Pre-mortem Surge

The final breaths seem near.

But then, she awoke! But then, he spoke!

Was it a miracle, terminal agitation, or a . . . pre-mortem surge?

The myth of the Phoenix. (Bettman/Corbis photo)

The myth of the Phoenix. (Bettman/Corbis photo)

No one wants a loved one to die. Ever. But when a parent or spouse or best friend has entered hospice care, we (mostly) resign ourselves to death’s inevitability. We hear oncologists mutter that our mother has six months or less to live. Or we’re speechless when the surgeon declared, “There’s nothing more we can do for your husband.” If you’re told you only have a 1% chance of the new drug giving another month or year of life, some expect to be included in the smidgen of percentage of survivors. Others resign themselves to the harsh reality of living and dying among the 99%. But whatever you or a loved one was told (and believed or disbelieved), there comes a time when all percentages narrow to zero. The months of life once predicted by the medical experts dwindle down to hours.

Past the prayers, past the optimistic guesses, past the clutching-the-straw hopes, we sit vigil beside the one whose life wanes like a setting sun in winter.

Our loved one’s breath may slow.

Now we can’t remember when she or he ate a meal, a real meal.

We grasp their hands, we stay up late or get up early or both. We don’t want to leave their side.

And then, amazingly, our father or favorite uncle, our wife or our sister-in-law, seems to stir.

She talks!

He makes eye contact!

She requests a glass of water!

He asks who won the World Series or if Aunt Madge finished her first marathon!

How can this be? How can the nearly dead become the lively living? You, having settled into the grim routine of waiting, now gaze at your loved one as if he was a 21st century Lazarus or she were the flesh and blood example of the myth of the Phoenix. Arise, Lazarus! Come from the ashes, O Winged Phoenix!

One of the hospice nurses where I work mentioned there was a new way to describe “terminal agitation.” It is called the “pre-mortem surge.” After she shared the phrase, I searched for it online and found a reference here. It is a new term. Not many in the medical field use it right now, and it may never catch on. Regardless of how often the term may (or may not) be used in the future, it sure sounds better than “terminal agitation.” After all, terminal—unless you’re riding in a plane, train, or bus—is not a popular word.

However, in both medical research and in the anecdotal have-you-heard-this stories told by hospice professionals, there are many examples of patients with sudden activity—from engaging in an upbeat conversation to simply making eye contact and nodding a yes or no—that truly surprises their caregivers. How can someone sharing memories or asking for a second helping of pudding die in hours or days? Some, though not all, patients do seem like the Bible’s Lazarus: once dead, now alive!

I’ve witnessed a “pre-mortem surge” in a few patients. I’ve had families report the phenomena to me when they described the final days of a loved one’s life. Why does it happen? Why does it happen to some and not others? The questions are easy to ask; the answers are rarely easy to give.

And the “surge” can trick us. Oh, how we long for the forever miracle of life. But then, minutes or hours or days later, the one who requested pudding, the one marveling at Aunt Madge completing her marathon, does die.

This I hope . . . every moment we have with another is a miracle. I’m glad for those who have a brief, unexpected lucid moment with a dying beloved. I’m sad when this doesn’t happen because a final hand squeeze or a last I love you is precious.

But there is the time right now with the ones you love. Talk now. Spend time now. If there’s that story you wanted to share, or that forgiveness that needs to be given or received, do it now. Make the call. Send the text. Set up the Skype. Drive to the house. Share coffee. Yes, one day, near the last day, there may be a “pre-mortem surge,” but for all mortals, there is today.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

Phoenix image from here.

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