Dr. Christopher Kerr – hospice and palliative care doctor and researcher – studies and works daily with people who are at the end of their lives. After realizing that many of his patients had extraordinary experiences as death approached, he decided to design a study that would tabulate these experiences in a scientifically meaningful way. Fascinatingly, he found that the medical world barely took note of his research, but then it “began to go around the world” – through Youtube and the New York Times, to India, China and beyond. What propelled this work forward was the people, families and caregivers who had these experiences – seeing the deceased return, making meaning of past tragedy, having a sense of “being guided, reassured, and simply loved.”

Dr. Kerr believes that these visions and healing experiences are “enormous gifts” to the dying and also to those left behind. They impact the bereaved because “how people leave us matters” – how we grieve is impacted by how we experienced the death. When someone conveys that they see their loved ones waiting for them… How might we hold that with reverence and mystery? And how might that impact our sense of loss?

Listen in as Dr. Kerr and I discuss all of this and so much more in Part I of our conversation!

Transcript of podcast below:

[00:00:00] Diane Hullet: Hi, and welcome to the best life. Best step podcast today, I’ll be talking with Dr. Christopher Kerr, hospice and palliative care physician CEO, and chief medical officer of hospice and palliative care Buffalo. That’s a mouthful to say all that in there. But I think that Dr. Kerr is a incredibly interesting researcher in end of life experiences.

[00:00:31] He has a PhD in neurobiology, and they’re seeing thousands of patients a day at hospice and palliative care of Buffalo. You can find out more about his. Uh, Dr. Christopher Kerr, K E R r.com or hospice buffalo.com. He’s also got a wonderful Ted talk. And this is where I first came across. Dr. Kerr, his Ted talk is called.

[00:00:55] I see dead people, dreams and visions of the dying. [00:01:00] He made this Ted talk in 2015, and since then he turned his research into a book called death is budded dream finding hope and meaning at lifestyle. And also a movie by the same name death is, but a dream. So lots of interesting ways to learn what Dr.

[00:01:19] Kerr is up to. And today in part one, he and I will be talking about the research he has done on end of life experiences. Thanks so much. So welcome Dr. Chris Kerr.

[00:01:33] Dr. Christopher Kerr: Thank you for having me.

[00:01:34] Diane Hullet: I’m so excited. Um, as I told Dr. Kerr, I feel like his Ted talk is just one that I come back to again and again. And in this part, one of our conversation, we’re going to be talking about.

[00:01:46] You know how we kind of came to his research, what the research is and how that has led to something so much bigger Ted talk book, documentary, film, um, such amazing, amazing pieces. So how, you [00:02:00] know, how would you summarize for listeners kind of what research you got into?

[00:02:04] Dr. Christopher Kerr: Yeah, it’s um, it, it, in a way it was spurred by my journey.

[00:02:10] To hospice. So I, I never sought out to do this work. In fact, I petitioned to get out of the rotation in hospice as a resident. And, uh, in 1999, I was just looking to Moonlight when I was a cardiology fellow. I ended up at hospice and, um, I wasn’t here very long and, uh, You know, I had to reconcile the fact that I wasn’t prepared to know much about death, let alone the process of dying, let alone the patient’s experience in it.

[00:02:40] And it was really my colleagues in other areas. Non-medical who, um, forced me. Th to closer to the pest side and to acknowledge and release, recognize that patients were having these inner experiences, which are not surprising given that dying [00:03:00] actually, you know, of course does change your vantage point and your perception.

[00:03:03] And, um, and, um, uh, w w with that, I, I just started, it was undeniable. As much as I, I tried to turn away that patients were having these profound events and that, um, the point I got to was that I was less concerned with the why or how, or dismissing or diagnosing and disrespecting the fact or developing a reverence for the fact that these were the dying was much more of a human experience than a medical.

[00:03:37] Paradigm to solve. And that, regardless of what was happening, is there a profoundly real to the patient? And as importantly, they were deeply therapeutic and not just for them, but the ones that.

