Article by: Linnea Crowther

What good is music?

Music can soothe us, creating peace where there was agitation. It can exhilarate us, conjuring euphoria out of thin air. It can take control of our senses, letting us forget our troubles for awhile. Music has more power over our psyches than any other art form – it has been with us for eons, predating written history. We hear it in the womb. We play it as we say goodbye at a funeral. Music is an inextricable part of the human experience.

In the hands of health care workers – those who aid us in life’s passages, from womb to funeral – music can also be a meaningful form of therapy. Melodies sound through hospital rooms, schools, correctional institutions, and rehab facilities, helping laboring mothers, autistic children, patients with brain injuries. And increasingly, music therapy is used in hospice, enhancing the last months of life in myriad ways.

We talked to Russell Hilliard, a music therapist with Seasons Hospice who founded the Center for Music Therapy in End of Life Care, about the work he has pioneered with hospice residents. Hilliard is believed to have been the nation’s first full-time paid hospice music therapist, beginning his work in 1994. Almost a quarter-century later, he’s an enthusiastic advocate for the clear benefits of his work.

As Hilliard put it, music therapy is much more than “a nurse with a boom box.” Therapists may perform music for the patient, singing and playing an instrument. The patient and therapist may discuss lyrics, connecting the music to their lives and memories, or the patient may even be a part of the music making. Each music therapy session is unique, tailored to the individual.

Watch Russell’s colleagues demonstrate the remarkable power of music therapy:

As we talked to Hilliard, he shared stories that demonstrated some of the many ways music can ease a hospice patient’s final months. Here are a few of our favorites.

Music for Pain Reduction

If science developed a painkiller with absolutely zero side effects, we’d be all over it, right? That painkiller already exists – it’s music. Music therapists have discovered that their work can ease pain and improve well-being. Hilliard notes that music doesn’t entirely replace medication, but “music and medication work beautifully together in end-of-life care.” He goes on: “A lot of patients who report pain at a level of eight, nine, 10 on a scale of one to 10, at the beginning of a music therapy session will often fall asleep during music therapy, or report their pain lessened dramatically as a result.”

Hilliard told us a story of an extraordinary interaction with a patient who discovered how music could ease her pain:

“I had a patient. Her name was Martha. I’m Caucasian; Martha was African-American – it’s important in our story. She was 52, had cancer, writhing in pain, brand-new admission to the hospice program. We were still working the medications to get her pain under control, and the physician told me, ‘See Martha’ to see if we could use music therapy to take the edge off until the medications could get balanced and working for her.

“I went out to see Martha, and I asked her, ‘What kind of music do you like?’ She said, ‘Well, I like gospel music,’ and kind of rolled her eyes. I’m sure she was thinking, ‘How does this white boy know my kind of gospel music?’ And I get that. I said, ‘I can see you’re in a bad way today. Your doctor asked me to come and do some music. We find that a lot of people, when they can hear their preferred music, it kind of gets their mind off their pain a little bit. So I’m going to sing some music for you. If I do something you don’t like, just raise your hand and I’ll stop.’

“She just kept her eyes closed, didn’t respond to me at all. She was on her couch in a small trailer; sisters were in the home, a lot of women family members, very close family, and they were worried. There was a lot of tension in the home because she was moaning in pain, she had a cold washcloth on her head, and she was literally moaning in pain.

“So I started singing gospel music. And what Martha didn’t know is I grew up in an integrated black-and-white, 75 percent black, 25 percent white Baptist church in the church choir, and I felt like I could raise the roof for Jesus just like any black guy could. I didn’t feel like there was a racial divide with me in that experience, although there is to a lot of people.

“I started singing gospel music that most white people don’t know, and she looked at me like, ‘Well, how do you know this music?’ I just kept singing, so her mind got on the music. It was her preferred music from her life experiences where she had already a history of feeling good.

“I’m using the music to match her moaning, her pain, her respirations, how labored her breathing is, and over time I’m modifying it. Typically, we calm people down with music. In this case, because in a black Baptist community you raise the roof for Jesus with music, I picked it up a little bit.

“And as I started to pick up the music, she had a sheet over her body, and you know how the sheet goes over the foot and it creates a little tent on the toe? I saw the tent of the toe moving in rhythm to the music. Now, she’s still moaning in pain, but her foot is moving in rhythm to the music. So I said, ‘Oh, I got her.’ I used her toe to watch how the rest of her body was responding to the music, and then I was modifying the music.

“After 45 minutes of nonstop singing, this was how the session ended. I had taken out a tambourine that was in my bag, I was playing guitar and singing, and I set it on the floor. Several of the women had come around and were singing with me as I was singing for Martha. And Martha started singing. Martha sat up on her couch, and she was singing.

“And the music never stopped. Forty-five minutes of praise and worship music, and Martha is standing up in her trailer, and she’s got the tambourine, and she’s playing it, and she’s got her hands raised to the ceiling. And the last song ended with Martha, this beautiful, beautiful smile on her face, screaming, ‘Jesus is rocking my trailer, y’all! He’s rocking my trailer!’

