3 - Pre-death Visions

Just what was I trying to do? Trying to comprehend what happens beyond the great divide? Hoping to help patients cope with a rapidly approaching death?

Both those things, actually. The medical establishment wears mental blinders when it comes to the subject of death. In some respects, it should be that way. After all, a patient expects life from his physician. He expects healing for his sickness, comfort for his ailments. He expects success since failure usually means pain. But doctors should be able to answer questions about death just as we can about other aspects of normal development and life stages.

In many ways, the physician is as poorly equipped to handle failure as is the patient. For instance, it is well documented that as patients get closer to death their doctors spend less time at their bedsides.

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The greater the ignorance, the greater the dogmatism.

—Sir William Osier, M.D.

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Time and motion studies in intensive care units show that as patients become sicker physicians spend more time performing procedures and much less time examining the patient or providing psychological comfort. Part of the reason that many doctors don't want to work with AIDS patients is the depressing fact that so far there is a zero rate of recovery from the disease.

In five years of residency training, I had only one lecture on death and dying that explained how to deal with the emotions and stresses that working with dying patients may generate. In that lecture, I was given an "excellent formula" with which to talk to parents about the events surrounding the death of a child to make sure that they understood that everything that should have been done was done. I was also told to explain that they might hear their child after he has died and that these "hallucinations" should resolve themselves in three to six weeks.

Soon I changed this formula to a more palatable one. I simply told the grieving parents that they would hear their child's voice again and not to let it worry or distress them. After making this change, I began to get the most wonderful thank-you letters from parents. Telling them the simple truth—that they would hear their child's voice again—but not labeling it an hallucination, gave dignity to the experience.

Other than that formula, we were given no tools to help people cope with the angst of death. This is especially bad since death is something a physician is forced to deal with early in a medical career. Most of us are just out of medical school when we face the all too frequent failures of medicine.

The lesson stated by my partner, Dr. David Christopher, that "medicine is great, but not that great" is a hard one for a doctor to learn.

I learned my first and harshest lesson about death after serving as an intern for only three days. I was working in the infant intensive care unit when one of the patients died. The weeping parents took their baby into a small room to be alone with him in their grief.

The baby hadn't died suddenly. Another intern and I had spent three hours trying to save him. We had started resuscitation at the end of a thirty-six-hour shift and were exhausted when it was finally all over. It was my first hands-on cardiac arrest, and it didn't seem real to me. Though absolutely worn-out, we were filled with the excitement and adrenaline that such an intense experience can generate.

In our exhaustion, we made the ghoulish jokes that callow interns sometimes make. We laughed and spoke loudly about what a great case this had been. "I got to put in three chest tubes and an arterial line," my partner bragged to one of the nurses. In the midst of this shamefully boisterous conversation, the parents came out of the room.

The shame hit me so hard I almost lost my breath. The nurses covered their mouths and walked away slowly. The other intern and I were left alone in the hallway to face the parents. The heavy weight of shame that I felt prevented me from looking the sad couple in the eyes.

Gently they took our hands and thanked us for what we had done to save their son. The mother then spoke to one of the nurses. "We heard your laughter and at first we were angry. We were shocked that you would be laughing at a time like this. Then we suddenly found ourselves enjoying the sound of your laughter. We knew that we suffered the loss of our son, but that life and joy still existed in the world.

Thank you for your laughter and thank you for trying to save our son."

To avoid thinking about death, I turned to the technical skills of medicine, taking my joy from placing lines in patients and reading machines. I never questioned the need to resuscitate a patient. Most of us believed in doing everything medically possible to save patients. When I was a doctor with Airlift Northwest, 'we transported many people who had no chance of survival to hospitals. Some were victims of automobile accidents.

Others were patients of private physicians who didn't want them to die in their community hospital. Whatever the case, these patients were never permitted to die en route. They were kept alive and typically would die hours or days later. Even then, they were often attached to life-sustaining machines and actually needed "permission" from relatives to die.

