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SEEKINGABLESSEDDEATH:
TheImpactofMusic-Thanatologyonthe
MedicalCommunityin
Missoula,MT
Submittedby:
JudyA.Fay,ClinicalIntern
TheChaliceofReposeProject
Missoula, MT
Fall,1999
Copyright©1999JudyA.Fay
AllRightsReserved
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Doctorsarehealersofthebody;
Ministersarehealersofthesoul;
‘YouandIarecalled
Tobehealersoftheheart.
It ‘f.
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I.HYPOTHESIS
TheChaliceofReposeProject,Missoula,MT,isamusic-thanatologyinitiativeincludinga
palliative-clinicalpracticeandaneducationalprogram,thatassiststhedyingandtheirfamiliesin
thedyingprocesswiththeuseofmusic-thanatology, Music-thanatology,developedbyTherese
Schroeder-Sheker,employsprescriptivemusictolovinglyassistthephysicalandspiritualneeds
ofthedying.Ms.Schroeder-Shekerdescribesthisworkasacontemplativepracticewithclinical
applications.
"Fromitsinception,theChaliceofReposevisionhasbeentofindawayto
offerlovingservicetothephysicalandspiritualneedsofthedyingthrough
thedeliveryofprescriptivemusic,performedliveatthebedsideofthedying
person……inteamsoftwo,professionalstrainedasmusician-clinicians
cometothebedsideofeachdyingpatientandattendthemwithcompletely
uniquemelodicandharmonicsequencingandcontent. Thismusicis
analogoustocompoundmedicines,andnotwopatients,evenwithsimilar
diagnosesandprognoses,receivethesamedeliveries.Theprescriptivemusic
reflectstheconstantlychanging,dynamicphysiologicalconditionofthe
patientasevidencedbycontinuallymonitoredvitalsigns….Prescriptive'.
musicmeetstherealsituationofeachpatient,inmeasurableandperceptible
needsandsymptoms .•..•.Music-thanatologistshaveseamlessly
mainstreamedmusicaspalliativemedicine•.."(Schroeder-Sheker,pp,26-
27)
TheSchoolofMusic-Thanatology, theeducationalcomponentoftheorganization,pursuesa
widevisionandunderstandingofthenormaldeathprocess.Drawingonthewisdom
ofleadingmedical,nursing,religiousandethicsscholars,theSchooleducatesitsstudentsabout
thesocialconditions,medicalcapacities,theologicalbeliefsandethicalimperativesthatshape
ourquestforgracefuldying. Itsdistinguishedfacultyisdrawnfromthearts,sciencesand
humanities.Whiletheologyorreligiousstudiesarenottaught,historicalandanthropological
studiesofferdeeplyreligioustexts,especiallyfrommonasticmedicine.Inthemodempractice
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ofpalliativecareandmusic-thanatology, theneedsofeachdyingperson,regardlessofspiritual
orientation,mustbecaredfor.TheSchoolunderstandsspiritualitynotintermsofaffiliationor
non-affiliationwithreligiousinstitutions,butintermsofsourcesofmeaning. Spiritualityis
appliedinapracticalmanner,expressedthroughthemediumofmusicwithinamedicalsetting.
TheworkpresentedinthispaperhasevolvedoutofmyexperienceasastudentoftheChaliceof
ReposeProjectSchoolofMusic-Thanatologyforthepastthreeyears.Thecurriculum includes
foursemestersofclassroomworkinmedical, musical,academicandinner-developmentstudies.
Thefirstyearofcourseworkisfoundationalandthesecondyearbuildsuponthisfoundation
withaclinicalinternship.Iapprenticedwithprofessionalsinclinicalrotationsattendinga
minimumof60vigilstofulfillcertificationrequirements.
Itismyviewthatwe,asasociety, areinthemidstofmakingafundamentalchangetoagreater
levelofexperienceandunderstandingofthedyingprocess. Ratherthanlookingatdeathasthe
enemy,somethingtobeignored,thoseinvolvedinservicetothedyingthroughmusic-
thanatologycometomakedistinctattitudinalchangesinthewaytheyviewthedyingexperience.
Sincetheprogram'sinception, scoresofmedicalprofessionalshavebeenexposedtotheideas
representedbyCORPandtotheactualworkofmusic-thanatology atthebedside.Itismybelief
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thatthisexposurehasassistedthemasindividualsandprofessionals,tomovebeyondtheold
waysinwhichwehave vieweddeathanddying, intoafargreaterdegreeofhealthand
functioningwithinboththeirouterprofessionalworldsandtheirinnerpersonalworlds.
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PurposeofStudy
Thepurposeofthisstudyistwo-fold.1.ToassesstheimpacttheChaliceofReposeProjecthas
hadonthepracticeofmedicineandonthelivesanddeathsofpatientsinthecommunityof
Missoula,Montanainordertodeterminewhetherornotithasinfactchangedthewayinwhich
thedyingandtheirfamiliesarebeingtreated,and,2.Todeterminehowtheclinicalpracticecan
extenditselftothepracticeofmedicineinhospitals,geriatric,andprivatehomesinitsreferral
process.
RationaleoftheStudy
SincetherelocationoftheclinicalpracticetoMissoula,over2500death-bedvigilshavebeen
providedtothedyinginMissoula,MT.AccordingtoThereseSchroeder-Sheker,referralswere
initiallyobtainedfromonlyonereferringphysicianandonereferringnurse. Theprogramnow
hasover100referralsourcesincludingdoctors,nurses,chaplainsandothermedicalpersonnel.
Thebulkofreferralscomefromtheranksofphysiciansandnurses.Atnoothertimeinmodem
historyhastherebeensuchajoiningofmedicineandmusicinWesternculture. Theimpactof
thisco-existencehasyettobestudied.
