Terminal lucidity, sometimes called end of life rallying, is a phenomenon seen among terminally ill patients where they experience a sudden influx of energy, alertness, and awareness before death. In Grey’s Anatomy, they call it The Surge when McSteamy meets his delayed demise following a near-fatal plane crash (before you come at us for “spoilers”, that was 10 seasons ago, that one’s on you).
In the episode, we see Mark Sloan seemingly bounce back from his increasingly poor health as he waxes lyrical about profound facts of life. His terminal lucidity grants him a window to give an express directive on his end of life care before slipping into an irreversible coma.
It's a heart-wrenching story inspired by true events witnessed by hospice and hospital workers, as well as the loved ones of people with terminal illnesses. We know it happens, but what is terminal lucidity, and why does it happen?
What is terminal lucidity?
Dr Michael Nahm, a biologist credited for naming the phenomenon, defined it in an article published in the Journal of Near-Death Studies as:
“The (re-)emergence of normal or unusually enhanced mental abilities in dull, unconscious, or mentally ill patients shortly before death, including considerable elevation of mood and spiritual affectation, or the ability to speak in a previously unusual spiritualized and elated manner.”
Nahm is a leading name in terminal lucidity research and also co-authored a pivotal 2009 review of terminal lucidity reports with Bruce Greyson. Their research revealed that not only does the lucidity see terminally ill people seemingly bounce back, but it even extends to people with mental illness who become asymptomatic of their specific condition shortly before death. Terminal lucidity has even seen people who had been living with dementia for years return to their former cognitive function, only to die some time after.
How long before death can it happen?
The gap between terminal lucidity and time of death has triggered debate around the phenomenon’s name, with further research having recoined it “paradoxical lucidity” owing to the fact that the state of mental clarity can kick 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 would appear to support that yes, terminal lucidity is real and it may even be common. “I think it’s safe to say that this phenomenon exists, and it likely exists more often than we expect, or than we would have believed.”
Why does it happen?
According to the 2009 review, historical cases of terminal lucidity were explained as consequences of the way our brain physiology changes when we’re dying, though detailed explanations to support this were lacking. It’s a particularly puzzling phenomenon to work out, as it’s seen among patients whose brain function is considered to be irreversibly damaged by disease, as in the case of Alzheimer’s. How, then, is it possible for seemingly deleted memories to be made accessible again?
The answer, for now, is that we don’t know. Accounts of terminal lucidity have seen people overcome disease and brain injury such as brain abscesses, stroke, and tumors to recall memories and people it was thought they had lost.
Among some of the most incredible accounts is the story of a young girl named Anna (“Käthe”) Katharina Ehmer, reported Jesse Bering for Scientific American. Käthe was said to have been profoundly disabled since birth and was later kept in an asylum where she experienced multiple and severe meningitis infections that damaged her brain. In the face of all of that, and despite never having learned how to speak, she was heard singing to herself in the last half hour of her life.
It's Nahm’s outlook that if terminal lucidity can see such a profound remission of mental disorders before death, understanding could be crucial in “the development of both improved therapies and a better understanding of unresolved aspects of cognition and memory processing.” For now, we await further insights into the curious phenomenon.
Terminal lucidity, paradoxical lucidity, end of life rallying, or The Surge – we might not agree on what exactly to call it, but we can all agree it is truly remarkable.