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I landed my dream
job right out of school.
For work each day,
I drove all over Los Angeles County to visit clients. As I walked into each facility, the smell of
cleaning fluids and bleach would hit my olfactory senses. Ah, the good ol’ nursing home stench. Along with another scent that I characterized
as “that old people smell”.
But I didn’t
mind. I always walked up briskly to the
nursing station and informed the charge nurse that I worked for the Hospice and
was here to see so-and-so. With a brief
jerk of the head, the nurse would show me the right direction to take, and I’d
walk away just as briskly as I’d arrived, the click of my shoes echoing sharply
along the hallways.
Entering the
patient’s room was another story. I made
sure to soften my steps as I walked in, taking note of the lighting of the
room, the placement of personal items, and the patient’s body position. Oftentimes the patient would be sleeping,
snoring with mouth open and saliva dripping onto the chin. At other times, if I came right after
mealtime, the patient would be sitting up, either in the bed or in a
wheelchair, staring vacantly ahead or at a TV screen.
Ten minutes into
the visit, the atmosphere of the room would be completely different. As I provided music by singing and accompanying
myself on guitar, the patient would respond by tapping hands and feet to the
rhythm, singing along, or simply maintaining eye contact with me. The music would draw curious staff members to
the room—random heads popped in at the doorway, faces brightened up with
smiles, and the hum of voices traveled down the hallway as they continued on to
their next task with a tune on their lips.
After the visit,
as I filled in my paperwork at the nurse’s station, some of the same staff
would stop by again to chat.
“So, you’re from
the Hospice?”
“Yes, I’m the
music therapist”
“Wow. Music is such a gift to these patients. It improves their quality of life.”
“You’re so
right. And in fact, music therapy has
been proven to help decrease perception of pain, provide sensory stimulation,
and help regulate breathing during respiratory distress.”
“Make sure you
come back to visit soon, then.”
I
drove away from each visit feeling satisfied and fulfilled. To get paid to bring the comfort of music to
hospice patients—individuals from all walks of life who, due to disease and
age, were only given 6 months or less to live—was more than I could ever ask
for in a career. They say that if you’re
wired for hospice, sooner or later you wind up there. My co-workers—from the nurses to the
chaplains to the medical doctors—all agreed that hospice was a calling.
In particular,
there was one patient to whom I felt particularly called. Annette* lived in the locked unit in an
assisted living facility. Her diagnosis
was dementia. She had a daughter living
in the Midwest, a son with whom she was estranged, and no other family members
around. The first time I saw her, I
played a song called “When Irish Eyes Are Smiling”, which brought a big smile
to her face.
“In New York City…”
she started to mumble.
“Oooh, New
York? What about New York City?”
“I was a
schoolgirl…in the choir”.
“Did you grow up
in New York City?” She nodded. “And you sang in the choir at school?” Another nod.
“Th-there
was….there was a man….a man w-with…a b-big….big cigar”.
“There was a man
with a big cigar? Who was he?”
“I-in the
choir. I sang in the choir.”
“Was this man the
choir director?” A big smile broke out
on her face, erasing the furrowed brow that had formed when she started
speaking. I could tell it took a lot of
effort to piece together her thoughts.
“Yes. The choir director.”
I sang “Irish
Eyes” to her many times that day. In
between each time, she would tell me the same story—about singing the song as a
schoolgirl growing up in New York, and about the choir director who had a big
cigar. Eventually Annette grew tired and
asked to take a nap. I squeezed her hand
and told her I’d enjoyed getting to know her.
I went back to see
Annette many times. Each time, she would
be sitting in her wheelchair, with her gray hair tightly French braided. Her eyes lighted up when she saw me with my
guitar. And each time, I made sure to
sing “Irish Eyes” to her. Over time, her
condition declined, and in Hospice team meetings the nurses talked about how
she was speaking fewer than 6 words at one time, which was a sign of end-stage
dementia. She was eating less and losing
weight, too.
One day, I got a
call from her nurse case manager.
“Annette’s under respiratory distress.
Can you go see her?”
I drove over as
quickly as I could. When I entered the
room, I saw Annette sitting up in bed, propped up with pillows; she had an
oxygen mask on and was breathing quickly and heavily, with a look of panic in
her eyes. Quickly, I unpacked my guitar
and began playing and singing in a tempo that matched her agitation. I called to her and had her maintain eye
contact with me. The chorus of the song
I sang had the words: Bring back, bring back, oh bring back my Bonnie to me,
to me. I changed the name Bonnie to
Annette, and I sang the chorus over and over again.
Little by little,
I slowed down the tempo and decreased the volume and vigor of my
strumming. Annette’s breathing became
more regulated as she entrained to my music, and after about twenty minutes,
she closed her eyes and lay resting peacefully.
I continued to play softly until she drifted into sleep, and then I
squeezed her hand and whispered in her ear that I was glad she was feeling
better and that I was glad to have spent the afternoon with her.
I never told my
patients, “I’ll see you next week”, because I never knew if they would make it
until next week. Instead, I wished them
well and told them that I cherished my time with them. For individuals living near the edge—the edge
of what lies beyond life on earth—tomorrow is never a guarantee. And we never knew when they would step up to
the edge and take the final plunge into the place where we could not follow or
help them.
Annette did make
it until the next week, however, and her turnaround took all of us by surprise,
although it was not uncommon for our patients to delay death with the sheer
will to live. The next time I visited
her, she seemed to be back to her old self—sitting in her wheelchair with her
hair tightly French braided. But there
was no joy in her eyes when she saw me.
“Hi Annette. It’s me!
Remember, I sing “Irish Eyes” for you!”
She nodded
slightly.
“Remember, that’s
the song you used to sing in New York City, with the choir director with the
big cigar!”
