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. 

The Intern Chronicles: Snow Day

I swore I would not get behind on updating friends and family on my adventures.

That obviously did not happen. It's mostly that I have been too busy having said adventures.

I promise I am making up for it though, because I am inserting three (!) videos of non-symphonic instruments into this post. Spoiler alert: one of Native American flute and two of Irish Penny Whistle.

But first, a quick recap of the past few weeks and all the adventures!

In no particular order (because the days are all starting to run together), I give you a quick list of really awesome experiences that have happened since my last post:

- I got to see a patient go from crying out, hallucinating, and doing some intense end-of-life grief work to smiling, nodding along to the music, and telling me and my internship director how she was ready to die. She had two lucid periods in the last two weeks that we know of and I got to be present for both. She took my hand and told me goodbye and she is so ready to lay down her struggle. It is wonderful to see her finally have some peace. This is an adventure that doesn't translate into words very easily but I know it is an experience that will stay with me forever. 

- I got to play my penny whistle for a patient with an Irish background and she totally ate it up. She had been very depressed over a recent medical procedure but we left her giggling in her chair. Music therapy is not actually magic - it just looks a lot like it.  This lady is the reason I learned the two Irish folk songs below. "My Wild Irish Rose" and "When Irish Eyes are Smiling" are two of her favorites!

- One of my other patients is Italian. When she got to visit Italy, the Sistine Chapel was closed. It has always bothered her. So, we used my iPad to take a virtual tour of the Sistine Chapel while we played a CD of her favorite Italian music. I promised to actually sing in Italian for her next time. I have never seen such a smile! I can't wait for that session!

- One lady I saw was having a decent bit of discomfort. While we waited for her nurse, I kept her more comfortable by singing her favorite music with her. She was so hard of hearing that the only way to do this was to lay my head down by hers and sing directly into her ear. Instead of grimacing and bracing and groaning, I had her singing, chuckling, and remarking. "We love to sing, don't we honey?" I am loving getting to use some of our fancy music therapy tricks like chaining and the iso principle to increase patient comfort. 

- Yesterday, my internship director was sick and the other music therapist was on vacation, so I got to provide all the scheduled music therapy yesterday and nothing caught on fire! I really think I am doing what I am supposed to be doing. 

- Today, the office was closed and hospice took a snow day. Except, when you are an adult who works for hospice, "snow days" mean that you work on things that are less cool than seeing your patients. So instead of seeing patients, I updated the schedule and practiced and worked on some required reading. But I also got to learn the Native American cedar flute and had time to learn those Irish folk songs. I was the only living thing in the office all day which was moderately creepy but I refuse to work from my apartment because I have a hard enough time putting my patients down at the end of the day without blurring the lines between work space and me space. 

- This hasn't happened yet (look, I'm ahead!) but on Friday I get to provide all the music for a patient's birthday party because the other music therapists can't. I am excited! 

- On February 14th, I will again be functioning as the entirety of the hospice music therapy department. Wish me luck! 

In the absence of more cool things to tell you, please see below for my early attempts at Native American flute noodling, and two Irish penny whistle songs. 

http://youtu.be/HPPM-RMIY2c

http://youtu.be/Cykq8ZTNGb8

http://youtu.be/CGIG8WAqwFs

The Intern Chronicles: Silverware and Songs

Given the right context, the essence of something can change. Or sometimes, its essence may just appear to change. Sometimes, that can be enough.


I first experienced this transformation early last week as I was getting fully settled into my new surroundings. I noticed how all of my favorite things were in their proper place in the new apartment, but they didn't look much like my favorite things anymore. My favorite mug looks different on this counter. My reading lamp has been transformed by sitting on another end table. I even noticed details about the decorative engraving on my silverware for the very first time after it was in place in a different drawer.


This phenomenon was hanging around the back of my mind when I was asked to sing with a hospice patient for the first time. I had a wonderful morning shadowing one of our nurses and when we visited our last patient for the day, the nurse mentioned what I was interning for and the patient requested that I sing.


I used what I knew from the patient's background and the decoration of her home to quickly assess what her preferred music might be. I asked if she enjoyed hymns and offered her a choice between two to respect her autonomy. She chose "In the Garden." I had not been expecting to provide any music that afternoon and so I did not have my guitar. I leaned in to the side of the hospital bed and began softly singing to this dear lady.


A stillness descended over the room as she visibly relaxed back into her pillow and reached for my hand. She held my hand and softly mouthed the words to the chorus each time. Her breathing grew deeper and more even and when I had finished singing, the room was silent and peaceful. The nurse and I left her resting comfortably with a gentle smile on her face.


As she had softly tried to sing with me, the patient was transformed. When she entered into a supportive musical context, the hospital bed, the oxygen tubes, and the shallow breathing all seemed to melt away. Instead, in the context of music making, this patient could express her basic humanity and her wholeness.


It would seem that the first lesson I learned in my new context is: You are not sick while you are in the music. Within that humanizing context, you become whole again, even if only for a song.