From the Pittsburgh Post-Gazette

PITTSBURGH (AP) — Beth Roncevich's father was in his last few days of life, lying in bed in his Indiana Township home with her and her mother somberly by his side.

Though his eyes were closed while terminally ill from lung disease on that day four years ago, laughter unexpectedly emerged from Albin Langus.

"I said 'Dad, what are you laughing at?' He said, 'Oh, we're all together.' "

The bewildered Roncevich and her mother wondered who and what he was seeing. He was even giggling.

"He said, 'Everybody's together and we're all just having a wonderful time. We're having so much fun' ... and those were the last words he spoke," she recounted last week between her visits to patients of UPMC Family Hospice and Palliative Care. "I said to my mom, 'What more could we ask for than that?' Wherever he was going, he was in a good place and happy."

Her father's sense of a final party with whoever it was — she's still not sure who — occurred shortly before Roncevich became a hospice nurse. In that field, she's become accustomed to hearing of such positive encounters from her patients — or from their relatives who describe what the patients told them.

In particular, say she and others who work with the dying, individuals might report a vision, hallucination or dream of someone who preceded them in death. It is often a long-lost loved one — mothers are most common, but fathers, siblings, grandparents and even pets also frequently show up, seemingly welcoming them to whatever lies next.

"It's always a calming experience. I have never come across an experience that it was scary," said Roncevich, 48. "Another thing they experience is that, even in an unconscious state, their arms will lift up as though taking someone's else's hand, and their mouths will move as though speaking to someone."

To skeptics, such descriptions could verge on the paranormal — the type of other-worldly experiences that make for supernatural thrillers in film or literature. Or they might wonder if patients are delirious from pain or medication and thus babbling in confusion.

But that is not what is described in research that was published in 2014, based on interviews with patients at The Center for Hospice & Palliative Care, located in a Buffalo, N.Y., suburb. The patients were interviewed about dreams they had while asleep, visions they had while awake and things they saw or sensed while in the blurry state between sleep and wakefulness that is common during final days and weeks.

Of 63 patients in the analysis, 52 reported a dream or vision — and the dreams typically would be different from those of the general population with their everyday experiences and anxieties.

"As we approach death, dreams increase dramatically in frequency, and the dreams increasing most frequently have to do with the deceased — the loved ones who have passed," said Christopher Kerr, CEO of The Center for Hospice & Palliative Care.

Of participants in that study, more than half the time they were reported to be either awake or a combination of asleep and awake during their experiences. In about three-fifths of cases, there was a theme of preparing to go somewhere. In fewer than one of five instances, the patient reported distress from the dream or vision.

"There's almost like this built-in mechanism of serenity or safety, and the fear of death kind of diminishes," said Dr. Kerr, who was involved in the research, which is being updated and broadened, and in plans for a book and film documentary, "Death is But a Dream," tied to such end-of-life experiences.

Among those who feel positive, Dr. Kerr said, "the predominant themes are of love and forgiveness." He noted, however, that individuals are often reluctant to volunteer information until told that what they've experienced is normal among the dying. One reason the phenomenon may not be widely known is dying people — or their family members — fear the perceptions of their mental state if they discuss it.

In a 2015 Ted Talk, Dr. Kerr explained his own awakening to the topic as a relatively new doctor of hospice patients in 1999. He advised a nurse that a terminally ill patient still had quality time ahead if given IV antibiotics and other fluids. When the experienced nurse, Nancy, suggested otherwise, he asked why.

"She said, 'Because he's seeing his deceased mother.' " Dr. Kerr related. "What Nancy knew was Tom's end-of-life experiences had meaning. They were significant."

Local nurses in the field, besides Roncevich, have had similar realizations about a phenomenon that has been referred to by different names: end-of-life experiences, death bed visions, death-related sensory experiences and more.

Katie Hayes, also with UPMC Family Hospice and Palliative Care, recalled an elderly woman terminally ill with heart disease whom she got to know well over a period of months.

