Dying ~ moving beyond, out of this world

Vocal music used to support the journey through the major life-passages of birthing and dying Victoria, B.C.

On this page		Lack of energy		Easing pain, restlessness, tension
		Dying alone		Inner journeys
		'End Stage' Dementia		Coma
		Seriously ill/recovering		Permission to die
		For family and friends		Funerals and Memorials
		Limitations of Bedside Singing		Articles on Music used to support the dying process

Testimonial My Mom spent the last 6 months of her life in a nursing home, suffering from vascular dementia.Pashta had been visiting with her regularly, and using songs to engage her Mom couldn't speak coherently, but hummed along with the melodies until two weeks before her death.A few friends gathered with me around Mom as she was dying Pashta leading us in songs, until Mom's breathing gently and gradually slowed down and stopped.One of my friends then lead us in a Buddhist chant to honour her passing, and then they all left to allow me time to say my own 'goodbyes'.Of course, one never knows for sure but I hope that Mom could feel our presence and hear the love in the songs, as she left this world. RM

Lack of energy People who are dying have very little energy so even if they are still able to communicate, they are generally not capable of long conversations.Simply being present with them is meaningful but your loved one may continue to feel obliged to engage in conversation with their visitors, even though they don't have the energy to speak.They may also feel guilty about exploring their own thoughts/feelings and not sharing them when visitors are present; and/or that their visitors might not understand what they are experiencing.Bedside Singing is a gentle presence, that puts no pressure on your loved one to infer any expected demands on their attention in a sense, 'filling up the space' so that they can relax, and not feel duty-bound to talk or actively interact with visitors.

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Easing pain, restlessness, tension It can take some time for the medical professionals to figure out the appropriate pain medications for the patient, as each individual responds differently: and in some cases, medication is simply not able to eliminate the pain.This sometimes causes the patient to be very restless, in an attempt to find some position that reduces the pain.Especially during the final dying process, they may become uncontrollably restless as the body shuts down, and nerves are confused.At the same time, hands/arms and legs may tense into rigid positions, reducing blood flow.Obviously, both of these coniditions are likely to increase the pain levels.Bedside Singing can often help with this as the gentle melodies speak to a more instinctive part of the brain, encouraging it to relax the body and reduce the experience of pain.

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Dying alone In the modern world, families often don't live in the same region: and elderly people often find that their friends and closest family members have died before them, or are in a similarly non-mobile condition.Some may have cut themselves off from friends and family because of estrangement; or contrariwise, their unwillingness to lay the practical and emotional difficulties of their dying on those they care about.A lonely death is the ironic result of living in an urbanized and medically/technologically-advanced culture.Those, who died alone, are also the ones who are most likely to die in a care facility not having family or friends who are able to care for them at home.

As a result, they may go through their dying process without any of the comforting elements of 'that which is familiar' (place or people).Although the care home staff tends to become their new family, Bedside Singing (along with other regular support services) can help alleviate some of the loneliness becoming 'like family', but without the history/baggage; and supporting the patient to re-claim (in a simplified form) the best memories of their life.

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Inner journeys Whether exploring life memories, or envisioning the beyond, much of your loved one's attention is drawn into their own inner journeys.Life memories may weave together, and be shared in ways that are difficult for family and friends to understand especially in the modern world, where people move around a lot, and family or friends may not have been present for the particular memories that their loved one is weaving woven together.

However, this 'web of memories' is particularly significant to your loved one and decoded, can provide useful information about their present wishes/needs.On occasion, Bedside Singing may draw out the 'decoder key', as your loved one responds to particular images in the songs/chants.Sometimes, these woven memories cause anxiety, embarrassment or sorrow about past situations that can no longer be resolved and therefore, may be uncomfortable to share with the family or friends present.Bedside Singing can help your loved one either process them (to some degree of acceptance) or redirect the emotions to more peaceful memories.This might be done through the simple message of appropriate songs/chants: other times, these messages may offer permission for your loved one to speak about their concerns, more directly than they would otherwise with family/friends or medical caretakers.

