No Time for Guitar

Today, I went to visit someone who seemed to be a bit of crisis. She has dementia, so she get confused. This is a common symptom in any dementia diagnosis and can result in a number of behaviors. Sometimes, people are quite happy with their situation. I call these people "pleasantly confused" in my documentation. Sometimes, however, they get to be very anxious. Imagine yourself in a place you don't know, surrounded by people you don't recognize, and you have no idea how to leave. I think that would definitely make me anxious. Usually, I find the best thing to do in this situation is refocus their attention or just distract them long enough to "reset" their emotions. This brings me to my client today.

When I arrived, she was sitting in the common area. The client was really tearful, crying out, and working herself into frenzy. She had a CNA next to her, trying to calm her down, and looking rather exasperated herself. I offered to sit with her and, before I could even get my guitar out, the client grabbed my hands and I could not get loose. The CNA turned to me and said, "She's got quite a grip today." Occasionally, this will happen and I've learned to "roll with the punches." I started to sing and she initially stopped to listen. It didn't take long, though, for her to get back to crying. I realized that if I sang 2 or 3 songs and alternated between them quickly, I could keep her attention. I sang "Shenandoah", "Amazing Grace", and "Red River Valley" while alternating verses. It was really comforting to see her really start to settle down

When I left, she was sitting calmly in her wheel chair. The facility staff came to get her for lunch and said, "I don't know what you did and I don't know how long it will last but thank you!" It's nice to see some very observable signs that what I'm doing helps so quickly and drastically sometimes!

Once a Conductor...

Wow. It has been way too long. I guess it's safe to say that I've lost track of time. Some exciting things in my life have been happening. One of those things, and a main reason that I am adding this post, is that I was interviewed by The Songwriting Podcast recently. If you are new to my blog from that episode, welcome! I promise I'll make a point to update this more regularly!

Not to mince words, I'd like to just tell a story that way I usually do [or did, as it were]. Last week was the end of the month. As anybody in the health care field knows, this is the time when it gets a little hectic. I have monthly frequencies for all my clients and, when things work out well, I get everybody seen and do not feel rushed at all. Last month was one of those months. It worked out really well, then, that this particular story comes from my last visit of the month.

My client in this session was a long-time band and choir conductor. He claims to have only taught for 23 years, but I know that he did much longer than that. Many students have been musically trained by this man and now I get a chance to improve his life in a nursing home with music. Being a vocal trainer, but also having dementia, I need to be sure that the songs I'm choosing are songs that are both familiar but not too easy. I end up choosing a lot of hymns, but also mixing it up with some folk tunes. I have to choose carefully because, when he sings, he sings loud and proud. I could liken his voice to that of the Cowardly Lion from the Wizard of Oz. Even if he doesn't remember the words. I close the door, but I'm sure that does little to muffle our music to the ears of the other residents.

Aside from the song choice, I also need to be careful where I sit because, as a conductor, my client gets very exuberant with his gestures. This, I think, is the key to our sessions. He becomes who he has been for a long time. He directs again. I make sure I follow his tempo, volume, and entrance cues while playing and this seems to bring back a life into his eyes again. Needless-to-say, he is always conducting forte [loud, for all you non-music geeks out there] and just as expressive as we can muster. It's really neat to see this little man become a giant in a sense. His actions are broad, his face expressive, and his posture upright. It's a very distinct transformation.

I guess when you've made a living with music [either professionally or not], once you're hooked into music, you always will be.

Reaffirmation

My apologies for not posting recently. I guess life caught up with me a bit the last few weeks and I didn't get to the blog. I'll try my best to not let it happen routinely!

This last week was rare in that I didn't have a ton of people to see at the end of the month, so I could take my time with each client I did see. One client in particular was especially enjoyable. She's one of those people who is either in a great mood or extremely anxious. She was in a good mood that day, but had been pretty anxious most of this week. We talked a lot about how she could cope when she is anxious and she stated that she will close her eyes, pray, and then sing silently to herself. I asked her what she sings and she stated that she sings old hymns. That lead to a nice time of reminiscing and discussion of her faith. She spoke of times when her faith has helped her cope with other things in her life. She was really talking a lot, which was fun for her and gave me a lot of good information.

I finally got into the music portion of our session by suggesting that we sing some songs that she can easily recall when she gets anxious again. She thought that was a good idea and I played and sang hymns with her that recalled portions of our conversation. "Nearer My God to Thee", "What a Friend We Have in Jesus", and "God Be With You 'Til We Meet Again" were some of her favorites that we identified as some that she could use and enjoy. While I sang, she stared at a picture of Jesus praying very intently. It was quite touching to see.

I guess the main thing I took from this session is just an affirmation of something I think we all know on some level. Regardless of faith or religion, our spiritual well-being is drastically tied to our sense of quality of life. Take some time this week to explore more how your beliefs affect your current sense of well-being and how you can take care of yourself spiritually today. It may mean praying, reading, taking a walk, talking with a friend, or just sitting quietly for a while. Whatever it means for you, take care of yourself this week!

One More Reason

I met with a fairly new client this week. I've never seen him awake, really. He's always been sleeping or unresponsive. He does have several family members who, although they seem to rarely get along, are very loyal to him and are around pretty much constantly. They are the ones who actually requested my visit this week. They connect very well with the music and are able to release their emotions through singing and talking about their father between songs.

When I got there this time, true to tradition, he was sleeping. He had recently been placed on RLC care, which is a designation we give to people who the nurses feel are imminent, or close to being to it. His family hadn't seen him awake for quite some time. He had 2 daughters with him and they began sharing memories, singing with me, and shedding some tears. Although it was hard emotionally, it was actually why I got in hospice care. Then, the coolest part happened. He started to wake up. When I left, he had his eyes open and he said the only thing I've heard him say: "Thank you, buddy. I enjoyed it." It was really touching to me. It meant that: a] he had heard me and b] he used whatever limited energy he had to let me know my visit meant a lot to him.

I think that people have all heard stories of other people who "come to" for a brief moment when it seems they never will. It's something completely different, though, when you're there to experience it. Chalk it up to another great reason I love my job!

Am I 100?

