10 Things Your Hospice Music Therapist Wants You to Know

I was recently contracted to provide hospice music therapy part time with a hospice in my hometown. 

I love what I do and I know many people have not had previous exposure to music therapy, or music therapy in the hospice setting. 

There are frequently things I wish my patients could know before I ever meet them, so here are 10 things I would want you to know if you were my patient.

1. I Care About You

My paycheck pays the bills, but the real payoff of this job is my relationship with you. I treasure every moment of your company I am privileged to receive. I am invested in your happiness and your quality of life, especially now that modern medicine can no longer extend your life expectancy. I genuinely long for joy-filled days for you. I am humbled and honored that you allow me in to share such an intimate and vulnerable time in your life. Thank you. I care about you. 

2. You Don't Have to Be a Musician

Please don't be shy about letting me come by to visit you for the first time because you have never had any formal musical training or experience. One unique skill of a music therapist is being able to create musical experiences that ANYONE can be successful in with NO prior experience. I promise, on the days you feel up to it, we will make music together just fine, and it will be delightfully fun for both of us. 

3. I LOVE it When You Sing

And I don't care what your voice sounds like! I really don't. Just because I had to take voice lessons to do this job doesn't mean you need to sound like you're ready to win American Idol. Does singing special, significant songs bring you joy? Fantastic! Then please sing! I'm never going to judge what you sound like, because I'm not here to make you a fantastic singer. You will benefit on so many levels from the process of singing.

4. But It's Also Great if You Don't

If you are having a rough day, or you find that singing just takes too much energy right now, please don't worry that I will be sad if you don't sing with me today. Because you and I decide together what kind of musical experiences we have each time, I will always meet you where you are and adjust our normal plan to make you the most comfortable. If today happens to be a day where listening and quietly pondering your own thoughts and memories is what will comfort you, that is what we will do.

5. I Won't be Offended if You Fall Asleep

Speaking of listening and quiet thinking, you may find yourself nodding off while I am with you. I promise, I will not be the least bit upset if you fall asleep in the middle of a song I am singing. I am not there to give an award-winning musical performance. I am there to help your comfort, and I take it as a very high compliment if I can help you relax well enough that you fall asleep and get some good rest. Go ahead, sneak in a nap. Pleasant dreams! 

6. The Days You Feel the Worst May be the Best Days to See Me

Maybe the last time I came to see you, your children and grandchildren were all there and I passed out tambourines and drums and egg shakers and we had a rousing family singalong with your favorite jazz standards or gospel tunes. And maybe today, you just don't feel up for that kind of energy level and experience. Intuitively, you may want to send me away because you are having some pain, discomfort, anxiety, or maybe you feel down in the dumps today. I will always respect your right to ask me not to visit, but you should know that I am qualified to help you manage those symptoms and negative feelings. I have music therapy techniques that look completely different than what we did during the family singalong, and I could provide therapy to help you feel better than you currently do. Think about letting me come visit even when you aren't feeling quite like yourself. 

7. I am Here for Your Family, Too

I am always delighted to have any significant person from your life join us for music therapy. I know how much you care about them, and I have no problem looking out for their needs, as well. That's part of the hospice philosophy of care - we take care of your family, too. I can help you write songs that convey messages for your family to keep after you have died. I can help them with their own stress and anxiety over your health. You can trust that they are in good hands with me and especially the rest of the hospice team.

8. I'm Waterproof

I fully realize that sometimes music brings STRONG emotions to the surface very suddenly. You might find yourself tearing up during a song, and needing to have a full crying spell. That's ok. Your tears will not hurt me because I am "waterproof." When I am with you, it is a safe space for you to shed those tears. I can be a listening ear and a supportive presence if you need to talk about what was on your mind during a particular song. If you need more assistance, I will always report back to the appropriate members of the hospice team and we will do our best to take care of you. Please feel free to cry on my shoulder. 

9. I Will Keep Caring for You

As you know, at a certain point on our journey together, you will be too sick to acknowledge my presence or even open your eyes when I come to see you. Don't worry, I will still come to see you even in your final moments. There is good reason to believe you can still hear even when you cannot respond. I will communicate how much I have enjoyed our time together. I will share the music we enjoyed together with any family and friends who are with you at this time. I will be there to help and comfort your family during the very difficult process of saying "goodbye" to you. If either you or your family asks me to provide music for your memorial service, I will continue caring for you and for your legacy after you are gone.

