What is Terminal Lucidity?
The Clip: Original Content
When someone is about to die, something strange can happen…
The dying human can become incredibly alert, even if afflicted with an advanced stage neurological disease.
This phenomenon has been observed by physicians throughout the ages, from Hippocrates (c.465 BC - 375 BC), Schubert (1780 AD - 1860 AD), to physicians in the modern era.
Some said it was the soul releasing itself from the body, others believed that the movement of blood and fluid in the brain were the cause of this strange behavior.
More recently, in 2009, a German Ph.D named Michael Nahm consolidated the recorded observations throughout time and coined the phrase “Terminal Lucidity”. Summing it up as:
“...the sudden return of mental clarity shortly before death.” 
Despite being observed so often, there are still many questions yet to be answered: What exactly is mechanism? How can someone with advanced dementia suddenly become lucid? Is it possible to reverse degenerative brain disease?
As nurses, we are often the ones at the bedside when someone reaches the end, it’s a special, yet tragic part of our duties.
Once, I experienced such an event with a patient who arrived at the hospital in the middle of the night. In order to protect his privacy, we will call him Jim.
Jim presented with symptoms all too common in the elderly population where I worked:
- Uncontrolled heart failure
- Advanced dementia.
- and Diabetes.
He was also listed as DNR, or Do Not Resuscitate, which meant if his heart or lungs stopped working suddenly, he did not want us to perform CPR to try to bring him back.
My initial assessment went as expected, he was oxygenating fairly well, though he had slight crackles in his lungs caused by the fluid backed up from his faulty heart.
I asked if he knew his name. He said his name was Jim, but he could not answer any questions about his history more difficult than that.
He barely moved.
I got a call from the nurses station: Jim’s wife was on the phone, she wanted to check on him. We’ll call her Sheila.
Sheila’s was the opposite of Jim. She was sharp as a tack, and she knew everything about Jim. She could recite his medications, when he took them last, how long he'd be experiencing his symptoms, and so much more.
She was a good partner.
When I remarked at how much she knew about her husband, she laughed and told me they “were married for a very, very, long time.”
When I went to Jim's room to tell him his wife called, that's when it happened.
I couldn’t believe what I saw.
The man who couldn’t even remember his own birthday, who could barely uttered a single word had suddenly come to life.
His eyes lit up, looked around the room, and asked: “Where is Sheila?”
“I just spoke to her, she told me to tell you hi, and to stay out of trouble” I joked.
We talked about his marriage for awhile. I was shocked that we were having a totally normal conversation. This was a guy who barely knew his name, but could remember his wife with such vivid detail.
The significance of their love and the impact on his memory was not lost on me.
I was a new grad nurse, and I had never heard of Terminal Lucidity. I thought his remarkable improvement in cognitive function was a good sign…
I was wrong.
Before I even had the time to finish his admission paperwork, I got an alert from the telemetry technician, that Jim's heart rhythm had become irregular.
I grabbed a helping hand in my Charge Nurse, and we went to check on him. His heart monitor was beeping, but he had no pulse. I tried to shake him awake, but he did not respond.
The brightness that was in his eyes just moments before was gone, and so was he.
I spend a lot of time thinking about that night. The exact details are fuzzy, the time it all went down felt like seconds, but it could have been minutes, or hours. I don’t remember a single thing about the other 3 patients I had that night, but I can still feel the guilt, self-doubt, and confusion that I experienced as if it all happened yesterday.
I look back and I wonder if my lack of experience was the reason why he was never able to say goodbye to his wife of so many years.
I think about how funny our minds work. How we spend our entire lives acting so selfishly, and in the moments before our light goes out, all we can do is think about others.
I wonder if more of us knew about Terminal Lucidity, would we act differently toward each other? Would we be more kind to those closest to us, knowing that in the end that’s all we’ll care about? Would we be more present with our family members whose minds have gone, knowing that at any moment, we could relive all of our greatest hits?
Most of all, I think about an old Buddhist adage:
“Thousands of candles can be lit from a single one, and the life of the candle will not be shortened.
Like the fire passing from one candle to another, one’s happiness can never decrease if it is being shared
So to Jim and Sheila,
Thank you for sharing part of your story with me, I hope that I did right by you, and I hope that by sharing your story with our readers, we can keep your flame going, even if it’s just a flicker of the happiness you two had in your time together.
Articles Mentioned in the Story:
Nahm, Michael Ph.D. Terminal Lucidity in People with Mental Illness and Other Mental Illness and Other Mental Disability: An Overview and Implications for Possible Explanatory Models (2009)