The Diary Of A CEO

0:00Speaker A · Identity not confirmed

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0:59Speaker B · Identity not confirmed

and what our research has shown is nearly 90% of people start to have very intense dreams or visions as they get closer to death, and it's unlike anything they've ever experienced. And what's fascinating is these events don't resemble delirium. When we ask them to scale it 0 to 10 on the degree of realism, it's always a 10. So it feels like this actually happened.

1:20Speaker A · Identity not confirmed

Tell me about those people.

1:22Speaker B · Identity not confirmed

Um, would it help to see a video? So after doing this for 30 years, what I've come to understand is we've lost our way with dying. There's such a lack of information, and that void is overwhelmingly filled with fear and mistrust Truths compounded by the fact that doctors don't have these discussions.

1:39Speaker A · Identity not confirmed

Can you list them for me?

1:40Speaker B · Identity not confirmed

First, I don't see people bringing up regret towards the end of their life.

1:44Speaker A · Identity not confirmed

They're not thinking about, do they regret something?

1:46Speaker B · Identity not confirmed

No. Hell no. No, it's gone. Death is this unbelievably truthful place. You're stripped to the bare bones of who you are. And if you think of the best version of yourself, it was never achieving something. It was being a son. It was being a brother. It was being a friend. And then the big myths are that pain is expected, and that's actually not true.

2:05Speaker A · Identity not confirmed

It's less painful than people think.

2:07Speaker B · Identity not confirmed

Oh, God. Oh my gosh, by a mile. But it's damning how little conversations there are to address that issue. And then the next— this is one that fascinates me. You're going to see why.

2:15Speaker A · Identity not confirmed

And also, we have these 6 handwritten cards of lessons you've learned from caring for the dying. We'll go into the full list, but from everything you've experienced, do you think there is life after death?

2:25Speaker B · Identity not confirmed

This is probably the most remarkable thing of all. So I think

2:33Speaker A · Identity not confirmed

Guys, I've got a favor to ask before this episode begins. The algorithm, if you follow a show, will deliver you the best episodes from that show very prominently in your feed. So when we have our best episodes on this show, the most shared episodes, the most rated episodes, I would love you to know. And the simple way for you to know that is to hit that follow button. But also, it's the simple, easy, free thing that you can do to help us make this show better. And I would be hugely grateful if you could take a minute on the app you're listening to this on right now and hit that follow button. Thank you so, so, so much. Thank you. Dr. Christopher Kerr, you spend 3 decades of your life experiencing something that most of us probably spend our lives trying to avoid. What is it you've done for the last 3 decades?

3:21Speaker B · Identity not confirmed

I was trying to avoid it too, but more by accident, I ended up becoming a hospice doctor.

3:28Speaker A · Identity not confirmed

What does that mean?

3:30Speaker B · Identity not confirmed

A hospice doctor cares for that individual who is no longer deemed treatable.

3:35Speaker A · Identity not confirmed

So you've spent 30 years caring for people that are going to die shortly.

3:41Speaker B · Identity not confirmed

Yes.

3:41Speaker A · Identity not confirmed

And you started interviewing them.

3:44Speaker B · Identity not confirmed

Mm-hmm. Probably 1,500 at this point.

3:47Speaker A · Identity not confirmed

Why did you start interviewing people that were about to die?

3:50Speaker B · Identity not confirmed

Because their perspectives matter. I arrived at hospice completely unprepared to be a doctor of the dying. Medical school prepares you really to defeat death, not to care for those who are dying. But my colleagues, particularly in nursing, were much more attuned to what the actual patient was experiencing. What I've come to understand is what the patient perspective is the one that matters. And that when you start to see patients as people, you start to understand that they have these rich emotional and personal lives, and that's what matters at the end of life.

4:26Speaker A · Identity not confirmed

How much research have you done? Because I've got, I think, 15 research papers here that you've published.

4:30Speaker B · Identity not confirmed

Yeah, we've done a lot. And we do very important things. So we rule out confusion states. We've done studies on post-traumatic growth to see whether within these negative experience of dying, was there actually positive gain? We've looked at the effect on children.

4:45Speaker A · Identity not confirmed

When children die?

4:46Speaker B · Identity not confirmed

And we've looked at the effect of these things on bereavement. Those left behind, how did that influence their bereavement?

4:53Speaker A · Identity not confirmed

And you've also done a lot of research on the visions people see. as they're dying and the dreams they have in the days leading up to their dying.

5:02Speaker B · Identity not confirmed

Yes, that's the focus. The vast majority of people, nearly 90% of people, start to have very intense dreams or visions. And the overriding theme is that they're seeing people who they've loved and who they've lost. And very specifically, it's those that have loved them unconditionally, purely, and those that didn't aren't there. Dying is, um, progressive sleep. Your sleep architecture changes, your sleep cycles changes, and evermore you start to have these kind of inner experiences. It makes sense, right, that as you're dying, you're going to be reflective, you're going to be introspective, and they usually become more prevalent towards the last kind of week or two of life. And what was very interesting in the frequency of these events increases as people approach death. So it's all been an attempt to really humanize the dying process. So take it from a medical model, which looks at organ failure and management of disease, and instead let's look instead what the patient's actually experiencing towards the end of their life. And what's fascinating is when you measure what themes bring them the most comfort, it's seeing the deceased.

6:13Speaker A · Identity not confirmed

So if I'm passing away, the thing that brings me the most comfort is seeing my deceased relatives.

6:20Speaker B · Identity not confirmed

Yes.

6:21Speaker A · Identity not confirmed

And I've got a graph here which shows the dreams of the dead that were most comforting. I'll throw that up on the screen.

6:27Speaker B · Identity not confirmed

Yeah. Yeah. So we measured on a scale what brought them the most comfort, and you can see it goes up between the living and seeing the dead. Would it help to see a video?

6:39Speaker A · Identity not confirmed

Yeah.

6:39Speaker B · Identity not confirmed

What happened was we videoed patients early because we knew that our audience, particularly medical audience, would have a view of what a dying patient was, that they were either compromised or feeble-minded. And so it became very important to capture them on film. So this is Paul. This is actually 3 weeks before his death. And he kind of covers all the bases. So very vivid, these dreams. Very little is said between the dreamer and the person in the dream. What you'll notice in all these videos that's striking is the absolute absence of fear. So these dreams never deny the fact that they're dying. They almost transcend it. And they really sometimes have trouble to find language for what they're seeing, but they know how they're left felt, which is they're kind of put back together.

7:29Speaker C · Identity not confirmed

I've probably had 15 dreams about her, maybe somewhere in there. She always wears— I dream in color most times, and she always wears a beautiful light blue. It could be a suit, it could be a gown, it could be a dress, but it's always light blue. And a couple of times she's gave me the little beauty pageant wave. And a couple times she sort of greeted, always with a smile. Doesn't, only one or twice I've ever heard her voice, but she always kind of lets me know that she's fine.

8:01Speaker A · Identity not confirmed

So in the lead up to his death, he's having what, 15 dreams about his deceased wife? Yes. What do you make of that? Like, what does that mean?

8:09Speaker B · Identity not confirmed

Yeah. Honestly, my view of this is changing. I would have told you before when I started doing it that this was a rekindled memory.

8:20Speaker A · Identity not confirmed

So it was just a memory?

8:21Speaker B · Identity not confirmed

Yeah. It was like looking at a picture.

8:23Speaker A · Identity not confirmed

Yeah.

8:24Speaker B · Identity not confirmed

Right. And recalling the imagery. There's a couple features that stand out that suggest there's a lot more than that, that there's almost this continued consciousness. And one is the detail that's rekindled is remarkable. 95-year-old man, he lost his mother when he's 5, and he talks about smelling her perfume and hearing her voice. The other is that Often these interactions, and you're gonna see this in other videos, there's communication. So they're not, they're not in still form. It's again, not like looking at a picture.

8:56Speaker A · Identity not confirmed

Do you believe his wife is still truly accessible, or are you saying that the memory of her is accessible through his dreams? 'Cause they're very different propositions.

9:07Speaker B · Identity not confirmed

I don't know what this means. I don't know if this, I, I wouldn't be so bold as to say this speaks to an afterlife. What I am more convinced of is that those who have loved us are never gone. They're accessible to us. And what is fascinating to me is that at the end of life, when people are neurologically compromised, they're fading, they can't move, the remnant of function is still this core sense of being connected and loved. And that remains. It's like we enter the world and leave the world with remarkable symmetry. You know, you come into the world and The infant doesn't know language, undeveloped brain, but it knows its mother's love. It knows it feels connected and secured. And at the very end of life, it's kind of the same thing. They're diminished, they're less capable, but what they're feeling and sensing, even without language, is the same thing.

10:10Speaker A · Identity not confirmed

Was there one particular video you got with a patient that was approaching their death that was most persuasive to you as it relates to believing that consciousness continues, or that our loved ones aren't really ever gone. They are able to be summoned back into this world.

