Abstract
M
It wasn't until later, when I was approached with a new project by The Center for Hospice & Palliative Care (CHPC), that I was able to truly reflect on this experience and the memories they elicited. CHPC's Expressive Therapies Department has an extensive music therapy program which provides patients and families with therapeutic interventions to address a spectrum of clinical needs. The department further aimed to facilitate a widespread means of impacting the auditory experience of the care environments. Through generous funding from a private donor, CHPC started their own version of a program, Music & Memory (M&M), previously created for residents with dementia in the nursing home setting. M&M is a nonprofit organization created by Dan Cohen as a means of providing patients with personalized music through the use of digital music technology. My role, under the guidance of a licensed music therapist, was to implement and coordinate a modified version of the M&M program to offer patients and families the opportunity to access personalized music in one of our care environments.
The M&M program is based on research showing a strong neurological bond between music and the brain. It is a bond that remains powerful even when brain function is declining due to illnesses such as dementia. It is not uncommon for patients who are not responsive to their environment to be “brought back to life,” so to speak, with a song that conjures up memories from the past. Equally powerful is the positive impact of personalized music on patients' overall well-being. Our program was implemented at one of CHPC's hospice inpatient units, and was offered to patients, regardless of their diagnosis. Working with patients and their families reminded me of my own experiences with my father and how much joy and comfort music brought to our lives. I have seen patients, families, and staff transformed as a result of this program.
One patient, George (names have been changed to maintain confidentiality), came into our St. John Baptist Hospice Inpatient Unit (SJB) with clear cognitive decline. His wife, Mary, would visit faithfully every day, from early in the morning until late in the evening. It was difficult for her to speak of her husband of 50 plus years without becoming tearful. After meeting with Mary and George, I discovered that he had been an accomplished musician, having played the accordion for many years. I offered to provide some of the music that he had loved to play so much. Mary was doubtful that the music would even be available, but using an iTunes® database, an iPod®, and a set of speakers, I was able to create a custom playlist and upload some of his favorite accordion songs. I set up the speakers on his bedside table, hooked up the iPod®, and began playing the music. The effect was immediate and moving. George relaxed, closed his eyes, and began tapping rhythmically in response to the familiar songs. Throughout his stay at SJB, Mary frequently asked that music be provided for her and George. She began to share videos and pictures of her husband and family as well as stories of his musicianship. Even after her husband's death, Mary continues to visit SJB and each time we see her we are able to reflect fondly about her late husband and the music they shared.
Another patient, Charles, was admitted to SJB under very different circumstances. Having immigrated to this country almost 30 years prior, Charles had no family, very few friends, and little support. When he was admitted to SJB, he was still coming to terms with the fact that he was quickly approaching the end of his life. He was very guarded, not sharing much of his personal life with staff. During our first meeting, Charles was apathetic and withdrawn, but named a few obscure artists he listened to while growing up in his native country. I was again able to track down his favorite musicians and presented him with this music on an iPod® with a pair of headphones. Upon first hearing the music, his face immediately lit up. We began spending time together, walking the halls of the unit and speaking about the music, his life growing up, and his time here in the United States. He explained that he originally came here with the hopes that he and his band members would make a name for themselves. He eventually spoke of his daughters, who both still lived in his home country, and gradually opened up to the idea of conversing with them via Skype®. It was truly eye opening for me to see how strong Charles's connection to music was, particularly the music he grew up listening to in his home country, and to see how music helped him to acknowledge and express a wide range of other feelings, memories, and emotions.
One of the most poignant examples of the effects of the M&M program involved a family that spent almost a month at SJB. Betty was declining due to congestive heart failure. While she seemed to accept her situation, her family was having difficulty acknowledging that she would soon be gone. I was uncertain how well the idea of Betty participating in our individualized music program would be received, but after I met with her and her family, they were open to participating. Betty's husband, Michael, mentioned that he and his wife enjoyed big band and swing music. Based on this information, I carefully tailored a playlist for Betty and uploaded the music to an iPod®. What followed was truly rewarding. As Betty continued to decline, her family progressively opened up; each song added to the playlist conjured a new memory that would be reflected upon fondly by everyone. When it was clear that Betty's death was near, Michael and his daughter asked for music that was a bit more soothing. I prepared a playlist of “relaxing music” and allowed them their privacy. When I stopped by later to check on them, I could see the profound impact the music had had on Betty's husband. He asked what the name of one particular song was. When I told him, he began to cry, telling me that he remembered the song playing in the background while they shopped at their favorite department store many years before. In their 60-plus years of marriage, he had never forgotten this tune. He was very grateful and later expressed his feelings in a card sent to SJB, saying how much comfort he had received from the music.
This is exactly what this newly launched individualized music program strives to do—connect patients and their families through meaningful sensory experiences while providing additional comforts that medical interventions alone cannot. I was fortunate to witness the power of the program while using something I am passionate about as a tool to help others. The M&M program enhances the care environment for those near the end of life, reducing anxiety and stress and helping patients and their families connect emotionally in profound ways. As music therapist Dr. Kenneth Bruscia once so eloquently noted:
“Songs are a way that human beings explore emotions. They express who we are and how we feel, they bring us closer to others, they keep us company when we are alone. They articulate our beliefs and values…. As the years pass, songs bear witness to our lives…. They are our musical diaries, our life stories.”
Footnotes
Acknowledgments
The author would like to thank Phil Hubbell and his family for their generous support and funding of the Music & Memory program. The author would also like to acknowledge the CHPC Research Team and CHPC Expressive Therapies Department for their contributions in implementing this program and their input in the paper. The author would also like to thank Dr. Debra Luczkiewicz for her editorial review of the paper. Finally, the author would like to thank the families and patients for sharing their memories and stories.