Introduction to Death and Dying

Death is inevitable.  Yet are we sure of exactly what it is? We understand medical death. Respiration stops due to terminal illness, accidents or natural causes. Medical death is the end stage of life as we know it. We are born, we live and die.  The heart is no longer pumping, organs, tissues and all cells cease their functions. This is biological death.

Religion offers us the concept of theological death, defining the moment when the soul leaves the body. It gives the hope of something further, while offering closure.

Psychological death is said to occur when there is severe brain damage such as with Alzheimer’s disease, atherosclerosis, other illnesses, accidents, major infections or traumas. Lost are the awareness of self and environment.

We live in a death denying society. Death has been in the closet for years, a forbidden topic. Just thinking of dying brings feelings of panic and helplessness to many people. One way we disguise the connotations and fears of death is through the use of euphemisms such as bloody murder, only the good die young, and angel of death, to name a few.

Death education is essential. It enables us to think and talk productively about our own death as well as that of others. Many people have difficulty making important decisions regarding Advance Directives, wills and funerals. Becoming familiar with these issues greatly alleviates the stress of performing these tasks.

Learning to feel comfortable and accepting of our own death, we can become valuable sources of help and support to others. We can dispel fears people have about aging or illness by providing educational information about death and related events. We can learn to cope with our own grief, and thus offer better support to the dying.

Recommended Activities for the Dying Resident

• Pet Therapy - a visit from a facility pet, bird, or an animal from an animal visitation program can bring incredible happiness and comfort.  If the resident’s bed is near a window, a bird feeder is a wonderful passive hobby. A birthbath outside can also provide hours of interesting viewing.  A fish tank is also a valuable asset. These can provide topics of conversation for the resident, staff and visitors, as well as benefits of mental stimulation, and in turn, relaxation.

• Art Therapy - When working with a resident who has a terminal illness and not actively dying, you might provide them with activities they enjoy, such as drawing, needlework, painting, craft projects or puzzles.

• Religion or spirituality - Have a variety of religious items, reading materials, Bibles, etc. available. Contact appropriate clergy and volunteers to provide services, communion, visits, etc.

• Music Therapy - When someone is actively dying, the music that should be played should be Yanni, Enya, New Age Music, Nature Sounds (wind, water, bird songs). You DO NOT want to play recognizable songs when someone is dying.  DON'T play the radio - songs/talk shows. The music should be improvised and arrhythmic. You don't want to "bring the person back”.

• Live music can: reduce blood pressure, accelerate physical healing, stimulate memories, relieve anxiety, induce mental imaging, reduce stress, facilitate the transition process of the dying, augment pain management, provide an outlet for grieving, and relieve body tension.

• Other activities may include Reminiscence, Life Review, Relaxation Techniques, Aromatherapy, and Guided Imagery.

Bedside Harp – Therapeutic for the Dying

Music touches everyone in a very personal way and offers diverse beneficial effect. Just as a person experiences the various rhythms of life, the end has its own cadence.

As the final stages of dying approach, there is a diminished emphasis on “cure”, and more attention is focused on providing comfort and dignity. Dying encompasses a myriad of physical and emotional states including pain, anxiety, anger, fear and depression. To alleviate these stressors, some providers have enlisted the services of Certified Music Practitioners to create a peaceful environment by playing harp at the bedside. 

The Harp

The harp has always been an instrument related to comfort and peace. The resonance from the strings, the range of pitch and tones create a bond between sound and the recipient.

Live harp music offers several healing properties and can benefit:

• The temporarily, chronically, and/or critically ill
• Alzheimer’s patients
• Patients before, during and after surgery
• Premature and healthy babies
• Birthing mothers
• The elderly, comatose, and the dying

Live music can encourage mental imaging, augments pain management, and can facilitate the transition from life to death. This also opens the way for grieving, and can relieve body tension.

