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August 3, 2009

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Heavenly harpstrings help dying patients pass on in peace

IN a white-walled hospital room, pancreatic cancer slowly drained all the life that remained in Carolyn.

There was nothing more to do for this 62-year-old woman - no oxygen or other life support, just a morphine drip to keep her as comfortable as possible.

That, and the ministrations of Jane Franz, a music-thanatologist in Portland, Oregon, the United States.

Franz brought her harp to the foot of Carolyn's bed, and started to play, weaving a hypnotic and soothing melody. Occasionally, she paused to adjust to the rhythm of Carolyn's heartbeat and breathing. After 20 minutes, the last notes settled like a benediction over the room.

Three family members sat at her bedside, sometimes holding hands. There were tears and hugs. Franz returned the next day to play one last time, and then Carolyn died.

This is what Franz does. As a music-thanatologist on the staff of Sacred Heart Hospital in Portland, she uses music to bring comfort to the dying.

"Doctors can write lots of medical prescriptions and not get the right response," says Dr Stewart Mones, medical director at Sacred Heart. "There are times when no medicines are as effective as music therapy."

Music-thanatology - thanatology derives from thantos, the Greek word for death - has been around in various forms for centuries. Its roots extend at least back to the monastic medicine of Benedictine monks in 11th-century Cluny, France.

As practiced today, it was developed over more than 30 years by Therese Schroeder-Sheker. Her Chalice of Repose program was located in Colorado and Montana before 2002, when it moved to Mt Angel in the quiet farm country of the Willamette Valley south of Portland.

It stresses carefully individualized "prescriptive music," a concept Schroeder-Sheker developed in which a harpist observes the body processes and mental state of a patient and adjusts tone and tempo to match.

Music-thanatologists say they use the harp for the many sounds it can make and for its warm, low, resonant tones. And it's portable.

Their "vigils," as they are called, are held at no cost to the patient at a growing number of hospitals and hospices across the United States and elsewhere.

Chalice grew from Schroeder-Sheker's work as an orderly in a geriatric home. She saw that people often died alone in a room with nothing more than canned laughter from TV sitcoms.

She began using music to care for the dying in 1973. She recalls the throes and death rattles of an often-abusive emphysema patient assigned to her in the home. She held his hand, called his name, made eye contact, found herself singing softly to him: "The Mass of the Angels," "Adoro te Devote," "Salve Regina."

The thrashing stopped. The rattle quieted.

From that moment, a movement has grown.

"We come in with this music that does whatever it does for the patient and the family," says Franz, who heads the program at the Peace-Hope campus of Sacred Heart and the new two-year music-thanatology program at Eugene's Lane Community College, a first for a public institution. Its first class was graduated last month.

Lane stresses an intensive monthly training class for two years; students commute from as far away as Utah.

Beyond classes, clinical internships are an essential part of the training and provide 300 hours of direct contact with patients. Students seek certification through the independent Music-Thanatology Association International; 38 have been certified to date.

At Chalice, Schroeder-Sheker conducts a graduate program involving four semesters and a yearlong clinical internship. There is a demand for her students: the Strings of Compassion program at Sacred Heart has three full-time staff music-thanatologists and would like a fourth; they handle about 1,000 vigils a year, and could do 500 to 600 more.

The thanatologists respond to requests and referrals from doctors, social workers, families and nurses. The programs are not tied to any church and do not discriminate on basis of faith.

In the struggle at the end of life, Mones says, music-thanatology is an important factor in dealing with emotional and physical issues. "When the music begins to play I have seen shoulders relax, I have seen people take a deep sigh. Emotions bubble to the surface."

Sharilyn Cohn, who co-directs Portland's nonprofit Sacred Flight, which contracts with 15 Portland-area hospitals, said every encounter is unique.

She said the music is viewed as a compound medicine in which melody, harmony and rhythm combine to soothe the patient and the family.

A harpist might enter a hospital or hospice room not knowing what he or she will play.

"We try to gather information about them as a person, what's going on with them right now, any physical stress, anxiety, fears, restlessness. We try to get a sense of the whole person before we go into the room," Cohn says.

"It can change from moment to moment," Franz says. "We follow them. They lead."

The intention, she says, is to help patients let go when they are ready. "We try to use music that is not really so familiar to people because when we use familiar music people would think, 'What are the words to that?' or think 'The last time I heard that song, this happened.' The experience becomes very different from the focus or our work."

She says they try to conduct multiple vigils for patients. They played daily for Carolyn for a week and a half before her death. "As (death) draws closer they know what to do with that music, to take it and use it profoundly toward a peaceful death."

Music-thanatologists have access to the medical charts read and updated by doctors and nurses.

They, in turn, record their own observations: after she played for Carolyn, Franz noted her breathing, heart rate before and after, the atmosphere of the room, any response.

When Carolyn arrived, she said, "we didn't think she would make it through the shift. None of us did. It shows how little we know."

They do know that their music has its intended effect.

"At the end of life our job and our desire is not to engage people, to engage their minds, to have them hook onto specific thoughts or memories," Franz says, but rather to have them recognize and flow with melody, "to offer an atmosphere in which they can do whatever they need to do at whatever level they need to do it while the music is present and because the music is present.

"They have that feeling of what the harp feels like. That stays with them," she says.


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