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End-of-life rallies are a gift that can confuse family members

"Minding Our Elders" columnist Carol Bradley Bursack says it's best to simply cherish having extra time to say goodbye.

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Carol Bradley Bursack, "Minding Our Elders" columnist.
Contributed / Carol Bradley Bursack

Dear Carol: My mom was in hospice care for over five months. During those months, we thought that she was near death several times, but she’d rally (that’s what they call it) after each episode. Until she didn’t. I guess I’d become complacent because she’d improved so often, but her death felt like a shock.

Apparently, such rallies aren’t unusual. Have you experienced it with your family? Does anyone have any idea why this happens? It’s been hard losing my mom right after she perked up so I’m struggling to find acceptance with the fact that she did finally pass. — WP.

Dear WP: I’m so sorry, and yes, I understand. It would be normal for you to become somewhat complacent under the circumstances. Even when we know that this is the end of a loved one’s journey, it’s hard when they take the final step. When due to patient history the family expects yet another rally that does not come, the finality is bound to feel extra intense.

Interestingly, your experience isn’t too far out of the norm. When someone we care about enters hospice, we mentally prepare ourselves for the fact that we will lose them within months or weeks because a limited lifespan is what qualifies people for this care. Many people do improve while in hospice care and even “graduate,” though most will eventually go back on the program. As I understand it, quite a few people do experience rallies during this process. A pre-death rally can last a few moments, a few hours or even days.

My mother-in-law had several close calls from which she rallied several times over a few months before she had one last seizure that took her. My sister and I witnessed an end-of-life rally with our dad. My aunt died the evening of my oldest son’s first band concert. She’d rallied that day, but she and my parents wanted me to go to his concert (I’m glad that I did).


How do we explain this end-of-life rally? Maybe we can’t.

Hospice caregivers and chaplains often see rallies and they describe it as the person’s unique way of saying goodbye. They suggest that some people feel the need to hang on for a time while others feel that it’s time to go. Even through their grief, many family members find spiritual comfort in these words.

Pre-death rallies can be especially frustrating when a family that has waited diligently by the bedside of a dying relative feels it’s safe to leave and get some rest only to find out that their loved one died in their absence. This, too, is not unusual.

WP, scientists have come to understand the physical changes of active death, but there’s still much about the process that remains a mystery. Maybe that’s as it should be. If we witness a rally, it’s best to simply cherish the gift of having had extra time to say goodbye.

Hospice grief groups can be helpful in case you want to look into that.

Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of “Minding Our Elders: Caregivers Share Their Personal Stories.” Bradley Bursack hosts a website supporting caregivers and elders at www.mindingourelders.com. She can be reached through the contact form on her website.

Carol Bradley Bursack is a veteran family caregiver and a nationally-recognized presence in caregiver support. She's the author of “Minding Our Elders: Caregivers Share Their Personal Stories,” a longtime newspaper columnist and host of her blog at mindingoureldersblog.com. Carol's an introverted book nerd, so you won't see her mugging in viral videos, but you can easily reach her using the contact form at mindingourelders.com.
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