Twentiethcenturymedicalprofessionalsaretrainedtocure.Insomanycaseswhencuringisno
longerapossibility,whenthephysicianhasexhaustedtheextentofhis/herprofessionalabilities,
theestablisheddoctor/patient relationshipends.Additionally,thetrainingofdoctorsandnurses
hashelpedformtheiroutlookondeathanddying.Traditionally,theirtraininghasitsrootsinthe
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traditionalworld-viewofmechanisticthought.Withinthisthought,"objects"areseenas
bundlesofenergy,four-dimensionalentitiesinspace/time ratherthanbeingseenasstaticthree-
dimensionalobjects.Inquantumreality,however,thereliesanunderstandingofadynamic
interplayofobject,aprobabilityofinterconnections,adefinedsetofrelationshipsthatreachout
toothersetsofrelationships.Quantumphysicshasledustoanewnotionofunbroken
wholenessthatdeniestheClassicalideaofanalyzabilityoftheworldintoseparatelyexisting
parts. Rather,matternowappearstobecompletely mutable.Particlescanbetransmutedinto
otherparticles;theycanbecreatedfromenergyandvanishintoenergy.Thewholeuniverse
appearsasadynamicwebofinseparableenergy patterns. (Capra,1976, p.80)
Withinthisframeworkofrelationsisinterwoventheconsciousnessoftheobserverwhostandsat
theendofalongprocessofpreparationandmeasurementinanyexperiment."Todescribe what
hashappened, onehastocrossoutthatoldword"observer" andputinitsplacethenewword
"participator.""Insomestrangesensetheuniverseisaparticipatoryuniverse." (Walker,p.244)
Fundamentally, thereisnoobjectivity orobjectivedescriptionofnaturepossible. Since,
however,theconsciousnessofthehumanobserveralwaysliesattheendpointofthelongchain
ofprocesses,thelinksofwhicharetheatomicphenomena(Wilbur, p.172),itcannowbesaid
thatanyfuturetheoriesofmattermustexplicitlyincludehumanconsciousness.
Inhiswork,"TheTaoofPhysics," FritjofCaprapointsoutthecoming togetheroftheviewsof
themodernphysicist andthemystic.Astheyexamine themechanisticappearanceofeveryday
life,onelookingdeeperintorealmsofmatterandtheotherlooking moredeeply intotherealms
ofconsciousness, theyarriveatparallelworld-views. AccordingtoCapra(1982), theyboth
shareseveralfundamentalfeatures.
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1.Theunityofallthings.Allphenomenaareinterconnected,interrelated,
interdependentmanifestationsofthesameultimaterealityandcanbe
understoodonlyasintegratedpartsofthewhole,notasisolatedentities.(pp.
130-31)
2.Theunityofopposites.Phenomenawhichappearcontradictoryor
irreconcilableareinessencedifferentaspectsofthesamereality;extreme
partsof.asinglewhole.(pp.145,151)
3.Space/time.Allspaceandtimemeasurementsarerelativesincespaceand
timeareultimatelyconnectedandinterpenetratinginwhathasbeencalleda
fourth-dimensionalspace/time continuum.
4.Thedynamicuniverse.Theuniverseisintrinsicallydynamic,manifesting
itselfinmultitudinousformswhichareinconstantmovementofbirth, death
andtransformation.
5.Emptinessandform.Emptiness(thevoidorthefield)notonlycontainsthe
potentialityforallforms,butalsobringsintobeing, sustains,andreabsorbs
theinfinitevarietyofformswhicharebuttransientmanifestationsofitself.
6.Thecosmicdance.Theuniverseisonecontinuousrhythmicebbandflowof
energy.
7.Interpenetration.Theuniverseisaninseparablewholewhereallformsare
fluidandeverchangingandharmoniouslyconnectedtoeverythingelse. The
propertiesofanypartaredetermined,notbysomefundamentallaw,butby
thepropertiesofalltheotherparts.(pp.290-91)
Allofoursciencesareinthemidstofthisshiftinperception.Astrictlyrationalconceptual
frameworkcannotbegintoexplainalllifeand,especially,deathexperiencesthatcaninclude
religiousormysticalexperiences.Itisnowincumbentuponmedicalpersonstotreatmorethan
symptoms,toparticipateinanotherwaywiththeirpatients,toviewthemfromasystems
approach.Toseethemaswholeandtorecognizethatdissectingthemintoseparateparts
destroystheirsystemicuniqueness.Healthinonearenaofaperson'ssystemwillbereflectedin
ameasureofhealththroughoutthesystem.Likewise,disorderwithinanyofthese
interconnectedfieldswillaffecttheentiresystem.Relationshipandintegrationbecomekey
emphases.ItisfromthisunderstandingthatIwishtoexploretheeffectmusic-thanatologyhas
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hadonmembersofthemedicalcommunityandhowithasaffectedtheirexperiencewiththe
dying.Howdoesmusic-thanatologyfitintothechangingtechnologiesthathaveimpactedendof
lifeissuesandhasit,infact,affectedorchangedthedyingprocessinMissoula,Montana?
SummaryandOverviewofRemainingChapters
Itispossibletoapproachdeathanddyingfromnewviewpoints,theoretical,phenomenological,
andexperiential,thatwillserveboththelivingandthedyingmoreeffectivelyandappropriately
thanthoseemployedatpresent.Thereismuchevidencetosubstantiatethatourcultureisnow
inthethroesofajumpintoaneworderofcomplexity andreorganizationthathasbeentermeda
paradigmshift;itispossibletoviewthecomplexityofissuesbroughttobearattheendoflife
fromthisnewperspective.
II.BackgroundtotheStudy, willcontainadescriptionoftheparadigmshiftand
thechangesinthewayourcultureviewsdeathanddying.
III.MethodologyandResults,willcontain anoverviewoftheinterviewsconducted
forthepurposesofthisstudyandd~lineatecommonthemesandissues.
IV.DiscussionandConclusions.
