What Our Final Conversations Tell Us

An excerpt from Words at the Threshold by Lisa Smartt

One day, if not today, you will sit at the bedside of someone you love and have a final conversation. That conversation will invite you into a unique territory — the one that exists between living and dying. You may hear words expressing a desire for forgiveness, reconciliation, or the fulfillment of last requests. You may hear phrases that confuse you, like “The circles say it’s time to complete the cycle.”

There may be references to things you do not see or understand, such as “The white butterflies are coming out of your mouth. They are beautiful.” Or “If you have passed the quiz. You have passed the quiz, haven’t you?”

Your beloved may describe being visited by deceased family members, angels, or animals or speak of viewing lush landscapes, where in reality there are only white hospital walls. Trains, boats, or buses and tales of new travels may appear in the speech of the person who is dying. Your family member or friend may also speak of being afraid and seek your comfort as well as your guidance: “I am stuck here between two countries. I am here but I want to be there.” Your beloved may whisper in your ear, “Help me,” or, “I am daring to die.”

And as you listen closely, it may be a conversation that changes not only how you think about dying but also how you think about living.

Over a period of four years, I collected accounts and transcripts from health-care providers, friends, and family members of the dying who generously shared what they had witnessed. Through the Final Words Project, its website, Facebook, and email, I gathered data across the United States and Canada while also conducting interviews in person and by phone. I gathered over fifteen hundred English utterances, which ranged from single words to complete sentences, from those who were a few hours to a few weeks from dying.

While I considered the use of digital recorders at the bedsides of the dying to capture final utterances, the sacred and private nature of those last days made this both ethically and logistically untenable. So, I decided to turn to those who had been at the bedside — loved ones and health-care providers — and ask them to share transcriptions, interviews, and recollections. I also interviewed professionals in the fields of linguistics, psychology, palliative medicine, and neuroscience to gain greater insight into terminal illness and cognitive and psychological processes. Participants included the dying individuals I heard or observed directly, family members and friends who shared transcriptions and accounts, and experts in the field who shared their observations.

I organized the language samples and accounts by linguistic features and themes. Many of the patterns that emerged were present also in the observations of health-care professionals and experts I interviewed. As I learned of these patterns, I shared them with families, friends, and hospice personnel with the aim of offering tools and insight that could guide their communications with the dying. I am not a medical expert — my training is in linguistics — so I approach the study of death and dying through the lens of language.

This inquiry was inspired by what I heard and saw in the three weeks my father spent dying from complications related to radiation therapy for prostate cancer. As I sat with him, it was as if a portal had opened — and I discovered a new language, one rich with metaphor and nonsense that spilled from my father’s lips. As I transcribed his words from between the worlds, I witnessed a remarkable transformation.

My father was a cigar-chomping New Yorker whose definition of the Divine was corned beef on rye with slaw on the side and a cold glass of cream soda. He placed his faith in Lucky Sam in the fifth race and in his beloved wife of fifty-four years, Susan. “This is it,” my dad would say when asked about his spiritual life. “Good food, love, and the ponies.” My father savored life’s pleasures and was both a skeptic and a rationalist. “We are all headed for the same afterlife, six feet under.”

So when he started talking about seeing and hearing angels in his last weeks of life, I was stunned. How was it that my father, a skeptic, would accurately predict the timing of his own death with these words: “Enough...enough...the angels say enough...only three days left...”? From the moment he left the hospital after deciding to come home to die, I was struck by his language. Compelled by my linguistics training, I grabbed pencil and paper and tracked his final utterances as if I were a visitor in a foreign country. For indeed, I was.

This inquiry began with my father’s language and, within four years, became a collection of hundreds of utterances analyzed for their linguistic patterns and themes. The words I collected were much like my father’s: sometimes confusing, often metaphoric, frequently nonsensical, and always intriguing. I have come to understand that the language patterns and themes that at first stunned me in my father’s speech are actually common in the speech of others as they approach the end of life.

From my interviews with friends, family members, health-care providers, and researchers, it appears that in hospitals, homes, and hospices, the dying enter new states of being, and their words are a window into those states. My research of four years indicates that my father was not alone in experiencing metaphorical and nonsensical changes in language, seeing visions of angels, and making references to another dimension in his final days.

The words at the threshold suggest to me that consciousness does indeed survive, and that we ourselves can be both guides and tourists as we journey with those we love to the portal.