There's an increased use of live music at Bay Area’s major hospitals and hospices to bring healing and comfort to people who are near death.
Music At The End Of Life
Hospitals are not the most relaxing places for people nearing the end of life. The intensive-care units, lobbies and hospital wards are full of glaring bright lights and institutional noises.
In this stressful environment, music can be the great equalizer. The soothing sounds can bring peace and calmness. Music can help defuse the tension felt by anxious patients and their families. Today, in many of the Bay Area’s major medical centers, musicians are playing in hospital lobbies and at the bedside.
"One of the hottest topics is music and the brain," says Judith Kate Friedman, a professional songwriter who works with seniors. "Music lights up the brain more than almost any other human activity."
Music at the end of life is an ancient tradition that dates back to the Middle Ages, when eleventh-century Benedictine monks used music as part of their deathbed vigils.
Those practices fell out of favor as monasteries disappeared with the coming of the Reformation and the Industrial Age.
But today, music at the end of life is making a comeback. Many Bay Area medical professionals now recognize the benefits of live music played at the bedside. And in some of the Bay Area's leading hospices now have volunteer musicians playing music for their patients.
Volunteer musicians at the bedside
Thad Povey, a volunteer at San Francisco’s Zen Hospice Project, has played guitar for hospice residents over the last four years.
Today, he’s getting ready to play for Bruce Davis, a 67-year-old man with incurable brain cancer.
Davis looks weak and frail. His brain tumor has grown larger, and the cancer has metastasized. Laying in bed, he’s barely able to move, and is surrounded by several friends.
Although he is close to death, he is not ready to let go yet. He’s in a joyful mood and he wants to hear something familiar, like the Beach Boys, the Safaris or Led Zeppelin.
Unfortunately, Povey doesn’t know any of those songs, but he does know the Beatles’ “Blackbird.”
The moment he starts singing the first verses, Davis’ face lights up and it isn’t long before he and his friends are singing along.
“He was elated,” says Jan Flatow, a friend who’s known Davis since kindergarten when they were growing up together in Brooklyn. “He was so happy. It’s the work of angels. [Povey] had a wonderful effect on Bruce. He loved it. I wish there was more of it. I mean, it would be fantastic.”
A presence in hospitals
Thirty years ago, it was unusual to find live music in hospitals.
With advanced technology on the rise, music seemed to have no place in a clinical setting.
But today, more doctors now acknowledge that even the most sophisticated medical treatment cannot address all pain and suffering.
In the Bay Area, many hospitals now welcome live music as an integral part of care at the end of life.
"The nurses and the doctors want to care for the patient," says Portia Diwa, a harp therapist with the California Pacific Medical Center. "When they know there's not that much they can do for them and they can offer harp music, they're quite excited that they can offer something of comfort."
Since the 1990s, several Bay Area hospitals have invited musicians to play or sing at the bedside. For dying patients, Celtic harps and vocal ensembles are frequently used. Music at the end of life is a form of palliative medicine. The goal is to help ease suffering and provide comfort for patients and their families, when a cure is no longer possible.
Diwa says like any medicine, one size doesn't fit all. The music needs to be tailored to what the patient finds relaxing.
“I would experiment a little bit, to see if there’s a mode or chord that the patient might resonate with or that seems to be more peaceful in that space,” says Diwa, “And once I found what that resonant tone was, then I would choose a song that’s in that mode."
Studies have found that music can lower blood pressure and respiration rates, and it can increase endorphins, which reduces pain.
“I have seen firsthand how people calm down, slow down and respond," says Patrice Haan, executive director of Healing Muses, a nonprofit that provides healing harp music at the bedside.
For patients who are dying, the ultimate goal of healing harpists is entrainment, a process aimed at synchronizing the patient's vital signs with the music.
"We meet them where they are, then sedating them, slowing them down," says Haan, "The pulse slows down. The tonal range of the music often becomes smaller."
She adds: "Lullabies are a perfect example — maybe a couple of notes, with a lulling rhythm behind it."
"'What could it hurt? I'm going to sing her songs back to her.' And every so often, it looked like her lips were mouthing the words." —Judith Kate Friedman, Songwriting Works
Brain-wave studies suggest that even non-responsive people in comas and those near death can still hear sounds.Hearing may be the last sense lost before death.
Haan remembers playing for a young woman severely damaged in a car accident.
"(She) seemed to be incapable of any kind of response," Haan says. "And yet, I remember watching her breathing a tune to the music, watching those two things synchronize and then watching her eyelids start to flutter. I'm utterly convinced she was hearing it."
Age and music
Music can also engage people are afflicted with Alzheimer's or advanced dementia.
Musician and former Bay Area resident Judith Kate Friedman is the founder of Songwriting Works, a nonprofit based in Port Townsend, Washington, that uses songwriting to connect with elders in assisted living facilities.
Friedman says many of the patients with advanced dementia she's worked with can still remember and respond to music, even if their memories are severely impaired.
"Sometimes people will remember the songs when you come back, even many months later," she says, "It is mysterious."
When she was writing songs with elders at the Jewish Home in San Francisco over ten years ago, Friedman remembers an elderly woman who had co-written several songs.
The woman had a stroke and when Friedman visited her, and was in a coma. Friedman said, "What could it hurt? I'm going to sing her songs back to her. And every so often, it looked like her lips were mouthing the words."
"Researchers have said it looks like the music gets through to people, even if they can't consciously interact," Friedman added.
Dr. Oliver Sacks, the famed neurologist, theorized that music is hardwired into our brains in a way that defies easy explanation.
Even when their brains are ravaged by Alzheimer's, dementia, and severe memory loss, many of Sacks' patients could still sing songs from childhood.
A similar theory posited by Daniel J. Levitin, author of This Is Your Brain On Music, is that music taps into a part of the brain that doesn't require interpretation to communicate as words do, and that allows a direct connection to feelings.
In his book Musicophilia, Sacks argued that "we humans are a musical species no less than a linguistic one."
Songwriting Works’ Friedman agrees with Sacks. “I’ve been with people in the last day of their life, where just the touch of the hand — there’s a pulse there, there’s still a connection there," says Friedman. "The ancient part of the life force is still in us. And it has a music to it."
She adds: "The earliest instruments of humanity are the drum and the voice. And the drum is the heartbeat and that’s where it started. And maybe towards the end of life, it goes back to that simplicity.”
A gentle landing
Back at Zen Hospice, it’s time for Thad Povey to pack up his guitar.
He’ll return the following week to play some more for Bruce Davis.Given the rapid progression of his cancer, Davis most likely has one or two months left to live.
As his life winds down, so will the music. Povey expects the songs he’ll play in the coming weeks will be quieter, maybe more Beatles, and more atmospheric — music that will allow Davis to hoist anchor, set sail and gently move on.
JoAnn Mar's report was produced with the support of a journalism fellowship from New America Media, the Gerontological Society of America, and AARP.
