying, lived experience he could not wait to rejoin, again and again. 

Christopher Kerr, “Experiences of the Dying: Evidence of Survival of Human Consciousness,” an essay written for the 2021 Bigelow Institute for Consciousness Studies in response to the question: “What is the best evidence for survival of consciousness after bodily death?” Dr. Kerr, MD, PhD, is the Chief Medical Officer and Chief Executive Officer for Hospice & Palliative Care Buffalo. The full text with notes is available at https://bigelowinstitute.org/contest_winners3.php.

Reuniting with dead loved ones: Kerr excerpt #7

After several years of studying the subjective experiences of the dying, we began to question the common perception of dying as a passive process leading to emptiness and finality. We were now intrigued by the notion that dying was not about a “fading of the light” but may instead represent a period of remarkable growth for the patient. We conducted a study that asked if experiencing ELDVs affected patients’ post-traumatic growth, or the positive psychological changes that can occur during or after trauma. Here, the trauma for patients is forgoing curative treatment and entering hospice, as accepting one’s impending death is undoubtedly a traumatic event. Could ELDVs change the amount of post-traumatic growth felt by a dying individual?

In this study, patients experiencing ELDVs generally scored higher in every category of post-traumatic growth than patients who were not having ELDVs. The most significant differences were in personal strength, spiritual change, and overall post-traumatic growth. This means that patients with ELDVs showed greater strength and resilience, forged a deeper spiritual and existential connection, and generally exhibited greater positive change. In other words, patients do not stop living because they are dying. This definition of “living” defies physical form and instead occurs when eyes are closed, and brains are fading. The inner world of the dying patients, defined more by mind than brain function, appears to thrive in dimensions unseen.

Having reviewed the data above, this section will provide a series of case examples drawn from our formal studies. The facts and numbers presented from our studies cannot fully capture what is a deeply human experience, as unique as each individual experiencing the End-of-Life Dreams and Visions (ELDVs). Ultimately, the specific meaning and experience of ELDVs need to be understood on an individual basis and within the context of the life that was led. These cases studies are not only significant in number but share remarkably similar qualities. At end of life, consciousness heightens and reveals an existence that is ultimately not defined by a before or an after death but instead connects us to those who have died and continue to exist through, with as well as within us.

The sample cases below will move from more to less representative examples, to reveal the extent to which the continued presence of consciousness after death can be observed irrespective of the patient’s background, age, or variations in cognition.

Of the over 1500 patient/families interviewed, few could be more representative than Bridget, an 81-year-old devoted Lutheran grandmother who suffered from chronic obstructive lung disease.

Bridget was so uneasy about the implications of her ELDVs that she grew increasingly, and uncharacteristically, quiet. When her dreams became so vivid that they seemed to blend into her awake state, she repeatedly asked, “why am I seeing this? Am I going crazy?” Bridget’s daughter, herself uncertain, did not know what to say. 

Bridget shared her recurring dream of two deceased aunts who were standing and watching over her. These experiences were followed by visions of her mother, dressed in a long, luminous white dress and sitting at the dining room table, crocheting. Although without voice, this motherly figure was a powerfully felt presence. Bridget could not come to terms with what she herself described as her “visions.” They created somewhat of a crisis of faith since at life’s end, she could not reconcile what she saw with the precepts of her religion. She had expected to see angels, not dead people. Like so many, the deceased return to the dying in a way that feels as though they were never gone but waiting to reunite at the appointed hour. As with most patients, such reunions feel not only needed but right. Bridget’s consciousness was not only vibrant, defined by love but was now shared with those she loved most. These were the relationships that had defined her in life. The reunion of the deceased with the dying suggests that consciousness, beyond our physical existence, may be shared or unifying. As Fenwick postulates, in this way consciousness appears to act as a filter, one that arises and opens up towards the end of life.

The weight of the world was lifted off of Bridget’s shoulders when we explained to her how common these end-of-life dreams and visions were, that what was happening to her was no anecdotal oddity but a recognized and studied phenomenon. It helped to cite the results of our study: that the vast majority of our patients, nearly 90% in fact, had reported at least one end-of-life experience during their enrollment in our research. From that point on, Bridget became so comfortable discussing her end-of-life experiences that she delighted in telling us that spirits like to follow the living, especially disbelieving people.

