Russell* was a hospice patient I had been working with over several months. Suffering from dementia, he responded well to familiar music during our first session. But his ability to engage and process sound deteriorated over time, leaving him minimally responsive during my last few visits. Recently, I received a call from his daughter-in-law requesting another session. Russell was dying.
When I entered his room, family members were standing around the bed, holding hands and singing hymns with a CD. Rich music filled the room as they celebrated Russell’s life as his nurse sat nearby. The family is close, united by a deep faith in God. Their devotion to Russell was evident as they cared for him and one another. On this day, they were there for him as he had always been there for them.
As I assessed his condition, I recognized subtle signs of agitation. Conferring with his care team earlier, I knew he had been sedated and that he should have been more restful. I discreetly asked Russell’s nurse how long the family had been singing, and she replied, “Just about all morning.” The affects were real, though perhaps not obvious if you weren’t watching closely. Russell’s teeth were clenched and he was feebly pulling at his bedding and O2 tubing while shifting in his bed.
In that instant, I faced a challenging dilemma. The volume, tempo and complexity of the music filling the room was over-stimulating Russell. My role was to comfort and soothe him, allowing him to transition peacefully. For Russell’s sake, I silently whispered a prayer for wisdom and addressed his family.
Asking the nurse to turn off the CD and thanking the family for their beautiful music, I invited them to listen while I played softly, explaining that Russell had reached a point where subtle tones were more beneficial than his beloved hymns. As my guitar produced soft arrhythmic tones that entrained with Russell’s weakening body, he responded almost immediately. He stopped pulling on his sheet and his jaw relaxed. Moments later, he closed his eyes. His respiration rate, 28 when I began, slowed to 12. Soon after, Russell seemed to sense his time was at hand. The family was silent while I played soft, slow arpeggios. As my tempo slowed, his breathing followed. Soon, he was taking only a few breaths per minute. Then he sipped two shallow breaths and was gone. Peacefully, silently, and surrounded by generations of love, Russell slipped away and entered his Rest.
In no way do I wish to criticize Russell’s family for singing to him. Families have helped loved ones cross over with music for centuries. But while singing may comfort the family, it seldom benefits the patient in their final moments. Sadly, we have no definitive manual on how to die, but research confirms that over-stimulation during one’s final hours can produce unnecessary discomfort and agitation. Our brains simply cannot process complex stimuli at the end of life.
I was honored to help Russell complete his earthly journey and transition peacefully and play live therapeutic music for patients in my community. My desire is to not only comfort the suffering through live therapeutic music, but to also help others understand how therapeutic music can comfort patients in various conditions, and especially those in their final moments this side of eternity.
*Names may have been changed to protect identities and comply with HIPAA guidelines