Songs for the End of Life

Most of my patients like hymns, and I often play what I call the Big 3:  “The Old Rugged Cross,” “In the Garden,” and “How Great Thou Art”. “Amazing Grace” isn’t part of the Big 3 because it’s in a class entirely by itself. It is by far my most requested song. “Jesus Loves Me” gets an honorable mention. There are other hymns I like to incorporate, lesser known than the Big 3, but still familiar: “Softly and Tenderly,” “Just a Closer Walk With Thee,” “What a Friend We Have in Jesus,” and “Sweet Hour of Prayer,” among many others.

When the patient has reached the very end of life, with literally hours or minutes left, and every breath calculated and delicate, these songs take on an almost unfathomable new meaning. Songs that might have been sung hundreds of times in church or at camp or revivals are now so potent when being sung to a loved one taking his or her last breaths. Consider these lyrics:

from The Old Rugged Cross:

To the Old Rugged Cross, I will ever be true
It’s shame and reproach gladly bear
Then He’ll call me someday to my home far away
Where His glory forever I’ll share

from Softly and Tenderly:

Come home, come home
Ye who are weary come home
Earnestly, tenderly, Jesus is calling
Calling, oh sinner, come home

from How Great Thou Art:

When Christ shall come, with shout of acclamation
And take me home, what joy shall fill my heart
Then I will bow with humble adoration
And there proclaim, “My God, how great Thou art.”

Anytime there are lyrics that talk about home it really hits you how relevant the song is. It’s a powerful message, so powerful that I have to be careful with these words. If the family or the patient isn’t ready or hasn’t accepted that death is coming, I could do real damage. I’ve been in situations where I held back from singing songs with these lyrics because I didn’t know what the reaction would be. It’s at times like those I have to rely on my intuition and empathy to make the right choices.

When I can sense that the patient is ready and the family has accepted the circumstances, I feel comfortable and led to sing these songs. I also like to sing a song called “Going Home.” The lyrics are simple, poetic, and usually comforting for the family.

Going Home

Going home, going home
I’m jus’ going home
Quiet like, some still day
I’m jus’ going home

It’s not far, just close by
Through an open door
Work all done, cares laid by
Going to fear no more

Mama’s there ‘specting me
Papa’s waiting, too
Lots of folk gathered there
All the friends I knew

Nothing lost, all’s gain
No more fret nor pain
No more stumbling on the way
No more longing for the day
Going to roam no more

Morning star lights the way
Restless dream all done
Shadows gone, break of day
Real life yes begun

There’s no break, aint no end
Jus’ a livin’ on
Wide awake with a smile
Going on and on
I’m a’goin home.

The other night my boyfriend and I were talking about heaven and all the descriptions it’s been given. I mentioned how I feel heaven is too glorious, too substantial to be up in the clouds like it’s always imagined. He said he likes to think of it how Tolkien described “the West” at the end of the Lord of the Rings trilogy:

“And the ship went out into the High Sea and passed into the West, until at last on a night of rain Frodo smelled a sweet fragrance on the air and heard the sound of singing that came over the water…the grey rain-curtain turned all to silver glass and was rolled back, and he beheld white shores and beyond them a far green country under a swift sunrise.”

I’ve occasionally used the song “Into the West,” from the LOTR movies, in my sessions, when I’ve felt it’s been appropriate. The imagery paints a beautiful picture and can be comforting for the patients.

Into the West

Lay down
Your sweet and weary head
Night is falling
You’ve come to journey’s end
Sleep now
And dream of the ones who came before
They are calling
From across the distant shore

Why do you weep?
What are these tears upon your face?
Soon you will see
All of your fears will pass away
Safe in my arms
You’re only sleeping

What can you see
On the horizon?
Why do the white gulls call?
Across the sea
A pale moon rises
The ships have come to carry you home

And all will turn
To silver glass
A light on the water
All souls pass

Hope fades
Into the world of night
Through shadows falling
Out of memory and time
Don’t say: We have come now to the end
White shores are calling
You and I will meet again

And you’ll be here in my arms
Just sleeping

What can you see
On the horizon?
Why do the white gulls call?
Across the sea
A pale moon rises
The ships have come to carry you home

And all will turn
To silver glass
A light on the water
Grey ships pass
Into the West

Finally, not a song (yet), but I came across a poem that is often used in hospice care and at funerals. I was probably drawn to it because it reminded me of the Tolkien words. The poem is called “Gone From My Sight” by Henry Van Dyke.

Gone From My Sight

I am standing upon the seashore. A ship, at my side,
spreads her white sails to the moving breeze and starts
for the blue ocean. She is an object of beauty and strength.
I stand and watch her until, at length, she hangs like a speck
of white cloud just where the sea and sky come to mingle with each other.

Then, someone at my side says, “There, she is gone”

Gone where?

Gone from my sight. That is all. She is just as large in mast,
hull and spar as she was when she left my side.
And, she is just as able to bear her load of living freight to her destined port.

Her diminished size is in me — not in her.
And, just at the moment when someone says, “There, she is gone,”
there are other eyes watching her coming, and other voices
ready to take up the glad shout, “Here she comes!”

And that is dying…

haven

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Thoughts on CT Shooting Through Psychology of Death and Dying

I just finished a course on the psychology of death and dying. I took the class because I am planning my music therapy career in the hospice field, but what I learned from the textbook was eerily relevant just about every week of the semester. We were assigned to read the chapter on suicide the week before the NFL player shot his girlfriend and himself.