When patients have their pre-death dreams and visions validated, life’s end can become a journey toward a transformed state, often of wholeness regained. Our study confirmed that ELDVs help patients connect and reconnect to who they were, those they loved and who loved them back. They become a way of preserving or resurrecting the integrity of the self. Within the words of our dying patients were illuminating stories of deeper meaning, an inner journey through which selves were honored, wounds were healed, and bonds restored. For many, this meant reuniting with those who loved them best and whom they needed most. 

 

Christopher Kerr, “Experiences of the Dying: Evidence of Survival of Human Consciousness,” an essay written for the 2021 Bigelow Institute for Consciousness Studies in response to the question: “What is the best evidence for survival of consciousness after bodily death?” Dr. Kerr, MD, PhD, is the Chief Medical Officer and Chief Executive Officer for Hospice & Palliative Care Buffalo. The full text with notes is available at https://bigelowinstitute.org/contest_winners3.php.

The bereaved perspective: Kerr excerpt #6

Dr. Christopher Kerr writes that two research studies: "assessed the effect of our patients’ End-of-Life Dreams and Visions (ELDVs) on the bereaved, specifically, how ELDVs affect grief and bereavement for those who lost a loved one. These studies,* which combined included roughly 750 bereaved loved ones, demonstrate that participants felt the dreams helped with their overall grief (58.2%), accepting their loss (49.3%), working through the pain of grief (46.1%), adjusting to their new world without the deceased (39%), and continuing the bond with their loved one (45.9%). In general, the more comfort they felt an ELDV brought to their dying loved one, the more comforted caregivers were during bereavement. The impact of ELDV’s impact on grief processing was also quantified and shown to be statistically significant when measured using validated instruments such as the Core Bereavement Items. The video of a widower named Norb is one example (Link to Norb Interview Video: https://www.youtube.com/watch?v=3cmo7UyFBwY).

"In addition to the above studies which focused on the impact of the dying patients’ experiences on the bereaved, we also published a study which focuses on the dreams of the bereaved, specifically dreams that focus on loved ones who have passed.** The distinction is important: these individuals were not actively dying yet they too often reported a continuous connection to loved ones who had passed. In this study, 58% of 278 bereaved respondents reported dreaming of the deceased. Prevalent dream themes include pleasant memories or experiences, the deceased free of illness, memories of the deceased’s illness or time of death, the deceased in the afterlife appearing comfortable and at peace, and the deceased communicating a message. The following video is of a woman named Patricia who is recalling dreams of her deceased husband, Chuck, who had passed 13 years earlier. In these dreams, Patricia gets to reexperience a daily ritual that they shared during their long marriage (Link to Patricia Interview Video: https://www.youtube.com/watch?v=ZTzzAUgJDq0).

"Those who dreamed about a loved one did so with varying frequency: daily (7.5%, n = 12), weekly (23.6%, n = 38), monthly (15.5%, n = 25), less than monthly (26.7%, n = 43), and other (25.5%, n = 41). Most respondents reported that their dreams were pleasant (n = 89), specifically dreams that featured pleasant past memories or experiences (n = 105). Other prominent categories included the deceased free of illness (n = 65), memories of the deceased’s illness or time of death (n = 56), the deceased in the afterlife appearing comfortable and at peace (n = 43), and the deceased communicating a message (n = 41). Many respondents described the content of their dreams in vivid detail. Most respondents who dreamed of the deceased also felt that this experience impacted the emotions related to their bereavement process (60.2%, n = 97). Some reported that their dreams helped them accept the death of a loved one. Others described how their dreams helped them retain a connection with the deceased: 'I feel closer to mom than at the time of her death. At the time I felt cut off. Now feel as if I was reconnected in at least a small way.' The deceased continued to live in the consciousness of those left behind, in a way that represented both the bereaved’s vantage point and that of the deceased. Again, these experiences are less 'dream-like' than experiential.

"Taken together, the above studies strongly suggest that both the dying and the bereaved experience meaningful inner processes that strengthen connectivity amongst those they love and were loved by, whether physically present or not. Such connectivity exists beyond our physical forms and supports the existence of a consciousness that extends beyond our dichotomized understanding of life and death."

