The last song you will ever hear

The Washington Post Sunday - - SUNDAY OPINION - BY MARK TAUBERT The writer is a doc­tor in pal­lia­tive medicine and se­nior lec­turer in the Cardiff Univer­sity School of Medicine.

Wind­blown rain lashes against the hos­pi­tal win­dows in an un­cer­tain rhythm that seems even more un­steady as I en­ter the pa­tient’s room near the nurs­ing sta­tion. There is mu­sic in this room. Two peo­ple sit in chairs by the bed of a pa­tient, a woman who is ly­ing very still. I rec­og­nize the voice of El­ton John com­ing from a tablet com­puter on the bed­side ta­ble. He’s singing “Croc­o­dile Rock.”

“She liked this,” says the woman’s daugh­ter, smil­ing and rolling her eyes, as though to say “El­ton John, re­ally?” The dy­ing woman’s hus­band glances at his daugh­ter, then at me, and says, “We fol­lowed the ad­vice from one of the nurses to play some mu­sic in her last few hours and days.” He smiles slightly, as if in apol­ogy for the jaunty tune (I never knew me a bet­ter time and I guess I never will) in this solemn set­ting.

His wife’s eyes are closed. Her breath­ing is steady. Her pulse is fine, about 90 beats per minute. She is much calmer than yes­ter­day, when she was flushed, frown­ing and seemed in con­sid­er­able pain. But she is dy­ing. We are giv­ing her as much sup­port as we can to help her be free of dis­tress or dis­com­fort.

I’m a pal­lia­tive care doc­tor. I work in Bri­tain in a gen­eral hos­pi­tal, a can­cer hos­pi­tal and a hospice. Sit­ting with some­one you know and love who is dy­ing can stir a crav­ing for a bit of nor­mal­ity in what oth­er­wise might seem a sur­real set­ting. Not that dy­ing isn’t “nor­mal,” but nowa­days death and dy­ing are of­ten hid­den away in hos­pi­tal wards or nurs­ing homes, and many peo­ple don’t know what to do, or what not to do.

I of­ten tell the fam­ily and friends of a dy­ing per­son that they needn’t speak in hushed tones, that they are wel­come to chat or share a joke or call out cross­word clues. Or play some tunes. Putting on a fa­vorite song can be­come a rit­ual cel­e­bra­tion as you en­joy a mo­ment you shared many times be­fore.

Some peo­ple don’t need any en­cour­age­ment — I have seen plenty of ter­mi­nally ill pa­tients die with mu­sic play­ing in the back­ground. But in the past few years, as the ben­e­fits of mu­sic in these set­tings have be­come more ap­par­ent to me, I have paid more at­ten­tion to what is on.

Mu­sic can even help with those who are se­verely ill but re­cov­er­ing. The fa­ther of one of my younger pa­tients put his playlist on while his daugh­ter was in crit­i­cal con­di­tion. Through her delir­ium, she com­plained when a well­known rap song from the ’90s came on. Later, af­ter she awoke and was more re­spon­sive, her fa­ther de­fended his back cat­a­logue of mu­sic, and a de­bate about good taste en­sued — their con­ver­sa­tion ac­com­pa­nied by the usual hos­pi­tal sound­track of beeps and in­fu­sion drip alarms and squeak­ing cart wheels.

Lis­ten­ing to fa­mil­iar mu­si­cal pas­sages can prompt sig­nif­i­cant emo­tional re­sponses, caus­ing the re­lease of neu­ro­trans­mit­ters such as dopamine. In par­tic­u­lar, they are re­leased in an an­cient seg­ment of our brains, known as the stria­tum, which is as­so­ci­ated with emo­tional re­sponses to rewarding in­puts such as food, sex, drugs and . . . rock-and-roll.

What hap­pens to the brain in our dy­ing mo­ments? The shut­ting-down process is not as straight­for­ward as you might imag­ine. Most of the re­search on the topic has been done with ro­dents, so we may not be able to ex­trap­o­late too much. But dy­ing rats ex­pe­ri­ence height­ened ac­tiv­ity in their frontal cor­ti­cal ar­eas, when the oxy­gen and glu­cose have been taken away and there is a huge in­flux of cal­cium into their brain cells. Our abil­ity to have con­scious thought and ex­pe­ri­ence de­pends on the strength of the con­nec­tions be­tween the frontal ar­eas of the brain, as­so­ci­ated with men­tal abil­i­ties, and those nearer the back of the brain that process sen­sory in­for­ma­tion. These con­nec­tions, in dy­ing rats, ac­tu­ally strength­ened by five to eight times af­ter car­diac ar­rest, com­pared with wak­ing mo­ments.

Such a surge in the hu­man brain may ex­plain why some peo­ple who have near-death ex­pe­ri­ences re­port height­ened sen­sory in­for­ma­tion. Those who are dy­ing may also be able to process au­di­tory in­for­ma­tion bet­ter than is gen­er­ally as­sumed. It is en­tirely fea­si­ble that, in our dy­ing mo­ments, we are more aware of what is hap­pen­ing around us than pre­vi­ously be­lieved.

Over the past few years, my co­work­ers and I have com­piled what amounts to a deathbed playlist of songs we’ve heard in rooms where peo­ple are dy­ing. The en­tries range from Barry White’s “You’re the First, the Last, My Ev­ery­thing” and Harry Nils­son’s “Ev­ery­body’s Talkin’ ” to Mahler sym­phonies and Oa­sis’s “Won­der­wall.” What will be on yours?

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