I see dead people: dreams and visions of the dying | Christopher Kerr | TEDxBuffalo

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Dr. Christopher Kerr share his research about end-of-life experiences, supported by some real interviews, with the hope that we would hear what he have heard from the dying. "Their words are compelling and relevant," he said, and they might leave open the possibility that end-of-life experiences affirm rather than deny life.

Dr. Christopher W. Kerr is the Chief Medical Officer at The Center for Hospice and Palliative Care, where he has worked since 1999. His background in research has evolved from bench science towards the human experience of illness as witnessed from the bedside, specifically patients' dreams and visions at the end of life. Although medically ignored, these near universal experiences often provide comfort and meaning as well as insight into the life led and the death anticipated.

I read a recent survey, and the title was,
"Survey on American Fears,"

and what Americans fear most
is public speaking and dying.

In other words, my TEDx talk.

(Laughter)

If that weren't tough enough,
tonight's topic is illumination,

and the question is really:
can dying be illuminating?

What we know of dying is based on
what we have observed as witnesses.

We have all seen grim,
physiological decline and suffering,

and we've all felt profound loss.

So, if there is light
within the darkness of dying,

it's in the experience
not in the observing.

So tonight, I'm going to share with you

the words and experience
of dying patients.

And my hope is that you hear
what I have heard:

the dying often describing
their end of life

in ways that are actually life-affirming,

and rich with meaning,
love, and even grace.

Before I go any further, I need
to give a few disclaimers.

If it looks like I cannot stand still
and I'm pacing, it's because it's true.

(Laughter)

The second is that, aside from my mother,

nobody has ever described me

as particularly spiritual
or for that matter, enlightened.

And trust me, this talk has nothing
to do with the paranormal.

A much harder truth for me
is that I have a deep aversion

to the non-physical,
spiritual aspects of dying

that goes back to my childhood.

On August 6, 1974, I was 12 years old,

and I was standing over the bed
of my dying father, who was 42.

As he lay in there,

he reached out and started
playing with my buttons on my shirt,

and he said we had to hurry;
we had to catch a plane.

We were going to go up north
and fish like we had before.

And that was the last time I saw him.

My point here is
I didn't choose this topic of dying;

I feel it has chosen or followed me
throughout my life,

personally and professionally.

Like my father, I became a doctor.

This may sound strange,
but if you have an aversion to dying,

medical schools are
a pretty safe place to be.

They never mention dying,
let alone the experiencing of it.

Medical training is learning
how to defy death,

and when you can't defy it,
you deny it, in whole or in part.

This approach to medicine worked for me

when I was doing things
like working in emergency rooms.

But in 1999, through a series
of unusual events,

I ended up at this place called hospice.

At hospice, the curative science

has not only failed the patient
but has abandoned the doctor

who is, eventually,
compelled to be present.

And when I was present
at the bedside of the dying,

I was confronted by what I had seen

and tried so hard
to forget from my childhood.

I saw dying patients
reaching and calling out

to mothers, and to fathers,
and to children,

many of whom hadn't been seen
for many years.

But what was remarkable was
that so many of them looked at peace.

In April of 1999,

I was in the room of a patient
I was particularly fond of.

Her name was Mary.

She was nearing the end of her life,
and her four children were also present.

One day, Mary starts cradling
a baby that nobody can see.

She refers to him as Danny
- a reference nobody understands.

The next day, Mary's sister
arrives from out of town,

and explains that Danny was, actually,
Mary's first child, who was stillborn.

The loss was so deep

that Mary was unable
to speak of it during her life.

Yet, while dying,
this indescribable loss returns to her

in some manner of tangible warmth
and tangible love.

Mary, like so many dying patients,

had physical wounds
that could not be cured,

yet her spiritual wounds
were [being] tended to.

A few weeks later, I went and saw
a young man named Tom.

I came out to the nurse's station,
and I said, "I think Tom has more time

if we just give him some IV antibiotics
and some IV fluids."

Without so much as looking up,

a nurse named Nancy
says, "Nope, he's dying."

I say, "Why?"

She says, "Because he's seeing
his deceased mother."

I say, "I don't remember
that class from medical school!"

She says, "Son,
you missed a lot of classes!"

Anyways...

(Laughter)

Tom ends up dying.

What Nancy knew that I did not know

was that Tom's end-of-life
experiences had meaning.

They were significant,
and not just to him,

but to those of us
entrusted with his care.

So, if I were to have any worth,

I needed to understand, I needed to learn.

I learned that end-of-life experiences are
the subjective experiences of the dying

and often refer to
pre-death dreams and visions.

