2011 Lyn Miletich – Theological Reflection: Enhancing the Spiritual Dimension of Music-Thanatology.pdf – Music-Thanatology Association International

Theological Reflection: Enhancing the Spiritual Dimension of
Music-Thanatology

Lane Community College Music-Thanatology Program

Professional/Academic Research Paper

Lyn Miletich
September 30, 2011

Acknowledgements:

My husband, Brian, for his unwavering support and belief in me throughout the
program and the writing of this paper
and
Jennifer Hollis, paper advisor extra-ordinaire

2
Theological Reflection: Enhancing the Spiritual Dimension of Music-
Thanatology

Summary: Music-Thanatologists are often employees or contractors within the Spiritual
Care departments of health care institutions. Theological reflection has long been part of
the training of chaplains. The inclusion of theological reflection to vigil narrative writing
can offer an additional spiritual dimension to the practice of Music-Thanatology and
increase opportunities for potential personal growth and development.

“Music thanatology is concerned with addressing the complex needs of the dying.”
1
~
Therese Schroeder-Sheker
Schroeder-Sheker’s definition of Music-Thanatology captures the concept in one
sentence. However, the simplicity of the sentence belies a systemic body of training and
knowledge for the practitioner in the field of caring for the dying and their loved ones. This
includes exploring ways that transcend the physical to also embrace the unknown and the
spiritual realms.
As founder of the Chalice of Repose Project, Schroeder-Sheker captured the elemental
root of an historical period when death and dying were viewed as holistic, rather than
compartmentalized. She adapted the 11
th
Century death ritual at Cluny to the modern world.
According to the monks at Cluny, care of the body and cure of the soul were of primary
importance, particularly at death. There is no separation or difference in the ways the dying were
tended. Schroeder-Sheker states, “Central to Cluniac spirituality was the understanding of the
human need for beauty.”
2
The focus was the “physical, emotional, mental or spiritual pain that

3
might impede or prevent anyone from a blessed death.”
3
Schroeder-Sheker gives detailed
accounts of the musical ways that the dying were tended. “The Cluny monastery developed a
series of infirmary practices concerning the care of the dying that predate palliative medicine by
800 years.”
4
In her article “Music for the Dying: A Personal Account of the New Field of Music
Thanatology—History, Theories, and Clinical Narratives,” she states that “if the monastic
infirmary was once both a sanctuary to complete the last stage of life and a gateway to a
conscious death, the pioneering field of music thanatology is working to provide such a palliative
art and science for patients again.”
5
Now, in the 21
st
Century, the original concepts of such care
are being taught, shared, refined and practiced in various health care settings and institutions,
often as part of palliative care or spiritual care departments. Music-thanatology is a professional
field within the broader sub-specialty of palliative care. It is a musical and clinical modality that
unites music and medicine in end-of-life care. The Music Thanatology Association International
website offers: “The music-thanatologist utilizes harp and voice at the bedside to lovingly serve
the physical, emotional and spiritual needs of the dying and their loved ones with prescriptive
music.”
6

There is a connection between the deathbed rituals at Cluny and the modern day practice
of music-thanatology. Both include a community of loved ones around the bed of the dying
patient while music is offered. The music is a grounding and unifying force for all present.
7

However, there are also differences. Jennifer Hollis, in her book Music at the End of Life: Easing
the Pain and Preparing the Passage, elucidates this even further: “Today music-thanatologists
can replicate neither the community of the monastery nor its intimately familiar musical
repertoire. Music-thanatology instead strives to engage in an even more challenging task—to
provide the same warmth, love, and intention of wholeness to strangers, using music that may be

4
strange to them. The music-thanatologist and the patient engage in a ritual that is mediated by the
music itself.”
8
She also states that music-thanatology “is both an art and a science, weaving
together medicine, music and spirituality.”
9