“It doesn’t matter if you were Hindu or Jewish or an atheist or Buddhist, you knew something was rocking her trailer and she was feeling better, right? The euphoric experience she was having. That doesn’t sound really typical, but some version of that is pretty typical for most of our patients with music and pain management.

“What happened for Martha is that the music tapped into, for her, a spiritual experience. She had praised her God through music many times, and it just tapped right into that. Your brain can’t process pain and spiritual euphoria at the same time. So for her, the spiritual euphoria overrode her pain, and she forgot about her pain or didn’t feel it or experience it for a while, and it had some lasting effect.”

Music to Help Define a Legacy

Songwriting plays a big part in Hilliard’s work as a hospice music therapist. He told us a story to illustrate how a music therapist might engage in songwriting with a patient.

“We had a patient who wanted her life story told and had been documenting it through a blog on the internet. She had cancer, and her cognitive ability began to deteriorate – either because of medication or perhaps metastases to the brain, we’re not really sure – but her blog became a little jumbled.

“She became a little confused, and the music therapist was visiting with her, and they were talking about her blog. She said, ‘Wow, this is an amazing life story.’ Advocacy was a big deal for this woman. So the music therapist took elements from the blog and moments of clarity that she had on this blog throughout her stream of consciousness, and she pulled out these quotes that the patient had written on her blog and put them into a song. With the patient, she wrote an original song composition.

“Seasons Hospice Foundation is our nonprofit arm, and we accessed the grant foundation and sent the music therapist to a professional studio to record the song that she and her patient wrote. They put pictures of the patient together, her advocacy, what she wanted to be documented in a video stream with the original song playing behind it, and then the woman could put it on her blog. The patient ultimately put it on a public YouTube forum, and every time the music therapist would come to visit, she would be delighted to say, ‘I got 100 more likes on my YouTube video with our song!’

“And for her, this was her legacy, it was her purpose, her meaning in her life, what she was leaving behind – that her voice was going to carry on beyond her death. For her, it was one of the most powerful things we could have done.”

Music to Make Healthcare Human

Hilliard told us one surprising story about how music therapy can be used to smooth the transition – often, into death – as a terminal patient is removed from a ventilator. It’s one of many ways that music can ease the harsh realities of medical procedures.

“So we do a lot of extubations, which are when a patient’s on a ventilator, and the ventilator is being discontinued. That’s a common procedure for us. Not a lot of hospices do that. People tend to be weaned from a vent at the ICU, which is a very medical procedure and mechanical. And then if they survive the weaning, then they go to hospice.

“We do things a little bit differently. We partner with our hospitals, and we offer to do that for them and admit them to the hospice earlier. We think that we can do it with compassion, so it’s not a medical procedure or a mechanical event, but it really is about life and honoring life and offering hope at that time.

“Some of the most powerful experiences I’ve had have been doing that. When a patient is going to be discontinuing a ventilator, he or she may die when the ventilator has been turned off. Sometimes patients live. Sometimes they pass away right away. And everybody’s a little bit different. We prepare their family that either may occur, because they think it’s like it is on the television. You know, you turn off the button and Daddy is gone, but that doesn’t happen always. Many times people do breathe, and they live for a few days.

“What we do is provide music therapy during that whole experience, so it keeps the patient calm, it keeps the family calm. Family members who report that it was a very sad time, but they remember sitting around Mom or Dad while the procedure was happening and hearing their parent’s favorite music, or singing to him and knowing that their loved one felt their love, they heard their voices, they felt their love, they knew they weren’t alone.

“To me, that’s one of the most rewarding things – when we can make health care human. And that’s a great example. The actual event is the same as it is in the ICU. All we’ve done is added music therapy and dimmed the lights and put them in a more home-like environment, making it a spiritual, emotionally validating experience rather than a mechanical procedure.

“Our family members report feeling very supported in that process. We’ve had other family members come to us saying their loved ones were weaned from the vent in the ICU, and it was traumatic for them. They heard the sounds, the beeping sounds, the sound of the tube coming out, and they talk about that as trauma.

“They don’t do that when they’ve had music therapy in the hospice setting for the [process of being weaned from the ventilator.] The music therapist has masked the sounds of the machine, has masked the sounds of the tube. They don’t hear it at that moment, and they certainly don’t remember it after the patient has passed away, either.”

Learn More about Hospice Music Therapy

Hilliard sums up hospice music therapy: “For patients facing the end of life and their families, music therapy is often what they need to affirm life, to help them define their purpose and meaning in life. And many times, they report forgetting about having cancer or dementia for a little while. It is one of the most life-affirming things for our patients.”

To learn more about how Russell and his colleague use music therapy to aid patients in hospice, visit the American Music Therapy Association or Seasons Hospice.

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