10:31Speaker B · Identity not confirmed

Definitely the ones where people have injury or harm for having lived, and they've struggled with that often for decades. And no matter how much therapy, talk therapy, medication, they've never found peace, and they find it in the end in these experiences. So an old veteran who suffers with survival, death, and PTSD. And in the last days of life, he's brought back to those who died overseas and he's comforting. And I think some of the most remarkable ones, of course, are the children who do this so differently. But just the fact that there's so much innate ability within us to heal these harmed and broken pieces. And for children who do this in in ways that are absolutely inspiring. They're often not dramatic. They're very, there's no great epiphany, no great reveal. These are moments of just having lived and mattered. They're sitting around a kitchen table. If you want, we can show Florence, and she's an example. She's lost her husband and she's lost her daughter, and this is 5 days before her passing. Tell us about the dreams.

11:46Speaker D · Identity not confirmed

But the other night, I fell right into a sleep. We were like sitting at the kitchen table laughing. I could see their faces. I could tell it was full force. We were laughing, we were talking, we were eating. It made me feel like that whole 12 years had never existed.

12:09Speaker C · Identity not confirmed

Because it was so real that it was, he was there in the present.

12:12Speaker D · Identity not confirmed

And 7 years since my daughter was It was like we were always together, never separated.

12:19Speaker B · Identity not confirmed

Yeah. How does it make you feel about the prospect of dying? How does it change with you?

12:26Speaker D · Identity not confirmed

I'm not afraid.

12:28Speaker A · Identity not confirmed

When you see something like that, people might say, you know, because they are aware that they're going to pass away at some point, they've been given that diagnosis, that prognosis, presumably, yeah, the end of their life, their family. These are the things that would be on their mind. And if they're on their mind, they'd be in their dreams. So is it the process of death that's provoking these kind of dreams or visions, or is it just the case that you dream about what you think about and obviously these people are thinking about the end of their lives?

12:58Speaker B · Identity not confirmed

Yeah. The only rebuttal to that is when you ask them these sorts of questions, the thing that gets them most distressed is when you refer to them as dreams. Because these are unlike anything they've ever experienced. So they're not dreams in the sense they're not metaphorical, they're not fantastical, they don't require interpretation. I've never had a patient say, hey, what do you think this means? They're given this sense of knowing and they'll often say, I don't normally dream, or I don't recall my dream, or no, this was virtual, this was a happening. So they have no doubt. When we ask them to scale it 0 to 10 on the degree of realism, it's always a 10. So it feels like this actually happened. And those of them who are having these experiences in the wake state, you can watch them. They're looking right through you. They're looking at the room. They're petting the dog that isn't there.

13:52Speaker A · Identity not confirmed

Oh, so some of them have these visions?

13:53Speaker B · Identity not confirmed

50% occurring when they're awake. Yeah.

13:56Speaker A · Identity not confirmed

Even if it's quite some time before they pass away?

13:59Speaker B · Identity not confirmed

No, it's usually measurable within weeks, a couple of weeks. And it picks up as As you get closer to death.

14:07Speaker A · Identity not confirmed

And when it gets closer to death, how do these visions change or evolve?

14:10Speaker B · Identity not confirmed

Become more immersive. So again, dying is progressive sleep. So they're living more in this other state where they're deeper and deeper asleep. So they spend more time there and they'll often wake up. It's interesting and wish they were going back into that other state. Oftentimes they're just warmed by reunion of what they were experiencing. And time and distance go away. So they're decades removed and they're recalling very vivid memories of a dog they lost in childhood, for example.

14:43Speaker A · Identity not confirmed

So do you think this is a biological, physiological thing in their brain, a bunch of chemicals that are sloshing around, or do you think it is spiritual?

14:53Speaker B · Identity not confirmed

I'm also a PhD in neurobiology. I spent 5, 6 years studying the brain. So I I'm drawn to that. No one knows. And I'm good with that. I think you could, you point to parts of the brain here and say, love lives in this certain areas, certain neurotransmitters are correlated with happiness. You can take all the pieces and you can't make the whole. I can't show you where love is. I can't recreate love in a dish. And I can't create this. I think it really goes beyond brain function into something else.

15:33Speaker A · Identity not confirmed

So you think it is spiritual?

15:35Speaker B · Identity not confirmed

I do very much.

15:37Speaker A · Identity not confirmed

Yeah. Do you believe there is a soul?

15:38Speaker B · Identity not confirmed

Yes.

15:39Speaker A · Identity not confirmed

And so you would posit, I guess, that lives beyond the physiology of the human body and brain? Yes. Half of Americans say a dead relative has visited them. And the answer here that has that 53% of votes is, Have you ever felt a dead family member visit you in a dream or in any other form? And 53% of people say they have. 34% say in the past year they felt the presence of a dead family member. And 28% say in the past year they've told dead family members about events in their life.

16:13Speaker B · Identity not confirmed

Yeah, we remain connected.

16:15Speaker A · Identity not confirmed

15% say in the past year they've had a dead family member communicate with them.

16:19Speaker B · Identity not confirmed

All the data has always suggested that, at least in this country, there's a higher degree of spiritual orientation than you would expect, but that's always been the case.

16:31Speaker A · Identity not confirmed

When people are in their last days, do they become more religious and more spiritual?

16:36Speaker B · Identity not confirmed

Yes. We know it because of what they focus on. They tend to think about these big things, and again, they tend to be about relationships. They ask these better questions. We've looked at this question of religion and we have not found that having a religious belief changes how you experience these end-of-life events. It just doesn't seem to matter.

17:00Speaker A · Identity not confirmed

And most dying patients report end-of-life dreams and visions. The stats here show that 80% of healthcare professionals have witnessed or been told of one. I didn't realize it was so many people that are having these end-of-life dreams and visions. I didn't realize it was 80%. And again, people might think this is because of delirium, because of their illness.

17:20Speaker B · Identity not confirmed

No, it's a good question. And that's what our studies did that was smart is we sorted out the patients who were delirious. So we screened them every day before they did a questionnaire. Again, these are approved by a university, so you have to be witnessed, you have to have consent, you have to be cognitively intact. So before they did our questionnaire every day, they had to get a screen for delirium. And these events don't resemble delirium. Delirium is very disorganized. And the biggest difference is most people are left frightened or distressed by delirium. These events are recalled with acuity. They're based on real happenings, and they're left with a feeling of comfort, not distress or fear.

17:58Speaker A · Identity not confirmed

Acuity.

17:59Speaker B · Identity not confirmed

Acuity, their sharpness.

18:00Speaker A · Identity not confirmed

What are the other sort of fundamental misunderstandings people have about death that you've spent your career trying to confront and reverse?

18:09Speaker B · Identity not confirmed

Oh, there are many. Dying is a process. Death is a moment. It changes over time. The big myths are that pain is expected or anticipated, and that's actually not true. Pain isn't, and the pain that is there can be resolved. The other misconceptions around eating and drinking, People stop eating and drinking. It doesn't hurt. They're not eating and drinking because they're dying. Something happens in nature that we don't die in want, so it just kind of dwindles. And dying is really like a dimming of the shades. It's gradual. You start to lose function, do less. If you have the flu, you know to go to bed. It just doesn't pay to do. Sleep is preferred, and most people die in sleep. The key is to die, you have to be able to sleep well, but to sleep well, you have to be comfortable. And what people tend to think is to be comfortable means you need to be physically comfortable, but you also need to be psychologically at peace, existentially at peace. So the holy grail for us, the vital sign that matters for us is comfortable sleep because you can't sleep if you're in discomfort and you can't die if you can't sleep.

19:21Speaker A · Identity not confirmed

There's that famous study by Bronnie Ware, who I think was a palliative nurse in Australia, who interviewed people on their last days and asked them about their regrets. Have you ever done any research like that towards dying?

19:33Speaker B · Identity not confirmed

No. And I really have trouble with the study.

19:35Speaker A · Identity not confirmed

Really?

19:35Speaker B · Identity not confirmed

Yeah. First of all, it wasn't empiric, right? It was based off of conversations. And that's not my experience. I don't see people bringing up regret towards the end of their life. Now, if you ask people, What if they had regrets? I'm sure they would give you an answer. It's like if I asked you, what's your favorite color? You have an answer, but you don't go around thinking, oh, this is my favorite color. So regrets, and this shows in our quantifiable study, don't come to the surface actually. A lot of that gets let go of. I can honestly say I've done this for nearly 30 years and that's not what I hear.

20:13Speaker A · Identity not confirmed

So let's take a look at this because I think This is quite important. And I funnily enough had this conversation with my fiancée yesterday when we were talking about what actually matters in life. So here we have 11 things that medical students say they think will matter to a dying patient at the end of their life.

20:35Speaker B · Identity not confirmed

Yes, exactly.

20:36Speaker A · Identity not confirmed

And then you are going to tell me what actually mattered when you did an empirical peer-reviewed study and asking patients, With days to live, what actually mattered to them?