Our job was to follow the motto "every patient deserves the absolute best care possible." I never questioned that the "best care" meant aggressive intervention at the point of death to revive the patient. I still don't question that credo.

The physician's dilemma is, where to draw the line? In his book New Meanings of Death, Herman Feifel recounts how Americans die isolated deaths in hospitals today. "Dying and death are now the province of the professional, i.e., the physician. Unfortunately, too many of them tend to use their professional knowledge as a buffer against unprotected encounters with death to bind their own anxieties. Accordingly, when the physician is called upon to blunt the edge of grief, to interpret death to family, he is usually unsuccessful."

So just what was I trying to do with this study? I was trying to understand the near-death experience was my answer to the skeptical chief of research.

As one of my medical professors said of the human body, "If you don't understand it, you can't explain it." The same is true of death and the near-death experience. All I was trying to do was understand it.

Underground Interest

The cold reception the Seattle study received from some of my colleagues did little to stifle my interest. I continued to collect stories of patients' near-death experiences from other doctors who knew of my interest and were curious themselves.

Hardly a week went by without a doctor or nurse telling me a puzzling story about a patient having a detailed out-of-body experience or about someone being revived from near death only to tell of a world of light and beauty on the other side. I listened, took notes, and then interviewed the patient to the verify details.

These pre-death visions are intensely real experiences that a dying person has while still conscious. Reality is not distorted or altered. The dying patient often sees God, angels, dead relatives or visions of heaven superimposed upon reality or actually present at the deathbed. The experiences are considered mystical and visionary in content and resemble NDEs.

A fascinating category of experiences began to emerge from these referrals, a phenomenon other researchers have called predeath visions.

Karlis Osis and Erlendur Haraldsson, two psychologists who collected many case studies of visions at the hour of death, have done the most extensive work in this field. They have found that these pre-death visions have many things in common with near-death experiences.

For instance, the dying patient who has been in pain for several days suddenly finds himself devoid of pain and discomfort, a trait similar to people having near-death experiences. Also, pre-death visions frequently involve visions of other worlds and conversations with dead loved ones.

Osis and Haraldsson have stated that the pre-death visions they collected usually occurred to unsedated patients whose minds were clear a few hours before death. The contents differed widely, but they were dominated by deceased relatives and friends who the patients perceived as coming to take them away. Here is one example of a pre-death vision that was reported by a nurse who was at the deathbed of a man in his forties:

"He was unsedated, fully conscious, and had a low temperature. He was a rather religious person and believed in life after death. We expected him to die, and he probably did too, as he was asking us to pray for him. In the room where he was lying, there was a staircase leading to the second floor. Suddenly he exclaimed: 'See, the angels are coming down the stairs. The glass has fallen and broken.' All of us in the room looked toward the staircase where a drinking glass had been placed on one of the steps. As we looked, we saw the glass break into a thousand pieces without any apparent cause. It did not fall; it simply exploded. The angels, of course, we did not see. A happy and peaceful expression came over the patient's face, and the next moment he expired. Even after his death, the serene, peaceful expression remained on his face."

In another pre-death vision from the research of Osis and Haraldsson, a doctor recalls the experience of a seriously ill patient:

"The condition [of the man] suffering from a heart attack had been serious for the last few days. Suddenly he gained consciousness. He looked better and cheerful. He talked nicely to his relatives and requested them to go home. He also said, 'I shall go to my home. Angels have come to take me away.' He looked relieved and cheerful."

After years of studying these visions, Osis and Haraldsson have concluded that pre-death visions and near-death experiences are one in the same. I am inclined to agree with their assessment that the difference between the two is in terminology only. The following two cases are typical of what I encountered. In many ways, the first could be called a "pre-life" vision in that the patient had a vision of remission from what would normally be a fatal disease.

Six-year-old Derek was dying of a type of tumor called a "neuroblastoma," or at least that is what the doctors thought. He had been in the hospital for several weeks, and his rapid deterioration indicated a very grim prognosis. At best, Derek was expected to live only about a month longer.