[00:03:52] Diane Hullet: The book is titled. The book is called death is, but a dream, but you really in the book go on to say these aren’t [00:04:00] really dreams.

[00:04:00] These are really you call them end of life experiences, things that people have happened to them that are kind of unexplainable by.

[00:04:09] Dr. Christopher Kerr: Yeah, I, and I actually, um, uh, resisted the idea. Titled and still do, because if we’re to listen to our patients, they’re going out of their way to tell us are not dreams. So we don’t have another nomenclature and reference points.

[00:04:24] So that’s what we use. But the statements we most commonly hear is, no, you don’t understand. I don’t normally dream or these wasn’t like a dream. And, um, he, when we measured realism in our studies, it was 10 out of 10. So these feel more virtual. Um, and then they’re there. They don’t go to places where they’re working out, you know, 40 and conflicts are deep Laden meanings, and they’re not asking for interpretation.

[00:04:51] So these are very different than dreams in a lot of ways. But, so what happened is I CA I came to the recognition that these were obviously significant [00:05:00] and, and, and we should have reverence for them. And then I was trying to keep. Um, medical students and residents. And of course we live in an evidence-based time and they would say there’s no evidence.

[00:05:11] Of course there’s an abundance of Everence, but it’s largely in the humanities. Um, in a religion it’s always been talked about throughout time and cultures across the world. Um, the evidence we had on the medical side of the equation tended to be more case studies or anecdotal reportings, and they didn’t control for enough variables, like, is this patient confused?

[00:05:33] And so what we did was we started our first study and it’s kind of funny to stay sat on a table to design for probably 10 years. I had thought nobody would be interested in it until the young fellow said, you’re crazy. This is really interesting. So we proceeded with the study. And we’re shocked because it, it, it, it received essentially zero responses from the medical community, but Dennis started all [00:06:00] around the world.

[00:06:00] You ended up in the front of the New York times, um, ended up in India, China, you name it and it spread. And, and, and it, that says several things. One there’s this clear gap between. How the regard for these experiences from the providers of care on the clinical medical side versus the recipient or those who are caring for the dying, what they’re actually experiencing.

[00:06:26] Um, so there was this there’s this need to put the, to validate these phenomena, but put in a caregiving context or framework that at least gave it meaning or. And I think that’s the best part of the story. What propelled this work forward was not that our research was not elaborate or, you know, w we were basically telling, what’s already been told, we just put a different frame of.

[00:06:52] But what it did is it gave us momentum and energy, and most importantly, validation to people who [00:07:00] were having these events

[00:07:01] Diane Hullet: for like, for a listener who is like, wait, wait, what, what is Dr. Kerr talking about? Like, can you give us an example of, of one of know, one of your favorite patients and kind of the experiences that they were having?

[00:07:15] Dr. Christopher Kerr: Oh gosh. They run the gamut. Um, so the, the, the vast majority of these are comforting, you know, um, 85 plus percent are highly competent. Basically. What happens is people near death, the frequency of these events increases and what happens. You start to see more of the deceased to you. Who are, who returned to you.

[00:07:40] And when we measure comfort, seeing the deceased associated was with the highest comfort. So there’s this built in mechanism where you’re sued as you’re approaching death. Um, and we actually looked at post-traumatic growth as a phenomenon where people are actually growing, gaining insight, and it’s almost like they’re being reconnected and put back together with the best [00:08:00] parts of having.

[00:08:01] Um, in terms of the most profound, you know, mothers who had lost children, um, and a common phenomena is a time and distance seemed to be irrelevant so that it feels as though they were never. And what their re-experience is the love that they once had known, um, that in life had left them. Um, but rose returned to them.