A faint smile, but
still, no joy in her eyes.
I played a few
songs for her, keeping the tonality somber to match her mood. Eventually, she seemed to brighten up, and I
introduced a new song to her, “Que Sera”, which depicts the interactions
between a mother and her child. As I sang,
Annette’s whole body began to shake.
Tears rolled down her eyes, but no sound came out of her mouth. I offered her a tissue, asking if she was OK
and if she wanted me to keep playing; she nodded. As I continued to sing, the tears and the
shaking continued, but still no sounds of sobbing. Eventually, the shaking subsided and the
tears stopped coming, and I let my hands continue to strum softly as I sat with
her.
“Did that song
make you sad, Annette?”
She nodded.
“Sometimes music
does that to us, doesn’t it?”
Anther nod.
“Did that song
make you think of your own children?”
This time, she
began to shake again, and the tears appeared in her eyes but did not roll down
her cheeks.
My mind went over
what little I knew about her family situation: daughter living far away, son
estranged—and neither had paid her a visit since the time I’d known her. It must be so lonely to live in that locked
unit, losing her memory and waiting to die—and perhaps, I surmised, bearing feelings
of regret or guilt…and feeling like she was somehow to blame for ending up like
this at the end of her life.
Hospice confronts
us with some hard questions. It brings
us to the “fault zone”, where we must reflect upon our lives and the
relationships we’ve had. Perhaps
Annette’s recovery from her episode of respiratory distress—her refusal to
succumb to the process of actively dying—had something to do with the fact that
she needed to process and come to peace with the issues that still clouded her
heart. It was not my job to tell her how
to think, but I could provide a safe space in which she could do her own
healing and processing.
“Annette”, I
said. “I don’t know what you’re thinking
about that makes you so sad. But if it’s
OK with you, I’ll keep playing some music and you can just sit here and think
it through. Would you like that?”
She nodded.
“And if you need
to cry, I don’t mind.”
She smiled
faintly.
I told her that
sometimes when I was missing someone or wishing things could be different, I
would think good thoughts towards that person or situation in order to come to
peace about it in my heart. I sang the
chorus from before—Bring back, bring back—and I told her she could
insert the name of whomever she was thinking of into that chorus. As I sang, she still made no sound, but I saw
her mouthing the words, Bring back, bring back, over and over again.
A glimmer of hope
began to come into her eyes. I sang
another song with her, “My Favorite Things”, encouraging her to insert her own
favorite things and memories into the lyrics of the song. I sang softly and steadily, supporting the
peaceful reverie that she had sunk into.
I sat with her a
long time that day. We watched the
afternoon sunlight fade into early evening.
Finally, it was time to go. As I
squeezed her hand farewell, she spoke for the first time that day.
“Thank you.” And a tear rolled down her cheek as she
smiled at me.
In that moment, I
took a mental snapshot of her face. This
was one of those times when nothing else in life really mattered—what mattered
was that I had made a connection and a difference in someone’s life. As I walked out of the facility and drove
home, I savored the experience in my mind like a peppermint whose taste lingers
even after it is swallowed.
Personal
circumstances took me out of town for the next few weeks. I went to the East Coast, enjoying my time
away from work and the chance to travel.
Now and then, I saw an elderly person sitting in a wheelchair, and I
would think about Annette. I blessed her
from my heart and wished her well.
Back at work, I
attended the weekly hospice team meeting.
We always started our meetings with a run-down of the deaths in the most
recent few days, followed by a short time of remembrance led by the chaplain. Then we discussed new admissions, their diagnoses,
and the services they would need.
Finally we talked about current patients and how they were doing—how
much they were declining, whether or not to adjust medications, and how funeral
arrangements were coming along.
Annette’s name did not come up today, and I wondered if she had passed
on while I was away.
At the end of the
meeting, her nurse case manager approached me.
“Annette finally
let go. She’s in a better place now.”
I clasped hands
with the nurse. We had both walked with
Annette during the final days of her life.
Her children mailed cards to her and made legal decisions for her—she
was a “Do Not Resuscitate”—but we were there with her when she was happy and
when she was agitated and when she was sad.
We had been her companions as she processed, accepted, and learned to
celebrate her life for what it was. And
when she passed on, we released her with our full blessing, and wished her
well.
I drove away from
the meeting with a medley of songs in my head, songs that I had shared with Annette.
Raindrops
on roses and whiskers on kittens …these are a few of my favorite things…
My favorite things.
Yes, it was the little moments and memories in life that brought joy and
peace. I had shared a few of these
moments with Annette, and they had brought such meaning and fulfillment to my
life.
Bring back, bring back, oh
bring back my Annette to me, to me…
Part of me wished she was still with us and that I
could have had a few more sessions with her.
I also wished that I had gotten to have more conversations with her
before she lost her ability to speak—perhaps that would have helped me to
understand better what she was thinking of and going through near the end.
Que sera, sera. Whatever will be, will be. The future’s not ours to see. Que sera, sera. What will be, will be.
All of us can say “I wish” and “If only” about so
many things. But at the end of the day,
we must accept whatever comes our way and make the best out of it. Perhaps the music had helped Annette come to
that place, and perhaps the music had been her guide as she navigated her way
through the fault zone.
When
Irish eyes are smiling, sure it’s like a morn’ in spring…
Annette had the most beautiful smile in her eyes—eyes
that communicated with me even when her words failed. She had taught me so much just by sharing her
journey with me, and I knew that the image of her smiling eyes would always
stay in my heart. I had come in contact
with death in a deep and meaningful way, and I resolved to live in such a way
as to be ready to go in peace when it was my turn to step up to the edge and
join Annette on the other side.
**********
*Name changed to protect privacy
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