Monique, a hospice nurse, told me that most of the people she’s cared for over the years have come to know, at a certain point, exactly when they will die. And that within roughly 72 hours of the end of their lives, they begin to talk of excursions or travel. From Opening Heaven’s Door.
“We all know we are going to die… one day,” said Teresa Dellar, executive director of the residence, in the Montreal Gazette. “This is different.” Within roughly seventy-two hours of the end of their lives, many dying people in hospice settings begin to speak in metaphors of journey. They are not being euphemistic. They are far beyond the task of making everyone feel better. They often haven’t said a word in days, and then suddenly they say something focused on travel. They sincerely want to know where their train tickets or hiking shoes or tide charts are.
Monique offers me an example. “We had a patient who was agitated. It was a Friday evening. She keeps saying, ‘I want to go shopping.’ In life, she was a real shopper. I said, ‘When do you want to go shopping? She said, ‘Monday.’ I said, ‘Fine, let’s go shopping Monday.’ For me, she was telling me ‘I’m going.’ And actually, she died that Monday evening.”
To families, a desire to go shopping on Monday would have been delusional talk, febrile mutterings of no importance. Far more significant to them, perhaps, would be the anticipated deathbed confession, something for which they had a cinematic sense—a whispered “I love you” or “Take care of the children” before the head falls back onto the pillow. But hospice staff know that when their patients begin to talk about excursions or travel, they are announcing their departure. They do not behave like perishing actors in Hollywood movies. Instead of offering some eleventh-hour contemplation about their lives, they request tickets, or boats. Some ask for their coats, others inquire about the bus schedule. They’re caught up in the busy preoccupation of leaving, not reflecting on what they’re leaving behind. My sister asked, “When am I leaving?” and expressed frustration about her “hapless flight attendants” in the way I might double-check my flight time to Newark.
David Kessler, former chair of the Hospital Association of Southern California Palliative Care Transitions Committee, has observed this phenomenon countless times—in his own work, and in conversation with medical colleagues. “The notion of the dying preparing for a journey isn’t new or unusual,” he writes in his book Visions, Trips, and Crowded Rooms. “Although, interestingly enough, it’s always referring to an earthly journey. People talk about packing their bags or looking for their tickets—they don’t mention chariots descending from heaven or traveling to eternity in some other manner.” Kessler recalled a ninety-six-year-old man who suddenly woke up in his hospice bed and told his daughter:
“Gail, it’s time to go.”
“Out! Let’s make a run for it. I have to be free.”
“She didn’t know what to say,” reports Kessler. “She helped him sit up, as he seemed to want to get out of bed. ‘Is the car ready?’ he asked. When she assured him that it was right outside the hospice he said, ‘Good. I’m ready, are you?’ She asked him where they were going, and he said he wasn’t sure. ‘I only know that I’ve got this trip in front of me, and the time has come.’ He decided to rest a bit before the trip,’ and died that morning.”
There is no known medical reason for the dying to have such an acute sense of timing about their demise. Palliative-care conferences often devote sessions to how to improve doctors’ ability to prognosticate about death. When patients make their announcements about going off on a trip, rarely are there physical signs of imminent decline, such as a marked deterioration in blood pressure or oxygen levels. On the contrary, the bodily symptoms take place afterward. “I’m going away tonight,” the blues singer James Brown told his manager on Christmas Day 2006, after being admitted to the hospital for a pneumonia that wasn’t considered to be fatal, whereupon his breathing began to slow.
In the most comprehensive, cross-national study of deathbed experiences ever done, the psychologists Karlis Osis and Erlendur Haraldsson confirmed that these intimations of departure even occurred in people who weren’t considered by doctors to be terminally unwell. Here is a case reported by one of the physicians to the researchers:
“A male patient in his fifties was going to be discharged on the seventh day after an operation on a fractured hip. The patient was without fever and was not receiving any sedation. Then he developed chest pain and I was called to him. When I came, he told me he was going to die. ‘Why do you say so? Having a little pain in the chest does not mean you are going to die.’ Then the patient told how immediately after the pain in the chest started he had had a hallucination, but still remained in his full consciousness. He said he felt himself for a few seconds to be not in this world but elsewhere… ‘I am going,’ he said, and departed a few minutes later.”