I was seeing a patient this week that I have had some fun with. This is not going to be one of those really heart-wrenching tales to read this week. This is just one of those sessions that I like to facilitate.

The patient is 100 years old and has dementia. Unlike a lot of patients under those circumstances, however, she is very cheerful and is able to carry a conversation pretty well. The first time I met her, she said, "How old am I?" I honestly didn't know, so I told her so. She said, "Am I 100?" Again, I replied that I don't know. "Well, I sure feel like it!" was her reply. It was very funny. This last session, she agreed to a music therapy session, but said, "I'm not sure what to do for you, though." I told her that I just wanted to share some music with her, but if she wanted to sing with me even just relax with her eyes closed, that was okay. She only sang one one song, but was able to remember all the lyrics to "Let Me Call You Sweetheart."

A majority of my clients are similar to this. Hospice care is not always about big, world-shattering emotional events. A majority of the time, this is a normal thing. The people we see are just that. People. People can be goofy, serious, angry, happy, sad, and sometimes just sleepy. People are almost always the same people they were before they were on hospice care. A diagnosis or prognosis does not start when the medical tests get back. It starts long before, when they can still be themselves. It continues throughout the rest of their life. In the best case scenario, people can remain themselves until the end. That's what I'm trying to help them do.

A Little Out of my League

This week was really hard in some spots. I had a GPS stolen from my company car, almost killed a few times by people pulling out in front of me, and had a particularly hostile encounter with a client's son. Those weeks happen and I'm admitting that it stressed me out quite a bit. However, I refuse to let that define my week. Here's a story from Tuesday that was a bright spot in my week.

I got a new referral over the weekend and went to go complete the assessment. In case I haven't covered this in a previous post, I'll do a quick review of what I look for in an assessment. I am assessing how I can help a client with my services, so I look for their needs and how I can use my role and their strengths to help them meet that need. I look for social needs [such as isolation or loneliness], emotional distress [anger, depression, anxiety], physical discomfort [pain or agitation], and spiritual concerns [questions of afterlife or suffering]. I can meet these needs through a variety of means on a case-by-case basis.

Okay, back to the story. This woman is in her 60s, which is fairly young, but not unheard of. She is very aware of her situation but is having a difficult time coping. She regularly spoke of wanting to "get better". When I was able to bring up the subject of music, however, her whole demeanor changed. She likes classical music, which is something you don't hear often in northern Iowa. Usually, I get a response of "Lawrence Welk" or "country western" with an occasional "jazz music", all of which I am well stocked. Classical music, though, is something different. We started talking about it and she enjoys not just little guitar etudes, of which I have a few, but she started throwing about composers like Wagner and Vivaldi and operas like La Boheme. Way out of my league as far as playing ability, although I do enjoy listening to them at times. She described the music as having the ability to "make my heart soar" and she loved to sing. She did not study music or perform, but always had a deep seeded love of that style. At the end, she did state that she likes "little swing tunes, too" which gave me something to play for her. She would close her eyes, bob her head around, and smile when I was done and she'd talk about her experiences in music. It was a good session, not in that a lot of emotions were processed, but in a rapport building sense. I feel she really opened up to me, which will be a huge tool in my favor going forward.


With the knowledge I now have of her, I'm planning on trying to provide a CD player and some classical music for her to listen to. To help with her grief, I'm going to try to lead her in some guided imagery, which I'll try to blog about when it happens. That's definitely a topic I'd need another post to do even a hint of justice to. Until then, here's some more reading for you to do. Check out The Mindful Music Therapist to read up on some great music therapy conversations!

Wind Beneath My Wings

This week, I met with a client I've had for a while and was trying to get her to open up more. I was hoping we could really process her situation, as it is rather hard. She's in her 50s and has a disease process where she understands what is going on, she's completely aware of her situation, but cannot do anything to stop it. She's at the age where she feels that she should be starting to take care of her parents and helping her son get ready for his wedding, but instead her parents and son are now having to take care of her. It's hard for her to stay in bed when she'd rather be outside, or rather, would rather be anywhere but a nursing home.


She enjoys the music she listened to when she was younger, which happens to be 80s popular music. With that in mind, I pulled out Bette Midler's "Wind Beneath My Wings", which you can listen to below.

Before I sang it, I asked her to think about who this song describes for her. After the song was finished, she said, "That's easy. It makes me think of my parents." We began talking about her parents and she was saying how they were such good people and really had tried everything to help her. As she was talking, her expression seemed to show that she was thinking very hard. At one point she stopped and said, "Me being in this situation must be really hard for them, too." I was so glad she made that shift in perspective. Not that she was complaining about herself before, but now it seemed that she was aware that her parents were grieving for her and it helped her to appreciate them that much more. She shared some stories of how they have helped her and then we discussed plans for her to tell them how much they mean to her. 


I don't know if she has or will let them know how much they mean to her, but I know that she really is grateful for them and I just hope they know it.


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New blog to check out is : Bliss Music Therapy. She hasn't updated her blog for a while, but what she has posted is good information!

One More Session

Every once in a while, a nurse gives me a call and asks me to see a client who has taken a quick decline. Many times, patients who need extra support are given an "RLC" or "Radical Loving Care" designation for a short time. This is texted out to everybody in the office so they know who needs the extra help at that time. We all try to make it there, but I'm not always able to be there before they die. Many times, that is the end result of RLC, but sometimes the decline levels off and they may not need they extra support as much as initially thought. On Monday, I got the call before the text was even sent out, so I know it was important for the client and family that I be there, so first thing I did was stop there. This is the client who I spoke of in Play One More. When I got there, there were 3 daughters and some of their children, as well as the client's pastor. That is always a big red flag for me. Pastors always have people to see and things to do, despite all the jokes implying they only work for one hour on Sundays. If a pastor is just sitting in a chair in the dining room, waiting for something to happen, then I always assume something will happen soon. I got set up in the patient's bedroom [she lived in her own home] and invited everyone into the room. I wanted this to be a group session. I wanted to not only help the client relax [something she was not very good at in the past], but also to allow the family to communicate with the client, share stories, and feel the support that they were all providing for each other.

