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Soothing Strings

Hospital musical vigils may help ease passage for dying patients

Anchorage Daily News - February 23rd, 2003
By Ann Potempa

Karen Gilley steps into Room 531 to see her patient. Leaning over his hospital bed, she checks his pulse and strokes his balding head. Guy McGee’s heart is racing, and his skin is clammy. Lung cancer and pneumonia make him struggle for every breath. “Hello, Guy,” she said, almost whispering near his cheek. “I’m going to play for you.”


Gilley, a registered nurse, comes with an unusual medical instrument. She’s trained to play the harp to ease the pain and anxiety of critical illness and death. Her profession is called music thanatology. The treatment prescribes music, not medication, for dying patients. Gilley met McGee when he didn’t have much life left. Part of her job is to honor his dying hours as an important part of his life. His death will become part of the fabric of his life, just like the day he was born in Idaho 85 years ago, his marriage to wife Pat almost 55 years ago, and the almost four years he spent surviving as a prisoner of war during World War II. But he won’t survive this. Pat watches her husband lie motionless in a white T-shirt, covered in white bedsheets and a white blanket. His cancer is inoperable, she said.

Gilley sits in a dim corner of McGee’s room at Providence Alaska Medical Center, breathes deeply and cradles the harp between her legs. Instead of reading music, she reads McGee. She studies his face, his breathing, his physical reactions as she plays a soft song. McGee doesn’t react when Gilley starts. But she plays anyway, believing her music might provide some relief for him or the family and friends with him. The entire time, McGee doesn’t stir, just rests soundly with his eyes shut and his right cheek leaning into his pillow. Gilley thinks her patient is asleep, which is a complete switch from the first time she came to play for him earlier that week. “My God, he wouldn’t shut his eyes,” Pat said. “He was just fascinated.”


LONG HISTORY
Gilley’s profession has a long history. Therese Schroeder-Sheker’s book “Transitus: A Blessed Death in the Modern World” explains how music thanatology made its way from France to Montana to Alaska. Schroeder-Sheker was the dean of the program in Montana that taught Gilley how to play the harp. Schroeder-Sheker’s work with dying patients began when she was an undergraduate student working in an elderly home. She often watched as people died alone, in pain and depressed. “Many died accompanied only by the blare of the television and the canned laughter of ‘I Love Lucy’ re-runs,” she wrote. She decided to change that. One day she showed up for work and learned an elderly man was quickly dying of emphysema. She walked into his room and saw him thrashing, gasping and crying out. “Everything fell away, and just two human beings were left in the same room, facing a moment that would become very large,” she wrote. Schroeder-Sheker climbed onto his bed, sat behind him and held up his body. She began singing quietly. He rested into her and stopped thrashing. They began breathing together until he stopped. She held him as he died. Death had been treated as the enemy, but she looked at it another way. To her, a person’s last moments were a part of the fullness of life. Schroeder-Sheker expanded on this experience by pulling from history. Her 20th-century music thanatology program drew from 11th-century France. Back then, Benedictine monks incorporated music into their daily routines, singing their prayers and psalms. Monastic medicine sought to care for the body and cure the soul by combining physical medicine like drugs and surgery with spiritual medicine like prayers and blessings. Music became a tool the monks used to tend to dying patients. As modern-day medicine became more and more complex, with advanced MRIs and genetic therapies, Schroeder-Sheker created the Chalice of Repose Project to offer relief solely with harp and voice. In the early 1990s, she brought her work to Missoula, Mont., and started a two-year training program at St. Patrick Hospital. The students, many of whom were nurses, learned how to play harp and sing Gregorian chants that addressed patients’ physical, emotional and spiritual needs. They studied how different religions and nationalities deal with death. In 2000, Gilley committed to the two-year program. “It was something I always wanted to do before I died,” she said. “I would always have thought about that on my deathbed: What would you regret not doing in your life? “And that would have been it.”

MUSIC IS MEDICINE
The Chalice of Repose came to Providence Alaska Medical Center partly because of Gilley’s drive to start it and partly due to administrator Gene O’Hara’s decision to bring the program with him to a new job. For almost 10 years, O’Hara worked as the chief operating officer at St. Patrick Hospital in Missoula. He watched as the Chalice of Repose started as an idea and then grew to include nurses playing the harp in hospital rooms and studying music in classrooms. “It served a need that hospitals have really been ignoring forever,” O’Hara said. “Modern health care does an excellent job addressing diagnosis, cure and therapy. We do not do as well in addressing death. Why is that?” Everyone dies, O’Hara continued, so why don’t medical professions strive to ease the pain that comes with inevitable death instead of treating death like a failure? Gilley said one problem is nurses lack time to comfort patients as well as treat them. “My nursing care on the floor was definitely lacking when someone was dying,” she said. “You’re so busy. You’re understaffed a lot of times. You just don’t have the time to sit there and do what you learned to do in school—the ideal world where you can sit there and hold somebody’s hand and talk to them and the family for hours.” O’Hara was invited to attend harp vigils at St. Patrick and saw firsthand the music’s calming effect on patients and families. “I made a commitment back then that I’m going to take this program to whatever hospital I go to,” he said. In 1997, he took a job as chief executive officer at Providence Alaska Medical Center. O’Hara and Monica Anderson, the hospital’s former spiritual-care director, learned Gilley wanted to bring the Chalice to Providence. Anderson secured hospital foundation money to cover Gilley’s tuition. When Gilley finished the program and returned to Providence, administrators committed to offering her services full time at no charge to hospital patients.