The art and science of weaving together music, medicine and spirituality is what first
attracted me to the profession. As a former hospital and hospice chaplain, I always desired to
bring music into my ministry. And as a musician I am attracted to using music in ways beyond
performance. For me, it is truly a calling or a vocation that demands a response. Hollis speaks to
this so beautifully: “When I understand myself to be a minister, contemplative music becomes a
vehicle of my ministry, and the work of music-thanatology becomes my vocation.”
10
These
could be my words as well. I discovered the fit in music-thanatology.
“We are not human beings having a spiritual experience; we are spiritual beings having a
human experience.” ~Pierre Teilhard de Chardin
11
It is no accident that a number of working music-thanatologists are within spiritual care
departments. In his book Out of Solitude, Henri Nouwen states that “to care means first of all to
be present to each other.”
12
The similarities in being present with and for the sick and dying can
be found in both professions. And in the process of training to be a music-thanatologist I noticed
another concrete similarity in the way the two professions document their experiences with
patients.
Clinical Pastoral Education students write verbatims (Appendix A) while Music-
Thanatology students complete Clinical Assessment and Narrative forms (Appendix B). Each
require information such as date, time, location of visit or vigil, age of the patient, diagnosis,
religious preference and other information about the encounter or vigil. At the first clinical
discussion I attended as a music-thanatology student I remember thinking that one of the main

5
differences between verbatims and clinical narratives was the lack of a reflective, evaluative,
theological or spiritual reflection at the end of a narrative. Otherwise I saw many similarities
between both exercises and quickly realized the value in completing clinical narratives as part of
the learning process.
Reflection requires us to slow down our processes of contemporary lives to take a closer
look at an experience and our framework for interpretation. Patricia O’Connell Killen and John
de Beer discuss this framework: “Theological reflection puts our experience into a genuine
conversation with our religious heritage.”
13
I would expand this beyond religious heritage to
include one’s philosophy of life or spiritual belief system. The Judeo-Christian model is only one
way among many to delve into the process of theological reflection. However, for the purposes
of this paper, I will use specific Christian references that spring from my personal faith tradition,
Roman Catholicism.
Robert L. Kinast speaks of theological reflection as “making faith-sense” and claims that
it is a new term for an ancient practice. Making faith-sense is what the early Christians called
mystical or wisdom theology. It was just a way of life for the early disciples of Jesus.
14
Kinast
states that “making faith-sense begins with experiences that have their own meaning and
value.”
15
Kinast goes on to say that “beginning with a factual account of an experience and
letting it reveal its own spiritual meaning on its own terms is a very incarnational approach to
life.”
16
This captures Teilhard de Chardin’s theory in the Phenomenon of Man that “we are
spiritual beings having a human experience”
17
and makes it come alive in new ways. Theological
reflection is intimately grounded in the fundamental human drive for meaning.
18

There is no one “right” way to do a practice of theological reflection. There are numerous
models of theory and practice. Killen and de Beer’s basic framework for theological reflection

6
includes “focusing on some aspect of experience; identifying the heart of the matter; putting the
heart of the matter into conversation with the wisdom of the Christian heritage; and identifying
new meanings and truths to take into daily living.”
19
In his article, “Models of Theological
Reflection Theory and Practice,” John Trokan identifies eight models or methods, each with its
own reference point.
20
One of those methods is by theologian John Shea who uses story to
“engage participants in examining the primordial truth of God in their experience and seeing that
experience in light of Christianity. There is truth in story.”
21
Again I would expand the concept
beyond God and Christianity to include one’s personal faith, spiritual belief system or
philosophy of life.
The majority of the Clinical Narrative and Assessment form includes a section for the
music-thanatologist to write a narrative which is devoted to telling the story of the vigil in its
entirety from a phenomenological stance. As Killen and de Beer state “for reflection that leads to
insight, we need to reenter our experience openly, so that it is fresh, slightly unfamiliar and thus
a potential source of revelation.”
22

“Musical-sacramental-midwifery is not merely a mechanical skill. Rather it is a
contemplative practice with clinical applications.”~Therese Schroeder-Sheker
23

The practice of theological reflection takes the vigil experience beyond the
phenomenological into a realm that could be termed a philosophy of integrated wholeness
wherein one’s reflection is viewed from the lens of spiritual beliefs and cultural systems. Killen
and de Beer: “Theological reflection therefore may confirm, challenge, clarify and expand how
we understand our own experience and how we understand the religious tradition. The outcome
is new truth and meaning for living.”
24