It started off with the family members showing little interest in being a part of music. Despite my encouragement, I was pretty much singing alone to the client. I began to engage the family more by asking them questions, specifically about music and their mother. They all seemed to recall a song she enjoyed, a story of the her dancing, or [for those that were there for my previous sessions] how she would light up during our sessions. This began a nice time of sharing and music. People would talk about songs she liked and I would play the ones I had. While playing, though, only one other person was singing. The only time I got them to sing was on the last song, "Jesus Loves Me." I set up by saying, "I can really feel the love you have for your mother. She's so lucky to have you here with her. This is an important time to spend with her and I know that she knows you're here. I know she's very happy you're with her. Let's sing this one like we're taking her place for a moment, thinking about what she's feeling right now." We started singing and everybody else joined it, tearfully making their way through that familiar tune. Even the pastor was getting misty, which speaks volumes about his connection and dedication to this family. After this, I tried to encourage them, told them to call with any concerns or changes, and left.

The patient died about an hour after I left. I will remember her fondly, as someone who walked in the first time assuming I'd be kicked out and was really welcomed with open arms, both in a literal and figurative sense. I hope Lillian's family knows how much their mother meant to everybody who got to see her.

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New to the music therapy blogosphere is The Traveling Songstress. Check out her new blog and give her some support!

Taking Cues

Sometimes, I get a chance to see a video that really affects my work. Last week, I saw a YouTube video of something called "validation therapy", which was very interesting. I don't necessarily subscribe to every aspect of this video, but really liked a lot of the concepts. Give this a watch before reading on.

Notice how Naomi Feil used touch and music to connect with Gladys Wilson. It really seemed that through the two aspects, she was able to put herself in very deep relationship with Gladys. Although not music therapy, this was definitely therapeutic. The changing of tempo with Gladys's is a concept very common in music therapy called the iso-principle. "Iso" means same, similar, or alike in Greek. The idea is that by matching someone else's cues, we can incorporate someone in a music therapy session who may not be able interact in other ways. It can also be used to affect and judge non-verbal signs of pain or anxiety. For example, fast shallow breathing at the beginning of a session may signify some level of anxiety, but by the end of a session using the iso-principle, the client may have slowed their breath and may be breathing comfortably.

I tried to incorporate touch and music into one of my sessions this week. A new assessment with a patient with dementia left me wondering what to do. Many times, with a hospice diagnosis, which is the diagnosis that makes them appropriate for our services, dementia, little interaction, if any, can be had with them. These are times when I generally try to just provide a compassionate presence, which I wrote about last week. This time, I sang unaccompanied and held the client's hand. I did not get a huge response from the client, but I did feel much more connected to the client. I used the client's breath rate to direct the tempo of my music. As I stated, there were no huge breakthroughs, but I can say that I felt very close to the client at that time. I think this is something I'll be doing more often.

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This week, I've enjoyed the posts of the Music Therapy Tween. She's a fantastic music therapist who also is part of a great podcast called the Music Therapy Round Table.

Thoughts on Being a Compassionate Presence

This week, I had a new nurse shadowing me. Every time a new IDT [interdisciplinary team] member signs on with Iowa Hospice, part of their orientation is to shadow me [and the other disciplines as well]. This is show them the roles of their other team members. As we were driving to see a client, she asked me, "What are your goals if someone cannot respond to you at all? What if you've never heard them talk or seen them respond? Do you still see them?" I responded by saying, "Well, then, if I see them, it is to provide compassionate presence." Then I had the task of trying to define what that looks like and the rationale for that little phrase "compassionate presence."

I like the way this Edge Magazine article defines "compassionate presence":

"Being completely present with one who is suffering means being able to be present with the suffering itself. This, you may recall, is the very definition of compassion. True compassionate presence is not about denying someone his experience with the dark realities he is experiencing; instead, it provides illumination that allows him to explore all the aspects of his situation with clarity."

That sounds very holistic and spiritual, right? This is something I strive to be in my professional and personal life, but what does that look like in a medical setting? What does that look like? How does one become or provide a compassionate presence? I am by no means an expert on the subject, but I would like to take some time and discuss how it plays into the care I provide for my clients.

It's a hard thing to see happening, first off. If someone walks into a session where the goals are to provide compassionate presence, it may just look like I'm playing guitar for someone who is sleeping. The music may sound pretty, but it's hard to see what is being accomplished. I hold the belief, however, that part of showing someone they matter and giving them the dignity that is due all people is spending quality time with them. Essentially saying, in not so many words, "You matter! If you did not matter, I would not be here spending time with you." It is being empathetic, aware of how they may be feeling, even if they cannot tell you, and being a part of their journey for a short time. This may be accomplished simply by breathing with someone or talking with someone about the things that matter, or used to matter, to them. Being completely present with someone, not worried about what else you have to do or where you should be, is a gift that everyone can bring.

In the medical field, even hospice [although not to the same degree], a lot of emphasis is placed on results. Is this medication working? Do we need to adjust their visits? What is the problem and how do we fix it? All this is most definitely valuable, but does not give people much time to just sit and be with someone, not thinking about the laundry list of other tasks to be completed in the day. Simply focusing, instead, on the patient. This makes them more than a patient with a diagnosis and poor prognosis, but transforms them into a person, capable, or once capable, of so many things. This levels the playing field, bringing people to their most basic role - being people who help people.

My challenge for you, then, is to take some time this next week, and really try to be a compassionate presence for someone. Whether that is your spouse, friend, co-worker, parent, or child, give it a try. It may be hard, but, like everything, it takes practice and the dividends are great.

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As you do this, which I hope you do, take some time to read up on another great music therapy blog called Mindful Music Therapist.

Music as a Coping Technique

I had an interesting session on Monday morning with a client. She's fairly young, in her late 60s, and had a rough weekend. One of her medications causes some blood thinning and she got a cut that would not stop bleeding. It had slowed and stopped by Monday, but emotions were still raw for her. She was very anxious and, literally, afraid for her life. Another bleed like that could be her cause of death. When I got there, I saw that she was attempting to convince me [and possibly herself] that she was doing okay. One thing I do feel I excel at, however, is reading people's emotions, and I was picking up that she was not feeling positive about her situation.