Derek had an entirely different notion of what would happen. One day, he drew a picture of himself in which the tumor disappeared. He told his doctor that he'd had a vision the night before in which the tumor left his body. Although his doctor insisted it was merely a dream, Derek claimed it was much more than that. He said it was real.

Derek proved to be right. From that day on, the boy improved until he had a complete remission of his disease.

The opposite was true in another case. A young girl, Becky, was told by her physicians that chemotherapy had worked and that she was going to survive her brain tumor. All of their high-tech medical tests said it was so.

That night, she had a vision in which a woman in white told her that she was going to die. Her doctor insisted that it was only a dream. Becky knew that it was real, she said. The vision was as clear as though people had come into the room and had spoken to her. Within weeks she deteriorated and died.

I quickly realized that a death experience presents a dilemma for the person who has it and everyone around them as well.

Cory's Brave Decision

A young man named Cory was diagnosed at age three as having leukemia; at seven, he was coming to the end of a life spent dying.

The frightening thing for Cory's attending physician was this: Cory wanted to stop medical treatment. He wanted nature to take its course. His parents supported their son's decision. They were prepared to take him to a cabin in the woods, if need be, to let him have his wish.

Cory's doctor didn't know what to do. He felt ethically bound to keep Cory alive for as long as possible. Yet how could he go against the firmly stated wishes of the patient and his family?

He asked me to talk to Cory and his family.

The first thing I did was to examine Cory's medical chart. He had suffered four relapses of the blood disease, each one becoming harder and harder to treat. Although treatment of leukemia is many times more effective now than it was twenty years ago, when the average life-span was only a matter of months, chemotherapy is still brutally difficult. Leukemia is a disease of the body's white blood cells. These special cells are our disease fighters. When an infection occurs, thousands upon thousands of these cells are made in the bone marrow and are then released into the bloodstream to protect the body.

With leukemia, there is a malfunction in the bone marrow, where these important blood cells are manufactured. Instead of healthy cells, hundreds of thousands of immature, mutated cells are produced. When these cells are released into the bloodstream, they clog the workings of vital organs such as the brain, liver, spleen, or lungs. These mutant cells prevent the white cells from stopping infection, the platelets from helping the blood to clot, and the red cells from carrying oxygen throughout the body.

To fight leukemia, the body must be turned into a medical battleground. Chemotherapeutic agents, which are specialized poisons, are administered intravenously in large doses. In theory, these poisons will kill the weaker leukemic cells without killing the patient. By carefully timing these doses, the cells can be caught dividing, at which point they are especially vulnerable to chemotherapy. Although improved drugs and increased knowledge have made the treatment of leukemia more effective, it is still extremely difficult for the patient to endure. Severe infections, days of nausea, and loss of hair are side effects of this treatment.

As a result of this terrible disease, patients are often frightened and their families are frequently in chaos. When I visited Cory at home several months before he died, I expected to find the usual tension and disbelief that surround the terminally ill child and his family. But that wasn't the case. There was almost a joy, a sort of deep understanding as Cory and his mother discussed their desire to end treatment.

Cory said that he had been very depressed after learning of his most recent bone-marrow relapse. He was full of hope that his last round of chemotherapy had been successful. He had almost looked forward to the bone-marrow test to see if the medicine had finally done its job. In this test, a large needle is inserted into the center of the pelvic bone to draw out a sample of bone marrow. In Cory's case, the malignant cells were still present. The prognosis was grim. Cory would have to undergo more chemotherapy and extensive radiation treatment.

It was a sad boy who had ridden home from Children's Hospital that day. He talked to his mother for a while and then fell asleep in the back seat. When they arrived home, Cory sat on the couch with his mother, very much at ease.

The way she described him, I imagined the relaxed look of a boy just back from fishing.

"Don't worry about my leukemia," he told her. "I have been to the crystal castle and have talked with God."
Cory said that while asleep in the car he had traveled up a beam of light to heaven, where he crossed a moat on a rainbow bridge and visited the crystal castle, a place he called "Summerland."

