When a loved one is dying, it is customary for close family members to remain at their bedside, sometimes for days. This time together is precious, allowing loved ones to share final moments and work through accepting the loss and what this absence will mean in their lives.
What is an End-of-Life Rally?
End-of-life journeys are complex. In some cases, a loved one’s decline suddenly and inexplicably seems to stop. They become more stable and may want to talk or even begin eating again. This period of perking up can be accompanied by such a notable change in cognition that hospice professionals have coined the term "terminal lucidity" to describe it. We grasp at what seems to be a turnaround in their health and sigh with relief. It appears as if they are going to hang on for a while, right?
Sadly, rallying is usually an indicator that death is near. I have known many hospice professionals who have seen their patients rally shortly before death. Some patients want to talk, and some become restless and act as if they need to start preparing for a trip. Others will simply become more relaxed, yet tuned in. Still, others will show signs of physical stability when, seconds before, they seemed on the edge of letting go. A rally can last for a few moments or even days. Short or long, these temporary “improvements” can have a profound effect on the loved ones keeping vigil.
End-of-Life Rallies Can Be Conflicting for Families
One story I recall was shared with me while I was interviewing people for my book, Minding Our Elders: Caregivers Share Their Stories. A woman’s whole family had gathered by her dying father’s bedside. Some of them had already been there for days, while others had only arrived a few hours ago, but the entire family was finally together. Her father had been withdrawing into himself, and they knew that his time to leave would soon come. But, then he surprised them all and rallied. He was able to sit up and even talk a bit. There was a spark in his eye. He convinced his family to leave and get something to eat, but during the time it took them to grab some fast food at a nearby restaurant, he passed away.
This family was understandably upset. They felt guilty that they hadn’t been there to comfort this man, but the primary hospice nurse told them that some people feel it is too hard for their loved ones to watch them die, so they wait until they have a moment alone. Others believe that the person who is dying needs time alone to prepare, so they encourage those around them to leave. No one knows why rallies occur, why some people wait until they are alone to die or why others wait for someone to arrive before letting go. Because we are each unique, it only makes sense that our deaths will be unique as well.
Personal Experiences with Rallying Loved Ones
I have witnessed pre-death rallies several times, so I will share a few experiences of my own.
Many years ago, my aunt was in the hospital dying of cancer. My parents were with her most of the time, but I still went to see her as often as possible. One afternoon before leaving the hospital, I said that if Aunt Marion was stable, I wouldn’t be back later because my youngest son had his first band concert that evening. He was in the sixth grade, and this was an important event. Marion seemed to rally as I told her and my parents about the performance.
That evening, while I was watching my son play his clarinet, my aunt died. At first, I felt guilty. But later, after some thought, I knew that Aunt Marion would have wanted me to attend my son’s concert. Whether or not her brief rally had anything to do with our conversation about the event, I will never know. However, I bless her for it. She helped me do the right thing for myself and my family.
The most difficult pre-death rally in our family occurred with my father after he had been receiving hospice care for several weeks. One afternoon, my sister Beth and I received word to come to the nursing home immediately because Dad was close to death. We hurried to be by his side, held his hand, talked to him and waited. Suddenly, Dad rallied.
Beth worked in town, but she lived 50 miles away. Once Dad seemed more stable, she decided to drive home, tend to her teenage sons and dog, and return to the nursing home first thing in the morning. Sadly, Dad passed away just as she pulled onto the highway. My heart broke for her, but I waited until I knew she was safely home before I called her and shared the news.
Dad would not have known how we would react to a rally, so my thought is that he simply came back from the brink to finish his preparations before leaving for good. On the other hand, perhaps he did want one last interaction with his family before letting go.
When my mom’s time came shortly thereafter, there was only a moment when her eyes fluttered and she left us. There was no hesitation for her, and I believe that her sole purpose was to reunite with Dad. I believe that many rallies are part of the spiritual process of death for some people, but, for others, it may be purely physical. Again, we cannot truly know.
Embrace an End-of-Life Rally with Gratitude
What causes our loved ones to rally before death? Why do some people rally and others do not? Is our loved one consciously preparing for his or her last journey, or are rallies some physical reaction to the death process? Life is full of questions, and some of them simply are not meant to be answered. This may be one of the latter cases.
Those who are left behind make their own peace with each loss. I hope that those of you who are accompanying a loved one through his or her last earthly journey will also find courage and peace in the process. A rally can be confusing and even heartbreaking at times, but if you witness one, try to cherish it.
Like a moment of clarity for someone who has dementia, a rally is one last opportunity to connect with a loved one while you are still both earthly creatures. During the difficult end-of-life process, we seek any comfort we can get. A short rally that connects us deeply or allows a loved one to pass on their own terms is a gift.