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“The huge challenge of this work is to help patients feel more normal and less alone during this unusual experience of dying,” he said. “The more we can articulate that people do have vivid dreams and visions, the more we can be helpful.”
“这项工作所面临的巨大挑战是，我们需要帮助患者在逐步走向死亡这种不寻常的历程中感觉更正常，减轻他们的孤独感，”他说。“人在临终时确实有着生动的梦境和幻象。这一点我们传达得越清楚，对患者的帮助就越大。”
Other research suggests that dreams seem to express emotions that have been building. Tore Nielsen, a dream neuroscience researcher and director of the Dream and Nightmare Laboratory, at the University of Montreal, surmised that at the end of life, such a need becomes more insistent. Troubled dreams erupt with excessive energy. But positive dreams can serve a similar purpose.
其他的一些研究表明，梦境是对累积情绪的一种表达。加拿大蒙特利尔大学(University of Montreal)梦境与梦魇研究实验室(Dream and Nightmare Laboratory)主任、梦境神经系统科学研究员托雷·尼尔森(Tore Nielsen)推测，人在走到生命尽头时，用做梦宣泄情感的需求变得越发迫切。患者通过噩梦来发泄过剩的精力。不过，积极的梦境也可以起到类似的作用。
“The motivation and pressure for these dreams is coming from a place of fear and uncertainty,” he said. “The dreamers are literally helping themselves out of a tough spot.”
“患者之所以会做这种梦，出自他们的恐惧和不确定，”他说。“实际上，他们是在通过做梦这种方式帮助自己走出困境。”
In the weeks and days before death, the dreams of the patients in the study tended to occur with greater frequency, populated with the dead rather than the living. The researchers suggest that such phenomena might even have prognostic value.
这项研究中的患者在离世前几周或几天内做梦往往更加频繁，且梦境中故去者要多于活着的人。研究人员认为，这种现象甚至可能具有一定的预测价值。
“I was an aggressive physician, always asking, ‘Is there more we can do?’ ” said Dr. Kerr, who is also the chief medical officer for Hospice Buffalo. “There was a patient who I thought needed to be rehydrated, and we could buy him some time.” But, he said, a nurse, familiar with the patient’s dreams, cautioned: “‘You don’t get it. He is seeing his dead mother.’ He died two days later.”
“我是一个有进取心的医生，我总是问自己：‘我们是不是还可以再做些什么？’”克尔博士说道；他也是水牛城临终关怀中心的首席医疗官。“曾有一名患者，我认为他需要接受再水化治疗，这样可以让他多活些时日。”但是，一位熟悉患者梦境的护士告诫他说：“你不明白。他梦见了自己死去的母亲。”“两天后，那名患者去世了。”他说。
Certainly, many dying patients cannot communicate. Or they recount typical dream detritus: a dwarf lifting the refrigerator, neighbors bringing a chicken and a monkey into the patient’s apartment. And some patients, to their disappointment, do not remember their dreams.
当然，有许多垂危的患者丧失了与人交流的能力，或者他们只能回忆起梦境中的细枝末节：侏儒抬着冰箱；邻居把一只鸡和一只猴子带进患者的公寓什么的。还有患者沮丧地表示自己记不起做了什么梦。
Dr. Kerr, who recently gave a talk at TEDxBuffalo about the research, said he was simply advocating that health care providers ask patients open-ended questions about dreams, without fear of recrimination from family and colleagues.
克尔博士最近在TEDxBuffalo就这项研究发表了演讲，他说自己只是提倡医务人员用开放式的问题来询问患者的梦境，无需担心会招致患者家属和同事的指责。
“Often when we sedate them, we are sterilizing them from their own dying process,” he said. “I have done it, and it feels horrible. They’ll say, ‘You robbed me — I was with my wife.’”
“我们常常会给他们使用镇静剂，使他们走得平静，”他说。“我干过这种事，感觉很糟糕。患者们会说：‘你们打扰了我——我本来正在梦中和妻子相会呢。’”
While the patient was lying in bed, her mother by her side, she had a vision: She saw her mother’s best friend, Mary, who died of leukemia years ago, in her mother’s bedroom, playing with the curtains. Mary’s hair was long again. “I had a feeling she was coming to say, ‘You’re going to be O.K.’ I felt relief and happiness and I wasn’t afraid of it at all.” — Jessica Stone, 13, who had Ewing’s sarcoma, a type of bone cancer, a few months before she died.