We talked for a bit and I began to offer song choice for her, which is one way that I've found to read people's emotions. This client, generally, chooses the song that reflects how she feels. I would offer a "happy" song and once that I felt seemed to reflect what she was feeling. She always chose the reflective song. After a few of these songs, I began to make reflections on the songs and "pry" into her emotions. After she realized what songs she had been choosing what she perceived to be "sad" or "negative", she began crying. I let her cry, without interrupting, and, when she had finished, I said, "It seems like the music is helping you cope with your emotions, but not in the way you thought it was." She agreed and discussed how she used music to "help me when I'm really down", but hadn't realized that by reflecting what she felt, she was coping. 

I think a misconception of using music as a coping technique is that if you play happy music, it will make you happy. Conversely, in this scenario, if you play sad music, it will make you sad. People do not want to be sad, generally, so people may only play happy music. This coping technique, sometimes called avoidance, may be useful for some people, but they do not realize there are other ways. Reflecting the emotions, and owning up to them, can also be an effective way to handle emotions.


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Blog for the week is Music Therapy Source. It's run by a great hospice music therapist out of Iowa City.

Regional Conference review

Yesterday, I went to the Midwestern American Music Therapy Association regional conference at the University of Iowa. It's a multi-day event, but I only went to it yesterday. My employer offered to pay for one day there and reimbursed one day's worth of registration fees. It was a really great thing for them to do. As this was the first day of concurrent sessions, there was an opening session, with a keynote address outlining the accomplishments of music therapy advocacy over the past year. It was by Dr. Mary Ellen Wylie, who is the president of the American Music Therapy Association. It also featured the Afro-Cuban drum and dance performance group at UI, which was really interesting and fun to see and hear.

There were two times of concurrent sessions, which means that there were multiple presentations going on at one time and you get choose which you attend. It is always a tough decision, however, because there are usually more than one presentation that sounds interesting. Because there are multiple music therapists that work for Iowa Hospice, we sat down and decided we'd each go to one, take notes, and pass them off to each other at a later day. Then, overall, we all get more useful information. My first session, then, was entitled "ENGAGE in Advocacy: Your Role in State Recognition." To make a long story short, music therapy "task forces" in 38 states are trying work with state governments to become a licensed or registered profession according to state law. This would increase music therapy awareness and make it easier for people to become involved in music therapy, either by becoming a music therapist, becoming a client, or letting music therapists [potentially] be reimbursed through Medicare/Medicaid. There have been a few successes, the most recent in Georgia, where a bill passed through their state Senate licensing music therapists. This would increasing the regard for music therapists by the state government. Iowa, where I call home, is planning a Hill Day next year where we can, perhaps, meet a state representative who will sponsor a bill for us. Overall, this was a very informative session and, to be honest, much more interesting that I had anticipated! To take part in advocacy, the presenters encouraged us to ENGAGE, stands for the following:

Educate everyone

Nurture relationships

Grassroots networking

Access for clients

Grasstop connections

Empower people

The second session I attended was called "Therapeutic Music or Entertainment: A View from Health Professionals and our Response." This presentation outlined an in-service provided by two music therapists to hospital and hospice employees. They educated on the differences between music therapy and entertainment and between music therapy and other therapeutic music practices. The three other practices they discussed were music practitioners, music thanatologists, and harp therapists. All these practices have some similarities with music therapists, in that they have training programs, use music, work in medical settings, and are generally misunderstood by the public as entertainment. Music therapy differs from the other practices in that music therapists actively engage clients, can work with mental health, have measurable non-musical goals, document outcomes, and have the longest training period. These other practices are not widely known in the Midwest, but are becoming more well-known on the coasts. As music therapists, then, we not only need to establish ourselves as health professionals [as opposed to "entertainers"], but also be able to educate on the differences between music therapy and these other fields. It is important to respect these other practices, but be able to differentiate and educate the public so they can make informed decisions.

I learned a lot from these sessions and, if you want more information, feel free to ask me. I took copious notes throughout the sessions. I've learned how to more effectively advocate for myself, as a music therapist, and my profession. It was great to see a bunch of other music therapists from around the country. When I work alone so often, it can seem that I'm a "lone ranger", but I'm not! It was good to connect with other MT-BCs and I look forward to more conferences in the future!

By the way, I will begin giving links to other music therapists' blogs at the end of my posts to give my colleagues some love. This week's blog is Soundscape Music Therapy. Rachelle presented the advocacy session I attended yesterday.

Perspective on Goodbye

A few weeks ago, I visited a woman who I have only seen a handful of times. Despite her fairly short time with us so far, we have built a very strong therapeutic relationship. This is dangerous for me, because I know that one way or the other, she will leave our services. She will either get better and be inappropriate for hospice services or she will decline further and die. This is the hardest aspect of hospice care. As a hospice worker, I need to be able to protect myself, keep boundaries between myself and my clients. Every once-in-a-while, however, I don't do a very good job.

This particular client played organ for 30+ years in her church and enjoys a lot of hymns that I've never heard before, so she's been challenging me and stretching me musically. She's still very gracious, though, when I mess up. She still has her cognitive abilities, so she converses easily and I do not feel like I need to "perform" or pretend to be extroverted in our sessions. It's one visit I know I can be myself. I say all this to say that during our last session, she was tearful when we were saying goodbye. She had a pretty quick decline for a few days and she was saying what she thought would be our final goodbye. She shook my hand and said, with tears, "I don't know that I should say 'See you later' this time." I thought for a second and said, "It doesn't matter to me what you say. Either way, whether we see each other or not, I'm glad we've had this time. If we have more time, I'll be very happy, but we can't count on that. We should be grateful for the time we've had and take it one day at a time." That seemed to put it in perspective for her and we said our goodbyes.

Those conversations are always hard to have with people. I guess, on some level, it's a conversation we should all be having all the time. There are so many things that could happen - car accidents, disease, etc - that could make "see you later" not applicable. I know a lot of people take Easter weekends to spend time with family and friends, so I encourage you to take this to heart. Nothing is guaranteed, so make sure every goodbye is suitable for be the last.

