Of all the music one hears in their life, what would you want to be the last song you hear before you die?
Normally I wouldn’t say anything but given how emotionally challenging it was to write this article, I feel it only fair to warn those sensitive to end-of-life topics that portions of this article could trigger related anxieties. Please use your best judgment in continuing.
This article contains several links with useful information related to the subject. Don’t be afraid to click on them and examine the information for yourself.
When a thought is put out into the universe on the scale of an article in The Washington Post one has to assume that there are a lot of people meant to receive that message. One can only speculate as to why so many people need that message at that particular time, especially when the topic isn’t one of national concern, such as the president losing the launch codes or some similar disaster. When the message strikes at a more personal level, one finds it difficult to ask the universe what’s about to happen for so many people to need that thought right now.
Such was the case when the Post published this opinion piece recently by Dr. Mark Taubert. Dr. Taubert specializes in palliative medicine in Britain. He’s the one who looks for the best way to make a patient comfortable when curing their disease is no longer an option. For many, he’s the last doctor one sees before death. Sounds like a cheery job, doesn’t it?
Dr. Taubert wrote the article after walking into the room of a dying patient whose family was playing Elton John’s “Crocodile Rock.” Dr. Taubert found the selection amusing, given the cheerful disposition of the music juxtaposed against the gravity of the inevitable end-of-life event. He quite nicely, and in fewer words than I tend to use, spoke of how our brain functions shift as we are in the process of dying, allowing our auditory system to receive a higher level of energy while other portions of our body, and our brain, are shutting down. He makes a case for making one’s wishes known in advance should our own families be faced with similar circumstances.
Articles like this tend to come off as rather morbid. No one likes to think of the inevitability of death, even though doing so is one of the most responsible and compassionate things one can do. With all the other negatively-toned news the Post has to published, I can’t help but wonder why the paper chose to publish this article at all, and especially right at this particular moment. A brief op-ed like this seems like perfect fodder for an online publication that needs something to fill space on a Tuesday, not valuable column inches in the Sunday edition.
I don’t believe accidents just “happen” anywhere in the universe. The implosion of a star millions of light years away creates a massive amount of energy that expands throughout the galaxy for eons, affecting everything it touches. If the op-ed team at the Post was convinced this was a good article to publish at this exact moment, I have to believe that a lot of people need to consider this situation right now, including me.
Before delving into the issue of trying to unravel which song I want to hear last, though, we need to consider the issues surrounding chronic and terminal illness as well as the manner in which one dies. Yes, these are challenging conversations to have but, again, we are at our most responsible when we tackle these issues before they become necessary. After making a will, discussing and planning our end-of-life care is one of the most important things we can do for our families. As for choosing a final song, well, that may be the most difficult aspect of all.
Planning For The Longest Life Possible
Everyone dies. We understand that. We don’t necessarily like to think about it, but it inevitably happens. If we’re fortunate, by the time we get to that stage in our existence we’ve lived a full life and are ready to pass peacefully. Certainly, not everyone gets that opportunity and we are more than aware of situations where lives ended without any warning. The amount of planning we can do for sudden death is limited to having a will and a pre-paid service plan of some form (I’ll discuss those later). However, for the greater majority of people, death is something we at least get a hint at. There’s no good reason to not give the matter some serious thought.
Let’s look at the facts for a minute. Those of us living in the United States have a reasonably long life expectancy, despite the numbers having shrunken slightly in the past couple of years. Most women can expect to live well into their 80s and most men into their mid-70s. Yes, death is sexist if one goes strictly by the numbers. Still, compared to our parents’ and grandparents’ generations, we likely have a lot of life ahead of us. Few people are terribly surprised to hear of someone reaching the century mark in life. As medicine continues to develop ways for us to maintain a relatively decent quality of life, more of us may live to be 110 or even 120.
However, living a long time doesn’t necessary mean that we’re all that healthy.
Roughly 65% of all deaths in the US are due to some form of chronic illness. I know, you thought I was going to say heart disease. Heart disease, cancer, lung disease, sepsis, high blood pressure, diabetes, stroke, COPD, and HIV are all among the rather long list of chronic diseases that ultimately prove fatal for those who have them. Those numbers skyrocket when one adds developing countries into the mix.
