The Last Thing You’ll Hear: What the Brain Still Listens for as Life Fades

By the time my grandmother died after a series of strokes, she’d been unresponsive for about a week. My mother wouldn’t leave Grandma’s bedside — not to eat, not to sleep, not to bathe; she moved in. I delivered whatever Mom needed and stayed much of each day. Other family visited regularly, and we always included Grandma in the conversation. Visits were pleasant things, everyone laughing. This, my mom the oncology nurse, told us, was important for Grandma ‘s comfort .

The final day, I arrived around noon. Mom announced me, as she always did, in a joyful, upbeat tone that belied the exhaustion in her face. I greeted them brightly and happily and headed straight to the bathroom, where I cried as quietly as I could. I tried to hurry up about it; of course I wanted to be there, but the vigil was physically relentless and emotionally depleting.

Hours later before I headed home I hugged my grandmother tightly, as I always did, fussing over her. I covered her face with loud kisses, something she would have resisted under regular circumstances. “Ha ha!” I said, kiss-smacking her all over. “You’re powerless! You can’t stop me!” We laughed.

And Grandma kissed back. Weakly, imperfectly, incompletely, she kissed back. For a week she hadn’t responded to words or hugs or hand squeezes; now, with this full-on assault, she puckered up. I laughed, delighted. Mom, however, was unsurprised; she had seen such moments may times. “Told you,” she said.

 “I love you Grandma,” I said for the last time, then headed home.

She died before I got to the elevator.

“You loved her to death,” Mom laughed while we cried.

“She deserved it,” I said.

Evidence

That was 1999. Twenty-one years later EEG results from a study at UBC demonstrated what families of the unresponsive dying have long believed— that the sense of hearing in dying, unresponsive patients persists long after they stop reacting outwardly.

The study compared EEG readings from three groups: healthy, conscious responders; conscious hospice patients; and unresponsive hospice patients. Findings revealed brainwave activity that was consistent with conscious responses to auditory stimuli in all subjects, even the unresponsive hospice patients.

People who have resurfaced from comas report similar experiences. Some coma patients who regain consciousness reported the content and participants of conversations that happened in their presence while they were believed to be fully unaware; one man, under for six years, woke up able to speak English — a language he didn’t know — likely because of the exposure to his English-speaking nurses.

Coma isn’t the same as unresponsiveness — each lies along a spectrum of altered consciousness with varying degrees of brain activity. Coma, for example, lacks any consciousness whtsoever and can show global (whole-brain) dysfunction; its clinical features include total absence of waking/sleep cycles, no active reflexes (even to pain), and no EEG activation in response to sound. End-of-life unresponsiveness, by contrast, sometimes includes reactions to stimuli, including startle response and hearing… we just don’t always see it.

Saying goodbye

These findings emphasize and validate one of love’s deep instincts. Even when based on hope alone, even if a patient could not respond, we now know our voices and words (and possibly touch) can provide comfort to the actively dying... they get through. Does such one-sided effort ease suffering? Does it blunt fears? Not only for them.

This was my experience the day my grandmother died. My mother, the oncology nurse who had seen dozens of patients and their families through the entire dying process, told me then that she believed Grandma heard and knew us both. At the time, this soothed me, so I took her at her word… which is now supported by evidence.

The comfort was not just Grandma’s.