What is left in one
who does not remember?
Love and music.

Not a name but the fullness.
Not the sequence of events
but order of rhythm and pitch,

a piece of time in which to exist.

From Let The Last Thing Be Song by Hannah Fries

Since early in 2017, I’ve been volunteering as a musical companion with a local hospice service. With individuals or groups, I play old familiar songs on my accordion and invite my companions to sing along. People sing the words they know, and I add la-la-la verses to songs for when the words are inaccessible. Foot and finger tapping is common, and for some, simple smiles of recognition show their engagement. In between songs, I’ll often make a comment related to the previous or next song. Once they catch on that talking in between songs is encouraged, participants will sometimes take that opportunity to chime in with a comment or  story of their own.

The positive effects of music in end of life settings are well documented, with studies showing benefits such as reduction of pain and anxiety after musical activities. Many of these studies have looked at formal music therapy, with patient assessments and specific therapeutic goals. I have great appreciation for the people working in this field. Even though I wouldn’t call what I do music therapy, much of my experience echoes these findings. 

Participants are often able to access their memories of familiar song lyrics more easily than the complexities of conversation or managing daily affairs. Being able to be competent at something is a rare occurrence for many, and I can see the sense of accomplishment they feel at the end of a song. Because our activity has no goal besides enjoyment, there is no pressure to perform a task correctly, so it doesn’t provoke anxiety like other daily encounters. I occasionally forget words too, and  make a point to comment and laugh it off — and they seem less self-critical as they feel free to be amused at my failings.

Some of my companions can be disoriented about where they are, why they are there, when today falls in the arc of their life saga — they don’t have a sense of who they are and what their story is. But familiar songs can bring back memories, sometimes of a time they heard the song, sometimes of an experience similar to the lyrics. One participant hadn’t spoken at all for weeks, but after listening to Bicycle Built For Two, she told me that she had roller-skated to that song on her first date with her husband. 

Besides recollections triggered by individual songs, the overall experience of these familiar songs can be a reminder of a life outside their health issues and the routines of institutional care that dominate their days. When I am assigned to a hospice patient living in a group setting, if it is appropriate for the needs of the patient I sing with them in a general use space and invite others to join in. The social aspect of sing-alongs is a way for my companion to be someone more than a patient. The institutional social life can be challenging, thrown together with people they may not recognize and competing for the attention of the staff who provide for their needs. In a group singing situation, they can enjoy each other’s company, and see each other as individuals with their own abilities and favorite songs. One of my patients was physically very limited and confined to a large specialized chair, which kept his co-residents at a distance. But when we all sang together, his beautiful tenor voice and church choir experience caught everyone’s attention, and the group could experience that there was more to him than his contraption. 

Music has been a part of my life for a long time, and I’m grateful to have this powerful tool to bring to my hospice visits. I also visit with patients for conversation and companionship when music and group singing aren’t appropriate. I have found there’s a common experience  running through all these encounters, musical and not: there can be moments of deep human connection even in challenging circumstances, and those moments feel important. This has changed how I approach my visits. I used to practice songs; now my practice has become focussing on nurturing those moments of connection.

 As a hospice companion, I can concentrate on being totally engaged with a patient without any attachment to an outcome. Other members of the care team work to provide ease and address solvable problems as they come up. But in my role I feel free from trying to achieve anything in particular. This was hard for me at first, as someone who tends to make action plans and tries to fix things. In my visits, I find that as I let go of plans and goals, I have more space to be open to whatever is present, and I can respond with nothing more or less than being there  to connect with the patient in that moment. Many times I have been amazed by patients whose situation seems to provide them with little agency, but who can still reach out, sometimes with no more than a gaze, to make that human to human connection. When I am free from the distraction of goals, I am better able to meet them, especially when I need to meet them more than halfway.

This includes letting go of my personal goals as well, not only for whatever plans I have for the rest of my day, but also how this visit fits into my self-image, checking off a box for good deeds for the day. I have found that small rituals for the transition into the visit help create a time separate from the ongoing day to day routines. If a facility has hydraulic doors, the hiss of the door opening can feel like a breath, and an opportunity to let go whatever I’m carrying with me. Any doorway is a handy reminder to leave plans behind as I pass through, and of course my own breath is always available to mark the separation from my routine. Using hand sanitizer in the car on my way in and out of the visit can also serve that purpose. I admit I am less concerned about marking the end of this special time, and I sometimes cling to that sense of openness even after the visit ends.

Being with hospice patients is in part defined by the acknowledgement that their time is short. At the beginning of my experience, I saw my role as providing some fun and distraction; but over time I’ve learned how the context of mortality brings a sense of importance to each moment. When time is precious, every passing emotion and every story or fragment of memory means so much, and just being there to share and acknowledge that meaning is an act of love and connection.

Sometimes it isn’t easy to find a way to connect. When words and logic fail, one approach I’ve tried is to respond to the emotion even when the story isn’t clear. If my companion is agitated, and there doesn’t seem to be an immediate cause that can be remedied, I can often connect simply by acknowledging what they’re feeling about whatever it is they are trying to say. I try to do so in a way that leaves the moment open rather than closing it down. For example, saying “I hear that you are frustrated” feels like it is communicating that we don’t have to discuss this further because I already hear you; but saying “That must have been frustrating” leaves the topic open for them to express more. Another variation of this is to use the comedy improv technique of “yes, and.” Not getting stuck on their logical lapses gives me more time to find a connection. If a companion is concerned about packing to go home, telling them that this unfamiliar room in a facility is where they live doesn’t meet them where they are; but asking what they’ll need for the trip allows for them to express more about their current state, which is the ground for any connection.

Sometimes it’s hard to tell if my presence is noticed at all. If I’m not focussed on achieving outcomes, this doesn’t really change my actions. But I also find it important to give the subtle signs of engagement a chance to be heard. Eye movements behind closed lids while I am speaking, toe or finger movements along with a song, a deep breath as I say goodbye — these could all be autonomic responses independent from my actions. But without ascribing too much intent to them, I find it valuable to at least suspend disbelief in their significance. This helps me remain open to the possibility for connection without expectations. Sometimes patients open their eyes and smile when I stop singing or talking, giving me a chance to make eye contact and smile back at them. If they hadn’t experienced what I was doing, they wouldn’t have noticed that I stopped. This perspective helps me play and talk with someone with no visible response, as if what I’m doing is setting up the potential for a future moment of connection that may or may not occur. 

I continue to learn ways to nurture connections in my companionship visits, from the mentorship of hospice professionals, from writers and speakers on mindfulness and compassion, and from the time spent with my companions. Hospice encounters have become an integral part of my life, and I have found ways these lessons apply to other relationships in my life. They inform how I try to be a connected spouse, father, grandfather, and friend. Closing the circle, they also apply to the communal activity of making music with others. The experience of bringing music into hospice companionship has made me a better musician, listening more closely, not getting as distracted by goals or fazed by unattained desired outcomes, being open to unexpected possibilities, feeling the importance of each moment. As I slow down, focus, drop expectations, and open up to the unique moment of each encounter, the scope of my practice continues to grow.