Trigger Warning: This story contains content & media about death.

“Death is violent, death is a struggle. The body clings to life, as ivy to a wall, and will not easily let go, will not surrender its grip without a fight.” The instinctive will of the body to go on living is a grounding factor in the cyclonic heartbreak that is Maggie O’Farrell’s Hamnet. Speculative and oozing with grief, the novel reimagines the story of Shakespeare’s son, the child’s death, and how that loss influenced the writer’s famous tragedy. Characterized by one critic as being “told with the urgency of a whispered prayer,” the novel is as beautifully and hauntingly written as the story that unfolds and is also a subsuming consideration of the sensory nature of death.

The fight O’Farrell describes is sensual. A fever entrenches Hamnet’s body with sweat and heat, and his hallucinating mind allows him to drift from the room he occupies with his sisters and mother as they attempt to save him. The scene is a frantic imagining of the last moments of life, filled with the stench and blue-grey skin of a body rotting from the inside. According to recent reports, though, what O’Farrell envisions—that Hamnet understands himself to be wandering through a place of snow and ice, and the cold, crisp, white landscape entreats him to lie down and rest for just a moment—is perhaps not entirely what occurs when we cross from life to death.

Just as hearing is the first fully developed sense, it is also the last to leave us as we die. A study in Scientific Reports utilized electroencephalography, a method of recording brain activity, to investigate whether hospice patients would register a series of sounds just before death. Researchers found these subjects were responsive to the tones, although they weren’t able to decipher whether the patients were simply aware of noise or if they could potentially comprehend words, as well. “Their brains responded to the auditory stimuli, but we can’t possibly know if they’re remembering, identifying voices, or understanding language,” one of the study’s authors, Elizabeth Blundon, said in an interview. “There are all these other questions that have yet to be answered. This first glimpse supports the idea that we have to keep talking to people when they are dying because something is happening in their brain.” As one COVID-19 patient reports, though, even in a coma, he heard medical professionals speaking around him.

Hamnet’s passing in the novel is notably quiet, lacking the noises characteristic of an ending. Common sounds include the “death rattle,” the crackling that occurs when a person is too weak to swallow and saliva builds up in the throat instead. There’s also the equally disquieting Cheyne-Stokes respirations, an abnormal cycle of short, shallow inhalations and moments with no breath at all. O’Farrell’s protagonist experiences neither of these, though. “All at once, he stops shaking and a great soundlessness falls over the room. His body is suddenly motionless, his gaze focused on something far above him,” she writes. “And there, by the fire…Hamnet takes his last breath. He draws it in, he lets it out. Then there is silence, stillness. Nothing more.”

In Shakespeare’s time and well after, a lack of breath was a determining factor in death. Take the terrifying story of Alice Blunden, for example, who was buried alive (twice!) in 17th century England after falling unconscious from drinking too much poppy water and failing to fog a mirror held to her mouth.

We might consider the silence O’Farrell describes, then, as echoing the cultural impulse to not speak about death, rather than solely evoking the firsthand experience of dying itself. Those reeling from losing a loved one are all too often left to quietly pass through grief’s stages alone, and this happens, in part, because addressing our own mortality tends to spark anxiety about our inevitable fate. Our inability to confront the unavoidable sometimes falls under the realm of thanatophobia, or “prolonged, excessive fear of death,” and also has broader implications beyond our internal worries: addressing our mortality has shown to make us more punitive and prejudiced.

Our fear of dying has the power to both self-silence and riddle our subconscious with dread and unease, a problem that significantly decreases when we undergo a near-death experience or trip on psychedelics, according to a study published in the journal PLOS ONE. Reports from those who’ve faced the former through a car crash or medical emergency suggest that these often traumatic, out-of-body events do alleviate some worry about the final moments. Although anecdotal, they also indicate that the liminal space between life and death is deeply rooted in the body: people recount a range of sensations, from total silence and faint muttering to the surreal sounds of “the tunnel,” or the noise of moving through space at high speed. Even if the mind is disengaged, the body reacts.

Just as Shakespeare channeled his unfathomable grief into his work with Hamlet—Hamnet and Hamlet were interchangeable names during this time—art can be a pathway to healing when we lose someone. “Part of what I love about music is the way it relaxes the usual need to understand,” writes author Wendy Lesser in Room for Doubt, a book born out of her friend’s death. “Sometimes the pleasure of an artwork comes from not knowing, not understanding, not recognizing.” Lesser’s description of the confusing nature of grief resonates with that of death, too, something we’ll never fully grasp until we experience it and find ourselves on the other side.

For those reaching the ends of their lives, sound can be comforting. Many palliative caretakers advocate for auditory connection, most often by ensuring that patients can communicate with nurses, doctors, and their families. Hearing loss is known to increase isolation and loneliness, so verifying that devices are available and working properly is essential to keeping patients at ease and involved in their medical plans. It also offers the opportunity to hear from visitors and loved ones, making those final connections and goodbyes possible.

It makes sense that the sublime, incomprehensible moments in art offer comfort as we confront the unknown and that simply hearing a loved one’s voice, even if we can’t parse their words, can calm us as we transition. A push toward sound healing to ease anxiety and manage pain is not new for those dealing with chronic illnesses, but for hospice patients, in particular, the reverberations of tuning forks can help mitigate the difficulty of such a dramatic life change. Similarly, music therapists use a wide array of methods from songwriting and improv to singing and playing instruments to aid those struggling with emotional, cognitive, physical, and spiritual wellness.

As with any type of commodifiable healing, the wellness industry can certainly capitalize on end-of-life care, even if the experiences provide some relief. Just as psychedelic retreats touted for their eye-opening abilities continue to rise in popularity, programs for those interested in addressing their own death or helping lead others are cropping up, as well. One center in California offers a course designed to guide participants “through a process of living this year as if it were our last.” Its sessions range from the spiritual to the practical, including establishing wills and memorials, finding peace, and even “practicing dying,” and many of the topics seem to involve group talk therapy and guided auditory meditations. Given the long list of failings of the U.S. healthcare system, it’s no surprise that more Americans are turning to alternative treatments as they navigate their care.

There’s also a rise in the positive death movement, which is trying to shift the narrative around our mortality. A key part of that is end-of-life doulas, who, similar to their birthing counterparts, are trained to provide nonmedical services and offer support to patients’ loved ones. This care is often outside traditional Western medicine, and many practitioners incorporate holistic treatments like sound baths, music therapies, and other forms of auditory healing as part of their regimens.

Whether we’re forced to directly confront our death because of an illness or traumatic event or abstractly contemplating what it means to no longer occupy a living body, sound, in all its forms, can be an embodied consolation. As Lesser writes, the voices of the Berlin Philharmonic, although incomprehensible to her grieving self, offer solace as they “echo through my body: I felt them, quite literally, instead of understanding them.”