20:46Speaker B · Identity not confirmed

Well, the first one the hospice patient cares about is not being a burden. They become selfless. They don't want to tax their family. They don't want their illness to compromise their life. They want to spend time with them, but they don't want to interfere with their living. You would think as people are close, nearing the end of their life, they would become more and more self-focused and they become other-focused. And what's really interesting is actually this aligns well with the science of happiness work, which says that the happier people derive meaning from doing for others rather than doing for self. These better features kind of come to life at the end.

21:26Speaker A · Identity not confirmed

If I've got a relative who's passing away, if this is the thing they care about most, not being a burden, is there something I can do as the loved one or the relative to ease this concern for them?

21:39Speaker B · Identity not confirmed

Oh, I think it's aligning your wishes with their hope, which is your wish is you actually want to be a presence.

21:46Speaker A · Identity not confirmed

And letting them know that you're not a burden.

21:48Speaker B · Identity not confirmed

Yeah, yeah.

21:49Speaker A · Identity not confirmed

They're not a burden. Okay. Number 2?

21:50Speaker B · Identity not confirmed

They want time.

21:53Speaker A · Identity not confirmed

Okay. So they want to be around their friends and family. That's what they care about.

21:57Speaker B · Identity not confirmed

Again, fundamental here is it's relationships, right? That's what it's about.

22:01Speaker A · Identity not confirmed

And the medical students thought it would be

22:04Speaker B · Identity not confirmed

Feeling that life was meaningful.

22:06Speaker A · Identity not confirmed

Again, this—

22:07Speaker B · Identity not confirmed

I think this is wonderful. This is one that fascinates me, the boys. So you're in your 20s and you're on this journey of development and that you've had this impact of some sort. That door's shut and they're not living in the rearview mirror and they're not wondering whether they have meaning or not.

22:26Speaker A · Identity not confirmed

This is very relevant because me and my fiancée were in a car the other day and we— it was yesterday, and we were talking about this and she turned to me and said like, what's your why? And having sat here on this podcast with a guest a couple of weeks ago who asked me to close my eyes and imagined it was the last day of my life, the only thing that mattered in that moment was who was around my bed and what they thought of me and were they safe and secure.

22:49Speaker B · Identity not confirmed

Mm-hmm.

22:49Speaker A · Identity not confirmed

And it didn't dawn on me in that moment where I visualized being on my deathbed, my legacy or the impact I'd had or the achievements I'd accomplished. It's made me really reconsider what my why is. Because really, if in the last moments of my life, what I'm concerned about is who stood there and what they think of me. And when I say what they think of me, it's like, do my kids think dad was a good man? And did he leave us with lessons and principles so we can live a good life too? That seems to be most important. So it was just interesting because we go through life and we read Instagram and LinkedIn and it tells us like, what's your why? What's your legacy? What impact do you want to have on the world? What's your purpose? What's your passion? And these are all things that are very self-focused. But actually it appears to me as you've described that actually in those moments it's about others.

23:35Speaker B · Identity not confirmed

Yeah. I mean, and there's good work on this, right? Is the brain's ability to predict what makes us happy is horribly wrong. What we predict makes us happy is never sustainable. And what's important is to kind of de-want what matters.

23:52Speaker A · Identity not confirmed

De-want what matters?

23:54Speaker B · Identity not confirmed

Yeah. Because what does that mean? Well, we're on this treadmill of things that we think are going to make us happy. Job promotion. Yeah.

23:59Speaker A · Identity not confirmed

Yeah.

24:02Speaker B · Identity not confirmed

sustainable things. And that's proven over and over and over and over again. Belonging, connection, meaning, those are the things that, I mean, we're fundamentally meant to belong to one another. If you think of the best version of yourself, it was never achieving something. It was being a son, it was being a brother, it was being a friend, it was being a fiancé or boyfriend, whatever. It's those things that make us important. And ultimately what you find out of this research is the enormous value of interdependency. And that's the whole deal, whether it's in the physical world, the natural world, the ecosystems. But as humans, we're meant to be interdependent, and that's most clear in moments of vulnerability. So you posed yourself the question, kind of last day stuff, you're immediately vulnerable.

24:58Speaker A · Identity not confirmed

Yeah.

24:59Speaker B · Identity not confirmed

Right? And what you did is you pulled in all these other people that matter to you because we're defined redeemed only by our relationships. That's the only surviving thing, not by these other things that seem in a transient sense important. And that bears us out. And what's beautiful is their concern shifts from self. And I mean, hope changes in that way, right? It's hope for cure, then just hope for others. It's just this really wonderful story about who we are.

25:30Speaker A · Identity not confirmed

It's interesting because the things you're saying, a lot of people will sort of intellectually understand and believe that it's about the relationships in last moments, but therefore it's about relationships through our life. But then when you look at how we allocate our time on a weekly, monthly basis—

25:43Speaker B · Identity not confirmed

Oh yeah, there's a disproportionate—

25:45Speaker A · Identity not confirmed

There's a disconnect.

25:45Speaker B · Identity not confirmed

Yeah, yeah, yeah.

25:46Speaker A · Identity not confirmed

Because we're allocating our time towards accomplishment or achievement or money or promotions or cars, whatever. But then in the final hour, it's all about something else. And if I even reviewed the allocation of my time this week and day, I'd be like, well— Yeah.

25:59Speaker B · Identity not confirmed

Well, I mean, dying is the— death is this unbelievably truthful place. Pretense goes away, all the superficiality goes away. You're stripped to the bare bones of who you are. And what you end up finding is that we're more alike than unlike, and there's a universality to being human, and it involves being connected to one another. Our struggle is to remain humane, and we go through this together, not alone. And that's, again, there's a symmetry. You see it at the beginning of life and you see it at the end

26:38Speaker A · Identity not confirmed

Politics falls away?

26:39Speaker B · Identity not confirmed

I sure as hell hope so.

26:42Speaker A · Identity not confirmed

It's interesting because so many people spend their lives getting agitated. The reason I say that is because you said we're more alike than we believe.

26:49Speaker B · Identity not confirmed

Oh, absolutely.

26:50Speaker A · Identity not confirmed

And so when you're bare bones, you're not really thinking about the left, the right, this politics, this political issue.

26:56Speaker B · Identity not confirmed

What you end up seeing when people are most vulnerable, you see beauty. You see love, you see tenderness, you see vulnerability. There are some awful humans that have lived a bad life, but in the end, when you see them in a more vulnerable state, I think you see their better nature. You see tenderness, you see expressions of love. There's a lot of pretense that people have to work through, personas that they present, and illness kind of strips you of that.

27:27Speaker A · Identity not confirmed

Hmm.

27:27Speaker B · Identity not confirmed

It's this great leveling effect. to be sick, that what matters to you 2 weeks earlier doesn't matter to you now.

27:34Speaker A · Identity not confirmed

Okay. So medical students thought the third would be pain symptom management. And according to your hospice patients, they agree.

27:42Speaker B · Identity not confirmed

Yep. They got that one right.

27:44Speaker A · Identity not confirmed

And what does that mean? That's just their concern is not being in pain?

27:46Speaker B · Identity not confirmed

Yeah. I mean, unfortunately, there's not a lot of conversation about what to expect. We just completed a study on this. If you were told you had a terminal disease, I guarantee one of your first overwhelming thoughts is suffering. And unfortunately, it's damning how little conversations there are to address that issue in terms of what to expect, when to expect it, what you're going to feel, and reassure people. And these honest conversations actually don't take away hope. They restore agency.

28:16Speaker A · Identity not confirmed

So what is the misunderstanding?

28:18Speaker B · Identity not confirmed

Oh my gosh, that it's far worse than people think, that there isn't a pain, rarely a pain we can't manage.

28:24Speaker A · Identity not confirmed

It's less painful than people think.

28:26Speaker B · Identity not confirmed

Oh my gosh, by a mile. Yeah, that's probably the biggest myth.

28:31Speaker A · Identity not confirmed

About death and dying?

28:32Speaker B · Identity not confirmed

100%. And honestly, it's compounded by the fact that doctors don't have these discussions.

28:38Speaker A · Identity not confirmed

Okay. So number 4, in terms of what hospice patients say matters most to them?

28:43Speaker B · Identity not confirmed

Peace with God.

28:45Speaker A · Identity not confirmed

Being at peace with God. Hmm. And presumably just the religious ones, right?

28:50Speaker B · Identity not confirmed

No, it's peace with a belief of something larger. I've asked patients this and they'll say what I would say is that I don't know. It's an existential feeling that doesn't necessarily have to be attributed to a belief or a God.

29:05Speaker A · Identity not confirmed

Now, is it because they're concerned they're going to go to hell or that they're going to get— they don't know?

29:09Speaker B · Identity not confirmed

No, I don't hear that. I'm sure there was a time when judgment, the role of judgment played in, but just to be at peace with the universe existentially.

29:18Speaker A · Identity not confirmed

And is there a way to become at peace that patients will

29:23Speaker B · Identity not confirmed

I don't hear, but I imagine it's to ask for forgiveness in part.

29:27Speaker A · Identity not confirmed

And the medical students you interviewed thought number 4 would be being mentally aware.

29:33Speaker B · Identity not confirmed

Yes. And that does come up, right? So here we are.

