Therapists are attuned to their patients' breath, bodies and spirits
For a decade, certified music-thanatologist Laura Moya has played the harp for terminally ill patients at Providence St. Vincent Medical Center in Portland, Ore. She brings comfort to the agitated, joy to the despondent. But these performances are not concerts; they are vigils. To practitioners of the growing field of music-thanatology, the distinction is enormous.
"Our cultural perception of music is that it's entertainment," said Moya. "But it's so much more. We play music that transcends entertainment to make spiritual connections and provide real clinical benefits. It's a big cultural hurdle to see music in such a different way, but there is, in fact, a long history of music and medicine."
Moya said Providence Health & Services Oregon Region's decision to offer music-thanatology was born out of concern over the state's 1997 assisted suicide law. She said leaders of the Providence region wanted to find new ways to give dying patients and their families meaningful support. They discovered the Chalice of Repose Project of Missoula, Mont., a decades-old music-thanatology program that serves dying patients in hospices, nursing homes and hospitals including Providence Health & Services' St. Patrick Hospital and Health Sciences Center in Missoula. Moya joined St. Vincent as the first music-thanatologist in Providence's Oregon Region. Now the service is offered at sister facilities. Chalice of Repose trained Moya and her Oregon colleague Raya Partenheimer, a certified music-thanatologist who practices at Providence Portland Medical Center.
Thanatology is the study of death and the coping methods used during the passage from life to death. Music-thanatologists receive training in music, medicine and psychology. As Partenheimer explained: "We have a unique role in that we are clinical professionals and also spiritual care professionals, so we are very actively holding the two worlds."
Rhythm of breath
Patients are referred by both doctors and palliative care staff members. Before visiting a patient, Moya consults with physicians and reviews a patient's chart. Some patients are sedated; some are comatose. Most are terminally ill, but some will be discharged from the hospital.
Once inside the patient's room, Moya assesses the patient's breathing and the rate and quality of the pulse as well as the patient's emotional and spiritual state. These observations coupled with her training in disease progression and the unique rhythm of various organ systems determine what music she plays.
"We try to be in sync with what's happening internally," said Moya. "If someone is breathing 30 breaths a minute, we'll try to meet their breath maybe on every other exhalation. It's very intimate."
A growing body of clinical research shows music-thanatology can reduce patients' perception of pain and ease breathing.
"Just like people have different responses to medicine, people have different responses to music," said Partenheimer. "In some cases, within a minute of playing, their breathing eases or starts to slow. I just had a woman who started crying. She said, 'These aren't tears of sadness. This music is just doing something to my soul.' And a few weeks ago, a man said, 'Oh, this is better than morphine.'"
It can be hard to gauge the response of patients who are unable to speak, but even under those circumstances, Partenheimer said, she usually feels that the music has shifted something in the room.
Tom Redmond experienced the power of music-thanatology firsthand when his father Richard was dying in February 2011 of pancreatic cancer. His father initially rejected Moya's offer to play.
"He didn't get into things like that," said Redmond of Beaverton, Ore. "He's in the hospital, he knows he doesn't have long to go. He wasn't a real people person. So he's laying in bed. She came by to ask if he would like her to play. He says, 'Nah, that's fine. No thanks.'"
But when Moya learned it was Redmond's 92nd birthday, she offered to play "Happy Birthday." After playing the song, she returned later and performed more music.
"He totally relaxed, all of us did," said Redmond. "It was so soothing. At that point, nothing was taking care of the pain. He felt better listening than he did from the pain medication. It was amazing how she so quickly knew what was happening in his body and picked exactly the right music."
Ancient practice
Though music-thanatology is a relatively new practice in the United States, ancient cultures around the globe have used music to soothe their dying.
"We are part of a long lineage that goes back a long time, of people supporting each other through music," said Partenheimer. "We know that French monks cared for their dying ones through prayer and chant and music. That's the same vision we try to carry today — that music can affect every part of a person and the people who are with them."
Moya added that the monks believed they could directly experience the divine through beauty.
"They felt it was important in life and in the dying process to have this sense of beauty surrounding their community members," said Moya. "Music is the one way we try to offer a sense of beauty and reverence for patients and patients' families."
The harp is the instrument of choice among music-thanatologists because of its large tonal range. Partenheimer plays a 33-string harp that's smaller and more portable than a concert harp.
"I would be very sad if I didn't have the lowest 10 notes on my harp because they are so therapeutic for so many people and yet the higher pitches can be very helpful as well," said Partenheimer. "Having the range is so important."
Musically discerning neonates
Today the Providence music-thanatology program has expanded to the St. Vincent neonatal intensive care unit. At first nurses there were leery. They work hard to keep the NICU as quiet as possible, and some worried the music would disrupt their tiny patients. But babies respond to music much like adults.
"These little neonates are very particular about the music. They largely respond to what they heard in utero," said Moya, who can judge a baby's response by observing heart rate, respiratory rate and oxygen saturation levels. "But what's also interesting is how the nurses respond. They've told us that not only is it important that the babies and the parents get supported and calmed, they feel their (own) stress levels go down."
Like many St. Vincent patients, Pastoral Care Director Fr. Freddy Ocun never heard of music-thanatology before arriving at the hospital in 2005. But he did understand music's inherent power. In his native Africa, people sing the dying into the next life.
"So many families have said to me, 'What a gift. It was what my mother or my father wanted,'" Fr. Ocun said of the harp music. "When I came here, I made a point of visiting one of Laura's vigils, and what a sacred moment that was. It is a very profound way of caring for the whole person — body, mind and soul."