Minter Dialogue with Dr Chris Kerr

Dr Chris Kerr is a hospice physician and end-of-life researcher. He’s also the acclaimed author of “Death is But a Dream” as well as one of the most viewed TEDx speakers, with over 5 million views for his talk, “I See Dead People: Dreams and Visions of the Dying.” In this conversation, we discuss his work, what he has observed about people dying and death, the way the medical community evaluates and embraces (or doesn’t) death. We look at the difference between psychedelic-assisted therapy to deal with fear of death versus the types of the visions one has naturally. We touch on assisted suicide and euthanasia, as well as explore the major lessons Dr Kerr has extracted over the course of his fascinating 25+-year career.

Please send me your questions — as an audio file if you’d like — to nminterdial@gmail.com. Otherwise, below, you’ll find the show notes and, of course, you are invited to comment. If you liked the podcast, please take a moment to rate it here.

About Dr Chris Kerr:

• Find his eponymous site here
• You can find his documentary film, Death is But a Dream on PBS
• Check out his TEDx talk, “I See Dead People: Dreams and Visions of the Dying” here
• Find/buy Dr Chris Kerr’s book, “”Death is But a Dream,” here via Amazon

Other mentions/sites:

• “Being Mortal” by Atul Gawande: here
• The Hippocratic Oath

Further resources for the Minter Dialogue podcast:

Meanwhile, you can find my other interviews on the Minter Dialogue Show in this podcast tab, on Megaphone or via Apple Podcasts. If you like the show, please go over to rate this podcast via RateThisPodcast! And for the francophones reading this, if you want to get more podcasts, you can also find my radio show en français over at: MinterDial.fr, on Megaphone or in iTunes.
Music credit: The jingle at the beginning of the show is courtesy of my friend, Pierre Journel, author of the Guitar Channel. And, the new sign-off music is “A Convinced Man,” a song I co-wrote and recorded with Stephanie Singer back in the late 1980s (please excuse the quality of the sound!).

SUMMARY KEYWORDS: dying, patient, life, psychedelic, experience, talk, visions, death, lost, loved, fear, doctor, people, physician, work, feel, happen, thought, conversation, medical

SPEAKERS: Dr Chris Kerr, Minter Dial

Minter Dial  00:04

Dr. Chris Kerr, I am so happy to have you on my show. You’re the second Kerr on my show. But you have a unique story, a unique perspective and one that the world needs to hear. So, in your own words, how would you like to describe who is Dr. Chris Kerr?

Dr Chris Kerr  00:23

Oh, gosh. I guess I’d start off by saying, I’m a physician that specializes in hospice and palliative care for the last 25 years. And, as an aside, I also have a PhD in neurobiology. So, I have a research background and started researching the subjective experiences of dying, probably 15 years ago.

Minter Dial  00:50

What is remarkable about your trajectory, Chris, is that you started off as a physician. And you really talk very much about the way the medical community, the medical training, tends to avoid the topic of death. And what you did after you had the experience of your father’s passing, is that you really lent into death. Can you talk us through that journey from, let’s say, being a typical physician, to somebody who has another regard for and a need to talk about death?

Dr Chris Kerr  01:27

Yeah, I actually I leaned away from it. I was in the traditional mainstream of medicine, and was absolutely enamored with acute care, loved emergency rooms, loved the intensive care unit, loved cardiology, and this was more an accident. I was just moonlighting to support my family at hospice, but completely untrained, and not knowing what to do. And so, I started working here on weekends, periodically. And that really forced me to be a different type of doctor, to be present, to worry less about what I was doing to somebody, but who I was to somebody. And the contrast between swinging from cardiology to a hospice inpatient unit was striking, but enriching, and meaningful. So, I changed paths. And it’s 25 years later, I’ve never looked back.

Minter Dial  02:26

It strikes me that maybe, this is my opinion, that at the core of the issue is the Hippocratic Oath. I’ve read it, and or at least I’ve read portions of it to the best of my abilities in English, of course. And it seems that the idea of saving patients and ensuring everything to avoid them dying is what being a doctor is all about. Yet, what you have done is sort of gone the other side and looked at how to accept it and to make it a comfortable experience. Is that a fair statement?