[00:08:28] Um, some of the most moving, uh, that I have witnessed are actually uncomfortable dreams, but because he’s, don’t deny having lived, which includes being wounded. Um, but the brought certain closure or awareness that was transformation. Um, so, and this is on the documentary of a fellow who was a drug addict, spent most of his life in prison and he had had a neck cancer and his experience was he was being [00:09:00] stabbed at the site of his neck.

[00:09:03] And he unfolds actually on camera. Cause he was always jovial, but he, he starts telling his story. He started to weep uncontrollably. But what that did was that led to him to do an honest assessment and he reaches out to a daughter who had, had lost touch of a bit and just say how much he loved her and that he was sorry.

[00:09:22] And then he slept after that. Um, so yeah, they’re all, it’s just a privilege to be a part of this sort of extent.

[00:09:29] Diane Hullet: You really, you talk about, um, in the book, you talk about this beautiful list. You kind of say, you know, these end of life experiences are not just easing the dying process, but they also address a life in its entirety.

[00:09:42] And that’s what you’re talking about here. And sometimes people have a sense of being forgiven or guided or reassured or simply loved. And, um, You know, I, I think that’s so powerful to think that these experiences can come. When we’re we’re facing [00:10:00] death. And I found it fascinating that some many of your patients know they’re facing death, but even in the experience of one patient who was very much in denial and did not want to be dying and would not admit there was death imminent, she had had these kinds of life experiences where I believe it was her grandfather was visiting her.

[00:10:18] So even when we consciously are pushing it away, there is this, um, Not always a neat clean resolution, but kind of a going back over a coming to terms with what we’ve experienced.

[00:10:32] Dr. Christopher Kerr: Yeah. And there’s almost this fascinating editing process too, where the people who conditioned or withheld or compromised, loved or heard us, or kind of kept out and those that secured.

[00:10:44] That’s R R pulled back in, but yeah, it becomes highly predictive. So we had a woman she’s also in the film who taught, she had lost a daughter and a husband she’s around the kitchen table with them. [00:11:00] And she’s just enjoying the warmth of that familiarity that had been lost. And, um, but she looked really good in health and she had sudden death three or four days later.

[00:11:11] So. You don’t know. Very interesting. Clearly these kind of life experiences do self informed and we see that with children, um, where everybody is contorted on how to, uh, Communicate impending death to a child who may not have a sense of mortality or permanence. And yet they start dreaming in ways that, um, tells them they’re loved.

[00:11:39] And a lot of, uh, not alone when I can work a return of a pet and, um, who’s deceased and somehow there’s enough homeless data points put together. Th they get the gestalt and, um, and it’s all, it’s in our experience. In our cases, we [00:12:00] publish some of these cases that they tell the patient and the child is often then becomes a messenger of reassurance to the parents, you know, I’m okay.

[00:12:11] And there’s a wonderful. During lady in the film, Jenny who builds a whole tassel around and she says, it’s my, this is where I’m going to safe and all the deceased,

[00:12:24] Diane Hullet: you can convey it to her parents. And there’s the sense of, oh, she gave

[00:12:27] Dr. Christopher Kerr: all this tactile, uh, interpret piece of too. So warm sunlight coming through.

[00:12:33] Um, the animals that were injured, but now back to life and playful. And so, yeah, she breaks. She put energy and life back together for herself while saying goodbye.

[00:12:44] Diane Hullet: While saying goodbye that there’s this opportunity. And I think, I do think it’s fascinating that there isn’t really a level of interpretation that people are looking for.

[00:12:53] They that it’s not about interpretation. It’s about almost an integration or, um, an [00:13:00] experiential understanding of what they’ve gone through in their lifetime that comes back.

[00:13:03] Dr. Christopher Kerr: Yeah. I’ve been knowing this 0.2 years and I got to tell you, I’ve never had a patient say to me, um, what do you think those mean?

[00:13:12] Um, and I think that’s great because in practical sense, the time for therapy is over, right. And that struggle, um, to put together and to dissect and amalgamate isn’t necessary. Instead you’re given a feeling of something knocking a puzzle. Um, you’re you’re, you’re, you’re giving the answers.