The thing about living with a chronic illness is that one can’t always predict how quickly it’s going to do its dirty deed. When caught early and treated correctly by a professional (don’t even talk to me about “holistic” cures), their effect can be minimized and one can enjoy a quality life for a very long time. Yet, one has to live with the knowledge that at any given moment something unseen and unsuspected can trigger a rapid advancement of the disease, bringing one to a critical state literally in the blink of an eye.
Whether it happens quickly or over the long term, we eventually get to that point where we’re no longer ambulatory, our quality of life declines, and our disease becomes terminal. Still, we might live several more years. My paternal grandfather lived almost 14 years past his doctor’s initial diagnosis. My father, unfortunately, was not so lucky and passed within a matter of months. Either way, death is more likely to take us slowly, over days, weeks, or months, rather than suddenly and unexpected.
Given such inevitability, it makes much more sense to plan not only for our eventual demise but for whatever term of palliative and hospice care one might need in the final period. Again, yes, I understand this is not a fun conversation, but it is a necessary one.
Giving Some Dignity To Death
The call came late in the afternoon, December 1, 2002. I was sitting in my downstairs office at home. The day was cloudy, the temperatures relatively cool for North Georgia. I don’t remember exactly what else had my attention, but I was waiting for this call. There was no hesitation in answering when the phone rang.
My father had started chemotherapy that morning. Weeks of radiation had failed to reduce the size of the tumor growing on the left side of his head. The hope, presented to my father as cheerfully as possible, was that the chemotherapy would kill the tumor and that surgery might be possible afterward. That wasn’t the way things turned out.
Mother was sobbing as she relayed the news. Poppa had responded negatively to the treatment and had almost died on the table. The doctor would not be making another attempt. Poppa’s situation was now terminal.
Instead of killing the tumor, the attempt at chemotherapy seemed to invigorate the damn thing. While we had already made a trip to Oklahoma earlier that year, we hastily made plans to be back there for the holidays, knowing that they would be my father’s last. We talked with the boys, attempted to prepare them for what was coming, but the truth is that we were all caught off guard. We had not planned at all for this scenario.
Unfortunately, we are not alone in being caught off guard. Of the millions of deaths that occur due to chronic illness, the number of families prepared to handle the challenges of long-term end-of-life care are few. Think you can handle some numbers? Here are some of the statistics most pertinent to our conversation:
- Over eight million people annually receive support from a long-term care service: home health agencies, nursing facilities, hospices, residential care communities, and adult day service centers.
- As of 2015 (the last year for which accurate numbers are available) 12 million Americans needed some form of long-term care (longer than six months).
- 69% of persons over the age of 65 develop disabilities before they die. One fifth of those will incur over $25,000 in out-of-pocket expenses.
- The National Alliance for Caregiving estimates that approximately 65 million family and informal (non licensed) caregivers provide for an elderly family member.
- A national survey conducted by Myers Research Institute shows that the majority of assisted living facilities discharge residents whose cognitive abilities reach moderate to advanced stages. This often limits the patient’s ability to find suitable care outside a nursing home.
Now, how many people actually want to spend their last days in a nursing home? Not many. While the conditions of many nursing facilities has dramatically improved over the past 20 years, the greater majority of people would much rather live out their final days in their own home surrounded by faces they know (or once knew in the case of dementia patients). In fact, in 1999, the Supreme Court of the United States confirmed the right to receive care “within the community” as opposed to an institution whenever such care does not diminish the patient’s quality of life.
“Dying with dignity” is a phrase we often heat associated with arguments for selected life termination in the event of terminal diagnosis. However, that phrase should also be applied to that term leading up to one’s end of life. While how we die is an important conversation for some, the manner in which we live our final years, weeks, or days is important for everyone. If we want to preserve the dignity of our life, then we need to plan for that eventuality and discuss those plans with our loved ones.