Dr Chris Kerr  03:01

No, actually, the Oath says something entirely different. The intention and promise of the Oath is beautiful. It’s two sides of the sword, and one side’s been dulled. So, the promise is to treat where possible, but to comfort always. And what’s happened as technical medicine has evolved, an origin-based approach to human suffering has taken over. We’re obsessed with the intervention and acts of doing and when you are no longer deemed curative. First of all, we have a hard time recognizing that. And so, we’ve gotten more and more uncomfortable with our role as physicians, as being comforters. So, we’re fine, as long as we’re in a system that allows us to be interventional and to bill. The whole economics of health care is built along… it’s not enough to be suffering, you need to do. It’s transactional. And what that’s done, it’s created miracles on one hand, but it’s forgotten the totality of the person, and particularly their experience. And when you are deemed no longer cured, which occur in the Western world, you kind of fall off the cliff, you go from getting a million-dollar treatment in a comprehensive cancer center, and then when you’re low longer responding to treatment, you kind of fall off this cliff. So, the patient is seen as much as they’re not dying. And of course, the irony is, when they need help the most, there’s often the least amount to be received.

Minter Dial  04:47

Beautiful, thank you for the correction. And, I wonder to what extent this falling off the cliff, or this disruption, the transactional element, is more societal or medical school-led, if you will?

Dr Chris Kerr  05:03

Oh, it’s such a good point. It’s both. On the medical school side, absolutely. We have become enamored with technology. And, they’ve done studies looking at how often the word dying is used in medical textbooks, and it’s rare. In fact, when I was a resident, we would have somebody on our teaching service. And when they were deemed dying, we would sign off, because there was nothing more to learn. So, we institutionalized patient abandonment, as part of our educational system. As a society, we’re obviously ageist. We’re death denying. We’re consumers of health care. There’s always this notion that there’s something you can do about something. And we’ve sterilized dying. You know, people used to die in their homes with their families, in a village. There’d be ceremonies around it and whatnot, and there were remembrances. And now you kind of go off somewhere, and you die in a unit, in a cold and dehumanizing space. So, you’re right, it’s both.

Minter Dial  06:18

As you said, in your speech, your amazing TEDx speech, there are two things people fear the most death and public speaking. So, I’m a public speaker, you’re a death specialist. But this notion of society’s ageism, and the billions of dollars that are being poured into anti-aging, anti-senescence, immortality, it seems like an illness in itself.

Dr Chris Kerr  06:46

Yes. And one that we can’t evade. And I often see when the biology meets reality, and people get to that inevitable point, it’s hard to age gracefully in the Western world.

Minter Dial  07:04

I think that the problem can also be existing in other countries in the East, where we only have one or two children. Whereas before, we might have had 10. It was like if you had a football team, well, soccer team, and one or two die, and oh, no biggie, whatever. Now, you have one or two, and they are obviously precious, and made out to be sort of godlike sometimes at the at the dinner table. So, it’s all about them as opposed to us and community.

Dr Chris Kerr  07:40

Yeah, very much, right.

Minter Dial  07:44

So, in one of the sentences I extracted from your TEDx, you said “in our culture, the richest and most thoughtful discussions have always come from the humanities and never medicine, but from poets, playwrights and philosophers.” And I was wondering, what kind of reading you do that inspires you, and the types of poets playwrights that that you enjoy reading?

Dr Chris Kerr  08:12

Gosh, it’s a wide range. I’m a huge John Steinbeck fan. I grew up on Shakespeare. Yeah, I, I think that in the humanities, they ponder existence, they ponder the soul^. And so, they bring life to those dimensions, in a way medicine, at least modern medicine, can’t. So, the base of the research was, I was trying to teach this to students, and we live in an evidence-based time and they would, of course, say, well, there’s no evidence for it. And there was some truth to that there was anecdotal case studies, and third-person reporting, but it was rich in the humanities, it’s rich within other cultures. So, it’s in the Bible. Citizen Kane. That that’s where the experience of subjective elements of dying are discussed and pondered.

Minter Dial  09:28

One of the things is going back to the medical community that we were talking about, and it struck me, was that you make a line somehow between doctors and nurses in their experience or regard on death?

