Explained: Why some people suddenly seem to get better just before they die |

It can be a moment that stops families in their tracks. A loved one who has spent weeks fading eating, little, barely speaking, drifting in and out of sleep, suddenly seems almost themselves again. They sit up, smile, ask for their favourite meal, perhaps even make a joke. Relief fills the room. “They’re getting better,” someone whispers hopefully. But within hours or days, the person slips away.This bittersweet moment, described by many who have witnessed death up close, has a name: terminal lucidity, a short-lived return of clarity, energy and awareness that appears just before death. Though it can feel like a miracle, experts say it is not a recovery, but rather a part of the dying process itself.

A phenomenon hospice workers know too well

Hospice nurse Julie McFadden, a 42-year-old from California, has seen this countless times during her years caring for the dying. On her channel Hospice Nurse Julie, she shares her mission to “alleviate the fear and stigma around death,” speaking openly about what really happens in a person’s final days.“There’s one phenomenon that happens during the death and dying process that medical professionals, like myself, cannot explain,” she says. “This is when someone is really sick and almost towards actively dying, meaning dying within a few days, and then suddenly they look like they are ‘better’.”

She explains that this improvement can show up in many ways: “They suddenly will eat, they’ll suddenly talk, maybe even walk. They act like their old selves. They have a little more of a personality, kind of laughing, talking, joking, but then usually they die within a few days after this, sometimes even that night. It happens to probably a third of our hospice patients, so it happens quite a bit.”McFadden calls this the “number one phenomenon” she sees near the end of life. In medical or hospice circles, it’s often referred to as “the surge” or “the rally.” Whatever the name, the meaning is the same, a brief moment of brightness before the body finally lets go.She often tries to prepare families for it: “We try to educate the family about this before it happens so it doesn’t devastate them when they suddenly pass after doing so well for a few days. The hard part is enjoying that while it’s happening and knowing they will likely die shortly after.”

The science behind the mystery

Although hospice nurses recognise terminal lucidity as a real and recurring part of dying, science still has no definitive explanation for why it happens.Research suggests it could involve temporary changes in brain function. Some studies indicate that as oxygen levels drop, the brain briefly becomes more active, especially in areas linked with alertness and memory. A spike in gamma wave activity, which is associated with cognition, has been observed during near-death experiences such as cardiac arrest. This may help explain why some people regain lost abilities, speaking clearly, recognising loved ones, recalling memories, even when the brain is in decline.However, as McFadden emphasises, “There is nothing that has been scientifically proven or studied to tell us exactly why it’s happening.”A 2018 study investigating terminal lucidity in a hospital setting found that, out of 338 reported deaths, only six included such episodes, and all six patients died within nine days of the event. Meanwhile, a 2023 study exploring paradoxical lucidity, a related phenomenon, surveyed 33 healthcare workers; 73% reported witnessing an episode. In 22.2% of cases, the person died within three days, and another 14.8% died within three months.Researchers note that the terms “terminal” and “paradoxical” lucidity can be confusing. Paradoxical lucidity describes similar episodes that happen weeks or even months before death, while terminal lucidity usually occurs within days or hours. Both challenge our understanding of how the brain functions at life’s end.

What families see, and feel

The experience can be emotionally complex. Families often interpret the sudden burst of energy as a sign of recovery, sometimes even questioning whether hospice care is still needed. But as experts caution,these moments are fleeting and should not prompt changes to treatment or medication.“For many people, a lucid episode may look like a sign that their loved one is getting better,” experts explain. “It can be tempting to take them off hospice and try treatments to cure them instead. But the reality is that these medicines are keeping your loved one free from pain. Terminal lucidity is fleeting.”McFadden recalls how her own grandmother, at 91, experienced “the rally.” After refusing food and sleeping almost constantly, her grandmother suddenly sat up one day, tried to put on her shoes, and even shared a meal. She died the following day. “That’s the perfect example of the rally,” McFadden says.Those caring for the dying may notice several signs during such moments of lucidity:

Episodes can last from a few minutes to a few hours, sometimes stretching to a day or two, rarely longer.While terminal lucidity can be heartbreaking in hindsight, hospice professionals encourage families to see it differently. As McFadden puts it, “Try to stay present in the moment with your loved one having that really good day and look at it as a true blessing, almost like a gift your loved one is giving you.”For caregivers and families, understanding this phenomenon can soften the confusion and shock that often follows. It reframes those final moments not as false hope, but as a window, a last shared clarity before parting.Researchers are continuing to study these episodes more closely, gathering firsthand accounts from healthcare workers to better prepare families and professionals alike. But for now, terminal lucidity remains one of the most profound and mysterious aspects of dying, a moment when the body begins to shut down, yet somehow, just before the end, life shines briefly and beautifully through.