Terminal lucidity, also known as paradoxical lucidity, rallying or the rally, is an unexpected return of mental clarity and memory, or suddenly regained consciousness that occurs in the time shortly before death in patients with severe psychiatric or neurological disorders.
Palliative and hospice experts refer to this as “rallying” or terminal lucidity and say it is a common occurrence but no one is sure why it happens. These bounce-backs generally last only a couple hours, but some go on for so long that the patients can take a break from a hospice for a few months.
Rallying tends to occur in the final stages of death. In the final stages of death the body is shutting down and functions are steadily slowing. This could mean someone rallies just a day or two before passing away although it differs from person to person.
What is the last surge of energy before death called?
This difficult time may be complicated by a phenomenon known as the surge before death, or terminal lucidity, which can happen days, hours, or even minutes before a person's passing. Often occurring abruptly, this period of increased energy and alertness may give families false hope that their loved ones will recover.
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.
As death nears, the person's metabolism slows contributing to fatigue and an increased need for sleep. The increase in sleep and loss of appetite seem to go hand in hand. A decrease in eating and drinking creates dehydration which may contribute to these symptoms.
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.
The end-of-life period—when body systems shut down and death is imminent—typically lasts from a matter of days to a couple of weeks. Some patients die gently and tranquilly, while others seem to fight the inevitable. Reassuring your loved one it is okay to die can help both of you through this process.
End-of-life transition refers to a person's journey to death, especially in those with a terminal diagnosis. This process occurs differently for everyone. For some, it takes days or weeks; for others, it occurs rapidly. Partnering with a trusted medical team during this time can limit pain.
As the moment of death comes nearer, breathing usually slows down and becomes irregular. It might stop and then start again or there might be long pauses or stops between breaths . This is known as Cheyne-Stokes breathing. This can last for a short time or long time before breathing finally stops.
There is no evidence that opioids such as morphine speed up the dying process when a person receives the right dose to control the symptoms they are experiencing. In fact, research suggests that using opioids to treat pain or trouble breathing near the end of life may help a person live a bit longer.
Hospice does not expedite death and does not help patients die. In fact, we sometimes find that patients live longer than expected when they choose to receive the support of hospice services. Hospice is about ensuring the patient is no longer suffering from the symptoms of their terminal illness.
What happens when someone is transitioning to death?
As a person approaches death, they become less active. This means their body needs less energy than it did. They stop eating or drinking as much, as their appetite gradually reduces. If a person is caring for a dying loved one who loses their appetite, they should let them eat when they feel hungry.
What does transitioning mean when someone is dying?
Transitioning is the first stage of dying. It describes a patient's decline as they get closer to actively dying. Generally, when one is transitioning, they likely have days — or even weeks — to live. I have seen some patients completely skip the transitioning phase and some stay in it for weeks.
Their jaw will relax and their mouth will be slightly open. There may be a release from the bowel or bladder. Because it is an expected death, there is no need to call police or 911. If you do call 911, the police will have to come as part of the response.
Changes to the metabolism of the dying person can cause their breath, skin and body fluids to have a distinctive smell similar to that of nail polish remover. If a person is dying from bowel or stomach cancer, this smell might be quite strong. The person's hands, feet, ears and nose may feel cold.
Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing. Towards the end, dying people will often only breathe periodically, with an intake of breath followed by no breath for several seconds.
When a person dies What is the last organ to stop functioning?
The brain and nerve cells require a constant supply of oxygen and will die within a few minutes, once you stop breathing. The next to go will be the heart, followed by the liver, then the kidneys and pancreas, which can last for about an hour. Skin, tendons, heart valves and corneas will still be alive after a day.
Summary: Hearing is widely thought to be the last sense to go in the dying process. Now, the first study to investigate hearing in palliative care patients who are close to death provides evidence that some may still be able to hear while in an unresponsive state.