Dreaming whether in pleasant reverie or nightmarish angst has long been accepted not only as a real physiological phenomenon but as a common human experience. But when the dying describe open-eyed visions of long-dead relatives and friends, those who don't "see" the extra people in the room usually grow skeptical.
"Demented," "crazy" or "lost it" are the labels, whether whispered or silent.
Yet some of those who work most closely with the dying report such events as highly spiritual experiences that occur across faith traditions and cultures, and includes agnostics and atheists. And though it is still taboo to validate such things in clinical or academic settings, science is making some room for near-death experiences beyond the tangible, physical world.
Meanwhile, hospice chaplains watch such "pre-death visions" play out daily as their patients slip away.
Jennifer Hammargren was told by doctors that she had only six months to live. As a patient facing death, much of the knowledge she acquired preparing to be a hospital administrator seemed less important than preparing spiritually for her future.
Given what she calls a "reprieve," Hammargren not only didn't die, but she uses what she learned through the process of preparing for her own death to help those who are in the last stages of life. As a local chaplain for VistaCare hospice services, she's watched thousands of people make the transition from life to death.
She sees a definable pattern of behavior in patients who are dying, much of it involving a "life review" that includes making amends with family and friends and a process called "faith questioning." As patients examine their religious beliefs, or the lack of, they come to define what "spiritual" means for them whether specific beliefs or simply the love of nature or laughter. Hammargren believes those personality traits are part of each person's spirituality.
Once patients come to a deeper spiritual understanding, they often begin to "see" people in the room whom they don't know, sometimes children who "visit" and may not speak. Some describe people they are not related to but who they think they may have known when they were young, she said. Others describe relatives they don't know personally but have heard stories about. Still others describe visits by favorite pets.
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.
"All humans engage in (spiritual thinking), so it's part of the human experience. How do we educate families to be open and supportive" of experiences with the dead? she asks. "How frustrating for a patient in the midst of this transition to try to talk to family members and be told they are nuts. Well-meaning families who are not prepared can damage their relationship they've worked so hard to develop with the loved one who is dying."
She's watched a huge interest in spirituality around death develop in the past few years, with "a big burst of interest in having spiritual care in nursing homes and hospitals. I think that's a result of people becoming more and more aware that we are spiritual beings."
Nationally, academic programs featuring classes on education about spirituality and death are on the increase, according to Jean Miller, professor of nursing at the University of Rhode Island. She has developed and taught courses on spirituality, loss and death for health professionals. A national initiative called the "End of Life Nursing Education Consortium" as been in place for about six years, focused on training nurses across the country.
"When working with these patients we're looking for their sources of hope what gives them meaning and comfort, strength and peace. We're also looking for how their religion might help them, and if they have any personal spirituality or religious practices that would be important to observe."
She said such practices "began with Florence Nightingale" but have come in and out of vogue since then. "During my education in the '60s, it was not recognized so much we were not supposed to talk about this. That was part of the emphasis on science and being very objective in what we observed and treated.
"Now we're realizing that good care is more than technology, more than medicines. There is something about loving care, about the spiritual. Some are uncomfortable with that in an academic setting. It just depends on their personal experience with it."
Miller taught courses in Sweden on the topic last summer, "and they are interested in it, but they have no words to put around it, because they don't go to church in Sweden. They're practically all Lutherans, but they only go there for baptism, weddings and funerals. But they're feeling the need to have this in their curriculum, yet they don't know how to put words on it."
When it comes to discussion of seeing deceased relatives or friends, "that happens," Miller said. "I don't know the real reason behind it. Some think it's a physiological reason, and others believe they really do see those people." She said the threat of a terminal diagnosis "often opens us up to thinking about really important things like our relationships relationships to a higher being, to others and to ourselves.
"For me it's seeming to be involved a lot with connections, if I were to use a single word our connectivity and oneness with others and a higher power."
In his recent book, "Palliative Care Perspectives," Dr. James L. Hallenbeck calls the experience patients report of seeing dead loved ones an "altered state" of consciousness, comparing it to how we think about radio frequencies. Hallenbeck is director of palliative care services with the V.A. Palo Alto Health Care System.
"In normal wakefulness, we function and interact on a relatively narrow and shared frequency that allows both transmission and reception of shared experiences. When patients at the end of life experience altered states, it is as if their radio frequency, their wavelength, has shifted," with the radio dial turned slightly.
That small turn "allows the patient to experience both the 'normal' wavelength on which we coexist and yet receive signals on a wavelength that we cannot perceive. Such a patient might be perfectly aware of being in a hospital bed and of dying but be able to see and hear a deceased relative sitting in a chair next to the bed."
Often the only clues that doctors, nurses or family members have that a "frequency shift" has occurred is to see the patient "speaking or gesturing in an indicative way or the patient reporting on the experience after returning to our wavelength. At this point I must stress that in discussing such altered states, I am not commenting on whether the late Aunt Edna is really sitting next to the dying patient, that is, whether such altered states are real.
"The point is, they are experienced as real. This shifting of wavelengths may seem fantastic, but, in fact, we experience such states every night when we dream."
He writes that patients most commonly see deceased relatives. "It is remarkable how frequent an occurrence this is estimated to occur before at least 25 percent of deaths. Also remarkable is the fact that virtually always the relatives are, in fact, dead; visits by otherwise unseen living relatives are rare."
Hallenbeck said the next most frequent visitors, in his experience, are "guardian beings, angels and others. . . . Often, they will communicate to the patient that their time (to die, to crossover) has not yet come or some similar message. I have noticed no correlation between the appearance of such beings and religiosity in patients."
Usually, such visitors are welcomed, he writes, though one devout atheist patient of his was an exception. "When angels appeared in his room, he screamed, 'Get out of here, there is no God!' "
Hammargren believes that death is a transition, just like childbirth, when "you have all these loving people anticipating your birth and anxiously awaiting your arrival."
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