What End-of-Life Dreams Can Teach Us About Living, with Hospice Doctor Christopher Kerr

- You have witnessed thousands of people take their last breath. What are some of the end of life experiences or dream experiences that your dying patients have told you about? - The most common thing they would dream about is seeing their deceased loved ones. They say this was a happy, sometimes they actually get offended when you imply that it was a dream. - Because it was a visitation for them? - Yeah, it was very real for them. - It was very, very real. And they're not dream-like, and it wasn't just anybody. It was those that loved and secured the most. There's almost this form of final justice. If somebody with hell love, one parent, they were excluded, but the one who nurtured and loved and secured was included. Maybe one sibling or not two. - The people show up who loved you. - Yes. - And had a pivotal role in the formation of who you were. - Wow. - And in that sense, in the end, you're almost put back together by being brought back to family. - Hi, and welcome to The Oprah Podcast. We heard about a phenomenon called End of Life Dreams, which is when people are near their last days of life. They often have visions or visitations in their dreams. And those of you who've experienced this, you've had the blessed sacredness of being with somebody as they're passing. Maybe you have experienced this with a loved one or will in the future. Dr. Chris Kerr is a neurobiologist and the chief medical officer at Hospice and Piliative Care Buffalo. And his TEDx talk has 5.5 million views already and he's written a book called Death is Butter Dream, Finding Hope and Meaning at Life's Inn. So what do you mean by that? Death is Butter Dream. - That there's the death that we see, and we know the physical, the objective, the physical lessening and the suffering, but then there's a subjective aspect of it. There's this inner world of dying. There's the patient perspective. And the closest nomenclature we have for that is a dream-like state. - Is a dream-like state? It's not a dream, it's just a dream-like state. - Yeah, when we actually asked patients in survey about half of them said they were actually awake when these were happening. And we actually asked them to measure on realism. It was 10 out of 10 closest to being real. - These so-called death-bed dreams are now being more fully understood as end-of-life experiences. Neurobiologist Dr. Chris Kerr is the leading expert on this mysterious phenomenon. He and his research team have conducted more than 1,500 interviews with fully lucid patients nearing the end of their life. And many of these patients describe vivid encounters with deceased loved ones. - Well, the last one, we were talking. - Yeah, yeah. - It was like a regular Sunday down that night. - They report that these visitations don't feel like dreams at all, but as deeply real experiences that can bring comfort, peace, and closure for the dying, and also those they leave behind. You have witnessed thousands of people, actually, take their last breath. Can you just share for us for a moment what that is like and it never gets old? I'm sure. - No, it's more anti-climatic than climatic. Dying is a state of progressive sleep on a letting go. It's very hard to die in fact if you're not physically comfortable as well as psychologically at peace, and so people get deeper in sleep and death happens in that state. And you usually see it coming and there just usually isn't a next breath. - So it's very hard to die if you're not physically comfortable and not psychologically. - Yes, so people don't die in a wake state. They die in the depths of sleep and you can't get there unless you're comfortable. And everybody seems to have an understanding of that from a physical perspective, but psychologically, and existentially you also have to find peace. - And here's what you write on page 13, I appreciated this. End of life experiences testify to our greatest needs, to love and be loved, to be nurtured, and feel connected to be remembered and forgiven. They provide continuity between and across lives. Based on the content of these dreams, it's obvious that the forgiveness and love that count the most come from family. You've seen this over and over and over and over. What impact do they have on them and also on their family members? - When we measured this with patients, when we give them a questionnaire every day before death, and they had a menu list to choose from, the most common thing they would dream about is seeing their deceased loved ones. And it wasn't just anybody. So there's almost this form of final justice. Maybe one sibling and not two. We've even had people who had multiple spouses. They loved the second, not one in three. Second one appears. So it's very conditioned on that. - Yes. And had a pivotal role in the formation of who you were. - Wow. - And in that sense, in the end, there's this, you're almost put back together, by being brought back to family. - And also it's so comforting. - Overwhelmingly, 88% rated them comforting. And in the dying process was fascinating. The closer they got to death, the more likely they were to see the deceased who had passed. And those were the ones when they were measured