29:35Speaker A · Identity not confirmed

That's number 5.

29:37Speaker B · Identity not confirmed

Yes.

29:37Speaker A · Identity not confirmed

In what hospital? Okay.

29:38Speaker B · Identity not confirmed

And then the next is dying at home. And this is tragic because 80% of Americans want to die at home and about 30% do.

29:50Speaker A · Identity not confirmed

Why is that?

29:50Speaker B · Identity not confirmed

It's really reflective of mostly our medicalization of dying. As a country, we underinvest in care for at home so that people end up having to go into the hospital and the death that they fear is the one they get. The more tertiary or advanced the hospital is, the more aggressive treatment there is. It's part of the death-defying approach of medicine. There's always something you can do. So they die in units and they die in those sorts. And the irony is The more they get, it actually hasn't been shown to enhance life.

30:25Speaker A · Identity not confirmed

The more what they get?

30:26Speaker B · Identity not confirmed

The more care, more aggressive care they get when they're dying.

30:29Speaker A · Identity not confirmed

So you're saying that we kind of drag it out a bit unnecessarily sometimes?

30:33Speaker B · Identity not confirmed

I think medicine does its best to defy death, and unfortunately it often denies it even when it's obvious and when things have become futile. And if medicine can't appreciate death when it's objectively there, they're certainly not going to pay attention to the experience of the dying. And I think it's complicated, but we've lost our way with dying. Dying used to be in the home and in the community in connection to our church. And in the last 100 years, it's become institutionalized. So death is now like a rumor. It's something that happens somewhere down the line, probably to somebody else, but it's not proximate to us like it used to be. So you take all these factors together, the fact that we've institutionalized dying, the fact that medicines become technically focused and no longer Artful. It's not okay to be there for presence. I mean, people can't die of old age anymore. You got to have about 5 diagnoses. So it's lost its grace. It's lost its humanity.

31:35Speaker A · Identity not confirmed

So if someone knows they're going to die, you would recommend they usually didn't come to a hospice and they—

31:42Speaker B · Identity not confirmed

No, get into a hospice so you can die at home.

31:45Speaker A · Identity not confirmed

Oh, versus at home.

31:46Speaker B · Identity not confirmed

So hospice is more likely to align your wish to an outcome. Hospice developed out of our communities as an answer, as a rebuttal to the way dying were traditionally treated in a hospital.

32:00Speaker A · Identity not confirmed

Yeah. So what is it about dying in a hospital that is worse than dying at home?

32:06Speaker B · Identity not confirmed

I don't know where to begin. What matters to the dying patient is familiarity, to be connected, to be where they live, The things that make them comfortable, the people they love. They don't want to be woken in the night. They don't want to be poked. They don't want IVs. They don't want another scan. It goes down to what will make you comfortable, what matters to you in the end. And being at home with your people is what matters to people.

32:33Speaker A · Identity not confirmed

Makes sense. So number 7, having care directives followed. What does that mean?

32:40Speaker B · Identity not confirmed

Making sure that what you want to happen is going to happen.

32:44Speaker A · Identity not confirmed

Okay.

32:45Speaker B · Identity not confirmed

Yeah. And this one is interesting, I think, resolving conflicts.

32:49Speaker A · Identity not confirmed

So medical students who are asked about what matters most to those that are dying, they ranked the 7th thing that would matter as resolving conflicts.

32:59Speaker B · Identity not confirmed

And what's interesting is these 2, right? Is was life meaningful and resolving conflicts? And the dying patient's kind of all good. They don't want to be a— they're not a problem to be solved.

33:10Speaker A · Identity not confirmed

You're right. That is the most interesting takeaway so far is Living people think the dying will be really concerned with legacy and what they accomplished and did they have any beef with anybody? But dying patients—

33:22Speaker B · Identity not confirmed

And that's why I have trouble with that regret literature, okay? Because that's not what they're saying. They're not focused really on the negative aspects of having lived, right? They're trying to preserve what makes them them. And what makes them them is their family and being in their home and being at peace with their God.

33:41Speaker A · Identity not confirmed

I mean, that speaks to what we should be thinking about in our lives day to day to some degree.

33:45Speaker B · Identity not confirmed

Well, and again, there's a bridge between these 2 things. It's not that actually the idea that this changes in death actually isn't all that true. I think we're aware of it in dying. Dr. Santos at Yale does this wonderful work on happiness. If you go upstream and you do good, you do that, like her sort of work on happiness, you reveal a lot of these same truths.

34:07Speaker A · Identity not confirmed

Well, we also live in a commercialized world where we're exposed to marketing and we're told what matters every day when we turn on the TV or open our phones. And we're told that the Louis Vuitton bag matters, where we clap when someone gets the promotion. So there is an element of sort of socialization that orientates our values towards being more materialistic and I guess shallow to some degree.

34:28Speaker B · Identity not confirmed

Those things are transient and non-sustaining. And one of the things that comes out of this happiness work is the importance of savoring. and savoring things of worth like our relationships.

34:39Speaker A · Identity not confirmed

Are there any people that were days from their own passing that were truly unhappy because of the way that they'd lived their lives?

34:46Speaker B · Identity not confirmed

Yeah, you die how you live, right? You can't reinvent it. It's not rainbows and flowers. I've certainly seen that and I've written about them and they're people who had done wrong and they were fearful of dying.

35:01Speaker A · Identity not confirmed

Fearful of what?

35:02Speaker B · Identity not confirmed

Well, in several cases they had been raised Catholic and they were worried about judgment and one case was actually a police officer. So he thought that he— because he'd been raised with confession, that he had to tell everybody all the horrible things he did wrong. And it was kind of interesting. We had a reporter from the New York Times, and she got an earful. He just had to be cathartic and say everything. He's trying to unleash his sins. But it's very rare.

35:27Speaker A · Identity not confirmed

In that case, you've got a police officer unleashing their sins. Could that not result in legal consequences if they say things that

35:37Speaker B · Identity not confirmed

Yeah, you'd think so because he talked about beating up witnesses and things like that. I never thought of that, but it's certainly true.

35:43Speaker A · Identity not confirmed

And nothing was done about that.

35:44Speaker B · Identity not confirmed

No. And unfortunately, what was interesting is we had a criminal, a guy who had spent more time in prison than out at the same time, and actually he's on film, and he had regrets, true, but they got addressed at the end.

35:58Speaker A · Identity not confirmed

What do you mean?

35:59Speaker B · Identity not confirmed

Well, it's one of the most beautiful things about 12% of our patients report dreams that are distressing or uncomfortable. They're not all comfortable. And again, it's not surprising. You're going to die the way you lived. And what we got wrong was those are sometimes the most transformational. Those are the ones where they find healing.

36:20Speaker A · Identity not confirmed

He had a dream about some of the bad things he'd done.

36:22Speaker B · Identity not confirmed

Oh yeah.

36:23Speaker A · Identity not confirmed

And that

36:24Speaker B · Identity not confirmed

caused a transformation. Dwayne.

36:27Speaker A · Identity not confirmed

And he'd committed crimes in his life.

36:29Speaker B · Identity not confirmed

Oh, yeah.

36:29Speaker A · Identity not confirmed

What kind of crimes?

36:30Speaker B · Identity not confirmed

2 attempted murders. 2 murders, sorry, but both were self-defense on the street. Somebody were trying to rob him, sort of thing. He lived on the streets most of his life. But he never, again, he never reckoned with the things he had done wrong. And this is his reckoning.

36:46Speaker A · Identity not confirmed

And how many days was this before he passed away?

36:50Speaker B · Identity not confirmed

12.

36:50Speaker A · Identity not confirmed

12 days.

36:51Speaker E · Identity not confirmed

My dreams, man, and all my nightmares, I don't like them. I think it's because my past is coming back to me from doing wrong. Because I'm not going to say I'm the perfect guy when I was out there, because I was ripping and running the streets, doing wrong to individuals. And now they know my symptoms. They know I'm sick. So now they want to try to hurt me. You know, it was like they were jigging a knife, you know, trying to cut, cut out, you know, my neck where my cancer was at.

37:33Speaker C · Identity not confirmed

Right.

37:33Speaker E · Identity not confirmed

Stop, stop trying to fight, you know. I'm sorry, I'm sorry, you know, trying to fight this guy off from hurting him. It scared me. I'm not a bad individual, man. Well, I don't cross a lot of people in my life. You know, and I need help. I need help. You know, I don't want to live my life being all at the side, walking, having to look over my back, man. I just want people to forgive me and please know that I was sick at the time when I was doing it. Mm-hmm. certain things that would concern them and their families. You know, that's all I want. I don't want them to look at me as a bad individual because I'm not. I need help.

38:27Speaker B · Identity not confirmed

What ends up happening, and he can't sleep, and again, going back to this idea that it's very hard to die if you can't sleep, he ends up waking up and he asks to see his daughter. And But she comes on the film and what she describes is for the first time in her life, he holds her for minutes and says how much he loves her and that he's sorry for what he had done. So this negative experience that was happening when his eyes closed brought this reckoning and this ask for forgiveness, which of course she gave.