Otherwise, families are too often left in a lurch, told they need to provide care for a loved one and having no substantive idea of who to call or where to turn. Siblings squabble, families splinter, and meanwhile the patient’s quality of life is reduced to the point where significant time is shaved off their life simply because no one knows what to do. In worst case scenarios, the government steps in, minimal care is provided, and any dignity that was left is lost.
Facing Our Fears With Peaceful Determination
My father’s last words to me were, “I love you, son. Take care of your mother. Tell those boys how much I love them.” His physical pain in those final hours was so severe that no amount of morphine was sufficient. Seeing tears roll down his face broke my heart. He did not look forward to death because, as always, he was concerned about his family more than himself. He did not fear death, though. He knew that everything surrounding the next step was secure. He was confident in his faith and in the knowledge that Mom would not have to worry.
I have never understood why we fear death so much that we are unable to discuss it intelligently and plan for its inevitability. For people of faith, so very much of the music and rhetoric that dominates religious services revolves around the promises of what comes after this life. Christians, especially, have whole volumes of hymns such as “When The Roll Is Called Up Yonder,” “The Old Ship of Zion,” “It Is Well With My Soul,” and “Take My Hand, Precious Lord.,” all of which celebrate moving on beyond this life. For those agnostic or atheist, the end of this life is simply a transfer of our energy back into the cosmos. Allowing mythologies and old tales to subdue us with fear regarding death is something that has never made sense to me.
What I do understand, however, is Poppa’s desire to take care of his family, especially Mother. Most people (there are always ornery exceptions) don’t want their passing, or their end-of-life care to cause unnecessary burden or trouble for their family. My maternal grandfather lived with us off and on for several years and it always bothered him when any aspect of our lives, no matter how trivial, required adjusting to make sure he had the care he needed. While I tease my boys that I plan on hanging around and embarrassing them until I’m 150, the reality is that I hope they never have to worry about any aspect of my care. Love leads us to make our transition from this life as peaceful as possible for everyone, not just ourselves.
Achieving that goal, however, requires some determination and planning in three general areas that one can never address too early in life. When one considers the possibility that a stroke or accident or unexpected disease may leave us without the ability to participate in our care planning when we need it, the assurance that those possibilities have already been addressed allows us to live our entire lives with a greater level of peace.
There are three areas of planning one needs to address.
If we’re being honest with ourselves, the population can be divided into two groups when it comes to financial planning: those who do and those who don’t. I’m in the latter group. Not that I didn’t try, but when one’s income is inconsistent, as it is not only for most creatives or anyone who is self-employed or a serial entrepreneur, the consistent contributions necessary for intelligent financial planning are not always there.
Planning early is the advice financial planners always give, but in an economy that emphasises experiences over savings that often doesn’t happen. When we do realize we need to plan, somewhere past age 40, we start realizing that we’ve already missed out on a lot of options that would benefit us. Past the age of 45, a number of insurance options grow considerably more expensive and if one has a pre-existing condition or four, as many of us have, the best life insurance policies are often out of our reach.
There are a couple of necessary steps to take regardless of one’s circumstances. First, know what the costs are in your area. The Genworth Long Term Care Survey is a helpful resource that breaks down costs for one’s general region. This is helpful when one is considering their options.
Second, get some help. This is tough for a lot of us. Admitting that we need help planning for our final years feels fatalistic, as though we’re already giving up. We’re not. Asking for help is a move that makes us stronger. AARP has a number of suggestions (no big surprise there). However, what might make more sense is consulting a local palliative care provider who offers a full range of services. They often have financial planners on staff or can put one in contact with social workers who are aware of the full range of financial options. Know that Medicare does not pay for what they call “custodial care,” so one is likely to need other options.
Long-Term Care Preparation
How does one plan for something when they don’t know exactly what they’re going to need or when they’re going to need it? Again, there are two critical steps that we have to consider. The first can be done to a certain extent online: know what options are available. Most palliative care companies have websites that detail the various services available. Interestingly enough, the VA website does a good job of covering a great many of the options, though I certainly wouldn’t recommend going through the VA to exercise any of those options.
The second step is a little more involved: deciding what you want. This is challenging because as we sit here right at this moment I know I’m not sure exactly what I want. I know I don’t want to be a burden on Kat or any of my boys. At the same time, I’m far to grumpy an old man to tolerate being in a facility as long as there are other options.
