In the Trenches

When will the healthcare we offer be as warm, as human, as authentic as the people to whom we offer it?

Seriously. I'm asking.

I work with and for real, living, loving, breathing, hurting, healing, and dying human beings, each a complex universe of human experience unto him or herself.

One of the reasons I was so drawn to hospice work is because the hospice philosophy of care is acutely aware of this reality, and every policy in place reflects this reality for providing individualized patient care.

But earlier this week, my therapist heart got slammed up against a wall because of someone I wasn't working with. In short, it hurt and it made me intensely frustrated with the big, overall umbrella of providing healthcare to older adults in this country.

I pulled up to outside of an assisted living and skilled nursing facility where one of my patients resides. I was there on my employer's time to see someone on my hospice caseload. This means I don't have the luxury of interacting with every resident in the facility.

That's why my heart sank as I wound my way past the nurse's station, guitar on my back -- I heard a gentleman call out from behind me, "Miss? Miss! Is that a guitar? Are you going to share some good, old music with me today?"

I turned back long enough to wave at him, to give him the warmest, most compassionate smile I could, and said, "I'm so sorry, but I am here to see someone specific."

I tried to ignore the pangs in my heart as his face fell and I kept moving.

After a beautiful, delightful routine visit to my patient, I passed back by this gentleman and several other ladies, all parked in wheelchairs, dozing or making hushed small talk in front of the nursing station.

This time, the gentleman leaned forward and asked me what kind of guitar I owned. I told him, and his eyes lit up. He exclaimed, "That's a great guitar! I used to have one, but with 12 strings. I had to get rid of most of my guitars when I moved here though...not enough room." The lady next to him joined our conversation, asking me if I knew the entertainer that was scheduled to appear later that afternoon. They invited me to join them sometime and said they wished I had been there to see them.

I lingered just a few moments with these people. I had other patients to see that day and paperwork to finish after that. By way of parting, I started singing the old standard, "Show Me the Way to Go Home."

A woman had been sitting silently this entire time, with her head bent way down over her lap and her eyes closed. I started singing this song and she immediately sprang to life. Her posture changed. She made eye contact, and her eyes began to sparkle with the smile that was now illuminating her entire face. She opened her mouth and sang the entire little song in beautiful harmony to my melody. In an instant, she was transformed into a former, vibrant version of herself.

The facility staff that observed this brief interaction remarked that she had a cousin who was a famous singer and that she had occasionally sung duets with him.

This woman said nothing, but continued to smile at me expectantly, as though waiting for her next cue to sing.

That's when my heart slammed into the wall.

I was not there for her. I cannot bill for time spent interacting with her. No one has asked me to assess her needs, limitations, strengths, abilities, and responses for clinical music therapy.

I wanted nothing more than to advocate for her access to a certified music therapist. To speak with the facility staff about the real and significant changes in her when a live person interacted with her using her preferred music. To demonstrate the ways in which I could meet her care plan needs and improve her quality of life.

I wanted to see what other songs she remembered and took joy from. I wanted to provide human touch as I supported her in playing small rhythm instruments with me, if she was willing.

In short, I wanted to serve as music therapist to her -- to use music to bring her out of the world in which she spends her days drooped silently over her knees in a wheelchair.

The gentleman who had to give up his guitar collection, this woman, and every other resident there were warm, human, authentic.

But I had to rush along. That's what it's like to work in the trenches of healthcare in this country.

The trenches are where I meet my fellow human beings and offer them help and therapy through the medium of music.

So the trenches are where I want to stay. I want to change the culture of healthcare from the inside.

And today I am asking...when will he healthcare we offer be as warm, as human, as authentic as the people to whom we offer it?

The Top 5 Reasons I LOVE Providing Music for Memorial Services

This past week, I was very privileged to provide the music for two memorial services. That's a mark of a great week to me, because as a hospice music therapist, using music in this way is a part of the job. It also happens to be one of my favorite parts of the job. People are often surprised to hear me say this, so without further ado, please allow me to explain the top 5 reasons I enjoy this so much!

1. My Own Closure
While I try to keep one eye on the on-call updates from the nurses, and it is always my policy to offer a visit if my patient is actively dying, the reality is that I don't always get the opportunity to tell my patients goodbye. Sometimes their dying process moves in a way no one is expecting and I don't get the opportunity to tell them one more time how much our client-therapist relationship has meant to me and what an honor it was to serve as their therapist. I don't  always get to say I will miss them and remember them. Being asked to provide the music for their memorial service meets that need for closure for me. It gives me one final task to complete within the context of that therapeutic relationship.

