Speaker: Jana Rambo
Good morning. I’m Jana Rambo. I’ve attended here since 1999, and currently co-chair the Caring Committee, and serve on the Committee on Ministry.
I’ve been asked to tell you about my involvement with a program called Music for Healing in Transitions, which trains people to play appropriate music for people in various types of medical situations. Hereafter I’ll refer to the program as MHTP. I’m seated because I’ll be demonstrating the different types of music we use. My instrument is a mountain dulcimer, which I’ve played it since 1984 after purchasing it at an estate sale.
First, a bit of history about how I got where I am today. For several years I was involved with a local dulcimer club, where I learned basic techniques and later helped teach workshops. In 1997, I got a computer, and my time for music seemed to disappear as I explored the wonderful world of cyberspace. I’m still trying to find ways to pull myself away from the computer after I’ve done what I need to do, but I like to think I’m getting better about that.
My involvement with the 1st UU Caring Committee was partially responsible for my interest in playing for people with medical issues. Many of you will remember Helen Brewer, wife of Joe and mother of David & Maggie, and a very active long-time member. When she became bedfast in the last few months of her life, the Caring Committee was involved getting people to sit with her for a few hours each day to give her family a break. I spent several Saturday afternoons with Helen, sometimes taking my dulcimer and playing for her. Helen was always interested in the folk songs I played for her, wanting to know where they originated, if they had words, and so on, and telling me about her travels in those countries, or about songs she recalled. Although I didn’t know at that time that some kinds of music were more helpful than others, I felt that the music at least gave Helen something else to think about, and brought back memories of good times. After Helen’s passing, when I was applying to MHTP in 2005, Joe was kind enough to write a letter of recommendation for me.
Now, on to the program itself. MHTP is based in Hillsdale, New York. It has existed for about 13 years. The program’s objectives are:
“Serving the ill and dying with live music to facilitate and promote healing or assist in the life/death
transition; Teaching the professional practice of this service; Establishing centers for education all over the United States; Publishing information, research findings and other material about this unique profession; Developing affiliations with healing, charitable and educational organizations where this service may be provided by Certified Music Practitioners (CMP).”
To become a student of MHTP, one has to complete an application describing musical background, personal experiences related to this type of work, and personal or spiritual practices used to keep from getting burned out. The course work is divided into 5 modules, which are held over weekends about 2 or 3 months apart. I started in the summer of 2005 and completed the Modules in April of 2007. Following the modules, we take a test to be sure we have grasped the information we need, and then complete an internship in a local medical facility. MHTP graduates are not music therapists, which is a degree program, but receive a certification as Music Practitioners.
The internship consists of 45 hours of playing for patients at the bedside. Only the time playing can be counted. Sometimes patients wanted only 2 or 3 songs, others would have listened for hours if I had been able to stay. Responses ranged no apparent reaction in some cases, to profuse thanks. I was amazed at how gracious and cordial many of the people were in spite of their serious medical problems. I suggested to Amy that we use hymn # 6 (“Just as Long as I Have Breath, I will Answer ‘Yes’ to Life) today to honor that spirit.
In approaching patients, a distinction is drawn between curing and healing. In curing, the patient’s symptoms are addressed and impacted by the treatment. For example, physicians or nurses provide medication or other treatment, or a music therapist might engage the patient in producing the music, by writing a song about feelings, by drumming, or other means. A CMP plays at the bedside with the intent of providing healing, which is defined as joining the patient in their journey, wherever that may be, with the intent of helping them to resolution or acceptance of things as they are at the present time. We are not doing a performance, which is more ego-based, but play as an act of service to the patient, which is described as being more based in our intentions.
All of us are energy systems, affecting and being affected by our environment. Healing is a part of the human potential, and is aided by being in balance.
In approaching a patient, we need first to desire to help or be of service. To do so, we need to center ourselves and be aware of our own issues in coming into the presence of the patient; we have the intention to help, which means we are focused on the patient’s needs, not our own. We take the situation as it is rather than imposing our own agenda. It’s easy for the ego to step in here with its own agenda, but if we’re truly focused on the patient, our concern is what is best for that person. Often people in the hospital have lost a lot of control over their choices, and they need to have their wishes respected regarding, for example, whether or not they want music played, how long it’s played, etc.
In the modules we discussed music theory and modes, how to care for ourselves physically and emotionally, and the business aspects of doing CMP work. In some places, people actually make a living at this, if they can find a facility with the funding to pay them. We also learned about hospital etiquette, how to approach different situations with patients, confidentiality, and the dying process.
Four of the modules were held in Miller Hall at WSU. One of the violin instructors there is a CMP and served as our coordinator. Module 5 was held at Wesley Medical Center, where we utilized a classroom, and then spent some time on the patient floors, first touring, then playing together in the lobby, and finally, going with a partner to a patient’s room and playing for them. We then regathered and discussed our experiences.
Most of us know that we’re affected by music, identifying it as a spiritual or emotional effect. MHTP recognizes these interpretations, but also incorporates the science needed to convince the medical community of the impact music can have. MHTP does not endorse any spiritual tradition, and none is required. They do want people to be self aware, and reflective enough to process and learn from their experiences with the program.
We learned about scientific studies related to the effects of music in various medical situations, which inform our choice of how to play for a given patient. We are not told specific songs to play, but rather, how to affect patients by rhythm, mode, and the rate at which we play. Each student is encouraged to develop their own repertoire. I was somewhat concerned about this since my musical affinity is for folk and Celtic music, and most people today like to listen to the commercial radio stations. I wondered if I’d need to learn a lot of new songs, but was assured that that wouldn’t be necessary. I found that people responded quite well to the Celtic songs, which can be played in a variety of ways to meet the patient’s needs.
