What Happens In A Death Rally?

Dear Barbara, Can a person have more than one death rally?

At first, I wasn’t sure what was meant by the term “death rally.” While I haven’t heard that particular expression used before, I have often witnessed what could be described as a "rally" just before death. I am going to address the question using this definition of “death rally” - a person who has been actively dying (with everyone thinking it will be in days to hours), “rallies” or appears to get better, only to quickly revert back to actively dying.

I have seen this "rally" occur many, many times. The person, over a period of several months, has gradually withdrawn. Now, they are sleeping all the time, and are not eating or drinking. All of the signs tell us that death is rapidly approaching. Then one morning they wake up and seem to have gotten better over night. They are less confused, they want to eat, they want to get up. They may even begin interacting with us. They no longer look like they are actively dying and we, the family, get excited and think our prayers have been answered. Dad is getting better. All will be well. Then 24 or 48 hours later dad dies. This is what I consider a “death rally”.

What has just happened? I really don’t know the physiological reasons, but I have seen it many times and, yes, it can happen more than once.

It is like a person gets to death’s door and says, “Wait! I’m not quite ready yet. I have something left undone. Give me just a little while longer” and the Universe does.

I see this “rally” as a gift, an opportunity to be in a person’s presence a bit longer. An opportunity to hug some more, to say what might not have already been said.

Something More... about What Happens In A Death Rally...

Families need to know what to expect when their loved one is dying of disease or old age. I have a complete set of booklets that supports patients and families called The End of Life Guideline Series. It covers what to expect from diagnosis to grief.

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10 comments

Lauri Rose

I work in palliative care and End of Life care. Some physicians have told me they think the death rally comes as dehydration allows the swelling in the brain to recede just a bit. Seems plausible. As does the notion, expressed by Joyce, that the kidneys do a last little adrenaline kick. It is always hard to explain to families that, ‘no, it is not prayers answered, but it is a last time to share.’ Thank you Barbara for all your wise words.

barbara

Oh Stephany, you certainly have experienced, more than most, the intensity of grief. You are so right, death from disease, knowing it is coming, is a gift of time. Time to adjust, to prepare, to say your goodbyes. Not everyone takes the gift but it is there. Fast death is no gift for us the survivors. It is a gift for the person who died (less pain, less suffering) but for us left behind it leaves all the unsaid words and feelings. Grief for fast and gradual death manifests the same, except fast death adds more questions (what if, why didn’t I, I should have). The unanswerable questions compound our grief filled emotions. You might find my grief booklet My Friend, I Care helpful. Blessings to you. Barbara

Stephany Duarte

Unfortunately in my case I only witnessed one normal passing. My dad at 64 passed away from cirrhosis of the liver. He spent about one week in a hospice center before he passed. The other close deaths I actually experienced was my brother being murdered and my sister in law fine one day and the next morning she’s taking her last breath. At 20 years old my nephew passed away from leukemia! My brother and his wife were assured by doctors that he would recover from it! He only lived 9 months and passed away!
The unexpected shock of the deaths are the hardest to accept! My brother was only 47 years old and my sister in law had just turned 61 and was full of life! I think this grief is harder on the loved ones than if someone has an illness and they’ve been sick for awhile and you are able to accept the fact that they are going to pass away from it. You are prepared for that 2am phone call that their loved one passed away.
So can you explain to me the stages of grief in these situations? I know first hand that their is allot of anger and what ifs!
Thank you for listening to me.

Alice

Unbeknownst to me at the time, I found your blog post the day of my mom’s “rally”. She’d taken a downturn in the past week. Accepting food and drink but not actually swallowing. She’d just chew or hold fluids in her mouth then eventually spit them out. She wouldn’t speak but just had a mischievous smile when we’d try to talk to her.
The next morning, she woke up drinking a ton and gobbling blueberries like she hadn’t eaten in days (which she hadn’t). We thought she was on an upswing but the next day (today), she was agitated and then passed in her sleep. It was faster than we’d expected. The surge was so obvious in retrospect.
Thank you for your guidance through this difficult time.

Joyce Petrosky

I’ve been a nurse for 50 years, mostly in the critical care areas. I have witnessed this rallying so many times and I believe it is the bodies response where it gives its one last shove to try and reverse the process that causes people to wake and act normally and the pass away soon after.

It seems like there is that final boost of adrenaline that some part of the body signals it needs that causes it. It’s conjecture on my part and for many families, it gives them hope that is soon dashed. I’ve explained this phenomenon to many and it has helped them have more closure.

A good friend of mine was dying of cancer and the family was called to come in as they were sure she would die that day. Instead, she sat up and said to her family: “What the hell am I supposed to do today, I was supposed to die yesterday!” It was my friend to a tee…..

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