[00:13:38] Diane Hullet: Yeah. Yeah. And I think it’s fascinating that you started your research thinking, oh, this will be so powerful for doctors and nurses.

[00:13:46] And then again, it was the families that were most impacted. Impacted, um, and say a little about that because you, you talk about how it’s not just the patients who are impacted by that and you just spoke of it with this [00:14:00] child, but also the bereaved are impacted by these experiences.

[00:14:03] Dr. Christopher Kerr: Yeah. You know what I mean?

[00:14:04] It kind of makes sense. So how people leave us matters. It informs us, it tells us how we remember them. Um, it allows us to grieve very differently if it, depending on how we view. Uh, the laws and in the case of a lost child to a parent, if that person’s life partners with them, they’re viewing that person leaving.

[00:14:31] It’s actually life affirming, not life denied. And we actually measured, you know, we’ve had I think seven, 800. Sir as a Brie people in two separate studies, and we looked at Bregman scales and how people process loss, and they do it very differently. These they’re witness to these experience, which also speaks to the need for the clinician to help not.

[00:14:55] Uh, not at least translate that these events are [00:15:00] normal. Um, rather than men, the stations of the disease brain, because of viewed in the right context, then, um, there are enormous gifts. Um, to those left behind, um, and we were able to actually measure that, which was interesting,

[00:15:16] Diane Hullet: really interesting, really interesting.

[00:15:18] Along these lines, you say in the book pre-death dreams and visions assist loved ones in their journey toward acceptance, and that this is the key to processing. When the dying patient becomes absorbed in and then comforted by their end of life experiences, it changes the context of dying from loneliness to a life affirming connection.

[00:15:38] And this is as significant for the bereaved as it is for the dying.

[00:15:43] Dr. Christopher Kerr: Yeah. And you know, it’s so funny that that had to come out of a research paradigm because it would be look to other cultures I’m in touch now with this filmmaker is doing in Australia is doing this very, very interesting work with indigenous people in Australia and south America.[00:16:00]

[00:16:00] And it’s inherent to their belief systems. And it’s critical in that it’s their ties to their ancestors, you know? So they, they mourned up, they don’t fear. Um, because it’s their means of they’re there. They’re never broken from the chain and, um, So I had to put that in a study and for, but, but that’s a given in a lot of cultures in this world.

[00:16:26] Um, so

[00:16:29] Diane Hullet: very interesting. And you had to sort of study it to legitimize it. I was just telling a friend this morning that I was going to be interviewing you and kind of what your book and movie were about and so on. And. And, um, he described something that had happened with his grandmother and he said, yeah, it was kind of bizarre.

[00:16:44] And I said, well, that’s just it though. It’s not bizarre. It’s really actually common. But because we don’t talk about it, we don’t quite know where to put it. Um, right.

[00:16:54] Dr. Christopher Kerr: Yeah. Well, and that’s been the fuel for this work all the time because people it’s, it’s like a weird word, [00:17:00] shock test, and people want to share their interpretation of what their experience to bear on it is.

[00:17:07] It’s fast. It

[00:17:08] Diane Hullet: is, it’s fascinating. How many patients have you worked with in this, in this kind of context?

[00:17:13] Dr. Christopher Kerr: I think we’re almost at 1600 total patients and families

[00:17:17] Diane Hullet: together now 1600 and mostly

[00:17:20] Dr. Christopher Kerr: through, and those are all, those are, those are all informal studies. Right. And then the job is here. All the informal

[00:17:25] Diane Hullet: ones.

[00:17:26] Yeah. Fascinating. Well, I just think it’s such an interesting line of work. Have you found, have other researchers come on board and become interested in.

[00:17:35] Dr. Christopher Kerr: Um, you know, we, we we’ve seen pockets of it, uh, a purist, but nice to see it done in India. Some not in China. So just to show the cross cultural aspects of it, um, not a lot, not a lot has been done here per se, in terms of replicated.

