The following three anecdotes have been taken from the book Near Death in the ICU: Stories from Patients Near Death and Why We Should Listen to Them by a critical care physician named Laurin Bellg. Dr. Bellg graduated from the University of Tennessee College of Medicine, completed her internal medicine residency at the Medical College of Wisconsin, and completed her pulmonary and critical care medicine fellowship at Rush University Medical Center.
It’s not very often that I have personally witnessed patients experiencing bedside visitations – apparent interactions with entities we can’t see that clearly they can – but it has happened. More often I’ve been privy to family member accounts (even my own) as they share with me in awe and soft whispers what they’ve observed as they hold vigil, awaiting their loved one’s passing. “He’s been having a conversation with Mom,” they might say. Or, “Can’t you see him? He’s right there waiting for me,” a patient may muse in wonder.
What seems different about these events in particular, setting them apart from hallucinations or delirium, is that patients are often very coherent with family and staff. They don’t seem delusional or even subject to confusion in these moments. Perhaps they are having hallucinations of some kind, but it is hard to discount what they report while they simultaneously interact in a normal way with us. Having witnessed lucid and oriented patients interact with something or someone that’s not visible to us makes it difficult for me to pass it off as a misfiring of a dying synapse. It quickly becomes clear to all involved that they can see something we can’t. Often there is an expression of wonder from the patient and the families when it occurs.
Of course, not all patients are clear and coherent so close to death. I have also observed patients who, after hours or days of being unresponsive, suddenly become acutely aware of their surroundings in a way that totally excludes those of us bearing witness. Having someone emerge acutely from a state of not responding at all to seeing and interacting with something they apparently see that’s so important to them that they actually ignore us, certainly stands out!
One of my most memorable encounters with the mystery of bedside visitations happened when I was an internal medicine resident doing a required oncology rotation. The cancer ward also served as an inpatient hospice, and we took call for both. When you are a resident physician in training, you usually are on call overnight in the hospital. You can sleep there during your shift if it’s not busy, but the accommodations are not exactly luxe.
The oncology ward where I trained was a separate wing set apart from the rest of the hospital and, oddly enough, connected to the Children’s Hospital, although we only cared for adult patients there. The isolated call room where we slept when we could was literally nothing more than a closet with a bed wedged into it. It was quite drab, with no window, and the lighting was either blaring or pitch black, so I spent as little time in there as possible. I preferred hanging out in the nurses’ work area in the early evening until I was tired enough to become blind to the claustrophobic feel of the tiny room. If the overnight workload permitted and admissions had slowed, it was a good idea to catch at least a couple of hours of sleep in order to make it coherently through the next day.
One of the hospice patients on our service at that time was a 63-year-old woman with breast cancer that had metastasized to her brain, lungs and bones. Her body was wracked with pain, and as her condition deteriorated and her body continued to waste away, she became so weak she could not move of her own accord. It took generous doses of morphine and several nurses to be able to move her for her daily care needs without causing considerable discomfort.
Earlier in the week, there had been a family meeting that resulted in a shift in her treatment goals toward palliative care. It was the pivotal point where we all understood that we were at the stage where we were no longer prolonging her life but prolonging her death, so we all agreed to keep her comfortable until she passed away. There would be no more chemotherapy, no more radiation. In keeping with the patient’s wishes, she was placed on pure comfort care, and nothing other than those measures necessary to relieve pain and suffering would be administered until she died. For the next few days, family members and friends drifted in and out to pay their respects and hold vigil.
One particular evening when I had the overnight duty, I was heading to a small workroom near the nurses’ station to catch up on some of my documentation. As I passed the patient’s open door, I noticed a woman whom I recognized from the family meeting earlier in the week sitting at her mother’s bedside. The overhead lights had been turned off for the evening, except for a small bank of track lighting above the bed casting an indirect glow toward the ceiling. It was comfortably dim.
I leaned into the room to ask quietly how things were going. The daughter seemed in a mood to talk, so with nothing much else happening on the ward, I pulled up a chair in the room’s soft light and we began chatting quietly. It was an easy conversation and seemed to be a comfort to her. As my eyes adjusted to the low light of the room, I could see the patient lying there more clearly. She appeared weak and her breathing was so shallow as to be barely perceptible. It wouldn’t be long now until she passed, I surmised, and I could certainly understand why her daughter was reluctant to leave her side.