Playing for the Dying

As an LCSW and Thanatologist in a local nursing home, I was always looking for something new in the field of death and dying. When attending an end of life seminar, I learned of the Music for Healing and Transition course that is given all around the country. It teaches you to use your voice or an instrument to play for the elderly, the critically ill, chronically ill and the dying. I had previously purchased a small lap harp, took a few lessons, and with the help of the course, became a Certified Music Practitioner. We learned that when playing music for the dying, you don’t want to play recognizable music, because you don’t want to bring that person “back”. You don’t want to interfere with the process of letting go by playing music that they might recognize. So, we improvise, playing along with their breathing patterns. People have often asked me to “play that pretty melody again”, but I can’t because I don’t remember what I just played!

Certified Music Practitioners differ from Music Therapists, in that therapists actively involve or instruct the patient in the process of creating sound. Practitioners play directly for the actively dying to relieve stress and promote a gentle passing.

A fund for the terminally ill has provided grant money to create a position for me to play therapeutic bedside harp for the dying. Presently, I work with two nursing homes and a local hospital. The fund works through the Spiritual Care Departments. I am on call, 24/7, with a beeper. When a patient is actively dying, the nursing staff notifies the chaplains who will first speak with the family members to see if they would like the harp played for their family member. If they agree, the chaplain will beep me. They’ll give me the information, and I will be on my way. The response from the families is 99% in favor of music. Many want to be there when I play. This is not a performance; I play 1-1 for the patient.

The first time I played for a patient, her two grandsons were there. They wanted to stay and listen. Fifteen minutes later, all three were snoring. For a moment I felt insulted, but then realized the music had the correct effect- they were relaxed and comfortable enough to let go and fall asleep. The woman died soon after.

A patient who had a day stay procedure said, “You’ll never know how helpful and wonderful your music was for me. After you left I was so much more relaxed. I had been shaking uncontrollably during the test even though I had Valium and Benadryl. I had brought a CD player and meditation music with me, but the interesting thing was after I had listened for awhile, I turned it off and I could hear your harp music in my head, not the music I was listening to. Thank you so much”.

One December day I played for a dying woman, her family crowded around and on the bed. Suddenly there was a flash of light and a crash of thunder. She died that moment. One of her daughters turned to me with a smile and tears in her eyes and said, “She died to your music.”

Family members, nursing staff and other residents/patient derive benefits from live music. Music can soften stressful situations and allow them to express grief and achieve closure. I’ve been told by many nurses that they feel more at ease, making it easier to go about their jobs, when they know someone is there providing comforting music for their patients. “Half an hour of music produces the same effect as 10 mgs. of Valium”, Raymond Bahr, MD, Head of Coronary Care Unit, St. Agnes Hospital, Baltimore, MD. Many time patients will stand by the doorway, or come in their wheelchairs to listen. The music brings such a calming atmosphere to the floor.

In nursing homes and hospitals when someone is actively dying, the radio is playing jazz, rock and roll, talk shows, or the television is on. Staff sometimes feel that there has to be some kind of music/talk in the room when there’s no one there. Unless a person specifically requests that there be a certain type of music while they’re dying, (and I once sat with a man who wanted to die to rock and roll, and we listened to WDRC Oldies for 9 hours as he died), I strongly recommend Yanni, Enya, nature sounds (water, birdsong, wind, chimes), or New Age music be played. (no specific melodies, non-melodic and peaceful).

Bedside music is appropriate and beneficial in hospitals, hospice programs, nursing homes, clinics, and private homes. Referrals and requests for the services of a music practitioner can be made by administrators, medical staff, social workers, clergy or families.

Donalyn Gross’ 30 year career as a Thanatologist includes working with hospitals, hospice, correctional systems, and long term care facilities. She tought college courses in Death and Dying, and offered training workshops for healthcare professionals. She is the the author of several books, therapeutic music CD’s, and a video, she was the creator of the Good Endings® Program. The Cinnabar Press/Good Endings Program closed Feb. 25, 2013