V. ImplicationsandRecommendationsforfurtherresearch.
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II.BACKGROUND TOTHESTUDY
Aparadigmisapatternforunderstandingreality.Whenthethoughts,perceptions,andvalues
thatformaperson'svisionofrealityundergoaprofoundchange,itcanbesaidthatone
experiencesaparadigmshift.Ourcultureandallinstitutionsalsoundergoparadigmshiftsas
theirexperiencesgrow,changeandexpand.Inphysicsthisisachangebeyondthemechanistic
viewoflifeintothesystemsviewoflife;inpsychologyitisanenlargementofthe
psychodynamic-behavioralorientationintoamoreholistic,transpersonalortransformational
psychology.
Viewedfromtheoldparadigm,deathpresentsuswithdifficultchallenges. Thehumanmindis
incapableofimaginingorperceivingitsnon-existence. Sometraditionsviewdeathasapurely
physicalevent,othersrecognizeitasaspiritualeventaswell.Deatheludesusandourabilityto
know.Itisaproblemthathasplaguedhumankindsincethebeginningoftime. Onethatcannot
be"fixed"noraddressedinthewayotherlifeproblemscanbe.Welongtoknowthisunknown.
Howcanwetranslatepersonaltruthintoapracticalpedagogy?Howcanwe
bringdoctors,patientsandtheirfamiliesfacetofaceinacommunityof
truth?Howcanwedeveloprealisticwaysofcaringforthedyingthatmove
ustoobedience,freedomandtruth?(Palmer,p.69)
Regardlessofhowourphilosophical,social,culturalorspiritualbeliefshaveimpactedour
attitudesaboutdeath,wecanallagreethatdeathisaninevitablepartoflife.Deathis"natural"
andexpectedforalllivingthings.Fromaholisticsystem,deathcanbeviewedasapartoflife,
perhapsevenanextensionorexpansionoflifeitself.Deathandthechaoswhichaccompaniesit,
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hasthepotentialofassistingustoachievehigherlevelsofintegration.Whenpresentedwiththis
perspectiveandtheopportunitytobemid-wifedthroughthistransformation,wehavethe
potential,theabilitytoassistthedyingandourcultureinexperiencingdeathinatotallynew
way,onethatresultsinanewlevelofhealthandwellbeing.Thefieldofmusic-thanatology
recognizesdeathasaspiritualaswellasaphysicaleventandrecognizesthepossibilitythat
healingwithoutcuringcanoccurforthepatient,forfamilymembers, orforhealth-care
providers. Healingintherealmofthesoulorinnerlife,notnecessarilyinthephysicalbody.
HowdoweconfrontdyinginAmerica? Dr.IraByockinaMissoulacommunityforumentitled,
"DyingWellinAmerica: What WouldSuccessLookLike?"stated, "Whatweknowaboutdying
isnotgood. Andwewanttomakeitbetter." Largewell-developedcultures, suchasours,have
lessdevelopedfuneraryanddyingrituals.Theindividualislefttomakethemupandtomake
theirwayonetheirown.Technologyhasforcedmanychangesinendoflifeissues.Dr.Byock
feelsthat"muchofourmedicalizedmisery isself-inflicted" theresultofwhathecallsa
"collectiveculturaldenial"ofthedyingprocess. Hesuggeststhatwebegintoaddressthis
psychologicalblockbylisteningtothestories ofthosewhohavediedwell. "Storiesarethe
seedsofourcollectiveimagination. Awayforustoreintegratedyingintotheprocessofliving."
Inaddition, accordingtoByock, wemustadoptamore holistic,interdisciplinaryapproachtothe
dyingprocess, onethatmeasuresnotonlyhowtheindividualisserved,butalsothefamily and
thecommunity atlarge. "Ournewdefinitionsmust includeawiderangeofstandardsthat
incorporatethephysical,psychological, economic, andspiritualwelfareofeveryone involved in
thedyingprocess. "Thevisionweshouldstrive forisoneofpeoplebeingbornintothe
welcomingarmsofacommunity anddyingfromthereluctantarmsofacommunity." (Byock,p.
3)
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Iampersonallymotivatedbyadesiretoassistinpositivelyaddressingthemyriadissues
associatedwiththedying,particularlyastheyconcernourmedicalprofession.Ihopetoassist
inreconcilingtheestrangementandalienationthatexistsbetweencare-giversandthosethey
serve,betweenthedyingandtheirfamiliesandthelargercommunitiesinwhichtheyliveand
die.Spiritualtraditionclaimsthattheoriginofknowledgeislove.Thisisourspiritualheritage
anditiswiththisspiritualintentionthatIentermyinterviewprocess.
"Themindmotivatedbycompassionreachesouttoknowastheheartreaches
outtolive.Theactofknowingisanactoflove,theactofenteringand
embracingtherealityofanother,ofallowingtheothertoenterandembrace
ourown."(Palmer,p.8)
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III.METHODOLOGY
Theparticipantsweremedicalprofessionals,nursesandphysicians,whohadexperiencedthe
workoftheChaliceofReposeProjectastheycaredforthedying.Theywereinitiallycontacted
bytelephoneandaskediftheywouldbeinterestedinparticipatinginthisstudy. Ifthey
indicatedawillingnesstodoso,aface-to-faceinterviewwasconducted.
Informationgatheredwasbothstatisticalanddescriptiveinnature.Theresearcherlookedfor
patternsorthemesinthedatathatmightallowforconclusionstobereachedorgeneratefurther
research.
Feelingtheneedtopursuethisstudywithatleastafewassumptions,Iproceedinghopingthat
theeducation,clinicalexperience,professionalandpersonalchallengesandmedicalexpertiseof
thesevenprofessionalsIinterviewedwassimilaroranalagoustotheircolleaguesthroughoutthe
UnitedStates.Furtherthattheexperiencesoftheintervieweeswoulddifferdependinginlarge
partonthenumberofvigilsattendedandtheirlevelofinvolvementinthevigilprocess.