on comfort, gave them the greatest comfort. So there's this built-in process as they get close to death. They're ever more comforting. Really, what's happening is the life gets affirmed. And none of these deny death, they just affirm life. And in doing so, less than the fear of dying. - Your research shows that our dreams change as we near death. - Yeah. And the question about came because the nurses that I was working with at hospice were so able to predict or propagate. And I had no clue. I mean, this is not something you learned in medical school. - That's exactly what happened when my father passed. The doctors were saying one thing. And the hospice nurse said, your father's gonna leave this world within a week. And the doctors were saying he had months to live. And other family members were saying, the doctors were saying, but the hospice nurse said to me, you need to stick around 'cause your father's gonna be gone with family, yes. - And that's where we propelled this. - Yes. - It was humbling to be consistently put in my place. And it's the inability to recognize dying in totality. So the medicine you think of dying in terms of organ systems and failure. And people die in whole non-parts. And the people at the bedside, the nurses, pastoral care, they could see this through what it was. - They could see it coming. - Yeah. - Yeah, 'cause she said all the signs are there. - Yes, very much. - But he's on his way out. Yeah, and what are those signs? Actually, what we're talking about, when you start to have visions of people who have passed away, that's a sign that you're very close to the end. - Yeah, absolutely. So the end game, that's happening in the context of sleep. So you're sleeping more. And within this sleep state, more and more, you're immersed in these experiences. - But isn't that a beautiful thing to know that the people who have loved you here on Earth come back and visit you through your dreams in order to help the transition to the other side? - You know, it's a really better story, right? That for being her loved and having mattered, those things are still there for you. They're tangent to you, they're proximate. And time and distance seem to go away. - Yeah. - So you can be 95 years old, lost your mother when you were five, but it's her voice you hear. You smell the perfume, you're put back together. And again, this feels virtual to the patient. It feels real. - You prefer the phrase end-of-life experience rather than dream when we're talking about that. Why have you come to believe that dream is an inadequate term for this? Or description for this? - Yeah. I think in part, it's because our job was to translate the words and experiences of our patients. And what they tell us is, typically, I don't normally dream. I don't remember my dream. You know, this was different. This was a virtual, they say this was a happy. Sometimes they actually get offended when you imply that it was a dream. And they're not dream-like and there's not symbolism. They're not metaphor. Very little is said between the person in the dream and the dreamer, but everything seems to be understood. And when I think it's most fascinating, I've been doing it for 27 years. I've never had a patient ask me, what do you think this means? So there's no space for analysis. - 'Cause they know what it means. - Well, if you saw your parent that you lost as a child, you don't need that translated. - That's right, you know what it means. - Yeah, they're not looking for answers to questions and answer. - And also what's important that you right here and also just said here, is that it doesn't come to you in the form of symbolism. - Yeah. - Like tornadoes and what is tornadoes symbolize? Disruption, chaos. - The metaphors aren't there. - The symbols aren't there. - It's just real. - It's based on real life half means real life. People is recalled with absolute clarity. They have heightened acuity. They have insight into these experiences and they know what it means without a translator. And if you think about it and this is very different than near death experiences, they're actually dying. They shouldn't have to do the work of process. It just should be brought to them. - Right. - And it's understood. So our dreams or end of life experience, end of life experience. life experiences, these end-of-life visitations, are they different for a child? Because a child who is dying of cancer at six or seven or eight years old hasn't had the experience of losing people in life who have gone to the other side or who died. - Yeah, children do all this differently. And we publish cases of this. They don't have to work through acceptance, it's just every day's a new. It is what it is, so there's a factuality about it. They don't distinguish between the imaginary and the real in the same way. They don't have language from mortality, finality. And they often won't know somebody who has died, but they will know an animal that's died, whether it's theirs or neighbors or grandparents. And the symbolism or the meaning is the same. And the children have used the same language, which is that I'm not alone, and then I'm loved. - Right, so the animal comes back. The cat comes back. - Come back should the same, same meaning, and they see them