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!

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.

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.

Loss and the Holidays

I don't have a very long time to write, as I am at my in-laws with a little down time. I wanted to take a little time to talk about dealing with people dealing with loss around the holidays. For a majority of people, the holidays are seen as a time of family, fun, and celebration but for many people, holiday celebrations are just a reminder of the loved one whom they may have lost. It's important that we give people space, acknowledging their loss, but still not alienating them if they should still want to celebrate. In my experience, people who aren't grieving may have misconceptions of how the bereaved person should cope. Some want the bereaved to "get over it" and join in the fun, while others assume that the bereaved will not want to take part in anything even remotely associated with happiness or joy.

I played at a memorial service for a client who I had only seen once (in which she was unresponsive), so I did not have the opportunity to build up a great relationship with her. Her daughter, however, wanted me to play at the memorial service. When choosing music, she said she wanted celebratory songs and at least one Christmas song. I chose "Away in the Manger" because of the last verse: "Be near me Lord Jesus, I ask thee to stay close by me forever and love me I pray, bless all the dear children in thy tender care and take me to Heaven to live with thee there." I thought it was very bold to want a Christmas song and, as I was playing it, I could feel the tension in the room. It's very hard to reconcile the joy of the holiday season with the grief of loss and it's something that thousands of people struggle with every year.

I guess the point this little story is this: Don't assume that everyone is having a "merry" Christmas. If you know someone who is grieving this holiday season, don't assume you know what's best for them.

I hope everyone reading this has a very blessed Christmas and peaceful New Year!

How Hospice Works Affects My: Priorities

This post is on how hospice work affects my priorities. Specifically, I'm talking about priorities related to home/work balance. This issue can be a slight point of contention with people I care about.

Before you think anything, let me explain. I understand that boundaries need to be set between my job and me to prevent burnout and healthy relationships outside of work. I do my best to do this, but I'm still learning, so my work sneaks up on me occasionally. I know this is something I need to continue working on. The thing that makes it hard is that I really enjoy my job and people tend to think about the things they enjoy. You can start to see my dilemma, here.

I think that this issue is compounded by the fact that I see clients and families at one of their most vulnerable moments. By the time they are involved with hospice, many of them have tried all other treatments and they see hospice as "giving up", which it is not. They just want themselves, their mom, their dad, brother, sister, or spouse to be comfortable. That is really where hospice workers shine the most. As a music therapist, I tend to get some special treatment, I admit. Many people, even if they do not understand that what I'm doing with them is therapeutic, enjoy and look forward to my next visit. People I visit benefit from my visits, which makes me feel better, which makes me enjoy my job more. See how this cycle continues? I see people when they need the most help, whether that is a physical, legal/financial, spiritual, or emotional issue they are dealing with. As a hospice worker, my heart naturally wants to help and be with these people and be there for them. I want to give them all the treatment they need, but there are not enough hours in a day to accomplish that task.

This can manifest itself in my everyday life through the choices I make regarding vacation time, travel schedule, my weekly schedule, and extra activities. As I said before, I know I should not be thinking about work all the time when I'm not on the clock. I am trying to be better at it, and I think this blog is helping me to regulate that through critically thinking about my work/home habits. If you have any tips or stories about how work, whether you're a music therapist, hospice worker, or have a completely different job, please let me know.

How Hospice Works Affects My: Hobbies

This post is about how being hospice music therapist has affected my personal life by changing what I do for fun. As you can guess, my work can get pretty emotionally intense, although it is not as "doom and gloom" as some think. All this can have a pretty big impact on what I do with the rest of my week. After thinking about it, I've come to realize that I tend to do one of two things when it comes to my hobbies the rest of the week. I tend to either do something that uses my brain a lot, but not thinking about hospice, or I do something that my brain can go on autopilot for.

An example of the "autopilot" activities is cycling. I have a friend who is really big into bicycles and got me into it. I never really cared either way about cycling before, but he is so into it that I got sucked in. It's funny how when you find someone really fired up about something, it gets contagious. Basically, when I get out riding, I don't really think about anything. I get a nice workout and feel great when I get back, both physically and mentally. The things that make my brain work a lot and focus on what I'm doing instead of hospice are things like songwriting or reading. I try to read at least a half hour a day, if not more. I do songwriting whenever I have an inspiration. The songs usually start in my car, where I write the lyrics and then get home and try to put the lyrics and melody I created to chords and get the rest of it figured out.

I was thinking about my hobbies and how they help me and how I could make this post applicable to anyone. I think it all boils down to taking care of yourself and not obsessing about one thing. It's almost never a good thing to do that. I think part of taking care of yourself is taking your mind off things. By thinking about one thing all the time, you are putting yourself at risk of burnout. When people get burned out, they don't care about their work and they usually start to do poorly in the work place. In hospice, caring and doing a good job are paramount to our patients getting the care and quality of life they deserve. It is the epitome of a lose-lose situation when you're burned out - you don't want to be there and the people you are with suffer for it. I think this is true for anyone, whether you are a music therapist, teacher, nurse, electrician, etc.

I encourage you to take a few minutes and think about your hobbies. Do they contrast your work? Do they exist at all? How do they affect your patients? How do they affect you? If you realize you don't really have any hobbies that take your mind off work, make a plan and start one. Even something as simple as knitting or getting an exercise program can drastically help.

What are your hobbies?

