Module 5 Practicum

DISCLAIMER: This is a very long post ... read when you've got an entire weekend.

[GRIN]

Sunday, November 11, was Practicum Day. My class of six made their way to Kansas City Hospice House early to play at the bedside for the first time.

KC Hospice House is a new facility on 120th & Wornall in South KC … and it's beautiful. It was a bit like walking into a 4-star hotel, only the warmest and most welcoming hotel you've ever been to. The peace in the air was palpable. It immediately calmed my nerves.

Our teacher had arrived before us to check in with the nurses as to which patients would be the best candidates. She then spoke to each patient and/or family member to obtain permission for us to come and play therapeutic music in their respective rooms.

Each of us was assigned two patients – typically Module 5 students play for just one in the Practicum. We were fortunate. AND, each of us had the opportunity to play for someone who was actively dying.

Actively Dying refers to someone who is very close to death (within hours or a few days). At some point, there is a definitive shift in the person's behavior, demeanor, physical condition that will point to impending death. And this process of death is as varied in people as the process of labor & delivery.

One of the things we discussed at great length in class is that it's hard for the body to die. By design, it wants to keep functioning, keep working. One book described it as shutting down a large factory with multiple machines that need to be turned off one or two at a time. This process, as I said, is hard for the body – but it doesn't necessarily mean that the patient is in great pain. (Sometimes they are – but with the pain management options available in hospice settings, it can be minimized greatly.) This leads to one of the big reasons I pursued this course of study … death is as much a part of life here on earth as living. And death, in my opinion, should be handled with as much care as birth.

It is possible for many people to experience a dignified and peaceful death. Sometimes the disease that inflicts a body works against this – but not always. If a patient has resolved his/her relationships and is "current" with friends and loved ones, this can greatly enhance one's ability to let go when it’s time.

My goal is to offer some assistance in those moments of an actively dying person's life – by helping to create an atmosphere of relaxation and comfort. This is achieved by playing something called "arrhythmic music."

The term arrhythmic music can sound rather harsh or experimental. Really, it's neither. It means to play with no set rhythm, no beat, and no recognizable melody. Maybe the word "ethereal" would be a better description. As a person dies, they are separating from the things and people around them. It has been said that some people, during the dying process, hover between spiritual planes of existence – this life and that of the next. As an outsider in the patient's room, the last thing I want to do is to unintentionally "pull" that person back from wherever they are. Whether we realize it or not, when we listen to music, our brains are looking for and anticipating patterns, trying to make sense of the music's structure. Arrhythmic music provides soothing sounds and moments of silence that allow the patient to relax and let the music truly be a background element rather than sounds to which they are actively engaged in listening.

Lots of verbiage here … but I thought it important to help y'all understand how this works.

So, back to the patient assignments …

After our teacher gave us the pertinent info on who we would be playing for, she said, "Now, go play for your actively dying patients first so they don't pass away before you get a chance to play for them."

GULP.

(Inner Monologue) "She means it about this actively dying thing. This is REAL."

I played for an 80-year-old woman who was in the final stages of Alzheimer's. She was unresponsive, and her breathing was very fast and labored. She had been like that for several hours.

I introduced myself to her two sons and a daughter-in-law and then introduced myself to the patient. (Although a patient may be unresponsive or even comatose, we treat them as though they can hear every word – because hearing is said to be the last thing to go.)

Several minutes into playing for this woman, her breathing made a dramatic shift. She started to breathe much slower and in a more relaxed way. Shortly after that, her breathing stopped altogether …

(Inner Monologue) "Oh my gosh – is this woman going to actually DIE while I'm here?”

The daughter-in-law got up to say goodbye to the patient.

(More Inner Monologue) “Is this a good thing, a bad thing? How do I handle this???"

… and after about 30 seconds, the patient began to breathe again, still slow and relaxed.

I played for about 25 minutes and decided it was time to gently wrap things up. (Honestly, I completely lost track of the time and thought it had only been 10 minutes or so. It wasn’t until after the fact that I realized how much time had gone by.) I sat quietly for a moment after I finished, and the patient's breathing became labored again. I made the call to listen to my gut and resumed playing … and her breathing returned to the calmer state. After about 5 minutes, I wrapped up again, thanked the family members, said my goodbyes to the patient, and quietly left the room.

My mind was spinning at such a rate, I was SURE everyone could hear it.

The surprising thing to me (aside from the overwhelming nature of the whole experience) was that her two sons sat as still as posts while I played. I honestly thought they may get bored and walk around or maybe even leave the room – which was absolutely their right. After all, they were waiting for the football game to start. (Not that they weren’t fully engaged in what was going on with their mother … I think it was going to be a welcome distraction for them for a short while.) When I left the room, these two men had tears rolling down their cheeks. It was very moving.

I forgot to mention earlier that our teacher had paired us up with one of the other students. So while I played, my partner observed me, and vice versa. The woman I was paired up with used to be a hospice chaplain. This was a very familiar environment for her. As we stood in the hallway outside my patient's room (with me, looking like a deer in headlights), she said this:

"I don't think you realize what happened in there. You gave that woman her breath back."

I almost lost mine ...

(GRAND, VERY PREGNANT PAUSE HERE)

My second patient was a gentleman in his early 70s, dying of pancreatic and liver cancer. He was awake and alert, sitting up in his bed. A very educated and cultured man, he became the quintessential host when I entered his room. He was very concerned that I was comfortable. His wife, who had died several years before, was an opera singer; he enjoyed listening to my songs and comparing the sound of her voice with mine and how unique each was. He became very reflective and was able to relax back into his pillow and rest. We had a lovely conversation before I left. Meeting him was a rich experience.

My classmates and I stayed at the hospice all day and finished up our remaining classwork that afternoon in one of the conference rooms. We got done around 3:30pm. On my way out, I ran into one of the sons and the daughter-in-law of the first woman I had played for that morning. He pulled me aside and said, "You wouldn't believe the change in my mother today! It's amazing. She's awake and alert, and we've been talking to her." Then he added, tongue-in-cheek, "They keep trying to put her down, but she's just not ready to go." He thanked me over and over again for playing for her. And then they left.

Wow. (CHOKE BACK TEARS ...)

While I don't truly know what happened with that patient and why she became more alert (because, let's face it, there are so many factors involved), it was incredibly meaningful to get feedback like that from a family member.

Let's just say I had a good day. Incredibly emotional and intense, but oh so positive.

(Inner Monologue) "I really want to do this. I'm in the right place."

And boy, is that a good feeling.