I wanted to share some excerpts from my textbook in light of yesterday’s shooting, in order to provide an objective, scholarly view on loss and coping.

Reference:  DeSpelder, L. A., & Strickland, A. L. (2011). Last dance: Encountering death and dying (9th ed.). New York, NY: McGraw-Hill.

On children’s understanding of death:

[Maria] Nagy found three developmental stages in children’s understanding of death between the ages of three and ten. Her research showed that, in the first stage (ages three to five), children understood death as somehow being less alive; the dead “live on” under changed circumstances and can return to normal life. In the second stage (ages five to nine), children understood death as final but as avoidable and lacking inevitability and personal reference (“I will die”). In the third stage (ages nine and older), children recognized death as the result of a biological process that is final, inevitable, universal, and personal.
Although research generally has indicated that most children have acquired a mature concept of death around the age of nine, recent studies show that children begin to conceptualize death as a biological event at the same time they construct a “biological model” of how the human body functions. By preschool age, a potent animate/inanimate distinction serves “as the center of a vast cluster of conceptual distinctions,” including a naive theory of biology. Only after children begin to think purposefully about the biological functions of life-sustaining body parts (e.g., the heart is for pumping blood) do they become “life theorizers” able to reason that, without these parts, one would die. Older children are more apt than younger children to state that bodily functions cease at death (p. 51).

On children as survivors of a close death:

A particular child’s response to loss reflects the influence of such factors as age, stage of mental and emotional development, patterns of interaction and communication within his or her family, relationship with the person who has died, and previous experiences with death. Generally speaking, bereaved children experience grief reactions similar to those experienced by adults. However, children differ from adults in cognitive abilities, need for identification figures, and dependence on adults for support.
Adolescents’ developmental tasks of feeling in control, attaining a sense of mastery, and being able to predict events are compromised by death. In a study of adolescents’ responses to the terror attacks of September 11, 2oo1, researchers found that adolescents (especially girls) were frightened and reports concerns about dying from other disasters, such as tornadoes or earthquakes. These anxiety reactions are consistent with adolescents’ developmental issues related to vulnerability to death. Resilience, too, was seen in their efforts to make a coherent narrative of the events and to refocus on their daily living (p. 387).

On violence:

Violence is one of the most potent of our encounters with death. It can affect our thoughts and actions even when we have not been victimized ourselves. Potentially, anyone may become its unsuspecting victim. In the most recent year for which statistics are available, nearly fifteen thousand murders occurred in the United States. In two-thirds of these, guns were used as the murder weapon. While slightly more than 16 percent of these murders were related to the commission of a felony, the larger percentage was related to gang killings, alcohol-influenced brawls, “romantic triangles,” and other, unspecified causes.
Emergency room physicians report being besieged with patients whose injuries are identical to wounds incurred by soldiers in combat. These wounds result from semi-automatic assault weapons that fire dozens of bullets per minute at several times the velocity of an ordinary pistol: “Organs that would have been merely grazed or even cleanly pierced by a handgun bullet are exploded by assault weapon fire, requiring massive transfusions of blood.”
Young people are disproportionately represented among victims of violence. Among the must troubling aspects of handgun violence “is the fact that children very often are the victims of fatal gunshot wounds, self-inflicted either intentionally or accidentally, or received as innocent bystanders in scenes of domestic or street violence.”
Children who witness violence have been called “silent victims.” They may be physically unharmed but are nevertheless emotionally affected as they hear gunshots outside their homes, witness shootings on the playground, or have a family member (often an older sibling) involved with violence (pp. 488-489).

On grief:

Grief involves the whole person and is manifest in a variety of ways: mentally, emotionally, physically, behaviorally, and spiritually. When we limit the definition of grief, it reduces our chances of accepting all of the reactions to loss we may experience. Many kinds of thoughts, feelings, behaviors, and so on are a normal part of grief (p. 336).

When there is a substantial difference between a survivor’s emotional and mental responses to death, and the survivor believes only one response can be right, the result is conflict. To expect the head and the heart to react exactly the same to loss is unrealistic; disparity between thoughts and feelings is likely. When a person is grieving, many different emotions will be felt, and many different thoughts will arise. By allowing them all and withholding judgment as to the rightness and wrongness of particular emotions or thoughts, a bereaved person is more likely to experience grief as healing.
Survivors sometimes have rigid rules about what kind of emotions can be expressed in grief, and when–such as where and when it is acceptable to be angry or to be open to the pain and release an intense outburst of sadness. Permission to have and express feelings is important in coping with loss. We may think, “How can I be mad at someone for dying?” Yet, anger may indeed be a component of grief (p. 346)

Finally:

Just as no two persons are alike, no two experiences of grief are alike. The circumstances of death, they personality and social roles of the bereaved, the relationship with the deceased–these are among the factors that influence grief and mourning. These factors offer clues about why some deaths are especially devastating to survivors (p. 354).

I would offer this: Articles are popping up everywhere about what to say and what not to say in this situation. Read them. These people are right. This experience can really teach us all how to support someone who has suffered a loss. Don’t try to fix it. Don’t judge. If you can’t think of anything to say, don’t say anything. The most important thing you can do for someone who is grieving is be there.