November/December 2004 Living Now
SacredFlight: The Role of Music-Thanatology in Compassionate End-of-Life Care

by Michael Sasnow, Music-Thanatologist

"Our mission is to lovingly and compassionately serve the spiritual and physical needs of those nearing the end of life with prescriptive music." This statement of commitment by SacredFlight, a palliative music practice in Portland, echoes the one made by each graduate at the Chalice of Repose Project-School of Music-Thanatology, before we received our certificates in 2000. When I enrolled in the two year Masters level program in Missoula, Montana in 1998, I never imagined what would be required of me academically, musically, emotionally and spiritually to get to that point. Nor could I have imagined the depth of meaning it would hold for me at that moment, nor how it would grow as I would continue to grow with this work.

The development of music-thanatology goes back about 30 years. Harpist Therese Schroeder-Sheker brought together the gentle, moving sounds of harp and voice with healing streams from medieval and ancient times to create a modern clinical practice that crosses boundaries between palliative and spiritual care. Palliative care specialists in hospitals and hospice are at the leading edge of "comfort care": care given to control pain and address quality of life issues, after the decision has been made to discontinue aggressive therapies aimed at curing a disease condition. Music-thanatologists trained at the Chalice of Repose Project-School of Music-Thanatology now provide "music vigils" at hospitals and hospices across the US (as well as Canada, Australia, Europe and Israel), and are often called in to play by other members of the palliative care team. The music often helps with pain, breathing problems, restlessness and sleep problems. But the roots of music-thanatology are also deeply spiritual, and our services are often requested by members of the spiritual care team who, after a music vigil, have seen patients become calmer, less fearful or anxious, or more at peace. In addition, and often equally as important, family and loved ones present at the vigil often experience many of the same benefits. In the calming atmosphere provided by the music, a space of beauty and reverence is created where interior reflection and processing of grief and other emotions can safely occur.

Ancient Roots

The synergy of music and medicine (or music as medicine) stretches back through millennia. Sound and rhythm have been, and remain, an integral part of indigenous healing rites around the world. Music was central to the healing work practiced by the ancient Greeks in the temples dedicated to Aesclepius, the god of medicine. In 10th century France, at the monastery at Cluny, "infirmary music" was a central element offered as part of the ritual care for those ready to pass over, providing comfort to body and soul, as well as energetic provision for the coming journey. The "sh’ma," the Hebrew prayer recognizing the oneness of all, is to be the last thing on the lips of a Jew at the time of physical death. It is a command to hear: that it is through deep listening and true hearing that we come to know the One. Hearing is the last sense to remain active as one approaches the final incarnate moments.

Prescriptive music and the musician-clinician

Music-thanatology is a contemplative clinical modality, practiced by trained musician-clinicians. We utilize musical aspects such as melody, harmony, rhythm, scales and modes, meter, tempo, complexity level, intervals, and register as the "raw materials" of music, which we can employ with specific intention in our work. The music vigil is deeply personal and fluid. Along with musical, medical, and historical elements, much of our training focuses on being able to bring a reverent, compassionate, non-judgmental presence to the bedside. This more fully allows us to take subtle cues from patient and family to create a musical field that facilitates processing and unbinding without intruding on these vulnerable moments. We are there to serve the time and needs of the patient and family, leaving our own personal agendas and time-frames at the door. We are part of the growing movement that acknowledges the same level of awe, mystery, reverence and significance in the soul passage out of this world, as into it. Our work is to build a musical bridge, to help navigate this passage for all involved. It is in this sense that music-thanatology has been referred to as "musical spiritual midwifery."

Music-thanatology vigils

I have provided approximately 500 music vigils over the past five years, and no two have been the same. It is very common after a vigil to hear someone express the wish that this service had been available when a particular loved one was near the end of life. We see this as a return to a time when there was no compartmentalization between different types of healing modalities, and no lines of demarcation drawn between the care of body, mind, and spirit. Vigils are appropriate for those at or near end-of-life, and their families; patients with pain or other symptom management concerns toward end-of-life; those with a new, life-altering diagnosis, and the accompanying coping challenges; families experiencing grief or bereavement issues; and anyone in what may be in their last year of life, with any of the complex of issues that may be present.

While we often see such changes as easier, slower, deeper breathing, slowing of rapid heart rate, and less physical discomfort, patients and loved ones often describe a profound sense of serenity, consolation and peace that comes with the music. In the vigil setting, I have experienced spouses being told for the first time that it’s okay for them to leave, and family members releasing held back tears and coming together in profound ways. I have had many experiences of being present for the removal of life support systems, providing music to fill the void left by the cessation of stark mechanical noise. I provided one such vigil early on in my training, for a 75 year old man who just had a massive stroke. There was no brain activity, and his wife and two daughters had made the decision to remove him from the ventilator. We played through the procedure, continuing on afterwards as his family said their goodbyes. His wife kissed him on both cheeks and bent over him, her chest resting on his, as he took his last breath. One of the daughters approached us afterwards and said, "This was a beautiful experience because you were here."

Many people comment that this work must be extremely difficult. While there are difficult moments, we experience this as the most rewarding work we can imagine doing: having the privilege of being invited into such a vulnerable and intimate setting, to provide, through living music, a comforting beyond words, that transcends cultural and religious boundaries. We consider it a great honor to do this work, and we extend our gratitude for the countless gifts we receive by being in the presence of those nearing the end of their physical lives.

SacredFlight has been providing music vigils in the Portland area over the past three years. For more information, please visit our website, www.sacredflight.org, or call us at (503-241-3344.