PHILADELPHIA — My brother took more trains, planes and automobiles in the last week of his life than he had taken in months, perhaps years. Those journeys were all the more surprising because they occurred in an intensive-care unit at the end of his three-year battle with bone marrow cancer.
Bedridden after being rushed to the hospital for what would be the final eight days of his life, Kenny casually mentioned that he was visiting Detroit. It was a rather odd place for him to be traveling -- even if only in his imagination -- because the hospital was near home in suburban Philadelphia and he didn't have any ties to the Motor City.
But it was near a border, a border he seemed intent on crossing, be it real or metaphoric.
"How far is it to Canada?" he wanted to know. "Where's the map?"
Though very weak, Kenny, 45, intermittently recognized and chatted lucidly with family gathered by his bedside. But he would drop in news of his varied travels: He had gone skiing one afternoon in Australia, he told us, stopped by North Carolina another day, and more than once had been "stuck in passport control."
At first, our family dismissed these journeys as confusion; we would laugh through our tears about the various places and modes of transport he had been taking. It must be the painkillers, we thought. Or maybe hypoxia, the oxygen deprivation in the blood that often contributes to delirium in sick people. Or that the cancer now was destroying his mind, just as it had racked his body.
But then our cousin Lynne mentioned that her parents had done a lot of similar traveling in the last days of their cancer battles. Uncle Larry (Lynne's father) had insisted that his passport and fanny pack be kept by his bedside; he was intent on keeping an imaginary 3 p.m. appointment with the emperor of Japan, where I was living then and where he had hoped to visit. He too had asked for a map -- of Japan. Aunt Lois, who had died four years before, had talked about needing to catch a train, asking Lynne to buy her a ticket.
There seemed to be a pattern. A nearby bookstore turned up a 1992 title that offered some clues: "Final Gifts: Understanding the Special Awareness, Needs and Communications of the Dying."
Its chapter titles were uncanny: "Where's the Map?" and "I'm Getting Ready To Leave." Authors Patricia Kelley and Maggie Callanan, longtime Washington, D.C.-area hospice nurses, had heard similar talk so often from their dying patients -- conveying this sense of moving from one place to another, of being in transition -- that they concluded it must be a special language the dying have to communicate what is happening to them.
"It would be easy to say it's just coincidence, but when you see it over and over, there has to be something there," Kelley said in a telephone interview. "I do think people experience something we can't describe."
The authors termed the phenomenon "nearing death awareness" -- a state they think reveals what dying might be like and what a person needs to die peacefully.
It has some similarities with the more widely known near-death experiences reported by some patients who are resuscitated on operating tables or at the scenes of accidents. They report seeing a bright light at the end of a tunnel, with people and events of their lives flashing as if in a kaleidoscope.
In contrast, however, those dying slowly often talk of preparing for a trip or of trying to finish something, Kelley and Callanan found, perhaps using language pertaining to their professions or hobbies. One dying man who liked to sail, for instance, talked about the ebbing of the tides; a watchmaker mentioned that the clock was not ticking fast enough; a carpenter described details of completing an imaginary house.
The observations built on an earlier four-year study by physicians Karlis Osis and Erlendur Haraldsson, in which hundreds of physicians and nurses observed 50,000 dying patients from India and the U.S. In both cultures, patients commonly reported deathbed visions of movement toward something and of being greeted by deceased loved ones who were helping them to "cross over" in their last moments.
Several healthcare workers and bereaved families interviewed for this article also witnessed similar phenomena. A few days before Jennifer Lee Foster, 26, of Millbrook, N.Y., died of leukemia, she told her relatives she had seen a young neighborhood boy who had been killed years earlier in an auto accident. The boy said, " 'How you doing, Jen? I was waiting to say hi to you,' " recalls her mother, Jean DiMarco, of Millbrook.
Kathy Pollard, educational director at Hospice of the Valley in Phoenix, said that she had seen dying patients countless times shaking their heads "yes" or "no" and making motions with their hands as they talk with deceased people.