Earlier this week, I took a moment to watch the Netflix movie, The Last Laugh, with Chevy Chase, Richard Dreyfuss, and Andie MacDowell. While the movie itself had a number of inaccuracies that bugged me, what it drove home for me was that very few of us want to be “put up” somewhere. We’d much rather remain active even if it means doing something out of character, like driving across country on a comedy tour or posing nude for an art sculpture. Another important point, however, is the need to communicate our desires with our families.
We’re not as likely to get what we want in our final years if no one knows what we want, and I mean in excruciating detail, such as wanting to have a hound dog by my side no matter what, and what might happen if a caregiver ever comes at me with gazpacho. I’ve never understood the point of cold soup.
Sure, we want to consider what happens when we reach that point where we can’t get out of bed unassisted or its no longer safe to make our own coffee. We also need to communicate what we want prior to that point as well. If we don’t want to look at latter life planning as a fatalistic exercise, we should make it clear exactly how we want to live.
FInally, it is important that we have someone we can trust who has some form of power of attorney. At any point where we are unable to communicate for ourselves for any reason, we need to know who has our back and that they’re going to respect our plans and wishes. There are various forms of Power of Attorney, so talk with a social worker or legal expert to determine which works best for you and then choose carefully.
Finally, let’s deal with the inevitable. Talk about it, plan for it, and then don’t worry about it. No, this isn’t going to be a fun conversation no matter when it occurs. However, here’s what I do know: it’s a lot easier to make those decisions now than leaving them to a grief-stricken family. There are no exceptions to this rule.
Coming from the background I do, where not only did Poppa officiate at a number of funerals but family members owned funeral homes and I even worked in a couple during college, I am extremely well versed in how the family that seemed to be holding it together during one’s decline falls completely apart in all the worst ways after one is actually gone. Trust me, leaving your end-of-life planning to the grief-stricken is not advisable.
I no longer have any family members (that I know) still involved in the funeral business, so I reached out to Chris Highsmith, a former classmate who now owns Burckhalter-Highsmith Funeral Home in Vinita, Oklahoma. I wanted to know if prepaid, pre-planned funeral services were still available. They are, and I want to encourage people to consider this option no matter what other financial options they might have at their disposal.
Both my parents had prepaid plans that they had purchased when my brother and I were still very young. I cannot begin to express how much of a relief that was when they passed. When Poppa died, all Mother had to do was sign papers ordering the sufficient number of death certificates and deliver the suit in which Poppa would be buried. Perhaps even more critical, though, was when Mother passed six months later. Her death was sudden and unexpected. There was no emotional planning. Still, my brother and I walked into the funeral home and were immediately assured that everything was in place. We only had to provide her clothes.
Again, we are a unique family. The funeral director we were using was a family friend with whom we had worked for years. What I didn’t know, however, if plans such as the ones my parents had were still available for purchase. There had been talk in the late 80s and 90s of discontinuing those options due to a lack of interest on the investment.
Chris assured me of two important things: A number of funeral homes still offer the service, and yes, they are transferable. Just this past week, Chris was fulfilling a prepaid plan that had originated in California in 2002. This is important as many of us don’t know exactly where we’ll be when we pass. I’m still holding out for eventually moving to the West Coast. There are plenty of people who have dreams of spending their final years somewhere warm. That doesn’t mean we can’t go ahead and plan for this final event.
Do this. If the thought of going to a funeral home creeps you out, a number of funeral service providers, including Chris’, provide pre-planning forms on their websites. Let me encourage you, though, to develop a relationship with a funeral director. They really are wonderful people, often with the best sense of humor. In my opinion, this is just as important as having a will. Define exactly what you want and get that emotional challenge out of the way. Once it’s done, communicate to someone where those plans are and then proceed to live the rest of your life with all the bliss one can muster.
Listening To The Music
Now that we’ve gotten all the necessary planning out of the way, let’s get back to talking about music. Specifically, the music we want dominating the latter part of our lives. This is important on a number of levels.