2. The Family's Closure
Having a member of the hospice team, such as the music therapist, or the chaplain, facilitate some aspect of the memorial service assists the grieving family with an element of closure, as well. In hospice, the family is my "patient," too. The whole hospice team builds relationships with the family as we journey with them through their loved one's end of life. The family realizes they are going to miss their wonderful nurse coming to see them, and just how much they had been leaning on their social worker or chaplain in the days, weeks, or months prior to their loved one's death. Having a chance to tell their hospice team goodbye is good for the family, too.

3. An Opportunity for Grief Support
I'll be honest - I never memorized my multiplication tables and my dancing abilities are suspect at best. However, one of my personal and professional strengths is sitting comfortably with the grief of others. My social work friends may know this concept as "leaning in" or "holding space," for others. For me, it is my ability to show up with an open heart and non-judgmental compassion and simply BE with someone else's grief. This is a strength of mine that I am not afraid to embrace, and it's not a skill I get to use as often as I would like to. Being involved in the memorial service gives me a chance to function professionally in a way I find deeply fulfilling.

4. Precious Gems of Insight
There is something extremely surreal about getting to know a person even better after they have passed away, but it is also deeply gratifying. I LOVE getting to see more pictures of my patients when they were young and to hear their close loved ones reflect on their life. It deepens my sense of awe and humility that I am allowed to accompany these incredible individuals through the final miles of their journey. I cannot say enough about how much I treasure every insight into someone's life I gain by being present at their memorial.

5. Bringing Beauty
There is a reason humans offer one another flowers in  times of unspeakable sorrow. Sometimes the best and only thing we have to offer to one another is the gift of something beautiful. Most people bring flowers to memorials for this reason. As a musician, first and foremost, I bring music. It is my hope than an experience with something beautiful will help soothe some of the ache that is felt with each loss of a human life. Musically, I take the music for a memorial service VERY seriously, because high-quality music is a precursor to anyone having a transcendent, healing, aesthetic experience. Whenever possible and appropriate, I also invite those in attending to make music WITH me because shared music making is one of the most healing, transformative, and connecting experiences available to humans.

So, there you have it! The top 5 reasons I love providing music for memorial services! If you also find yourself providing this service, please sound off in the comments and share your reasons with me!

Same Bottle, Different Contents

Almost daily, I have experiences in my clinical hospice work that cause me to reflect back on all my education and training. This is fabulous because it means I am continuing to stretch myself and grow as a clinician, and my patients and their families deserve nothing less from me.

I had one such experience recently. I made two routine hospice music therapy visits back to back and I found myself singing the exact same song during both clinical encounters. That, by itself, is not unusual or noteworthy. Many of my patients share similar demographics that play a significant role in determining their music preferences, and by nature of having a life-limiting illness, many of my patients will present with similar clinical needs to be addressed in music therapy.

What really stuck out to me was how very different the experience was of using this song with each patient and family. Again, there is nothing too shocking here. Responses to music are highly individualized and depend on a massive variety of factors and variables. The same song that brings me comfort and peace of mind might be reminiscent of nails on a chalkboard to you. As a board-certified music therapist, this knowledge was part of my training and it is part of my job to continually assess my patient's responses to music via their own self-report and my clinical observations.

So, if it's not unusual for me to use the same music with multiple people, and I am fully prepared for each person to respond uniquely to the same song, what exactly about my day was significant enough to stop me in my tracks and prompt me to blog about it?

It was the degree of absolute contrast between those two home visits that got my attention. The same three minutes of organized sound functioned in two polar opposite ways for each patient-family group.

In one home, my patient needed distraction and refocus from physiological discomfort. The song in this context functioned as an upbeat, external focal point to divert attention from pain and discomfort. Here, this song is associated with happy memories and current happy experiences. In this home, the song elicited smiling, laughing, toe-tapping, and intentional optimism as a coping skill. As a music therapist, I expected to see those responses and that is why that song was used over any of the other hundreds of thousands of songs out there.

In the other home, my patient and their family needed a safe place to openly grieve a deceased loved one. This song was a favorite of their loved one, and here, the same song elicited tears, naming of grief feelings, emotional catharsis and active grief processing. Bittersweet memories of this song came rushing to the surface and the lasting connections with their departed family member were strengthened. Here, too, I was expecting and prepared for this reaction and had a good sense of the appropriate bottle to take off the shelf and open.

The experience of using one song to remember joy, and less than an hour later, the same song to appropriately channel sorrow was surreal to me. Opening that musical bottle in each home revealed something very different inside.

This experience has sharpened my awareness of the way the same bottle can hold dramatically different things for two people. It has pushed me to dig deeper in my clinical work, to always strive to observe more closely, listen more intently, and keep building my musical skills and repertoire so that I am always prepared to offer the best clinical experience to the people I serve.

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?