Just a Rose Will Do

A few months ago, I introduced the song "Just a Rose Will Do" to a client of mine. Since I've known her, she has been very spiritual and I spend a lot of my session listening to her talk about her faith and how it has helped her through all her struggles. I usually just listen and facilitate her discussion with songs that tie in with her conversation. With all her talk of the afterlife and faith, she never really planned out any of her memorial service. I thought that this song may be a good segue into that conversation. She took to this song very quickly and it soon became the song we start each session with.

In our session this week, she was pretty tearful. After this song and several other hymns that she enjoys, she would be wiping tears from her eyes. She's been on our services for quite some time and has just continued to decline, but very slowly. I wonder, however, if she knows something we don't. This session, after "Just a Rose Will Do", she began to talk about her funeral, specifically the music. She has group/congregational music planned out already, but asked that I sing it as special music.

I'm honored to do it. Obviously, the "event" has not been planned yet, but I think it's very important to plan these things out. In parting, I want to post the lyrics of this song, written by Porter Wagoner, as some food for thought. What do you want your funeral to look like? It's not morbid or depressing, it's a way for you to choose how your loved ones remember you.

When time shall come for my leaving  

When I bid you adieu  

Don't spend your money for flowers  

Just a rose will do. 

Chorus: 

I'll go to a beautiful garden  

At last when life's work is through.  

Don't spend your money for flowers  

Just a rose will do. 

I'll need no organization  

To make a bid to-do,  

I'll need no fine decorations,  

Just a rose will do.  

Just have an old-fashioned preacher 

To preach a sermon or two 

Don't spend your money for flowers 

Just a rose will do.

Copied from MetroLyrics.com

Play One More

I have an incredible job and have such a unique opportunity to help people. Oftentimes, I get the chance to help people, but they don't realize that I'm helping them. This week, I got a referral for a hospice patient who has a history of refusing visitors and sending people out who actually get in to see her. She lives at home, so you can assume that she's pretty feisty. Obviously, I felt a little trepidation about going there.

She lives pretty out of the way and I had tried to to contact the daughters who help her out to schedule a session, but was unable to get a hold of them. I decided to just stop by and actually found her while she was awake and both daughters were there. Still, it was not certain that she'd let me visit or let me stay. I cautiously said, "I came to see if you'd like some music today." She shrugged her shoulders as if to say, "I don't care." The most important thing on her mind was getting her blood pressure medications and I was just someone in the room. I began playing some music, country music that she enjoyed listening and dancing to, and I could see her demeanor change. She began making eye contact with me, tapping her toes, and eventually I could see that she would let me stay. We switched to a few hymns when she looked at me and said, "How Great Thou Art." I began playing that and she even sang along. I played a few more hymns and, as I was packing up, she said, "Play one more." I looked at her, aghast, I'm sure, and said, "Sure! I can play one more." We sang "How Great Thou Art" again and, as I left, she shook my hand and gave me a big smile.

It was really neat to see how music was able to connect us. She has such a hard time connecting with a lot of other people, but when we shared music together, she connected immediately. Music, especially when people are singing together, seems to create very strong social bonds and may not be achieved without music. I invite you to think of, and share, a time when music formed friendships between you and someone you had never met before. I know I have plenty of instances, but I would like to hear yours!

Grief Group Self-Review

Yesterday, I led a grief group in place of the bereavement coordinator. I haven't led a group for quite some time, and had never led solo. I wanted to just talk a bit about what I did and what I would have done differently.

I started off with "The Rose", which I did some research on. Apparently, the song was voted #83 of American Film Institute's "100 Years of the Greatest Songs" in 2004. This song was written by Andrea McBloom, but was made famous by Bette Midler. Other covers done by Conway Twitty, Leann Rimes, and Westlife.

I sang the song and we talked about different lyrics of the song that stood out to them and compared them to their grief journey. It turned out that this song was used for the funeral of the mother of one of the participants, so it already carried quite a punch. We talked about the lyrics and it sort of went on a few rabbit trails after that. I tried to concentrate on coping strategies, especially when they talked about being angry or depressed. At the end, I tried to lead a relaxation exercise, but it didn't really work out very well.

I think some of this next section may be due to walking into a new group. I had never met any of these people before and some of them had other issues that they were dealing with. I try not to blame others, but one lady in particular tended to dominate the conversation, which was actually a bit of help at first. In the end, however, I wish I had attempted to take a little more control so I could include others, one in particular who didn't actually say anything. Another thing I would have liked to see happen is some realizations toward the end. I understand that everybody works at a different pace, but I felt as though the participants were more depressed when they left.

Despite this, I do feel that there was a lot of great sharing. My intentions were good and I felt I did stay mentally present throughout the entire session. I felt that I was able to take a tangents and connect them to some lessons that I've learned working with patients. I especially tried to show that they were very connected through their grief and I encouraged them to lean on each other when they are feeling depressed or needed to talk.

I guess that's all I have. Sorry for the ramblings, but this blog is great for me to process how things went. That's important for anybody to do.

First Mom, Now Dad

I have a little extra time tonight and, although there are other things I could be doing, I felt like writing a bit tonight. It is rare for me to do a mi-week post, so I hope you enjoy it.

Today I did an assessment with a gentleman who has quite a remarkable story. He's actually the husband of a client I had last summer, but only saw once. Apparently, the client told her daughter about me and the daughter was there today. She was excited to meet me, share in this session, and tell me about her father. The client is a member of a small Christian congregation that is very conservative ["They make Baptists look liberal"], small ["They meet in each other homes, like Amish"], and pacifist. Despite all this, the client is fiercely patriotic and served as front line medic and dentist in WWII. He refused to carry a gun, but still wanted to serve his country. He did this all on an 8th-grade education. At one point, the battalion he was with overtook a Japanese village. As they were basically making POW camp, he met and talked with a young man of the village that caught his attention as a bright boy. He convinced his CO to let him take this 16-year old under his wing and tutor him. He taught the boy to be a medic, and now he's a doctor in Japan. He still keeps in touch with my client, calling almost everyday to check on him once he heard of his hospice admission. Now, it was my turn to take care of this man who saved this young man's life.

