The Symphony At The End Of Life

Lately, I’ve been thinking about how a good hospice experience is analogous to a symphonic experience. Each family presents with their own instruments, some are in perfect tune, some are so out of tune, that the dissonance is palpable when hospice staff enters the room.

The team must take inventories of the experiences each member brings to their instrument, how long it has been silent, untouched by loving hands.Sometimes, the family has not played together in decades, and they bring preconceived notions of where the others have played and presumptions about their own relative talent and mastery of their instruments. Sometimes, just observing them tune up is a gift.

Each member of the team assesses for the range of notes and ease of movement through the scales possessed by each of the family members. Do they love unconditionally, or are there mysterious stops that are inserted into the score? Uncovering those stops, the stories behind them and the resulting interactions of the other musicians is the role of the social worker. Can they each hear the others? Is the tempo too fast or slow for some of the members? How can that be interpreted and presented by the social worker, so that the other family members do not resent or blame the one who struggles to hear, recognize or listen for the appropriate cue?

The nurse assesses for comfort. Can changes be made in the score to keep the tempo slowing at a pace that all can understand and respond to?  Pain becomes a staccato element that must be quelled, brought back into control with a gentle gesture of the baton.

The team never knows what shape the instruments are in, but they are determined to present a belief, and respect, for craft and the efforts of each family.

The team doesn’t make the music they just stand at the podium and signal when the various elements need to be employed. The members of the hospice team alternate in keeping the time, signaling the tempo; the entry of the various instruments as they keep an eye on the score and tender the close. The prayers, beliefs and experiences of the team carry them through the most dissonant of families. They cannot take their eyes off of any family member, lest they are met with a tone, unexpected and disruptive to a beautiful death.

It isn’t always easy, but when the tuning is completed, they eyes of each family member are on the team and the trust is established, the music flows with a grace that cannot be misunderstood or unrecognized. The symphony moves through the shadow of ignorance into harmony, as each member of the family contributes, forgives, acknowledges and learns to let go. The final movement is that of the patient, relaxing their grip to leave in silence.

Every symphony is unique. Every life deserves the dignity of a safe and comfortable death. Every family deserves the opportunity to let their talent shine, even if the only audience is the hospice team. We will never forget the grace and skill, the push to excel and the risk required to welcome and trust in the team and our direction.