Dr Chris Kerr  09:44

That’s very perceptive. Yes. I learned this the hard way because it was nurses who taught me on this subject. The closer you are to the bedside. So, in less of a transactional way, a bit more present around the model of caring, rather than rounding, let’s say rather than spot welding, the more likely you are to have a deeper appreciation for what the patient feels. What they see what they fear. All these other elements that nurses capture so beautifully. So, what I find is when I lecture to a group of nurses — I’ve had this happen the same day — the audience is all shaking their heads. I’m not really telling them anything they don’t know. Because I’ve discovered nothing. I’ve just shot a light on something that’s always been known but lost. I mean, it’s still held on to in other cultures, indigenous people around the world these days. Whereas doctors who are more and more, only live in the sphere of the objective, don’t appreciate what can’t be biopsied or imaged or quantified. They’re more, you know, as I mentioned, they’re more comfortable with the brain than the mind. And so, feeling is something you compartmentalize off to spiritual care or psychiatry, but it’s not within the toolbox, necessarily, of the physician. But if a nurse is doing their job, and they’re present, and they’re hearing what the patient has experienced, they tend to grasp this.

Minter Dial  11:23

I’ve done a few rounds with doctors. And what struck me was that, in the rounds that you do, especially when you’re in a university or learning environment, you spend a lot more time off the ball than on the ball. And what I mean by that is talking outside the patient’s room, conferring and talking, and then only a few minutes, actually, at the bedside.

Dr Chris Kerr  11:47

Oh, my God, you’re so right. I never thought of it that way. Well, it used to be worse in a when in a paternalistic version of a male-dominated medical culture. That extended to the point that there was one conversation with the patient that was fictitious, and one conversation outside of the patient’s room that was accurate. So, when I started, it was not uncommon to get on the phone with a doctor. And the doctor said, you know, yeah, well, I know she’s dying, but I don’t want to take away hope. You know, meanwhile, it’s that person’s life to negotiate and to understand. And, you know, you’re not protecting them from the reality. They figure it out. It’s their body and their life. But what you’re doing is you’re taking away their ability to choose what information they have access to. But yeah, you’re right, yeah.

Minter Dial  12:46

There are many cultural differences to death. And so, in France, I have a memory of someone near to me, who had terminal cancer. And rather than tell the patient, they told his son, because they wanted him to stay with hope, the father, and then the son had to deal with the mechanics and the logistics.

Dr Chris Kerr  13:14

Well, yeah, that never works. Because you can’t be protected from your own reality. Even if you look at our work, they become self-informed. We’ve seen this with children who they often haven’t had that discussion around mortality. They don’t have reference points, but their end of life experiences inform them as they go. I once had a patient who was dying, who asked to go to rehab so he could get stronger, so he could confront the physician who had lied about his status. Because it had so many practical implications. He had told his daughter from California not to fly in. He owned a company, he wanted to have this party where he was going to make all these speeches. And he was deprived the ability to manage the own trajectory of his last days of life, because a doctor felt he could deceive him from the reality. And the reality is, the people who die worse are the people who are not prepared. The people who die best still hope for cure, hope for recovery, but also prepare for the worst. And people can do those two things at once, and they can do them well. Where this becomes important is not just for the patient, but for the family. So, a young parent, I’ve seen this many times who didn’t know until the very end and had lost that window, to have those very important conversations with dependent children to bring in counselors or religious figures into their life. All that gets lost. There are practical considerations that people get deprived of all the time. And if you look at the prognostication data, it’s horrible. You know, they’re off by a factor of two to three, erring on the side of longer. And, unfortunately, what they do is they’ll tell you when you’re going to die, but not how you’re going to die. So, you may live six months, but you may not know that four of those months, you may be bed-bound and need help. It’s not like you’re walking along, and you fall over. There’s a decline.

Minter Dial  15:24

One of the things that’s most mysterious to me is knowledge of when I’m going to die, or at least that I’m dying. You know you can have the hypochondriac saying, oh, you know, I’ve got a cold, I’m going to die. There are some people may have an illness and believe they’re going to die, and maybe that then foreshadows what’s going to happen, or at least it’s a self-fulfilling prophecy. To what extent does someone who is dying, have a better grasp than you as a doctor. When can that happen?

