Music therapy intern Danielle Robert on the power and practice of music therapy at the end of life
“What is amazing is that music never ceases to bring patients at the end of life to different moments in time, and perhaps the greatest gift is that music helps them embrace the present.”
By Devon Phillips. Starting at age 16, Danielle Robert knew she loved music and that she wanted to help people. After she discovered the music therapy program at Wilfrid Laurier University in Ontario, there was no looking back. Now at age 22, and deep in her 1,000-hour internship program at the palliative care unit at the MUHC, Danielle provides her fresh impressions of the music therapy experience and its wide-reaching benefits.
Q: How did you become interested in music therapy and what brought you to the palliative care unit?
A: Ever since I was in grade 11, I had this desire to write music but also to help people and I found out that music therapy existed and I was so happy! So I decided to do my undergrad degree in music therapy at Wilfrid Laurier University. As part of my accreditation, the next step was to fulfill a 1000-hour internship under the supervision of a registered music therapist. Looking through the list of available internships across Canada, obviously the MUHC internship in Palliative Care stood out for me! And what’s more is that I would have the opportunity to study under Deborah Salmon, who is definitely a superstar in the field of music therapy. So I thought I should interview for this, and sure enough, I got accepted! It’s a perfect fit!
Q: What’s it like to practice music therapy in a palliative care setting?
A: It’s pretty exciting to be in a hospital setting, working within a multidisciplinary team. I get to work alongside doctors, nurses, volunteers, PABs, OTs, spiritual care workers, psychologists... It’s an incredible feeling to be surrounded by people who all play a part in taking care of a patient’s whole person needs. There is a freeing feeling in knowing that I don’t have to be a doctor, I don’t have to be a nurse, I just have to be me and do my job and that is to provide music therapy. And it’s a great feeling knowing that our work feeds into each other and that music therapy can improve pain perception, decrease anxiety, improve quality of life and many other things. Whenever a patient is admitted to the10E unit at the MUHC, I know and trust that our team will make them feel as comfortable and welcome as possible – incredible teamwork goes on here.
Q: What is the aim and approach of music therapy in palliative care?
A: In palliative care, music therapists aim to provide the best care for the patient and also for the family. We include the family as much as possible in the music therapy process. The first step is assessment. We go to weekly morning rounds and have access to patients’ charts, noting the patients’ prominent physical symptoms, cognitive or behavioural issues, spiritual background, ethnicity, occupation and so on. We try to gather as much information before we meet them so that we can have somewhat of an understanding of who the patient is and what their needs might be and how we can address some of those needs with music therapy.
Once we have that information, we introduce ourselves, and the first question we often ask is “what kind of music do you enjoy listening to?” Most patients have a particular preference but in the context of their disease progression, they often ask “soft or relaxing music” even though their past preference might have been more upbeat beat music like rock and roll or tango. The beauty of music is that not only does it have the ability to connect patients and their families, but it can act as a shortcut to a patient’s innermost thoughts and feelings.
Deborah plays the flute, sings and also plays the guitar. I play the piano, sing, and play the guitar as well. Depending on the patient’s wishes, we can offer live music, pre-recorded music, or even if they wish to take part in creating music, both improvisational or in song-format. We have binders full of sheet music from world lullabies, anthems, to 40s through 90s music. Often what we find is that patients are most responsive to live music played at the bedside. Sometimes patients break into tears, sometimes they are smiling and singing along, dancing in their bed, and sometimes they are praying.
With some patients we use visualization to help them “escape the hospital bed”. This is the part where we often use the ocean drum –it’s a big drum with little metal beads in it and when you tilt it from side to side it makes the sound of an ocean. We start guiding them on a journey in their mind using soundscapes. Some patients respond very well to this and say they feel very relaxed afterwards, even rejuvenated. It’s as if they have been somewhere else but in reality, have been lying in their hospital bed the whole time.