We had been sitting there a few minutes, talking about nothing in particular, when we began to hear murmuring coming from the patient’s direction. Turning our attention to her, we noticed that she appeared to be having a conversation. This seemed odd to both of us because she had not been responsive at all for the past two days, and even before that had not done much more than utter moans or random single sounds.
Although her body hadn’t moved on its own for several days, she then began to add subtle hand movements as one would in the course of normal conversation. It seemed absolutely conversational, complete with pauses and subtle head gestures, suggesting that she was listening when she wasn’t talking. Her daughter and I fell into silence watching her, leaning in to try to make out what she was saying. But despite the conversational cadence, it was only distinguishable as mumbles. This went on for about ten minutes, when she suddenly opened her eyes and seemed to focus intently on something in middle space. Her daughter tried to speak with her, but there was no recognition or acknowledgement. Her mother’s eyes looked past her and up, toward the corner of the room.
Then her attention shifted to an area of the ceiling above, requiring her to turn her head from where she had lain for the past few hours on her right side. Her daughter moved forward in fascination to observe her mother, but said nothing. After staring into the area above her bed for several moments, she began to make movements, attempting to sit up. Her daughter looked at me and we both exchanged amazed glances at what we were seeing. We understood that we were witnessing something quite extraordinary.
This woman had not moved for days, and certainly not without complete help or immense pain, but now she was moving with relative ease and gave no indication of any discomfort. She seemed to be engaged in a process that clearly did not involve us, so we simply watched in awe and let it unfold. Then in one deft movement, she pushed herself up to a near-sitting position, leaned forward and lifted her hand up as if reaching for something. She then said very clearly and with obvious surprise, “You’re here!”
I heard her daughter begin to softly cry, and I sat back just to be present to whatever was happening. The patient maintained this position for thirty seconds or so, and then, as if being lowered by unseen hands, slowly lay back down on the pillow. With eyes closed, she exhaled deeply her last breath – and died. We sat in silence for a long time, neither of us knowing what to say but clearly aware that something mysterious and wonderful had just taken place. Finally, with tears streaming down her face and her voice trembling, her daughter said, “I’m so grateful I was here to witness that.” I was too. I think that was the moment that I fell in love with the mystery that surrounds death and dying.
I had my own strange experience of observing what seemed to be a bedside visitation when my grandmother was dying. She’d had a gradual descent into vascular dementia over the years leading up to her passing, and was nearly totally withdrawn toward the end. She wouldn’t interact, she wouldn’t eat, and with her increasing failure to thrive, she was clearly dying.
A few weeks before my grandmother’s death at age ninety-one, hospice became involved and spent a great deal of time in her home, both caring for her and comforting my grandfather. When her decline accelerated, I flew in from my home in the upper Midwest to spend whatever time I could with her. I remember my grandfather, knowing I was a physician, sitting at her bedside when I arrived at the house, looking at me helplessly and saying through thick tears, “Is there anything you can do to save her?”
“No, Grandpa,” I replied. “It’s her time.”
He nodded sadly and turned his attention back to her wrinkled hand, which he held and caressed with such love and tenderness that it broke my heart. By this time she was totally unresponsive, and it was not clear to us what she did and did not understand. Could she hear us when we told her we loved her? Was she suffering in ways she couldn’t tell us? With the help of the hospice nurses, we gave her morphine under her tongue if she moaned, and we repositioned her periodically, trying to guess at what would make her most comfortable – but we couldn’t know for sure, and we frequently found ourselves feeling quite helpless to meet her unspoken needs.
One night I was up late with one of the hospice nurses, who were by now staying in shifts around the clock. We chatted quietly now and then, but mostly we sat in the dim silence of my grandparents’ old Southern farm home, not saying a word. Suddenly, my grandmother began talking. It was hard to understand, but it seemed as if she was carrying on a conversation. All that we could understand was when she gazed softly with a faraway look in her eye and said, “Almost there. Almost.”
“She must be getting close,” the hospice nurse said. “She’s starting to talk.” I knew what she meant, having had patients of my own who had apparent discourse with a presence none of us could see.
It was tough seeing my grandmother dying. Although by all appearances a simple farmer’s wife, she was one of the most naturally elegant people I knew, and I had always admired her for her calmness and grace. Even with drama erupting all around her, she seemed to maintain a cool and centered calm – one I sought to emulate but never quite succeeded in doing. Not the way she did, anyway. Having witnessed my patients’ beside visitations, I was deeply moved to be able to experience this with someone I was so close to.
