There is something about the human spirit, some amazing inner strength that people have that allows them to hold on for special occasions. Two major milestones for people are Christmas Day and New Year’s Day. Out of the past ten years I have worked 8/10 of the New Year’s holidays. What usually happened was that no matter what spiritual belief people had they would likely hold on for Christmas Day, and possibly for New Year’s Day and then we would see a large number of people dying once they had achieved their milestone(s.)

Sometimes it can be living through their wedding anniversary, or beyond a loved one’s birthday.
People often will try not to die on a significant other’s birthday, so that the birthday will not be spoiled from thence on.

How does a comatose person even know the date let alone know what the time is? Somewhere deep inside ticks a very accurate body clock? People may be holding on for special occasions such as the wedding of their child, or grandchild. Or it might be the birth of the newest family member.

In Aotearoa New Zealand a lot depends on the national religion. People will hold on for the Rugby World Cup – the Rubgy League World Cup, not so much.

How can a person sense their environment when they physiologically have been made insensate?

Studies of people under general anaesthesia were done in which people were made unconscious and supposedly insensate, and then conversations were had around them. On awakening they were quizzed as to the contents of the conversations and the people could recall what had been spoken about, even though at the time the brain was supposedly turned off.

I often talk about hearing being the last of the senses to go when someone is dying, that a person even deep in a coma, may be able to hear what people are saying to them. They may be too weak to actually respond, but hearing their loved ones’ voices will provide comfort and reassurance to them. Hearing is one of the first senses to develop in the foetus, have you told a little baby to kick his mum from the inside? The reassuring regularity of the mother’s heartbeat heard within the surround sound chamber of the placenta, the start of parental recognition.

Somehow people have environmental awareness of what is happening around them, even though their eyes are closed, and possibly higher functions have been scrambled. Maybe it is more primitive areas of the brain which are switched back on when the higher functions are shutting down?

Families will hold their vigils, making sure that their loved ones always have someone nearby. Then one of the loved ones is alone in the room with the dying person. They are only away from the room for mere minutes, when Nature or someone else calls, and the dying person, takes the opportunity to slip away. I do warn people that no matter how intense a vigil they hold, that sometimes people do want to die without anyone being around. That they want to spare their loved ones from the actual moment of dying. I’ve had it happen too often with patients I have looked after, it really is a thing. One patient that I looked after said that, “I’m ready to go, but I can’t leave when there is so much love in the room keeping me here.”

The last hurrah or the rally is also something that happens. A dying person somehow gathers together energy from who knows where in order to wake up for a final period of improvement. This may be only short-lived sometimes just for minutes, or for days, sometimes for much longer.

I was unfamiliar with this concept until I started working full-time in palliative care. An elderly man had been unwell for weeks, and had fallen unconscious. His prognosis appeared to be poor, and he had not spoken to anyone in 10 days. It looked like he could die at any time. We talked to the family and prepared them for his likely continued deterioration and death over the next days to weeks. We promised that he would be kept comfortable no matter what time remained. This was on Friday afternoon, and we were worried that he would not make it through the weekend. When I went to see him again on Monday, the family excitedly related that he had woken up on Sunday morning. He had a lovely time with his whole family, talking animatedly with his grandchildren about his favourite thing of all, fishing off the islands. He spent a lovely Sunday with his whole family, paying special attention to his wife of many years. It was actually a special day for her, that instead was spent in hospital, but it was still special, and much different from her usual Mother’s Days celebrations. He’d had a lovely day with his wife and family before becoming unconscious again in the late evening. He never woke up again and lived for another ten days in hospital.

Some people may be waiting for family members to visit one last time before they can go?

With others the mystery remains unsolved.

Consistently fascinating work from which I learn so much.