However,Iquestionwhetherornotthereisanyrealitybasetothisassumption. Universities
frequentlyundergocurriculumrevision. WouldIfindamarkeddifferencebetween50-60year
oldphysiciansand30-40yearoldphysicians?Isthephysicianboardcertifiedinoneormore
disciplines?Thediversityinnursingspecialtiesisvast.What,ifany,differencesexistin
trainingfromonesub-specialtytoanother?
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—.— —–_. – ._—- —- —– -' –.—-~~-=–…:…. .
THEINTERVIEWS
MyresearchinterviewswereconductedsolelyinMissoula,Montanaandincludedfourfemale
nursesandthreemaledoctors,allwhite.Theiragesrangedfrom29to48.Theseven
questionnairerespondentsreceivedtheirmedicaltrainingoveratwentyyearspan,1972-1992.
Withoutexception,noneoftherespondentsIIIthissurvey,physiciansornurses,received
thanatologycoursesintheirtraining.
"It'sveryunfortunatebecausewhenIfirstcamehereIhadahardtiurewith
it(death).Myfirstinclinationwastosay,'Oh,you'regoingtobefine,' and
leavetheroom.Icouldnotcopewithitatfirst."
"….itisamazingtometothinkback…weneverreallyhadevenalecture
thatIcanrecallonhowdoyoutalktosomebodywhohasterminalillness?
Whatdoyoutellthem?Howdoyoupresenttheinformation?I'veread
articlesalongthewayandfigureditout…butitwasn'tapieceofeducational
information."
Ialsodiscoveredthatspiritualitybeennotaddressedforthemselvesasaclinicianorfortheir
patients.Twoelectedtotakeclassesinwhichspiritualitywasaddressedbecauseoftheir
personalinterestinthesubjectandoneindicateditwastoucheduponinanethicsclass. In
addition,accordingtotherespondents,nothingintheirtrainingassistedtheminaddressing
spiritualityandtheirpersonalreligiousidentity.
"I'dcertainlycomeincontactwithteachersandpatientswhoI'velearned
fromintermsofhowspiritualityplaysaroleintheircare,intheirrecovery
ordyingprocess,butIneverhadanykindofformaltrainingintermsof
thoseaspectseitherinmedicalschoolorresidency."
"….1haveIthinkafairlystronggroundingspirituallythat'sanimportant
partofthewayIlookatmyexistenceandlookatwhatIdo…..Thereare
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variouswaysthenthatthespiritualaspectofcareariseswithdifferent
patients. Sometimesit'sveryobvious,someonesays'praywithme'.More
frequently it'smoresubtle,yousomehowcometohavingakindof
conversationwiththepersoninthataspectoftheirlife….•whatthey're
experiencingintermsoftheirillness,…wheredotheygotochurchorwhat
istheirspirituallife,andhowdoesthatinteractwiththeirsociallifeand
howmightthatsupportthem…Itfrequentlyarisesinasettingwherea
personisscared,likeillness,…andobviouslywhenpeoplearedyingitcan
arise.So…Ithinkthephysicianhastobeopentoandwillingtotapintothat,
useitaspartoftheprocess."
"Ithinkitcomesoutinoccasionalsettings.Isuspectthatsomeofthe
medicineandhumanitiescourseshavefocusedonthis.It'snotlikecatching
somebodyinthehallwayandtalkingabouttheclinicalaspectsofthings,it's
notsomethingyoushareanditmakesyouuncomfortable."
Inre-countingtheirfirstexperiencewiththedeathofapatientasapracticingnurseorphysician,
thoughthesituations variedseveralcommonthemesemerged.
"SomeonehadarrestedandweweredoingCPRandIhadhadhimasa
patientforacoupleofweeks…..wecouldn'tbringhimback, yourworkis
supposedtobebringingthembackandsavingthemandwecouldn'tdo
anythingaboutit…..andtryingtodealwiththefamilywhowasn'tdealing
wellwithit.Itwasvery,veryhard."
"…itwasapatientduringmyfirstyearofresidencyofmedicinerotation.
HeknewthathewasgoingtodieandIstayedatthehospitalthatnightand
didclinicalthingstotrytohelphim.Inretrospect,therecouldhavebeena
lotofotherthingsthatIcouldhavebeendoingthatwouldhavemadethis
experiencemorecomfortable,butitwasarealfeelingofpowerlessnessand
futilityofwhatIwasabletodoandnotdo.Thefeelingoflossthenext
morning,thefeelingofexhaustionoverthatexperience….(it)leftafeeling
of'whatcanwedo',Imeanthere'snothingtodo."
"MyfirstexperiencewaswhenIwasanintern•..itwasverytraumaticfor
me….therewasanarrest,shewasunresponsive,shewasblueandshedied.
Buttheystartedresuscitatingherandtheyaskedmetoputajugularlinein.
…soheretheyarebaggingher,givingcardiaccompression.Butwhatwas
theworstwastheykeptgoingatherfor45minutesandIwasappalled."
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"TheonlythingIreallyrememberisthesmellintheroomandhavingthe
familyreallykindoftearintome…'mymother'snotasackofpotatoesand
youjustcomeinhereandturnheroverlikeaninanimateobject'.Andsoit
wasfairlynegative….itwasunpleasantforeveryoneinvolvedandthe
familyhadahardtimecopingwiththiswoman'sdying."
Astherespondentsre-countedtheirfirstexperienceofdeathwiththeworkofmusic-thanatology
present,aqualitativelydifferentexperiencewasdescribed.
"Inintensivecarewehaveeverythingonmonitors,youcouldmonitortheir
respiration.Youknow,ratherthanjustseeingthepatientquietdownand
thefamilygettingmorecalm,youcouldactuallylookatwhatyou'redoing,
lookatthenumbers.Bloodpressurewouldcomedown,respirationwould
comedown,they'dbecomemoreshallow.Painmedicationswereminimal.