It was a fun place to go, he said, because it "felt good." God was there. He engulfed Cory in "loving light" and told him not to worry. "He said I wouldn't be dying yet. I would be dying later."

After that, Cory began having many visions. Sometimes they occurred when he was asleep, but usually when he was awake. They also became more and more believable.

On one occasion, he told his mother that he had met an old high school boyfriend of hers who had been crippled in an automobile accident. She had never mentioned the man to Cory, not to hide her relationship, but simply because she had not seen him in many years. Yet after one vision in which he went to the crystal castle, Cory told her about a man who approached him and introduced himself as his mother's ex-boyfriend. He told Cory about his automobile accident and how he had spent many unhappy years unable to walk.

"Don't worry now, Mom," said Cory. "He said to tell you he can walk now. He's in the crystal castle."

Calls to some friends confirmed that the former boyfriend had died the very day of Cory's vision.

Cory told his mother about another vision in which one of his best friends at the hospital had joined him in the crystal castle. She thought that that was impossible because they had seen him only the week before. When they returned to the hospital the next day for more chemotherapy, they learned that Cory's friend had died unexpectedly that night. Cory had nine friends who started cancer treatment at the same time he did. Most of them died, and he saw them during his visions of the crystal castle.

He told me of other visions. One night God appeared to him when he was taking a shower. He said that he appeared alone, "without angels or heaven," and told him specifically when he would die, a date that ultimately was correct within a few days.

Cory described God as an old man with a beard and a halo. This description surprised his mother, who believed in such Eastern teachings as reincarnation and karma, not in a Judeo-Christian male deity.

During his powerful visions, Cory was often told that he should forgo further chemotherapy. It would no longer make a difference in how long he lived, these spiritual visitors told him. It would also make no difference in the quality of his remaining months. The date of his death had been established, and nothing would change it.

He told his parents what he had learned. Together they decided that no further treatment would be necessary.

Why Cory's mother would refuse medical treatment is beyond me. I personally would not deny my child medical treatment because of a spiritual vision. This was not, however, my decision to make. My responsibility as a physician is to give my medical opinions to the best of my ability. Any patient faced with a serious disease must make difficult decisions about the risks and benefits of treatment.

Cory was dying of leukemia and we had little to offer to prolong his life. The side effects of his treatment were making what little time he had left intolerable. In his case, we gave control of his life to him and his family and trusted them to choose wisely.

In retrospect I still have trouble with the family's decision. I remember watching an elated Cory surrounded by clowns and balloons at his last birthday party and thinking, Just one more treatment. I have discussed this case with colleagues, who think the parents were guilty of child abuse. They equate it with the cases of Christian Scientists who, because of religious convictions, refuse life-saving blood transfusions for their children.

In the end, two things happened that convinced me that Cory was right in trusting his visions. For one, he far outlived my predictions for a treated patient who'd had four relapses. For another, Cory died the same week that God told him he would when they met in the shower.

Were these visions real? Was Cory really talking to God? I don't know. I don't think we are supposed to know, either.
I do know that these visions had a positive effect on Cory and his family. They brought control back into their lives. Instead of feeling like victims of disease and medical technology, Cory took control of his life and—ultimately—his death.

Many studies have demonstrated the importance of control in a person's physical and mental well-being. Patients allowed to choose medications respond better to treatment than those who aren't.

I believe that Cory did so well after he was off the chemotherapy because those visions generated a sense of love and spirituality in his life that gave him reason to live longer than the statistics say he should have.
As a physician, I wish I could have continued his treatments. As a human being, I applaud his courage.

Seth's Preview Of Heaven

For thousands of years, predeath visions were accepted as part of the dying process. Before death became the domain of the hospital, these visions were common and expected.

French historian Philippe Aries has documented that before 1000 A.D. people had entirely different death experiences than the ones we have today. When the dying person felt his time was near he usually reviewed his life, his achievements and failures, and wept for the sorrow he felt in knowing he wouldn't see family or friends again. The dying person then asked forgiveness of friends and family for any trespasses he might have committed in the life he was about to leave. Usually, says Aries, the dying would tell of visions of God and of seeing those who had died before them.