有一名患者在母亲陪在她床边的时候出现了幻象：她看到了她母亲最好的朋友，多年前死于白血病的玛丽在她母亲的卧室摆弄着窗帘。玛丽的头发又长长了。“我有一种感觉，她来是想对我说：‘没关系，一切都会好起来的。’我感到宽慰和幸福，再也不害怕了。”——身患尤文氏肉瘤（一种骨癌）的13岁女孩杰西卡·斯通(Jessica Stone)在去世几个月前讲述。
Many in hospice suffer from delirium, which can affect up to 85 percent of hospitalized patients at the end of life. In a delirious state, brought on by fever, brain metastases or end-stage changes in body chemistry, circadian rhythms are severely disordered, so the patient may not know whether he is awake or dreaming. Cognition is altered.
临终关怀中心的许多患者都患有谵妄(delirium)，患病率在住院的临终患者中可高达85%。发热、肿瘤的脑转移或人体在垂危时的化学变化导致患者神志不清，这种状态下他们的昼夜节律严重紊乱，因此很可能搞不清楚自己究竟是醒着还是在做梦，认知功能也受到了影响。
Those who care for the terminally ill are inclined to see end-of-life dreams as manifestations of delirium. But the Hospice Buffalo researchers say that while some study patients slipped in and out of delirium, their end-of-life dreams were not, by definition, the product of such a state. Delirious patients generally cannot engage with others or give a coherent, organized narrative. The hallucinations they are able to describe may be traumatizing, not comforting.
照顾绝症患者的人倾向于将临终的梦境视作谵妄的表现。但水牛城临终关怀中心的研究人员表示，虽然参与研究的患者时不时地陷入谵妄，但依据定义来看，临终的梦境并非这种状态的产物。神志不清的患者一般无法与他人互动或进行连贯的、有条理的陈述。他们能描述出来的只有那些给他们带来伤害和不适的幻觉，而舒适安逸的那类则不行。
Yet the question remains of what to make of these patients’ claims of “dreaming while awake,” or having “visions” — and the not-uncommon phenomena of seeing deceased relatives or friends hovering on the ceiling or in corners.
然而，问题是：这些患者“做白日梦”或出现“幻象”，“看到已故亲友在天花板或角落徘徊”等这类异常现象，其根源究竟在哪里。
Donna Brennan, a longtime nurse with Hospice Buffalo, recalled chatting on the couch with a 92-year-old patient with congestive heart failure. Suddenly, the patient looked over at the door and called out, “Just a minute, I’m speaking with the nurse.”
唐娜·布伦南(Donna Brennan)是水牛城临终关怀中心的一名老护士了，她回忆起与一名92岁的充血性心力衰竭患者在沙发上聊天的情形：突然之间，患者朝门口看了一眼，喊道，“稍等一下，我在跟护士谈话呢。”
Told that no one was there, the patient smiled, saying it was Aunt Janiece (her dead sister) and patted a couch cushion, showing “the visitor” where to sit. Then the patient cheerfully turned back to Mrs. Brennan and finished her conversation.
在被告知那里没有人后，患者露出了微笑，说来者是詹妮斯阿姨（Aunt Janiece，她已故的姊姊），还拍拍沙发坐垫，示意“访客”坐下。然后乐呵呵地转回身来继续跟布伦南谈话。
In her notes, Mrs. Brennan described the episode as a “hallucination,” a red flag for delirium. When the episode was recounted to Dr. Kerr and Anne Banas, a Hospice Buffalo neurologist and palliative care physician, they preferred the term “vision.”
布伦南在记录中将此事称为“幻觉(hallucination)”，这是谵妄的一个警示信号。而当克尔博士和水牛城临终关怀中心的神经学家、姑息治疗医生安妮·巴纳斯(Anne Banas)听到这段叙述时，他们更偏向于使用“幻象(vision)”一词。
“Is there meaning to the vision or is it disorganized?” Dr. Banas asked. “If there is meaning, does that need to be explored? Does it bring comfort or is it distressing? We have a responsibility to ask that next question. It can be cathartic, and patients often need to share. And if we don’t ask, look what we may miss.”
