夢境與幻覺或許可以預示死亡降至(上)

One evening in the late fall, Lucien Majors, 84, sat at his kitchen table, his wife Jan by his side, as he described a recent dream.

一個深秋的晚上，84歲的呂西安·梅傑斯(Lucien Majors)坐在廚房的桌子旁，他的妻子簡(Jan)陪在他的身邊，聽他講述最近做的一個夢。

Mr. Majors had end-stage bladder cancer and was in renal failure. As he spoke with a doctor from Hospice Buffalo , he was alert but faltering.

梅傑斯患有終末期膀胱癌，併發腎功能衰竭。在他與美國水牛城臨終關懷中心(Hospice Buffalo)的醫生交談時，他顯得思維敏捷，說話卻含含糊糊。

In the dream, he said, he was in his car with his great pal, Carmen. His three sons, teenagers, were in the back seat, joking around.

他說，他夢見自己駕車出行，好朋友卡門(Carmen)和他同車，三個兒子還是十幾歲的樣子，在後座上又笑又鬧。

“We’re driving down Clinton Street,” said Mr. Majors, his watery, pale blue eyes widening with delight at the thought of the road trip.

“我們沿着克林頓街往前開，”梅傑斯說，一回想起那次夢中的旅行，他那水汪汪的淡藍色眼睛裏就充滿了喜悅。

“We were looking for the Grand Canyon.” And then they saw it. “We talked about how amazing, because there it was — all this time, the Grand Canyon was just at the end of Clinton Street!”

“我們在找大峽谷(Grand Canyon)。”接着他們就看到了它。“我們都說這太神奇了，因爲它就在那兒——大峽谷居然就在克林頓街的盡頭！”

Mr. Majors had not spoken with Carmen in more than 20 years. His sons are in their late 50s and early 60s.

事實上，梅傑斯有20多年沒跟卡門說過話了。他的兒子們也都已經60歲上下。

“Why do you think your boys were in the car?” asked Dr. Christopher W. Kerr, a Hospice Buffalo palliative care physician who researches the therapeutic role of patients’ end-of-life dreams and visions.

水牛城臨終關懷中心的姑息治療醫生克里斯托弗·W·克爾(Christopher W. Kerr)博士一直在研究患者臨終的夢境和幻象有何治療作用。他問梅傑斯：“你爲什麼會覺得你的兒子們也在車上？”

“My sons are the greatest accomplishment of my life,” Mr. Majors said.

梅傑斯回答說：“因爲兒子是我一生最大的成就。”

He died three weeks later.

三週之後，梅傑斯離開了人世。

For thousands of years, the dreams and visions of the dying have captivated cultures, which imbued them with sacred import. Anthropologists, theologians and sociologists have studied these so-called deathbed phenomena. They appear in medieval writings and Renaissance paintings, in Shakespearean works and set pieces from 19th-century American and British novels, particularly by Dickens. One of the most famous moments in film is the mysterious deathbed murmur in “Citizen Kane”: “Rosebud!”

千百年來，各種文化都爲臨終前的夢境和幻象着迷，並賦予它們神聖的意義。人類學家、神學家和社會學家都在研究這些“臨終現象”。它們在中世紀的著述、文藝復興時期的繪畫和莎士比亞的作品中都有出現，更成爲了19世紀的美國和英國小說，尤其是狄更斯(Dickens)作品中的固定套路。在電影《公民凱恩》(Citizen Kane)中也有這樣的一個著名橋段——主角臨終前神祕地低語：“玫瑰花蕾！”

Even the law reveres a dying person’s final words, allowing them to be admitted as evidence in an unusual exception to hearsay rules.

甚至連法律也尊重垂死之人的遺言，容許它們作爲傳聞證據禁用規則(hearsay rules)外的特例被接納爲證據。

In the modern medical world, such experiences have been noted by psychologists, social workers and nurses. But doctors tend to give them a wide berth because “we don’t know what the hell they are,” said Dr. Timothy E. Quill, an expert on palliative care medicine at the University of Rochester Medical Center. Some researchers have surmised that patients and doctors avoid reporting these phenomena for fear of ridicule.

在現代醫學界，心理學家、社會工作者和護士也都注意到了患者的此類體驗。但醫生們傾向於拒之於千里之外，因爲“我們不知道這到底是怎麼一回事”,羅切斯特大學醫學中心(University of Rochester Medical Center)的姑息醫療專家蒂莫西·E·奎爾(Timothy E. Quill)博士說。有研究人員推測，由於害怕遭到嘲笑，患者和醫生們都不願意報告這些現象。

Now a team of clinicians and researchers led by Dr. Kerr at Hospice Buffalo, an internist who has a doctorate in neurobiology, are seeking to demystify these experiences and understand their role and importance in supporting “a good death” — for the patient and the bereaved.

現在，水牛城臨終關懷中心的克爾博士（他也是一位擁有神經生物學博士學位的內科醫師）領導着一個由臨牀醫生和研究人員組成的團隊，試圖破解這些神祕的經驗，瞭解它們在“善終”過程中對患者及其家屬的支持作用和重要意義。

These events are distinct from “near-death experiences,” such as those recalled by people revived in intensive care units, said Pei C. Grant, the director of the research team. “These are people on a journey towards death, not people who just missed it.”