7
Questions will naturally arise from this process: What arose in me? How can I frame that
from my own life experience? Is there a sense of meaning, forgiveness, relatedness and hope?
And these are only a few.
There are numerous models for theological and spiritual reflection. None fit perfectly for
a process to use for music-thanatology but I would like to propose the following model. It
focuses on four main areas: the story, attention and intention, the theme of the vigil and insights
that could be of a personal, spiritual or theological nature. The questions attached to each section
are a springboard for reflection.
Story (narrative): Review the detailed account from the Clinical Assessment and
Narrative form. Re-read it, review it with new eyes. Pay attention and relive the experience. Be
the observer and go beyond the clinical aspects of the narrative. It might be helpful to write a
synopsis of the narrative as a way of “re-living” the experience.
Reflect on the music. What pieces of thematic material did you choose? Focus on aspects
beyond the prescriptive qualities or the musical elements. What were you thinking at the time in
choosing the music? Is there a new insight that arises now in this reflection?
Attention/Intention: Did I have a specific intention when I entered the room? Did I attach
it to an outcome or a goal? Where was my attention focused: patient, family, staff member, self?
Did I allow the patient to lead the vigil? If so, how? If not, what did I miss? Was my personal
agenda getting in the way?
Theme of the vigil: Is there a theme that arises within you when you reflect on this story?
Is there something that in one or two words may capture the experience? Examples are themes
around sacredness, silence, family, aloneness, suffering, seeking forgiveness, grace, etc.

8
Insights: Self/Theological/Spiritual: Reflecting on the experience in a theological and/or
spiritual fashion brings up the question of meaning. What does this vigil say to me? Is there
something I would say back? If so, what? How do I understand the identified theme (suffering,
grace, etc) from an emotional and spiritual perspective? How does God move with these
situations? Is God asking something of me as a response? If you come to some insight or place of
meaning, does it require a response? If you miss the meaning, why and how did you get off
track?
The following are two examples of using this process of theological or spiritual
reflection. The first is taken from a clinical narrative and the other is a vigil experience that was
not written for a narrative but is rich with experience and insight. Here are the stories.
Example #1:
The vigil: This is the first harp vigil for “Paul” an 87-year-old male patient hospitalized
with leukocytosis. He also has a history of altered mental status. Paul is alone in his room and is
outwardly unresponsive. The chaplain’s notes state that he is dealing with issues of wanting
forgiveness. My mentor and I mentally hold this information thinking that this may inform some
of our prescriptive choices.
We enter Paul’s room. Everything in the room strikes me as ‘white,’ including Paul’s
pale skin and stubble of hair on his head. He is lying in bed, on his back, with his eyes closed.
There is a nasal cannula in Paul’s nose and he is breathing with periods of apnea.
We greet Paul, and I notice his slightly furrowed brow. He stares at me intently when I
talk to him, though his look is vacant. He appears restless. After a few moments of silent
presence, my mentor offers a macaronic hymn (Deus Meus) in the Hypodorian mode with ¾
meter. She begins with her treble hand before adding a simple accompaniment. I double the

9
melody line and add an accompaniment as well. My mentor begins to hum. Many repetitions of
this metered offering with a narrow ambitus create a foundation opening a pathway revealed in
the translation of the words: “My God, help me. Give me your bright shining light, O Sun-like
one.”
25
Register changes up and down the strings of the harp add different layers of interest and
texture, opening additional pathways of entry.
Transitioning smoothly into an unmetered chant in a tri-partite form in the fixed Lydian
mode, (Kyrie de Angelis) we play antiphonally, surrounding and covering Paul with flowing
musical lines. The words, though not sung, are a plea for mercy and forgiveness. The suite
continues transitioning into another ¾ piece. The words are of praise and are sung to honor Paul
as well as to acknowledge the Divine. (Ehre) The short repetitive pattern lends itself to the
simplicity of the words before switching to singing “la” and then “o.” I enter with harp and
vocalize the “o” adding texture of warmth and depth.
My mentor continues moving back and forth among different registers. Without
interruption we return to the unmetered chant, offering melismatic lines inviting Paul to rest into
the undulating waves of sound. The suite concludes with a return to the first Hypodorian piece in
¾ meter. The entire suites mirrors itself: Major and minor, metered and unmetered – together
they create a container acknowledging both Paul’s inner process but also his going back and
forth from mostly outwardly unconscious to moments of waking to semi-consciousness as the
vigil progresses.
We sit in silence. I notice that Paul’s apnea is gone and his respirations are now regular
and wonder if the music had any effect. Being careful not to disturb Paul, and to acknowledge
his process, my mentor softly begins playing an unmetered suite in the Dorian mode (Ave maris
stella and Jesu dulcis memoria). The combination of the foundation set by one chant opening

