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The Last Song

Yumiko Sato

The Last Song

For the last several years Ive been listening to people with terminal illness as a hospice music therapist. They often say, "I want to die," when they grow tired of living with their illness. When their words change to something like, "I am dying," I always believe that their death is near because they know their fates better than anyone else. Such patients tend to die within a few days. I dont know how this happens, but even those with impaired cognitive abilities seem to know when theyre dying. As a music therapy intern, I met a patient who was the first to reveal to me this inner awareness of deaths approach.

For a few months I visited Herb weekly in an old, crowded nursing home outside of town. I remember the low ceiling of the hallway, the faded blue carpet, and the strong scent of vanilla refresher. At first my visit on one fall afternoon seemed to be nothing unusual, but it was, in retrospect, nothing usual.

As I played several songs on a guitar, Herbs face brightened as he recognized the familiar melodies. On this particular afternoon he seemed calmer than he had been the previous weeks. He had often been agitated and at times combative, going back and forth through the hallway in his wheelchair, as if running from a demon. Herb was in the last stage of Alzheimers disease, which meant that he showed significant personality changes and losses of cognitive functions. He had lost his ability to speak, except for occasional mumbling, and his ability to understand words. I imagined how scary it must have been for him to wake up every morning, not knowing where he was or who he was.

Conversations agitated him. If anyone tried to talk to him, he would frown, become nervous, and get angry. His disease progressed slowly as the heart breaking characteristics of Alzheimers disease became more and more apparent. The more ill he became the fewer visits he got from his friends and family. He and I communicated through music because it was the only thing he could recall. Music comforted him.

After a while I said, "This will be our last song today." I sang "What a Wonderful World," one of his favorite songs. At the end of the song he clapped as he always did, even though I had told him he didnt have to. Sunlight from the window lit up his face, making his smile look soft. A black Navy hat on a cabinet and the collections of music tapes were the only reminder of who he once was. Herb could no longer remember the name of his daughter. Yet, he could remember the songs from his past.

As I was getting ready to leave, I said "Herb, it was nice to see you again."

He looked at me with a calm expression on his face. I packed my guitar and walked toward the door. Just then I heard him say, "Im going to sing for you."

I turned around and saw that he was smiling like a mischievous child. It had been a long time since I had heard him speak so clearly. Singing was one thing he had always refused to do even though he had once been a singer, which was the original reason his hospice nurse, Donna, referred him to music therapy. But he had always said, "I cant sing anymore."

I walked back and sat in a chair next to him. He was still smiling.

"So, is B-flat okay?" He asked.

He wanted me to accompany him, but I had no idea what he was going to sing.

"OK," I said as I took my guitar from its case. I strummed a B-flat chord and then he began. He took his eyes off my guitar, and looked into space, as if he was in a different place and time altogether. He was out of tune, but his low and warm tone of voice gave no doubt he was once a great singer. The words came effortlessly out of a man who recently struggled to put together a sentence. The beautiful and nostalgic melody seemed to reflect a time he once had with someone. It sounded like a jazz song, but I had never heard this melody before.

When he finished, I clapped for him, as he always did for me. He looked at me and smiled. At that moment I realized I was seeing Herb for the first time as he once was: a man whose life was filled with music, a man who wore a uniform and fought for his country, a man whose beloved wife died young, and a man who raised his daughter to be proud as he was. Underneath the terrible disease, there was a whole person.

On the way back to the office my mind was filled with questions. Why did he suddenly decide to sing? What did the song mean to him? Perhaps I got answers two days later when Herb died. His death surprised everyone including the hospice staff and me. His daughter, Katy, was upset that the hospice nurse hadnt notified her of Herbs impending death. The nurse, Donna, explained to Katy that he hadnt shown any signs of decline in the past few weeks, and that she and the doctor couldnt have predicted that Herb would die so soon. Donna then told Katy about the music therapy session and about his singing two days before his death. Katy said there was one special jazz song he used to sing all the time, and she thought it might have been the song he sang to me.

Did Herb know he was dying, if not consciously, then deep in his subconscious mind? After having met countless patients like Herb, Ive come to believe that he did and that people who are dying have an inner awareness of their own impending deaths. Perhaps it was this awareness that promoted Herb to sing on that day. Ill never know it for sure. One thing I know is that his song became the last gift for his daughter, giving her comfort in knowing he was himself again even for a brief moment. It was a gift for me too, because it taught me the mystery of dying.

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Voices: A World Forum for Music Therapy (ISSN 1504-1611)