“这些幻象是别有意义还是杂乱无章？”巴纳斯博士问道。“如果它们别有意义，那是否需要深入探讨？我们有责任进一步追问：它们是令人舒心还是苦恼？临终的幻象可能充满了情绪宣泄，患者通常需要有人和他们一同分担。要是我们不闻不问，我们恐怕会错过什么！”
Dr. William Breitbart, chairman of the psychiatry department at Memorial Sloan Kettering Cancer Center, who has written about delirium and palliative care, said that a team’s response must also consider bedside caregivers: “These dreams or visions can be interpreted by family members as comforting, linking them to the legacy of their ancestry.
美国纪念斯隆-凯特琳癌症中心(Memorial Sloan Kettering Cancer Center)的精神科主任威廉·布赖特巴特(William Breitbart)博士曾经撰写过关于谵妄和姑息治疗的报告，他表示，医护团队在工作时必须将床边照护者也考虑在内：“家属们可能会将这些梦境和幻象解读为一种安慰，将它们视作与祖先相联系的纽带。
“But if people don’t believe that, they can be distressed. ‘My mother is hallucinating and seeing dead people. Do something about it!’” Dr. Breitbart trains staff to respect the families’ beliefs and help them understand the complexities of delirium.
“但是，如果人们不相信这些，就可能因此而苦恼。“我的母亲产生了幻觉，老是看到死去的人。快做点什么来改变这种状况！’”布赖特巴特博士训练工作人员尊重家属的观念，并帮助他们了解谵妄的复杂性。
Some dream episodes occur during what is known as “mixed-state sleep” — when the boundaries between wakefulness and sleep become fragmented, said Dr. Carlos H. Schenck, a psychiatrist and sleep expert at the University of Minnesota Medical School. Jessica Stone, the teenager with Ewing’s sarcoma, spoke movingly about a dream of her dead dog, Shadow. When she awoke, she said, she saw his long, dark shape alongside her bed.
美国明尼苏达大学医学院(University of Minnesota Medical School)的精神病学家、睡眠专家卡洛斯·H·申克(Carlos H. Schenck)博士说，某些梦发生在所谓的“混合睡眠”，也就是俗话说的半睡半醒状态下。身患尤文氏肉瘤的少女杰西卡·斯通生前曾经动情地讲述她梦见了自己死去的爱犬——影子(Shadow)。她还说，自己醒过来的时候，看到它修长的深色身影就在她的床边。
Dr. Banas, the neurologist, favors the phrase end-of-life experiences. “I try to normalize it for the family, because how they perceive it can push them away from that bedside or bring them closer,” she said.
神经学家巴纳斯博士更喜欢称其为“临终体验”。她说：“我试着让患者的家属视其为一种正常的现象，因为他们对此的看法可以令他们与患者的关系变得疏离或者亲近。”
The patient had never really talked about the war. But in his final dreams, the stories emerged. In the first, the bloody dying were everywhere. On Omaha Beach, at Normandy. In the waves. He was a 17-year-old gunner on a rescue boat, trying frantically to bring them back to the U.S.S. Texas. “There is nothing but death and dead soldiers all around me,” he said. In another, a dead soldier told him, “They are going to come get you next week.” Finally, he dreamed of getting his discharge papers, which he described as “comforting.” He died in his sleep two days later. — John, 88, who had lymphoma.
有一名患者，之前从未怎么谈及过战争。但在他生命最后的梦境中，那些故事浮出了水面。第一个梦里，他梦见到处都是血淋淋的濒死的士兵。那是诺曼底的奥马哈海滩，波涛拍岸。当年才17岁的他是救援艇上的射击手，他们拼命地想把伤员们抢救出来，送回得克萨斯号战舰(U.S.S.Texas)上。“我的周围除了死亡和死去的大兵之外，一无所有，”他说。在另一个梦里，一名死去的士兵对他说：“他们下周会来接你。”最后，他梦见自己拿到了退伍证书，他说这让自己“松了一口气”。两天后，患者在睡梦中离开了人世。——他的名字是约翰(John)，88岁，患有淋巴瘤。
Not all end-of-life dreams soothe the dying. Researchers found that about 20 percent were upsetting. Often, those who had suffered trauma might revisit it in their dying dreams. Some can resolve those experiences. Some cannot.