10. I Will Always Remember and Treasure You

I will never forget what an honor and joy it was to know you and to share music with you. Any patient I am privileged to see becomes a part of my heart forever. Again, thank you for allowing me to care about you in this way. I would rather be with you than on any stage in the world.

The Nerve!

I am absolutely thrilled, humbled, grateful, and elated to announce that on Monday, I will begin a part-time position with Oxford Hospice in Springfield, MO.

This position did not exist when I graduated and moved back home from my internship.

It represents months of waiting, creation and revision of a grant, and one very daring move: I applied for a position that did not exist and asked to interview anyway.

The nerve of some young professionals!

But, it was my nerve and my passion that sold my hospice director. I had the audacity to apply for a position that didn't exist yet, acting on the belief that it would exist eventually.

Just having the nerve to show up and be fully present and ask boldly for what I wanted was the spark that set us off on a journey to write a grant and create a music therapy position where there was not one before.

It's an exciting time to be a young music therapist, but it can also be daunting. I sincerely hope that if you are in a similar boat, waiting to start your first "real" music therapy job, you can find the nerve to show up and make someone listen.

The right opportunities are out there!

 I, for one, am looking forward to being back at the bedside with my patients again soon.

Any other young professionals have a success story to share? Let me know in the comments!

The Best of Both Worlds

On Friday I will have the distinct pleasure of performing with the Drury University Wind Symphony at the Missouri Music Educators Association annual convention. Being around that many music educators always gets me thinking about the differences and similarities between music therapists and music educators. 

Music therapists are uniquely sandwiched between the world of musicians and the world of medical professionals. 

Many times, our colleagues in music and our colleagues in medicine are equally mystified by our profession because we are both fully musical and fully clinical.  We get the best of both worlds.

The clinical nature of our work dictates our use of music, and our musicianship enables our unique approach to clinical issues. 

Our music educator friends may shake their heads in disbelief when we describe some of the non-traditional instruments or adapted music techniques we use to enable our patients and clients to make music, or the ways we might abruptly change the key or tempo within a song to adapt to our patients changing clinical needs in the moment. 

In other words, to a musician, my work may seem highly clinical. 

Similarly, the colleagues who are physicians, nurses, social workers, and other allied health therapists are frequently lost when we discuss manipulating musical elements to achieve clinical outcomes. They may not understand why I am transposing the key of a song as I keep an eye on a patient's respiration rate, or why I may choose one guitar accompaniment over another, or none at all, and what relevance that has to the patient's alertness and reality orientation. 

To a clinician, my work may seem overly musical.

It is always my responsibility and joy to educate my colleagues on either side about music therapy.

I am a musician.

I am therapist. 

My work is fully musical.

It is fully clinical. 

I am a music therapist and I get the best of both worlds. 

The Most Unexpected "Day in the Life" Ever

Literally nothing about work today went the way I was expecting. Typically I have at least some idea of what my day might look like beforehand. Not today. Nope.

Oddly enough, however, today is a really great example of what a day in the life of a hospice music therapy intern might look like. While unexpected, everything about today was also fantastic. 

7:50 Running late from having slept through alarm. No time to linger over morning coffee. Dump it and some ice cubes into a thermos like my big brother man does. Am wistfully reminded of brother and must remember to text him at next break. 

8:00 Checking emails and closing out yesterday's paperwork after internship director (ID) looks over it. This would have been yesterday but she wasn't in yesterday. 

Side note: working Memorial Day was not actually awful. 

8:20 ID reminds me that music therapy has the "Meditative Moment" before our interdisciplinary team (IDT) meeting this week and I agreed last week to sing an original song since most of the hospice staff couldn't hear it at the talent show. 

8:20:05 Rising anxiety. Thought occurs: "You don't have time to be nervous about this. Just go do it."

8:30 Find myself explaining how a former patient encouraged me to shout down my inner meanie perfectionist and how my nieces and nephews inspired the creation of a song. Proceed to sing a piece of my soul for my coworkers and find myself not totally freaked out by the experience. 

