When a person is nearing the end of their life, it’s not uncommon for them to experience a sudden improvement in their condition. This phenomenon, known as a “rally,” can be confusing and upsetting for caregivers and loved ones who are already grieving. While it’s impossible to say definitively why this happens, there are a few possible explanations.
In this article, we discuss exactly what it means to rally before death. We also examine a few possible explanations for this sudden surge in energy, and break down the very best ways to support someone who is experiencing the process of death.
Rallying before death (also known as terminal lucidity, “the last hurrah,” or “the final goodbye”) is a sudden and unexpected improvement in a person’s condition that can occur in the final days or hours before death. It is most commonly seen in older patients dying from a terminal illness, but can occur as part of any expected death.
The most characteristic sign of a final rally is talking, especially if the person has not been communicative for awhile. During a rally, the person’s speech suddenly becomes very clear. They may reminisce about old times, start making plans for the future, or make requests of or amends with family members or friends. The sudden increase in communication can sometimes be alarming for loved ones—especially in the case of someone dying of dementia, Alzheimer’s, or another brain disorder that has affected their ability to communicate effectively.
A rallying person may also start asking for specific foods or drinks. These requests are usually very specific, and often are long-time favorites or even dishes from childhood.
In some cases, the dying person may express fears (or the lack of fear) about dying. This could also be accompanied by desires to make amends, solwikve any lingering conflicts, or ensure the continued care of a loved one, pet, car, or house.
Seeing pets or people that are not there is another sign of rallying. A dying person might see and begin speaking to past relatives, pets, and friends, or start speaking about them.
Everyone experiences death differently, and no two rallies are the same. According to Michael Nahm, a German biologist and parapsychologist who specializes in near-death experiences and terminal lucidity, about 42% of people die the same day as their rally, while 84% of people die within one week.
Witnessing a final rally before death can be confusing and concerning for family and friends. However, it is important to remember that a rally does not mean that the person is getting better. In fact, it is usually a sign that death is imminent.
Descriptions of rallying before death can be found in medical literature dating back to at least the mid-1700s, but there has been very little research done to understand exactly why some people experience sudden surges of energy and clarity before death. Granted, studying such a phenomenon is potentially impossible.
As Dr. Craig Blinderman, the director of adult palliative medicine at Columbia University Medical Center, told the New York Times, “Aside from the challenges of catching dying people at the moment of springing back, it’d be tough to get the medical ethics board to determine that the research would benefit the patient. This type of study would require constant drawing of blood and monitoring of patients, which runs counter to the quiet fade away that is a signature element of palliative care.”
Still, medical professionals do have a few theories as to what might cause a final rally.
For many—if not most—people, the sudden realization that death is imminant can be downright terrifying. One common theory is that this realization triggers the body into releasing a burst of adrenaline in response to the stress. Sometimes described as the body trying one last time to go into survival mode, this surge of hormone can temporarily increase heart rate and blood pressure, providing the dying person with a boost of energy.
Most people who experience an end-of-life rally are those in hospice care after a long battle with a terminal illness—in other words, those whose dying process is sadly filled with discomfort.
Perhaps for this reason, another common theory is that the brain releases high levels of dopamine and endorphins in an effort to ease pain and suffering. These neurochemicals have been shown to have analgesic effects, and they could help to explain why some people seem oddly peaceful in their final moments.
Many end-of-life patients spend weeks, or even months, on various medications and fluids like those used for chemotherapy. These drugs often have strong toxic side effects that can affect the body’s muscle and brain functions in a negative way.
Some medical professionals believe that stopping these medications before death make the mind clearer and the body more responsive, allowing the patient to briefly appear like their old self.
Some hospice nurses and other healthcare professionals have compared the end-of-life rally to the overwhelming urge to nest that many expectant mothers feel before their baby is born. In other words, the final surge of energy before death could be seen as a way for the body to allow closure and acceptance of death. It allows the patient to tie up loose ends, say a last goodbye to loved ones, and make peace with their impending death.
Still others prefer to look at the end-of-life rally as a gift from God, or as something more miraculous than scientific. This explanation—which, with current technology, can be neither proven nor falsified—lends credence to the fact that so many rallying patients are focused on forming final connections with those they love.
Though watching a loved one rally can feel encouraging, it is important to realize that this phenomenon is not a sudden or miraculous recovery. Many hospice workers recommend that family members speak directly with their loved one’s doctor if they have any questions about what to expect during this process.
As anyone who has watched someone face a terminal illness knows, the journey toward death can be long and arduous. For loved ones, it can be difficult to know how to best support a dying family member or friend. There are many factors to consider, including the person’s wishes for end-of-life care. Still, there are some best practices that can help loved ones offer support during a final rally before death.
Many patients who experience an end-of-life rally have not been able to communicate for awhile, and now want to be heard. Answer any direct questions, but otherwise, just listen. The dying person may say something beautiful—or they could say something confusing or downright upsetting. Try to maintain an open mind as you offer this final gift of an ear.
No one has full control over their death—a scary realization for many. This could help explain why many patients make very specific requests in their final hours.
Hospice workers recommend making an effort to honor any final requests a loved one might have. Whether it is grabbing a favorite meal or beverage, getting a particular person on the phone, or even re-telling a favorite story, these small gestures of accommodation can mean a great deal to someone who is facing the end of their life.
Of course, it is not always possible to fulfill every request, but even making an effort to do so can be a valuable way of providing a dying person with some measure of comfort and peace.
Death is an inevitable part of life, and it is natural to want to comfort a dying person. However, offering false hope can be more harmful than helpful. When a person is facing death, they need to be able to come to terms with their own mortality. This process can be made more difficult if they are led to believe they may recover, as it could prevent them from saying goodbye and putting their affairs in order.
As hard or conflicting as it may be to witness someone rally before death, try to stay as positive as possible. Unless the dying person brings it up, there’s no need to rehash old conflicts. Be supportive of any discussion about the past, and try not to correct any recollections. Finally, stay calm and present in the moment so as not to impart any anxiety or stress.
Finally, stay with them. Despite any surges of dopamine or adrenaline, impending death can be scary. A loved one by their side, offering a friendly smile, could make their final transition one of peace and comfort.
How long does rallying last before death?
The temporary increase in strength before death, known as rallying, can last for hours or even a full week. In the vast majority of cases, death occurs within one week of the rally, and about half of those occur the same day.
What is the final surge before death?
The final surge—most commonly known as “rallying”—is a last burst of energy before death. Researchers and doctors are still unsure as to what causes the final surge, though theories include a sudden release of endorphins, a rush of adrenaline, or simply a reaction to the outpouring of attention from caregivers and loved ones.
What is the purpose of terminal lucidity?
Terminal lucidity is another term for “rallying,” and refers to the short period of mental clarity and alertness that sometimes occurs before death. Though it is unknown exactly why terminal lucidity occurs, this temporary phenomenon is typically welcomed by those who love and care for the dying person.
How does the body know when to die?
In the days and hours before death, a person’s heart begins to slow. As blood circulation becomes less effective, the brain and other organs receive less of the oxygen they need to function properly. At this point, the body begins to shut down.
It’s not entirely clear why some people rally before death, but plenty of medical professionals have ideas about possible scientific explanations. Though a sudden surge of energy can incite a slew of emotions in caregivers, friends, and family members, many choose to look at this amazing phenomenon as a chance to say a final goodbye to those they love.