Another Touching Story: Reframing the Sounds of Dying

I could hear the patient even before entering her room.  Her respirations were congested with “gurgling,” a sign of active dying.  Apart from that, she was making a soft sound with each exhalation.  It sounded like “ahhhhhhhh.”

I sat at the bedside and gently caressed her forehead.  Her eyes were closed, her face was soft.  There was no grimace or other indication of distress in her expression.  But the sound was worrisome to me.  Was she in pain, I wondered?  I left the patient’s side to find her nurse, returning to hold her hand while the nurse provided IV pain medication.  I thought the sound would stop once she was medicated.  But the sound did not stop.  It just slowed down, as the patient’s respirations became more relaxed.  I asked the nurse about family and learned that the patient had a brother who would visit in the afternoon.

Two hours later, I wondered how the patient was doing.  I returned to her room, to encounter her in a left-leaning position which helped the gurgling.  But the vocalizations continued with each exhalation, maybe even a little louder than before.  I held the patient’s hand, placing my other hand lightly on her torso and syncing my breathing with hers.  And then I began to say “ahhhhhhhh” with her, matching her tone and volume.  We hummed together for a while.  Her limbs and torso were completely relaxed. But the sound continued.

Toward the end of my work day, the patient’s voice grew louder.  I entered the room with the nurse to encounter the patient’s brother at the bedside. He appeared stricken and abruptly fled the room, saying “I can’t bear to hear her like this.” The nurse and I repositioned the patient to see if it might help.  The patient did not protest being moved.  Her body was heavy.  Her face remained soft.  She continued to vocalize.  I exited her room and found her brother in the waiting area with his head in his hands.

I introduced myself and gently shared with this man that I had spent some time with his sister. I said, “I know that the sound she is making is unsettling. But I have watched your sister’s face all day and my impression is that she is not in any kind of distress.”  I went on to share the evidence I’d observed: no facial grimace, no furrowed brow, no restlessness or agitation, no crying or moaning during repositioning.  “I am wondering,” I said, “if your sister is simply needing to make sound right now.  Maybe the vibration is comforting to her.”

The man perked up at this. “You know,” he said, “She used to be a singer.” I listened quietly as he shared that his sister had performed in various choirs throughout her life and that she often hummed at home while doing chores. With the patient’s vocalizations reframed, the man was able to return to his sister’s room and sit with her through her remaining hours.