What Does It Mean to Rally Before Death?

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Death is a mystery. As much as we continue to discover about the dying process, much remains unknown. It is human nature to want your loved one to stay lucid and for you to hold out hope for recovery or rebound. Letting someone go is hard.

Jump ahead to these sections:

We know that the dying process and what happens when you die has several stages, although not everyone goes through each step. The advantage to knowing and understanding these stages is that you can be prepared and ready for the last moments. There is no way to know how many people rally before death, but it happens often enough that discussions on why, how, and when it occurs are ongoing. 

Understanding more about this phenomenon will help you accept it for what it is and appreciate the mystery of why it happens. If you are fortunate to be with your loved one when they rally, take full advantage of the opportunity to be present with them one last time.

Definition of Rallying Before Death

When someone is dying, they typically become non-responsive, weak, and in a semi-conscious state towards the very end of life. As a person’s body shuts down they no longer want food or water. Family may be at the bedside for hours, not knowing when the time of death will arrive. 

Then, suddenly your loved one becomes more alert and energetic than they have been in days. They might be able to converse coherently with friends and family. The other term for rallying is “terminal lucidity.” 

If this occurs, it can be shocking to families who don’t expect it, creating false hope. No one knows for certain what causes rallying before death, but there are some theories about this phenomenon.

Physiological explanation

Some scientists and physicians speculate that several different physical processes could be occurring. One is that as organs shut down, they release steroid-like compounds that wake the body. In other words, just before death, the body releases chemicals that energize both body and mind.

Another idea is that the mind becomes more responsive when a patient is taken off the fluids and medications such as those used for chemotherapy that have toxic effects. Stopping medications can restore the body to more of its natural state.

Even people with significant neurological conditions such as Alzheimer's disease whose brain is damaged can rally and have the first coherent and clear conversations in months. 

Spiritual or psychological explanation

Then there is the idea that a loved one who is dying has a compelling urge to say goodbye or voice some need. Or there could be some kind of unfinished business that they want to communicate. Also, perhaps there is a desire to connect with clergy or another spiritual leader. Maybe the dying person is waiting for another family member to arrive that they haven’t seen in a long time, and they rally when that person comes.

What Happens When Someone Rallies Before Death?

Reports from family and hospice care professionals are relatively consistent about what happens when someone rallies before death. But your loved one may have some or none of these things happen. 

  • A person who rallies starts talking after not communicating for a long time. The unique characteristic of this symptom of rallying is that the dying person may not have communicated clearly for a long time before the dying process. For example, they may have dementia or some other brain disorder, and suddenly they speak in coherent sentences. The person may talk about the past or the future. Communication may be very clear, as if they are back to themselves. 
  • The person suddenly asks for food and or drink. It’s not unusual for people who are dying to no longer desire food or drink. When someone rallies, they may suddenly request long past favorite foods or completely unexpected food. They may be thirsty and ask for water or other beverages. 
  • The dying person expresses final wishes or makes requests. When someone rallies, they may make specific requests to give items to certain family members. There is the expression of a need to take care of unfinished business.
  • They may see people or pets that aren’t there. When a person rallies, they may see past relatives, friends, or pets that have died and talk about it.
  • Old conflicts could arise, as well as regrets or fears about dying. The dying person might want to talk about their fears or desire to mend past conflicts.

How Long Does Rallying Before Death Usually Last?

A German researcher, Michael Nahm has researched terminal lucidity and estimates that about 84% of people who experience a rally die within a week, and 42% die the same day. A dying person can rally for less than an hour or for weeks. There’s no way to know how long your loved one will rally, so plan on taking advantage of what could be a very short window of time. 

Depending on your loved one’s disease, prognosis, and condition, it is possible for a rally to last so long that you can discontinue hospice. But it is rare. Consult with your loved one’s hospice doctor and the care staff before assuming that a rally is a recovery.

What Can Loved Ones Do When Someone’s Rallying Before Death?

Now that you are prepared if your loved one rallies, you may wonder what to do if and when it occurs. Considering that your time could be very limited, we have some suggestions. You may not get another chance, so being ready will help you make the most of the situation.

Stay close

If at all possible, stay close to your loved one if they rally. You may have very little time, and if you leave thinking your loved one will be the same when you return, they may not be. Hopefully, you will have the time you need with your loved one.

Listen

Depending on the situation, just listen to what your loved one has to say. They may not have had the opportunity to speak in a long time and want to be heard. Try and center yourself and keep an open heart and mind as you listen to what could be confusing, upsetting, or beautiful communications.

Your loved one may want to talk about their life story or ask questions about the dying process. If it seems right, feel free to express yourself when the time is right.

Accommodate requests

Do everything you can to accommodate requests. If your loved one wants a pickle, get them a pickle! If there is someone they want to see and communicate with and that person is not there, do what you can by using Facetime or some other video platform. Perhaps your loved one wants you to gift something of theirs.

Simply reply that you will make it happen. There is no need at this point to get into details unless they want to do so.

Try not to give false hope

A rally is rarely a sign of any kind of meaningful recovery. Try not to voice any sort of false hope around the idea that death is not imminent. Valuable time can be wasted by discussing or thinking that your loved one is going to recover.

Be positive

Now is not the time to bring up old conflicts unless your loved one does. If they want to talk about forgiveness, then that is good. Try to be positive and receptive. If your loved one talks about past experiences, be supportive. You don’t need to correct any recollections of the past. Try not to impart stress or anxiety. Keep calm and focused on the moment. 

Educate the rest of the family

Help the rest of your family understand that a rally may happen, what to expect, and how to handle it. That way, they aren’t in shock or have unrealistic expectations. If several of you are present for a rally simultaneously, it will be beneficial for everyone to understand what is happening. 

Accept the unknown

As challenging as it can be for anyone, accepting the unknown mysteries of how and when someone dies is a gift to your loved one. They will feel your expectations or fears, so try to be open to the unknown with calm and grace. 

Have gratitude

Life and death are mysteries to ponder and experience in all of their heartache and joy. If your loved one rallies, be grateful that you have the opportunity for such a unique experience. Focus on the love and care you have for the person and the rest of your family that are there with you. 

Rallying Before Death

Rallying before death may be one of those mysteries that we never completely understand. Most importantly, be ready when it happens and show your unconditional love. Be as present and accepting as you can to allow your loved one a peaceful transition at the time of death.


Sources:
  1. Fowler, Kate. “Hospice Nurse Reveals Unexplained Phenomena That Happen Before Death Including ‘The Rally.’” News, Newsweek 16, November 2021, Newsweek.com.
  2. Matloff, Judith. “ The Mystery of End-of-Life Rallies.” Well, The New York Times, 24 July 2018, Nytimes.com

Icons sourced from FlatIcon.