Imminent Death and Spontaneous Return to Mental Awareness

The day before he died, my father, who over the course of several years had suffered a steadily decreasing awareness of and interest in his and others’ lives, finally appearing to no longer have an inner life, suddenly, briefly and inexplicably returned to the world. I described this here.

I’ve found out two things since then. There are many anecdotal reports about this phenomena, and there is next to no medical research, explanations, or theories about how this happens.

I can’t really imagine how researching an unexpected event could proceed. I suppose there could be people on call, like transplant teams, but then what? Would the dying person who has returned one last time to engage with the world be rushed into an MRI and subject to various medical tests? Perhaps some would agree to this, if they believed that by so doing others could be spared their suffering, and if they were asked before they lost the mental capacity to make that decision: you can see the difficulties.

I finally found one study about this subject: “Terminal Lucidity in Patients With Chronic Schizophrenia and Dementia: A Survey of the Literature” by Michael Nahm and Bruce Greyson, published in The Journal of Nervous and Mental Disease (December 2009, pp 942-944).

Continue reading “Imminent Death and Spontaneous Return to Mental Awareness”

Of Spectres and Death and Will

It’s my father’s spontaneous two smiles that I find so astounding, even now, nearly a month after his death. I had not seen him smile in years, nor had my mother.

If you’ve read Philip Pullman’s His Dark Materials, you’ll remember the Spectres, those “children of the abyss” who steal from their victims any “conscious and informed interest in the world.” Those attacked by Spectres don’t always die immediately; some linger, but, as one child tells another,”‘it’s like they been eaten from the inside. You look in they eyes, you see the back of they heads. Ain nothing there.'”

If you’ve ever been around someone with Alzheimer’s or dementia, you’ll know why each time I visited my dad the Spectres came to mind. He would respond to questions, but he never asked any. He’d appear to listen to conversation, but never initiated one. His mood was flat. He was there, that’s all.

So where did those two smiles come from? Where had he been and how and why did he make one final and brief appearance as the self he once was? Less than 24 hours before his blood pressure had been very low, something like 60/40, pulse slow, temperature dropping, and he seemed deeply asleep or unconscious.

His vital signs didn’t improve the next day, but certainly his level of consciousness did.

My father’s hospice nurses, as well as several friends I talked to later, were not surprised by this. It is far from rare for the terminally ill to experience a final period of lucidity, and yet I can’t seem to find discussions of this phenomenon that amount to more than anecdotes.

I’d think neurologists would be intrigued by spontaneous but brief returns to lucidity among those whose brains are damaged. Arguments that near-death experiences (NDE) have more to do with oxygen deprivation than with life after death are easy to find, but if I studied the brain, the question I’d ask is what happens to the dying brain that allows the mind to return before it is finally extinguished.

Could there be a way to effect this restoration that doesn’t require dying?

I finally found a term in limited use relating to these final returns to lucidity: nearing-death awareness (NDA), introduced in 1992 by two hospice nurses, Maggie Callanan and Margaret Kelly, in their book, Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying. They describe two sets of experiences. One focus is the similarities of NDA and NDE. Some of their patients have had experiences in their last hours that are consistent with the narratives of NDE.

Callanan and Kelly also describe unexpected spells of lucidity among the dying, including behaviors such as seemingly choosing their time of death or delaying it until a relative arrives.

It’s these efforts of will that show an attachment to this life rather than anticipation of an afterlife that interest me.

Before my father died, I’d wonder why people were allowed to relieve their terminally ill, much beloved pets of a prolonged descent into death, but were prohibited from extending the same mercy to their human loved ones.

While I still think that a fully conscious, terminally ill person should be able to ask for assistance in ending her own life, I see now that even were it permitted, I could not choose for my human family members the active euthanasia I might allow a semi-conscious pet.

So often you hear of an elderly and sick pet just disappearing, going off alone to die. Mammals must have near-death awareness, most likely keener than ours.

But do they ever exert their will to stay alive until they know their children are with their mate, or until they can say goodbye to someone they love very much?

At its end, all my father had left in life was his death — and a little bit of will.

He summoned his strength and vanquished the Spectres at last. He exerted his will. He was at last again Joe in all his Joe-ness.

Then he allowed Death to arrive.