并非所有的临终梦境都能给濒死之人带来抚慰。研究人员发现，约20%的梦令人郁闷。通常情况下，曾经遭受过创伤的人很可能会在临终的梦境中再度体会到那些伤痛。有些人可以泰然处之，不会为之所困扰。有些人则做不到。
When should doctors intervene with antipsychotic or anti-anxiety medication, to best allow the patient a peaceful death? For the Hospice Buffalo physicians, the decision is made with a team assessment that includes input from family members.
医生应该在何时采用抗精神病药物或抗焦虑药物等手段进行干预，从而尽可能地令患者在平静安详中渡过人生的最后时光呢？水牛城临终关怀中心的医生们认为，这种决策应通过团队评估来达成，包括患者家属提供的信息。
Dr. Kerr said: “Children will see their parents in an altered state and think they’re suffering and fighting their dying. But if you say: ‘She’s talking about dead people, and that’s normal. I’ll bet you can learn a lot about her and your family,’ you may see the relative calming down and taking notes.”
克尔博士说：“儿女们发现父母处于异常的精神状态下，会觉得他们是在痛苦地与死亡抗争。但如果这时你告诉他们：‘她是在与故去的人交谈，这很正常。我敢打赌你能从中了解到很多关于她以及你的家庭的事情，’说不定家属们就会慢慢平静下来，还会做记录。”
Without receiving sufficient information from the family, a team may not know how to read the patient’s agitation. One patient seemed tormented by nightmares. The Hospice Buffalo team interviewed family members, who reluctantly disclosed that the woman had been sexually abused as a girl. The family was horrified that she was reliving these memories in her dying days.
如果不能从患者的家人那里获得足够的信息，团队可能就无从解读患者焦躁不安的根源。有一名患者一直噩梦缠身。水牛城临终关怀中心的团队约见了他的亲属，他不情愿地透露，患者在少女时代曾遭受过性侵。她在临终之际又一次陷入了这些记忆，令她的家人惊骇不已。
Armed with this information, the team chose to administer anti-anxiety medication, rather than just antipsychotics. The woman relaxed and was able to have a powerful exchange with a priest. She died during a quiet sleep, several days later.
获得了这一信息，团队选择给患者使用抗焦虑药物治疗，而非单用抗精神病药物。这名患者放松了下来，也可以与牧师进行有效的交流了。几天后，她在平静的睡眠中逝世。
This fall, Mrs. Brennan, the nurse, would check in on a patient with end-stage lung cancer who was a former police officer. He told her that he had “done bad stuff” on the job. He said he had cheated on his wife and was estranged from his children. His dreams are never peaceful, Mrs. Brennan said. “He gets stabbed, shot or can’t breathe. He apologizes to his wife, and she isn’t responding, or she reminds him that he broke her heart. He’s a tortured soul.”
去年秋天，护士布伦南照料一名终末期肺癌患者。他以前是一名警官。他告诉她，他在工作时“干过坏事”，还说自己曾对妻子不忠，孩子们都疏远他。他的梦都不平静，布伦南说道。“他梦见自己被刀捅、被枪击或者无法呼吸。他向太太道歉，但她没有理会他，反而提醒他是怎样伤透了她的心。他的灵魂备受煎熬。”
Some palliative care providers maintain that such dreams are the core of a spiritual experience and should not be tampered with. Dr. Quill, who calls people with such views “hospice romantics,” disagreed.
