Family members are often relieved and hopeful when a dying loved one suddenly becomes more aware of their surroundings or begins talking or eating again. But, are they truly getting better or just consciously preparing for their final journey?
When a person 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, work through accepting the loss and process what this absence will mean in their lives.
End-of-life journeys are complex. Most people expect or imagine a progressive decline that often ends with a lapse into a coma (a deep state of unconsciousness) shortly before passing away. But in some cases, a loved one’s decline may seem to stop suddenly and inexplicably.
What Is an End-of-Life Rally?
When a person facing the end of life “rallies,” they become more stable and may want to talk or even begin eating and drinking again. Some people describe this phenomenon as a sudden burst of energy before death. This period of perking up can be accompanied by such a notable change in mental clarity that hospice professionals have coined the phrase “terminal lucidity” to describe it. This change in cognition and behavior goes against everything families learn about the physical signs that the end of life is near. We grasp at what seems to be a turnaround in our loved one’s health and sigh with relief. It appears as if they are going to hang on for a while, right?
Sadly, rallying is usually a hallmark pre-death sign. I have known many family caregivers, hospice aides, nurses and doctors who have seen their patients show “improvement” before death. Some patients want to talk, while some become restless and act as if they need to start preparing for a trip. Others will simply become more relaxed yet remain tuned in to what is going on around them. Still others will show signs of physical stability when, seconds before, they seemed on the verge 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 loved ones who are keeping vigil.
Terminal Lucidity Can Be Confusing for Families
One story I recall was shared with me while I was interviewing people for my book, Minding Our Elders: Caregivers Share Their Personal 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 earlier, 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 Before Death
I have seen patients experience a sudden improvement before death several times, so I will share a few end-of-life rally stories 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 that I hadn’t been there. But later, after some thought, I knew that Aunt Marion would have wanted me to attend my son’s concert. Whether 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 my family and myself.
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 hands, talked to him and waited. Suddenly, Dad began exhibiting symptoms of terminal lucidity.
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 prior to passing on.
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 think 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 a Final Rally With Gratitude
What causes our loved ones to experience a surge of energy before death? Why do some people get a second wind before dying while others do not? Is our loved one consciously preparing for his or her last journey, or are rallies some sort of physical reaction to the death process? How long does an end-of-life rally last? Each person’s experience is unique and impossible to predict with total accuracy. Life is full of questions, and some of them simply are not meant to be answered. This may be one of the latter cases.
Surviving family members must make their own peace with each loss. I hope that those of you who are accompanying a loved one through their last earthly journey will also find courage and calm in the process. A rally can be confusing and even heartbreaking at times, but if you witness one, try to cherish it. Reputable hospice providers are incredible sources of assistance, information and support for both patients and families who are navigating the end of life.
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 priceless gift.