Music as Medicine
Soothing Sounds Help Provide Peace to Terminally Ill Patinets - and their Families
Beneath a crisp, white hospital sheet, a woman’s crumpled form rises and fialls with each labored breath.She lies unconscious as her sister, bedside, comforts her with gloved hands. A few feet away, another woman sits on a black metal stool, holding a large wooden harp.
The harpist takes a moment to compose herself, looks at the woman in the bed and begins plucking the brightly coloured strings. The sound fills the room gradually, like water pouring into a glass.
The music blankets the odd angles of the room, wrapping itself around the rolling funiture and the linoleum and the clear plastic bag labeled “drip narcotic.”
As the harpist starts chanting a soft, shallow voice, the sister dabs her eyes with a tissue, and the dying woman appears to twitch her nose in response to the music in the room.
THE HARP has long been associated with the pearly gates of heaven. But for terminally ill patients at Eugene’s Sacred Heart Mecical Center and their family members, the instrument is more than an image - it’s medicine, and it works. “They sang and played the harp, and my mother completely relaxed,” says Linda Kraus of Lake Oswego, who attended two bedside harp vigils at Sacred Heart while her mother, Betty Risgby, lay dying earlier this year. “It was like a little miracle happening.”
Photo Caption: Sister Vivian Ripp (left) and Loraine McCarthy, music thanatologists at Sacred Heart, give a harp vigil for patient Mary Rooney and her daughter, Patricia Casey.
Photo Caption:After playing the harp for more than 30 minutes, Sister Vivian Ripp consoles Patricia Casey during the vigil for her mother, Mary Rooney.
Each year, dozens of patients and family members attend similar ceremonies at Sacred Heart, thanks to a pastoral care program called Strings of Compassion. Staffed by Sister Vivian Ripp and Loraine McCarthy, the free program seeks to improve the quality of life for dying patients, perhaps even relieve some of their pain.
Known as music-thanatology, the treatment is based on 11th century monastic practices and modern-day teachings. “I love what I do,” McCarthy says. “It’s such a privilege. Every vigil is unique and special. It’s like being invited into a sacred space.” Sister Vivian says the program is more than just live music at the bedside.“Music touches us holistically. It’s a mind-body-spirit connection,” she says. “What I hope to bring is the possibility of some pain relief, anxiety relief, group support and relaxation.” And relaxation isn’t just being relaxed. It’s being relaxed and centered so that there is a sense of peace.”
Four years ago, when Bob Scheri, director of pastoral and spiritual care services at Sacred Heart, hired Sister Vivian, the hospital became only the second in the country to offer a fully integrated music-thanatology program. The initiative, Scheri says, grew out of a desire to improve the quality of care for terminally ill patients, who are too often told: “There’s nothing more we can do.”
“When someone is dying there is a great deal you can to do to provide healing, care and support,” Scheri says. “This was something that I felt could be a real strong statement about our care giving.” Today, there are music-thanatology programs at hospitals in Spain, Australia, the Netherlahds, Scotland and, closer to home, at hospitals in Bend, Seattle, Baltimore and, soon, Portland. Strings of Compassion has become a model for other hospitals looking to improve their end-of-life care. The program has outperformed even Scheri’s hopes.
“We expected a certain amount of skepticism, and we have not really received any,” Scheri says. “We have received only open arms and affirmation.”
When Linda Kraus’ mother fell ill earlier this year, she already had heard about Strings of Compassion. Still, she was surprised by the calming effect it had on her mother and her family. “It made the experience less paintul for me,” Kraus says. “I think it did for my sister, too, and I know it did for my mother.”
Kraus attended two bedside vigils for her mother. During the first she cried while her mother was slowly lulled to sleep by Sister Vivian’s harp.
The second service was attended by Kraus’ husband, Robert; her sister, Vickie Hamory, and some family friends. It was less emotional for Kraus, but proved extremely moving for the others. Several people left the room to collect themselves.“I would recommend it to anyone,” Kraus says. “We felt most thankfull that we were able to have the experience.”
Photo Caption:Loraine McCarthy says one of her goals as a music-thanatologist is to help the people she is playing for find a comfortable, peaceful death.
