The unseen realm

While she has seen nurses become afraid when patients begin "interacting" with such visitors, Hammargren said she tries to participate in the experience with patients, asking them to described their loved ones and what is being said. She tries to prepare them in advance by talking about experiences previous patients have had with the "unseen," so when it happens to them, it "helps eliminate the weirdness."

One patient told Hammargren that " 'they keep wanting me to get in line,' and I told her to tell them you don't want to get in line, because you're not ready yet.' " The woman did so, and lived two more weeks, sharing quality time with her family. Unlike people who die catastrophically, many in hospice care are "really in control of the dying process, and those who are open to sharing and education have a much easier time of it," she said.

Accepting the fact that such experiences are often part of the dying process can enrich the journey for family and friends who support patients in sharing their reality. At such times, Hammargren feels she is walking in the realm of the sacred.

One patient stared intently at her when she entered the room for a visit, and when she asked what the woman was seeing, she replied "all these other women behind you" and said it was something like living "in two TV shows at once." When Hammargren asked the patient if she recognized some of them, she said she did, then proceeded to "actually describe some of my relatives, which I felt was really fascinating."

Trained in multifaith and multicultural ministry, Hammargren said there is limited universal terminology to describe such events but said as patients get closer to death, they become "more and more aware of the thinning of the veil" between life and death. "Many of them get more touchy. They really need to know you are solid — that this is really who you are. They're starting to see changes in themselves."

Some patients describe bugs crawling on the walls and seeing things that aren't pleasant, which Hammargren often finds is a reaction to the drugs her patients are being given. But those experiences are vastly different in description and "feel" than the ones that happen with loved ones, she said.

"When they get to the point that they start to see relatives they do know — at that point we know they're getting fairly close," to death. As they do so, she asks them whom they want to help them make that transition, and patients are usually "very clear about whom they want it to be."

Despite a scientific background personally and in her family of origin, Hammargren isn't afraid to talk about the unseen realm her patients' experience. She's seen it happen across the religious spectrum with Buddhists, Catholics, Jews, Christians, Unitarians, agnostics and humanists.