Whereyouweregivinglotsandlotsofmorphine,itdidn'trequireasmuch."
"…therewerelotsofpeopleinthissmallspace.Thepatient'sdeathhad
beenimminentforawhile.Weknewforaperiodofacoupleofdaysthat
thiswascoming.Wemadethedecisiontostoptreatments..•.Thepresence
ofamusician-cliniciandoesacoupleofthings.Oneishowthepresenceof
thatteamreallyprovidesacalmandsoothingatmosphereforeverybodyin.
theroom,justseeingeverythingquiet,peopleseemtorelax,theirdemeanor
changesabit.It'snotthattheydon'tstillcryandexpressgriefbutitseems
tohappeninadifferentwayandIthinkithelpsthetransition."
"…itwasjustamuchmorepeacefulfeelingandthefamilywascopingmuch
betterandgrievingmoreappropriately.Idon'twanttosayit's
inappropriatetobemadeatthecaregiversbut,youknow,grievingand
supportingeachotherinamorepositiveway.Dealingwithwhat's
happenlngratherthanlookingforblameandangeratthesituation."
"…there'sonlysomuchthenursecandointermsofthephysicalpainand
givingmedicineandposition.Youreachapointwhereyoufeellikeyou've
doneeverythingyoucando,kindofhopelessorfeelinghelplesstodoany
more.Music-thanatologyhasawayofoffering,ofbeingabletogivemore,
tryingtoprovidemoretothefamilybeyondwhatIcoulddoasanurse."
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Respondentswereaskedwhat.theywantedtohavehappenatthevigil,whattheirexpectations
were,andwhetherornotitorsomethingelsehappened.
"…shewassoanxiousandsorestlessandalwaysinpainthat…inthebackof
mymindIwasthinkingthiswouldhelpherpassmorequickly.AndIthink
thatwasprobablymyhopethatthiswouldspeedtheprocessupandshe
wouldquietdownwhichIthinkitactuallydid.And,oddlyenough,it
coincidedwitharelativeshowingupatthatsametimewhoshehadbeen
waitingforandshediedwithinanhour."
"IthinkthemainthingIwantedtodowastoleavefamilieswithasenseof
thisnotbeingapurelyhospitalclinicaldeaththattheywerepartof,that
therewassomehumanisticaspectsofwhathappened….it'sforcomfort,it's
forcomfortofthefamilyandcomfortofthepatient."
"Thispatient'spainwasa45,onascaleof1-10!Iwantedhertoreceive
reliefforherpain.Sheabsolutelygotwhatsheneeded."
"..•initiallyIwasalwayskindofafraidthatthepersonwasgoingtodie
duringthevigil.Notthatthatwouldbebad.IThat'swhatIexpectedto
happen."
"Myintentionwastooffersomeemotionalreleaseortherapytothefamily
andthepatient.Alsotoenhancepaincontrolforthepatient,thephysical
paincontrolorforpeoplewhohaverespiratorydistress."
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Whenaskediftheirexperiencewiththemedicalmodality ofmusic-thanatology changedtheway
theytreatdyingpatients,allrespondentsanswered'yes'.
"Ithinkthemainwayit'schangedisthatusingmusic-thauatulogyisOUtof
thefirstthingsthat'sonmylistofthingstodo.That'sprobablytheprincipal
wayinwhichit'schanged.It'sinmytoolboxnowandIpullitoutquickly."
"Ithinkithelpedmedealwiththem(patient'sfamilies)bettersoprobablyin
turnmydealingwiththembetterhashelpedthepatientinthatindirect
way."
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"…1feelbetterthatthemusichelpsthem.Iknowthepatientisfeeling
betterbecausewhenIcanseeonthemonitorthatthey'renotasanxiousand
they'redealingwiththisbetterandphysiologicallythey'rehandlingitbetter,
Ifeelbetter.IfeellikeI'vedonesomethingbyhavingthatprocessstarted.I
thinkit'salwaysagoodsuggestionandithelpsme."
"I'mmuchmoresensitive.You(anurse)getde-sensitizedbecauseit'seasier
thanbecomingemotionallyinvolved.I'mmorewillingtotouchthe
emotionalwhichmostpeopleinthefielddon'tdobecauseit'stoohardto
bondemotionally."
"Iusemusic-thanatologyalotincrisistimesattheHospiceHousewhen
nothingelseisworking….therewasadominoeffect.Byhelpingthepatient,
ithelpsthecaregivers."
"I'veseenpeopleincomasreallyrespondtothemusicwhichmademe
realize,taughtme,thatthere'salwaysapersonthereuntiltheveryendno
matterwhat.Iwouldsaythatitchangedmetonotforgetthepersonisthere
andso,ifit'snotChalice,Ihavesomesoftmusicplayingintheirroomor
make' surethatI'mgoinginandholdingtheirhandandtouchingthemand
talkingtothemstillandencouragingthefamilytodothatinsteadofjust
havingthissterilequiet."
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"Itwasdefinitelymusic-thanatologythattaughtmeapersonwillstill
respond.Wejusthavetobetrainedtoseethosechanges."
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"Itrulybelievethattheprocessofmusic-thanatologyhaschangedthewayI
lookatmypatients,changedthewayIlookattheirfamilies,changedthe
wayIviewthedyingprocessandwhatneedstohappenforagooddeath.
What'smyrolehere?Insteadofjustgivingmedications,Icanbeanactive
participator,takeanactiveroleinsteadofbeingpassive,bewillingtorisk."
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WhenaskedwhetherornottheyroutinelycalledtheChaliceofReposeclinicalofficeandmade
areferraltoChalice,itbecameapparentthatmedicalprofessionalscanusemoreinformation
aboutthereferralprocess.