Such experiences have been reported
throughout history and across cultures.

They are mentioned in the Bible,
Plato's "Republic", Shakespeare.

In our culture, the richest
and most thoughtful discussions

have always come from the humanities
and never medicine

but from poets, playwrights,
and philosophers.

These observers have commented

that end-of-life experiences
are so frequent

they are essentially intrinsic
to the process of dying.

They're characterized
as real, intense, meaningful;

provide comfort, insight, and in so doing,
help alleviate the fear of dying.

So why does medicine has so little to say

about something that's so meaningful,
and actually, potentially therapeutic,

not just for the patient
but for the patient's loved ones?

In part,

it's because end-of-life experiences
can easily be dismissed as confusion.

And it's true;

many dying patients experience confusion
as they go through the process.

However,

in contrast to patients' experience
with end-of-life dreams and visions,

confused patients are detached.

They have disorganized thinking.

They're unable to figure out
their surroundings,

and they are more often than not
terribly agitated and anxious.

The distinction is best [understood]
by listening to a patient.

The patient you are about to see
in this video - her name is Jeanne -

was nearing the end of her life;
and she has since passed.

(Video starts)

Jeanne: I was lying in bed,

and people were walking,
very slowly, by me.

The right hand side, I didn't know,
but they were all very friendly,

and they touched my arm
or my hand when they went by.

But the other side,

were people that I knew.

My mom and dad were there, my uncle;

Everybody I knew
that was dead was there.

And they passed and did the same thing.

I thought it was a good dream,

but boy, I remember seeing
every piece of their face.

I mean, I know that was my mom and dad,
and uncle, and my brother-in-law.

I have seen my mother, recently, more.

Interviewer: How do you feel
when you see her?

Jeanne: Oh...! Wonderful!

I can't say that my mother and I
got along all those years,

but we made up for it, at the end.

(Video ends)

Christopher Kerr: Jeanne isn't confused,

and it would be dehumanizing her
to label her as such.

But she shows us so much more.

She shows us that dying is this paradox:

she is physically declining,

yet, emotionally and spiritually,

she's vivid; she's alive,
and she's present.

End-of-life experiences are not only
tied to our personal meanings

but they are tied
to some of our greatest needs:

the need to love, to be loved,
nurtured, forgiven.

End-of-life experiences
also represent a rich inter-connectivity

between body and soul,

between the realities we know,
and those we don't,

between our past and our present.

But most importantly,

end-of-life experiences
represent continuity

between and across lives,
both living and dead,

so that mothers like Mary
can hold their long-deceased children,

and children like Jeanne

can be reunited and comforted
by their long-deceased mothers.

So, again, the question:

why are the words of the dying
not worthier of our consideration?

I don't have all of the answer,

but it's true we live in a time
where seeing is believing,

and where data and evidence are requisites
for both understanding and acceptance.

Unfortunately, when it comes
to end-of-life experiences,

most of the reports were based
on anecdotal reporting.

In other words, nobody
had asked patients directly

or attempted to quantify or measure.

So that's what we've done,

and to date, we have
over 1,400 interviews with dying patients.

In our first study,

we spoke with 66 patients
every day, until their death,

and gathered 450 interviews.

What we found was
a vast majority, over 80%,

reported at least
one pre-death dream and vision,

described as more real than real,
and distinct from normal dreaming.

The next question is:
what were they dreaming of?

We found out that 72%
dreamed of the deceased:

family, relatives, or pets,

59% of this theme of going
or preparing to go [somewhere],

29% of the living, and 28%
of past meaningful experiences.

So the next question was this:

did different dream content provide
different levels of comfort?

Here's comfort on a zero to five scale,
with five being the highest.

And of all the dream types,

seeing the deceased was associated
with the greatest degree of comfort.

The next question was:

were there changes over time

in either the content or frequency
of dreaming as patients approached death?

Essentially, the Nancy question;

could you almost predict death
based on changes of these variables?

Of course, again, Nancy's right.

Frequency is on the y-axis,
weeks before death are on the x-axis.

As patients approach death,

they've a dramatic increase
in the frequency of their dreaming.

They are dreaming,
specifically, of the deceased,

which is associated with
the greatest comfort.

So, the next question we wanted
to ask in our next study

was what did these mean to the dreamer?

Were there common themes?
Were there common meanings?

The most common theme
was that of a comforting presence.

Seeing the dead or seeing the living
was overwhelmingly positive

provided a sense of reunion,
and the feeling that one was not alone.

Maggie, for example, was in her 80s.

She had been harmed greatly
by a childhood friend, later in life.

