Companioning: Eight Months of Connection with D.
For eight months, I companioned D., a hospice client living in a care facility. D. was in the late stages of dementia, and our visits were shaped by her limited ability to converse. Most of her attempts at verbal communication resulted in a confused or unintelligible mixture of seemingly random words and phrases. Her emotional state was often marked by sadness and sorrow, which she expressed through tears and a distraught demeanor. Guided by background information from her family, I tried to engage her in conversations about the people and places she loved. I also chatted about other topics, hoping to offer uplifting companionship. Occasionally, D. responded with a brief smile, but these moments were fleeting and sadness soon returned. Sometimes, I sensed that my conversation might be distressing for her, so I would shift my approach, offering companionship through something that seemed to more reliably soothe her for a bit … music.
The Power of Music and Dance
D.’s family had shared with me her deep fondness for music and dance, and I was aware of who her favorite singer was. Drawing on this knowledge, I often incorporated music into our visits, hoping to bring her comfort and moments of joy. Music often brought a temporary lift to her spirits. She could sometimes sing a few words of her favorite songs before the shadows of sadness would cross her face again. Dementia patients can often remember music because the neural pathways and brain regions associated with music are less affected by neurodegeneration than other memory-related areas. Listening to familiar music activates diverse regions of the brain involved in emotion, memory, and movement, which enables patients to recall songs and sing, even when verbal and other cognitive functions have declined.
A Joyful Breakthrough
One afternoon, I arrived for my usual visit and found D. awake in her bed. As I greeted her and pulled a chair up close, I noticed a big smile on her face and a gentle, intent look in her eyes. Unlike previous visits, there was no sadness in her expression — she was bright and alert. I chatted with her, and she continued to smile and engage. Sunlight streamed through a window near the foot of her bed. This captured her attention, and she seemed happy to be looking at it. I commented on the beautiful light, suggesting that it was showing its beauty just for her that day. She smiled even brighter. On this day, D. was demonstrating active engagement and displayed an untroubled and cheerful demeanor. During my eight months of visits, this was an unprecedented development.
Endless Smiles
To further engage her, I chose framed photos of her children and husband from the side table and brought them into her view. I spoke about how much they loved her and how I knew she was the best wife and mother to them. These words brought even more smiles. Later, I opened a music app. and played a song by her favorite singer.
D. began to sing along. In previous visits, I would often gently tap the beat of the music on her arm or hands, hoping to connect us through the rhythm. There was never a response to this. However, this time as I started tapping on her hands, D. reached out to me with both arms, her face radiant with joy. I took her hands in mine, and together we “danced”, swaying to the music. Her smile was steady, her joy shining through.
She was not just passively following my movements; she was fully engaged, actively moving to the beat, and enjoying herself immensely. I was following her lead today! D. also began tapping her fingers to the beat of the music on my hands. Between songs, she spoke clearly and coherently several times and even called me a “hot ticket,” which was highly atypical for her. She was engaged, happy and more at peace than I had ever seen her during our eight months together. Today her sadness was replaced with a steady, radiant smile. These precious moments of delight and engagement stood in stark contrast to the sorrow she usually displayed. When I told her it was time for me to leave, she replied, “Not yet,” with a big smile, expressing herself perfectly. I agreed to stay for a few more songs and dances. (I wish I could have stayed longer!) At one point, she gently kissed my hands—a sweet gesture that moved me deeply. I wondered if she was dancing with me, or perhaps with the memory of her husband, children, or grandchildren. It didn’t matter; D. was happy and content.
Reflections on Terminal Lucidity
I left that day with D.’s favorite music playing and a beautiful smile on her face that reached from her bright blue eyes to the corners of her mouth. Reflecting on this extraordinary visit, I considered whether she might have been experiencing terminal lucidity—an end-of-life rally. If so, I was grateful that she was able to find joy and happiness that afternoon and felt privileged to have witnessed her peace. D. passed away a few days later, and the memory of her happiness on that special day remains with me.
Lisa Fortune Creeden, End-of-Life Doula, WintersGrace.com