Dr Chris Kerr  16:05

Oh, often. It’s fascinating. Typically, the older they get. Because you accept the inevitable differently if you have less dependent lives around you, as opposed to the young parent who can deny the reality. Oh, but it’s very, very common that they self-inform. It’s their body, you know. They used to be able to go up the stairs, now they can’t. Then they used to be able to get their mail. Now they can’t. They want to nap more. They don’t feel like eating the same amount. They look at their arm, and it’s half the size. So, they know. Illness has this way, at its root, of pulling you to rest and to sleep. And people interpret that. They know what that means. And some people welcome it, particularly if there’s been a struggle within an illness. And it feels better to do less. So, they often are able to extrapolate. It’s funny we’re having this conversation because today was the first time in 10 months least that I had somebody who was truly unaccepting and they’re actively dying, they’ll probably be dead by tomorrow. And it was very interesting because they had signed on for a naturopathic management, which is often like joining a cult because there’s not a lot of evidence necessarily, but you’ve got to have full and complete devotion and faith, which is great as an additive treatment. So, she had gone on to this naturopathic room, and she’s actively dying, the family feels robbed, because they didn’t have any conversation. But it’s rare.

Minter Dial  17:50

So, I’d like to zero in on this notion of conversation. The society rejects it, denies it. Medical school never talks about it, also denies it somehow. And it can be difficult for somebody who’s not dying to be talking with someone who is dying. For a lack of words, you don’t know what to say. It’s the same for grieving, you know, if someone loses something very close, I’m sorry, condolences. But you feel awkward. What kind of advice would you have for individuals who have someone close to them, who is dying? What roads into it? I mean, obviously, you talk about the idea of visions. That seems like an interesting topic. But what’s your approach to that conversation?

Dr Chris Kerr  18:37

It’s a great question. Thank you. Well, first of all, we tend to sterilize the dying, to put them on the shelf and treat them like they’re frail and fragile. And the truth is, and dying patients will tell you this, dying is lonely, and it’s isolating. And we don’t need to make it more isolating by not engaging. It’s shocking. When we went to do this study, the university didn’t give it approval, at first, because they thought, “Oh my gosh, the patients are dying, you can’t intrude.” And I said, how many of you have actually cared for anyone dying. I said, they’re lying in bed, they’re looking at a white ceiling. And what they want to do is connect and to feel human. So, when everyone has an instinct to keep it a distance, actually what they want to do is feel less lonely, to feel connected, that their words matter. So, in our effort to humanize, we need to relate, not distance ourselves. And I think there’s this tendency to over inquire about how people feel and everything. They get a lot of that, right? I don’t meet many people who, except for the hypochondriac, who want to be seen, identified or defined by illness. They want to talk about other things. Things that make them feel human again, connected and mattering. So, I think that’s the best thing is to be less fearful, to get closer, not farther from the bed. And to engage with as much normalcy as you’re capable of doing.

Minter Dial  20:29

I love this word mattering. Professor John Vervaeke, he talks about the importance of mattering today. And the end of the day, relationships are the most important thing. And it sparks a thought, Chris, which in this transactional world, there are those who might say, “Oh, she’s dying, there’s no worth buying her present for Christmas.” A reduction to the most transactional, consumerist of methods, where we don’t know how to do anything else. You don’t know how to do the relationship thing. Or what worth is it to make her smile today, right now she’s going to die anyway.

Dr Chris Kerr  21:14

But let me contextualize this a little bit. So, when we were doing our studies, we’ve done probably seven or eight. The initial thought was people wouldn’t want to participate. And they certainly didn’t want to be in a video. So, we videotaped a lot of people. That’s what became part of the Netflix series and the PBS documentary, as they thought, well, you know, they’re disfigured, they’re ill-appearing, whatever. And what happened was the opposite. Almost, with very few exceptions, did anyone not want to participate in the study. These are people sometimes days away from death. And this is what gets lost is: the thought is, well, there’s no secondary gain. They are never going to read it, they’re never going to see it, they’re never going to be congratulated, recognized anything, no attaboys. But what happens with dying is that hope transitions, meaning transitions. So, it transitions from hopes of cure, to hope for others. So, the idea that people thought they were contributing, was enough for them to muster all their strength, to try to put their makeup on, smile, talk to the camera, and contribute right up until the last days. And I just think that’s such a beautiful story. So, I think we need to worry less about what second secondary gain there is, the Christmas that’s not going to be seen, what have you. But again, it just goes to the fact that they want to matter. And they still see worth in contributing. But, I just think it’s an amazing story that really everybody wants to… and the university had predicted the opposite. Because we had a large number of people we wanted to capture. And they thought, oh, we’ll never do that. And we did, very easily.

Minter Dial  23:11

You said, in your TEDx, “end of life experiences not only tied to our personal meanings, but they are tied to some of our greatest needs. The need to love to be loved, nurtured, forgiven.” And in those elements, there’s this other. The need to be loved by others, the need to nurture others.