First of all, for the vast majority of our lives music has played a role in all the important events we’ve experienced. We remember the song playing when we first fell in love, that song that just clicked at the first concert we attended, and the song we found comforting when we were really, really sad. We jam to music while driving, while working, and while at the gy. When music has played such an important part in all the rest of our lives it is silly to not include it in our end-of-life planning.
Secondly, there is increasing evidence that music has a positive effect on our health as we age. As I talked about palliative care with a friend who recently lost her father after a prolonged illness, I was pleasantly surprised to hear that one of his care providers would routinely bring her guitar and not only play music he knew but facilitated his participation, even if it was just tapping on a tambourine. Music helps us focus, at least for a while, on something other than the pain and loss of function that one often experiences in those last months of life.
Third, hearing is one of the last functions we lose before we die. In fact, there’s plenty of evidence that as other body functions begin to fail our hearing is actually enhanced, making it all that much more important that the sound around us be carefully considered. Would one rather here the beep-beep-beep of life monitors counting down our final heart beats or something that makes us smile as we remember the heart beats we’ve already enjoyed?
What we don’t want is some random selection of songs that hold no meaning for us. I have a broad and varied taste in music but if someone thinks I’m going to tolerate a playlist of “golden oldies” from the 1950s, they are sadly mistaken. When I reach that point where I could “go at any time,” I better not be hearing strains of Frank Sinatra’s “My Way” as I take my final breaths. So help me, I’ll come back and haunt someone if that happens.
Fortunately, we live in an amazing time where we don’t have to rely on our advice to family members or caregivers. We can create our own playlists of songs that actually have meaning to us, music that leaves us happy as we contemplate taking our final breath. There are plenty of ways of doing that, from putting songs on a flash drive to creating a playlist on one’s favorite streaming service. With just a little work we can rest easy knowing that some toneless contemporary drivel is not going to be stuck in our ears for eternity.
Mind you, we’re not talking about the music played at one’s funeral service. While there may be some overlap, the music at a memorial service is not for us but for the people who are left. This is a selfish moment. To hell with what anyone else wants to hear. Let this be your own playlist. No judgement allowed.
Sorting Through A Lifetime of Favorites
Of course, the moment one sits down to distill a lifetime of music memories into a handful of final choices, we begin to realize just how much music we’ve enjoyed over a lifetime. We also are likely to realize how much our tastes have changed. There are some songs that we thoroughly enjoyed in our teen years that we might not be able to stand now. How does one curate this final list so that it’s not 24 years long?
I cannot provide all the answers for you. Not everyone has complicated music tastes. I have a good friend who has been a country music radio DJ for over 40 years. His playlist is likely to be pretty straightforward. Mine, on the other hand, is all over the place. To help you narrow down your choices, here’s how I constructed my list.
- Five songs from my earliest memories. For me, these are all gospel songs with a heavy tendency toward traditional spirituals such as Mahalia Jackson’s “Great Gettin’ Up Morning,” and Ethel Waters’ “His Eye Is On The Sparrow.” Popular music was all but nonexistent when I was little so even though my belief system is dramatically different from my parents, these songs still tug at my heart and provide a sense of warmth and comfort.
- Five songs from when I first started choosing my own music. I received my first transistor radio in the summer of 1968. Oh, but the wonderful songs I suddenly discovered! The best part was that it came with an earpiece so I didn’t have to divulge to my parents the rebellious sound choices I was making. Songs from this period include Three Dog Night’s “Joy to the World,” Peter, Paul, and Mary’s take on “Blowin’ in the Wind,” and, perhaps somewhat inexplicably, Blood, Sweat & Tears’ “Spinning Wheel.” The line “What goes up must come down” is something I will always hear sung in my head and if one isn’t careful I must just get up out of my deathbed and dance to that one. The memories I have of that summer are still as fresh as any.
