I am a music therapist with Baycrest Centre for Geriatric Care in Toronto. Music therapy is the skillful use of music as a therapeutic tool to restore, maintain and improve mental, physical and emotional health. It provides a viable and humanistic approach that recognizes and develops the often untapped inner resources of the client. I want to share with you my experience in helping a 48-year-old client in our Palliative Care Unit confront her terminal illness. To respect her privacy, I will refer to her as D.
Last April, D. was admitted to Baycrest with lung cancer and brain metastases. A therapeutic recreationist on the unit referred D. for music therapy. D. was confined to her bed for the majority of the time that she was at Baycrest and was unable to access any group programs. I began individual music therapy sessions at her bedside.
Music had been a large part of D.’s life and she had always enjoyed singing. She spoke a great deal about her choir experiences and expressed sadness about not being able to perform at an upcoming concert. D. was not married and had no children.
D. expressed interest in taking part in music sessions with me. She was pleasant and rapport was established very quickly. She knew many of the songs I suggested and we sang them together. D. spoke about returning to sing in the choir and going home. She was in denial about her terminal illness. She spoke about her faith growing up and how she had attended church regularly. Spiritual music appeared to be comforting to her.
After my initial assessment, I scheduled D. for individual music therapy three times per week for one-hour sessions. I set the following goals:
- To decrease social isolation
- To increase communication and self-expression surrounding dying
- To reminisce and stimulate life review
- To sing
I looked up two songs D. had asked for that I did not know and typed the lyrics so we could sing the songs together and discuss them. “Farewell to Nova Scotia” is a song that talks about leaving and being remembered.
“…I grieve to leave my native land. I grieve to leave my comrades all…
And my parents whom I held so dear, and the bonny, bonny lass that I do adore.”
The other song,”One Day At A Time”, speaks about courage and strength to get through the day. D. told me this was her favourite song.
“One day at a time, sweet Jesus. That’s all I’m asking of you. Just give me the strength to do everyday what I have to do…”
D. talked to me about her childhood and watching Kristy Lane sing “One Day At A Time” on television. I asked if she would like to sing some hymns together. D. chose “How Great Thou Art”. Together we sang two verses and she asked me to sing the third verse. It begins:
“When Christ shall come with shout of acclamation and take me home, what joys shall fill my heart…”
After singing this song D. opened up a little and told me that a minister had been to see her earlier that day and they prayed together. She said she wasn’t really sure why he came to see her. Again D. was denying her illness and the reason for the spiritual visit.
We sang “Kum Ba Yah” together. D. chose the phrases.
“Someone’s crying Lord”
“Someone’s happy Lord”
“Someone’s dying Lord”.
After singing the song, D. said she wasn’t sure if those were the correct words. At this time I still did not feel that D. was ready to speak about dying. I felt she was using the music to express her feelings, but was not ready to discuss them.
After “Kum Ba Ya”, we sang several country songs, including Anne Murray’s “Snowbird”. In our third session, I let D. take the lead in picking the music. She looked through the books that I brought and we started with “The Sound of Music”. D. also selected classic childhood songs such as “Puff the Magic Dragon”. She reminisced about her school days and sang a few camp songs for me.
D. asked to sing some folk songs. She chose “Blowin’ In the Wind”, another song that talks about death.
“Yes and how many deaths will it take till he knows that too many people have died”
We sang “Shenandoah”. D. said she found the song comforting. We sang through a few hymns and D. asked to end with the “Battle Hymn of the Republic”.
At our fourth session I had planned on introducing the idea of songwriting to D, but she felt tired and wasn’t sure if she could sing. She asked me what I had for her (meaning songs) and I suggested we sing through some of her favourites. I also brought a tape for her of Kristy Lane singing “One Day At A Time”. D. sang through many of the songs with me quietly. She asked to hear “Battle Hymn of the Republic”. We sang two verses and D. asked to sing one. She had chosen to express her thoughts at this time using this song.
“Glory, Glory what a hell of a way to die
Glory, Glory cancer’s got me in the eye
Glory, Glory what a hell of a way to die
His truth is marching on”.
As soon as she finished D. said she thought she had heard those words when she was a child. I had never heard those words before, but assured her that it was okay to express personal thoughts or feelings in a song. I asked if these were her words. She sighed heavily and maintained eye contact with me. I felt that the time was right and we talked about death. D. was angry about her diagnoses and felt very alone. She had never let herself express these emotions to others before and it was important for her to do so.
In our fifth session, D. and I began to sing through songs from past sessions. We talked about the fact that many of these songs addressed death. To me, D. now felt comfortable expressing her fears and anger about her future. D. sang her verse of “Battle Hymn of the Republic”. She did not disclaim her words. We laughed a little about our voices and D. joked about my high soprano voice and her low alto voice. She said, “We made quite the pair”. She talked about how important her voice was to her and how upset she was about what the disease had done to her.
This was our last session together. D. passed away in early May.