TOGETHER, McCarthy and Sister Vivian have presided over about 500 bedside vigils. Sister Vivian once played for two hours for a dying 20 year old man injured in a falI. Another time, she played for only a few moments before an old man wasting away from lung cancer made her stop, he said he couldn’t stand the harp’s vibrations. McCarthy and Sister Vivian see dying patients of all ages. Some are in their prime, some are well past their prime and some are barely out of the womb. In each case, they say the pain and suffering is unique, as is the family’s response.“You are constantly making decisions about what you are playing and the way you are playing,” Sister Vivian says, “and that’s why the music is called prescriptive music.” Sister Vivian adjusts her musical prescription by altering the pace of the music to keep time with the breathing of her patients. Like a musician reading the mood of an audience, she plays different pieces to fit the needs of different patients. “I’m going in without an agenda,” she says. “I’m there to be available and to assist what is going to happen, ... to bring a sense of presence and passion to the experience.”
Nearly four years ago, when Julie Stoike’s mother, Barbara, entered the hospital with a brain aneurism, Sister Vivian approached the Eugene family and asked if they wished to have a vigil performed.
Initially, Stoike recalls, she was not interested. “My first instinct was, ‘No,’ Stoike recalls. “You’re at this pinnacle of grief at that point, your family really unites, and you don’t let outsiders in. “When she came up and said she was going to play the harp, all I could think was, ‘go away, we are grieving. We don’t want to be bothered. Nothing can help us with something so tragic and painful.”
Several days later, after talking it over with her sister, Stoike agreed to a vigil. Although her mother was unconscious, Stoike is convinced the treatment had a powerful effect.
In addition to providing her mother with some solace in her remaining hours, she says, it allowed Stoike and her family to open themselves to the experience. “In America, we have such denial when it comes to the death experience,” Stoike says. “People just want to run away from it; get away from it. They don’t want to deal with it, and they lose the experience. “It is a sacred experience, just like birth.” Stoike says taking part in her mother’s vigil changed her whole outlook on death and dying. She feels lucky to have been at her mother’s side as she took her last breaths.
“My advice to people is to make it an experience,” Stoike says. “It’s going te be the last experience you will ever have wilh your loved one, and you should make it a good one. I’m not saying bring drinks and have a party, but to not run away from it and to accept it. There was such respect for my mother’s life. It was not what I expected at all,” Stoike continues. “I never thought that the death experience could be beautiful, but I couldn’t have asked for a better passing of the greatest person I’ve ever loved.”
Sister Vivian, who grew up in Salem, first heard of music-thanatology while working as a medical oncology chaplain at St. Patrick Hospital in Missoula, Mont. The hospital happened to be the headquarters for a school founded by Therese Schroeder-Sheker, the mother of music-thanatology. Sister Vivian was intrigued. Schoeder-Sheker offered a care program and a graduate level school of music-thanatology called the Chalice of Repose Project. Sister Vivian, a musician with a master’s degree in applied spirituality from the University of San Francisco and a specialty in caring for the terminally ill, found that “all the pieces of my background fit into doing this work.” McCarthy, who hails from Seaside, also brought a musical background and an interest in working with the terminally ill to the Chalice of Repose Project. In order to graduate from the 2 1/2-year program, both women were required to perform 60 bedside vigils, complete a research project and pass a comprehensive exam. Sister Vivian graduated in the school’s first class in 1994; McCarthy finished up two years later.
Other programs offer music therapy to sick patients, but Chalice of Repose is the most comprehensive and the best known. Schroeder-Sheker, a former concert harpist who has performed at Carnegie Hall, began studying palliative medicine—treatment to improve the quality of life at its end - several decades ago. Regarded as on of the pioneers in the field, she has been the subject of features on ABC’s “Nightline” program and in Life magazine. Music-thanatologists who study with Schroeder-Sheker are not required to subscribe to a particular religion. But, Sister Vivian says most of those who practice the treatment do have some sort of spiritual belief system. Death has become an everyday part of Sister Vivian’s life, but her ease with the subject did not come without effort. “To be with the dying, you have to face what is the meaning of death,” Sister Vivian says. “You have to be comfortable with suffering, comfortable with people’s actions, comfortable with feelings of intense loss.”
Photo Caption:Above: Vickie Harmory clings to her mother’s hand while Sister Vivian plays a Gregorian chant.
Similarly, those who receive treatment from Sister Vivian are not required to practice an organized religion. Stoike says the treatment was more reverential of her mother’s life than anything else. “It was not, ‘Let’s bless her,’ ” Stoike says. “It was, ‘Let’s just play music, just take a moment out of all this stress and agony and just be able to listen to some beautitul music.”
Much of the music performed by McCarthy and Sister Vivian is church music written in the ninth through the 11th centuries. They are mostly Gregorian chants and other “unmetered” music, pieces that don’t have the clomping; heavy beats that might be disruptive to a frail patient. “The music isn’t entertainment,” Sister Vivian says. “This music is different. If you can enter into the music for 30 to 45 minutes, it’s like taking a journey. People often don’t talk. They just let the music speak to them.”