*Grant PC, Depner RM, Levy K, LaFever SM, Tenzek KE, Wright ST, Kerr CW. Family Caregiver Perspectives on End-of-Life Dreams and Visions during Bereavement: A Mixed Methods Approach. J Pall Med. 2020; 23(1);48-53. 

Grant PC, Levy K, Lattimer TA, Depner RM, Kerr CW. Attitudes and Perceptions of End-of-Life Dreams and Visions and Their Implication to the Bereaved Family Caregiver Experience. Am J Hosp Pall Med. 2020; 38(7);778-784.

 

**Wright ST, Kerr CW, Doroszczuk NM, Kuszczak SM, Hang PC, Luczkiewicz DL. The Impact of Dreams of the Deceased on Bereavement: A Survey of Hospice Caregivers. Am J of Hospice and Pall Med. 2014; 31(2);132-138.

 

Christopher Kerr, “Experiences of the Dying: Evidence of Survival of Human Consciousness,” an essay written for the 2021 Bigelow Institute for Consciousness Studies in response to the question: “What is the best evidence for survival of consciousness after bodily death?” Dr. Kerr, MD, PhD, is the Chief Medical Officer and Chief Executive Officer for Hospice & Palliative Care Buffalo. The full text with notes is available at https://bigelowinstitute.org/contest_winners3.php.

 

Pediatric patients: Kerr excerpt #5

Dr. Christopher Kerr writes: The study of end-of-life dreams and visions typically focuses on adults; however, children with terminal diagnoses also have these experiences, further demonstrating that this is an occurrence related to the transition to death and not to age or physical decline.

Our third publication was a pediatric case series*. Although children and adolescents process the experience of illness and impending death in ways that are distinct from adults, they still contend with existential and spiritual concerns no matter how difficult these may be for them to express. When facing serious illness, children are often confronted with an unimaginable reality for which both context and language are limited. As they struggle with illness, they also must cope with fears around death, including existential questions that are challenging to communicate and equally difficult for clinicians to answer. We have been fortunate to be able to film several of these children.

The study of end-of-life dreams and visions typically focuses on adults; however, children with terminal diagnoses also have these experiences, further demonstrating that this is an occurrence related to the transition to death and not to age or physical decline.

 

In several pediatric cases, the children’s ELDVs didn’t deny their impending death but informed and transcended the inevitable. In all cases recorded, their ELDVs provided comfort and meaning. For example, Ginny was a 15-year-old girl whose dreams and visions heavily impacted her dying process and her mother Michele’s bereavement experience (Link to Ginny and Michelle Interview Video: https://www.youtube.com/watch?v=hykQVBYDmsM).  

 

With exceptional detail, Ginny recounts a dream in which she is playing dolls and singing songs with her deceased aunt. She describes being in a beautiful castle filled with warmth and light. Adorning one of the walls is a stained-glass window depicting ‘‘a baby and you can see the sun through it.’’ In her own words, Ginny describes the castle as a “safe place” and emphasizes that she is “not alone.” In addition to her aunt, the castle is also populated with numerous pre-deceased family pets that now appear alive, healthy, and playful. 

 Upon waking from sleep, Ginny found immediate meaning in her ELDV experience, telling her mother, ‘‘I’m going to be okay, I’m not alone.’’ Four days before her death, on what had been a quiet afternoon, Michele heard an animated conversation through a baby monitor that was kept beside Ginny’s bed. When Michele asked Ginny whom 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.

 

*Levy, K, Grant, PC, Kerr, CW, End-of-Life Dreams and Visions in Terminal Children/Adolescents: A Case Study. J Pall Med. 2020; 23(11);1549-1552.

Christopher Kerr, “Experiences of the Dying: Evidence of Survival of Human Consciousness,” an essay written for the 2021 Bigelow Institute for Consciousness Studies in response to the question: “What is the best evidence for survival of consciousness after bodily death?” Dr. Kerr, MD, PhD, is the Chief Medical Officer and Chief Executive Officer for Hospice & Palliative Care Buffalo. The full text with notes is available at https://bigelowinstitute.org/contest_winners3.php.