There’s always time after the music or even between for the patient to share. They usually end up talking about how the music helped them to relax, touched them, or even brought up good memories. What is amazing is that music never ceases to bring patients at the end of life to different moments in time, and perhaps the greatest gift is that the music helps them embrace the present. They become more in touch with themselves it seems.
Q: I hear you do legacy song writing. How does this work?
A: Sometimes when we assess patients they tell us about their philosophy of life. I remember there was one patient that told me about her regrets and lessons she learned. I said, “why don’t we write a song about this?” She agreed. So I said, “you just say out loud what you want to say and I will write it down”. She was slightly delirious but even still, there was beauty in what she was saying, and there was coherence. And I put music to it. I presented it to her a few days later and she said, “this makes me feel young again”. When she passed on, we gave the CD to her son and he played it at her funeral. It was such an amazing experience to be able to witness this.
Q: That’s sounds like a major accomplishment- that you were able to compose a song with this patient, to give something back. It makes me think that doing this work might change you too.
A: Oh yes, it changes me! It is such a humbling experience, such a precious moment in time where I get to be a part of their care. Most of the time, I feel as though I learn more from them. Sometimes patients are overflowing with stories and experiences they would like to share. They are saying things like, “don’t sweat the small things”, or “leave a smile in every footprint.” These are the gifts I receive. One patient in particular taught me how to live through the way he died. He was always cheerful, knew everyone’s names and went out of his way to brighten the team’s day. He also taught me that the best days in life can actually be the last days of life. I am wholeheartedly humbled and grateful for these experiences and I take them wherever I go. Those gifts I receive plant little seeds in my heart and with that, my heart grows.
Q: You are also a performer. Can you tell me about that?
A: It’s music therapy by day and rock star by night! Just kidding! But it is kind of night and day. I like performing because it allows me to connect to people on a larger scale. I can also have a big impact on certain people in the crowd that are sensitive to my music. They often come up to me later after the show, sometimes crying. I get to meet so many new and different kinds of people – this never fails to feed my soul. It is also exhilarating to be on stage knowing that these people are ready with ears open to listen to what you have to say. But there is a lot of pressure too. What songs are appropriate for the crowd? Are you going to sing it in the moment with your heart or will the fear of making a mistake shake your performance? It is a challenge and is amazing always.
Q: So you are reaching people on a very intimate one-on-one way by day, and a larger audience by night. Has your experience in palliative care changed your own music or informed it in any way?
A: I really try to make the distinction between my work and my home life because it’s important that they don’t get blurred too much so that I can take care of myself. But my work in palliative care certainly has permeated my time alone in song writing. Sometimes I need to process things at work by putting my hands on the keys and just singing. Sometimes when I sing, things from work pop up and it allows me the chance to grieve over patients that I have been working with.
In fact I wrote a palliative care song and I perform it now at the memorial service we hold every few months for all the patients who have passed on our unit at the Montreal General Hospital. One of the people at the memorial whose nephew I was providing music therapy for over three months came to the service and said that she would never forget the song and especially the last line: “there is life in the tears that I cry”.
Q: What would you say about music therapy to someone coming in to palliative care?
A: I would say to the person: the music is for you, it is tailored to you - for you and your needs. It’s okay also to want silence. You don’t have to sing, you don’t have to play, you can just listen if that’s what you need. As music therapists, we will try our very best to empower you and to help you find your own strategies using music to relax, reminisce, or simply for your own pleasure. Sometimes the music will make you cry perhaps because it brings back memories or heightens your senses. Just know it’s ok to cry because music can touch us in ways that other forms of expression may not be able to and through this is the potential for release and growth. If you can, give yourself the freedom to be in the moment and let it happen because we will help guide you through this with the music and through our presence, best of all as a team.
For information about Danielle’s performances or to listen to her songs online: www.daniellerobert.com
Like her page at: facebook.com/daniellerobertmusic
Published March 26, 2015