He was very anxious and agitated. I played some traditional folk for him while his daughter held his hands, waved them around like dancing, and clapped them together. This engaged him in the music, which I'm not sure he would have done without his daughters' instincts. I gradually slowed the music down and he began to calm down, eventually falling asleep. As his daughter, son, and I talked, he began to rouse, in much high spirits than before his very short nap. Then I used the music to give him a little energy. I started playing more uptempo tunes, always trying to keep him engaged and redirect him whenever he began to become anxious. By the end, was calm but not too lethargic, which was great to see.

There was a moment that I loved seeing during the session. The daughter, admitting that she is a "crier", was wiping tears away at one point and the client inquired, "What's wrong?" She stated, "I'm just a little sad." "Why?" "Because you're sick." "Don't worry about that. Don't you have a job to do?" "I do, Dad. It's taking care of you." "Well, thank you."

I don't think I need to say much more about the session. I think that last little conversation sums up the session quite well. It's so special to be able to see those memories take place and makes the work worth doing.

You're Getting Sleepy

I think today I'll take some time and do a little bragging. This is WAY outside my nature. My general viewpoint is that I'm average at best and downright pitiful at worst. I've begun to notice a few talents of mine, however, and I'd like to take this post and illustrate one of them.

I am pretty good and getting people to relax and fall asleep. I cannot say that my success rate is 100%, but I think it may be close. My daughter usually will fall asleep shortly after I begin rocking her and humming, which I find refreshing. Usually, I have no idea what to do with her [although I am getting better], but when she's tired but won't sleep, I can jump into action. I've noticed I have the same effect on clients at work, as well. This week, I went to see a few people who were pretty confused and agitated. It can be very hard for someone who is confused to relax. Imagine feeling or knowing something is wrong, but not being able to tell someone what it is. Quite frustrating, I'm sure. Both clients agreed to a music therapy session, but it quickly became apparent that they were too agitated to have a positive conversation. I was able to redirect them enough to close their eyes while I sang. I'd say something like, "I am going to play a song for you, now, and I'd like you to close your eyes and listen to the words and tell me what you see in your mind." They would agree and I'd go to work. Both of them had fallen asleep within about 20 minutes.

I have a few techniques I use to get this, which I will divulge at this point. I feel my guitar playing is fairly adequate, in that I feel comfortable finger picking, so I generally play songs with long chord progressions. Holding chords for a long time can let those tones, especially the deep tones on the E and A strings, ring out. I try to match my voice to that feeling, but I do not force the breath into the notes. It's more like breathing into the notes, not using my breath to project the notes. I've read a little about this technique in some music therapy journals [some of them you can read about here], and believe it fits under the technique called "Toning". I do need to do more research to verify that, however. The songs I choose need some fairly obvious characteristics, like a predicable melody, harmony, rhyme scheme and a slow tempo. I also like to insert improvised interludes where I will sing a variation on the melody, but on an "ah" or "oh" sound. I find that humming closes off the sound and people cannot hear me [which is not always a bad thing, I suppose].

I think a portion of this comes fairly naturally to me, but it definitely helps that I started a relaxation group during my internship. There are many different techniques to use when it comes to relaxation, but this is one way that I can use it on the fly for people who are confused and anxious about something. I hope this post is helpful to other music therapists and interesting to everyone else. I hope you all have a relaxing weekend!

Thoughts on Funeral Music

I had the pleasure of meeting a new client this week. I'm an introvert by nature and usually do best when I work with people who are outgoing. Probably a majority of the time, however, people expect me to "entertain" and that requires some level of outgoing-ness. I have been learning to be better at pretending to be an extrovert, but my strength is still being introverted. This Monday I met a lady, who I would not call extroverted, but perhaps she and I managed to find a balance. As we were getting to know each other, she mentioned that she knew she was not doing well, because her daughter had asked her, "Are you ready to go to Heaven?" Although I do not think that she will die within the next month or so, it is a valid question. She discussed how she felt about this question, which lent itself well to a segue into funeral planning. She mentioned that she had a few things planned, but not the music. We talked about it, and next time I visit, in the next week or so, I'll bring her a few songs that she thought she might enjoy as funeral songs. One she thought of is "There is a Green Hill Far Away", which I posted below.

It is interesting to think about how you may want people to remember you by. I can rarely recall the homily at a memorial service, but I can usually remember the songs for a while longer. Because music has such an emotional effect, people generally will remember and recall that. So many times, I've heard people say, after hearing a hymn, "That was played at my mother's [father's, sister's, etc] funeral." The music you choose can really be remembered.

I've thought of this often as I have grown. Call it morbid, but that is something I've thought about it. At one point, I wanted "Alive" by P.O.D. [perhaps, ironically]. Now, I really have no solid ideas, but the styles of music I listen to have changed dramatically. It's interesting to think about what I will want when the time comes to plan.

As the client I talked about before and I learn new music, it will be interesting what themes emerge. Will it be a theme of forgiveness, celebration, salvation, grace, or something else? We will have to see!

A Losing Battle?

This week, I met with the daughter of a client of mine to discuss some goals the daughter had for her mother. The hospice nurse had informed me a little of what she wanted to accomplish a little beforehand and I was slightly discouraged. The daughter would like her mother to be able to talk again. On the surface, this seems admirable. The client has a very unusual brain disease [so unusual that I am not going to mention it's name, due to HIPPA regulation] which robbed her of her speech about a year ago. This, understandably upset the daughter, but she found that her mother could sing little songs, like "You are My Sunshine", long after she had lost the ability to talk. The daughter will come in a play music and occasionally get a response from her, such as humming, smiling, or hand movement. I was able to get responses like that in my assessment, so that was normal, as far as I knew.

The daughter, however, has known her mother talking, joking, and singing for much longer than she has known her in this state. She does not like what has been happening to her mother and wants to fix it, which is completely understandable. The chances that the client will talk again, however, are quite slim. In hospice care, we look for decline. Not to sound morbid or as though we like that aspect of our jobs, but if patients improve, then they are inappropriate for hospice care and we are required to discharge them. I would call it a flaw in the system, but that's the system we work in. That being said, I was quite wary and probably did not give the daughter the attention and time she deserved in our meeting. I attempted to listened closely, be supportive, and empathetic, but if I'm being honest with myself, I was quite skeptical. We had a short music therapy session with the client afterward and we got some results, mostly some brief smirks, eye contact, and a little vocalization.

