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The process of dying is rarely simple, and seldom a linear process. There’s a rare, elusive, and completely fascinating phenomenon that can occur towards the end of life, that you might not have heard of. Hospice staff know it as ‘the last rally’, or perhaps ‘the final surge’. It used to be known as ‘a Lazarus moment’, and in the 19th century some referred to it as ‘the last light shining’.

The medical literature has another name for it. Terminal Lucidity.

This term describes brief and fleeting moments in the last moments of patient with terminal degenerative conditions (dementia, but also stroke, meningitis, schizophrenia and others), who suddenly appear to ‘come back to themselves’ towards the end of their lives, for brief moments.

For example, patients who have been unable to make sense of their surroundings or recognise loved ones, might suddenly be able to do those things again for a short time. Patients who experienced profound personality change are ‘themselves’ again, briefly. Sometimes, there is an opportunity to share memories one last time, or to say goodbye. And often, this is followed within days or weeks by the patient’s death. It’s often a deeply moving event for the family of a patient, and it sometimes provides families with an opportunity to interact with their loved one for the final time.

This utterly fascinating but so far little-studied phenomena gives tantalising clues as to the nature of degenerative disease, and occasionally allows us to say goodbye to those we thought already long gone. It's rare - thought to occur in 1-3% of terminal patients. But why, and how does it happen? What mysterious processes could be happening in the body and brain as we wind down towards our end? And can we use our understanding of these conditions to treat them BEFORE the final curtain?

Emily Knight explores the final rally, and asks what it can tell us about life, consciousness, and the process of death. Perhaps if we can unravel the way it works, we might get clues into how to bring people back, way BEFORE death.