How different dying is today. Patients who have predeath visions are treated for "anxiety" with narcotics and Valium, both of which erase short-term memory and prevent patients from remembering any visions or near-death experiences they may have had.

These visions are a forgotten aspect of life's mysterious process. A case like Seth's illustrates that predeath visions can reduce pain—for the patient and the family.

Seth was a seven-year-old patient of mine who was dying of leukemia. In his last days, he was hospitalized with severe, untreatable pneumonia. Though he was having difficulty breathing and was in constant pain, he was given very few drugs such as morphine and Valium because they make breathing more difficult.

Three days before Seth died, a circle of loved ones gathered around his bed. They were startled when Seth suddenly sat upright and announced that Jesus was in the room. He then asked for everyone to pray for him.

At about three A.M., Seth sat up again, startling the four people who had gathered around the bed to pray. "There are beautiful colors in the sky!" he shouted. "There are beautiful colors and more colors. You can double jump up here, double jump!"

At four A.M. Seth's housebound grandmother saw a vision of him asking her to come to the hospital. Although she had not been out of her home in ten years, she said that the vision of Seth and their conversation were so graphic that she couldn't ignore them. She called a taxi and struggled out of her house to be at the boy's bedside.

By dawn, it seemed that life was almost over for Seth. His breathing was labored, and his heart was pounding like that of a marathon runner's. Even then, little Seth had more to communicate. Opening his eyes wide, he asked his grieving parents to "let me go."

"Don't be afraid," he said. "I've seen God, angels, and shepherds. I see the white horse."

As sick as he was, Seth still begged his family not to feel sorry for him. He had seen where he was going, and it was a joyous and wondrous place. "It's wonderful. It's beautiful," he said, his hand held out in front of him.

Soon he laid back and fell asleep. Seth never regained consciousness and died two days later.

Seth's visions and the incidents surrounding them intrigued me. For one, it seemed as though he had actually communicated with his grandmother in some way. Although she knew he had been hospitalized, it was during the period of his most powerful visions that she had her vision of Seth. Although I have nothing scientific to base this on, I think coincidence was too great for these periods of "vision activity" not to be connected in some way.

Paranormal occurrences aside, Seth's beautiful visions consoled his family. By reassuring his parents that he was going to a joyous and wondrous place with God, Seth brought his family closer together. Instead of suffering the shattering loss that so many families experience when they lose a child, Seth's family left the hospital knowing that they had done everything they could to save their son. They also firmly believed that he was safely at rest in God's hands.

Seth died a rare death in the world of modern medicine. He had taken no painkillers, no mind-altering medications; he was surrounded by family and friends. His visions left his family intact and comforted. I would have thought that this experience would generate tremendous interest in the healing aspects of predeath visions. After all, if he'd had a unique medical problem—even an unusual rash—his case would have been presented throughout the hospital.

Yet his visions and their healing effects on the family were never mentioned by nurses or physicians. It wasn't that we didn't believe they had happened. We just didn't know how to respond to them. A rash can be seen by everyone, but a vision belongs to the experiencer alone.

The one time I did hear another physician mention Seth's visions was when a new resident said that they were probably caused by a lack of oxygen. He said that they could have been "cured" by increasing Seth's morphine intake. To him, the visions were seen as a problem to be medicated away, not as a solution. About ninety percent of people who die in hospitals are heavily sedated, endlessly resuscitated and medicated until even the most aggressive physician has had enough, and the body is permitted to die.

When patients experience visions, doctors often repress them with medication and then flee to the comfort of their other, less sick patients. Nothing in medical school ever prepared them to do anything else.

Greg's Suburban Death

Greg was a bright thirteen-year-old who was dying of cystic fibrosis, a genetic disease in which the lungs become filled with scar tissue and eventually stop functioning. During his last days, his private physician asked me to pay a home visit to share what I knew about the process of dying. Greg had chosen to die at home, a decision supported by his family, who didn't want to see him hooked up to machines that would only belabor his death.