- Five songs my early teens. That period between ages 12-14 isn’t especially long, but they are extremely influential and for many people accompany a lot of “firsts,” such as the first love or first kiss. For me, however, my parents’ influence was especially strong during this period. Living in extreme northeastern Oklahoma, it was only country music on the radio (FM radio was just getting started) and most of the opportunities I had for experiencing live music involved the church, particularly the resurgence of gospel quartets. This has stuck with me forever. I love the harmonies and the passion found in this music, even if I don’t agree with their precepts. All the artists from this period are gone now, but I’ll never forget watching Rosie Rosell sing “Oh What A Savior” or George Younce stepping into “This Old House.” I have a ten-hour playlist filled with this music and it’s still my go-to specifically when I’m editing nude photographs. Don’t judge me.
- Five songs I will always want to hear one last time. Okay, calling this section of the playlist “songs” is a bit of an understatement. This is the music from my formal education in the field, the pieces that I’ve either played or conducted at significant points in my schooling. These five pieces alone are well over an hour in length. Sorry, not sorry. These are masterworks and, so help me, if there’s an ounce of muscle control left, my arms are coming up and my hands are going to move through all five. I also have to be very specific here, though. I was trying to explain this to Kat and she looked at me as though I am crazy. Not every classical recording is the same. If I’m listening to Tchaikovsky’s piano concerto in b-minor, it had damn well better be Van Cliburn at the piano or I’m likely to throw something. Similarly, if I hear some thin-toned rendition of the “Choral” from Beethoven’s 9th Symphony, know that I will get out of my bed, no matter how close to death I might be, and beat someone with the nearest baton-looking instrument I can find. The 1964 Decca recording with Leopold Stokowski conducting is pretty much the only one I find acceptable. The double bass sound is too thin on everything else.
- Five songs from my mid-late teens. Yeah, we’re skipping straight over the disco years. I don’t need that in my ears. There were some classic songs from this era, though, and this was probably the era most difficult to narrow down to only five songs. The various playlists I have from this period would take three full days to get through if we played them non-stop. I narrowed down my choices, though, by thinking which ones would likely have the greatest meaning for me as I lie in bed wondering if my next breath might be my last. Morbid, yes, but effective. The five I ultimately chose are songs that would, in one way or another, be fitting were I to die while they are playing. If given a choice, I’d rather “Listen To The Music” be the last thing I hear, though “Dust in the Wind” is also totally appropriate. Any of these five are fine, thank you. Not that I’ll remember, or be able to communicate my appreciation, but those who know me best will appreciate the significance.
Why have I not chosen anything from later in life? Because, let’s face it, music from the late 70s-early 80s was the best. There’s a reason these songs are still popular even in contemporary culture. By the time we made it to the 90s too much of the music was being over-produced, digitally influenced, and in many cases just plain horrible. Why would I want to listen to anything when I’m dying that I don’t listen to while I’m alive?
Sure, I try to keep up with contemporary music and there are artists like Jon Batiste and Kendra Foster whose talent I greatly respect. I need to be awake and have my cognitive abilities in tact, however, to appreciate their music. While I enjoy what they’re doing, their music has not had the opportunity yet to attach
One of the benefits of advance planning, however, is that we can always change things. If I live another 30 years (or 60) then I’m likely to revise the playlist, adding another section of music that speaks to me now. Planning ahead doesn’t mean that we can’t change things if our circumstances change.
What we have to realize is that we don’t have control over everything that happens to us. While we may live very long and active lives, and I certainly hope we all do, there is also the very real chance that one might suddenly find themselves with limited functionality, their body unable to fulfill all the tasks we expect from it. It is against that inevitability that we make these plans now.
I have absolutely no idea why the universe put this topic into the cosmic conversation at this particular time. As I’ve done research this week, I’ve come to appreciate the wealth of options that are available on every level. We who are past the age of dying young and leaving a good-looking corpse are surrounded by opportunities to remain active and vital participants in society even past the point of being fully ambulatory.
What I cannot over-emphasize is that we need to plan and make these decisions for ourselves and then fully communicate these decisions to our loved ones. How we spend our final years, months, and days should not be matters of hastily made decisions put off until the last minute. We control our quality of life for our entire life when we plan now.
Here’s my final playlist, for now. Listen if you like. More importantly, make your own. Let the last song you ever hear one that you can carry with you into eternity.
All images included in this article are the copyrighted property of charles i. letbetter and cannot be used elsewhere without express written consent.
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