People who are dying and especially during the later stages often have visions.We might call them hallucinations, but this tends to downplay their significance to our loved ones.In their experience, these visions are real: and they often provide significant clues as to what is needed for our loved ones to 'pass over in peace'.

Dying people also tend to make very strange statements that don't initially make any sense to us: they are usually metaphoric, based on some life experience or belief system.Here is an example from a patient I once worked with "I am waiting for the CEO to tell me whether to go up and right, or down and left" (paraphrased): she was actually asking 'how do I get this dying process over and done with?', and was not interested in anything else until her question was answered.Once decoded, Bedside Singing can provide an acceptable response through imagery that helps to continue the journey.

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"End stage" Dementia Although many dying people remain alert until their last breath, or fall into a peaceful sleep that they don't wake up from, many experience dementia during the last stages of dying which is quite different from having inner journey visions.The dementia may be temporary, as a result of medications still being adjusted; or permanent, because of their particular condition: and either can be partial or full dementia.Particularly the full and permanent kind can be very difficult for family members or friends to deal with, because the person they knew as they knew them is no longer present.

Melodies are generally easier to remember than words, so loved ones can be more comforted by familiar melodies or even ones that are new to them but repeated than by words.Even in full and radical dementia when it is not possible to communicate with them on any other level music can sometimes 'get through' and engage the loved one directly.For example, one patient would mutter nonsensical statements and wave his hands in the air, until the singer began to sing his favourite hymns.Then his hands slowly moved to his knees: and he began tapping them in rhythm to the song.His wife said that this was the only way left to engage with the actual person who was her husband, in the last week of his life.

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Coma Anecdotal evidence from patients who have had near-death experiences, or awakened from a coma, offer convincing evidence that dying coma patients may be aware of what is happening around them.For this reason, it is now common for even medical staff to be careful about what is said in the patient's room; and encourage family and friends to talk directly to their loved ones, but not argue/etc. in front of them.

Those in a coma may 'speak' in response (that is, communicate their reactions or wishes) through very subtle changes in their faces, body tensions, or breathing.Even eye movement behind closed lids may indicate that they are aware of what is happening around them and responding to it.Although these signs can be very difficult to read and may differ between individuals it is often possible to figure out what songs/chants they respond to the most positively.Bedside Singing may provide one of the few ways of actively engaging a loved one at this stage of their dying process, albeit subtle.

Even if your loved one isn't in a coma just sleeping, or perhaps, dozing there can be benefits from Bedside Singing, especially if they are experiencing restlessness or pain.As with a coma state, the music (and even the message) may get through and produce some noticeable relaxation.

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Seriously ill/recovering Bedside Singing can also be helpful to those who are recovering from a serious illness or operation in terms of pain and restlessness, and/or emotional issues.They also may experience visions, and are likely to have their own inner journeys that might be supported by the kind of chants/songs used in Bedside Singing.

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Permission to die Despite recent changes in our attitudes towards death, we still live in a overwhelmingly death-denying culture: and the inclination of the medical professionals is to maintain life at all costs.Because of this or your loved one's belief systems and/or the sense that their families are not ready to let them go they may feel that they do not have permission to die.They continue to hold on, despite the fact that there is little 'quality of life' left for them.

They may feel guilty about being personally 'ready to go' (especially if they think their family is not ready to release them); and therefore, feel uncomfortable about saying so.Others may state that they are ready to "go home" (which is the most common phrase), but still hold on until the right permission is given.

"Right", here, often relates to their spiritual beliefs and unless they are attended by a Catholic priest or have an active faith community, there may not be anyone to give that permission.Bedside Singing has a spiritual/pastoral component: and much of its repertoire uses imagery that refers to 'continuing the journey, wherever it leads' and/or 'finally arriving at a place of peace'.Although this imagery is indirect in terms of giving permission to die the mere simplicity of it, and the repetition, is often interpreted by the patient as giving that permission.[Note: it is not uncommon for patients to refer to Bedside Singers as "angels".]