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"Icouldusemoreinformationabouthowyouwouldlikeconsultationsto
occurwithsomeonewhosedeathisn'tgoingtooccurforawhilebuta
referraltoChalicemaybeveryappropriate."
"I'mnotsurehowtomaketheorder.Inotherwords,Icanorderthe
morphineeveryhour.ShouldIordertheChaliceeveryday?ShouldIlet
youfolksdecidethat?Withsomepatientsitwouldprobablybehelpfulto
havethatrepeatedvisitbutI'mnotsurewhattherighttimingis."
"Istherea24hourcall?Isanyoneoncallwhenthenightshiftbeginsafter
8:00p.m.?"
"Iwishtherewasmoreavailabilitywiththosepeoplethroughthenight."
"Whopaysforthevigils?"
"Canapatientwhohasnofamilyhaveavigil?"
"Asanurse,canIrequestavigildirectlyordoestheattendingphysician
needtomaketherequest?"
Therespondentswereaskedabout-their understanding oftheprinciplesofprescriptivemusic.
Allaremusicloversbytheirowndescriptionandthreearemusician-physiciansornurses.
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"Ihaveaverygoodsenseofhowit(music)fitsintowhatIdoandhowitis
beneficialtomypatients.Butifyouaskmerightnowhowthemusicworks,
Idon'tknow."
"I'venevereventouchedonanythingaboutthem(musicprinciples)…I
reallyhadnoideaoftheintensivetrainingyougothrough."
"Ihadbeentold(thatprescriptivemusiccouldhaveanimmediate
physiologicaleffectonthepatient)butIdon'tknowthatIreallybelievedit
untilIexperienceditinpractice."
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Whenaskedaboutthemostsignificantpersonalchallengefacedbyanurseorphysiciantreating
aterminallyillpatient,thefollowingresponseswerereceived.
"Probablydealingwiththefamilies,theemotionsoffamilies.Oftryingnot
tocrymorethantheycrywhichisn'talwayseasy."
"Thespiritualbattleofthepatientiftheydonothaveasystemofbelief,of
faithwhichwillsupportthem."
"Well,I'mnotsureifit'sthesamewitheverypatient.Notuncommonly,it's
gettingacrossthatbridgeweweretalkingabout. That'saverysignificant
partofdealingwithterminalillness.Sometimesit'stotryfacilitatingthe
processofpeoplehavingsomeclosurewithongoingdisease.Sometimes,it's
purelypractical. .•.howarewegoingtodealwiththisseverepainorthis
problemorthisulcer?Frequentlythere'sacomponentofeachandone
becomesmoreprominent."
"Tellingthefamilytheirlovedoneisdyingandhelpingthefamilyacceptthe
terminalnatureofthediseaseprocess."
"Compassionaterestraint."
"Thefamilydynamic.Thereisaphenomenalamountofworktobedone
withthefamilyofadyingpatient."
Incontrast,respondentswerealsoaskedwhattheirmostsignificantprofessionalchallengeis
whentreatingaterminallyillpatient.
"Withoutadoubt,easeofsuffering.Painrelief."
"Myfirstresponsibilityistoprovidethemwithenoughinformationand
goodresourcestoallowthemtodiewithdignity."
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"Itissometimesagreatchallengetoreconcilewhatthepatientwantsand
needswithwhatthefamilywantsandneeds.Sometimesthosethingsaren't
compatible."
"…tryingtobeobjectiveenoughtosuggestthingsthat1asaperson,if1was
relatedtothem,wouldwanttosuggest.Thingslikewithdrawingsupport,
youroptions.Addressingwithdrawalofsupportisthehardest."
Finally,respondentswereaskedwhattheyseetheirfirstresponsibilitytoadyingpatientisasa
medicalprofessionalandwhetherornotmusic-thanatologyoffersthemassistanceinmeeting
thisresponsibility. AllnotedthatthepresenceofChaliceworkerswasadvantageoustothemin
theircareofthedying.
"Myfirstresponsibilityistobecompassionate.Yes,music-thanatology
assistsmeinthisprocess.Italsoassistsinfamilyreconciliations."
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"Probablymakingitaslesspainfulaspossible,comfortable,secure..•.1
definitelythinkitdoes(assist)becauseIcanwatchmyendgoalforthe
patientmetwhentheyareplayedfor.1canseethatgoalbeingmet."
"Missoula's reallyaniceplacetobeintermsofdeathanddyingbecause
there'ssomanyresourcesavailable.We'vegotthisgreatdepthofresources
thatmakeitmucheasiertotakecareofdyingpatientsthanifyouwereina
smalltown.It'sagreatblessingtohaveaprogramliketheChaliceof
ReposeProject."
"Meetingphysicalcomfortneeds,emotional supportandhealing,easingthe
emotionaldistressofthefamily.Yes,music-thanatologyaddressesall
spheresofcareneeds."
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"Myfirstresponsibilityisfindingoutwhatisimportant tothem,whattheir
concernsare.Iftheyareconcernedaboutthephysicalpain,then1canhelp
them.Butifthey'rescared,it'sfindingoutwhattheirissuesareand
addressingthem….theyareherebecauseofpainbutitmightnotbebecause
ofthetumor.Itmightbetheyhaven'tsleptinfourdaysbecausetheyareso
scared.Music-thanatologyhelpsbecause1thinkmoreoftenitsnotthe
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physicalneeds.ThispartIknowIcanhelp.It'sthebiggerstuff…saying
'goodbye'toyourfamilyandyourfamilysaying'goodbye'toyouthatIhave
ahardtimedoingbymyself.Sothemusic,thechaplain'ssupporthelpsthem
findpeace90%ofthetime.WhatIdoforthemphysicallyisminimalwhen
itcomestodying."
