Thursday, August 07, 2014

Terminal lucidity

It's striking to contrast these two claims:

Some of us (myself included) [Douglas Hofstadter] believe that the late President Reagan was essentially “all gone” many years before his body gave up the ghost, and more generally we believe that people in the final stages of Alzheimer’s disease are essentially all gone…. The “I” has either wholly or partially vanished, gone down the drain, never to be found again.

Only recently have scientists begun to take note of a phenomenon first observed by doctors in 19th-century insane asylums in France, Germany and the U.S. Back then, they called it  terminal lucidity. 
Patients with severe and chronic mental illness or dementia would suddenly start speaking clearly and rationally before death. 
Even those with amnesia often recognised family members for the first time in years, and were able to say goodbye. 
More recently, nurses and physicians have been noticing this phenomenon as more people end their lives in hospices. 
In 2007, Dr Scott Haig wrote an account of his patient, David, who had lung cancer that had spread to the brain. 
First, David’s speech had become slurred and then he’d  lost the ability to speak or  even move. 
A brain scan done by his oncologist showed that there was scarcely any brain left. 
For days, said Haig, his patient had ‘no expression, no response to anything we did to him’. 
Then, when the doctor made his evening rounds one Friday, he noticed that David had lapsed into the laboured breathing that often presages death. 
But an hour before he died, he woke up, and talked calmly and coherently to his wife and three children, smiling and patting  their hands. 
As Haig noted: ‘It wasn’t David’s brain that woke him up to say goodbye that Friday. ‘His brain had already been destroyed.’ 
Psychiatrist Russell Noyes had  a similar case: a 91-year-old woman who’d lost her capacity for speech and movement as a result of two strokes. 
Yet she suddenly broke through those walls shortly before  her death. 
Smiling excitedly, the woman turned her head, sat up without effort, raised her arms, and  called out happily to her dead husband. Then she lay back down and died. 
Whether or not she’d had a vision of her husband, the far more difficult and astonishing fact was that she’d regained her speech and mobility.


  1. In 1995 after a long debilitating fight with leukemia, my father was unable to sit up without someone sitting beside him and holding him up. He had wasted away from 200 pounds to 98. On his final day he suddenly sat upright and peered over the foot of his bed as if seeing something unusual. " Ruby? Sugar? Neat?" he called out three sisters names who had passed away years before. "Is that you? Wait right there, I'm coming soon!" He passed away within the hour. He had not been lucid for weeks.

    1. That's really interesting. Thanks for sharing it, Mr. Kent McDonald!

    2. You are welcome. He was, of course, a believer. He knew where he was going and so did his family.

  2. This occurred several times in ICU patients with various illnesses of mind and body in my 4 years of hospital work. One incident that reminds me of Kent's example was the case of a patient (known to me, though I was not present at the time of the incident, which was related to me by the nurse later that day) who was succumbing to multiple organ failure due to complications from other disease issues and had not been lucid (much less conscious) during the previous several weeks of her hospital stay (whether she had been before admission is unknown to me). One day when she the nurse had just entered the room to care for the patient, the woman in the bed "woke up" and looked up to heaven, stretched out her arms, and said "come on… come on…", before expiring on the spot. I don't know if she was a believer or not, but the anecdote has stuck with me.

    1. Thanks, Tom! This is also quite an interesting story, to say the very least! My impression is terminal lucidity cases are more commonplace than most people think.