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For family and friendsBecause dying people are usually very tired (if not in a coma), much of the time spent with them may be in silence.This can be awkward for family and friends especially if they are used to having an active/engaged verbal relationship with their loved one.If the patient has dementia, or is in the common half-conscious or continually-restless state, those sitting in vigil with them may feel extremely frustrated because of not being able to 'get through' to their loved one and/or alleviate their discomfort.Bedside Singing can feel like a gentle message of 'peace and love' offered by the family/friends, albeit second-hand especially if the Bedside Singer can explain to them what the subtle changes in the loved one's body/facial movements might mean, thus giving the vigilers a sense of having touched and/or comforted their loved one in this indirect way.

Family/friends are likely experiencing very strong feelings themselves (and many different kinds of them); and may not want to distress their loved one by expressing them, or may assume that they won't be heard and absorbed.The fact of dying also usually brings up unresolved issues (see E~merging Beyond mediation services) pushed to the surface because there is no time left to resolve them: and this can make sitting vigil with a loved one a very confusing and difficult situation.Family/friends can feel caught between needing to make a final statement about these issues, and not wanting to upset their loved one.Even when a family or group of friends are close, they may hold back their feelings in order to not further distress each other.It may also be that one's feelings are simply 'beyond words', and no expression of them feels adequate making them difficult then to tap into and deal with.In this case, the music and simple message of a chant may elicit a outpouring of those feelings, when words would not.

Bedside Singing is not a grief counselling service but it often provides family and friends with a means to deal with some of their deeper or more personal feelings, while remaining in the room with their loved one and/or other friends and family.The imagery in a song/chant may give them permission to touch into their own feelings to mourn 'what might have been but wasn't', begin the grieving process, recall fond memories, and/or share sorrow with others, without necessarily expressing any of this directly to their loved one.

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Funerals and Memorials Especially if a loved one has been particularly affected by a Bedside Singing chant during their dying process, the family may want to have it sung in honour of those last days in the Memorial service.This can usually be arranged.En~chanting Beyond is also available for Bedside Singing during your loved one's deathbed vigil; and its sister-site Journeying Beyond provides support throughout the pan-death process as well as guiding after death care (avoiding traditional funeral homes), and developing a personalized funeral/memorial.

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Limitations of Bedside SingingBecause dying people have very little available energy/attention and sleep a lot, it can be difficult to set up a Bedside Singing visit at an appropriate time.

Although Bedside Singing can occasionally do what medication can't (in terms of relieving pain and restlessness), it may only result in a short time of distraction.Even if your loved one is awake, they may fall asleep after only a few minutes of the singing.

On the other hand especially if they are used to being the caretaker they may attempt to be a 'good audience' for the singer; and consider it impolite to allow themselves to relax and then fall asleep or drift into their own inner journeys or memories.

Most patients will either indicate that they don't find Bedside Singing helpful, or eventually accept that it is okay for them to use the music in any way they need.It is important to let them know that 'drifting away' or 'falling asleep' is regarded as applause to a Bedside Singer.Any form of 'easing the dying process' is considered a success no matter how short the visit might be since dying people measure their lives in moments; especially if they are experiencing pain or restlessness, or are dying without friends and family able to visit.

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For further information on the value of music in various forms of Palliative, Dementia, etc. care, please visit

the Music Therapy Association of British Columbia page on Music Therapy and Palliative Care;

Music Therapy in Hospice and Palliative Care: a Review of the Empirical Data from the Journal and Oxford University Press

Canadian Journal of Music Therapy Singing the Passage: Evaluating Volunteer Bedside Singing in a Palliative Care (En~chanting Beyond's Beside Singer was one of the originators of this program).

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Please click on Visits (left menu) to find out how to make arrangements
for a Bedside Singing visit in the Victoria, B.C. area.