What happened next was strange. Had I not experienced it first hand, I would have harbored skepticism, but because I was witness to it, I can only report my experience. At the risk of reading meaning into something that was a natural occurrence and strictly coincidental, I chose then to embrace a way of understanding it that brought me the most comfort. In doing so, I gained insight into why my patients and their families might do the same, believing with their whole heart that what they experienced was real. What happened was meaningful and real to me. I now understand that similar events are meaningful and real to them.
A day before my grandmother died, we noticed two doves right outside her window, perched on the back of the pale green metal glider that had been on their front porch for years and was now partly rusted from the ever-present humidity of the deep South. Those doves never left. More often than not, they were looking at the window of my grandmother’s bedroom, seeming to try to peer through it from time to time. Occasionally there was a soft peck at the window, and we would look up to see one or both of the gray birds ruffling their feathers and pacing back and forth along the back of the glider. Glancing through the window and cooing softly, they seemed to be watching her.
After a day of tending their perch outside my grandmother’s window, just hours before she died they became very agitated, pacing up and down along the back of the settee – roosting, fluffing, then settling over and over. They seemed restless. Around the same time, my grandmother’s conversations seemed to pick up. She talked and gestured with her eyes closed, quietly, but very purposefully. Occasionally, we would understand a word here and there, especially on the occasion that she would reach her hand out and say, “Almost. Almost.”
We would also hear her talking about roses. “Oh, look, a rose,” she would say, or “A rose, so beautiful.” My grandmother loved her roses and tended to them faithfully. It seemed so fitting that in her dying moments she would somehow be presented with the image of roses, and it was a great comfort to us.
Moments before she took her last breath, the doves became especially active. One in particular kept flying off a short distance, and then coming back. We were fascinated. Aunts, uncles, cousins, my mom and grandfather all took notice. Once, when my grandmother had a very long pause in her breathing, both doves flew away a short distance, only to return when her breathing resumed.
Then after several moments of her taking long pauses, stopping breathing, then starting again, she took her final breath. At that moment, when it was certain she would not breathe again, the two doves took off in a flurry and flew away. We never saw them again, and my grandmother never took another breath. She was clearly gone, and we mused among ourselves that perhaps she’d had company on her way – escorted by two gray doves that had kept vigil for those long hours. It comforted us to think so.
None of us had ever seen doves there before – not the children of my grandparents who had grown up in that house, nor the grandchildren who had spent many lazy summer days playing on that front porch. And since my grandmother’s passing, we’ve not seen them again. Ever.
What happened next, though, truly defies logic. Keep in mind that my grandparents were farmers, as were their parents and ancestors before them. They were intimately familiar with their land. In fact, my grandfather inherited the land from his father, and had been farming it since his father’s death when he had to drop out of the small grade school not far down the red dirt road to support his family. There wasn’t an inch of that eighty-acre plot of land my grandparents and our entire family weren’t familiar with – an area in northern Florida where generations of Registers, Carswells and Outlaws had farmed peanuts, cotton and occasionally sugar cane. In fact, tucked right up against the borders of Alabama and Georgia, along a vast network of winding red dirt roads, they knew every sound and wind shift that occurred on that land.
So it amazed us that a few moments after my grandmother died and the doves had flown away, we all heard what sounded like a horn play several sweet notes in the field right behind the house. The field was totally empty for the season – the bare cotton stalks had only a smattering of white cotton remnants still lingering in the few pods that had resisted the harvester several weeks earlier – but the sound of the trumpet-like horn was very close. Even younger cousins who had been playing in the back yard came running in to tell us they had heard a horn playing in the field near them but couldn’t see anyone. No one could explain it. There were no radios or televisions on. We had all been quiet and reverent before and at the time of my grandmother’s passing. No vehicle had passed the remote dirt road outside their modest farmhouse. It’s the kind of story that had I not experienced it personally, I would be tempted to discount it as made up, thinking that “you hear what you want to hear.”