Dr Chris Kerr  23:27

Yes. You know, life, as you’re dying gets distilled into what matters. And what matters most is our greatest achievement, which is our relationships. And that’s all. When you first get diagnosed, there are fears and there are practical concerns. You know, as you get closer to death, you’re not worried whether where your car keys are, what your tax bill is. It’s a vantage point that changes your perception and your perspective, and your focus. And you draw on the things that mattered most from living. And time seems to go away and you become very reflective, naturally.

Minter Dial  24:18

Present.

Dr Chris Kerr  24:20

Yes. Yeah. Right. Yeah.

Minter Dial  24:25

You mentioned loneliness before. And I wonder to what extent, the issue with death is also the issue that society has with death. It’s a reflection of the epidemic of loneliness that we have all along our lives these days. There are many studies that show that we are completely lonely despite being fully connected in today’s world. And mental health conditions are spiraling. If you’re a CEO, it’s one of the loneliest jobs out there, we end up being lonely in our lives. And then all that to end up lonely at death.

Dr Chris Kerr  25:06

But I think that the dying don’t feel … I think illness is lonely. I’m not so sure as you get closer to the end they’re still so lonely. Because, you know, the vast majority of people that we study are experiencing these things and they end up feeling very connected, maybe not to people that are present in front of them, but people who they’re thinking about. We saw this during COVID, because the fear was, you know, there they are separated from humans that they love. But if you actually talk to the patients themselves, when they’re my eyes were closed — and dying is progressive sleep, right? People don’t die awake, they just sleep more — they report a very different experience. You know, they’re bathed in memories, and recollections and remembrances. I think they leave us more connected than alone.

Minter Dial  25:56

And then there’s this whole topic of the visions that we have. I want to dive in on that in a moment. But recently, I was just talking to my wife about how, for her great aunt, the doctor said, “Oh, she’s delusional,” just before dying. And and when I talked about your concept of visions, she said that’s totally true. So, it felt real. But it was sort of shocking that the doctor would say, oh, delusional. She you know, she’s flipping off, she’s talking about dead people who don’t exist anymore, which is pretty much all your topic. And the topic I’d like to sort of segue into is hallucinations. Because today, I work a lot in AI and they always talk about how Artificial Intelligence hallucinates. But I also like to talk about psychedelics. And there’s a whole lot of body of work on how psychedelics help with fear of death. And I was wondering to what extent that’s part of your work and the idea of visions and psychedelic hallucinations? Is there any relationship in there?

Dr Chris Kerr  27:02

Oh, yeah. In fact, we’re working on part of a documentary that’s been done by a two-time Emmy Award winner an Academy Award nominee. And they were working with indigenous people on something else, found out their beliefs around dying, and then she read my book. And then she phones me and says, you know, these guys have language for this? Oh, yeah. I know, I didn’t discover this^. And so, she’s pairing that with our work. That led into the psychedelic space^. And so, they’ve done some fascinating work, where — I wish I could share the trailer, it will be out at Sundance in 2025 — but they gave psychedelics to dying patients. Absolutely, it addressed their fear and it gave them a whole new view. And the indigenous have been doing this forever. We are involved in some work, here. The problem, in the state I’m in which is New York, we’re very behind^. And so, there’s three pieces of legislation in front of the state to make it more legal. So, the work that’s done here is underground. So, I’m not directly experienced with it, but indirectly through the film, and obviously, through talking with others. It’s the experiences are very similar to what happens endogenously, at the end of life for people. I think they’re amped up a little more, a little more colorful. But yeah, they’re similar.

Minter Dial  28:42

I interviewed a friend who runs a ketamine-assisted therapy session in New York City. So, hopefully, we’re getting there.

Dr Chris Kerr  28:52

I’ve been doing ketamine for 20 years. Ketamine we do. I just took a patient off of it last week, after seven days. We use it as a as a treatment for pain and opioid tolerance. Secondarily, it manages very well existential or psychogenic distress. The problem with the ketamine clinics and everything, is the effect is brief. Not sustained.

Minter Dial  29:17

Yeah, the whole notion of integration is the challenge, right?

Dr Chris Kerr  29:21

Yeah. But it gets people, typically people who are severely distressed, back into a workable space.

Minter Dial  29:30

That’s progress.

Dr Chris Kerr  29:31

Yeah.