8:35-9:45 IDT meeting. We do this every week. Basically, we talk about all our patients in either the care center and hospice house, or the community. We plan and collaborate as a team to ensure comprehensive, compassionate care for each patient's individual needs. 

9:45-10:30 After IDT until lunch is my weekly scheduled time to follow our bereavement coordinator to learn how to fulfill this job myself someday if needed. We addressed the sympathy cards, made lots of phone calls, and planned a few bereavement visits. 

Spontaneously decide my time the rest of the day would best be spent doing bereavement work to make up for a few of the bereavement days we have missed in the last few weeks.

10:30 Get email that the funeral of a very, very dear patient is happening at 4:00. Realize there is no way I am not going. Realize it means I will be working late. Realize I do not care.

10:30-12:15 Unexpected bereavement/pre-bereavement visits. Somewhere in here I show our bereavement coordinator my processing artwork book. She is intrigued by the idea. Will pass along to anyone she thinks could benefit from coping in this way. 

Visits progress: Find myself visiting a patient I know well as she is a music therapy patient of my ID. Get requested to sing. Have no accompaniment instrument. Sing "Boogie Woogie Bugle Boy" with egg shakers and body percussion. Patient's daughter remembers she loves the Jeff Buckley version of "Hallelujah" and asks if I know it. Know this song by heart. Sing it acapella. For obvious reasons, am now super wistfully reminded of brother and make mental note to text him at lunch. 

12:25-12:55 Throw together random assortment of healthy food in my apartment. Finally text brother. 

Am standing in kitchen pondering this fact: Sometimes when I know a dear patient has a diagnosis that tends to cause a very rapid decline, I want to go see them all the time to squeeze as much caring for them in as I can before they die. Realize that this kind of panicky feeling is not helpful or necessary. 

Thought occurs: "If you need to panic, that's fine. Just try to do it calmly." 

12:55 Laugh until I cry at this thought. Decide to share my random brainworkings with Facebook.

1:00-3:30 Bereavement visits in community with people I have never met. Find opportunities to give them caring presence and attention. Learn as much as I possibly can about grief counseling from bereavement coordinator. 

3:35 Change and print directions to funeral. Briefly contemplate ditching the instruments in my bag before I go. Decide against it. 

3:50 Arrive for 4:00 funeral. Am suddenly being hugged by people I haven't met. Was mildly expecting this because I saw this patient the afternoon he died. Several family members asked permission to take video of me singing at the bedside because they thought it would comfort the family who could not be present for the vigil. Am super glad my efforts to bring comfort could be extended to them through technology.

3:57 Family realizes I have cedar flute with me. Asks if I wouldn't mind improvising something like I had done at the patient's bedside. I am touched beyond words. Begin choking up. Agree. Am glad I decided to leave it in my bag. Had tried to make contact to offer music for funeral ahead of time but spur of the moment would work, too. 

4:30-4:35 Explain to roomful of loved ones how much I enjoyed providing music therapy to this dear man. Sandwich the "Going Home" melody from Dvorak's New World Symphony in between some improvisations. Play my heart out in beautiful chapel with tears streaming down my face. 

5:00 Arrive in office to fill out paperwork for attending the funeral. Work on some projects for other patients and their families. 

5:45 Come back to apartment and realize I just had a super awesome, totally unexpected day and wish I could have this day every day. 

Thanks for reading! What was the most unexpected/awesome thing you lived through today? 

Looking Around

I've been musing lately. I'm musing because the world looks a little different to me right now than it ever has before. Encountering my patients and their families has changed me. It's expanded me.


When I go to be with my patients, I'm meeting their humanity in a very open, revealing, and vulnerable way. When you have a terminal diagnosis, it tends to motivate you to strip away a lot of the fluff, the veneer, and the barriers you have lived with your entire life. When you can no longer do many of the things you have been doing every day for your whole life, and many of the people you knew and loved are already gone, what's left?


My patients bring their authentic selves to me because their basic self is all that's left.


Sharing that with them is nothing short of a humbling honor.


That sort of interaction with another human being changes me.


It's made me realize that we all have far more in common than we think. At our innermost core, we are essentially the same, yet each individual retains a unique essence.


