The return before goodbye

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MYRNA BROWN, HOST: Up next: how life can literally flash before our eyes.

As the body slips into death, sometimes the mind briefly comes back. Consciousness and clarity may return for a few minutes to some patients who previously couldn’t move or speak.

Researchers are exploring that short flash of life before death, hoping it could hide a cure for severe brain damage.

WORLD’s Lauren Smyth has the story.

SMITH: Amazing grace, how sweet the sound that saved a wretch like me.

LAUREN SMYTH: Tim Smith was a hospice pastor in Arizona, singing that hymn at the beds of the dying. Sometimes, they seemed to see things he couldn’t.

SMITH: I was standing at the foot of a patient's bed one day, and his family was gathered around, and he asked me if I would move. And people said, "Well, why do you want him to move?” And he says, "Because there's an angel standing there.”

That unexpected mental clarity in a patient who was previously unresponsive or confused has a name: terminal lucidity. It can look like recovery, but it actually means death is near.

SMITH: I believe that as we get ready to make that transition from the land of the dying to the land of the living, that God gives us intimations of what's coming.

Smith’s mother was a nurse during World War 2. She told him stories of terminal lucidity in her patients, long before the medical community recognized the condition. One story Smith remembers well was about a blind missionary.

SMITH: She’s sitting with him, and about 3 o’clock in the morning, Dr. Ellis sat up in bed, reached out his arms, and said, “Jesus!” And his eyes opened.

Doctors don’t know what causes terminal lucidity. Capturing data is hard because the moments surrounding death are private, and clarity often doesn’t last for more than a few hours.

What they do know is that the brain appears to become more active just before the body gives way to death. Researchers hope finding out more about terminal lucidity could provide a clue to reversing dementia and other severe neurological damage.

Shelby Kirillin is an end-of-life doula who guides the terminally ill and their families through death and grief. She says an explosion of brain chemicals is one possible explanation for terminal lucidity.

KIRILLIN: The body or the brain just releases all our serotonin and all our dopamine at once, and so the body all of a sudden has this wakeful oomph.

Kirillin estimates terminal lucidity happens for about a quarter of her patients.

KIRILLIN: I had one gentleman who, again, bed bound on hospice, actively dying…all of a sudden he walks into the kitchen and asks for a donut and says he wants to go home.

Kirillin sees the terminal lucidity as a special last chance to communicate with loved ones … but she tries to warn families it’s not recovery. Otherwise, those few hours can feel like a gift that’s cruelly torn away.

But often, it inspires awe in those who witness it, especially for those not often around death.

SMITH: The best theology is learned not in the seminary classroom, but it's learned there in the mortuary, the funeral home, in the prison. I think it's an impoverishment of our culture, and it is an avoidance of death.

In the past, death would have most likely been a bedroom surrounded by family and everyday life. Now, death comes more commonly in a clean-smelling hospital room, and family is less involved in end-of-life care. Physical concerns can overshadow the spiritual nature of death, but terminal lucidity brings that perspective back.

SMITH: People respond often like people respond when they've been present at the birth of a child. That something big has happened—something transcendent has happened.

Smith says after everything he’s seen, he won’t be afraid of death.

SMITH: I tell people that the years I worked for hospice were some of the happiest years of my life.

For researchers, terminal lucidity offers a glimpse of the mysterious connection between body and soul, brain and consciousness.

But Smith says for the dying, it seems to be the first step out of the physical body and into the spiritual.

SMITH: And so that missionary doctor who was blind, that my mother saw sit up at 3 o'clock in the morning, open his eyes, put out his arms, and say, "Jesus,”—that's what it's about. That our time here is so minuscule compared to that which is coming.

And for families, it may be a last chance to say goodbye.

SMITH: I once was lost, but now I’m found. Was blind, but now I see.

For WORLD, I’m Lauren Smyth.

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