HOW IT WORKS
Once when Gilley sat down to play for McGee, his wife requested “Danny Boy.” Gilley explained that she plays personalized music, not songs that people would know. “Favorite pieces are more engaging,” Gilley said. “They have a tendency of provoking memories, and those memories are what’s binding you to your body, your life.” But how can you prepare to let go if you’re bonding with your memories, Gilley asks. And what if those memories aren’t happy ones? The songs Gilley typically plays lack meter and rhythm; instead, they’re free-flowing, with long, stretched-out notes. She might pick a piece with rippling notes to imitate the cooling effects of water. She’ll play a close interval of notes to draw together a family that’s struggling to connect. She’ll opt to play the Kyrie for Feasts of the Blessed Virgin because it’s made her cry and is likely to do the same for some patients. “There’s been some people that I’ve played for that you can see that they really want to cry but they just won’t,” she said. “You can see that in people.” The Kyrie has the power to make that happen, mixing major tones with minor ones. It’s the minor tones that can hit deep inside a person, she said, where they can reflect on what’s happening to them. When Gilley plays, the doors to the patient’s room are sometimes left ajar, allowing her music to waft down the hallways. Some people want her to perform for them later, but Gilley is emphatic when she says she’s not an entertainer. “To me, this is nursing,” she said. “It’s just a really special way of doing it.”

QUANTIFYING RESULTS
For years, nurses graduated from the Chalice of Repose school in Montana and took their craft across the country. Shortly after Gilley’s graduation last fall, however, the school closed at St. Patrick Hospital. Schroeder-Sheker became a visiting professor at Duke University in North Carolina but plans to restart the music thanatology training program in Mount Angel, Ore., said Sharon Murfin, a faculty member from the Montana school. Over time, music thanatologists have gained acceptance. O’Hara remembers the rough reception the prescriptive harp program received during its early days in Montana. Some physicians considered it “new age” medicine, he said, even though music thanatology has roots that extend back thousands of years. “They just didn’t understand it,” he said. Murfin, a music thanatologist for the past 10 years, knows it’s a challenge to talk about music as medicine. The Chalice of Repose staff and graduates, however, are trying to study it in a scientific way. Murfin said certified music thanatologists will study outcomes from new-patient cases in Spokane, Wash., this year. She hopes the research team will complete the project within a year. At St. Vincent Medical Center in Portland, Ore., nurse Laura Moya uses specialized software to help her recall her harp vigils. After each, she writes an entry in her computerized journal. She chronicles the patients’ breathing patterns and pulse rates, as well as if the patient starts to cry or if the family is able to grieve. Eventually, she hopes to discover trends. Usually, Moya said, she notices that music helps patients breathe more softly or sleep. In rare instances, she doesn’t detect any changes or she sees an extreme shift. “At times, there are the most profound vigils, where a person either has a most incredible, peaceful death or someone who’s struggling stops struggling,” she said. When Gilley returned to Providence from Missoula last fall, she started writing journal entries about her patients. She also organized brown-bag lunches to explain her new practice to nurses, doctors or anyone else wanting to know more. As a result, Providence’s program started with overwhelming support, O’Hara said. Jeannie Keith, nurse manager for the hospital’s medical oncology ward, said Gilley was busy from the start, fielding referrals for harp vigils from nurses, chaplains, families, even the patients. Gilley used her music to help Tom Morris overcome anxiety and pain after heart surgery. Morris is a music aficionado and can talk nonstop about the pleasures of listening to all kinds of performers. But he’d never heard anything like Gilley’s music. Even after she’d left his room, he’d keep thinking about one of her pieces. “That one song would go over and over in my mind,” he said. “I forgot all about the pain. “Boom, right there it went,” he said. The music made him visualize that he was elsewhere, feeling as if he wanted to laugh and cry at the same time. “It sends you into a different place, and I didn’t realize that could happen. I tell you, it’s the best medicine that you can ever get.”

MAKING IMPROVEMENTS
Back in Guy McGee’s hospital room, Gilley realizes her music is getting to her patient. She knows he isn’t feeling well, so she picks music that won’t overwhelm him. She starts with a short piece that begins on a note that’s higher than expected. That gives McGee a sense of suspension, she said. Gilley says it’s her way of offering a musical break after he had worked so hard to breathe. She switches to the Kyrie with minor tones designed to help him dig deep inside himself and release any pain or emotion he’s struggling with. The last piece she plays is a blessing, and she stretches and stretches the notes to calm him. As she finishes playing, the sun is setting over the treetops outside McGee’s window. His wife walks to his bedside, peers at him and then at the machine tracking his oxygen saturation level. All morning, the machine had beeped, warning that his levels were in the 70s. A normal oxygen level is 90 or higher. With music, his jumped from 88 to 93. Gilley approaches the bedside, checking his pulse and respiration. His pulse has fallen from 140 beats a minute to 100. She turns to McGee’s son and offers encouragement. “His respiration rate is a lot slower and deeper,” she said. “You can’t help but see it.” Gilley leaves the room, marveling at the outcomes. She wraps up her work and heads home for the weekend. But on Monday morning, she returns to Providence and hears unexpected news: Guy McGee died Sunday. “It just kind of blew my mind away,” she said, sitting outside the chapel awaiting her next referral for a harp vigil. “You never know about people. That’s why when you get the referral, you try to get there as soon as you can.”

Reporter Ann Potempa can be reached at 907-257-4581 or apotempa AT adn DOT com

© Copyright 2003, The Anchorage Daily News, a subsidiary of The McClatchy Companyimage
Reprinted with permission.

 


Created: February 23, 2003     Last updated: August 14, 2008

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