Hospice physician Megan O’Shea Farrell has been caring for patients at the end of their lives for more than 20 years, and many of them have told her about their deathbed dreams and visions. She has come to understand the importance of asking her patients about this phenomenon, she told me — that doing so “often provides a window into the experience of dying that might otherwise be missed.” She has found this to be true on numerous occasions, but never more so than on one afternoon in 2018.
Her patient was Sierra, a 28-year-old woman with a 4-year-old son, a fiancé, and metastatic colon cancer that had been diagnosed far too late to be treated. But Sierra was determined to persevere against her disease, Farrell said; she didn’t seem to understand that her body was already shutting down.
Wanting to better understand Sierra’s mindset, Farrell said, she first approached Sierra’s 26-year-old sister: “I said, ‘What do you think Sierra is thinking?’ And she said, ‘Honestly, doc, she really thinks she’s gonna beat this.’ So we had some work to do, and we decided to meet with her the following day, all of us together.”
Sierra’s mother, stepfather and older siblings accompanied Farrell, the hospice chaplain, a social worker and the inpatient unit director to Sierra’s room. She was days away from dying.
Farrell tried to gently help Sierra come to terms with what was going to happen. Farrell said how sorry she was that a cure for Sierra’s illness would not be possible.
“I’m going to beat it,” Sierra insisted.
Farrell moved to the bedside. She asked Sierra if she thought about the future, and Sierra began to weep.
Then Farrell asked whether Sierra had been having dreams. Sierra seemed surprised — but then she said yes, and she wasn’t sure what to make of them. “Is there anyone in particular you have been dreaming about?” Farrell asked.
She remembers how Sierra’s gaze fixed on a specific point in the room, and her demeanor abruptly calmed.
“Hi, Grandpa,” she said.
She was addressing her mother’s late father, a man Sierra adored, who had helped raise her. Farrell immediately looked at Sierra’s mother, Tammy, who started to cry. Tammy asked her daughter, “What is Grandpa saying to you?”
“Oh,” Sierra answered, “he’s telling me what a good mom I am, and what a good daughter I’ve been. He’s telling me he doesn’t want me to suffer anymore.”
Over the next several minutes, as Sierra engaged in conversation with a figure only she could see, she relayed to the others what she was hearing: that her grandfather was going to see her soon. That he said everything would be okay.
Sierra’s mother listened and then told her daughter, “When Grandpa comes for you, you go with him, baby girl.”
The transformation had unfolded in a matter of minutes. Sierra’s vision, Farrell said, had allowed her to finally accept her imminent death, and it had allowed Tammy to let her daughter go. The work that Sierra’s caregivers had set out to do was done, through a means they could neither control nor fully comprehend.
“Everyone walked out of there speechless,” Farrell said.
Farrell isn’t exactly sure how to explain what happened in Sierra’s room. What is certain, she said, is the depth of comfort it instilled in everyone present — Sierra’s loved ones as well as her hospice caregivers.
Every time Farrell has witnessed someone immersed in an end-of-life vision, she said, “it feels like these patients have one foot in each world.” But Sierra’s encounter felt exceptional: “It undoubtedly was the most powerful thing I’ve ever experienced as a physician.”
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