in health, and they see them well. You know, the next thing that they really often have to address, the lesion for them really is a life without a parent. And in many cases, somebody else comes in that form. It may be a deceased friend of the family. - Mm-hmm. - And they'll often build a world where we had a young lady who made a castle for herself and she was in the castle. And when asked what it was, she said it was a safe place. - Wow. - And the other thing is very clear from these experiences, it informs them in a way that we don't about their prognosis and what their understanding is. So they often have a very clear understanding that they are at the end of their life. - When these visitations start to occur. - And what's been fascinating several is they've known, but they haven't disclosed unless asked for why to protect their parents. - What did it do for you and the people who work with you? First of all, I just think that, yeah, I said to you before we started this conversation, you're doing the Lord's work out here, Dr. Kerb. How does it enhance or impact your life to be around so much death? - The opposite of what you'd think. I think when I start doing this work, I would not want to say this is what I do for all the responses that we've got. - Yeah. - And people assume that people assume, oh, that's so depressing? - Probably depressing, or you're depressed. - Mm-hmm. And in fact, if you came to where we are, you would find a work culture and a camaraderie that's remarkable, that's uplifting, that's full of humor. Of course, there's tragedy, but what people miss is we see the very best of humanity. We see caregivers who find remarkable strength and courage and love. We see people whose lives stop and have to go home and be a parent to their parent. So we see a form of love that's just on-spiring. And so I think we're better for being witnesses to all this. - And you write about, you know, patients, and not only write about patients, but you filmed thousands of patients. Why did you film them? - Because this is work was originally meant for doctors. So it came out of frustration in trying to teach young doctors that the patients were having an experience. There's more to dying than what we were seeing. You know, you may not understand it, but at least you have to have reverence for it. And there would say there was no evidence. So we lived in an evidence-based time. So we started to do the studies for that reason. Then the concern was whoever would think they're confused, they're drugged, they're feeble-minded. So we filmed them just so it was very important that people heard them in their own words and looked at them. - Yeah, there's a patient you write about so vividly here, Dwayne. Can you tell us a little bit about him and his reunion with his daughter and the desire to have forgiveness? - So 88% of these were overwhelmingly comforting. 12 were at discomforting. What we got wrong was a discomforting injury, actually some of the most transformative. So you could carry this lifelong spiritual, psychological injury that got addressed at the end. And that was really the story of doing. What happened to him was he had multi-generation substance abuse. He was imprisoned more than he was out of prison. He came into our impatient year because he couldn't sleep yet, hadn't that cancer. And he thought that he was being stabbed where his wounds were by everybody he had harmed. He was a lovely man, he was jovial, he was forward-looking, he had a life he couldn't look back. And then this started to happen. And again, he couldn't sleep, which makes it very hard to pass. And then he asked to see his daughter. And the daughter came to save him and we were all standing there and he dropped his walker and he hugged her and told her how much he loved her. And for the first time, it was honest and said he was sorry for all the things that he had done. And he broke down. I just want people to forgive me. And please, know that I was sick. When you had the time, when I was doing certain things, I was hurting them and they found me. You know, that's all I want. I don't want to look at me as a bad individual because I'm not. And so he was released finally from all the said he had been caring and then he was able to sleep. She stayed at his bedside and he passed comfortably. Yeah, and in that union, she said, I don't even care about all the stuff that she forgave him. She forgave him, yeah. A lot of people are still in the end looking for forgiveness if they feel. And it's hard for them to pass without it. Absolutely, yes. Dr. Kerr had a patient named Jean, who he interviewed before she passed. And let's watch Jean's sharing what happened in her end of life visitations. True. I was laying 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. And but the other side were people that I knew. My mom and dad were there. Everybody I knew that was dead was there. And they passed and did the same thing. Boy, I remember seeing every piece of their face. And I mean, I know that was my mom, dad, and uncle of my brother and mom. I have seen my mother recently. Or I can't say that my mother and I got along all those years. But we made up for it at the end. When I told my family that I was happy about it, and that's what