夢境與幻覺或許可以預示死亡降至(下)
“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.”
“這項工作所面臨的巨大挑戰是，我們需要幫助患者在逐步走向死亡這種不尋常的歷程中感覺更正常，減輕他們的孤獨感，”他說。“人在臨終時確實有着生動的夢境和幻象。這一點我們傳達得越清楚，對患者的幫助就越大。”
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，夢境是對累積情緒的一種表達。加拿大蒙特利爾大學(University of Montreal)夢境與夢魘研究實驗室(Dream and Nightmare Laboratory)主任、夢境神經系統科學研究員託雷·尼爾森(Tore Nielsen)推測，人在走到生命盡頭時，用做夢宣泄情感的需求變得越發迫切。患者通過噩夢來發泄過剩的精力。不過，積極的夢境也可以起到類似的作用。
“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.”
“患者之所以會做這種夢，出自他們的恐懼和不確定，”他說。“實際上，他們是在通過做夢這種方式幫助自己走出困境。”
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.
這項研究中的患者在離世前幾周或幾天內做夢往往更加頻繁，且夢境中故去者要多於活着的人。研究人員認爲，這種現象甚至可能具有一定的預測價值。
“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.”
“我是一個有進取心的醫生，我總是問自己：‘我們是不是還可以再做些什麼？’”克爾博士說道；他也是水牛城臨終關懷中心的首席醫療官。“曾有一名患者，我認爲他需要接受再水化治療，這樣可以讓他多活些時日。”但是，一位熟悉患者夢境的護士告誡他說：“你不明白。他夢見了自己死去的母親。”“兩天後，那名患者去世了。”他說。
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.
當然，有許多垂危的患者喪失了與人交流的能力，或者他們只能回憶起夢境中的細枝末節：侏儒擡着冰箱；鄰居把一隻雞和一隻猴子帶進患者的公寓什麼的。還有患者沮喪地表示自己記不起做了什麼夢。
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.
克爾博士最近在TEDxBuffalo就這項研究發表了演講，他說自己只是提倡醫務人員用開放式的問題來詢問患者的夢境，無需擔心會招致患者家屬和同事的指責。
“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.’”
“我們常常會給他們使用鎮靜劑，使他們走得平靜，”他說。“我幹過這種事，感覺很糟糕。患者們會說：‘你們打擾了我——我本來正在夢中和妻子相會呢。’”
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.
有一名患者在母親陪在她牀邊的時候出現了幻象：她看到了她母親最好的朋友，多年前死於白血病的瑪麗在她母親的臥室擺弄着窗簾。瑪麗的頭髮又長長了。“我有一種感覺，她來是想對我說：‘沒關係，一切都會好起來的。’我感到寬慰和幸福，再也不害怕了。”——身患尤文氏肉瘤（一種骨癌）的13歲女孩傑西卡·斯通(Jessica Stone)在去世幾個月前講述。
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.
臨終關懷中心的許多患者都患有譫妄(delirium)，患病率在住院的臨終患者中可高達85%。發熱、腫瘤的腦轉移或人體在垂危時的化學變化導致患者神志不清，這種狀態下他們的晝夜節律嚴重紊亂，因此很可能搞不清楚自己究竟是醒着還是在做夢，認知功能也受到了影響。
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.
照顧絕症患者的人傾向於將臨終的夢境視作譫妄的表現。但水牛城臨終關懷中心的研究人員表示，雖然參與研究的患者時不時地陷入譫妄，但依據定義來看，臨終的夢境並非這種狀態的產物。神志不清的患者一般無法與他人互動或進行連貫的、有條理的陳述。他們能描述出來的只有那些給他們帶來傷害和不適的幻覺，而舒適安逸的那類則不行。
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，問題是：這些患者“做白日夢”或出現“幻象”，“看到已故親友在天花板或角落徘徊”等這類異常現象，其根源究竟在哪裏。
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·布倫南(Donna Brennan)是水牛城臨終關懷中心的一名老護士了，她回憶起與一名92歲的充血性心力衰竭患者在沙發上聊天的情形：突然之間，患者朝門口看了一眼，喊道，“稍等一下，我在跟護士談話呢。”
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.
