When Words Fail

by C. Gourgey Ph.D., MT-BC, LCAT

(Reprinted from Fellowship in Prayer, Vol. 48, No. 4, 1997)
 

A woman was standing wordlessly by the bedside of her dying sister, in a room on the hospice inpatient unit. When I approached her, I saw tears in her eyes. Her sister lay in a coma, in some dark inaccessible place. "There are just so many things I want to tell her," the woman said, almost pleading, "and now she will never hear them."
 

I am a music therapist. I have worked in hospitals, nursing homes, and hospices, with people who are seriously ill or are dying. I especially look for patients who can no longer use words to tell me who they are or what they want. Something, perhaps a stroke, perhaps some unexplainable form of dementia, perhaps being in a coma, has robbed them of their ability to speak. I try to explore how music can become a bridge between these people and the outside world, including their loved ones.
 

We may have difficulty conceiving language without thinking of words. Yet I have found that these wordless people have their own languages, which do not depend on words. Recognizing this kind of language and learning to "speak" it can keep communication alive.
 

Once I visited a woman rendered totally aphasic by stroke. Her son and daughter came every day, trying to speak to her and expecting her to respond. Hearing nothing from her, they would repeat their words loudly, as if she were hard of hearing. She only receded further into her bed, her head slumping over her chest, her eyes closing protectively, creating a physical distance between herself and the words assaulting her like hard pebbles.
 

I began to play my wooden flute. She sat suddenly upright and smiled; her eyes opened, reflecting the sunlight streaming through the window. She stretched her arms towards me and began to dance with the upper part of her body, in perfect time to the music.
 

I have seen many kinds of response to music when words seem unable to get through. For such people music is more than entertainment; it is communication. Like words, music communicates a full range of emotion, but more directly. Nonverbal patients do respond to words, but they respond more to the "music" in the words than to their literal meaning. Words shouted or spoken harshly communicate impatience, frustration, and even rejection, regardless of what the words mean. Words spoken softly, slowly, gently, express the love in the speaker's heart.
 

It is important to me to help family members maintain a connection to a loved one who no longer speaks to them. It is so easy to lose faith. "How can music help?" one woman asked me. "My mother is sick; she is dying. Music seems like a waste of time." But it is precisely when someone is approaching the transition we call death that music can be of most value in offering comfort and connection. My hospice colleagues tell me that dying people have two great fears: the fear of pain, and the fear of abandonment. These people need to know they are surrounded by the loving, caring presence of others.
 

I visited this woman's mother in the hospital. She was 90 years old, slight and frail, disoriented and demented. With soft, low tones on my flute, I played some folk melodies I thought she might remember from childhood. She took my hand in both of hers and held it hard; I was surprised by her strength and the willfulness in her movements. Then she placed my hand over her breast, right by her heart, to let me know that I had reached her. The moment seemed both intimate and sacred.
 

On my next visit, I was surprised to find her very agitated. Her daughter was with her, trying to give her water to drink. Her mother would take one sip through a straw, then start coughing and spitting it up. The daughter tried again, several times, with the same frustrating result. Her mother lay on the bed, writhing and moaning. Finally, the daughter allowed me to approach.
 

I held the mother's hand, and sang to her a folk song in her language. I stopped singing and allowed her to rest her hand in mine. She became quiet and still. Then she took my hand in both of hers and held on hard. I waited a few moments, allowing myself to be with her quietly. Then I invited the daughter to put her hand there instead of mine, so her mother could hold her and feel her presence. I told the daughter she need do no more than just this, and it will reassure her mother greatly.
 

Exactly one hour later, her mother died. The head nurse told me the transition had been peaceful.
 

Families of people who are seriously or terminally ill experience many conflicted emotions. Fear is certainly one. Guilt is another. We want to do things for the sick person, make her well, or give now what we thought we should have given long before. Sometimes we try too hard, and what we communicate is not our concern but our anxiety. Much of this anxiety comes from a sense that we are losing this person, because the familiar ways of words are no longer available.
 

I would really like family members to know that there is never a moment, no matter how ill someone may be, that we can say with certainty that communication is impossible. And when communication exists, so can the expression of love. As long as the body is alive, it still carries the soul. In fact, when the body begins to weaken, the soul often becomes more visible, since the physical energy needed to maintain fear and control is lacking. And so I have found that it is often with those who are dying that moments of intimate peace and communion are most possible--although these usually occur without words.
 

To me, music therapy is really spiritual caregiving, but instead of a clerical collar I carry a flute or a guitar. I want to touch the person's soul, to let him know that love is still possible. As a music therapist, I know there are many kinds of music: a voice's gentle sound, a hand's light touch, the soft cadence of loving words. This music is available to all of us.
 

I explained to the woman at her dying sister's bedside that we believe most people in comas can still hear. It is not too late: tell her what is in your heart, and on some level she will know. I left the room to the sound of the music of the visitor's words, a sound of hope, a sound without tears.