And before she dies,

she dreams of this friend,
who comes back to her and says,

"Sorry, you are a good person.
If you need help, just call my name."

Kenny was 88 years old.

He lost his mother as a child.

And before he dies,
he dreams he's a child again.

He is in his mother's kitchen,
and he says, "I smell her perfume,"

and hears her soothing
voice say, "I love you!"

Sandy was raised by her sister Emily.

And before she passes, Emily returns
to her in a dream and says,

"Remember what I taught you."

Many patients reported
seeing the presence of others,

and they're described
as simply being there, watching.

Little is said, but much is understood.

This next video is Paul.

Paul has a terminal illness.

In fact, he dies three weeks
after this video.

But he's talking about his deceased wife.

(Video starts)

Paul: I dream in color, most times.

And she always wears
a beautiful light blue.

It could be a suit.
It could be a gown. It could be a dress.

But it's always light blue.

A couple of times, she's giving me
the little beauty pageant wave.

And a couple of times, she, sort of,
greets... always with a smile.

Only once or twice
have I ever heard her voice.

She always lets me know that she's fine.

I get that feeling
after a dream like that.

(Video ends)

CK: As I said, 60% dreamed
of this theme of travel.

Jimmy sees many deceased
friends and relatives and says,

"I haven't seen
some of these people in years.

I know we are going somewhere,
but I don't know where."

Others dreamed of the deceased
just there, waiting for them.

Sarah says, "There were six dead
family members in my room waiting for me.

It's good to see them."

Less frequently, people
had distressing dreams.

These are often relived, past,
traumatic events, such as war.

And here again is Paul.

(Video starts)

Paul: Another thing I've dreamed of
quite often, not lately,

is I'm back in the service.

I'm at Fort Devens up in Massachusetts,

where they were forming this company
we were going to oversee; a new company.

The guys are all young. They're like...
I remember them! And I am old.

And I'm trying to tell them,

"Guys! I've been here. I've done this.
I'm not going to do it again!"

And they're arguing with me!

(Video ends)

(Laughter)

CK: I have the deep privilege
of hearing many people's life stories

which tend to emerge
or come to surface at the end of life.

Sometimes, I'm saddened by the amount
of trauma and tragedy people have endured.

But more often, I'm inspired

by the strength of the human spirit,

and its endless quest to heal
what is harmed, and what is broken.

And this brings me to the story of Mack.

I met Mack in 2011.

When I walked into his room and started
to talk to ask him what was wrong,

he gave me three words, and he said,
"A war problem."

His family explained that Mack never spoke
about the war, but in the last few weeks,

he was unable to close his eyes
without reliving the horror.

He couldn't sleep that's why
he was coming into our facility.

Mac went on to explain
that he was a World War II vet.

He was very proud to be from Texas
and serve on the USS Texas.

At the age of 17, he was involved in
the invasion of Normandy, in June, 1944.

He was a gunner on a landing craft
that went from the ship to the shore.

But his nightmares were about
the return from the shore to the ship.

Because that's when he was
transporting the dead and the dying.

He called these nightmares
terrifying and realistic.

He says, "There is nothing but death...
dead soldiers all around me."

A few days later,

Mack was completely transformed.

He looked comfortable
and at peace. He could sleep.

He said the horrifying dream had quieted,
and in its place were two types of dreams.

There were comforting dreams
and neutral dreams.

In the comforting dreams,
he gets to relive the day

he got his discharge papers
from the military.

In the neutral dream, a dead soldier
comes up to him on a beach.

He doesn't know who he is, and he says,

"Soon, they, your fellow soldiers,
are going to come and get you."

Mack was rescued by the dead soldiers
he had tried so hard to save.

He had closure. He could close
his eyes. He could rest.

He died peacefully,
and he died with his dignity.

But just think about it.

The human spirit and that courageous
17-year-old boy fought for 67 years

to be free, to be released

from that enormous obligation,
from that pain,

from that horrible injustice.

His end-of-life experiences didn't deny
his reality, didn't deny him his war,

but it recast it in such a way

that he was finally granted
his hard-earned peace.

I want to end where I began:

my hope was that you'd hear
what I have heard from the dying.

Their words are compelling and relevant.

And I hope they leave open the possibility

that there is light
within the darkness of dying.

Look back on your own life.

Think of your greatest loss,

your greatest comfort,
and your greatest wonder

- loss of someone you loved,

the familiar, warm hug of a grandparent,
the birth of a child.

What if, at the end of your life,
at some appointed hour,

the lost return,

distant feelings become familiar,
and meaning is restored?

If any of that is true,
then dying is illuminating.

Thank you.

(Applause)