TMC PULSE

25 t m c » p u l s e | j u ly 2 0 1 9 Songs for a Final Journey Music can soothe patients in their last days and hours B y A l e x a n d r a B e c k e r D an Danford, a young chaplain- in-training, walked quietly into the hospital room. An elderly woman lay in bed, her two older sisters by her side. They had promised their mother they would always take care of "baby sis," who had been born with mental disabilities and was now in hospice care, only barely responsive. Danford began with a list of ques- tions, hoping to learn more about his patient. Had she gone to church? Yes, they said. She loved the music. Danford asked about songs, then sang a verse of "The Old Rugged Cross." "Look!" one of the sisters said, pointing to his patient's toe. It was moving to his voice. Danford explained that their baby sister could still hear them— that she knew they were there, she just couldn't respond. He encouraged them to sing to her, and together— the young chaplain and the two elderly sisters—finished the rest of the well-known hymn. Over the next few days, the women remained by their sister's side, humming and harmonizing melodies from their childhood. Later, they told Danford that she passed away peacefully in the middle of a song. "We sang her on into glory with her last breath, and that toe was tapping, so we know she was on her way to heaven," they said. Today, Danford—who has now been a chap- lain with Houston Hospice for 25 years—knows the power of music, especially for patients and their loved ones at the end of life. Songs can help patients relax and even prompt the release of dopamine—part of the brain's pleasure and reward system—during that transition. Reducing levels of pain, anxiety, depression and stress associated with end-of-life care for both patients and their families can greatly improve quality of life, according to a 2018 article pub- lished in the American Journal of Hospice music will make you feel at peace— it's personally what you find to be happy or uplifting or sad," Folsom said, adding that, typically, those inclinations are formed in a person's teens and early twenties. "That's the time in your life when you're forging your identity and fig- uring yourself out," Folsom explained. "It's not necessarily an equation, but it's certainly a starting point." Anthems Increasingly, music therapy has been recognized as a valuable tool in hos- pitals and clinical settings, and more research is being done on its impact on patients. "Music therapy is a board- certified, credentialed profession, and when we come into a room, we are actually working on clinical goals that a doctor or nurse has referred us for," Folsom said. "It might be that one patient needs to lower their anxiety or another patient doesn't have family and is feeling down and needs some- thing active to make them feel happy and uplifted. So, music is actually the catalyst for that non-musical goal." Music therapists will sometimes create playlists for clinical inter- ventions. Folsom described a technique known as the iso-principle, in which a music therapist begins the playlist with songs that try to match the patient's current emotional state, and then through the progression of songs, moves toward music that reflects a different state. "If someone is feeling sad or has low energy and we want them to feel happier, you start with music that validates their feelings. It's their own preferred music—so whatever you listen to when you're sad—and then you slowly have the playlist move towards songs that are more uplifting to you," Folsom said. Music therapy also engages the patient with the music therapist—conversations and even some counseling can take place. ➟ Dan Danford has been a Houston Hospice chaplain for 25 years. and Palliative Medicine. "Music is a direct line to emotion. There are areas of our brain that light up when we listen to certain music, and it can cause an emotional response associated with happiness," explained Sarah Folsom, a music therapist with The University of Texas MD Anderson Cancer Center, who spends at least half of her time at work with patients in palliative care. "A lot of patients will describe feeling a connection to themselves, a connection to their spirituality, a sense of peace and a sense of relaxation." Both Folsom and Danford said that choosing songs or music genres at the end of life should be based strictly on patient preference. "There really isn't a prescriptive for what kind of music will make you happy or what kind of

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