The Fifth Realm was a location marked on Chakotay's tribe's medicine wheel. At a certain point, it intersected with the Sixth Realm. Placing the Coyote Stone at this intersection was said to divert the soul of the patient towards the Mountains of the Antelope Women, a location which the individual might find it hard to leave.

In 2371, The Doctor warned B'Elanna Torres about the potential consequences when she placed the stone there.(VOY: "Cathexis")