39:01Speaker A · Identity not confirmed

And what do you make of that? Again, I'm asking you the same question I asked you earlier. What do you think is happening there? Is that a spiritual thing? Is that just him approaching the end of his life and feeling remorseful, so he's having a dream.

39:13Speaker B · Identity not confirmed

Oh no, he didn't have conscious control of this. I don't believe that for a second. This was happening when his eyes were closed. I think that he was caring at a very deep level. He knew the wrongs that he had done and that something was forcing him to find peace. And it did.

39:33Speaker A · Identity not confirmed

Something.

39:34Speaker B · Identity not confirmed

Something. Yeah. I think truth. I think somewhere in him, he couldn't joke and jive around it. Dying brought this to a surface and he needed to find peace. And it was wonderful for her. It changed her completely. And what ends up happening was she ends up spending every night with him and he ends up passing comfortably.

39:58Speaker A · Identity not confirmed

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42:14Speaker B · Identity not confirmed

Number 8? Feeling that life was meaningful.

42:17Speaker A · Identity not confirmed

So just to zoom out once again on this, were they given 11 options or were they given lots of options?

42:23Speaker B · Identity not confirmed

Lots of options.

42:23Speaker A · Identity not confirmed

Okay. And these are the 11 that they actually picked? Yeah. So number 8 is they cared that life was meaningful, but this is particularly low relative to the others.

42:31Speaker B · Identity not confirmed

Yeah. It's low. Yeah. And so is this one.

42:34Speaker A · Identity not confirmed

Living as long as possible.

42:36Speaker B · Identity not confirmed

And you want to know what? I've never had a dying patient say, I want to live as long as possible. What they want to do is live as well as they can, as long as they can. But unless you've been sick, that's not the goal, which is antithetical to the way medical world looks at patients, right? Is that we keep going at all costs.

43:01Speaker A · Identity not confirmed

I mean, there's some stats that I was reading here about how many years people spend sick on average. I think it was in the United States, if I have the stats right. Yeah, it says up to sort of 11 years of our lives are lived in poor health. So although our healthspan is, in the Western Pacific, 68 years, or in Europe, 66 years, we spend about a decade in poor health. And actually what you're saying to me is that people care more about their healthspan, how many years of good health they have versus their lifespan, which is just how many years they're alive.

43:35Speaker B · Identity not confirmed

Yeah. And I think that's a perspective that's very hard to understand in health. But it's hard work being sick and it's hard on those you love. So it makes sense to me.

43:45Speaker A · Identity not confirmed

What about this? Obviously a big subject at the moment is this longevity movement, people wanting to extend life and live forever and all these kinds of things. What is your perspective of seeing, of interviewing thousands of people that are dying? How has it shaped your perspective on longevity?

43:58Speaker B · Identity not confirmed

I think there's a risk of some illusion. There was an article in Science recently, 55% of lifespan is determined by genetics and it doesn't lead you immune from circumstances of disease and whatnot. I worry a lot of the lack of evidence around some of the efforts, and I think the focus really needs to be on living well. And if you look at the Blue Zone folks, I mean, that little lady in Japan or Italy isn't waking up in a cold plunge and measuring out creatinine. She's just living well. They move, they eat more plants, they're highly social. They take time to downgear through prayer, meditation, music, whatever.

44:46Speaker A · Identity not confirmed

When you think about all the people you've met who were days from their death, are there some who were more at peace with it because they had accomplished more? What is the corollary in terms of those that were most at peace with leaving this planet?

45:03Speaker B · Identity not confirmed

The love given and received, that's the only thing that matters. I've seen people who have led remarkably simple lives, but they were pure in the love that they were able to experience.

45:18Speaker A · Identity not confirmed

And so they were happier to leave.

45:20Speaker B · Identity not confirmed

Oh yeah. You want to live in a way that you can die well, and that means loving well.

45:26Speaker A · Identity not confirmed

And have you experienced the opposite where someone had nobody there?

45:29Speaker B · Identity not confirmed

Oh, I've had some very bad experiences. People who were, one of them I've written about, who was taken as a child into a home situation that was really for kids with a lot of complexity and had never seen or experienced love and the emptiness she felt. I never forget what she said to me. She was watching somebody kiss on a screen and she goes, you know, I look at that, I've never understood that. And her dying was empty. What

46:03Speaker A · Identity not confirmed

do you mean? Take me into the narcissism.

46:05Speaker B · Identity not confirmed

Just that she knew she never was loved. She was denied love, denied love by parents. She was misused by men. So what she knew of love hurt her, and she was aware enough to know that.

46:20Speaker A · Identity not confirmed

And there was no one there when she passed away?

46:22Speaker B · Identity not confirmed

No. No. It's interesting though. She had one very interesting dream. She had a man who had wanted to marry her, but she had been so taken advantage of that she was doubtful. And as soon as he asked her, she moved out of their apartment as a way to self-protect.

46:48Speaker A · Identity not confirmed

Yeah.

46:48Speaker B · Identity not confirmed

And at the end of her life, he came to her and told her that he really did love So she was showing some version of it that was soothing to her. That was it.

47:03Speaker A · Identity not confirmed

A lot of people, because of early traumas, are somewhat avoidant of love. You explained that she moved out of the apartment when someone tried to propose to her. I could almost relate to some degree. I remember in my early years of my— in my early teens, was extremely avoidant of commitment or relationships or whatever. And I remember this particular person turning around to me after I'd pursued them for 4 years, telling me that they would now want to be in a relationship with me. And I remember immediately dissuading them after pursuing them for 4 years.

47:33Speaker B · Identity not confirmed

Careful what you ask for, sort of thing.

47:35Speaker A · Identity not confirmed

Yeah. But a lot of it roots back to our early models of love and connection and relationships.

47:40Speaker B · Identity not confirmed

So

47:41Speaker A · Identity not confirmed

where we modeled it in a healthy way. And this kind of brings me to the point around sort of overcoming trauma and wounds. How does the process of dying help us confront our earliest traumas or the traumas that have held us back in our lives? Have you seen evidence of that?

47:58Speaker B · Identity not confirmed

Oh, lots. I've seen it in this end-of-life process. And again, I think this is the most meaningful for me personally, the most meaningful ones that I witness. So I've seen a man who had lost his arm at the age of 8, and he was from an impoverished family and developmentally, his whole identity was how was he going to be independent and be able to be a provider, et cetera. And at the end of his life, he sees himself lying in a bed and everyone who he worked with came by him and told him he was the best worker they had known. A mother whose child was in prison for drug offenses and her identity as a mother is being questioned. And at the end of her life, her parents come to her and tell her she's loved and she was a good parent.

48:48Speaker A · Identity not confirmed

In a vision, Not physically.

48:51Speaker B · Identity not confirmed

No.

48:51Speaker A · Identity not confirmed

Okay.

48:52Speaker B · Identity not confirmed

No. But again, there's something in us that's innate that can heal these kind of broken pieces of us at the end that make us whole. So a lot of, again, I come back to it, the most inspiring people are the people who have been harmed and often from nothing of their own doing, but that find peace in the end.

49:13Speaker A · Identity not confirmed

Do you think there life after death? Because one train of thought is that our bodies go into the ground or we're cremated and then we become dust and then the trees, we become part of the trees and the bees and the birds and that's it.

49:27Speaker B · Identity not confirmed

Yeah, I don't think we go on in a physical form, but I go back to this idea that there's the shared, seems to be the shared consciousness that the love that we've experienced early in life, and it's very interesting, it tends to be those who loved us unconditionally and the other ones kind of go by the wayside. They're inseparable from us and they become more present to us as we're leaving our physical form. So it does suggest that there's some sort of collective consciousness that goes on. And back to your survey on the bereaved, the fact that that many people feel that they're accessed by those who have passed is interesting. How do you see that?

50:11Speaker A · Identity not confirmed

I think consciousness is a really fascinating thing. I've interviewed lots of people on this subject and And I never really thought of consciousness as a thing before, but I've got a couple of hypotheses around what consciousness might be. None of them I can say I necessarily believe, but I remember one particular, I think he was a physicist, telling me that he thinks maybe consciousness is the way that the universe understands itself. And he hypothesized to me that consciousness breaks itself into lots of little pieces, into fish at the bottom of the ocean. Yeah. And human beings that walk the land and birds that see from the sky. And it's consciousness's way of learning about itself and understanding itself. It breaks itself into these living organisms. They send some of them to the bottom of the oceans and some of them to the top of the mountains, and they all explore. And it maybe explains why humans, but all animals, are so fascinated by novelty. The reason we go on holidays is because we want to have new experiences. We go and look up in awe at things we've never seen before, like mountains. And it's interesting. I was telling the story about being in, I think, Gibraltar or Malta or whatever it was, and driving down the street after I'd had this conversation with this physicist and looking at tourists in a completely new light because tourists are stood there for 10 minutes or an hour staring at something they've never seen before. And it's interesting to me that that's part of the animal experience is this fascination with things we haven't seen. So maybe this hypothesis that consciousness is this central source that breaks into lots of pieces and goes off into existence to understand itself, is a plausible, not completely indefensible, but plausible idea. And then maybe when I die, I return back to the source of consciousness.