在被告知那裏沒有人後，患者露出了微笑，說來者是詹妮斯阿姨（Aunt Janiece，她已故的姊姊），還拍拍沙發坐墊，示意“訪客”坐下。然後樂呵呵地轉回身來繼續跟布倫南談話。
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.”
布倫南在記錄中將此事稱爲“幻覺(hallucination)”，這是譫妄的一個警示信號。而當克爾博士和水牛城臨終關懷中心的神經學家、姑息治療醫生安妮·巴納斯(Anne Banas)聽到這段敘述時，他們更偏向於使用“幻象(vision)”一詞。
“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.”
“這些幻象是別有意義還是雜亂無章？”巴納斯博士問道。“如果它們別有意義，那是否需要深入探討？我們有責任進一步追問：它們是令人舒心還是苦惱？臨終的幻象可能充滿了情緒宣泄，患者通常需要有人和他們一同分擔。要是我們不聞不問，我們恐怕會錯過什麼！”
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.
美國紀念斯隆-凱特琳癌症中心(Memorial Sloan Kettering Cancer Center)的精神科主任威廉·布賴特巴特(William Breitbart)博士曾經撰寫過關於譫妄和姑息治療的報告，他表示，醫護團隊在工作時必須將牀邊照護者也考慮在內：“家屬們可能會將這些夢境和幻象解讀爲一種安慰，將它們視作與祖先相聯繫的紐帶。
“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，如果人們不相信這些，就可能因此而苦惱。“我的母親產生了幻覺，老是看到死去的人。快做點什麼來改變這種狀況！’”布賴特巴特博士訓練工作人員尊重家屬的觀念，並幫助他們瞭解譫妄的複雜性。
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.
美國明尼蘇達大學醫學院(University of Minnesota Medical School)的精神病學家、睡眠專家卡洛斯·H·申克(Carlos H. Schenck)博士說，某些夢發生在所謂的“混合睡眠”，也就是俗話說的半睡半醒狀態下。身患尤文氏肉瘤的少女傑西卡·斯通生前曾經動情地講述她夢見了自己死去的愛犬——影子(Shadow)。她還說，自己醒過來的時候，看到它修長的深色身影就在她的牀邊。
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.
神經學家巴納斯博士更喜歡稱其爲“臨終體驗”。她說：“我試着讓患者的家屬視其爲一種正常的現象，因爲他們對此的看法可以令他們與患者的關係變得疏離或者親近。”
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，之前從未怎麼談及過戰爭。但在他生命最後的夢境中，那些故事浮出了水面。第一個夢裏，他夢見到處都是血淋淋的瀕死的士兵。那是諾曼底的奧馬哈海灘，波濤拍岸。當年才17歲的他是救援艇上的射擊手，他們拼命地想把傷員們搶救出來，送回得克薩斯號戰艦(s)上。“我的周圍除了死亡和死去的大兵之外，一無所有，”他說。在另一個夢裏，一名死去的士兵對他說：“他們下週會來接你。”最後，他夢見自己拿到了退伍證書，他說這讓自己“鬆了一口氣”。兩天後，患者在睡夢中離開了人世。——他的名字是約翰(John)，88歲，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.
並非所有的臨終夢境都能給瀕死之人帶來撫慰。研究人員發現，約20%的夢令人鬱悶。通常情況下，曾經遭受過創傷的人很可能會在臨終的夢境中再度體會到那些傷痛。有些人可以泰然處之，不會爲之所困擾。有些人則做不到。
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.
醫生應該在何時採用抗精神病藥物或抗焦慮藥物等手段進行干預，從而儘可能地令患者在平靜安詳中渡過人生的最後時光呢？水牛城臨終關懷中心的醫生們認爲，這種決策應通過團隊評估來達成，包括患者家屬提供的信息。
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.”
克爾博士說：“兒女們發現父母處於異常的精神狀態下，會覺得他們是在痛苦地與死亡抗爭。但如果這時你告訴他們：‘她是在與故去的人交談，這很正常。我敢打賭你能從中瞭解到很多關於她以及你的家庭的事情，’說不定家屬們就會慢慢平靜下來，還會做記錄。”
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.