When we were done, I got back in the car and, as is my general practice, I processed the session and realized how unfair I was about our meeting. I realize that I did not give her the time or attention she deserved to express herself. I also realize that the daughter is probably in some denial about her mother's situation, but who can blame her? That's the coping mechanism that is helping her and, if or when her mother's health declines, all I can do is continue to be supportive and let her know that she always tried her best. Trying your best is worth a lot, I was reminded, even if the results will be hard to attain. Therefore, I am going on the record that I am going to try to help her regain her speech, but with a realistic view of her situation. I cannot guarantee that it will be successful, but if this will help the daughter cope or process her mother's situation, then that is the best that I can do. I am not the perfect person, and I never pretend to be, so I hope my mistake can be corrected and my apology accepted.

An Impromtpu Memorial

This week's story is one that really caught me by surprise. I came to a facility just in time to see one client before it was time for lunch, so I chose who I wanted to see. I was a little disappointed when I found out that he was getting a bath right before lunch, so I was unable to visit with him. I had another person in the facility, however, so I went to visit her.

This client, who I'll call Susan, is relatively young for hospice care, in her 60's, and easily converses, which is something I don't see all the time. I started the session much the way I usually do, silently reassessing her needs as we catch up. She said she had a headache, which is common for her diagnosis, but is also a sign of stress. I also noticed that she was knitting, which is not out of the ordinary for her, but she seemed to be a little extra shaky. Without a real reason for it, I asked how her family was doing, and that question opened the door to what was really bothering her. "I got a phone call about 10 minutes ago," she told me, "and they told me that my last aunt died of pancreatic cancer last night." She went on to explain, becoming tearful as she spoke, that her family had always been close and that she had lost her parents and all their siblings in the last decade. Susan's aunt had been the last of that generation to die and the funeral was too far for her to travel.

Grief is a reaction to loss, and Susan had lost a lot in the death of her aunt. She lost the last remaining member of her parents' generation. She lost someone she loved very much. She lost a sense of hope, that is her aunt could miraculously overcome her disease, then Susan could overcome her's. I sat there and listened to Susan pour out all these emotions, this intense grief, and wanted to help her. But, what do you say? What can you do? Distraction/redirection wouldn't take away this issue, so I saw no other option than to address it directly. I quietly asked, "Would you like to have a memorial service for her right now, right now? Just the two of us?" She agreed and we started out upon this impromptu memorial. Susan is a very spiritual person, so she started off by praying, and then I played "Amazing Grace" and "As the Deer", two songs that Susan finds very meaningful. I then encouraged her to talk about her aunt, a eulogy of sorts. During all this, she was very tearful and I just sat and listened. I tried to be fully present in her grief and listen quietly. After she wanted to stop talking, I played "On Eagle's Wings" and "You Raise Me Up", which I tied in with her eulogy. After those songs were done, she prayed again. Her headache was getting worse [it was time for her medicine again] and it was time for lunch, but she thanked me profusely for visiting. She said, "I can't believe you came when you did. God really was looking out for me today. I only got the phone call 10 minutes before you came. Thank you so much." With that, we parted ways and I'm sure our minds wandered on to something else, me to my paperwork and Susan to her overwhelming grief. But, for that hour, we were both present, sharing grief and stories, together.

I usually don't have a perfect idea of what will happen in a music therapy session. I usually have to be flexible and quick-thinking. This session, however, completely blindsided me. I had no idea what I was walking into and, if I would have known, I may have done a few things differently. I think, however, that this is one time where the bulk of what I did was what I needed to do for her. I do not claim to be the perfect music therapist, but it feels really good when I get something right and can help someone like that.

Story - "He Came Through Like Gangbusters"

It seems that my blog, lately, has become mainly a collection of stories from my work. I never really intended it to become so, but I don't think I mind it. I guess sometimes the best way to illustrate what I do is to see [or in this case, read] it in action. I hope that these stories do not sound vain, as I am truly not meaning to boast in myself, but to give a brief glimpse into the world of music therapy and hospice.

That being said, this story happened in my internship at CarePartners Hospice in Asheville, NC. My wife and I still miss it there and we hope to visit again soon, but no real plans. The client I was visiting was named Helen. She was fairly young by hospice standards, only in her early sixties. She and her husband were always welcoming to me, although, if I am going to be honest, they really intimidated me at first. Until that point, I could pretty much assume that the people I visited would want to hear either hymns, country, or Lawrence Welk-style tunes. Helen and her husband, however, loved music from the 60's and 70's. Learning Jim Croce, Chicago, Bob Dylan, and Pete Seeger was fun, but much different than what I had been playing. I slowly started adding them into my repertoire.


Although every session was pretty good, I vividly remember one session in particular. Helen's husband was not there, although he usually was, and I was enjoying talking with Helen. I steered the conversation to her husband, intending to get her to talk about him and process her anticipatory grief. She felt as though she was leaving him. In a segue, I played "Time in a Bottle" by Jim Croce and she broke down crying. If this were to happen now, I would feel comfortable confronting it a little more efficiently, but at that time, I was not. I finished the song and we both just sat there, staring at the floor. After what seemed like several minutes, she broke the silence. She explained that "Time in a Bottle" made her think of her husband and she began to explain her emotions. For several years, she said, she wondered whether or not she had made right decision to be with him. Just as she began to regret her decision, she was diagnosed with cancer. Helen said, through tears, that "he came through like gangbusters for me." She knew, after that event, that she had, indeed, made the absolute perfect decision. 


About a week or two later, Helen had a pretty fast decline and was declared "imminent" by her nurse, which means that the rest of her life could most likely be counted in hours, not days. I visited her and it was hard. She was once very full of life, but now she was unresponsive. Her husband, as well as her daughter, were there by her side, and agreed to let me sing for her. I hesitated before leafing past Jim Croce and decided to go for it. I told Helen's husband of our conversation earlier and how much his being there meant to her. As I started to play the song, everyone in the room [myself included], began to cry. We were all going to miss Helen very much. I finished my session and left. She died an hour later.