Yet we had all heard the horn, and we could only just stare quizzically at one another and contemplate what had just happened – the doves, the horn sounding. No one said a word. Finally, it was a hospice nurse, a gentle black woman, who broke the silence and said, “Now that is only the second or third time in all my years that I have heard that trumpet right after somebody died.” She was so matter of fact about it. I admit it was comforting to have her validate our experience, her simple words reinforcing its meaning for us.
I can’t logically explain what happened, and I don’t really feel a need to. Whether or not it was a totally random, collective auditory hallucination misinterpreted from another perfectly natural sound or not, I can’t say. But it happened. All of us who were gathered at my dying grandmother’s bedside – both inside and outside of the house – experienced it. Bearing mutual witness to this thing that we can’t explain during a moment of shared grief still holds deep meaning for our family. That is all the explanation I need, and it brings me comfort.
One of the most memorable bedside encounters I’ve had the privilege of hearing was that of a woman named Alice. She was gravely sick, but despite the touch-and-go course of her illness, she ultimately did not die. She did, however, experience a visitation.
Alice had a teenage nephew, Corbin, with whom she shared a special bond. She had watched over him during his early years before he started school while his parents both worked. During his elementary and junior high school years, the bus would pick him up and drop him off at her house until his parents could collect him after work. He was not an only child, but he was the youngest, being born much later than his older brothers and sisters. The sibling next in age to him was still sixteen years his elder, so he seemed like an only child and received a lot of love and attention from his parents, his brothers and sisters and his favorite Aunt Alice.
Corbin was one of those easy-going kids who was easy to like, at home and at school. He was popular and had a lot of friends. Good at sports and especially adept at math, he had plans of seeking a baseball scholarship for college and coming back to his hometown to be a teacher and a coach at the high school from which he would soon graduate.
Shortly after his aunt was admitted to the hospital with severe pneumonia and respiratory failure, Corbin was driving home from a school event one evening when a drunk driver veered into his lane, hitting him head on and killing them both. Everyone was devastated at this senseless loss of such a promising young life. When the accident happened, his aunt was probably at her sickest and it was at a point in her illness when we were not certain whether she would recover or not. She had severe lung injury from her pneumonia, and her kidneys, which were not in the best shape before her hospitalization, had become further impaired from her critical illness and she now required dialysis.
As she started to show signs of improvement and it looked as though she would survive, they decided not to tell her about Corbin’s death. They feared that because she and Corbin had been so close, she would lose the will to live. They were a close family and just didn’t feel they could handle another loss. They knew they would have to tell her eventually, but for now they decided to let her get further down the road in her own recovery before sharing the sad news. When she finally turned the corner, she was awakened from her medically induced coma and removed from the ventilator that was supporting her breathing. Much of her family was there for the occasion. When she was able to talk, she looked at them all with so much sadness and love and said, “I know about Corbin.”
There were gasps and murmurs of “who told you” and “we told the staff not to tell you.” They even looked at each other with misgiving, thinking that perhaps one of their own had divulged the devastating news. Her explanation shocked them all but also quickly righted an unsteady ship of suspicion of betrayal. With incredible love and gentleness, looking into her loved one’s faces and weighing her words, she softly said, “Corbin told me.” She let that information hang there a moment before she continued. “He came to me when I was so sick and he told me what happened. He told me about the accident and that it happened so suddenly. He assured me he didn’t suffer in the least. He saw bright lights, and then felt total peace.
“He also told me I would get better because my family needed me. He wanted me to tell every one of you how much he loves you and how grateful he is for the good life you provided for him. He said he is in a beautiful place, and that he will never be that far away from us but that he will be busy now.”
She continued, “When I asked him what he would be busy doing, he shrugged and laughed, saying he really didn’t know yet, but he was just told by a beautiful being of light, who met him when he left his physical body, to get some rest, because soon he was going to be very busy.”
Even though the loss of Corbin was so unbelievably sad and heartbreaking, this unexpected visitation provided incredible healing for the family. And while it didn’t totally erase their grief or their sense of loss, it did provide immeasurable comfort and softened the pain. It offered peace to learn that Corbin was okay and gave them a healing topic of conversation as they laughed and speculated about what new work was keeping him so busy.
I sometimes wonder if those who say there’s no evidence of something beyond this existence perhaps aren’t really looking for it. I once had a colleague say that in all his years of patient care, he had never once had a patient describe a near-death encounter and he had never seen evidence of bedside visitations. “Did you ever ask patients about those experiences?” I inquired. He had not.