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IV.DISCUSSIONSANDCONCLUSIONS
Theclinicalpracticeofmusic-thanatologyaspracticedfromtheendofDecember1992tothe
presentinMissoula,Montanahasplayedasignificantroleinthedyingprocessofover2500
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dyingpatientsandtheirfamilies,friendsandmedicalsupport;staffphysicians,nurses,social
workersandchaplains.
Ithasestablishedaroleforitselfwithinthemainstreampracticeofclinicalmedicineinatleast
threepsycho-socialsettings: thehospitals,nursinghomesandprivatehomes. Moreover,music-
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thanatologyisacceptedasamedicalmodality. Allmembersofthemedicalcommunity
interviewed withinthecontextofthisstudyrecognizeandhavebeenimpressedwiththebenefits
theirpatientsreceivedduringavigil. Ithasansweredaneedandacalltoprovidepatientsand
theirfamilieswithcarethatrecognizestheiruniquenessasaperson,notasadiseaseprocess.
ThemissionstatementoftheChaliceofResposeProject'sclinicalpracticereflectsacorevalue
ofpalliativemedicine,theacceptanceofdeathintothefullnessofthelifecycleispromotedwith
intimacy,reverenceandbeauty.Practicallyspeaking,patientsandtheirlovedonesareoffered
comfortandcarewhenmedicaltechnologyhasnothinglefttooffer.Thisthemeisfurther
imbeddedinthemindsandheartsofthestudents oftheSchoolofMusic-Thanatology.
Itinvitestheprimarycaregivers,includingphysicians,nurses,chaplains,and
interdisciplinaryteammembers,awaytoparticipateinthefinalgoodbye,
andtodosoinadeeplycommittedandemotionallyavailablemanner.Itis
particularlybeneficialatavulnerabletimeinaperson'slife,whentheyare
mostsusceptibletofear:fearofdeath,fearsofabandonment,disfigurement
andofbecomingaburden.(Schroeder-Sheker,p.29)
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Theintentionofassistingpatientstoagood,consciousorblesseddeathexpressedbytheChalice
ofReposeProjectallowsanopportunityfortheterminallyilltoenterdeeplyintotheprocessof
dyingbyprovidingthemwiththeoptionofavigil.
Whenweareatourbest,wecanhelptotransformtheintensivecareunitin
thehospitalintoasanctuaryforlife'scompletion."(Schroeder-Sheker,p,
29)
BarbaraMeyerhoffin"RememberedLives"describesa"GoodDeath"asfollows:
Agooddeathgiveschoiceandsupport.
Agooddeathincorporatesspirituality,bydefiningmoreclearlythe
experiencewhichrunsthegamutofqualitiesdescribedbybothsouland
spirit.
Agooddeathhasthegoalofinnerhealing,definedas"wholeness,a
processorreconnectionwhichpresupposesaprimalwoundedness,which
isnotauniversallyacceptablemodel.
Anewmodel:growthanddevelopmentattheendoflife.
Containsqualitiesofgrowthandtranscendentfunction
Thoughourattemptstounderstanddeathareflawedbyourmind-madestructures,wecontinue
toseekthetruthaboutdeath.Theintentionofassistingpatientstoagood,consciousorblessed
deathexpressedbytheChaliceofReposeProjectallowsanopportunityfortheterminallyillto
enterdeeplyintotheprocessofdyingbyprovidingthemwiththeoptionofavigil.
Whenweareatourbest,wecanhelptotransformtheintensivecareunitin
thehospitalintoasanctuaryforlife'scompletion."(Schroeder-Sheker,p,
29)
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Ourmedicalprofessionalsareaffectedbysocialconditioningandfurtherbytheireducational
experience. Physiciansandnursesreflectthemethodology,pedagogyandpracticeofthelate
20thCentury.Themedicalprofessionalswhoparticipatedinthisstudyarewithoutexception
individualswhopossesstheabilitytoletgoofanypre-conceivednotionstheypossessedandbe
willingtoexploreandconsidernewoptions.TheypossesswhattheSchoolofMusic-
ThanatologyfacultymemberKenThorp,M.D. calls"ObediencetoTruth," theabilitytofollow
Truth,tolistenwithadiscerningearandtorespondfaithfullytotheimplicationsofwhatone
hears. Individuallyandculturally,weneedindividualstrainedinsciencethatcanalsowrestle
withendoflifeissues. Weneedtheuseofboththeeyeofthemindandtheeyeoftheheart. We
need'whole'sight,avisionoftheworldinwhichmindandheartuniteinordertotransformthe
experienceofdyinginourcountry. "
Wecannotforsakeourheartsnorcanweabandon ourminds.(Palmer.P.7)
Anthropological researchrecognizes fieldworkandethnographyaswellascultureaspartofits
discipline.InThinkingAnthropologicallyAliceReichsays,"Ourtaskaslearnersistoknowthe
tellersaswellasthetold. Tobeengagedbothasaparticipantandasanobserverandwe
recognizethatthoughweareshapedbyculture,weareincollaborationwithothers,actively
responsiblefortheworldwearemaking. (Reich,1994)
AsImovetowardcertificationasamusic-thanatologist, Ianticipatereturningtomyhometown
andbeingasolepioneerinthisuniqueareaofpalliativecare.Igoforwardwiththeinformation
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Ihavegatheredfromthisstudy.Iamacutelyawareoftheneedtoeducateothercliniciansabout
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themodalityofmusic-thanatologyandhowitcanbeofservicetotheminthecareofthedying.
AsIformulateaprogram,perhapswithinanexistingagency,Iwillworktomakevigils
accessibletohealthcareprovidersandparticipantsandtoeducateothersaboutthebenefitsof
music-thanatologyatthebedsideofthedying. AsaresultofthisstudyIunderstandthat
outreachisanecessaryandvitalcomponentofthepracticeofmusic-thanatology. Medical
professionalsarefacedwithuniqueproblemsastheycareforthedying.Iamcommittedto
providingthemandthosetheyservewiththeuniquesupportaffordedbytheuseofthemodality
ofmusic-thanatology.