I guess this still is a strong memory for me, because I'm on the verge of tears again while I recount this story. Tears are not always a bad thing, despite what our culture may say about them. They are not weakness, they are not evil. They are natural, as natural as the love any one person can have for another. They are an outpouring of emotions that cannot be expressed in words, although music may come close. Tears are one way that I know what I do really matters.

One Profound Song

This week, I wanted to write a little about a particular song and how it affects a particular client of mine. This client is fairly young for hospice care and has an uncommon diagnosis. Due to HIPPA, I do not want to divulge too much information, but let's suffice it to say that he has been living with a developmental delay for his whole life. I've never actually gotten a word out of him. In fact, he spends a lot of time in bed, staring at the wall. Still, he deserves the same level of care, if not more, than anybody else.

He's really a sweet guy and he has a very supportive family. When I first started visiting him, the nursing staff told me, "Oh, he'll love having you visit. His favorite song is 'Jesus Loves Me'." So, I led off with "Jesus Loves Me" and he made eye contact with me, moved his head around, and occasionally made a noise, as though trying to sing along. Then I moved to some other "Sunday School"-style songs, but got no response, whatsoever. He simply stared at the wall. I played "Jesus Loves Me" again, and he reacted the same as before. I'm still not sure what it is about that song that affects him on such a base level! I just know that every time I play that song, which is every other song now, he perks up and seems to really interact with me. I don't understand it, but that's what happens.

In some ways, I envy him. Imagine having a connection to a song that was so strong, so ingrained in your being, that it was always fresh, new, and meaningful. In a time when top 40 radio is a constant blur of "old" songs being replaced by new, he is still in love with this song. And what a song to have a connection with! Regardless of your faith system, this song is empowering and validating the person singing it, even if he's singing it in his head. This song tells the singer that they are loved and important. "Jesus Loves Me" does not make stipulations on its love or ability. In fact, it says that when you are weaker, you are loved more! When you break it down, this song is very profound in our day and age. Television, radio, billboards, and music all tell us what we need to do to be better, whether that's looking better, buying nicer things, or being part of some special group. This song is simple, easy to remember, and is packed with love for the singer.

I hope that everyone reading this can find a song that really speaks to them this week. Find it and cling to it because it validates the best parts of you and doesn't care about the rest. No one is perfect, but everyone deserves to feel loved. I think music is one of the best ways to show that. I find that song, listen to it so many times you know it by heart, and live your life with the feeling it gives you.

Choosing the positive, acknowledging the negative

This week I had two very profound experiences. One was positive and one negative. It made it hard to choose, but the negative can be summed up pretty succinctly. Dementia is a terrible disease that robs people of their personalities and humanity. A once very lovely and charming woman, who was once a patient and then was discharged, was readmitted with a dementia diagnosis and now she is a completely different person. It made me quite sad.

However easy it is to focus on the negative, it is imperative that, in hospice care, you acknowledge, but do not obsess, the bad things in life. It is much more rewarding to look for the positive, but it has to be a choice. This leads me to my next experience, just a few days later. I was called in to do a visit for a patient who was actively dying and had loved music her whole life. When I started walking to her room, I found the family in the dining area talking with the hospice nurse and she introduced me to the family. They were very nice, obviously very loving, and mentioned how much the patient loved music, even the great grandchildren who were present. I invited them to join me for a music therapy session if they wanted and they quickly joined me.

Now, here is where I should point out that music therapy sessions with imminent patients and their families are the most rewarding experiences in my experience, but they can be tricky to get into. I played a few songs that the patient received comfort from in previous sessions and everybody listened intently, but there was no sharing, no community in the room. I decided to try something else. I asked the great grandkids if they wanted to sing a few songs for the patient. Their faces, especially the little boy's, lit right up and they requested "Go Tell it on the Mountain" and "Jesus Loves Me." That resulted in a veritable deluge of reminiscing and laughing. It was really incredible to witness. No body sang with me when I sang, but between songs, the gathering talked about the patient and her influence on a great number of people. The music supported the conversation and the conversation influenced the music. It was a great sharing of love and I was honored to be a part of it.

These little "mountaintop" experiences are what we, as hospice workers, music therapists, and people in general, need to cherish and focus on. The negative is there. It will always be there. But if you look deep enough, the positive will be there too.

Story: In the Hole

I wanted to share a quick story that means a lot to me. It isn't very long or detailed, but was a very uplifting point in my week. It was really a nice way to start the week out for me.

I went to go see a couple this week that have some pretty incredible attributes. The husband is 98 years old and the wife is 102 years old. Some quick math shows that there are 200 years of experience in that one room of their nursing home. Although the wife is unable to communicate, they husband loves to talk and tell stories. Many of those stories, I have heard already from previous visits, but when a person that old is telling you something, you'd better listen! Haha.

I have been providing music therapy sessions for the wife for longer than the husband, as he was not appropriate for hospice services for a while. He would be up and talking and enjoying the session, which mainly consisted of me just playing music to provide positive sensory stimulation and a compassionate presence. There was one session, however, where I found the husband lying in bed and looking about as bad as his wife. Due to the community nature of music, when I provided music therapy for his wife, he received it as well. I sang the old hymns for her that I was told she enjoyed and left.

Flash forward to this week and you'll see the continuation of the story. When I arrived this time, he was very happy to see me. He remembered where I was from and what I was there to do, which, at 98 years old, is quite a feat. He kept telling me about how he remembered me coming to play for him when he was "in the hole." He continued to talk about the time he was "in the hole" between songs for the rest of the session. As I was starting to pack up to leave, he shook my hand and started talking more about that experience when he was "in the hole" and I played music for he and his wife. As he spoke, his eyes lightened and he said, "Your music brought me a little closer to Heaven that day. I thank you for it." It was really a touching moment, especially for an old farmer to admit something like that.

Obviously, that was a great way to start the week. It made me realize [again] that when I'm sharing music, whether in session, in passing, or in concert, that I'm not just sharing it with one person, but anyone who can hear me. The emotions and comfort that a musician puts forth is not meant to be isolated and guarded, but shared with everyone in the room. You may direct your attention to one person, but simply sharing space with someone changes their life a little bit.