Shortly after Dr. Christopher Kerr joined the staff of the Hospice and Palliative Care, Buffalo, New York, he encountered a 40-year-old patient named Tom. Despite a grim diagnosis, Tom was relatively fit owing to years of strict exercise. Dr. Kerr was optimistic about life preservation treatment.
“I think we can buy Tom some time,” Dr. Kerr announced at the nurses’ station one day. “IV antibiotics and fluids should do it.”
Nancy, the charge nurse who heard Dr. Kerr’s assessment, replied that it was too late, Tom was dying. “He’s been dreaming about his mother,” she said.
Within 48 hours, Tom passed away.
Nancy had worked in hospice for more than 20 years — she was plugged into the predictive value of dream life in a patient’s final days.
This incident is recounted in Dr. Kerr’s 2020 book, Death is but a Dream, a summary of the research he and his team at Hospice Buffalo did on end of life experiences (ELEs) such as Tom’s.
“It was the remarkable incidence of pre-death dreams and visions among my dying patients that made me realize how significant a phenomenon this was, both at a clinical and a human level,” Dr. Kerr said.
Because end of life experiences were not dealt with in medical school, Dr. Kerr “failed to see how the subjective experience of dying could be relevant to my role as a doctor.”
Like many physicians, Dr. Kerr said he was well schooled in the curative phases of treatment, but knew little about the subjective dimensions of how patients actually experience illness, particularly dying.
“We’ve become more like technicians and it’s harder and harder for doctors whose model of care puts a premium on efficiency to stop and provide what the patient needs — which is simply a presence,” Dr. Kerr told Hospice News.
Dr. Kerr and his research team conducted semi-structured interviews with terminally ill patients. Using both open and closed questions, the team focused on the content and frequency of the patients’ dreams, as well as the level of comfort these dreams produced.
To capture the serious attention of the medical community, Dr. Kerr applied sound scientific methodology and avoided dealing with religious practices — he did not want the research to function as “a keyhole into the afterlife.”
Today, more than a decade later, this work has yielded Death is a Dream and a number of studies published in scholarly, peer-reviewed journals. Essentially, Dr. Kerr has demystified the dreams and, in doing so, diagrammed the vital role they play in the lives of dying patients and their bereaved loved ones.
The specific results of the research are highly intriguing. Ninety percent of the patients investigated had experienced at least one ELE (defined as a subjective experience at the end of life such as a dream or vision). Ninety-nine percent of those people reported that the ELE seemed real. And sixty percent found the experience to be comforting, while eighteen percent thought ELEs were distressing.
Dr. Kerr discovered that as the patients approached death, their dreams transitioned from focusing on living people to dreaming about the dead. These dreams grew increasingly vivid and emotionally charged as the individuals neared their final hours.
Death became paradoxical: as they declined physically, their emotional life was active — internally they had intense, powerful experiences.
The subject matter of the dreams was highly individualized, not a one-size-fits all process. Generally, they featured loved ones, a favorite pet, meaningful times, peaceful transitions, preparations for a trip, reassuring messages.
“Our study confirmed that end-of-life experiences help patients connect and reconnect to who they are and to those they loved,” Dr. Kerr said. “They become a way of preserving or resurrecting the integrity of the self. Within the words of our dying patients were illuminating stories of deeper meaning, an inner journey through which selves were honored, wounds were healed, and bonds restored.”
Can these dreams be written off as delirium, hallucinations, reactions to medicine, a function of cognitive decline? Dr. Kerr’s research does not agree with that — many of his patients were interviewed weeks or months prior to death, and all were functional, had mental clarity, and exhibited organized thinking.
It was Dr. Kerr’s desire that attention be paid to a “legitimate process during dying.” Treating the patient, not only the disease, is the appropriate medical approach to the dying.
“We need to bring doctors back to the bedside, to their roots as comforters of the dying rather than mere technicians trying to extend life at all costs,” Dr. Kerr concluded.