Terminal lucidity, sometimes called an end-of-life rally, is a phenomenon seen among terminally ill patients where they experience a sudden influx of energy, alertness, and awareness before death. In Grey’s Anatomythey call it The Surge when McSteamy meets his untimely death after a near-fatal plane crash (before you come to us for “spoilers,” that was 10 seasons ago, that was on you).
In the episode, we see Mark Sloan seemingly bounce back from his increasingly poor health as he waxes lyrical about profound life events. His final lucidity gives him a window to give an express directive for his end-of-life care before he slips into an irreversible coma.
It is a heartwarming story inspired by true events witnessed by hospice and hospital workers, as well as loved ones of people with terminal illnesses. We know it happens, but what is ultimate clarity and why does it happen?
What is ultimate clarity?
Dr. Michael Nahm, a biologist who named the phenomenon, defined it in an article published in the Journal of Near-Death Studies as:
“The (re)appearance of normal or abnormally enhanced mental faculties in dull, insensible, or mentally ill persons shortly before death, including marked elevation of spirits and spiritual affection, or the ability to speak in a previously unusual spirited and cheerful manner. “
Nahm is a leading name in terminal lucidity research and also co-authored an important 2009 review of terminal lucidity reports with Bruce Greyson. Their research revealed that not only does lucidity see terminally ill patients seemingly bounce back, but it even extends to people with mental illness who become asymptomatic of their particular condition shortly before they die. Final lucidity has even seen people living with dementia for years return to their previous cognitive function, only to die shortly afterwards.
How long before death can it occur?
The gap between final lucidity and time of death has fueled debate over the name of the phenomenon, with further research renaming it “paradoxical lucidity” due to the fact that the state of mental lucidity can begin in hours, days, weeks or even months before. death.
With such vague parameters, you might question the validity of the phenomenon. But as Dr Basil Eldadah from the National Institute of Aging told the Guardian, preliminary research seems to support that yes, terminal lucidity is real and may even be common. “I think it’s safe to say that this phenomenon exists, and it probably exists more often than we expected or thought.”
Why does it happen?
According to the 2009 review, historical cases of final lucidity were explained as consequences of how our brain physiology changes when we die, although detailed explanations to support this are lacking. It is a particularly puzzling phenomenon that needs to be resolved, as seen in patients whose brain function is thought to be irreparably damaged by disease, as in the case of Alzheimer’s. So how is it possible to make seemingly erased memories accessible again?
The answer, for now, is that we don’t know. Accounts of final lucidity have seen people overcome illnesses and brain injuries such as brain abscesses, stroke and tumors to recall memories and people they thought they had lost.
Among some of the more incredible accounts is the story of a young woman named Anna (“Käthe”) Katharina Ehmer, reported Jesse Bering for Scientific American. Käthe was said to have been profoundly disabled from birth and was later kept in an asylum where she suffered multiple and severe meningitis infections that destroyed her brain. In the face of all this, and though she never learned how to speak, she was heard singing to herself in the last half hour of her life.
Nahm’s view is that if final lucidity can see such a profound remission of mental disorders before death, understanding it could be vital to “developing improved treatments and better understanding unresolved aspects of cognition and memory processing”. For now, we await further information on the strange phenomenon.
Terminal Clarity, Paradoxical Clarity, End-of-Life Rally or The Surge – we may not agree on exactly what to call it, but we can all agree that it’s truly remarkable.