Three paths across the threshold

We can distinguish three different qualities in the phenomenology of dying, which can appear singly and clearly defined, or sometimes also simultaneously, or one after the other.
First, there are the patients who develop high fevers before crossing the threshold, and leave the invalid body behind through warmth, as if burning up.

This inflammatory process, which belongs to the metabolic system, is in contrast to another process that corresponds to the rhythmic system. Here, the patient develops tachycardia until the blood pressure begins to fall while the radial pulse becomes difficult to find. These changes are often accompanied by a quickening of breathing. In such cases, the clinical picture is determined by the midsection of the human being. Often, the extremities are cool and there is congestion of the warmth organism in the trunk. The patient feels too hot and tries to free himself from the blankets, which seem to him heavy and restrictive.

A third form of threshold-crossing concerns the consciousness and therefore the nerve-sense system. An increasing lassitude develops, which is connected to the loosening of the sheaths during the process of dying. It gradually and quietly progresses into long periods of sleep, from which the patient awakes less and less frequently.

CASE STUDY:

One especially moving example was a 50-year-old woman who was suffering from a metastasizing colon carcinoma. During one evening visit, I felt an impression of imminent departure from the earthly plane. When asked, she requested that we speak the “Lord’s Prayer” together. She began with a clear voice which gradually weakened, until her consciousness faded and she was only moving her lips, and then even that faded away. Within a few hours, she had crossed the threshold.

In the first situation, an often somnolent patient has an acute, inflammatory episode. The activity of the supersensible human being, who lives in the inflammation, turns against the body, which is becoming foreign, in order to finally reject it. Often, this fever is brought on by pneumonia or a urinary tract infection. In every inflammatory fever, the spiritual being—the “I”—is purposefully present. In this situation, one can recognize a manifestation of spiritual will, sheathed in warmth, which occurs far from waking consciousness.

In contrast, the second situation, with the agitated rhythmic system, can be accompanied by especially intensive emotional experiences before these dissolve during the threshold crossing. Anxiety and agitation occur more often in these cases, and require therapeutic attention.
The third situation shows different inner metamorphoses of an otherwise thought-oriented waking consciousness.

CASE STUDY:

A long-term patient with metastasizing mammary carcinoma began to experience increasingly image-oriented consciousness as hepatic metastasis progressed, which added dreamlike pictures to the physical world of objects, such as a (not actually existent) beard to the face of one of her caregivers. Only later did this imaginatively transformed consciousness give way to increasing sleepiness.

Patients can also experience completely different things, which are not only based on sensory observation:

CASE STUDY:

A patient with transverse spinal cord syndrome due to a mammary carcinoma with bone metastasis, who could no longer move her head without help, was able to recognize people as they entered her room, before they came into her line of vision. Certainly, acoustical input was likely of help to her here, but her caregivers had the impression of being “fully perceived.”

With dwindling consciousness of daily life, calm and peace often develop. Often, these three ways of approaching the threshold occur in the above order, either completely or partially. They are a sign of the loosening of the human soul and spirit that takes place through the sensory organization—and therefore the upper human being— similar to falling asleep. Hearing seems to be the last sense to fade away, in preparation for entering the supersensible realm. The arrangement of major sensory organs on the head supports this observation: The face, the front of the skull faces forward toward the world of sight. In contrast, everything in back lies in darkness, in terms of consciousness. The ears are positioned on the border of our field of vision, and the field which lies behind us, invisible, and so are the sensory organs on the threshold of that which we can see and that which we cannot see. In this way, they seem to accompany the individual’s crossing into the spiritual world. This emphasis on the sphere of hearing helps us to understand why music therapy takes on special importance in these situations.