如果不能從患者的家人那裏獲得足夠的信息，團隊可能就無從解讀患者焦躁不安的根源。有一名患者一直噩夢纏身。水牛城臨終關懷中心的團隊約見了他的親屬，他不情願地透露，患者在少女時代曾遭受過性侵。她在臨終之際又一次陷入了這些記憶，令她的家人驚駭不已。
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.
獲得了這一信息，團隊選擇給患者使用抗焦慮藥物治療，而非單用抗精神病藥物。這名患者放鬆了下來，也可以與牧師進行有效的交流了。幾天後，她在平靜的睡眠中逝世。
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，護士布倫南照料一名終末期肺癌患者。他以前是一名警官。他告訴她，他在工作時“幹過壞事”，還說自己曾對妻子不忠，孩子們都疏遠他。他的夢都不平靜，布倫南說道。“他夢見自己被刀捅、被槍擊或者無法呼吸。他向太太道歉，但她沒有理會他，反而提醒他是怎樣傷透了她的心。他的靈魂備受煎熬。”
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.
有些姑息治療提供者認爲，此類夢境是患者精神體驗的核心內容，不應該被打擾。奎爾博士不贊同這種觀點，稱這些人是“臨終關懷浪漫主義者”。
“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. ”
“我們應該用提問來打開患者的心門，但不可以強迫他們，”奎爾博士說。“我們的工作就是見證、探索並減輕他們的孤獨。如果夢境內容豐富且無害，就不用管它。但如果它揭開了慘痛的舊傷疤，就需要有心理學家或牧師提供切實的幫助——因爲我們這些普通醫生並不瞭解這個領域。”
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.
在第一個夢裏，一隻長着小眼睛的黑蜘蛛爬近了她的臉。然後，它變成了後掛一輛紅色平板拖車的黑色大卡車，朝她軋過來。她嚇壞了，驚醒過來。在另一個夢裏，她必須穿過洗衣房到廚房去。她低頭一瞥，只見有大約50只黑蜘蛛在地板上爬。她害怕極了！但是，等她細看端詳，才發現那只是些瓢蟲。她頓時又覺得慶幸不已！“瓢蟲還好，我知道它們不會傷害我，”她事後回憶道。“所以，我順利地走進了廚房。”——78歲的患者羅斯瑪麗·謝弗(Rosemary Shaffer)在因結腸癌去世兩個月前的講述。
The Hospice Buffalo researchers have found that these dreams offer comfort not only for the dying, but for their mourners.
水牛城臨終關懷中心的研究人員發現，這些夢不僅撫慰了垂死之人，受益的還有爲他們哀痛的人。
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.
凱瑟琳·赫頓緊緊握着她的姊姊、曾經擔任小學教師和校長的謝弗的日記，她在日記裏一絲不苟地記錄下了自己的臨終夢境。羅斯瑪麗·謝弗寫到了蜘蛛和卡車，然後還有瓢蟲。在一個夢裏，她看到了殯儀館裏的鮮花，這讓她想起了女兒在手工圍巾上描繪的花朵，令她感到愛和歡悅。
“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.”
“我很高興她能和臨終關懷中心的人說起自己做的夢,”赫頓說。“她知道這是她的潛意識通過她的感受在起作用。她變得平靜多了。”
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.
在造訪臨終關懷中心的家庭休息室時，赫頓拿着這些日記，落下淚來，她說自己會好過一些。
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.
幾個月前，護士布倫南坐在一名悲痛欲絕的丈夫身邊，他的妻子患了胰腺癌，已經擴散到肝臟。她說自己一直夢見工作、上帝和過世的熟人。布倫南說，患者認爲自己會在天堂受到歡迎。上帝告訴她，她是好妻子、也是好母親。
“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.’
“她的丈夫卻很生上帝的氣，”布倫南說。“於是我說：‘但是安(Ann)的心中全無怨憤。她的夢境一點也不令她感到恐懼。它們都充滿了對她一生的認可。’
“He just put his head down and wept.”
“他垂下頭，哭了起來。”