51:53Speaker B · Identity not confirmed

I like my version better. And you know what's interesting is that you should look at is the work that's done with psychedelics and dying patients.

52:02Speaker A · Identity not confirmed

Tell me about that.

52:04Speaker B · Identity not confirmed

Basically, when they give psychedelic drugs, which indigenous people have been doing for thousands of years, they come back structurally altered. First of all, their fear of dying dissipates, and they tend to see themselves as something larger, immersed within and connected to life at large, but they're at peace in a beautiful way. So they have this heightened awareness, and they come back differently, and they die differently. And that's like with this work, they die differently.

52:37Speaker A · Identity not confirmed

So back to our board here. What was the 10th thing? What matters most to people at the end of their life? Having finances in order. Hmm. Interesting.

52:47Speaker B · Identity not confirmed

And the last one is resolving conflicts. And that's where I have trouble with the idea of regret.

52:53Speaker A · Identity not confirmed

Yeah, because it's not that important to people.

52:56Speaker B · Identity not confirmed

So now invert this. So if you went to people and said, do you have conflicts? They'd go, yeah, I have conflicts. Or do you have regrets? Yeah, I have 'em. But when you actually rank order them as priorities, it's not

53:07Speaker A · Identity not confirmed

Very interesting. Very, very interesting. It's definitely changed my mind because you're right, because we talk about regrets at the end of your life and regret generally so often, we end up misunderstanding that to mean that regrets are the most important thing and that you need to live your life in a way where you don't have regrets. But actually, you're saying that having spoken to those that are dying, living their life free from regret seems to be quite low in Priorities have been different.

53:32Speaker B · Identity not confirmed

Well, I think it's a symptom of our times, which we become introspective and self-analytical. So if you ask these questions, they're going to come up, but in the lived experiences, are they actually relevant?

53:47Speaker A · Identity not confirmed

So we have these 6 handwritten cards.

53:50Speaker B · Identity not confirmed

So these are the lessons I've learned from actually caring for dying patients. And probably the one that stands out the most is that love Love endures after physical loss.

54:01Speaker A · Identity not confirmed

Love endures after physical loss.

54:03Speaker B · Identity not confirmed

So the idea that, and this is really what our research bears out, which is that people who have been lost often decades earlier are there for us at the end. And that part of that dying process is this reunion with and to them so that that survives.

54:22Speaker A · Identity not confirmed

And on that point, it's probably a good time to touch on the subject of grief. And how the dying process impacts the grief that those left behind experience.

54:31Speaker B · Identity not confirmed

Yeah. And we've done a lot of work on this. And a long story short is that how people die absolutely affects our bereavement. How we witness that changes our bereavement and it's measurable. So people who have had these experiences, who have watched their loved one reconnect, grieve very differently. And it's measurable actually in grief, how they remember, how they recall, how they get through obstacles, how they heal.

55:01Speaker A · Identity not confirmed

So if I want to grieve in the most healthy way, what dying experience is most conducive with that?

55:07Speaker B · Identity not confirmed

Oh, seeing that loved one as rich in love rather than empty and defined by their physical dimensions. And I don't know if it would help. Do you want to show the video of Jennifer?

55:19Speaker A · Identity not confirmed

Sure.

55:19Speaker B · Identity not confirmed

This is an interesting video for a couple of reasons because these end-of-life events are not these great epiphanies or revelations. They're just about very real moments that are symbolic usually of a relationship. And she's describing her partner Patrick, who's at the end of his life and he has these experiences, but she describes what it means to her.

55:41Speaker F · Identity not confirmed

Patrick was the only member of his family that knows how to make the sauce. And for all the years I knew him, He insisted something was missing. After his grandmother had passed? After she had passed. This would be the Sunday before he passed. He woke up in the morning and I couldn't get him to eat. He wasn't hungry. Total loss of appetite. And I'm like, baby, we got to make you something for breakfast. What do you want? He goes, I'm full. Pat, you had a Snack Pack pudding yesterday. You're not full. And he's like, oh no, I ate with, with Nana Dolores last night. He believed he made sauce with his grandmother the night before, said he could smell it, he could still taste it, he was full from it. And she showed him after all these years what he had done wrong. Which is the very last step before you take it off the burner was to add a teaspoon of sugar. We spent the next 7 and a half hours, cuz that's how long it takes, making his grandmother's sauce. He added the sugar. Last time Patrick ever ate. Every morning he woke up saying, is today the day I'm gonna die? And I said, you'll go when you're ready. And he was ready.

57:11Speaker G · Identity not confirmed

Did that dream help you accept that reality further? Absolutely.

57:19Speaker F · Identity not confirmed

Yeah, absolutely. And not only the reality that he is gone, it's made me think of maybe there is something out there after we go.

57:30Speaker B · Identity not confirmed

So how she remembers him in death was that he was put back together by being with those he loved.

57:38Speaker A · Identity not confirmed

If I know that one of my relatives is going to pass away, what should I be doing to— because my first instinct in that scenario is to protect my family from the grief of it, to make sure that the grief process is as healthy as it can possibly be. And I'm not trying to deny grief in any way, because I know that it's kind of unavoidable from everything I've read. But is there things we can do as a family to insulate us from having a really negative grieving process?

58:04Speaker B · Identity not confirmed

Yeah. I think one is obviously communicating and being open with each other and with what's happening. I think one of the worst outcomes we see is when death is denied. So if you see it, if it's forecastable and it's obvious and you're proximate to us, it's less of an injury than if it's denied, denied, denied, and then—

58:26Speaker A · Identity not confirmed

And then it happens.

58:27Speaker B · Identity not confirmed

Yes. And we see so much of that in medicine.

58:29Speaker A · Identity not confirmed

So this is a rule for life, which is acceptance.

58:31Speaker B · Identity not confirmed

Oh gosh, yeah. A third of our patients that come into hospice are dead in 7 days. They didn't just start dying 7 days, they became aware of it. So what we do is we refer to this as medical harm. We deny them and separate them and deny their reality. So they're left to figure it out suddenly and acutely. And that injury is you're robbing people of their agency, their time to spend the way they want to, the conversations they need to have. And the impact to the bereaved is enormous. Yeah.

59:01Speaker A · Identity not confirmed

So acceptance, number one. Anything else?

59:02Speaker B · Identity not confirmed

Yeah, presence.

59:04Speaker A · Identity not confirmed

Presence.

59:05Speaker B · Identity not confirmed

And it used to be this way. It used to be death was in the home and it was in the community. It was shared. And that shared grief is wonderful because we're meant to be mutually supportive. The opposite is a sterilized death. So in an intensive care unit, in a gown, anything that dehumanizes the process of dying is injurious.

59:25Speaker A · Identity not confirmed

So acceptance, Presence, physical presence.

59:28Speaker B · Identity not confirmed

Yeah.

59:29Speaker A · Identity not confirmed

Anything else that helps the grief process?

59:31Speaker B · Identity not confirmed

Loving each other, talking, sharing, acknowledging. Anything that's repressive or denying about it, whether it's your own feelings, whether it's what's happening to the patient, is harmful, period. That's why death in the home is so different. You know, the person's seen as a person, not a patient, And the patients know this instinctively. That's why they want to get back home.

1:00:01Speaker A · Identity not confirmed

This was your father? Passed away when you were—

1:00:04Speaker B · Identity not confirmed

Yeah, I was 12.

1:00:05Speaker A · Identity not confirmed

You were 12 and he was 41?

1:00:07Speaker B · Identity not confirmed

42, I think.

1:00:08Speaker A · Identity not confirmed

Yeah. 42. He passed away of—

1:00:10Speaker B · Identity not confirmed

Cancer.

1:00:11Speaker A · Identity not confirmed

Cancer. In what way was this formative?

1:00:15Speaker B · Identity not confirmed

Well, I think it shaped life in certainly ways that I wouldn't have chosen. And that I don't understand. The one thing was that, you know, that sort of loss at that sort of, at that point in your life changed the trajectory of your life. You just, you don't just lose the person, you lose the world the way it's supposed to be. And for my— for me, my world went off the track pretty badly. It was a pretty bumpy road. But, you know, and it's so unusual because the last time I saw him, he was having one of these end-of-life experiences. I still can't make sense of it all because then after he died for many years, I could never speak his name. I certainly couldn't talk about the last time I saw him. So the irony that the thing I could never talk about is the thing that I now share with millions of people. I feel like I'm getting punked. I didn't mean for this to happen. And you wonder though, that sort of loss does change you, right? It changes what you're sensitive to in others, what you see in others, what you feel from others, how you want to help.

1:01:37Speaker A · Identity not confirmed

Does grief ever go away? It doesn't.