有些姑息治疗提供者认为，此类梦境是患者精神体验的核心内容，不应该被打扰。奎尔博士不赞同这种观点，称这些人是“临终关怀浪漫主义者”。
“We should be opening the door with our questions, but not forcing patients through it,” Dr. Quill said. “Our job is witnessing, exploring and lessening their loneliness. If it’s benign and rich with content, let it go. But if it brings up serious old wounds, get real help — a psychologist, a chaplain — because in this area, we physicians don’t know what we’re doing. ”
“我们应该用提问来打开患者的心门，但不可以强迫他们，”奎尔博士说。“我们的工作就是见证、探索并减轻他们的孤独。如果梦境内容丰富且无害，就不用管它。但如果它揭开了惨痛的旧伤疤，就需要有心理学家或牧师提供切实的帮助——因为我们这些普通医生并不了解这个领域。”
In the first dream, a black spider with small eyes came close to her face. Then it turned into a large black truck with a red flatbed, bearing down on her. Terrified, she forced herself awake. In another dream, she had to pass through her laundry room to get to the kitchen. She glanced down and saw about 50 black spiders crawling on the floor. She was so scared! But when she looked closer, she saw they were ladybugs. She felt so happy! “Ladybugs are nice and I knew they weren’t going to hurt me,” she recounted later. “So I made my way to the kitchen.”— Rosemary Shaffer, 78, two months before she died of colon cancer.
在第一个梦里，一只长着小眼睛的黑蜘蛛爬近了她的脸。然后，它变成了后挂一辆红色平板拖车的黑色大卡车，朝她轧过来。她吓坏了，惊醒过来。在另一个梦里，她必须穿过洗衣房到厨房去。她低头一瞥，只见有大约50只黑蜘蛛在地板上爬。她害怕极了！但是，等她细看端详，才发现那只是些瓢虫。她顿时又觉得庆幸不已！“瓢虫还好，我知道它们不会伤害我，”她事后回忆道。“所以，我顺利地走进了厨房。”——78岁的患者罗斯玛丽·谢弗(Rosemary Shaffer)在因结肠癌去世两个月前的讲述。
The Hospice Buffalo researchers have found that these dreams offer comfort not only for the dying, but for their mourners.
水牛城临终关怀中心的研究人员发现，这些梦不仅抚慰了垂死之人，受益的还有为他们哀痛的人。
Kathleen Hutton holds fast to the end-of-life dream journals fastidiously kept by her sister, Mrs. Shaffer, a former elementary schoolteacher and principal. Rosemary Shaffer wrote about spiders and trucks, and then the ladybugs. In one dream, she saw flowers at a funeral home, which reminded her of those her daughter painted on handmade scarves. She felt loved and joyful.
凯瑟琳·赫顿紧紧握着她的姊姊、曾经担任小学教师和校长的谢弗的日记，她在日记里一丝不苟地记录下了自己的临终梦境。罗斯玛丽·谢弗写到了蜘蛛和卡车，然后还有瓢虫。在一个梦里，她看到了殡仪馆里的鲜花，这让她想起了女儿在手工围巾上描绘的花朵，令她感到爱和欢悦。
“I was glad she could talk about dreams with the hospice people,” Ms. Hutton said. “She knew it was her subconscious working through what she was feeling. She was much more at peace.”
“我很高兴她能和临终关怀中心的人说起自己做的梦,”赫顿说。“她知道这是她的潜意识通过她的感受在起作用。她变得平静多了。”
Knowing that has made her own grief more manageable, said Ms. Hutton, who teared up as she clasped the journals during a visit at the hospice’s family lounge.
在造访临终关怀中心的家庭休息室时，赫顿拿着这些日记，落下泪来，她说自己会好过一些。
Several months ago, Mrs. Brennan, the nurse, sat with a distraught husband, whose wife had pancreatic cancer that had spread to the liver. She had been reporting dreams about work, God and familiar people who had died. The patient thought that she would be welcomed in heaven, she said. That God told her she had been a good wife and mother.
几个月前，护士布伦南坐在一名悲痛欲绝的丈夫身边，他的妻子患了胰腺癌，已经扩散到肝脏。她说自己一直梦见工作、上帝和过世的熟人。布伦南说，患者认为自己会在天堂受到欢迎。上帝告诉她，她是好妻子、也是好母亲。
“Her husband was angry at God,” Mrs. Brennan said. “I said: ‘But Ann is not. Her dreams aren’t scary to her at all. They are all about validation.’
“她的丈夫却很生上帝的气，”布伦南说。“于是我说：‘但是安(Ann)的心中全无怨愤。她的梦境一点也不令她感到恐惧。它们都充满了对她一生的认可。’
“He just put his head down and wept.”
“他垂下头，哭了起来。”