Greg's recent "hallucinations" had been giving them second thoughts about home care. He was experiencing "a different reality," according to his mother, one that was similar to ours, but still "terrifying and confusing." His doctor had prescribed chloral hydrate, a mild sedative, but it had little effect on the hallucinations. They kept coming with greater frequency and intensity. Greg spoke to me on the telephone the day before I visited and told me about them. "We have to talk about them when you get here," he said.

The next day I drove to the affluent Seattle suburb where Greg would die. I admired his parent's home and the well-kept grounds that gave no hint of the mortality that lurked behind its manicured hedges. How difficult it must have been for these parents to allow their son to die at home. As his mother told me, "I am sure that none of our neighbors can understand this. They will be whispering for years behind their curtains about what went on in the Smith's home."

The emergency medical technicians who had helped bring Greg home questioned the family's judgment in having him brought there to die. And the people who delivered oxygen had been shocked to find a dying boy on their delivery route. At one time, people actually expected to die at home; now even the people who deliver medical supplies are shocked.

I spent about two hours in the living room talking with Greg's family about these "horrible hallucinations." They didn't think it would be this difficult, said his mother. They had pictured him dying quietly and peacefully at home, not "troubled by terrible visions." They did not think that their son's visions were supernatural or natural in any way. They thought that they were caused by a combination of medication and delirium. Even his social worker asked me if I could "take these hallucinations away." His physician and I discussed what drugs might suppress these experiences.

Then I went in and talked to Greg. His perception of the hallucinations was very different. After talking to him for almost two hours I realized that he was actually having beautiful and wondrous predeath visions. These weren't frightening or painful experiences for him at all. Instead, they contained a message of healing and hope for his family and comfort for himself in his final days.

Greg lay in bed and told me about things that only he could see:

"The visions come when I am awake. They scare me because I don't know when they will end and how they will stop. It scares me because I don't know reality. I see my reflection in the television set, and I know I am here. I feel my hair, and I know I am here. Then the visions start.

"In them, there are lots of people in the room. God is here too. He is in control, but sometimes he lets me be in control with him. There is bright light and people all around. But then I come out of it and I am Greg Smith and I am mortal.

"There is a religious part to these visions too. I can sometimes see a cross of light."

It became clear that Greg wasn't afraid of the visions, just confused by them. In this stressful situation, Greg's parents were reacting to this confusion with fear of their own. Greg and I devised a plan. We developed cues that would help him distinguish between reality and vision.

That way, instead of being frightened by what was happening, Greg could have some control over the situation by at least knowing where he was. He bashfully revealed one very poignant cue from his other world: Greg could have an erection, a very important event to him (as it is to most teenagers). He had never had an erection or orgasm because of the ravages of his disease. Only in his "other world" could he have them.

These cues gave Greg a feeling of mastery over the experiences. He began to relax and interpret them for his family. His calm changed the nature of these events for the family. Rather than thinking he was delirious (which he wasn't), his family was comforted by his visions. Instead of the frightening episodes they once were, his parents now wanted to know what he was seeing.

Six days before he passed away, the dreams became more frequent and intense. He reported almost daily that he saw bright lights, other people, and another land. He always mentioned that God was present in these visions. Although the parents didn't believe that Greg was actually visiting God, his visions helped them accept their son's death.

His peace with himself eased his parents' pain. The family had been torn by his impending death. Now he was bringing it back together with his acceptance of what was to be. He told us of the significant losses in his life, of not going to school or summer camp, of never having kissed a girl. He urged his parents to share their emotions with each other. He even gave his brother permission to go off to college without feeling guilty that he was at home dying.

From the time I met him, Greg looked forward to becoming "one with God" in his visions. "When I become one with God, the dreams will be over and I will be dead." That finally happened. Peacefully. It made me glad I hadn't taken those visions away from him.