Realizing this has changed the way I move through a day. I cannot drive through traffic without wondering about the people in every car around me. They are no longer part of the busy backdrop of every day life. Every other driver on the road has a story. They have needs. Concerns. Passions. Vulnerabilities. Joys.


I want to know them all. I want to give each of them a space and time to be heard and validated.


I cannot drive past a cemetery now without perceiving each headstone as a sparkling gem. Each one represents a life, a loved one. Each headstone represents someone who was once a newborn baby, a wondering toddler, a questioning teenager, a working adult, a reflecting elder.


And as I wonder about each beautiful life who has ever walked this earth, I have to wonder if I am the only one musing this way. Surely not. I find it unlikely that I am the only one reflecting on the enormity and beauty of the human experience in this way.


So now I want to know about you. I would be humbled and honored if you would share with me your musings about this life and the people living it with us.


"You matter because you are."
-Dame Cicely Saunders

Shouting Down the Inner Demons

For my internship, I had to create three professional and three personal goals that I want to accomplish while I am here. 

The three professional goals came to me almost instantly. It was so quick and easy to think of them that I actually have four. 

1. Implement a music therapy grief and bereavement support group. 

2. Develop the skills and materials needed to approach a hospice and create a music therapy job.

3. Complete a hospice music therapy research proposal.

4. Develop a much larger professional song repertoire. 

These are all fantastic things that I can't wait to accomplish! The personal goals, however, were much harder to come up with. Reflecting on myself as a professional is much easier than shining the bright light of self-examination into the dark corners of myself. 

After a lot of reflection, I came up with two fairly obvious goals and one really tricky one. Because music therapists like measurable outcomes, I also have to create behavioral objectives for my personal goals so that my internship director and I both know when I have accomplished my goals. Here's my best guesses so far. 

1. Continue to integrate self-care as a habitual way of being.

This is an obvious one. Sometimes caregivers are lousy at caring for themselves. My objectives here will likely center around logging healthy, self-care behaviors. 

2. Process any counter-transference issues that arise during internship relating to my own mortality or the death of my loved ones.

This is another gimme for end-of-life care. My objectives will probably consist of identifying a certain number of sources of counter-transference, either real or potential, and then utilizing a few different methods for working through those feelings. This is surprisingly cut and dried. 

The last one, however, was actually the one thing I thought of first and it's going to be the hardest. It's hard both in terms of creating objectives and in terms of managing to do it. 

3. Offer more of my genuine self without fear of repercussion.

This one merits a little explanation. 

Many times, the very most important thing we can offer patients is our genuine presence as a human being. Our own liveliness. Our creativity. These are all potent tools we can bring to our interactions. They are the tools that empower our musicianship. 

For most of my life, I have struggled with bringing these things to the table. 

I think I started life as a fairly open personality but one without a lot of social skills. 

Early experiments with being genuine with others taught me that being open and vulnerable was a bad idea.

Whether consciously or not, I thereafter decided I would not be open, vulnerable, or genuine with others unless it: 

A. Could not be avoided or 

B. Was with people I loved and trusted immensely. 

That's a fairly significant barrier to effective musicianship and effective therapeutic relationships, for starters, not to mention in relationships with friends and family. 

Over the years I have made huge leaps of progress in coming out of my "shell" and just being Emily with other people. Much to my surprise, this has not blown up in my face. 

Instead, it's actually been wonderful. 

However, I am still my own worst critic. I am a paradox of desperately wanting to be unabashedly creative and being far too internally hyper-critical of myself to actually create anything. 

There's a reason I don't write my own music, but in my heart of hearts, I want more than almost anything to be able to express my thoughts and feelings uniquely through my own music. 

Whenever a little blip of creativity sneaks up on me while I'm not looking, it never gets by for very long before the laser beam of internal criticism stops it dead. 

I think of lyrics. And the demons begin, "Does anyone actually talk that way? Now it just sounds contrived. Are you seriously calling that a rhyme scheme? Justin Bieber had more lyrical complexity." 

And the lyrics get trashed. 

I think of chord progressions or melodies. The demons continue: "That sounds exactly like every music theory exercise. That's too repetitive. A monkey could play that on guitar."

And so I trash the chords or the melody. 