10
with four repeated notes before dropping down a P5, juxtaposed with the rising melodic line in
the other chant, offers a wide ambitus creating a musical container that is simultaneously holding
and freeing. I play with her until she switches modalities modulating from minor to major,
offering a musical massage of waves of sound across Paul’s body.
Again we sit quietly observing Paul’s very regular breathing pattern as well as noticing
that his furrowed brow is now smooth. He appears to be sleeping more deeply, sinking into the
bed and pillow. Returning to a major, metered piece (Ro ho-ro ho) she begins slowly playing an
accompaniment pattern to a song of prayer. She then adds the melody line of the first four
measures in 4/8 time. The narrow ambitus of P4 and the stepwise movement of the notes with
fermatas at the end of each short phrase create a wide spaciousness. The addition of one
consonant and one vowel tone adds texture without disturbing Paul’s peaceful breathing pattern.
As she plays this simple accompaniment with phrases up and down the registers of the harp, I am
reminded of the intent of this sung prayer: a golden ray of light moving gently up and down,
offering solace to one who is suffering. How appropriate for Paul. My mentor plays in every
register and then modulates to a sub-dominant chord. The rocking motion created by these
cadences may offer rest for Paul in his spiritual struggles and a release from his bodily suffering.
I sit quietly, offering my silent presence. I hold the intent of the song. The “r” sound in
the first word of the sung-prayer creates movement leading into the sound and shape of “o”
which is warm and inviting. It embraces Paul, my mentor and myself in its wide circle.
The vigil concludes. We thank Paul for the honor of spending this time with him. Again
he opens his eyes and stares at me. I wonder what he is thinking and if his gaze is a way of
communicating his “thank you” to us. We gather our harps and quietly leave Paul’s room..

11
Story: The music is offered for rest and calm in the midst of Paul’s inner anxiety. He
wants forgiveness. Is this part of his outward anxiety? I am reminded of the meaning behind
some of the thematic material. Deus Meus is a petition for spiritual aid. The choice of Kyrie de
Angelis is a prayer and a plea for mercy: Lord have mercy, Christ have mercy, Lord have
Mercy…..upon Paul who wants forgiveness. Ro ho-ro ho calls down a golden ray of light which
moves gently up and down and from this illumination offers solace to one who is suffering. How
appropriate for Paul. Does the music offer comfort for Paul in his spiritual struggles and release
from his bodily suffering?
Attention/intention: Entering Paul’s room I wonder if we can relieve some of his spiritual
pain, especially that of wanting forgiveness, through the music we would offer. It certainly was
an intention. Would I even know if that happened? I realize shortly that we have no control over
what happens. Although I knew that I could not control the outcome, I had no idea if a music
vigil could help with this. How do I hold the balance with intention and not being wedded to the
outcome that I want to happen? It is a good reminder to be present and let the patient lead the
vigil.
Theme of vigil: wanting forgiveness/spiritual suffering
Insights: Self/theological/spiritual: What does it mean to “want forgiveness”? Is that
different from “seeking forgiveness”? Wanting forgiveness seems passive without action, just
desire. Seeking forgiveness is a very active stance. The concept of wanting forgiveness as
opposed to seeking forgiveness is an interesting concept. I wonder if the chaplain note is
accurate? Does it matter? Is Paul wanting forgiveness for himself? How often do I need to
forgive myself? Doing this work is a constant call to live in mystery. I am reminded of the
scripture, “The Lord is all merciful and forgiving.”

