What Hospice has taught me about listening

A reflection from a music therapist

By Sarah McInnis, Music Therapist at Valley Hospice

Before I worked in hospice, I thought listening meant paying close attention to words. I listened for meaning, for stories, for emotional cues hidden between sentences. Hospice gently and persistently taught me that listening is much wider than that.

In hospice, listening often begins before anyone speaks.

I listen to breath. To the rhythm of it, the pauses, the effort it takes. I listen to how a room feels when I enter. Sometimes it is heavy with worry. Sometimes it is quiet in a way that feels settled. Sometimes it is holding its breath, waiting for something unnamed. None of this shows up on a chart, but all of it matters.

As a music therapist, I learned quickly that my job is not to fill space. Music is not an answer to silence. Silence itself often has something important to say.

Hospice has taught me to listen for consent. A slight nod. A softening of the shoulders. A family member meeting my eyes as if to ask, is this okay. There are days when music is welcome and days when presence alone is enough. Listening means being willing to do less, even when I came prepared to do more.

I have learned to listen to what is not said. People nearing the end of life often protect their loved ones. Families protect patients in return. Listening means hearing the fear beneath reassurance, the love beneath frustration, the grief beneath practical questions. It means not rushing to soothe what needs to be witnessed first.

Music has sharpened my listening in unexpected ways. When I sing at the bedside, I listen constantly. I listen to breathing and adjust tempo. I listen to facial expressions and soften dynamics. I listen for restlessness, for fatigue, for moments when silence would serve better than sound. The music only works if the listening comes first.

Hospice has also taught me to listen to myself. To notice when I feel the urge to fix, to comfort too quickly, to explain away discomfort. Those urges are signals. They tell me when I need to slow down, ground myself, and return to the person in front of me rather than my own need to be helpful.

Some of the deepest listening happens during life review and songwriting. When someone shares a memory sparked by a song, my role is not to shape it or polish it. It is to hold it with care. When we write a song together, I listen for the words that matter most to them, not the ones that sound the nicest. The listening is the therapy. The song is simply one way it takes form.

Listening in hospice has made me humbler. It has taught me that presence is not passive. It is an active, attentive choice made again and again. It requires patience, restraint, and trust.

Most of all, hospice has taught me that listening is a way of honouring someone’s humanity. At the end of life, when so much control is lost, being deeply listened to can restore a sense of dignity and agency.

Sometimes the most meaningful thing I offer is not a song, a recording, or a keepsake. It is the experience of being heard fully, without interruption, without agenda, and without needing to be anything other than exactly who they are in that moment.

That is what hospice has taught me about listening.