Let’s say your loved one is at the end of life. She’s 84, with advanced cancer that is no longer treatable.
A decision has been made to put her in hospice — which is a level of care more than an actual location. (Most hospice actually occurs at home.)
The patient waxes in and out of consciousness, sometimes lucid, but mostly not.
While no one is ready for her to die, this end-of-life process brings some solace — it’s what your loved one has indicated she wants, and the time at home without aggressive, often fruitless, medical treatment, allows other friends and family members to make visits and share stories.
One afternoon, she perks up and asks for a sandwich. This is surprising, because she’s barely eaten anything in the last ten days. But we get her that sandwich!
She nibbles at it, happy, but doesn’t eat much of it.
That afternoon, she’s talkative and engaged with others in a way that she hasn’t heretofore seemed able to muster.
Is she making a comeback? Healing from her illness?
More likely, this is what is called “rallying,” and while there’s ample anecdote of its occurrence in situations like this, we have very little understanding of it.
How does it happen? As a recent New York Times article stated:
Physiologically, experts believe that the mind becomes more responsive when a hospice patient is taken off the extensive fluids and medications such as chemotherapy that have toxic effects. Stopping the overload restores the body to more of its natural balance, and the dying briefly become more like their old selves.
It’s deceiving because we think our loved one is getting better. And while she’s more like her old self, unfortunately, it’s not bound to last. Which is why it can be upsetting for some.
Spiritually, some suggest that the dying loved one is simply readying for transition — making sure that earthly concerns will be attended to in her absence and that final goodbyes may be uttered.
I’ve seen it — and especially in elders afflicted with dementia, it can be heartening to see them rally and seem to know what’s going on — accepting their impending death, and engaging with their loved ones before drifting off.
John Schumann is an internal medicine physician who blogs at GlassHospital.
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