By Ray Leone, MMT, MT-BC
Ray is a Board-Certified music therapist who directs A Place To Be’s medical music therapy program through a partnership with Inova Health Systems.
Working as a music therapist in acute care in a medical setting allows me the opportunity to work with a wide range of people. And part of the music therapy experience, what makes it therapeutic, along with the music, is the relationship that is established between the therapist and the person with whom we are working with. In acute care however, I very seldom get to work with someone for more then a few sessions; and many I work with just once. And even though we can’t establish “long-term” therapeutic relationships, we always connect, in some way, through music.
I did have the unique opportunity recently to work with a gentleman more “long-term” at the hospital. I met Mr. R. a few months ago in the oncology unit. A young gentleman in his late 30s, he was diagnosed with various terminal cancers and when we met, he was in the hospital as a result of complications with his treatment. Upon meeting him, I could tell that he was very ill and according to the medical records, he was rapidly declining…he was “terminal”. Over the course of the past few months, he was in and out of the hospital several times and recently he was in for a fairly long stay as he was, unfortunately, declining rapidly. In the recent progressing days, he was also dealing with extreme pain. And what was unique about my work with Mr. R. was that I saw him about 15 times over the course of those months.
Mr. R. was from the Middle East, only having been in the U.S. for a few years. I remember when I was first met him, in his hospital room. He spoke some English, although sometimes hard for me to understand, and I wondered how I was going to work with and help him considering our cultural differences and language barrier; how could I connect with him musically? Admittedly, I was a bit nervous at the onset. As I entered his room for our initial session, I remember him sitting in the middle of the bed, cross-legged, almost in a yoga-type pose. I sat in a chair at the foot of the bed and introduced myself and why I was there. Immediately, I knew that communicating may be somewhat of a challenge, so I thought I would rely on music. I had some instruments to offer him, perhaps we could just start with some improvisation to break the ice. As I started to take some out for him to perhaps choose from, he pointed to the guitar case and quietly said, “guitar”. “Do you want to play the guitar?” I asked. “No,” he said. “You play.” Okay…so I took out the guitar and he was fixating on it. Trying to get a sense of where to start, I simply said, “Is there anything in particular that you like?” He replied, “You play what you like.” Okay…so I started playing. I just started improvising a bit, just to get us both comfortable and to set up a place for us to go. I started playing what I thought he may be feeling inside. He watched my fingers intently and after a bit, his face changed. He looked less pained and his breathing was slowing, almost matching the tempo of the music. Then he closed his eyes and was just “in” the music. I could tell that he was really experiencing the music in his own way. Sitting in the bed, with his legs crossed, he almost looked as if he were moving into a trance-like state. I intently watched him, and followed him with the music. I played…for about 20 minutes. When I slowed to a finish, there was silence…silence…and after what seemed like several minutes, he opened his eyes. He looked peaceful and looked right into my eyes and said, “Thank you…come back tomorrow?”
And thus our relationship began.
When I went back to see him, he smiled and greeted me and got into his “position” on the bed. I played. And, again, he was using the music, experiencing it, letting it take him on some sort of journey to “another place”. After a few days he was discharged and, like most patients I see in acute care, I thought our work was done, we had a couple of really nice sessions and the music seemed to bring him some comfort. But after a few weeks he was back. And again, he welcomed me…and I played. As I continued to see him, as is the case with many patients in the oncology unit, I could see the progression of the disease taking hold of him. On one particular day, he was lying in his bed and he looked very uncomfortable. I said, “How are you?” “Pain…very bad.” I simply sat down and played, but this time, trying to comfort him with the music, trying to work with his pain. I used the music to work with his body, first matching what he may be feeling (dissonant chords, jagged rhythms) to show some empathy, and then slowly moving to more harmonic structures, hoping to take him with me, and move him out of the grips of the pain. He, again, was using the music, but in a different way this time. He seemed to find some relief, in the moment. And as he always did, when I was through he thanked me and said, “Tomorrow?”
Over the course of the past few weeks, I saw him each day that I was at the hospital. He was in for the long haul now, was declining rapidly; and…the pain. At times it seemed unbearable for him. But…I played, and often he would find some relief in the music. And always, “Thank you…tomorrow?” I remember one particularly tough day, he would occasionally find some comfort but sometimes the pain was just too much, it would consume his entire being and he would incoherently yell out…he would show signs of delirium. I tried to work with him, changing the music to try and give him some relief. On this particular day, I played…for almost an hour (there were no words). Finally…a little relief. “Thank you…tomorrow?”
It got to a point where I knew things were coming to an end and I heard that the doctors were discussing “plans” with him about suspending treatment. It was time to look at things differently. I could see that he was declining and I have to admit, each morning when I got to the hospital I would immediately look at the patient list to see if he was still “here”.
Then, on a particular day when I went to the unit to see him, as I usually did I spoke with his nurse to see how he was doing. She told me that they did indeed make a new plan, they were suspending treatment going forward and he was being discharged, that afternoon, going to Hospice. She also told me he was really not doing well at the moment; that he was really “out of it”. I went into his room. It was quiet and dark and he was lying in bed. Yes, he did look “out of it”. I wondered if he would even know that I was there. If I played…would he hear me? Would I be able to help at all? For one last time? So, as I always did…I played. He didn’t move. I continued and I did not see any response in his body showing that he knew I, or the music, was present. But, I continued…I played. And in that moment, I suddenly felt an unexpected wave of emotion starting to overtake me. This was it, after all of these weeks, all of our sessions, significantly more then any other patient I had ever worked with in the hospital, this was the final chapter. This was going to be the last time I was going to see him. I was battling my own emotions; this was a new feeling for me - after all of this time, this was the last time. And…I played. But it was a bit different. Now, I was playing what I was feeling inside. I needed something; perhaps some comfort for myself – some closure? I played…and when I finally finished, I just sat in silence for a bit.
As I slowly walked out of his room, for the last time, I paused at the doorway and looked at him. And I whispered…“Thank you.”
The healing power of music…
(*the stories presented in this blog are based on accounts and experiences and are not actual accounts and experiences)