Patients and their families aren’t the only ones who believe in music-thanatology. Dr. Joseph Dunn, a pain management specialist with a practice in Eugene, often works with terminally ill patients. He first heard about Strings of Compassion four years ago at a medical conference. “I don’t know if I was skeptical but I was confused,” Dunn says. “I didn’t know exactly what it was.” Dunn first witnessed the treatment when a 43-year-old man dying of cancer of the esophagus went through a vigil with Sister Vivian. The results were hard to quantify, Dunn says, but the benefits of the treatment were difficult to miss.
“It helped control his pain during the time it was going on,” Dunn says. “It helped decrease his anxiety. And it provided an environmen for he and his family to talk about what was going on, which was the most important thing.” Dunn now refers many of his terminally ill patients to Sister Vivian. He recommends the therapy not only as a means of relieving pain and anxiety, but also as a way to treat the emotional suffering that dying patients experience.
“You can do these same things with psychology, but here you can do it with a few strings of a harp,” Dunn says. The harp is the instrument of choice for music-thanatologists, and its most important quality is its resonance. The instrument’s 30 plus strings build a soothing sound that lingers in the room. Similar effects can be created on a piano or a guitar, but a Steinway is not exactly portable, and even a 12-string guitar can’t match a harp’s depth of sound. “For some people, certain instruments can hurt their ears, but for most people the harp can be very soothing,” says Janet Naylor, a professional harpist. She is not affiliated with Strings of Compassion, but she does volunteer to play for patients in nursing homes.
Barbara Eicher, a chaplain at Sacred Heart, was familiar with Strings of Compassion, but it wasn’t until her mother, Harriet Scott, fell ill with pneumonia earlier this year that she got a firsthand look at the program.
Eicher asked Sister Vivian to perform a vigil for her mother, who was living in a nearby care facility. “It seemed to just calm her and slow her breathing down and kind of ease the struggle,” Eicher says. “I wasn’t sure how receptive she would be, because she’s a pretty headstrong kind of person, but it really relaxed her. “It just made for a very special and closed moment.” In March, Patricia Casey’s mother, Mary Rooney, suffered a massive stroke. The decision to experience a vigil with Sister Vivian was not a difflcult one for Casey, who was the only family member at her mother’s bedside.
Sister Vivian Ripp pushes her portable, 22-pound lever harp through a corridor of Sacred Heart Medical Center.
“I thought it sounded great,” Casey says, describing her first impressions. “What a peaceful thing to do.” Although her mother was in a coma, Casey says she could sense the treatment was helping. And not only did it prepare her mother for the experience of death, but it soothed Casey’s own fears. “You’re totally helpless. There’s nothing you can do,” Casey says. “I think it made the journey a lot easier, and it made it a lot easier for me to see it happen.”
“She had a look of peace and serenity.”
Music-thanatology can provide relief from mental anxiety, physical pain and emotional suffering, but one of its most powerful benefits is simply the fact that it provides temporary escape from the sterile hospital environment, from the sound of gurneys rolling, televisions droning and life support machines pumping. “Our bodies are primarily fluid, so all of the sounds around us are impacting us subtly,” Sister Vivian says. “The computer, the television, the air conditioner - all of these sounds are influencing our physiology.”
Officials at the Providence Medical Center and St. Vincent’s Medical Center in Portland believe music-thanatology works. Both hospitals have hired a staff music-thanatologist, and both plan to implement programs of their own this summer after consulting with Sacred Heart.
One of the most important lessons the hospitals took away from the Eugene program is the need to inform people about the treatment ahead of time, says Sister Kathleen Kircher, a member of the pastoral care department at Providence Medical Center.
“Part of what (the therapists) will be doing is educating people about what music-thanatology is and how does it benefit the dying patient,” Kircher says. “You need to educate people at all levels - your physicians, your surgeons, your housekeepers, and your pharmacists - so that everybody feels like they’re a part of it.”
Music-thanatology is still a long way from mainstream medicine, but Sister Vivian and other are hopeful the treatment will someday earn the same respect as more traditional forms of therapy.
And there is the hope that programs such as Strings of Compassion will cause people to re-examine how they think about the dying. “The dying can teach us how to live in the most dramatic way,” Sister Vivian says. “When you’re with the dying, what is essential becomes clear - relationships, belief, hope and quality of life.”
For more information about the Sacred Heart program, call 6857402.
Reporter Lewis Taylor can be reached by phone at 3392512 or by e-mail at Ltaylor AT guardnet DOT com