Minter Dial  29:32

And in terms of the visions that you talk about how, as we get closer to death, we have these visions that are reconciling ourselves with past problems, maybe a lot of visualization of people who we’ve missed, who have died already, and those type of visions. To what extent is there a correlation between the psychedelic visions and those type of non-psychedelic visions. Are they just a colorful version of seeing my dead mother again or other dead person from my past?

Dr Chris Kerr  30:06

No. The psychedelic version is turbocharged. The end of life dreams and visions are pure in the sense that they don’t include great pronouncements and epiphanies, right? They’re sitting around the kitchen table with those you’ve loved and you’ve lost. It’s seeing the dog from your childhood. It’s self-explanatory. It feels natural. The psychedelic-charged experience opens up channels of consciousness and awareness that, it’s like an acid trip, in the sense it’s powerful stuff. It’s colorized. You come out of it with the same therapeutic experience, in that it’s relieving. It’s comforting. It’s insighting for you. Something happens, but they’re different. They’re very, very different.

Minter Dial  31:06

The way I’m interpreting that, Chris, is that you’ve got the one, which is the conversation around the table in the kitchen, which is sort of simple. And the other one, which is a million thoughts at 100 miles an hour, in multicolor. That’s the acid trip, which is just too many things. And it’s far less simple in that respect.

Dr Chris Kerr  31:27

Yes, yes. And, you know, I’ve never had a patient come out of end of life experiences and ask, what does this mean? Like, there’s no… the time for therapy is over. There’s no work to do. If you lost your mom, when you were a child, and you see your mother, that’s self-explanatory. And it’s yours. So, there’s no interpretive work. There’s no work at all. It’s a very peaceful, soothing process that doesn’t require additional input. Whereas, I think people sometimes, like near death experiences, which is kind of fake dying, I think they come up with all sorts of puzzles need to change or proselytize or whatever, right? That’s very, very different than people who are actually died. It’s more passive, and more obvious. And I think the psychedelic ones, it’s some heavy, heavy stuff. I mean, you’re opening aspects of your mind that you weren’t aware of.

Minter Dial  32:29

You can’t control?

Dr Chris Kerr  32:31

No, no. And that’s a little worrisome, in a way. I mean, one of the problems when the sort of drugs emerge, less from a scientific way, as you know, what’s the quality? What’s the dosing? Who’s a good candidate? Who’s not a good candidate? So, I’m talking to people who’ve done this for a long time, and they’re seeing some potential for misuse?

Minter Dial  32:56

Of course, yeah. That’s no doubt. I’m interested, of the different cases you talk about that, this visioning happens when you’re young as well. You talk about a 10-year-old boy, who has his vision and it synchronizes with the death of somebody that he didn’t even know had died. I think that’s the story. But I was shocked. You did mention before that sometimes younger people will have different types of existential issues about dying versus an older person. But this vision idea, these visions happen, even in the younger people.

Dr Chris Kerr  33:40

Well, they do it better. It’s the same way that people who are neurologically different, cognitively different do it better. Well, because there’s no edification. Children can imagine better. For example, they don’t distinguish between the animal and the human world in the same way. A doll

Minter Dial  34:01

Puppets.

Dr Chris Kerr  34:02

Yeah, yeah. Right. And, then they’re also not fearful of ridicule or judgment. So, they ease back and forth. The children that we’ve studied and filmed, are the most impressive. They’re not worried about judgment. So, it just comes out naturally. Right? They tend to do it better. And we’ve seen the same thing with the demented, people who have pretty advanced dementia, almost having had an easier access to this.

Minter Dial  34:33

I want to get into this other topic which is assisted suicide and euthanasia. Because at the end of the day, this is less natural, at some level. What is your opinion on that area? Of course, it depends. There’s a legal issue in here, but from a societal standpoint, there are many countries that have gone much further along the path of allowing it. I’ve seen the disadvantages of not having the option for that, in terms of end of life, quality of life. What’s your opinion on that? I want to get into the vision portion after that.

