So many times on my attachment in Care of the Elderly I have been struck by the varied ways that elderly people face death. They are much closer to it than many of us caring for them, and some handle it peacefully, trying to stay positive perhaps for those around them, whereas some struggle with it. I was particularly moved by an elderly patient, Mrs Rhyss who had terminal breast cancer. Her husband was at her bedside in the hospital for every possible hour of visiting times, if not more. They didn’t always talk, instead they were comforted by each other’s company. They said to me that they had experienced a long and happy marriage and had no regrets about life. They had been together through the ups and downs, the challenges. Mrs Rhyss felt peaceful about her death, not wanting to fight it: “If it’s time for me to go now, it’s time.”

I chose a work by the composer Richard Strauss (1864-1949) who wrote his very last ever song to words by the poet Joseph von Eichendorff in May 1948. It’s called Im Abendrot (At Sunset). It’s about an old couple coming to the end of their life, reflecting on it as they come to terms with approaching death. In the music, after a long orchestral introduction we are introduced to the companions, gazing “hand in hand” upon the setting sun. The old couple “so weary of wandering”, reflect as they come to the end of their life. Through the music, Strauss invites us to imagine what that final moment must be like. The couple pose this question, “can this perhaps be death?” At this point Strauss quotes a motif from his tone poem, Tod und Verklärung (Death and Transfiguration), written some sixty years earlier. This is a poignant moment, where we find Strauss looking back to a point in his life when at 26, at the start of his career, he had reflected on death in an abstract sense. This strikes a chord for me – as so many times when I’ve seen elderly patients close to death, I’ve tried to imagine what it feels like to be at the other end of life. This is how Strauss imagined when he wrote the piece in his 20s, but now he is actually there – he has the opportunity to reflect on what it is really like.

The final bars are prolonged with a second inversion chord in the strings – a delayed suspension of the conventional ending, almost as if Strauss is struggling to let go. At this point we hear distant echoes of a lark’s song as the harmonies finally resolve to the major. On his deathbed in 1949, Strauss revealed to his daughter-in-law: “Dying is just the way I composed it in Tod und Verklärung.”

Strauss never lived to hear these songs performed. The world premiere was on 22 May 1950 in the Royal Albert Hall, London, conducted by Furtwängler and sung by Kirsten Flagstad.