12
The vigil that I next relate both surprised and unnerved me. Music-thanatologists have
described seeing angels and other spiritual beings at the bedside during vigils. However, it is not
an experience that I desired. Although I was raised Catholic, and angels are part of that particular
faith tradition as messengers, it is not something that I held strongly or even believed. My
surprise was profound when I saw angels take form and shape in my experience in this next
example.
Example #2:
The vigil: “Jose” is a 70-year-old man on comfort care, outwardly unresponsive and
imminently dying. The referral to offer a vigil for Jose came from the chaplains and another
music-thanatologist. They visit him daily because he is totally alone. His family is most likely in
Mexico, and there is no emergency contact name listed in his chart. I wonder about his history
and his present condition. My mentor and I enter Jose’s room. I am immediately struck by the
sterility of the room and the brick wall outside his window.
Jose’s salt-and-pepper mid-length hair and dark beard contrast with the white sheets. He
is outwardly unresponsive and a soft gurgle emanates from his throat. The picture of him lying in
bed is almost iconic, representing an Hispanic portrait of the Christ figure. After the first piece of
thematic material, Salve Mater, I start crying. During Gartan Mother’s Lullaby, I can barely
sing. Tears run down my face; I need a tissue, but there is none to be found. My nose is running
uncontrollably. I do not know why I am crying. Maybe it is his aloneness during his dying
process that touches something deep within me. I grow calmer and resume playing, though I
cannot sing. Tears are still streaming down my face. I look at Jose and see a golden glow
surrounding him. It is larger than a halo and encompasses his head and torso with this brilliant
light. I notice two ethereal, translucently golden beings with outstretched arms, one on either side

13
of Jose. As I gaze at them I am reminded of artistic renderings of angels. They are kneeling by
his bedside, cradling Jose but not touching him. Jose and the angels are enclosed in this circular
cocoon of golden light. My mentor and I antiphonally play Kyrie de Angelis. The angels remain.
We are silent and then quietly leave Jose’s room.
Jose died about twelve hours after we offered the vigil. We were the last people to play
for him. I do not know if he was alone when he died.
Story: Jose is alone and imminently dying. We offer our presence and our music. Salve
Mater is a hymn to the Virgin Mary to be with Jose. Gartan Mother’s Lullaby reflects the
cradling in ¾ meter, again offering comfort. Kyrie de Angelis acknowledges the angels’ presence
and asks for mercy upon him. It is played antiphonally, offering a loving musical blanket.
Attention/intention: Be present and keep watch with Jose. Assure him he is not alone by
offering our music of harp and voice, and through our physical presence.
Theme of vigil: Aloneness; recognizing Christ in all persons
Insights: Self/theological/spiritual: What is it like to be dying, not surrounded by loved
ones but by strangers? Jose is dying and yet he is denied the warmth of human touch except
through hands that are encased in hospital gloves. As music-thanatologists, our offerings can
permeate the skin and offer touch to the soul through music. I weep for Jose; I weep for myself.
There is a part of me who saw my dad in Jose, though they do not look alike, and my father died
many years ago. My father is somehow present in this work yet I do not know how. The angels
at Jose’s bedside protect and comfort him, assuring Jose that he is not alone. I have never
witnessed angels or halos before in a vigil. How do I make “faith-sense” of that experience? It is
OK that I do not know right now. It is a process of listening to the small, inner voice. Maybe I
am afraid that I will be alone at the moment of my death and that is what touches me so deeply.

14
Christ assures us that we are never alone, even in times of death and despair. I pray that I will
remember and let my tears be a reminder.
These are just two examples of how the process of spiritual or theological reflection can
be applied to vigil experiences. This is only one format that can be expanded or adapted,
particularly for a non Judeo-Christian community. In a learning environment such as a music-
thanatology training program, the process of theological reflection can be included at the end of a
clinical narrative as a form of contemplative practice that may enrich the spiritual life of the
music-thanatologist.
This does raise the question of whether or not the practice of music-thanatology has a
religious or spiritual orientation. The Music-Thanatology Association International website
addresses this issue: “Music-thanatologists pledge to serve the physical, emotional and spiritual
needs of the dying, but the practice of music-thanatology is not carried-out under the auspices of
any religion. Spiritual needs may be addressed within or without the milieu of a religious
tradition, and acknowledging the inherent worth of each person and serving them with
unconditional love and attention is at the heart of the work of music-thanatology.”
26

The wisdom of this stance lies in its distinction between religions or religious traditions
and spirituality. Spirituality addresses questions of meaning, relatedness and hope which are
universal issues. On the level of religion, spiritual values are expressed in moral, philosophical,
and theological meanings. On the level of the spirit, spiritual values are often better expressed
through non-verbal, non-rational experience. As one patient told me during a vigil, “The music
makes me go inward.” Music-thanatology engages religious and non-religious people alike at the
level of the spirit.