Dr Chris Kerr  35:18

I’m Canadian. So, it’s pretty far evolved in Canada. So, I have a lot of friends, loved ones. But I live in the United States where it’s a very different view. I’ll tell you what, we were sitting at a medical meeting of palliative care doctors, there was probably 200 years of experience taking care of complex ill and dying patients, and between us, we maybe had five patients in our careers who had asked for a hastened death. And so, there’s a disconnect between the mainstream culture’s discussion of this as an issue and those of us who actually do this work. And one of my concerns is that how many people who choose this as an option have not received good palliative care. Because we see an enormous amount of suffering, and it’s really is a failure to treat. So, there’s not many symptoms that we can’t get an upper hand on. So, I’m struck by how is it that those of us who have lived this day-to-day don’t hear this much, but it’s so common in the literature, so common in the portraying outside of us. So, that I worry about. All throughout that, where I fall is patient autonomy. I have trouble with it as a doctor here, because I think I need to be respectful of everybody’s view, including those that may have a religious commitment that’s different from ours. So, I’m very reluctant to make a policy of it for us here. But at the same time, I respect individual choice. I am just fascinated that we don’t see it in practice. There is disease exception for me, personally. And I’ll give you an example of what it is. It’s ALS, Lou Gehrig’s disease, because that’s a disease where you can anticipate what lies ahead, right. So, you’re having escalating loss of function, including the ability to swallow, protect your airway, speak. And, I think that’s there is no lessening of that symptom burden. And psychologically, I can understand that not meeting the criteria of any quality of life for somebody. So, I don’t think we should look at disease as a monolith. I think we need to appreciate patient autonomy. Ultimately, it’s their life, you know. But I just think the caveat should be, you know, is this unmanaged, malignant depression? Is this pain that hasn’t been properly addressed? You know, is this nausea that’s unremitting? Has everything been done? We see so much poor symptom management, that it makes me worried, you know, who’s out there, and why are they suffering so much?

Minter Dial  38:29

Well, would you not also add into that mismanagement, how families manage around without knowledge of it, fear of death. And it makes me think of [Atul] Gawande’s book, “Being Mortal,” how, even as a doctor, he was less good at managing his father’s last ways. And sometimes, selfishly, as a child, “Oh, I wish you would live on for longer. I want you to see my, my babies.” They are grandparents, you know, I want you to do this as opposed to the other person who’s dying.

Dr Chris Kerr  39:01

Yeah. Oh, absolutely. But some of those conversations need to be brokered. So, we do a lot of that. And there’s a lot of miscommunication between what the patient’s experience and what the families see. So, that’s but that’s one of the objectives of palliative care is synthesizing the case, understanding the wishes and fears of the patient, understanding where the family is, are they and are they plugged in properly? A lot of it too, I should mention is that, the process of dying is so poorly addressed, that it’s a void that is filled with fear. When in reality, if you saw most of our dying patients here, they’re sleeping comfortably. They’re not medicated-induced sleeps, but their symptoms are managed. Oftentimes, it’s not sexy things like you know, their bladders emptied and they’re not constipated anymore. Their cough is controlled. But I think that because it’s not addressed, very few people come in here, knowing what to expect. So, one of our first interventions, is having discussions around what this process looks like. And you can watch people just go, “Oh,” because they just assume the worst and their experiences of illness is often bad. So, they project out, that dying is going to be far worse. And usually, it’s quieter. Nature takes care of this pretty well.

Minter Dial  40:34

So, I’ve had the extraordinary experience of talking to two individuals who were sentenced to death, and actually executed, except they survived the execution, Oh, and one in Iran and one in the Ukraine. And, then there’s the other one, the assisted suicide where there is sort of a premeditation of the death. There are also near-death experiences. And all along those, I was wondering to what extent visions might happen, when it’s more like forced, or unexpected at some level, you know, like the car accident, the kills you just is there? Do you think there’s flying through visions as you’re dying?

Dr Chris Kerr  41:19

Totally, I mean, it’s impossible to study. But, you know, the expression, “My life flashed before my eyes.” When George Floyd was having the air squeezed out of his chest, he calls out for his mother. Men in the battlefield were often crying for parents, not there. So, I think there’s a suggestion that even in the case of acute or subacute dying,, that they’re plugging into something. They’re flooded with something experiential that we don’t necessarily know or appreciate. It’s great question.

Minter Dial  42:01

I just have two last questions, Chris. One is sparked from your presentation when you were talking about this World War II veteran, John, who was in Normandy. And I’ve done a documentary film myself from the Second World War, and interviewed 130 veterans of the Second World War, most of whom were prisoners of the Japanese. And the link I have is this notion of humility. Not that they were all Humble Pie. But there was a greater sense of humility and community, it feels, in the past. Maybe it’s romanticized. And to what extent that sense of humility and community is a greater gateway to accepting death as opposed to the type of narcissism, loneliness, and fear that seems to be predominant today.

