Music Vigils at the Hospital

Once a week for the past seven years, Jennifer Hollis has phoned Elizabeth Collins, medical director of the palliative care service at the Tufts-affiliated Lahey Hospital & Medical Center, to ask whether there might be someone there who would benefit from her visit. “A patient may be struggling, or a family may be needing some peace,” Collins suggests.

Hollis is a certified music-thanatologist, a palliative care modality that uses harp and vocal music to comfort patients who are dying. The field, which began in the 1970s, is small, with something like 100 practitioners in the United States. As far as she knows, Hollis, who works as assistant director of admissions at Harvard Divinity School (where she also earned a master of divinity degree), is the sole practitioner in Massachusetts. She is the author of Music at the End of Life: Easing the Pain and Preparing the Passage (Praeger, 2010) and served as president of the Music-Thanatology Association International from 2006 to 2012.

Tufts Now: How would you describe music-thanatology?

Music-thanatologists share a small repertoire of music that we all learn when we go through our training, and then we work with the individual patient to create what we call a “musical prescription” for them. So rather than playing familiar songs, or songs from the era when patients were young, or something they might have heard at their wedding, we work with the underlying parts of music, the “raw materials”—the rhythm, the harmony, the melody, the tonality—to address what’s going on with the patient physically or emotionally—their heart rate, their respiration or their vital signs.

So it’s tailored to the individual patient?

That’s right. No two music vigils are exactly alike. We’re responding moment by moment to what’s going on for the patient, so we can make small changes, we can improvise and really attend very carefully to what’s happening for the patient right in the moment.

Why is the harp the instrument of choice?

One, it’s polyphonic, like a piano, so you can play chords and melodies, creating lots of layers of music at the same time. It’s portable. I have a folk harp that I built from a kit that’s about five feet tall, and I wheel it around on a cart that someone made for me. It fits in the back of my small car. It’s portable enough to get into elevators and into crowded hospital rooms. The other thing is that the harp has a really wide range, so you get these glistening high notes, and then you have really deep, low bass notes.

How does the singing work together with the harp?

Well, it’s sometimes just harp, sometimes just singing, sometimes harp and singing, and sometimes there are periods of silence. It really depends on what I’m observing and how the patient is responding to the music.

What effects of your playing have you seen?

The patients often fall asleep. Caregivers and visitors who are in the room will sometimes also fall asleep. I let people know that that’s all right, because it can be so stressful to be with someone who’s dying—to sit in that hospital room for days on end. I think the music creates a little bit of space so that people can rest.

Sometimes people begin to cry. Then I check in to see if they’re OK. Sometimes people tell stories. They may move closer to the patient’s bed; they may hold the person’s hand. I’ve seen family members lay their head down on the bed in this tender gesture of connection.

And I’ve also seen physical changes in people. One time I went to play for someone whose heartbeat had been very rapid all day long. The nurses weren’t able to get it under control, and so they asked me to come and play. After 20 minutes of music, a nurse came into the room and said, “I just want you to know that we could see on the monitors that as soon as you started playing, the heart rate dropped in half.”

What do dying patients gain from the experience?

I hope they get beauty, an experience of something tender and beautiful in the middle of what can be a challenging and confusing time. I hope they gain a feeling of support. I hope their suffering is relieved, physically or emotionally. And I hope it helps them to be more comfortable with their own death.

This article first appeared in the Winter 2013 issue of Tufts Medicine magazine.

Bruce Morgan can be reached at bruce.morgan@tufts.edu.