1:01:41Speaker B · Identity not confirmed

I think grief, There's a period where grief is unbearable and it's like having this rock in your pocket. You know it's there and other times you forget it. You lose the person in the physical form, but they still relate to you in other ways. It changes how you see the world for having known them. So they continue on in some way. We talk about grief in terms of what we lose, but not necessarily what remains. And a lot of that person remains and that's remembered. And I think grief is probably one of the most illuminating things that can happen in your life. It changes your life, the circumstances. I wouldn't be talking to you if I hadn't lost my father as a boy, for example. Wouldn't happen because a chain of events took place.

1:02:39Speaker A · Identity not confirmed

And you've interviewed 750 grieving families.

1:02:42Speaker B · Identity not confirmed

Mm-hmm. I think there's a great expression that the trick is, the art is, is to carry grief in one hand, gratitude in the other, and be stretched by both. You don't deny the grief, but you learn how to be grateful. And somewhere there's peace there

1:03:01Speaker A · Identity not confirmed

When you interviewed those 750 grieving families, did you notice a difference between those that really carried the grief well versus those that didn't carry it so well?

1:03:16Speaker B · Identity not confirmed

Yeah, but we were looking at a very specific question. We were looking at families who had seen these end-of-life experiences. And the best example I can give you is, so you have a couple, And they've been married for 6 decades. And part of their shared life was losing a child, an infant. And the spouse is looking down at his loved one in the bed, the woman in the bed. And she, in her inner experiences, is holding this deceased child. And she's at peace. And that, well, one connects all lives. right? Living and dead. But it reframes dying from something that could be empty and only defined by its physical dimensionality, what you're seeing. And it shows that it can be rich in meaning and love. Because the question always is, when you care for these families, is when that patient becomes nonverbal, when you become disconnected from them, is the question is, where are they and how are they? And if you're seeing that And that changes how you experience their loss and informs how you grieve. You view it very differently.

1:04:33Speaker A · Identity not confirmed

I've done almost 700 interviews with some of the most interesting people in the world. And one of the things you learn, which is unexpected, is that vulnerability is the doorway to connection. And after sitting here for 2, 3 hours with a guest, I feel a deep sense of connection to them. And as they leave, what I get them to is to write a question in the Diary of a CEO. We've taken all of the questions from the Diary of a CEO. We have put the question here on this card with the name of the person that wrote it. So you can sit at home, as I do with my fiancée and my colleagues at work and other people in my life, whenever we get a minute, we play the Diary of a CEO conversation cards. And it is incredible what happens. These are great if you're in a romantic relationship. And you wanna connect your partner more. These are also great if you're in a team and you want to bond your team together. And I have to say, they're also great for families that wanna learn more about each other and that need a good excuse to spend some time in a digital world, in the analog environment, connecting human to human. It is remarkable what the right question at the right time can do. Go to thediary.com and you can get these conversation cards right now. So that was the first point. Love endures after physical loss. Yes. Number 2.

1:05:50Speaker B · Identity not confirmed

Hope never fades. It changes. And it's a very interesting thing.

1:05:57Speaker A · Identity not confirmed

What does that mean? Sorry.

1:05:58Speaker B · Identity not confirmed

Well, when you're diagnosed with illness, you hope for cure. And then it's unbelievable how Acceptance comes into play. And they kind of get through that and then they hope for other things, but the hope doesn't change. It just evolves. It's fundamental. And it becomes hope I want to be comfortable, hope I want to have time with my family. It becomes all those things that they become. That's all based in hope. So hope didn't go away when they find out they're dying. It just changed shape.

1:06:34Speaker A · Identity not confirmed

They just hope for something else.

1:06:35Speaker B · Identity not confirmed

And then at the end, it's the most beautiful part is it becomes hope for others. And that's what you hear again and again. And it's just this wonderful story. Somehow we become less selfish. I found this when I was, when I tried to get the study approved, many studies approved, the university would say, oh, you can't, you know, we want to sterilize the dying. They're never going to participate. They're dying. Why would they want to waste your time with you? And actually they all did. And they even want to be filmed. And if you think about it, there's no secondary gain. They're never going to see, it's like the old man that plants a tree is never going to live under the shade, but somebody else is, right? And that's what we get from that. It mattered that they contributed. It mattered that they connected. It mattered that they were heard, that their words mattered. And that's a form of hope. So they've gone from cure when they were diagnosed and they let go of that. And then they think about things like comfort and having time with family. But then at the And what they always hope for is other people.

1:07:40Speaker A · Identity not confirmed

Maybe that's the essence of us.

1:07:42Speaker B · Identity not confirmed

Yeah, it's a better version of thinking. I think we live in a selfish space. I think we're robbed of that when you become a parent and whatnot. But I think in the end, I think it's wonderful that hope doesn't extinguish because cure has. The next is people don't stop living because they're dying. And when we did this study looking at dying and analogous to post-traumatic growth, the idea that within a negative adverse event like war, there's positive things like camaraderie. That's what we found with this is that people were growing and adapting, and this was measurable and significant according to post-traumatic growth scales right up into the last days of life. And it's paradoxical to the physical state. So physically they're declining, but psychologically and spiritually they're very much alive.

1:08:42Speaker A · Identity not confirmed

Number 4?

1:08:42Speaker B · Identity not confirmed

The dying leave us connected. This became very important, and I wrote about this during COVID because so many people were removed from their loved ones, which was an unbelievable tragedy. And what I wrote about was when they're having these inner experiences, actually they're immersed and very much connected. We don't see people who have these experiences in solitary. We tend to think of dying as lonely and a solitary event.

1:09:10Speaker A · Identity not confirmed

Yeah.

1:09:10Speaker B · Identity not confirmed

And what happens is in our inner world, we're bringing people into us. We're reflecting on life. And in these end-of-life dreams and visions, we're just immersed with people who we love. So even though it looks like they may be isolated in an intensive care unit, when their eyes are closed, they're also surrounded in love. But then externally, the dying process brings people together. Lives stop. You know, that son who has a roaring job in California has to fly home to New York. It tends to stop the world and we focus on what really matters, which is each other. And that's very clear. The dying can heal what's harmed or broken. And this happens in a multitude of ways. There's that external peace, whether it's making peace with their God, making peace with their family. It's amazing How many families come together, and what seemed like an issue of contention goes away and dissipates, and they're able to see beyond that. It reshuffles your priorities in ways that you can't imagine. The grudge that was held onto is let go. So there's this healing process that's innate to dying, and I think internally what we see again and again and again: people who are having negative or distressing dreams and visions—they're often centered. centered around harmful things, but they're often addressed within that process so that somehow, and this is probably the most remarkable thing of all, they've lived this life with this injury and it gets addressed in the end. There's almost like this final justice. People like Duane who has wrestled with these demons his whole life, and then at the end he's kind of made whole. Lesson number 6 is there's a better story than the one we fear. And the best analogy I can give you is that famous Dylan Thomas, the famous poet. It's a message to his father who was becoming blind and dying, I believe, but he was healthy. And it says, basically, don't surrender, don't fight the dying of the And most of us in health can relate to this idea of the resistance of death, you know, that you're going to— this is the enemy to be fought and you're going to muster all your strength and will and you're going to overcome and survive. And that's not what happens to the dying. The dying aren't fighting against anything. If anything, they're fighting towards, and what they're fighting towards is to get back to those that they've loved and they've lost. Horus is a great example. So Horus is, I believe, close to 90 years old, and he's very near the end of his life. And I think what's beautiful about Horus is that his inner world experiences are so overwhelming that he actually struggles to find language for what the beauty that he's experienced is, the colors that are richer, his wife, the relief he feels in seeing her. And it really highlights this notion that they actually aren't struggling against anything. If anything, Horus wants to go to this experience that he's having with his eyes closed. So if we could watch Horace, that would be great.

1:12:33Speaker H · Identity not confirmed

She was always beautiful. She was even prettier. She knew me inside out. Yeah. Mm-hmm. And maybe the— I guess maybe words weren't necessary. We just looked at each other and knew exactly what one was thinking.

1:13:11Speaker A · Identity not confirmed

And he's describing a vision he's had there.

1:13:13Speaker B · Identity not confirmed

Mm-hmm. Oh, it's beautiful. And he describes this relief like paying a bill, like it's over. And the greens of the grass are greener. And he's so emoted by it that he starts to get very tearful.

1:13:26Speaker A · Identity not confirmed

How has interviewing these people as they're leaving this world changed how you live your life on a day-to-day, week-to-week, month-to-month basis?

1:13:34Speaker B · Identity not confirmed

Oh, I think a lot. I think cancer did more to change how I live on a daily basis, probably.

1:13:44Speaker A · Identity not confirmed

You had stage 4?

1:13:45Speaker B · Identity not confirmed

Stage 4 cancer.

1:13:47Speaker A · Identity not confirmed

Has it changed your perspective of you dying yourself?

1:13:52Speaker B · Identity not confirmed

I can tell you that I'm certainly not fearful of the actual process of dying anymore. No. Yeah, I'm not.

1:13:59Speaker A · Identity not confirmed

Were you before?

1:14:00Speaker B · Identity not confirmed

Yeah, I think so. Yeah. Yeah. I mean, it's innate to us, right? It's why we survive is we're meant to resist.