they asked. How does it make you feel? Well, I feel good about it. Wow. Jean's daughter Julie now joins us. Welcome, Julie. Tell us more about your mother's experience. Hi, welcome. Hi. Thank you so much for having me. Thank you for talking about my mom. We want to hear about it. So tell us more about that moment we just saw. Yeah, so about two to four months before my mother died, she shared with me that she had been having visions of seeing her mom around her apartment. And her mother had died third years ago. So in this particular situation, mom and I were sitting down on the sofa having a conversation. And she said, you know, Julie, I want to tell you something, but I'm afraid you're going to think I'm crazy. And no, tell me, tell me anything. And she said that her mother was sitting in the chair across the room. And it was just a statement. Not, I think she is. She might be, but no, mom is sitting in the chair across the room. And she is waiting for me. And she wants me to know that she's going to be there for me. What did you think when she first told you that? You know, I am so glad that I didn't say anything at first. Because I didn't know how to react. But I took the cues from her. I listened, and I let her explain more about it. And once I saw that it made her feel calm and peaceful and very good about the experience, then I felt good. And my family felt good about it. How should we react? There are many of you who are watching us and listening to us right now, you're going to be in this situation where you are in the space with a loved one who has a visitation or has an end of life dream as we're discussing here. And what should the reaction be? Just to go along with it and not say, oh, no, mom, that can't be. It's really part of the reason we did this work is that dying is isolating and lonely. And there's some data that without validation, people keep this to themselves for fear of ridicule. Just like your mom said, you're going to think I'm crazy. So not acknowledging it and not normalizing it actually is just further isolating. So some people are enormously relieved when you tell them, oh, no, this is normal. And they go, thank goodness. But in her case, it's so fascinating. She was just so classic. It was vivid, we're called in detail. And normally seen deceased people would be a thing of nightmares and she's perfectly at peace. Oh, no, I saw them all so they were all right here. The other thing is, again, this idea of addressing an injury or a wound for having lived. In her case, there was some issue with her mother. And that got addressed towards the end within these experiences. And that gave her the peace that she needed. You believe, Julie, that your mom had an awakening before she passed, correct? What happened? Yes, about 10 to 12. days before she died. She went into a coma-like state. She was, she was unresponsive. Her body was shutting down. She hadn't had anything to eat or drink in several days. And family was around and we were just being with her and saying "Argobies" and she woke up. It was amazing. She opened her eyes and she smiled. This beautiful smile. And was she alert? She recognized all of us. She was clear. She let us know that she loved us. At the time she couldn't say a whole lot. She couldn't speak more than one or two words but she hugged her best friend. She said goodbye to her sister. It was truly lovely and such a gift and blessing to our family. And how soon she died the next day. Okay that's what I was gonna ask. Thank you so much for sharing and talking about your mother. Yeah thank you for being here with us. And thank you for having me. Thank you Julie. So you write that patients describe this end of life experiences as one of the most awake and alert and present they've they've ever been. Yeah one of the things you take away from watching is one the absence of fear. Like you saw with Jeannie complete absence of fear. The other is they struggle many times to find language for the clarity and the color and the vividness. And again nothing said but so much there the detail seems to be to be very much alive and present for them. Yes. Yeah and it feels virtual. And that's why I think I struggle with this dream. It doesn't seem distant and tangential seems near. Right it's near. In her case she had something very well known called terminal acidity where all of a sudden somebody wakes up and you know one of the things is that we can rekindle or unlock our memory with certain stimulus for example you're listening to an old song and you remember flashback to high school at dance. So whether these sort of dreams are kindling memory and driving wakefulness and recall and people will plug in but again she did what she need to do to close her life which was to say goodbye. One of the things that I read is that you believe that these end-of-life experiences help the dying to address life in its entirety. How so? Oh I just think you know we've all been harmed for having lived. Whether it's for grabs or loss. It is something's there and I'm just so touched that so much of that in the process of living lingers but at the end it often comes around and gets healed. So the physical wounds aren't healed but these kind of psychic wounds are tended to in remarkable