This is absolutely self-sabotage. It has to stop before I completely kill my ability to spontaneously express myself (in music or in speech) without beating my every thought or note to death with analysis.

It's a work in progress. Yesterday, I posted a video of me improvising with the Native American flute. I shared a moment of genuine, open, musical vulnerability with a lot of people and the world did not implode. Nobody even said they hated it. Or me. 

I had to shout down the inner criticism demons to allow myself to share. I am glad I did it. 

This blog post has my genuine self all over it, too. I am trusting that the world will not implode. 

Back to this very tricky goal. I think my objectives will probably consist of examining some of the factors that initially lead me to place a barrier between my genuine self and others, and then making myself engage in so many acts of uncensored creativity. Maybe it will be drawings that I am not allowed to throw away. Or more music that must be shared with at least one other person. 

Do you lovely people have any suggestions for more ways to work on shouting down my inner demons? 

Thank you for reading; it took a lot of courage for me to name these demons out loud. 

Do You "Get It?"

Today was an almost snow day in intern-land. 

I accomplished basically two things. At first those two things seem largely unrelated. On a closer look, the two tasks are intimately connected. 

First task:

I spent the entirety of the morning - four straight hours - using MS Paint to shade in a map of Missouri counties in which a music therapist works. This is part of my work for the CBMT State Recognition Task Force. That's the group of people who are working really hard to secure state licensure for music therapists in Missouri. 

This map project took hours because MS Paint is substandard for graphic design tasks. It's what we had to work with. This map will eventually be in the hands of many of our state congressmen and state senators, brought to them care of the music therapists taking time to attend a Hill Day this spring at the Capitol. It needs to look good. That's why I spent a lot of time outlining and shading one pixel at a time. 

It was a somewhat painful but effective way to burn through a snow day morning.

Second task:

I finally managed to dig my car out from the piles and mounds and heaps of snow to get over to the hospice house to see a patient this afternoon. This was the wonderful woman who had been wrestling with some serious grief and emotional/spiritual pain but who told us she had peace and she was ready the last time we saw her. 

She is now in the early phase of actively dying. She was awake but sort of staring "through" the ceiling when I arrived. She focused her gaze on the Native American flute when I pulled it from my bag, so I started with that. She was too weak to talk or smile, but she sure tried her best to smile at me. After a few minutes of flute, she also seemed pretty interested in my guitar. I played and sang the hymns I knew she really enjoyed in previous visits. 

It is astounding, but even with this much weakness and this much decline, she still nodded her head in time to a few of her favorite songs. I chained hymns together using the iso principle (it really is one of our favorite tricks) to increase her relaxation and help her breathe a little more deeply and evenly. She attempted another smile but when that didn't quite happen, she winked at me! 

I had all but played and sang her to sleep when I got a sense that she wanted something else before I left her to rest. I got the cedar flute back out and said I would improvise another song, one especially from me just for her. She nodded and sighed contentedly. As I finished my last improvisation of the visit, she winked at me again and promptly fell asleep. 

This kind of interaction with people is all in a day's work for a music therapist (or intern, as the case may be). 

What does the first task of map making have to do with providing supportive presence and comfort at the end of life? Or with helping a child achieve their academic goals? Or whether or not someone receives music therapy to help them walk and talk again after an accident? 

It all comes down to whether or not the right people "get it." Do you "get" music therapy? Does your employer? Neighbor? Grandmother? 

Our hospice administrator - the big boss - told me today she would gladly speak to any of my prospective hospice employers back home on the value of having a music therapy department when it comes time for me to find or create a job. She gets it. 

Do our legislators understand that music therapists are highly-trained clinicians and highly-skilled musicians, both? Do they understand that what we do is evidence-based treatment? 

Probably not. Not unless we tell them. 

Advocacy efforts like this map are one way we can make sure moments like my afternoon with my patient can continue to happen. 

Working on this map today revealed two important facts. 

The first is that there are a heck of a lot of music therapists providing services in many Missouri counties for a state that, as of yet, does not officially recognize their professional status and credentials. 

The second is that there is a shameful number of counties in our state alone that have absolutely no access to the services of a music therapist. 

The more people who "get" what we do, the faster we can change that.