Death is the one instance in which a picture does not say a thousand words, for in death it is not the disability or disfigurement, but the caresses, the gazes, the meticulous physical tending, the spiritual discoveries and the private emotions—spoken and unspoken—that truly convey what is happening. In the end, it is not the act of dying, but all those final moments of living, that are truly important. Virginia Morris
Music may be most powerful at end of life. The capacity music has to connect, communicate and companion makes it a peaceful presence for those facing an end of life journey. When we are overcome by grief and sorrow, music offers solace.
Death is another life passage where music can accompany us. In fact it may be most effective during the end of life journey. Relationship completion is a significant part of dying. Palliative doctor, Ira Byock states there are five sentiments that permit relationships to reach completion once they are expressed. These are “I love you”, “thank you”, “forgive me”, “I forgive you” and “good-bye”. Songs can convey these messages more powerfully and completely than words alone. Throughout the ages, songs have been important vehicles for the expression of the deepest human feelings. While the use of sacred songs has reflected the spiritual dimension, it is popular songs that reflect the everyday sentiments of everlasting love, missing a partner, cherishing a friend and gratitude for all that has happened. Songs may help express these five sentiments and be helpful in relationship completion.
There are a number of reasons why music is now being recognized as a complementary treatment in palliation and why music therapists are part of the palliative team. Non-pharmacological strategies like music therapy promote relief in pain and symptom management. Music is used to promote relaxation, to reduce anxiety and to supplement other pain control methods. A terminal illness highlights every psychological dynamic in the person’s life—dysfunctional patterns of behavior, unhealed emotional wounds, troubling relationships and unfulfilled dreams. Music may facilitate accessibility into unresolved aspects of the person’s life. Reminiscence through songs provides life review.
Music may help people cope with loss of control. Songwriting and improvisation may give a sense of empowerment. Music can assist in release and closure by providing hope and dignity.
Introducing music in end of life must first come from a place of love and trust. Each death is unique and there are no formulas or guaranteed outcomes when using music.
Assess: Does the patient have a preference to a certain style of music like country or classical or steel drum? Ask. “Would you like to listen to…?” Or, you might say something like “Here is something that may help you sleep.” Or, “I have found this music very relaxing”. Be sensitive. Music is evocative and for a number of reasons, it may be difficult for a family member to hear a song that surfaces very personal and sometimes private memories or feelings.