 

Six categories of ELDVs: Kerr excerpt #4

Dr. Kerr writes: After documenting the prevalence and characteristics of End-of-Life Dreams and Visions (ELDVs), we wanted to better understand their content, and what they meant to the dying. In the second study (19), we conducted multiple interviews with 63 Hospice patients. We began the study with patients in our Hospice Inpatient Unit, which included a survey and a structured interview. We visited participating individuals daily to complete the survey and interviewed them for as long as they were able. The study utilized quantitative data as well as open-ended questions and interviews, which allowed each participant to describe their experiences in detail. The data was analyzed using a mixed-method design called concurrent triangulation that is used to confirm or corroborate the findings of 2 different methods; both quantitative and qualitative data were collected at the same time. The results revealed 6 categories of ELDVs:

1. Comforting Presence: Dreams and visions that featured the presence of dead friends and relatives were well represented throughout the data. Some also included living friends and relatives as well as dead pets or other animals. These dreams and visions were overwhelmingly described as comforting to the patient. For example, one patient reported that she had frequent dreams of her dead sister sitting beside her bed. She described these dreams as extremely comforting because ‘‘I am not going alone [my sister] will be with me.’’ Another patient reported dreaming of her dead mother talking to her in a beautiful garden, saying ‘‘everything will be okay.’’ This was very comforting to the patient and she told her family that she wanted to go back to sleep because her mother would be coming back. Another patient who dreamed of both dead and living friends and relatives also reported that they were all ‘‘telling me I will be OK.’’ Yet another patient reported dreaming of his mother who had died when he was a child. The dream was so vivid that he reported smelling her perfume as well as hearing her soothing, comforting voice, say, “I love you”. The following video of Alice, who describes an intense vision of deceased loved ones and is left with a feeling of “enormous love” as well as a sense of “joy and peace that was hard to describe.” 

(Link to Alice Interview Video: https://www.youtube.com/watch?v=V4PzG8BFECM).

     2. Preparing to Go: Some participants reported that in their dreams they seemed to be preparing to go somewhere. One patient described seeing his parents, grandparents, and old friends in his dreams. He observed, ‘‘I know we are going somewhere, but don’t know where.’’ Another patient dreamed that he was driving around [town] and had to go somewhere, but again, he did not know where. A third patient dreamed of boarding a plane with her son and although she could not describe where they were going, she reported feeling comforted. In a subsequent interview, she said that she and her son ‘‘were on the edge’’ of leaving. Although there were a few reports of distress because dreamers felt ‘‘hurried,’’ the participants primarily found this experience of preparing to go somewhere to be comforting. 

     3. Watching or Engaging With the Dead: Participants in this category described the presence of others in their dreams/visions as simply being there or watching but not engaging with the patient. For example, one patient reported that she had dreamed of her two aunts standing over and watching her while she was lying on the couch. She found this to be very comforting. There were also reports, however, where patients described themselves as engaging with people in their dreams. One patient reported that her husband and her dead sister had joined her for breakfast; she also dreamed of playing cards with her dead friends. Another patient dreamed that her father and two brothers, all dead, were silently hugging her and playing games; then she described how ‘‘they were welcoming [her] to the dead.’’ Yet another patient described a dream where he was able to play with and pet his dead dog. Again, these experiences were largely reported as comforting.

     4. Loved Ones Waiting: Some patients in the study described dead friends and relatives in their dreams as ‘‘waiting for them.’’ One woman reported that she had both waking and sleeping dreams of six dead family members in her room. She added that they were ‘‘waiting for me’’ and that it was good to see them. Three days before another woman died, she reported experiencing both waking visions and dreams of being at the top of a staircase with her dead husband ‘‘waiting’’ for her at the bottom of the staircase. Once again, the presence of these dead friends and family members was primarily experienced as comforting. There were, however, some patients who expressed that they were not ready to die. These patients experienced some distress at the fact that the dead were ‘‘waiting’’ for them.