15
One of the benefits of theological and spiritual reflection in vigil experiences is that it
builds a bridge with the field of spiritual care, which is particularly helpful to music-
thanatologists who work in departments of spiritual care. It deepens the integration between
spiritual care departments and music-thanatology with a common language. Furthermore, it
broadens and expands appreciation for an understanding of the two professional fields.
For the individual music-thanatologist, spiritual and theological reflection is a way to
engage in an on-going process of a deepened learning beyond musical ability and presence to
become increasingly more consciously spiritually connected to ourselves, others and a Higher
being.
Freedom is an essential aspect of the spiritual life. A possible result of theological
reflection can deepen that sense of freedom within us and keep us mindful of the movement of
the spirit. What does it mean to be spiritually free? And is that an important quality in the life
and being of a music-thanatologist? Diane Whalen, a Roman Catholic Womanpriest and a
spiritual director, defines spiritual freedom as “the freedom to accept that the mystery of my
existence can only be known in communion with others and Other. And that I can only get a
glimpse of that by trying to be as authentic and loving as I am able, believing that somehow, that
is enough.”
27
To be authentic and loving, and also to believe that somehow that is enough,
touches on who we are as persons and also on what we bring musically into the vigil.
Both ministry as a music-thanatologist and ministry as a chaplain requires one to be
comfortable with just “being” and not “doing.” What matters is attention and intention. Henri
Nouwen: “…to care means first of all to be present to each other.”
28
We only have the present
moment, who are we in that moment. Can I be free enough to be vulnerable and open to the
other?

16
After a vigil, and even sometimes during a vigil, I will notice some common themes that
arise, such as silence, beauty, sacred presence, forgiveness. Even without using a highly
structured method for reflection, just acknowledging the themes may offer pathways for new
insights about the vigil experience.
Questions I would ask:
 Is spiritual and theological reflection helpful?
 Can I create a practice of reflection that is more consistent with who I am and my
personal journey?
 Are there models of theological and spiritual reflection that are beyond the scope and
limits of the Judeo-Christian experience? If so, would that be something that I would
adopt? The answer to this question is outside the scope of this paper.

“It is only with the heart that one can see rightly; what is essential is invisible to the eye.”
~ Antoine de Saint-Exupery
29

1
Schroeder-Sheker, “Music for the Dying: A Personal Account of the New Field of Music Thanatology—History,
Theories, and Clinical Narratives” (1993): 36.
2
Ibid.
3
Ibid., 37.
4
Ibid.
5
Ibid., 38.
6
Music-Thanatology Association International website: http://index.php/what_is.
7
Hollis, “Music at the End of Life: Easing the Pain and Preparing the Passage” (2010): 25.
8
Ibid., 26-27.
9
Ibid., 13.
10
Ibid., 10.
11
Teilhard de Chardin, “The Phenomenon of Man” (1955). The quote is widely attributed to Teilhard, almost
always citing “The Phenomenon of Man” but without page citation.
12
Nouwen , “ Out of Solitude” ( 1974): 36.
13
Killen and de Beer, “The Art of Theological Reflection” (1995): viii.
14
Kinast, “Making Faith Sense: Theological Reflection in Everyday Life” (1999): ix.
15
Ibid., 22.
16
Ibid., 23.
17
Teilhard de Chardin, ibid.
18
Killen and de Beer, ibid., xi.
19
Ibid., 87.

20
Trokan, “ Models of Theological Reflection Theory and Praxis” (1997): 37.
21
Ibid.
22
Killen and de Beer, ibid., 24.
23
Schroeder-Sheker, ibid., 41. In the early years of her work Schroeder-Sheker used the term “musical-
sacramental-midwifery” to refer to the contemplative dimension of music thanatology, 42. The term
“music-thanatology” is now the descriptive name of all aspects of the profession.
24
Killen and de Beer, ibid., viii.
25
Doyle, “ Songs of Celtic Christianity:”(1995): paraphrased translation by Anna Fiasca (1999) notated on “Deus
Meus” sheet music handout for students at Lane Community College, Music-Thanatology Program,
2010-2011.
26
Music-Thanatology Association International website: http://www.mtai.org/index.php/faq.
27
E-mail correspondence with Diane Whalen, August 11, 2011.
28
Nouwen , “ Out of Solitude” (1974): 36.
29
de Saint-Exupery, The Little Prince, (1943): 87.

