SOUNDING THE SOUL

As a Certified Music Practitioner (CMP), I play my harp 20 hours a week at the bedside of patients at the in-patient unit (IPU) of Casa de la Luz Hospice in Tucson, AZ. Persons at our IPU are there for end-of-life care, symptom management, or respite.

The music I play is not for entertainment (although for some patients it does serve as distraction and enjoyment), but for comfort care: relief of anxiety, agitation or pain; support of the patient’s breath rhythm (rather than the imposition of a musical beat); and in some cases, accompaniment to the patient’s final moments of transition.

At times, the patient is alone in the room; at other times, family and friends are present. My task is to create a healing (as opposed to a curative or rehabilitative) environment of sound. The Casa de la Luz IPU has nine beds, so I will tell you nine brief stories. But first, an illustrative and supportive metaphor.

If I was to set sail in a boat in unfamiliar waters, I would first study others’ navigational maps for the information they could afford me. Then I would inquire of local seaman, “What does the weather look like today?” Finally underway, I would use sound vibrations (sonar) to continually test the waters for depth, for obstacles, to discover the shape of the underwater environment, to navigate safely and comfortably.

Each day in my CMP work, I first study the recent narrative clinical notes of our nurses, social workers and spiritual counselors written about our admitted patients. Then I might chat with a staff member who has worked with any of the patients earlier that day. Finally, as I enter the patient’s room, I turn on my musical sonar.

How does this sonar work? As I approach each patient, I turn on my intention to pay attention, to create an environment of sound for the physical, mental, emotional and spiritual comfort and healing of this particular patient. Will he need slow regular rhythmic sound to calm his agitation? Will she benefit from spacious arrhythmic sound to create a safe nest for her letting go, her surrendering? Will this patient benefit more from familiar old tunes that evoke memories, or from unfamiliar music to accompany a presently unfolding mystery? As I play, I watch the patient closely, observe any responses or signs of stress or relaxation, listen to the breath or any speech or vocalizing, remain constantly open to signs that might tell me how to navigate musically.

I walk into Room 1. The patient has just arrived from the hospital where he has been told he is dying. He is sitting up in bed, alert and oriented, frantically trying to conceal his anxiety by talking and joking. Sonar says: meet him where he is, with a joke. “Hi, I am the Casa de la Luz Welcome Wagon. I come bearing harp music. May I come in?” I play old folk and love songs. He sings along, “Oh, give me a home,” his deep voice sounding loud in the quiet hospice. His wife says, “Shhhh, don’t sing so loud.” I say, “Let him sing.” He sings, breathing deeply. I slow the pace gradually until he is resting back on his pillow. He waves silently to me as I leave.

In Room 2, a robust-appearing Hispanic man lies actively dying. His buddies from the construction site stand with their backs against the wall. “You bring that harp in, and we’re outta here,” the biggest guy says to me. Sonar makes me say, “You stay here for one minute. After that you are free to leave.” I play a traditional Mexican song, perhaps not the best choice for the patient at the moment; but the patient’s buddies move closer to the bed, take his hand, and begin speaking softly to him in Spanish. I switch to music more appropriate for the patient. The men stay, perhaps even forgetting that I am there.

The elderly woman in Room 3, here for respite, must endure painful dressing changes on necrotic wounds on her legs. She is almost totally deaf. I sit on the arm of her recliner chair, put my arm around her shoulder, and sing the old songs—at a slow relaxed pace—directly into her “good ear.” She is peaceful throughout the dressing changes.

The patient in Room 4 is non-responsive. His wife says, “This is all too sudden. We haven’t had time to say goodbye.” I invite her to lie next to her husband in the bed, and hold him while I play to honor their love. She does. I play spacious music with lots of open 5ths to support the patient’s process, with a few allusions to love songs woven in. When I leave, I tell the wife to stay holding her husband as long as she likes, and to let the nurse know to raise the bedrail when she leaves.

The Spiritual Counselor’s notes on the gentleman in Room 5—here for symptom control—tell me that the patient has been married for 59 years, and loves his church involvement. I play love songs and hymns. He says repeatedly, “Oh, the memories, oh the memories.” After the music ends, he tells me about his wife who suffers from advanced Alzheimer’s. “Who cares if she doesn’t remember what she had for breakfast. She remembers our first date, and our wedding day.”

I have played for the patient in Room 6 all week. She died this morning; and now the family is gathering. “Could you play your harp as we bring the grandchildren and great-grandchildren through to say goodbye to Grandma?” They enter the room in a solemn line, parents holding the hands of the little ones. “See, Grandma has her ankles crossed just like she always did on the couch.” After the goodbyes, they remain, sitting on chairs and on the floor, weeping softly. I keep a gentle but firm and steady beat with the harp music in order to encourage relaxed breathing. Soon the stories begin, and then the laughter. The harp and I slip out the door.

The patient in Room 7 is young, an accomplished musician, dying of cancer, and now blind. Since she cannot see me when I enter her room, I am careful to announce my presence, to tell her my name, to ask permission to play my harp. There is no response. As I begin playing, she rolls her body away from the sound! Because I believe the harp sound may have agitated her, I put the harp aside, and tentatively sing an improvised wordless song of low, slow tones. She rolls to her back, lifts her legs in the air, then lowers them, again rolls away from the sound, and then toward it. I realize that what I first interpreted as agitation might be a dance!

The next day, during the dance, the patient raises her hands in the air and flutters her fingers, then holds them absolutely still. I accompany her movement and stillness with vocal sound and silence. The following morning, I drive to work anticipating a new dance, and am devastated to find her bed empty. I go to a private place to cry my heart out; then place a memory stone for her in the glass bowl in our hospice chapel.

As I pass by the nurses’ station on the way to Room 8, the LPN whispers, “He is very close. He has no family.” Setting the harp to a pentatonic scale, I accompany an improvised song of peace, gratitude and love. Despite periods of peacefulness, the patient still struggles, his breathing labored. I place the finger tips of one of my hands on the patient’s chest, and sing from my heart to his, “You are not alone. I love you.” I sing to him as I might to comfort a tiny baby. His breath slows and then quiets forever. I sit by his bed for some moments, thanking him for the honor of being able to love him even for this short time.

“Por favor,” I say to the husband and family gathered in the living room, “quisiera tocar mi arpa muy suavemente. Esta bien?” The entire group follows me into Room 9 where two women sit next to the bed praying the rosary in Spanish. The patient, a young mother with ovarian cancer, also holding a rosary, opens her eyes and smiles at the gathering crowd. I play a repeated four-chord sequence, and slowly and prayerfully chant the words of the Dios te salve, Maria (Hail, Mary). Lots of repetition. Soon many in the room have caught the simple repetitive melodic pattern, and are humming or singing along. The patient rests peacefully, eyes closed, listening to the voices of her beloved family and friends praying for her ahora y en la hora de nuestra muerte (now and at the hour of our death).

These stories are only 9 of many. Each day as a Certified Music Practitioner at Casa de la Luz, I am privileged to read the navigational maps and listen to the wisdom of a seasoned staff who understand profoundly the weather and waters of comfort care, and then to set sail—with harp—sounding my way through its sacred depths.

Author Carolyn Ancell, MA in Pastoral Ministry, Certified Music Practitioner (Music for Healing and Transition Program) works for Casa de la Luz Hospice in Tucson, AZ, and is currently studying to be ordained an interfaith minister.