Dr Chris Kerr  42:53

Oh, absolutely. That’s very well said. I wouldn’t have used the word humility, but something humanizing takes place. The layers become removed. There’s something in the process of becoming ill and dependent, losing physicality losing autonomy, that forces you to stop, to consider, to reflect. You end up in a very different place, perspective-wise, when you’re no longer in control. I think that’s an awful lot of it.

Minter Dial  43:33

So, the last question, Chris, is where do you sit now, with regard to your own mortality? I have to imagine you’ve reflected on this. And, do you imagine yourself taking a bunch of psilocybin, moving in towards the last steps? So, how do you approach? What have you learned, for yourself, from your entire bank of experience?

Dr Chris Kerr  43:59

Oh, well, I’m a cancer patient. So, I can tell you that being a hospice doctor, and also a cancer patient that I’m as scared shitless as the next person. The issue is not, I’m doing better, but in the dark moments, around diagnosis, etc, that my concern wasn’t myself. My concern was that I had people who depended on me, whose lives are incomplete with me^. And so, that strikes a trauma that’s hard to put into words. So, there’s that. The actual processing of dying doesn’t make me fearful. So, where I end up is thinking there’s a better story. I’m not religious. We don’t do this work looking through a keyhole into afterlife or paranormal. But after doing it for so many decades, you can’t help but recognize that the love and meaning that we’ve experienced for having lived, seems to be accessible to us, to the very end. And the things that really secured us, and loved us properly, are still there. And so, we see it all the time, people who have lost someone from eight decades ago, still feel their presence. So, I think there’s something there. We’re put back together in a way that’s very beautiful. And what I’m struck with is the absence of fear. You see in our videos, you know, we videotape a lot of patients, the biggest takeaway is the absence of fear. This whole notion of you know, fighting, the dying of the light is for people who aren’t yet sick. So, perspective changes. So, yeah, I am not fearful of the dying. Just not now.

Minter Dial  46:06

There’s also the epigenetic elements. Sometimes, it passes along. I have to imagine, Chris, that in your conversion to hospice care, and the entire message that you’re bringing out to the world, the work you’re doing, the book, the documentary, that must be very fulfilling and meaningful for you. I mean, at another level, than just being a physician,

Dr Chris Kerr  46:31

Yeah, it is. What’s interesting, it’s kind of a funny story. So, this work was all meant for a medical audience. We film patients, because we thought we knew people would have preconceived notions that these were feeble-minded, frail people who lost their sense. So, we filmed them. And what happened was, we published it and never heard a word in the medical community. But what was interesting is that it went in to the non-medical community, you know, ended up in The NY Times, The Post, everything within weeks. And so, what is rewarding is that it may not matter to the providers of care on the medical side of the equation, but it matters to the recipients of care, whether today or in the future. And I love that I’m part of that voice that is asking for something other than the doctor’s death. Where it’s a more humanized approach. Instead of dying of organ failure, it’s life closure. And I think that’s fun to be part of.

Minter Dial  47:42

Is there room for us to move back to the old way of dying at home, more often?

Dr Chris Kerr  47:47

Yeah, it’s happened. It’s actually happening in this country. So, 10 years ago, 75% of Americans wanted to die at home. 75% of Americans didn’t. It’s now we’ve crossed the 50% mark. And what’s happened is the baby boomers are reclaiming dying. And, we see it in death cafes, we see it in the receptivity to our work. They have questions. They don’t tolerate a medical model, where they’re being told to. They want choice and options. They want to have a say. So, we’re seeing the arc bend. Absolutely. Yeah.

Minter Dial  48:29

And that is a wonderful place to close. I want to take one last sentence which I had wanted to sort of conclude and I loved it from your TEDx. It says, “I hope they leave [these are your stories that you are sharing] leave open the possibility that there is light within the darkness of dying.” Dr. Chris Kerr, it has been an absolute pleasure deep down. To listen to you, get a chance to talk with you. You are on a mission, I feel very necessary for life, as a man who has followed the Grateful Dead and always thought that once we embrace death, we are more grateful, that this is what we should be thinking about and not rejecting it, not denying it, but embracing it.

Dr Chris Kerr  49:17

Very well said. So, perfect.

Minter Dial  49:20

Thank you very much.

Dr Chris Kerr  49:21

Thank you. Yeah.