"One day I went to her, and she was in bed. I sat down, and she said, 'Katie, you'll never believe what I saw last night. I saw all of my loved ones who have passed on before me. My mother, husband, sister — they were all standing right at the foot of my bed.'

"I said, 'Wow, that is amazing,' " Hayes recalled, "and the next day she passed."

She and others said the more comfortable and familiar patients get with hospice staff, the more likely it seems they are willing to bring up such experiences. Sightings of angels are also a common theme, which perhaps occurs more often with those who are religious.

"I've seen patients sit there and have a conversation in front of me with someone I couldn't see," said Melissa Brestensky, a nurse in the Cabot Inpatient Unit of Good Samaritan Hospice in Butler County. "I had one particular patient — it was hours later she passed away — she was describing the angels out in the hallway, saying, 'Look at how beautiful they are, they're in beautiful white gowns.' "

David Kessler, a Los Angeles writer who has worked in hospice care, interviewed doctors, nurses, social workers, clergy and others to learn what terminally ill patients had told them about seeing those who had preceded them in death. It led to his 2010 book, "Visions, Trips and Crowded Rooms: Who and What You See Before You Die."

"I thought the book would have more credibility if it relied on professionals," Kessler explained recently, while noting his own dying father had an experience seeing his late wife, which calmed him.

"It should be in the mainstream a little more, so if you're sitting there with your mom, and she says, 'Grandma's here,' I wouldn't want you to say, 'Grandma died, you're crazy,' " Kessler said. "Maybe she's hallucinating, and maybe she's not."

What people make of such encounters will vary by individual, naturally, based on their views of the afterlife or other factors.

Darin Martin, 58, of Penn Hills, told of her late husband, Steve, having sightings that made him smile some weeks before his death from cancer in August 2017. First, he saw his youngest brother, who had died in 1980, sitting on the couch with them. Later, he made sure she and he stepped out of the way of their Great Dane, Czar, who he imagined passing by them in their hallway though he had died four years earlier.

Both times, Martin said, the visions felt like a blessing for her husband.

"Just to see a smile on my husband's face was just wonderful," she recalled. "I think it brought some peace to him. ... I truly believe when you die and go to heaven you have family and friends there to greet you."

Maria DePasquale of Delmont, who has been a hospice nurse for 38 years, waits for patients and families to open up to her about such experiences, which she's always curious to hear. Such individuals are often curious, themselves, about what meaning to derive from someone who died long ago. She doesn't know herself, but she typically offers some reassurance to them.

"I maybe ask, 'Well, what do you think they're doing there?' They say something like, 'I think they're telling me it's time.' Then I say, 'Well, isn't it nice that somebody's there to share that with you?' And it would all seem to bring them peace."

Dr. Kerr said that if people are asleep, their end-of-life dreams seem distinct from more typical dreaming by the sense of deep, personal meaning in them. That could involve trying to heal or cement their relationships with people who were close to them or addressing long-buried traumas, such as an elderly woman who may seem to spend time with a child she lost in infancy.

Such patient experiences are rarely discussed in medical training, Dr. Kerr said, as the focus there is on curing people instead of improving understanding of late-life experiences. There remain skeptics in his profession, he said, who discount the meaning of such dreams and visions. That's part of what led him to delve into research.

"If people have had a personal experience with this, you're preaching to the choir," he said. "But if I'm talking to a group of medical students, they have no idea what I'm talking about. I knew a message about this could be important if it's coming from a doctor, not from someone coming at it from a spiritual or paranormal basis."

Dr. Kerr said he does not practice religion, but considering the frequency and realism of positive experiences by dying patients in connecting with those who died before them, "it's hard to walk away from this and not be more inspired and hopeful of both life and death. ... I guess it feels as though there's something of having lived that goes on."
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Information from: Pittsburgh Post-Gazette, http://www.post-gazette.com