ways. Women who've lost children that's who've had trouble with survivor's guilt. Very near the end of their life you know they're granted this kind of piece. Again this idea of being made whole. And is that what the dying are seeking? A wholeness and a forgiveness? Yeah I think so. You know we did an interesting study where we looked. But what have you haven't done anything? I don't know what I'd be asking to be forgiven for. Maybe not. Yeah but you might have you certainly carry loss. Yeah. You've lost people who are lingering in your heart and they come back to you. Yes. And so that that's a form of healing. And we did a study where we looked at whether looked at dying as post-a-matter growth to see where there was positive changes in dying and in fact you are gaining insight and you are growing spiritually. The kind of take home is you don't stop living because you're dying and in fact there's profound living within dying like Genie experienced. Well I know you do as I said to you you're doing the Lord's work you're handling you know multiple patients at one time. And so to take the time to sit down and write a book about it means you want to share it this information in this book death is about a dream you want to share it because you want the world to know what. Well the intention has changed it was originally to help doctors and I was holding the wrong end of the stick. Right. I don't see a lot of change in that direction. Right. I mean medicines medicines ever more transactional. It's diluted it's fragmented and it's not whole person care. But what has changed you weren't able to get through the deductors so now you're just speaking to us regularly. Yeah but you know the society our culture doesn't want the doctors death anymore. They want their own experience they want their voice to matter they don't want to hospitalize death they don't want an institutionalized death they want to be with their loved ones they want to be at home so I think that the future patients those of us who will be there are having a different experience. Are having a different experience? Yes yeah what do they have to say? And so for those of us who are in a position there's so many people who are listening who are either caregivers or will be caregivers in their lifetime for end of end of life experiences for their family members and you want them to know what? Dying is progressive sleep and it's dying is progressive sleep. And in that state it makes sense what matters to you from diagnosis to death is going to change and it's natural that as you get closer to the end you're going to reflect on what mattered most to you and our greatest achievement that's our relationships you're going to return back to love it's love that enters and you know the expression you know fighting the dying of the light they're not fighting against they're actually fighting towards they're fighting towards trying to get back to those they've loved and they've lost. Yes and you realized later in life that you are in this work because of your experience with your father tell us about that. Yeah the last time I saw my dad I was 12 and he was in one of these states and we fished every year of North and Canada and he was getting me ready to go on a plane to go up North and that's the last time I saw him. So I always had an aversion to this whole thing and I ended up in this work more or less by accident I was just moonlighting at hospice while I was a cardiology fellow and I'm seeing these patients in the first time as a physician I'm not allowed to sign off I actually have to be a comforter and be present and I saw what I had seen as a kid and I didn't understand it I still don't know where it comes from but I don't know where love comes from but I understood that what it meant to the patient and I certainly understood what meant to their family so I got to just learn to have reverence for it and that's how I got to this. Because you experienced the same thing with those patients that you'd experienced the last time you saw your father. Yeah. Yeah. Well Dr. Chris Kerr thank you so much for being here and for the life-affirming work that you and all of your team members do every day every day and for listening to the nurses. Okay. Death is but a dream available wherever books are so we'll see you back here next time. Thanks everybody. As always I thank you for joining the Oprah podcast and if you're a caregiver at the bedside of a loved one I hope you'll take a moment to acknowledge the sacredness the holiness and profound sense of living that comes with the dying experience and if this conversation resonated with you I encourage you to get your own copy of Death is but a dream. The stories in this book will reframe your understanding of life's final journey to buy a copy simply scan the QR code that's right there on your screen. Our listeners tell us that the podcast is resonating with you and is serving as a bright spot in your day. That means a lot to me so here's the thing I would really appreciate it if you like and subscribe to the Oprah podcast on YouTube or wherever you podcast. It's just a quick tap of the subscribe button and that way you won't miss an episode in your queue. 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