Chapter 2: Explaining common clinical issues

The rally

It’s not unusual before death for some patients to experience a “rally” in their disease progression. After hours or days of not communicating or being awake, the patient may become lucid and show signs of physical improvement. This improvement may last for a few minutes or many hours. Why this occurs isn’t fully understood. 

This rally may give the family unrealistic hope that the improvement will last. However, it’s important to know that most often this seeming recovery is followed by a steady and sometimes sharp decline. This second change in direction may be especially disheartening for the family, and as the natural decline resumes, they may feel confused and upset.

Conversation Prompts

“It’s common for people who are dying to experience a brief period of what looks like improvement. It’s not known why this happens. It can be confusing but it's often a sign that you should prepare for a decline in [patient's name]'s condition, which may be sudden and rapid.”

See also:A frequently asked question about why some people become suddenly alert right before death.