18
Bibliography

Anderson, Megory. Sacred Dying: Creating Rituals for Embracing the End of Life. Roseville,
California: Prima Publishing, 2001.
de Saint-Exupery, Antoine, The Little Prince, New York, New York: Harcourt, Brace & World,
Inc., 1943.
Doyle, Dennis and Doyle, Paula. Songs of Celtic Christianity. Glendale, California: Incarnation
Music, 1995.
Farley RSM, PhD., Sr. Margaret A. “Aging and Dying a Time of Grace.” Health Progress,
Volume 92, Number 1 (January-February 2011).
Groves, Richard F. and Klauser, Henriette Anne. The American Book of Living and Dying.
Berkeley, California: Celestial Arts, 2005.
Hollis, Jennifer L. Music at the End of Life: Easing the Pain and Preparing the Passage. Santa
Barbara, California: Praeger, 2010.
Killen, Patricia O’Connell and de Beer, John. The Art of Theological Reflection. New York, New
York: The Crossroad Publishing Company, 1995.
Kinast, Robert L. Making Faith Sense: Theological Reflection in Everyday Life. Collegeville,
Minnesota: The Liturgical Press, 1999.
Nouwen, Henri J.M. Out of Solitude: Three Meditations on the Christian Life. Notre Dame.
Indian: Ave Maria Press, 1974.
Nouwen, Henri J. M. With Open Hands. Notre Dame, Indiana: Ave Maria Press, 1972.
Nouwen, Henri J. M. The Wounded Healer: Ministry in Contemporary Society. Garden City,
New York: Doubleday & Company, Inc.
O’Donohue, John. Eternal Echoes: Celtic Reflections on Our Yearning to Belong. New York,
New York: HarperCollins Publishers, 1999.
O’Donohue, John. To Bless the Space Between Us. New York, New York: Doubleday, 2008.
Schroeder-Sheker, Therese. “Music for the Dying: A Personal Account of the New Field of
Music Thanatology—History, Theories, and Clinical Narratives.” ADVANCES, The
Journal of Mind-Body Health, Volume 9, Number 1 (Winter 1993).
Shaw, Ann Champion. “Till Death Do Us Part: Memoir of a Hospice Chaplain.” The Journal of
Pastoral Care and Counseling, Volume 63, No.1, 2 (2009).
Teilhard de Chardin, Pierre. The Phenomenon of Man. New York, New York: Harper & Row
Publishers, Inc. 1955, 1959.
Trokan, John. “Models of Theological Reflection Theory and Praxis.” Catholic Education: A
Journal of Inquiry and Practice, Volume 1, No. 2 (1997).

Websites:

Lane Community College Music-Thanatology Training, Eugene, Oregon
http://www.lanecc.edu/ce/music
Music-Thanatology Association International, Portland, Oregon

Music-Thanatology Association International

Sacred Art of Living, Bend, Oregon

HOME

Spiritual Directors International, Bellevue, Washington
http://www.sdiworld.org

19
Additional resources:
Rev. Dave Wendleton, CPE Supervisor, Evergreen Hospital, Kirkland, WA
Diane S. Whalen, Roman Catholic Womanpriest, Olympia, WA

Appendices
Appendix A: CPE Verbatim Template
Appendix B: Vigil Narrative Template

20
APPENDIX A: CPE Verbatim Template

Verbatim Report: Spiritual Care
CONFIDENTIAL

Chaplain: Date: Verbatim No.:

Care-seeker’s Initials/Pseudonym: Age:
Primary Support Person: Diagnosis:
Religion: Racial/Ethnic /
Cultural Info:

Date of
Visit:
Location: Length: Visit
No.:

1. The Preparation: Background/Initial Spiritual Assessment

2. The Care Plan
C= Chaplain P= Patient

3. The Spiritual Care Encounter
C1: Initial Greeting, etc.
P2: Patient Response (* Next exchange will be numbered C3, P4, etc.)