這類經驗與重症監護病房患者回憶起來的“瀕死體驗”不是一碼事，該研究團隊的負責人佩·C·格朗(Pei C. Grant)說。“這些人是在一步步走向死亡，而不是剛剛死裏逃生。”

Hospice Buffalo, in Cheektowaga, N.Y., cares for 5,000 patients a year, mostly with visits to private homes and nursing facilities. After doctors, nurses, social workers or chaplains ask patients, “How have you been sleeping?” they often follow up with, “Can you recall any dreams?”

水牛城臨終關懷中心位於紐約州的奇克託瓦加(Cheektowaga)，這裏每年可看護大約5000名患者，大部分情況下，中心會派醫護人員前往患者家庭和護理機構提供服務。醫生、護士、社會工作者或牧師在問過患者“你睡得怎麼樣？”之後，往往會接着問：“你記不記得自己做過什麼夢？”

I was laying in bed and people were walking very slowly by me. The right-hand side I didn’t know, but they were all very friendly and they touched my arm and my hand as they went by. But the other side were people that I knew — my mom and dad were there, my uncle. Everybody I knew that was dead was there. The only thing was, my husband wasn’t there, nor was my dog, and I knew that I would be seeing them. — Jeanne Faber, 75, months before her death from ovarian cancer.

我躺在牀上，人們慢慢從我身邊走過。右邊的人我不認識，但他們都非常友善，在經過我旁邊的時候還摸摸我的胳膊和手。左手邊的人是我認識的：我的父母和叔叔，只是他們早已不在人世了。唯一的遺憾是，我丈夫和我家的狗不在那裏，不過我知道以後會見到他們的。——75歲的珍妮·費伯(Jeanne Faber)在因卵巢癌去世前幾個月做的夢。

For their primary study, published in The Journal of Palliative Medicine, the researchers conducted multiple interviews with 59 terminally ill patients admitted to acute care at Hospice Buffalo, a facility furnished in warm woods, with windows that frame views of fountains, gazebos and gardens. Nearly all the patients reported having had dreams or visions. They described the majority of their dreams as comforting. About one in every five was associated with distress, and the remainder felt neutral.

研究人員將其初步研究發表在《姑息醫學雜誌》(The Journal of Palliative Medicine)上。在這項研究中，他們對水牛城臨終關懷中心收治的59名絕症患者進行了多次訪談；這裏裝備了暖色調的木料，窗外可以看到噴泉、涼亭和花園。幾乎所有的患者都報告自己曾經做過夢或出現過幻象。他們稱大部分夢境都讓他們感到欣慰，約五分之一令他們痛苦，其餘的則不好不壞。

The dreams and visions loosely sorted into categories: opportunities to engage with the deceased; loved ones “waiting;” unfinished business. Themes of love, given or withheld, coursed through the dreams, as did the need for resolution and even forgiveness. In their dreams, patients were reassured that they had been good parents, children and workers. They packed boxes, preparing for journeys, and, like Mr. Majors, often traveled with dear companions as guides. Although many patients said they rarely remembered their dreams, these they could not forget.

臨終的夢境和幻象大致可以分爲以下幾大類：與逝者的重聚；親人“在等待”；未竟的事業等等。愛這個主題——不論是給予與還是不給予——以及對決意乃至寬恕的渴求，貫穿夢境。患者往往在夢境中得到認可，被讚譽爲出色的父母、子女和員工，並因此而感到寬慰。在夢中，他們打點行裝，準備出行，而且，像梅傑斯一樣，往往有親密的夥伴同行嚮導。雖然很多患者表示他們基本上記不住自己做過的夢，但諸如此類的夢他們卻不會忘懷。

A 76-year-old patient said he dreamed of his mother, who died when he was a child. He could smell her perfume and hear her soothing voice saying, “I love you.”

一位76歲的患者說自己夢見了早在自己童年時代就已經去世的母親。他聞到了她身上的香水味，聽到她那充滿慰藉的聲音說：“我愛你。”

An older woman cradled an invisible infant as she lay in bed. (Her husband told researchers it was the couple’s first child, who had been stillborn.)

一個年齡更大的老婦人躺在牀上，姿勢如同懷抱着肉眼不可見的嬰兒（她的丈夫告訴研究人員，那個幻想中的嬰兒應該是他們胎死腹中的第一個孩子）。

Nine days before she died, a 54-year-old woman dreamed of a childhood friend who had caused her great pain decades earlier. The friend, who had since died, appeared as an old man and said, “Sorry, you’re a good person,” and “If you need help, just call my name.”

一名54歲的婦女在去世前9天夢見了兒時的夥伴。數十年前，他的早逝給她帶來了巨大的痛苦。這次在她的夢裏，他以一個老人的模樣出現，還對她說：“我很遺憾。你是個好人。”還說，“如果你需要幫助，只要呼喚我的名字就好。”

This is certainly research in its infancy. The investigators, counselors and palliative care doctors, are trying to identify and describe the phenomena. Dr. Quill said he believed the studies would help make these experiences more accessible to skeptical doctors.

當然，這項研究尚處於起步階段。調查人員、諮詢顧問和姑息治療醫生仍在試圖識別並描述該現象。奎爾博士說，他相信，這些研究將會幫助持懷疑態度的醫生更好地瞭解患者的此類經驗。