Palliative Medicine for Serious Illness:  Seeing Through the Veil

Dr. Ira Mandel MD, MPH, is Medical Director of Pen Bay Healthcare’s Hospice and Palliative Care program

When one nears death, it is often a time for spiritual reflection, healing of the soul and preparation for the “hereafter.”

Fortunately, most people do not experience significant spiritual distress prior to death. The closeness of family and friends reinforces previously held beliefs and provides comfort during difficult times. Such beliefs typically include the relationship to God (or to the “universe” for those who are less certain about their belief in God), the meaning of life, the impact of illness and death on one's relationships and the loss of one's place in the physical world.

Sometimes, people nearing death wish to have their local clergy present to give last rights, offer prayers or to discuss difficulties people want to sort through before dying. Upon patient or family request, Pen Bay Medical Center actively seeks involvement of local clergy in the care of patients and also provides chaplains for all hospitalized patients and for hospice patients in any location.

In recent times, physicians have been increasingly reflective of their role in spiritual care. Almost none have received any training in this area. Many feel uncomfortable with their lack of skill in addressing spiritual concerns and in general, spiritual topics. Despite this, 65 to 95% of patients say they’d like doctor to address spiritual issues. At this time, only about 10% of physicians feel willing and able to delve into these areas but slow progress is being made for more physicians to incorporate discussing spiritual care in their practices. (Pulchalski, Christina M. M.D., M.S. (2002). Spirituality and End-of-Life Care: A Time for Listening and Caring. Journal of Palliative Medicine, 5(2), 289-296). At Pen Bay, I am very willing and interested in addressing spiritual issues with patients. I try to always ask patients about their beliefs and if they are struggling with any spiritual issues.

Regardless of patients’ spiritual beliefs, with their permission, I offer to share some observations I have made about dying patients that often is quite reassuring to the patient and their family.

Experienced hospice staff have observed many times instances where a patient will awake from a long period of being unresponsive. Upon awakening, the patient seems quite alert and frequently very happy. Often, one is completely unaware of people in the room but can be observed talking to family members who have preceded them in death. Sometimes one raises one's hands as if to touch the unseen visitors and talk in loving ways about being together again. Commonly, these communications may last only minutes but are very moving to those who witness them. Professionals often refer to these events as “seeing through the veil,” as if one is actually seeing beyond this life into the “hereafter.” It is reassuring to family to see a patient look forward to “moving on.”

When I share “seeing through the veil” experiences with other dying patients and their families, I often reflect that is difficult not to believe that we are truly observing a real phenomenon: that there is another place that we go to after we die, that others are waiting for us, that they welcome us with love and joy and that, perhaps, we will all be reunited after our deaths in the future. This would imply that, while we will lose the loved one, the loss is only temporary and ultimate reunification will occur. Of course, no one knows this for certain other than those who have passed, but sharing information about observing patients in this process of transition can be very comforting to patients and families trying to cope with the loss of relationships.

Spiritual discussions are often helpful and are encouraged at Pen Bay Healthcare regardless of patients and families personal spiritual beliefs. For further information about spirituality and healthcare, please feel free to contact your own clergy, Pen Bay Medical Center’s chaplain, Abby Pettee, at 542-4432 or Dr. Ira Mandel at 594-9561.

Ira Mandel, M.D., MPH is a Palliative Medicine physician and is medical director of Pen Bay Healthcare’s Hospice and Palliative Care program. He provides compassionate care with a team of health professionals who honor the wishes of patients with serious illnesses. His monthly column seeks to inform the public about choices they may wish to consider. Disclaimer: All people described in this column are not actual patients but are derived from many hundreds of patients Dr. Mandel has treated over many years.