4. Reflection & Evaluation

5. Theological Spiritual Reflection

6. Ethical & Social Issues

7. Future Plans

8. Requests

21
APPENDIX B: Vigil Narrative Template

Lane Community College
Music-Thanatology Training
Clinical Assessment and Narrative Electronic Submission Form (eCAN)
Date submitted:

Intern:
CAN (Narrative) #:
Mentor:
Vigil Date:
Actual time:
Location: Hospital Nursing Home Private Home Hospice Facility ALF (other) Unit:
Referral Source:
Pt Vigil #:
Date of last vigil:
Consent By:

I- PATIENT INFORMATION
Age:
Sex: M F
Status: DNR DNI Comfort Care – Imminent Comfort Care – Processing Palliative
Care Hospice Supportive Care/Intervention Other
Diagnosis(es):
Sedation/Medication:
Level of Responsiveness:
Physical Issues:
Mental/Emotional Issues:
Faith Tradition/Religion:
Spiritual Issues:
Patient Notes:
Family Notes:

II- CLINICAL OBSERVATIONS: BEGINNING OF VIGIL
Respiration
Rhythm: regular, irregular, apnea
Rate: /minute
OR: Apneic cycle: ____ breaths over ____ seconds followed by _____seconds apnea
Depth:
1 – very shallow
2 – shallow
3 – normal
4 – somewhat deep
5 – very deep

22
Effort:
1 – easy
2 – slight effort
3 – moderate effort
4 – labored
5 – extremely labored

Pulse
Rhythm: regular irregular
Rate: /minute
Strength:
1- Palpable
2- Weak
3- Bounding
4- N/K

Skin temperature and moistness
Head: hot warm cool cold
very dry dry damp very moist sticky
Extremities:
hot warm cool cold
very dry dry damp very moist sticky

Wakefulness:
1 – deep sleep or unresponsiveness
2 – easily aroused from sleep
3 – alternating between sleep and wakefulness
4 – awake but not actively engaged in surroundings
5 – awake; no signs of sleepiness
N/K – level of wakefulness is not discernible

Agitation:
1 – calm, no visible signs of agitation
2 – occasional mild or infrequent signs of distress or discomfort
3 – mild restlessness; intermittent signs of agitation; fretting in sleep
4 – repeated signs of distress; unable to maintain restful state
5 – continuous agitation, verbalization of pain, exaggerated body movement
NK-level of agitation is not discernible

Responsiveness:
1 – no response to stimuli observed
2 – response only to vigorous, continuous stimuli
3 – lethargy-requires stimulus to respond
4 – confusion-spontaneous responses but may be inappropriate
5 – alert and responsive to normal stimuli
N/K – level of responsiveness not discernible

23
Attention, Focus and Orientation:
Attention: inward outward alternating between inward and outward N/K
Focus: very concentrated, diffused or balanced normally between the two (describe )
Orientation: oriented not oriented (people time surroundings) N/K

CLINICAL OBSERVATIONS: END OF VIGIL
Deceased— Time: _________

Respiration
Rhythm: regular, irregular, apnea
Rate: /minute
OR: Apneic cycle: ____ breaths over ____ seconds followed by _____seconds apnea

Depth:
1 – very shallow
2 – shallow
3 – normal
4 – somewhat deep
5 – very deep

Effort:
1 – easy
2 – slight effort
3 – moderate effort
4 – labored
5 – extremely labored

Pulse
Rhythm: regular irregular
Rate: /minute
Strength:
1- Palpable
2- Weak
3- Bounding
4- N/K

Skin temperature and moistness
Head: hot warm cool cold
very dry dry damp very moist sticky
Extremities:
hot warm cool cold
very dry dry damp very moist sticky

Wakefulness:
1 – deep sleep or unresponsiveness
2 – easily aroused from sleep

24
3 – alternating between sleep and wakefulness
4 – awake but not actively engaged in surroundings
5 – awake; no signs of sleepiness
N/K – level of wakefulness is not discernible

Attention, Focus and Orientation
Attention: inward outward alternating between inward and outward N/K
Focus: very concentrated, diffused or balanced normally between the two (describe )
Orientation: oriented not oriented (people time surroundings) N/K

Other observations
O2 device: none nasal cannula mask ventilator (other)
Eye-opening response:
Verbal response:
Gestural response:
Signs of physical pain during vigil:
Signs of interior pain, emotional or spiritual distress:
Signs of respiratory distress:

III – Changes during the vigil:

IV – Thematic Material: (List title or incipit with key or mode; indicate specific meter or if
unmetered)

V – Narrative Summary

VI – Clinical Narrative

2011 Lyn Miletich – Theological Reflection: Enhancing the Spiritual Dimension of Music-Thanatology.pdf

2011 Lyn Miletich – Theological Reflection: Enhancing the Spiritual Dimension of Music-Thanatology.pdf

Share This Story, Choose Your Platform!

About the Author: Romeo Montague