Thisstudyhasgeneratedanumberofquestionsforme.Iwonderabouttheroleofgenderin
affectingperception. Inretrospect,Iwouldhavebeenmorespecificinmyinterviewquestionsin
orderdiscernanddescribegender-relatedissues.
Someofmyintervieweesweremusicianswhileothersindicatedtheyenjoyedmusic thoughdid
notconsiderthemselves"musical". Iwouldbeinterestedinfurtherexaminingtherolemusic
playsinthemusician-clinician'spracticeofmedicine.Further,whatrolecanmusic playinthe
mannerinwhichmedicineispracticedinthefuture?
Thelackofeducationand/or trainingintheareaofthanatologyforthosemedicalprofessionalsI
interviewedastoundedme!Withoutexception,every medicalprofessionalIinterviewed
wrestledwiththeissueofspiritualitypersonally andprofessionallyastheycaredforterminally
illpatients.Noeducationalformatwasprovidedforthemthatfacilitatedpersonalexplorationin
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Thelackofexploration,educationandtrainingintheareaofthanatologyforthemedical
professionalsIinterviewedastoundedme!Withoutexception,everymedicalprofessionalI
interviewedwrestledwiththeissueofterminalillnessinbothapersonalandprofessionalway
astheycaredforterminallyillpatients.Noformatwasprovidedforthemintheireducational
experiencethatfacilitatedpersonalexplorationinthisareaorprovidedinformationgleaned
fromthepracticeofmedicineandtheexperienceofmedicalprofessionalswhohadgone
beforethem.
Spirituality,itsroleintheexperienceofdyingandinthepracticeofmedicineanditspractice
inthelivesofpatientsandmedicalprofessionalsisanequallyvast,unexploredarenainthe
educationofmedicalprofessionals.' Morestudyisneededinordertoassessthevalidityand
needformedicaleducationalinstitutionstoincorporatethestudyofspiritualityintotheir
curriculums. Ourmedicalschoolsshapethosemostcloselyinvolvedinthecareofthedying
andtheirfamilies.Ourearlymedicalinstitutionsrecognizedthevalidityofspiritualityin
medicalwor. CurrentlyWesternscienceanditspurelyscientificviewpointare
incompatiblewiththenotionofspirituality.Thisstrictlyscientificworldviewlimitsmedical
perceptionandsimplycannotexplainawaycertainpatternsandobservations. Futureresearch
isrequiredtodetermineandimplementwaystoimpactthecurriculumofourmedical
institutionstomoreadequatelypreparemedicalprofessionalstoaddressend-of-Iifeissues.
24
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Music-thanatologyhasbeensuccessfullyutilizedasanadjuncttocurrentpharmacological
prescriptionswithintheclinicalpracticeoftheChaliceofReposeProject.Iwonderwhatthe
implicationsareformusic-thanatologytobeviewedandusedmedicallyinthecareofthe
dyingasasubstituteforpharmacologicalprescriptions.Furtherstudyisnecessary to
determinewhetherornotmusic-thanatologycanbeutilizedandintegratedintothepracticeof
medicineinthisway.
WhatdoesaBlessedDeathlooklike?Whatcanbedonetoprovidemedicalprofessionals
withassistanceinhelpingindividualsandtheirfamiliesaccepttheterminalnatureofthe
diseaseprocess?Howwillweasaculturedeterminewhetherornotwehavebeensuccessful
inaddressingtheneedsofthedyingandtheirfamilies?ThefaceofdyinginAmericais
changing. Futurestudiesareneededtoexaminethechangingroleofmedicalprofessionalsas
theycareforthedyingandtopreparethemtomeetthenewchallengesfacingthem. This
informationwillhelpassureoursuccessinmakingthemoments ofonesdyinganexperience
thataddressesandintegratesthephysical,mental,emotionalandspiritualneedsofthedying,
theirfamiliesandallwhocareforthem.
25
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TABLE1:INTERVIEWSTAT'STICS
IntervieweeGender Age Position !Specialty
001 M 48 Physician Radiology
002 M 42 Physician GeneralMedicine
003 M 52 Physician Oncology
004 F 49 Nurse Hospice
005 F 40 Nurse CriticalCare
006 F 29 Nurse Hospice
007 F 38 Nurse CriticalCare
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BmLIOGRAPHY
Barnum,BarbaraStevens,SpiritualityinNursing:FromTraditiontoNewAge,
Byock,Ira,DyingWell: TheProspectforGrowthattheEndofLife.Riverhead,1997.
Byock,Ira,DyingWellinAmerica.MissoulaDemonstrationProjectUpdate,January1998.
Candib,LucyM.,WaysofKnowinginFamilyMedicine:ContributionsfromaFeminist
Perspective.FamilyMedicine.Vol.20,No.2, MarchiApril1988.
Capra,Frijof,TheTaoofPhysics.NewYork:Simon&Schuster,1975.
Capra,Frijof,TheTurningPoint. NewYork: Simon&Schuster,1982.
MyerhoffBarbara,RememberedLives:TheWorkofRitual,StorytellingandGettingOlder.
UniversityofMichiganPress:AnnArbor,1984.
Palmer,ParkerJ.,ToKnowAsWeAreKnown: EducationasaSpiritualJourney.
Reich,Alice,ThinkingAnthropologically.FortheChaliceofReposeProject, Autumn1994.
Schroeder-Sheker, Therese,ShapingaSanctuarywithSound:Music-ThanatologyandtheCare
oftheDying.PastoralMusic,February-March1998.
Walker, K.,AStudyofGurdjieff'sTeaching. NewYork: SamuelWeiser,1974.
Wilbur,Ken,TheSpectrumofConsciousness.London:TheosophicalPublishingCo.1977.
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