The End is a series about end-of-life issues.
“Have you ever been there when someone dies?” people ask when they find out I play the harp and sing for dying patients. It is the same tone I hear when someone asks, “Do you think you will have more children?” They want to talk about it, but they worry that the answer might be a secret. When I tell them I have been there at the moment of death, though not as often as they might suppose, they ask, “What is that like for you?”
I tell them it is intense. I wait to see if they would like to hear more, or if they have their own story to tell. I am a music thanatologist, trained to offer music in a prescriptive way, to create a calm space for dying patients and their families. I focus on the patient’s breath as I play the harp and sing. With this rhythm as my guide, music can echo and reflect the dying process. The patient leads the music vigil with his or her breath, right in the middle of the hum of machines, the trill of cellphones, and the voices and nose-blowing of family. It often feels to me as if the room becomes larger, warmed by music and filled with the courage of families preparing to say goodbye.
The people I play for are incredibly gracious. They say the music is relaxing and beautiful. They invite me in to their moments of vulnerability. I once played for a patient who was struggling with complicated symptoms. She was uncomfortable and having difficulty speaking. But she asked me to stay, and at one point during the music vigil she mouthed the words, “You are blessing my soul.”
The first time I was there when someone died, I was surprised by how peaceful it felt. The patient was on hospice in a nursing home, and we were alone in the room. I sat at her bedside and sang while resting my hand lightly on hers. Her breath slowed.
When I moved my hand away to reach for my harp she made a small movement. I returned my hand and continued to sing as her breath slowed, then stopped. It was just the two of us, in the late afternoon silence of her room. I did not feel frightened or distraught. I felt honored to be there and humbled by her connection to the music. I sat with her until a staff member walked in and spoke, and the bustle of phone calls began.
I feel pure astonishment in the presence of death. Who am I to be there? I feel the stillness of time and also its relentless push forward. As they leave, these patients remind me of my own body’s fragility and willfulness. By inviting me to witness their death, they teach me to live, to craft a life with joy and attention. They call me to be bold. What are you waiting for? I imagine them asking, as the door of their life gently closes.
My wonder and bewilderment at death has evolved. Thanks to good training and my practical nature, I do not get freaked out. But I am not entirely comfortable either. Even with years of experience, it doesn’t get easier to confront mortality, my own or that of the patients I meet. I never stop feeling like a beginner. Perhaps we are all beginners in times of profound human transition, no matter how much we have seen it before.
The cycles of human mortality seem especially vivid at this time of year, as the tide of the past year sweeps out and the new one is about to be born.
One thing I know for certain is that the presence of another person, even a stranger, can be transformative during transitions. It can turn an unendurable moment into an opportunity for meaning and awe. This is not something I could have learned in my training, or even in years of music vigils. I learned it giving birth to my son.
When my water broke three weeks before my due date I was on vacation with my family. We talked to the doctor at the local hospital, then made the three-hour return trip to Boston. My husband ordered Chinese food and my stepchildren binged on “Buffy the Vampire Slayer.”
After I checked into the hospital, my husband slept while I tried to cope with the contractions. This was my first pregnancy and I assumed it would be a long labor. When the pain became overwhelming, our doula arrived and began to coach me to breathe slowly and deeply. She made low noises along with me, showing me how to relax. When the contraction finished, she said, “Now lower your shoulders, and let a deep breath out. Let that contraction go.”
Her attention to my suffering calmed me down and made me feel deeply cared for. I focused on her quiet voice and clear instructions. Breath by breath, the doula accompanied me. This dynamic was familiar from my role in end-of-life care. She was an outsider providing help and experience at an intimate, vulnerable time. But I had never been the patient before. It was my first time as the one in the hospital bed.
I needed my husband’s love, kindness and good humor in order to endure the pain. But I found I also needed the doula’s confidence and wisdom. She had seen birth before, and knew strategies that could help. She couldn’t take the pain away, but she stayed with me. This companionship gave me the courage to relax and accept a process that was already underway, until my son was in my arms.
In those first days home from the hospital, I understood something new about my work with the dying. I realized that when families express their gratitude, when they say they feel blessed or that they will remember me, they are not just talking about the music. They are also grateful that I was with them through their suffering, as a witness to their grief.
Playing music for dying patients is not about giving a concert to distract them, or even trying to make them feel better. Perhaps it is not about music at all. It is about cradling a family with beauty as they end the conversation with someone they love. It is about helping them bear an impossible transition which — like labor — is both painful and unstoppable. It is about staying close and trying to do something useful, until they have the courage to say goodbye and leave that room, into a world where one precious voice has gone silent.
Jennifer L. Hollis is a music thanatologist and the author of “Music at the End of Life: Easing the Pain and Preparing the Passage.”