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.
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.
Some people experience a brief surge in energy in the hours or days before death. This may last from a few minutes to several hours. During this time, your loved one may talk more, be interested in engaging in conversation, or interested in eating or drinking.
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.
Terminal lucidity is the medical term that refers to a period of increased mental clarity and alertness during the dying process. It can last minutes, hours, and even days. It is commonly thought of as occurring within a week or a day of death but has been documented as occurring within the last month of life.
Often before death, people will lapse into an unconscious or coma-like state and become completely unresponsive. This is a very deep state of unconsciousness in which a person cannot be aroused, will not open their eyes, or will be unable to communicate or respond to touch.
End-of-life rallies are not fully understood, and no one can predict just how long a rally will last. In rare instances, it can last a week or more, but in most cases it's a very brief window to connect with your loved one. Families who understand this can spend that time chatting and making a final connection.
How Long Does the Active Stage of Dying Last? The active stage of dying generally only lasts for about 3 days. The active stage is preceded by an approximately 3-week period of the pre-active dying stage.
Some speculate that this could be a spiritual experience or divine gift. It certainly is a gift for family members attending the death to have one last opportunity to be with their loved one and to say their last goodbyes.
Active dying is the final phase of the dying process. While the pre-active stage lasts for about three weeks, the active stage of dying lasts roughly three days. By definition, actively dying patients are very close to death, and exhibit many signs and symptoms of near-death.
They might close their eyes frequently or they might be half-open. Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing.
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before.
They Know They're Dying
Dying is a natural process that the body has to work at. Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn't discuss their death, they most likely know it is coming.
Within one hour: Primary flaccidity (relaxation of muscles) will occur almost immediately followed by pallor mortis (paling of the skin). At two to six hours: Rigor mortis (stiffening of muscles) will begin. At seven to 12 hours: Rigor mortis is complete.
One of the wildest innovations is “living funerals.” You can attend a dry run of your own funeral, complete with casket, mourners, funeral procession, etc. You can witness the lavish proceedings without having an “out-of-body” experience, just an “out-of-disposable-income” experience.
You may develop Cheyne-Stokes breathing, when periods of shallow breathing alternate with periods of deeper, rapid breathing. The deep, rapid breathing may be followed by a pause before breathing begins again. Your breathing may also become more noisy as a result of the build-up of mucus.
There are three main stages of dying: the early stage, the middle stage, and the last stage. These are marked by various changes in responsiveness and functioning. However, it is important to keep mind that the timing of each stage and the symptoms experienced can vary from person to person.
Four-Six Days Before Death
Your loved one may sleep a lot more and be in an unresponsive state without the ability to be aroused (coma/semi-coma). This is very natural and it's important to let your loved one sleep. At this point, it's important for you to be with them rather than do for them.
A dying person may try to hold on, despite prolonged discomfort, to be sure loved ones will be all right. Your permission can include saying goodbye, saying it's all right to go and reassuring your loved one you will be all right.
In the last hours before dying a person may become very alert or active. This may be followed by a time of being unresponsive. You may see blotchiness and feel cooling of the arms and legs. Their eyes will often be open and not blinking.
As circulation slows, the arms and legs become cool and may be bluish in color. The underside of the body may darken and a pulse may be difficult or impossible to find. Loss of control of bladder and bowel functions may occur around the time of death.
During death, your body's vital functions stop entirely. Your heart no longer beats, your breath stops and your brain stops functioning. Studies suggest that brain activity may continue several minutes after a person has been declared dead. Still, brain activity isn't the same as consciousness or awareness.
In palliative care, the overuse of laxatives, typically seen when the management of constipation is suddenly 'stepped-up,' is a common cause. Other causes include partial intestinal obstruction, pancreatic insufficiency, Clostridium difficile infection, and radiation enteritis.