     5. Distressing Experiences: Not all dreams/visions experienced by the patients in the study were perceived as comforting. There were also reports of distressing dreams, some of which replayed traumatic life experiences. One patient, for example, reported dreaming of his previous war experience. A second patient reported dreaming of her son’s serious injury that occurred on a naval ship. Several patients had dreams about abusive childhood experiences. Other distressing dreams were reminiscent of the difficult situations or relationships the patients had had. For example, a male patient reported having distressing dreams of his brother being very critical of him and also reported distressing,

     6. Unfinished Business: Participants also reported dreams that centered on their fears of no longer being able to do the things they felt they needed to accomplish in life. One young mother, for example, had distressing dreams of her daily responsibilities with her children. The dreams involved getting her children ready for school, getting them to practice, and other parental responsibilities. A second young mother experienced distressing dreams related to real-life worries about her bills and her children. The continuity within the dying experience of the preoccupations and experiences that had defined living is itself significant. This too speaks to the continuity of consciousness across living, dying, and death.

      Christopher Kerr, “Experiences of the Dying: Evidence of Survival of Human Consciousness,” an essay written for the 2021 Bigelow Institute for Consciousness Studies in response to the question: “What is the best evidence for survival of consciousness after bodily death?” Dr. Kerr, MD, PhD, is the Chief Medical Officer and Chief Executive Officer for Hospice & Palliative Care Buffalo. The full text with notes is available at https://bigelowinstitute.org/contest_winners3.php.

 

 

 

 

Data on adult ELDVs: Kerr excerpt #3

Although there was growing cultural recognition that ELDVs [End-of-Life Dreams and Visions] are psychologically and existentially significant, they had rarely been explained in a clinical context or presented as medically relevant. There was also a scarcity of data addressing the prevalence, content, and significance of ELDVs. Nor had studies directly addressed the issue of delirium or confusional states that may confound our interpretation of ELDs [End-of-Life Dreams].

The first study* was therefore designed to 1) document ELDV experiences using a longitudinal survey and semi-structured interview format in hospice patients nearing the end of life; 2) examine the content and subjective significance of ELDVs; 3) relate the prevalence, content, and significance of ELEs over time until death and 4) clearly address the issue of altered cognition or confusion by excluding those who met diagnostic criteria for either dementia or delirium.

For this study, Hospice patients who had been admitted to a Hospice Inpatient Unit were screened for eligibility. Inclusion criteria were age 18 or older, capacity to provide informed consent, and a Palliative Performance Scale (PPS16) score of 40 or greater. Exclusion criteria were diagnosis of a psychotic disorder as per the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and a barrier of language or communication. 59 patients agreed to participate in the study and were interviewed daily by a study investigator using a standard framework of questions.

The study included close-ended questions related to the presence or absence of dreams/visions, whether these experiences occurred during sleep or wakefulness, dream/vision content and frequency, degree of realism, and comfort versus discomfort. For questions regarding dream content, investigators checked boxes from a list of eight items (deceased friends/relatives, living friends/relatives, other people, deceased pets/animals, living pets/animals, religious figures, past meaningful experiences, other). Patients reported dream frequency by choosing a range of once a day, 2 to 4 times/day, or > 4 times a day. Comfort provided by the dream/vision was rated on a 5-point semantic differential scale with 1 = Extremely Distressing and 5 = Extremely Comforting.

Investigators also recorded key clinical indicators: overall clinical status (Palliative Performance Score), oral intake, presence/absence of fever, alertness level, as well as medication changes. With respect to data analysis, multiple approaches were used and included descriptive statistics, graphic analyses, and inferential analyses. Multilevel models were chosen to account for the varying patterns of reports by individual patients, including variation in number of days included, missing days due to patient condition, and the possibility of multiple event reports per day.

The results of this initial study were based on 59 patients and a total of 453 interviews with a mean of 7.68 interviews per person. Range of days before death for interviews was 0 to 87 days, with a mean of 21.58 and a median of 15 days. Of the 59 patients who were interviewed, 52 (88.1%) reported experiencing at least one dream or vision. Almost half of the dreams/visions (45.3%) occurred while asleep, 15.7% occurred while awake, and 39.1% occurred while both asleep and awake. Degree of realism was recorded on a 10-point Likert scale and nearly all ELDV events (267/269, 99%) were reported by patients to seem or ‘‘feel more real than real.’’ Most daily reports included a single ELDV event (179, 81.4%) with two (13.2%), three (4.1%), and four events (1.4%) on other days.

