03/04/2014 08:49 BST | Updated 02/06/2014 06:59 BST

Do People Know When They're Dying?

Do people know when they're dying? My patients often say, "I want to die," when they've grown tired of living with terminally illnesses. Sometimes their words change from "I want to die" to "I am dying" as if they knew their fates. Such patients tend to die within a few days. I don't know how this happens, but even those with impaired cognitive abilities seem to sense their approaching death.

When I was a music therapy intern at hospice in North Carolina, I met a patient whom I'll call Herb. He was a former jazz singer suffering from the final stage of Alzheimer's disease. Herb was often restless and sometimes combative. He had lost his ability to speak, except for occasional mumbling, and his ability to understand words, which made it difficult for anyone to communicate with him. He was very confused to the point he could no longer remember his daughters' name. I imagined how scary it must have been for him to wake up every morning, not knowing where he was or who he was. But there was one thing he still remembered: Music from his past.

When I sang old tunes, such as "What a Wonderful World," Herb would calm down and smile. At the end of each song he clapped loudly, even though I told him he didn't have to do that. Through music we were able to make a meaningful connection. I thought this was a small miracle, but what followed was even more unexpected.

One afternoon I had just finished my session with Herb and was getting ready to leave the room, when he stopped me and said, "I'm going to sing for you today." He grinned like a mischievous child. I was shocked, because it had been a long time since I had heard him speak so clearly, and because singing was one thing he had always refused to do, saying "I can't sing anymore."

As Herb began singing a slow jazz song in his low voice, the words came effortlessly out of a man who recently struggled to put together a sentence. He was out of tune, but I could tell he had once been a great singer. When he finished, I clapped for him, as he always did for me. He looked at me and smiled proudly. At that moment I saw Herb for who he really was - a jazz singer whose life was filled with music, a navy veteran who fought during WWII, a family man who raised his daughter alone after his beloved wife died young. Beyond the terrible disease, there was a whole person.

But why did he decide to sing on that day? I was puzzled by his unexpected behavior.

Two days later Herb died suddenly. His death surprised everyone including the hospice staff and me, because he hadn't shown any signs of decline in the past few weeks. His daughter became very upset about the news of his death, but when the nurse told her that two days before he had sang a song during the music therapy session, she calmed down and said, "Dad had his favorite jazz song he used to sing all the time. I think that may be the song he sang."

Did Herb know he was dying, if not consciously, then deep in his unconscious mind? After having met countless patients like Herb, I've come to believe that he did, and that people who are dying have an inner awareness of their own impending deaths. Perhaps it was this awareness that promoted Herb to sing on that day. I'll never know it for sure. But one thing I know is that his song became the last gift for his daughter, giving her comfort in knowing he was himself again even for a brief moment. It was a gift for me too, because it taught me the mystery of dying.