Posted by Margaret Pasquesi
The patient's breathing was labored and his forehead was warm and clammy when I arrived. His pulse was present, but irregular and quick. He opened his eyes widely and wildly in response to having a pulse ox placed on his finger. The facility staff was trying to address his respiratory distress, and the hospice RN came in to help. Not far behind the nurse was one of the patient's children. Through all of this, the musical prescription began—first a cappella, and then, after the patient's son arrived, the harp and voice together helped ease the patient's respirations.
The patient closed his eyes when asked to do so by his son. After 45 minutes of continuous music, his respirations slowed and quieted. However, the peculiarities of this new quiet along with the sharp reduction in respiratory rate made it clear that the patient was going to die soon. While still playing, I relayed this prognosis to his son, who was getting ready to leave the room. Tearful, the son returned to his father's bedside.
The patient's active dying took place over the next 45 minutes. He began to have periods of apnea, in which the son would ask worriedly, "Is that it? Is he gone?" Continuing the music, I spoke to the son, soothing him, letting him know that his father's breathing may return, and that he may have cycles of breathing and not breathing for a time. I shared what to look for in his dad's face, in his breathing pattern, and began preparing him for what we would do as his dad died.
As the hospice nurse, the son and I waited, the music provided continuous support, a constancy, palliating the silences as the patient's breathing started and stopped, started and stopped irregularly—sometimes for minutes at a time—for nearly an hour. When his breaths became little gasps, the son, now sitting on his father's bed, removed his dad's oxygen mask. I encouraged him to stroke his dad's face to smooth out the creases left by the mask, and he did so as his father took his last breaths. The music vigil ended as it began, a cappella, only this time incorporating the text of a prayer of gratitude, remembrance and rest.
"This was so peaceful," the son said to me and the nurse. "I'm so glad you were here to coach me. I don't know what I would have done if I were alone."