Patients were also asked to describe what they had dreamt about. The interviewer coded responses on a checklist with eight categories, noting all that were included. Many patients reported end-of-life experiences that included reunions with deceased friends or relatives (72 %) living friends or relatives (17%), other people (10%), and deceased pets or animals, living pets or animals, religious figures, past meaningful experiences, and other content not listed (singly and in combination, 35%). Note that the total percentage is greater than 100% because multiple responses could be recorded for each event (e.g., deceased friend/relative and living friend/ relative in the same dream). In addition, 38.9% of all dreams included a theme of going or preparing to go somewhere.

Patients also rated the degree of comfort/distress associated with their ELDVs on a 5-point scale ranging from Extremely Comforting (5) to Extremely Distressing (1). The mean comfort rating for all dreams and visions was 3.59 (SD= 1.21, 95% confidence interval [CI] = 3.44–3.73) with 60.3% rated as comforting or extremely comforting, 18.8% distressing or extremely distressing and 20.7% neither comforting nor distressing. The highest average comfort rating was associated with dreams/visions about the deceased (mean = 4.08, SD= 1.05), followed by deceased and living (mean = 3.61, SD= 0.78), living (mean = 3.22, SD= 1.15), and finally other people and experiences (mean = 2.86, SD= 1.19).

One other clear pattern was evident: the frequency of end-of-life experiences not only increased as death neared, but the most prevalent ELDV content involved reunions with the deceased which were also rated as the most comforting theme. In other words, as patient drew closer to the physical end of life, they were progressively more soothed by the comforting presence of those they loved and who had died. ELDVs may also be prognostically significant based on changes in content and increased frequency as death nears. This pattern of ELDVs bringing greater level of comfort with approaching death challenges the notion the dying involves increasing psychogenic distress.

There seems to be a distinction between the dying process we imagine, and often fear, versus the death experienced. In the following video is of an interview of a dying woman named Jeanne, as well as input from her daughter Julie (Link to Jeanne and Julie Interview Video: https://www.youtube.com/watch?v=HAbhtQCB6SM). Clearly, Jeanne isn’t confused and describes the experiences as vivid, rich in detail (including tactile sensations) and interprets these experiences as having “actually happened”.

In summary, our original study demonstrated that ELDVs were common, as 87% of study patients reported such dreams/visions. Regardless of whether the experience occurred during waking (19%) or sleep states (46%) or both (35%), the dreams/visions conveyed a sense of realism. In fact, many patients reported that these in fact were not dreams but actual occurrences, and many were adamant that they don’t usually dream or recall their dreams. The descriptions of ELDVs provided by participants were typically vivid with great detail and personal meaning. There were several important and unforeseen observations made by the investigators while conducting the study. For example, patients’ predeath dreams were frequently so intense that the dream carried into wakefulness and the dying often experienced them as waking reality. The realism of predeath dreams/visions is consistent with prior research suggesting that during stages of transition or crisis, dreams become more vivid, intense, and memorable. In addition, despite very little spoken dialogue within the dreams/visions, the circumstances and significance of the experiences were still conveyed. The predominant quality of predeath dreams/visions was a sense of personal meaning, which frequently carried emotional significance for the patient. This was also true of ELDVs that were not comforting. 

*Kerr CW, Donnelly JP, Wright ST, Kuszczak SM, Banas A, Grant PC, Luczkiewicz DL. End-of-Life Dreams and Visions: A Longitudinal Study of Hospice Patients' Experiences. J Pall Med. 2014;17(3);296-303.

Christopher Kerr, “Experiences of the Dying: Evidence of Survival of Human Consciousness,” an essay written for the 2021 Bigelow Institute for Consciousness Studies in response to the question: “What is the best evidence for survival of consciousness after bodily death?” Dr. Kerr, MD, PhD, is the Chief Medical Officer and Chief Executive Officer for Hospice & Palliative Care Buffalo. The full text with notes is available at https://bigelowinstitute.org/contest_winners3.php.