Finding Hope & Meaning at the End of Life

The following is an excerpt from the book Death Is But a Dream: Finding Hope and Meaning at Life’s End by Christopher Kerr, MD, PhD and Carine Mardorossian, PhD. (Avery, 2020)

The making of a doctor is a process with a beginning, middle, and no end. Student doctors leave the halls of medical school with vast amounts of information and knowledge that they will eagerly dispense to their patients. When they arrive at the hospital for the next phase of their apprenticeship, they have learned about disease and have yet to learn about illness: the former occurs in organs; the latter in people. The last and most important phase of their training will be lifelong. This is when the patient teaches them, and they are hopefully ready to listen and humble enough to hear. This is when they learn that sometimes the best way to treat a failing human heart is to set the stethoscope aside and ask about what matters to the patient, rather than just what is the matter with them. And one day, just when they think they have mastered the science of medicine, they will meet a patient who will summon them to tend to the soul. This moment will hold a lesson in empathy these doctors will never forget, the first of many through which they will find the true richness of the calling. The patient who first guided me through that moment was Mary.

Mary was a 70-year-old artist and mother of four, and one of my first patients at Hospice Buffalo. I once visited her room when her “whole gang,” as she called them, was gathered around her sharing a bottle of wine. It was a low-key family affair, with Mary appearing to enjoy the company of her brood, even as she drifted in and out of alertness. Then something odd happened. With no prompting whatsoever, Mary started to cuddle a baby only she could see. Sitting up in her hospital bed, it was as if she’d lost touch with the here and now and was acting out a scene from a play, kissing this imaginary baby in her arms, cooing to him, stroking his head, and calling him Danny. Even more striking, this incomprehensible moment of maternal connection seemed to have put her in a state of bliss. Her kids all looked at me, uttering variations of “What’s happening? Is she hallucinating? This is a drug reaction, right?”

I may not have been able to explain what was happening or why, but I did understand that the only appropriate response at that moment was to refrain from intervening medically in anyway. There was no pain to alleviate, no medical concern to address. What I saw was a human being experiencing an unseen yet tangible love, all beyond my medical understanding and reach.

I was observing firsthand the undeniable state of comfort and ease with which she was approaching the end of her life’s journey. Refuting this was no more an option than explaining it.

I watched in awe, as did her grown children. After their initial outburst, they were overcome with emotion, no small part of which was due to their relief at seeing their mother’s serenity. She did not need them to intervene, any more than she needed me to make a decision or say anything that could or would alter the course of her last moments. Mary was tapping into an inner resource none of us knew she had. The feeling of gratitude and peace that overtook us was like no other.

The next day, Mary’s sister came in from out of town and unraveled the mystery. Long before any of Mary’s four children came into the world, she had given birth to a stillborn baby she had named Danny. She was overcome with grief after losing the baby, but she’d never spoken of it, which is why none of her surviving offspring even knew about him. Yet in this moment, with death waiting in the wings, the experience of new life had returned to Mary in a manner that clearly provided warmth and love, and maybe even some small compensation for her loss. At death’s door, she was revisiting her past trauma as a wrong redressed. She had reached a palpable level of acceptance and even looked like a younger version of herself. Mary’s physical ills couldn’t be cured, but it appeared that her spiritual wounds were being tended to. Not long after this remarkable episode, Mary died peacefully, but not before transforming what I understood “dying peacefully” to mean. There was something intrinsic to Mary’s dying process that was not only therapeutic but that also unfolded independently of the ministrations of her caretakers, including her doctor.