1:14:08Speaker A · Identity not confirmed

And what in particular has alleviated that fear?

1:14:11Speaker B · Identity not confirmed

Oh, I think seeing so many patients, I think having to face it myself, that possibility myself. I had to wrestle that demon.

1:14:21Speaker A · Identity not confirmed

And where does the comfort come from?

1:14:23Speaker B · Identity not confirmed

Because it becomes less about self. It's very interesting. When you have a diagnosis like I had, first you're confronted with this enormous responsibility, this reckoning with the lives that you're responsible to. And you worry about their wounds and how they're going to be, particularly if you have people who are dependent on you. So I went through that switch you first are confronted with. And then it changes you in a lot of ways.

1:14:53Speaker A · Identity not confirmed

What specifically has changed?

1:14:56Speaker B · Identity not confirmed

I was always restless. I could never sit, but cancer brought that to a stop suddenly. And it's a very weird thing because there's no period of adaption. All of a sudden you can't do, you're used to going into the world, and now the world has to come to you. And it forces you to do what I really could never do, which is kind of be more present. I rehabbed basically over many, many months on my farm. And I would gradually walk a little farther down the driveway, then in the barn, animals, walk in field and woods. And I can't quite describe this, but this one day I was there and I'm looking at these willow trees that I had planted decades earlier, and they were the most beautiful things I'd ever seen. And, you know, the trees hadn't changed. I changed. Viktor Frankl talks about this in the book Man's Search for Meaning, right?

1:16:06Speaker A · Identity not confirmed

He was a Holocaust survivor.

1:16:07Speaker B · Identity not confirmed

Yeah.

1:16:08Speaker A · Identity not confirmed

Yeah.

1:16:08Speaker B · Identity not confirmed

And somehow he came out of that experience and was able to put a lot of definition around finding meaning. And he describes a day when one of the prisoners runs out and says, look at this sunset. And they all come out and they're all admiring it despite their despair and destitute. And the one says, look at what the world could be. And the point is, is that beauty isn't about doing or accomplishing, but it's internalized. It's the finding meaning in the experience. And I never But I got it then when I got sick.

1:16:41Speaker A · Identity not confirmed

And on that point of meaning, which is the word on the front of your book here, what is the meaning of life from everything you've experienced and all the death, loss, grief you've seen? What is the meaning of life?

1:16:53Speaker B · Identity not confirmed

I don't know about meaning, but I know the destination is always love. And I think that we're meant to get there together and we're meant to endure struggle together. I think that that's just fundamental. Again, we're fundamentally interdependent and reliant on one another. If you think of the best parts of yourself, it's always in the context of love.

1:17:22Speaker A · Identity not confirmed

You wrote this wonderful book, Death Is But a Dream: Finding Hope and Meaning at Life's End. Who is this for?

1:17:33Speaker B · Identity not confirmed

Well, again, it was meant for a medical audience, but I think it's anybody who's caring for somebody. I think it's anybody who's wondering about their own mortality. I think what I find a lot of people are benefiting is people who have witnessed these experiences, but it's never been explained. And I think it's nice because it includes different types of patients. So it includes patients who are cognitively different, includes children, and each one of those is very unique.

1:18:00Speaker A · Identity not confirmed

Dr. Christopher, we have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're leaving it for. The question that has been left for you, it's a question I often ask. What is one thing we haven't talked about that we should have talked about?

1:18:12Speaker B · Identity not confirmed

The children.

1:18:13Speaker A · Identity not confirmed

Explain.

1:18:15Speaker B · Identity not confirmed

Children die very differently. I think that it's not so much lessons, but there's certainly inspiration. And I think it talks about what's innate in us.

1:18:27Speaker A · Identity not confirmed

How do children die differently from

1:18:32Speaker B · Identity not confirmed

Oh, well, for one, they don't struggle to find acceptance. They're already accepting. They don't think in terms of finality of mortality. They just accept the state that is. So they don't talk in terms of regrets and what-ifs. Children have this amazing ability to take care, to make themselves whole, to take care of themselves, to reassure themselves. So one of the ways they do that is they may not know known somebody who's died, so who comes back for them? And often it's an animal. And children don't have the same distinctions, obviously, between the human and the animal world. And they come with the same message, which is that they're loved and that they're not alone. The other thing that's just fascinating is they become very self-informed by these inner experiences. By that, I mean, they end up understanding where they are. You don't have to tell them they're They seem to put this together in remarkable ways. And far and away, the most remarkable thing about children is that they have this quiet courage and how they care for those around them. So they become so utterly selfless, it's almost hard to describe. I saw a young lady who was taking her pain medicine medicine. She didn't want to take her pain medicine because she was enjoying being awake and plugged in, but she was sensitive to what other people were observing and she didn't want her mother to see her grimace. Another one who was from Syria, she knew she was dying. Her parents couldn't talk to her about it, but she had already gone ahead on Facebook and said goodbye and given life lessons.

1:20:15Speaker A · Identity not confirmed

Do they have the same visions and dreams?

1:20:17Speaker B · Identity not confirmed

Oh yeah, they do And we could show that with Jessica.

1:20:22Speaker A · Identity not confirmed

So tell me about Jessica.

1:20:24Speaker B · Identity not confirmed

Jessica's 13 years old and she's raised by a single mother. And she sees this deceased friend of her mother's playing with her curtains. And she doesn't want to tell her mom because she didn't want to scare her, but it made her feel good because she was a good person. And again, she's not going to be alone. So they tend to look After— despite being children and being robbed of life, they somehow tend to worry about others and try to protect others. And that's what she does.

1:20:55Speaker G · Identity not confirmed

I had a feeling that she was just coming and telling me that you're going to be okay, everything's fine. But she didn't look at me. She was just looking. But I had a feeling if I called out her name, she would look at me. But I didn't want to scare my mom. I felt a sign of relief. Yeah. And happiness because she was a very strong person, and I know that I'm strong, and my mom tells me all the time that I was— I'm like her.

1:21:27Speaker F · Identity not confirmed

Wow. And you told me that you thought that, oh, Mom, I saw an angel. That's how you said you felt, and you felt peace, and then you were able to go to sleep.

1:21:36Speaker G · Identity not confirmed

And then I was able to go to sleep. So it was really comforting. It was comforting, yes. You weren't afraid? I wasn't afraid of it at all.

1:21:44Speaker B · Identity not confirmed

So children have this way of self-healing that's remarkable. We have another children— child on video who she creates this castle, and she can feel the warmth, the light coming through the window, and all the animals are well and playing. And when asked what the castle meant, she said it meant that there's a safe place.

1:22:09Speaker A · Identity not confirmed

ways. Dr. Christopher Kerr, what a wonderful reminder of what actually matters.

1:22:12Speaker B · Identity not confirmed

Good.

1:22:14Speaker A · Identity not confirmed

And also, when we think about how many of us ourselves fear our own death, it's quite high. It's about half of people, men and women, fear their own death. But actually, I think through your research, through the book that you've written, and through the studies that I have here in front of me, it's certainly made me think a lot less about the fear of my own death, because you're right, people think of it as being this sort of painful, prolonged process, but that's not what you report.

1:22:38Speaker B · Identity not confirmed

No. And actually we've looked at that and what they actually fear is isolation and being disconnected.

1:22:45Speaker A · Identity not confirmed

And more so than fearing our own death, we fear losing someone else.

1:22:50Speaker B · Identity not confirmed

Right. I have never come with the right way to frame it, but all of this comes back to this better idea that the concern is for others more than self.

1:22:59Speaker A · Identity not confirmed

And that's a beautiful thing. Death Is But a Dream: Finding Hope and Meaning at Life's End by Dr. Christopher Kerr. I'll link this book below for anyone that would like to read it and dive deeper into these subjects. They are illuminating subjects, again, because people in those moments of their life have such a wonderful retrospective clarity, but maybe it's just clarity. Maybe it's just clarity on what actually mattered the whole time, as you say. Thank you so much for doing this work because again, it's destigmatized a bunch of prevailing myths and ideas about the last stages of our life that probably cause us undue harm, both to those that are left behind, but also to those that pass on. And it does, it raises more questions about the nature of consciousness and spirituality and religion and the afterlife and all these things, which I guess are our individual questions to answer. Thank you. Thank you. It takes a little bit of time to realize this as a founder, but once you do, it's something you can't unsee— that having the right systems in place with your business is critical. One that's helped me across all of my investments is NetSuite, the number one cloud financial system and sponsor of today's conversation. Through their streamlined platform, you'll find all of your accounting, finance, management, inventory, and HR in one place. And their technology has been a massive unlock for all of my companies, especially for my team at Flight Story, as over the last year we've moved out of startup mode into scale-up mode. And that's the stage where we found it mission critical to use NetSuite. We no longer have to juggle multiple systems, and having everything together has reduced the number of manual tasks and of course the number of errors. Over 42,000 businesses have chosen to future-proof their business with NetSuite. So if you'd like to learn how it can help your business, head to netsuite.com/bartlett and free download The CFO's Guide to AI and Machine Learning. That's netsuite.com/bartlett.