Technical Skills And Human Understanding

I am not presenting these pre-death visions as a way of saying that medication should be withheld from dying patients. Nor am I criticizing doctors who want to prolong life even when things seem hopeless. Indeed, I am one of those physicians. I have resuscitated dozens of patients. I have see miraculous full recoveries in patients for whom I thought there would be no tomorrow. The fact that we are now hearing thousands of cases of near-death experiences is testimony to our improved ability to snatch patients from the jaws of death.

There comes a time when the doctor must close his black bag, take the stethoscope out of his ears, and listen to his patient. As Dr. Tinsley Randolph Harrison so eloquently put it in Harrison's Principles of Internal Medicine: "In the treating of suffering, there is need for technical skill, scientific knowledge and human understanding."

I advocate listening to the dying patient. Rather than making the wrong assumptions about the meaning of these pre-death visions, we should analyze what we are attempting to achieve when we routinely place dying patients on drugs "to make them comfortable." We should learn new routines and forge different attitudes that incorporate this new information about death and dying. By changing these attitudes, we can learn new methods of allowing patients to die in control and with dignity.

We physicians can also learn to treat the dying with dignity. It's no coincidence that time and motion studies show doctors spending less time with a patient as he nears death. Doctors like to think they are in control of situations. When a patient starts slipping away, the physician can feel uncomfortable with a situation he can't control. Physicians sometimes fear becoming involved with a patient. Feeling emotionally close

to a patient means that the doctor too will suffer an emotional loss when the patient dies.
I mentioned earlier a "formula" we were taught in medical school to help parents cope with the death of a child and at the same time help us stay uninvolved. I was lucky enough to have a mentor during my pediatric residency show me the fallacy of that formula.

I had just witnessed a healthy newborn die of an overwhelming infection at birth. The baby was literally healthy one minute and dying the next. Preliminary blood tests had hinted that something terrible was wrong. Before we had time to act, the baby deteriorated and died.

The older, more experienced physician and I went into the room to talk with the parents. I was filled with anxiety. I felt like a failure. I agonized about our inability to act fast enough and felt personally responsible for the death of this infant. How could I look at the parents and deliver the formula speech? Even though babies with this kind of infection almost always die, how could I tell them we had tried? I felt haunted by my failure.

To my surprise, my mentor didn't use a formula. He simply told them that their baby had died and that we had tried our best to save him.

He then started to cry.

We all sat in this starkly simple hospital room and cried together. Finally, he dried his eyes and said that there were other patients to see. He kissed them both, and we left.

This compassionate doctor showed me that it is possible to share the terror and grief of death with the patient. He was thinking of them and their loss, and they felt it. His tears were more reassuring than all my logical explanations of how a newborn is an immunocompromised host, a potential breeding ground for infection.
I had another such experience as a resident.

I was caring for a twenty-four-year-old man who was dying of leukemia. He insisted upon a regimen in which he would take his chemotherapy for several months and then leave the hospital before all of the cancer had been purged from his body. He would then return to his profession, which was teaching young children how to ride horses. When asked why he refused to complete a six-month course of chemotherapy, he replied, "I don't want to spend my whole life being sick. I've got to get back to work."

I was frustrated by his approach to treatment. I pleaded with him to finish an entire series of the chemotherapy and not quit before the healing process was complete. There was no question in my mind that this cavalier attitude was greatly shortening his life.

As angry as I was with this patient, I still liked him. He was the same age as I and took great pleasure in his work. His greatest concern was that his students learn proper riding techniques and enjoy it in the process. He seemed least concerned about his own well-being. I used to tell him that I liked him more than he liked himself.

He was in terrible shape when he came into the hospital for the last time. We both knew that this was the last round of chemotherapy he would attempt and that the cancer he refused to take seriously had finally won. He said that he only wanted to live two more weeks so he could see his students in their graduation ceremonies.

I was grief stricken by his impending death, but thought I concealed those feelings behind a wall of professionalism. I was wrong. During grand rounds one day, the attending physician asked him how he felt about dying. He startled me by saying, "I know I'm going to die pretty soon, and I'm okay with that. But what are we going to do about Mel here? How is he going to handle it?"

