"Can you visit Daniel? There is nothing more I can do for him..."
Judy, a veteran hospice nurse, told me about the new patient who was admitted to our hospice on the day before. It was a cold day in December.
"He has been trying to get out of bed all morning. I've talked to his doctor and we've tried everything, but nothing seems to work." Judy said with a sigh. I had known her for many years, but never before had I seen her so worried.
Daniel was showing signs of "terminal agitation." People at the end of life often experience this state characterized by confusion and restlessness. As a hospice music therapist I had seen many patients in this state before.
Typically, terminal agitation is treated with medications. But it doesn't always work, because the cause of pain may not be physical. It may be emotional or spiritual.
"Music therapy may help," said Judy. She knew that music therapy could bring relief for pain that couldn't be treated with medications.
Daniel was sitting up in bed in a dark room. He was a frail man in his early 50's. A volunteer was sitting beside him to make sure he wouldn't get up and fall, but there was no other visitor. As I greeted him, Daniel turned his head toward me but didn't make an eye contact. Instead he looked through me with his glassy eyes.
Seeing his agonizing face, I wondered what kind of life he had led. Perhaps he was suffering from something that couldn't be easily eased.
Since it was close to Christmas and he was Christian, I began playing Christmas carols on a keyboard. I tried to match the music with his breathing and slowly bring the tempo down to promote relaxation, but it didn't quite work. During the music he seemed calm at times, closing his eyes and resting in bed. But soon he would open his eyes and try to get out of bed again.
So I began singing, and suddenly, his reaction changed. He stopped moving his body and lied down quietly. I continued to sing more carols, such as "The First Noel" and "Silent Night." And eventually he fell asleep. Looking at his peaceful face, I knew it was time for me to go and let him rest.
A few minutes later someone patted on my shoulder. It was Judy.
"Daniel just died. I think music helped him let go. Thank you."
She smiled warmly. Shortly after the music therapy session Daniel took his last breath. What came to me was the gentle expression on his face as I had sung.
It is our job as hospice workers to help patients die peacefully. In order to do this we need to address not only their physical pain but also emotional and spiritual pain. Daniel reminded us of that.
I don't know what caused him to suffer on that day, but I hope that music helped bring comfort at the end of his life.
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All identifying information has been changed to protect peoples confidentiality.