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“It was the most peaceful sleep.” That’s how my paternal grandmother referred to the time she was technically dead for several minutes before doctors shocked her back to life. She lived another decade after that, but never once to my knowledge expressed a fear of dying.

As I trained to become a physician-scientist with a focus on neuropsychiatric disorders, I often thought of my grandmother’s description of temporary death. I learned that there were credible physiologic explanations for her to have experienced death as an immensely restful sleep.

It’s an idea that resonates even more strongly with me since I was diagnosed with metastatic kidney cancer. I fervently hope my superstar medical team will help me outrun this disease for many years to come, but I must also face the possibility that I could die young. That initially frightened me in the expected ways. What does it feel like to die? What if I experience a bad death with tubes going into or coming out of every orifice, or my ribs being cracked as doctors try to restart my heart?

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A recent experience with an endoscopy to find the source of cramping and vomiting after I ate muted those fears. As I laid on the gurney, the nurse let me know I would soon be getting medicine through the intravenous line: a little something to help me relax, to prevent pain, and to have no memory of the procedure, during which I would be partly awake.

As the fentanyl and midazolam began flowing into my vein, the last memory I had is feeling totally at peace. It was the most content I can ever recall feeling. I am thankful to have never struggled with addiction, but that moment gave me a better understanding of why people seek such a feeling no matter the cost.

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What has stuck with me since that procedure is the sense that leaving the world does not have to be gruesome, and might even be the best feeling ever, just like my grandmother described it.

There are, of course, physiologic explanations for why peace may accompany dying.

As the brain begins to adapt to oxygen deprivation, its noncritical regions begin to shut down, turning off for individuals who are actively dying the burdens of complex neurologic tasks like risk aversion, problem solving, and anticipatory worry that weigh on us during our waking lives. While these brain activities keep us alert and feeling attached to our bodies, tamping them down may account for the feeling of lightness, even floating above the body, which many near-death survivors describe.

The classic “death rattle” heard when the body can no longer clear fluids from the airway, often seen as a gruesome sign, is likely a signal of a transition to such a relaxed, unfettered state that the brain is no longer burdened with that task.

The emotional centers within the brain, however, are so deeply engrained in our functioning as humans that they remain on and engaged throughout much of the dying process. That aligns with descriptions of near-death experiences of vivid and realistic interactions with loved ones who have passed.

Even as death approaches and the body and brain are shutting down, there is good evidence to suggest that individuals are aware of their surroundings and can hear and feel the presence of their loved ones. These basic sensations persist in ways that can be a gift to dying individuals, ensuring they are not alone in their last moments — a most common fear.

Palliative care and hospice are stigmatized in our society because they are so closely associated with death, a topic that tends to make people uncomfortable. My attitude toward them has shifted dramatically since my diagnosis. With their focus entirely on providing comfort and maximizing quality of life — even in death — I think they play a most important role and intend to do everything in my power to engage in that process when I need it.

My maternal grandfather died two years ago at the age of 93, just before I learned I had cancer. He used to tell me he “wasn’t afraid of death, just all the things that [he] would miss.”

I think of him whenever something happens to me that would have sparked joy in him, and wish he was still alive. I’m not sure I believed him when he told me he wasn’t afraid of dying, but I do now. What frightens me today has little to do with my death and much more to do with the moments I’ll miss afterwards: anniversaries with my wife, birthdays and graduations with my son, watching my parents age and my brother and other loved ones continue to blossom in their lives.

I can’t say if this perspective will change again. I imagine it will. Death as an abstract concept is probably a lot less terrifying than staring it in the face. But I’ll remember what my grandparents said and try to move forward with the same kind of contented pragmatism they shared with me. In the interim, devoted oncology researchers, my particularly skilled doctors, and I are doing our absolute best to keep these musings firmly in the academic realm.

Adam Philip Stern, M.D., is the director of psychiatric applications at the Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center and an assistant professor of psychiatry at Harvard Medical School.

  • My own ‘near death’ experience was very similar. It is indeed a beautiful feeling of weightlessness, no longer burdened by gravity. I recall it as having my eyes closed and no desire to open them. Suspended in this weightless feeling, and also very aware of what was going on around me, including the voices of those around me. It was nirvana for those dying of natural causes, however, not an experience I am in any rush to experience again, for life is wonderful.
    John James Community Mental Health and Addictons Worker

  • I commend you on your positive attitude in the face of adversity. Clearly, the NDE offers us much hope in spite of attempts by some nihilists to debunk it. However, the best evidence for survival was developed by a number or renowned scientists and scholars between 1850 and 1925. Unfortunately, because it is not consistent with the mainstream materialistic paradigm, it is not well known. As an introduction to the material, let me suggest that you read the books of the world-renowned physicist Sir Oliver Lodge. Check out
    http://whitecrowbooks.com/michaeltymn/month/2018/04/ (scroll down to the second one)

  • Thank you for sharing your experiences with us. It is comforting to know that so many individuals really do experience dying with such peace and a profound joy, something that only one who has been through this themselves, or sat with others as they passed on from this life.

    Coming on two years since we were with our Mother who left this life of profound suffering, she was always sharing with us, her wisdom and experiences of what her life was, and even immediately after she passed on, she opened her eyes so wide and with a reverence that we never before saw with anyone else who passed on; even in her death, she looked so grateful and happy to see what she was experiencing, and it’s been something that I have held onto since she actually shared with her death, that she was as awed by what she was experiencing. The most significant aspect of our parents lives, was their faith. I know that I witnessed our Mother as she was looking into the face of God. My other close family members were all sharing after when we left her room, after our spending some time together saying our final farewells to our Mother, our exact same thoughts about the way that Mother looked, at the moment when she was in her next experience of life, she was sharing with us her looking into the face of God. That is something that I have never before seen, and felt. Death is not the end, rather it is the mystery of the essence of who and why we are now.

  • Adam, as usual you write so well and combine medical and intellectual ideas and knowledge with deep emotions. Everything you wrote gave me a new way of looking at death and being less afraid. So important to make each day count.

  • Very well written article which I can easily identify with. Almost 10 years ago I was diagnosed with Hodgkin’s lymph Phoma and after treatment developed non-Hodgkin’s lymph Phoma.
    Lots and lots of depression with the chemotherapy treatments. Then I was told I could increase my chances after the second cancer if I went for a an analogous bone marrow transplant. That experience in the hospital was pretty bad for me.
    So here it is almost 10 years later and I am generally healthy. Although I remain cancer free, I’ve had blood issues since the transplant. I have had several IV I G treatments and various other blood related issues. But I am blessed with the fact that my hospital system has the very best specialists Who share my information out of one computer system. They know me and have all of my information available 24 hours a day. I am also blessed with the fact that when special situations occur, they sometimes call me directly.
    I am 66 years of age and I look and view life in a totally different way then I used to.
    If I can continue to stay healthy, I will continue to pursue my personal interests which include the Convention Of States project and healthcare reform that protects the doctors (tort reform), hospitals and all patients.

  • Thank you for writing this Adam! I heard a quote the other day, “dying is absolutely safe” (from someone called Ram Dass), that hit it home for me along the same lines.

    • If I remember correctly Ram Dass was actually quoting Emmanuel, a channeled entity, who also said that death was like taking off a tight shoe. Ram Dass is still living happily in Hawaii after suffering a stroke some years back. His book “Be Here Now” was a huge influence on a generation now facing the idea of no longer being here.

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