I never handled it at all. One of the attending physicians talked to me about the dangers of over-identifying with patients. He didn't mention the sense of defeat that death brings to the doctor. He only offered advice on how to stay in control during any situation.

"It's My Time To Die"

This story involves an event I didn't witness. It was told to me by a physician in Utah.

A five-year-old boy was in a coma, dying from a malignant brain tumor. He had been in the coma for three weeks and was surrounded almost the entire time by his family. They encircled his bed and prayed constantly for his recovery, taking only brief breaks to eat and rest.

At the end of the third week, the pastor of the family's church came into the hospital room and told them a remarkable story. He'd had a dream, he said, in which the boy told him, "It's my time to die. You must tell my parents to quit praying. I am supposed to go now."

The pastor was nervous about delivering this message to the family. Still, he said, it was a message too vivid to ignore. "It's as though he was right there in the room, talking to me face to face."

The family members accepted the minister's dream as a message from their son. They prayed, they touched his comatose body, and they told him that he would be missed, but he had permission to die.

Suddenly, the boy regained consciousness. He thanked his family for letting him go and told them he would be dying soon. He died the next day.

Perhaps the most important aspect of this story is its cathartic nature. This family was allowed to assuage its grief because they knew that their son was ready to die. Their resentment of life's process and of God's will was replaced by the assurance that something mystical had taken place.

"I Wont Be Here Much Longer"

The healing nature of pre-death visions is evident in another experience that a man named Ted told me about his daughter. She was dying of cystic fibrosis at the age of sixteen. While lying awake in the hospital, she had a brief vision of a bright light and a glowing man who kindly beckoned her toward him.

When her family returned to her hospital room, they noticed an air of peace around her that had not been present before. "I have seen a beautiful light," she said. "I won't be here much longer."

The girl's pre-death vision transformed the deathbed scene from the grueling nightmare it had become to one of joy and love. She talked with her family about the experience and prepared them for her death.

The father said that the atmosphere lightened after the daughter spoke of her experience and of the death that would soon follow. The nurses cried and hugged one another, and the burden of guilt that parents feel was lifted.

Without the pre-death vision and the discussion it inspired, the healing process would have taken much longer, said the father. With it, the family accepted that it was time for the daughter to die.

"I Was So Happy"

Another patient who contacted me (and was not part of the study) told of a pre-death vision that happened to her mother. It was an emotionally healing experience for a family that had been wracked by the cancer death of a son only the year before. The woman describes the experience:

"In 1979, our son Tom died of leukemia at the age of ten. About a year later my mother became very ill with cancer and had to be placed in a nursing home. We visited her every day.

"One day when we entered the room, she was talking to someone. She was looking at them as though they were standing right next to her, but we could see no one.

" 'Who are you talking to?' I asked.

" I am talking to Tom.' she said.

"Over the course of the next two weeks, my mother had long conversations with Tom as well as with her dead mother and sister. In the hours before she died, she was visited by all three of them. It was a relief for us since they helped her to die, and they helped us to accept her death."

The woman who told me about this deathbed vision didn't focus on whether the deceased members of her family had really spoken to her mother. Instead, she felt the most important thing was that her mother at least "thought" she was being talked to by family members who had died.

Pre-death visions have taught me to listen to patients. I no longer have to be in control all the time. When the patient is dying, I can listen to what the patient is going through. Once we learn to listen again to dying patients, we can develop new ways of helping them through their darkest hour.

Just what was I trying to do with my Seattle study?

I was just trying to listen. My study wasn't an attempt to prove life after death. It wasn't an attempt to prove reincarnation. It was simply a means of listening to patients and learning from them.

I have found that parents and doctors alike feel responsible for the death of a child. The parents wonder if the illness is something genetic or perhaps the result of their life-style. The physician is concerned that he may not have used the right dose of medication at the right time, as though there is always a right dose of medication.

Frequently, neither party is listening to the patient, who is telling them that he or she is ready to die. I simply felt that the seeds of healing for the living might be found in the visions and perceptions of the dying.