The hallucinatory thoughts of the dying mind

My father, at one point, imagined himself on a Greek island. “Ouzo!” He’d offer from his hospital bed.

He was an avid fisherman and his last words were, distinctly, “Big fish.”

Yet, he was mostly unconscious for his last day. I spent time talking with him as he slept, massaging his hands and feet. Later we had a party for him and played music. Around 10 at night he began to die (the breathing changes). At the very end he opened his eyes, looked at my mother, sister and me, and passed.

It was a beautiful death.

About eight hours before my father died he was having a conversation with his unseen mother, who died when he was 14.

I asked him "Who are you talking to?" and got a rather rude response, not like him, "My mother" in a tone you give a five year old "go away kid you are bothering me".

The International Association for Near-Death Studies (IANDS) is worth checking out if you have interest. I've never had a NDE, however I've spent a lot of time in their library in Durham North Carolina.

https://iands.org

Even in the best of cases, our perceptions and interpretations of those perceptions are often dramatically flawed. Add on top of that neural atrophy, loss of oxygen, accumulation of senescent cells, poor clearance of waste products ... and what comes out is often going to be gibberish, as the remaining working parts of the mind attempts to construct a coherent narrative from the broken fragments of sensory input and failing memories.

I got interested in consciousness 35 years ago or so when I read Oliver Sacks' "The Man Who Mistook His Wife For A Hat". Although the various people depicted in the stories had some physical deficit due to a trauma of some kind, it vividly demonstrated how we rationalize our way through the world more than we reason our way through it. Our conscious mind is much more of a facade than we typically imagine.

When people say, "Well, LLMs are just generating token N+1 from the previous N tokens, they really aren't thinking", I counter with this: we have been having this discussion -- are you at all aware of the stream of words coming out of your mouth, or are you hearing them the same time that I am?

Yes, sometimes we have deliberate thought where we rehearse different lines of reasoning before uttering something, but 98% of the time we are spewing just like LLMs do. And when we do engage in deliberate thought, each of those trial sentences again just appears without consideration; we are simply post-hoc picking the one that feels best.

My mom passed recently. She battled Alzheimer's for 15 years, then passed five days after breaking her hip, even though she was singing and goofing around the day of the break. She was only 77.

A month prior to this, she had begun to sometimes stay in her bed often half the day, lying awake looking up at the ceiling with the most joyous look of peace in her eyes, as if seeing something or someone very special, often whispering as if in dialogue. This went on for hours sometimes.

I was incredibly moved at the time, but there were otherwise no indicators she was near death, so I filed it away as some new development in the progression of her disease.

I now take great comfort knowing this is not uncommon among people who are soon to die, especially since she was unable to communicate the day she died.

My wife and I experienced this when my father died. We visited him hours before his death. He looked up at my wife, smiled and said "Mother, you came!" For the next while she sat beside him, rubbed his brow and engaged in small talk as his mother. When he fell asleep we left. He died during the night...

Semi-related: not delirium, but if you haven't come across it, check out the "Everywhere at the end of time" series of albums. The music is written to track the timeline of dementia progressing [1].

[1] https://www.youtube.com/watch?v=wJWksPWDKOc

During final days before my grand mother's death, she was able to recall her childhood memories, asking her sons to bring her brother. Before that, she had some kind of memory loss. Anyway, here, we need some sort of neurological explanation: Childhood memories stay in the lower part of the brain, as I read it somewhere (probably Oliver Sacks'); the neurological basis of many memory loss is on top layers of brain, that's why sometimes people recall vividly of their childhood memories, even playing piano despite with dementia.

I don’t want to trivialize the positive aspects this can have on someone who otherwise might have a sad or challenging death, and to that extent perhaps it’s just an evolved mechanism to make us accept death more gracefully.

But if you’ve ever stayed awake for many days or had other hallucinogenic experiences, you’ll know how powerfully thoughts can manifest. And how deep our memory actually goes. Clearly it’s inappropriate to vividly see your memories during waking life, but as you transition to death those barriers are less necessary as the body diverts increasingly scarce resources to surviving just a few moments longer.

> "Do not contradict, explain away, belittle or argue about what the person claims to have seen or heard," reads a short text that a hospice provides about the dying process. "Just because you cannot see or hear it does not mean it is not real to your loved one. Affirm his or her experience. They are normal and common."

Not all hospice or elder-care providers recommend affirming hallucinations.

Here's a quote from a nursing home guide that explores the ethical considerations of this practice:

> Lying to someone with dementia, often termed “therapeutic lying,” poses a nuanced ethical dilemma. While entering a person’s altered reality can indeed reduce their immediate distress, it’s important to acknowledge that lying is still lying.

> Over time, this practice may lead to confusion, especially in moments of clarity, and strain the trust and relationship between the patient and caregiver.

> This complexity has led caregivers and professionals to explore alternative communication strategies that honor the truth while providing comfort and reducing agitation. Two such approaches are reflection and redirection. Reflection involves acknowledging the person’s feelings and statements without directly affirming the distorted reality or lying. Redirection gently shifts the conversation or activity towards something positive and engaging without directly contradicting the person’s beliefs.

My dad had a fall and suffered a pretty bad brain injury a few years ago. He has since fully recovered aside from more frequent short-term memory loss, but during his multi-week hospital stay, many aspects of his personality, maturity, and abilities changed, almost to the point of extreme dementia.

More relevant to this story, one incident I remember clearly was that he started talking about taking care of "him" and changing his diaper. Finally we got around to the fact that he was talking about his first nephew, who was born when my dad was quite young in the 1950s. My dad helped my aunt and grandma take care of him and it was his first exposure to caring for a child. All of those people are 30+ years out of existence now, so it was quite a flashback.

I wish there was a place I could share the experience of my father's death. This doesn't seem to be it, though I appreciate everyone's story.

Is there such a place?

Delirium, so called the organic psychosis, is the common end result of every diffuse brain dysfunction, so it be chemical toxicity, inflammation, trauma or most commonly senility-dementia. It's caused because of a chemical disturbance of the brain-'soup'. Any psychotic symptom can be manifested, not only visual hallucinations. Antipsychotic therapy has massively varied results