[00:17:51] It’s very. Uh, well, probably the biggest accomplishment was getting this through a review board of the university because we have this, [00:18:00] we have this unusual and inhumane habit of kind of sterilizing the dying process and putting them on the shelf to be quiet and not to be disturbed. So the fact that we got it through, um, an IRB, so that that’s an obstacle for a lot of places.

[00:18:14] Yeah. And not many hospices. Have a research department. So we’re extremely fortunate,

[00:18:20] Diane Hullet: right? The kind of scope that you have, that you can have that many patients come through your doors in a way that you can somewhat consistently create interviews and so on. Are there, are there other offshoots of this kind of research that you’d like to see happen?

[00:18:33] Are there other questions? They’re in your research mind? Um,

[00:18:39] Dr. Christopher Kerr: yeah, I, I there’s great questions. Some we we’ve we’ve worked on, um, which is, you know, more detailed about the dynamics of what people are experiencing. I think the whole area of pediatrics is interesting. I actually, the biggest undisclosed [00:19:00] ne I think is people who are cognitively different.

[00:19:03] And, um, that’s actually my favorite part of the book. Um, because unfortunately those folks are really included in formal studies because of the, uh, thresholds for participation, right. Yet what we, we measure particularly people with dementia in terms of their cognitive deficits with, and we disregard their emotions.

[00:19:27] Lives, which are often rich and ongoing and particular in the case of dementia, they’re awfully well-rooted in the distant past. So they remember what they want their high school prom, but they may not go to breakfast that morning. Um, they, they have end of life experiences that are powerful. And in fact, it’s an interest near that.

[00:19:52] I’m always fascinated with tree for terminals. Um, where all of a sudden that person who [00:20:00] has limited recall is able to verbalize and gains memory prowess, they didn’t have I’ve often wondered is it because what they’re doing is they’re kindling a lot of recall through their dream experiences. Or, or of life experiences because we see, we see it all the time.

[00:20:22] People have demanded folks have ended life experiences, and is that kindling memory that they have now have access to just like music, for example, make an otherwise non-verbal advanced dementia patient become verbal or vocal. And so this idea of rekindling oneself. Um, which is a very interesting way to look at dying as a process because instead of less than diminishing, you’re actually expanding and growing living.

[00:20:54] And again, it goes back to the central premise that when you stop [00:21:00] viewing dying, in terms of parts, sailing, organs, not working. And look at it in totality, which is, which is a life closing rather than a body sailing. It becomes a very, very, very different phenomena and yes, there’s lost tissues group, but there, there, there, there absolutely needs to be respect for something that’s bigger.

[00:21:23] Diane Hullet: I love that. That’s so powerful. I think that’s at the heart of what my work is trying to do, which is create conversations that, um, that at the bottom line B with that. Um, closure of a life, which is very different than, um,

[00:21:42] Dr. Christopher Kerr: and what’s so important in that, in the work you’re doing your reference duals is the first, um, critical rate-limiting step is being present.

[00:21:52] Yes. Yes. You know, it’s not a doctor flying by to listen to somebody whose heart and lungs. [00:22:00]

[00:22:00] Diane Hullet: Right. And it’s not a mindset of fixing. It’s a mindset of being with and witnessing. And then I think your work just expands. What is possible to be witnessed at those times. Well, this seems like a good place to pause for part one.

[00:22:17] And when we come back for part two, Dr. Curran, I want to talk more about, um, hospice and his work and all he’s seen in as many, many years, um, hospice and palliative care of Buffalo, how they’re a model for, um, what’s possible. So thanks for. You’ve been listening to the best life, best death podcast. You can find out more about the work I do at best life. [00:22:43] Best def.com. And you can find out about Dr. Chris Kerr at Dr. Christopher Kerr, K E R r.com. Thanks so much for joining me today for part one with Dr. Kerr and I look forward to