I’m going to spend the rest of the time talking about the various types of patients and medical situations, and demonstrating different types of music used for them.
When we enter a room, we observe the patient. We note their general demeanor, if they’re pale or flushed, still or active, & whether they‘re conscious or disoriented. This helps us to determine the best type of music for that patient.
MHTP teaches us that death is a part of life, and that music can help to ease that transition. This is an area where it’s a bit difficult to do the science, but there is much anecdotal evidence that supports the way we are taught to play for an actively dying person. The term actively dying refers to someone whose bodily systems are shutting down, who may be in & out of consciousness, with recognizable breathing patterns and other signs.
When we play for someone who’s not actively dying, a song with a strong beat can help bring their systems back into balance. With someone who is actively dying, it’s been observed that they can become agitated with rhythmic music, so the logical conclusion is to play arrhythmic music for them. I heard of one CMP who entered the room of a woman who was actively dying; her husband was singing love songs to her, & she was agitated. The CMP played arrhythmic music for her, and she became calmer. It’s as if the rhythmic music is experienced as calling them back to life, whereas the arrhythmic music helps them to let go.
I did not have any noticeable response when I played for dying people. I played for one man who didn’t seem to respond, but his family responded very strongly and positively; I played both types of music in that situation since I felt I was playing for them as well as for him. I played for another patient who was dying who was alone at the time as her family had gone home for awhile. I don’t know if my music helped her to let go and move on, but she died as I was playing for her.
MUSIC EXAMPLE: ARRHYTHMIC MUSIC
Patients in an acute or crisis situation can be helped to stabilize if music is played for them. In this type of patient, the body is out of sync due to irregular rhythms in such functions as the heart or respiration, or due to severe pain. Music with a strong, rhythmic beat played at 60-80 beats per minute, which is also called heartbeat rate, can be helpful. I experienced this rather dramatically with a patient who had respiratory problems & was on oxygen. She was having trouble getting her breath after doing her required walking in the hall. When I came into her room, she was gasping for air. I played for her, a song with a strong beat which I emphasized more than I would in a normal performance setting. When I looked up, she had her eyes closed & seemed to be absorbing the music at a deep level. When I finished, she said “that helped me recover”.
On another occasion, I played for a dementia patient who was somewhat agitated. I started out playing faster, but rhythmically, and gradually slowed down. When I finished, she was asleep. In the interest of full disclosure, this was the only time I was able to reach a dementia patient the effectively, but there was one other occasion when the nurse felt the patient was calmer after hearing the music.
Here’s an example of what I’d play for this type of patient.
MUSIC EXAMPLE: SIMPLE GIFTS
Another type of patient includes people who are not in a particular crisis situation, but who are fairly seriously & chronically ill. I would say this described the majority of the patients I saw at the hospital. My favorite response from them was when they said, in a slightly surprised tone, “I feel better”. Many times, the music reminded them of their own experiences playing or listening to music, or of trips they’d taken to areas where people play dulcimers. Recalling happy times seemed to lift their spirits, which affects the brain chemistry and helps them feel better. It also helped them relax, and more than one fell asleep while I was playing, another means of helping them to heal.
We were told in our classes that we could play a wide variety of music for patients in this category. I developed the practice of asking if the patient had a favorite type of music. Their answer helped me decide what to play for them. A number of people wanted hymns, but we were taught not to play them without knowing if the patient would want them. As many of us know, people can have very negative associations with hymns, and the last thing we want to do is bring up those negative feelings.
One of the first patients I played for had been in the hospital for awhile, and had had dialysis that morning. After I’d played, she told me she’d been feeling worse since the dialysis, and that the music had helped her feel better. Another patient was an elderly man who seemed rather sad, perhaps isolated. He was alone in his room, and wasn’t terribly enthused about the music, but said I could play. He wasn’t an effusive person, but when I left he shook my hand & said, “I like this; I like this very much.” Another man had been brought in on a Sunday morning, and was very much regretting missing his church service. I played hymns for him, and his response was “I feel better now.”
MUSIC EXAMPLE-SHEEBEG & SHEEMORE
Often the music I played for people was unfamiliar to them. This can be beneficial in that they have no previous association with it, and therefore no distracting associations connected to it. Patients are therefore more able to relax and respond to the music in that moment rather than focusing on past experiences with it. However, in some situations, familiar music is more helpful. Familiar music often invokes positive associations from the past, which affects the patient’s emotional state, which in turn affects healing. I learned the importance of playing familiar tunes while playing in the Alzheimers unit of a nursing home one day. The resident & I were in a common area where other patients were also sitting, and I was trying to find music that would help calm his agitation. I played a few Christmas carols, and then tried a quiet Celtic piece to see if it would help. The resident next to him informed me that I shouldn’t play that, since she didn’t know the song & “you get more out of it when you know the song.” I later learned she was a musician herself. I
don’t know what her normal mental state was, but it is often said of Alzheimers patients that music can reach a part of the brain where they can still function; some patients have been observed to sing or hum along, although unable to carry on a conversation.
Here’s one of the familiar pieces I use with the elderly.
FAMILIAR MUSIC EXAMPLE: HOME ON THE RANGE
There were times in the hospital when they hadn’t yet made up a list of patients for me, so I would sit in the lobby & play for the staff. Studies have shown that having music played where the staff can hear it helps them as well as the patients.
One of MHTP’s long-term visions is to have CMPs regarded as medical staff members whose work is viewed as valued and necessary. The program is fairly new to this part of the country; I am the 3rd person in this state to become certified. I don’t yet know where this work will take me, but the personal growth I’ve experienced just from going through the program has made it well worthwhile. I’d recommend it to any musician who’s interested.
That’s all I have. If you have questions, I’d be glad to talk with you after the service. Also, I have some books on the table that we used in our classes, if you’re interested in them.