How Hospice Works Affects My: Goodbyes

Hey all,

First off, I'd like to apologize for not posting as often as I ought to. Suffice it to say that it has been a pretty crazy few weeks.

I've recently begun to realize how working in hospice care has changes how I've lived my life. It's nothing Earth shattering, but there are just some subtle things that may seem odd to people who don't understand that hospice "lifestyle." So I'd like to do a few posts on specific things that I have noticed in myself. I may make these insights out to be rather melodramatic, but I think they are valid and worth considering.

The obvious choice for me to start is goodbyes. In hospice care, I can never be too sure that I will see any of my clients again before they die. Think about it: we share this really incredible time, sing songs, tell stories, sometimes laugh, sometimes cry, and then we part ways. It almost sounds like what happens when I get together with friends, right? The big difference is that I know the person I'm sharing this time with is dying. There isn't necessarily a "see you later" or a "I'll talk to you soon" after I have a music therapy session with my clients. There is sometimes a "I'll try to stop by and see you again" and a "take care." But very rarely do I say, "I'll see you later." There are really only goodbyes to be said and you need to make them count. If I say, "I'll see you later," and they die before I do, I feel terrible, like I've let them down. I try not to get stressed out (although I'm not always successful) but that is a surefire way to make me feel tense.

How, then, should I remedy this situation? I make sure that every time I leave someone, I've left on the best possible terms. Saying these goodbyes can be a little tiresome at times, but, for me, it beats the alternative. When you say "Goodbye" so make times a day, it becomes a habit. Now, I try to make sure that all my conversations or visits end on good terms. This can take different looks, and some of them might not be easily noticed. One example is that I always say, "I love you" to my wife after talking on the phone, even if it's just a one minute talk where I have to ask her some mundane question. It also means that I like to give out hugs to people when we part ways. After all, nothing is guaranteed, especially life. Say your goodbyes as if (God forbid) you might be hit by a bus or struck by lightning before you see them again.

I'm not saying these things to sound like a saint. I'm simply trying to put my finger on what it is that saying "Goodbye" should really mean. As people, we meet and leave so many people each day and I think we, as people, take life for granted sometimes. The person who gets your coffee for you, works at the bank, takes your messages, comes home to you, and talks to you on the phone all deserve a proper goodbye. Tell them "Thank you" and make sure they know you appreciate them. People need to hear that, especially people who are in a therapeutic relationship with you. Music therapists, especially those in hospice care, need to make sure they are affirming the clients and staff they work with through goodbyes.

So, next time you are saying "Goodbye", I hope you think about what you are saying to them. Make sure your "Goodbye" is one you can end with.

Insights: Amazing Grace

Amazing Grace seems to be the quintessential hymn of the United States. People from almost all Christian faiths, and even some who really have no affiliation with Christianity, find comfort in this hymn. Case in point, I seem to play Amazing Grace at least once a day. I try to get away from it sometimes, but it always comes creeping back up. As I've sung it over and over and over, and gotten to the point where sometimes I tend to zone out while I play it, I've had a few personal insights about this hymn that I feel compelled to share.

Insight #1 - Word usage in this song can be a little demeaning, I think. This of course depends on the patient, but sometimes I have a hard time calling someone a "wretch". Say that word out loud. Let the sounds slowly roll off your tongue. It's an ugly word. According to dictionary.com, a wretch is a) a deplorably unfortunate or unhappy person or b) a person of despicable or base character. Working in hospice, the last thing I want to do it tell people they are despicable or deplorable. Even some churches have a hard time with this word, too. One church I went to changed the wording from "that saved a wretch like me" to "that saved and set me free." Not a bad change, I suppose, but anytime I've tried that, it doesn't come out feeling natural. Instead, I have taken to using the word "soul" instead of "wretch". Just the vowels alone make a big difference for me. The e vowel in "wretch", to me, sounds tight, pinched off, and I can't say it without bearing my teeth on some level. My body tends to feel like the sounds and faces I'm making. How can I help someone feel comforted or relaxed when I'm making that face. The o vowel is "soul" sounds, to me, to be open, pure, and vulnerable, just like I want my clients to be with me, and vice versa. I should not expect my client to open up to me when I'm presenting him or her with a closed off appearance and actions. 


Insight #2 - The melody of Amazing Grace is easily recognized with everyone I've met on a therapeutic level. Because of the tune's recognition, it automatically can tie in with people's emotions. I have seen many people cry, even weep, while hearing this song. Sometimes the tears seem to be from sadness at having to let a loved one die, sometimes from relief,  and sometimes from just having to release all the tension they've been feeling for so long. If this hymn, which was first published in 1779, can be so powerful, how much more powerful can it be when it is personalized to the client. I have tried to add improvised verses for people and changed words within the verses ("When you've been there ten thousand years..."), which has seems to make it more meaningful for clients. One extra verse, which I learned in my internship, has consistently achieved a deeper connection, however. I tend to use this verse when a client is imminent especially when his or her family is present. To the same melody, I'll sing: 
     Dear Charlie (client's name), you are loved, you are loved, you are loved. 
     Dear Charlie, you are loved so much. 
     Dear Charlie, you are loved by your family and God above. 
     Dear Charlie, you are loved. You are loved.
By using this verse, I'm validating the client and letting them know they are loved by their family. Simultaneously, I'm validating the family and letting them know I can sense the love they have for their mother, father, sister, brother, or friend. It's a simple verse, but has had a large impact on how I approach this song. 


Those are all the insights I have at this time. I hope that you all have a great weekend!