Music, drugs, and rock n’ roll

c70f72d2f5ec952d0cc995fce1d4536cYou know that feeling when you hear a song and it instantly becomes your new favorite? When you can’t get enough, you put it on repeat, and you find yourself hearing it everywhere? I searched for a long time for a word or phrase that encompassed that feeling. Or more specifically, the feeling when the song finally loses its emotional spark and becomes ordinary again, subtly whisked away into the endless sea of playlists. Well, I found that phrase several years ago, in a play that I wrote some music for. The play was a series of poems, and in one poem, the speaker “wore out the magic” of a Spanish dance. I was struck.

A few years later, I was listening to a very complicated and interesting lecture in one of my music therapy graduate courses. Basically, my professor was discussing how music motivates parts of the brain at the cellular level. He said, “Dopamine gives cells their seeking behavior,” which makes sense. We all know music causes our bodies to release dopamine and endorphins through the chemical reactions that occur in the brain.

I thought back to my idea – wearing out the magic. I asked my professor about this idea and how it related to the discussion – the release of dopamine. What happens when you no longer feel that rush? And also, what is happening when you introduce novelty (like a new song)? He responded with a fascinating answer. He said the only thing he could compare it to was drugs. The more you indulge in a song, the more of a “fix” you need to feel that renewed high. Novelty can bring that. And time. Have you ever noticed how excited you get when you hear a song you used to love (see top) but haven’t heard it in a long time. There’s your fix.

After processing all of this information, it seemed pretty clear to me why so many famous musicians turn to drugs. They write (or are the voice of) a hit song, perform to thousands of fans – they must being riding quite a high. And then it all comes down. Night after night. That’s a lot of up and down, which can create a very unstable feeling, especially if the person is still maturing or insecure. So what else can give them that high? What’s a quick….fix?

I don’t have a solution to this problem, but perhaps a rather unique insight because of my work as a music therapist, and it’s this: Musicians might use drugs to provide that high – to match the benefits they get from their music. I use music to provide the benefits of drugs without using drugs.

Troubled musicians use drugs in place of music. I help the troubled by using music in place of drugs.

My patients are in hospice. They take a lot of medications, mostly for pain and anxiety. Personally, I don’t believe music therapy can completely take the place of drugs, but I believe music therapy can allow for a smaller dosage and lessened frequency of drugs.

Music is supposed to make you feel better, it was designed that way. So are drugs. But the difference between music and drugs is that music has (very little to) no harmful side effects. And that’s what I love about music therapy. It is a positive, enriching way to lift someone from a dark place without any* threat of harm. As a music therapist, it’s my job to pick the right drug (song) in the right dosage (volume, tempo, complexity) to reach the proper outcome (smile, memory, relaxation). I trust the music. I just hope the magic never wears out.

*It doesn’t escape me that some music can bring back painful memories and events, but for the most part, I think people would agree that music is painless.

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Songs for the End of Life

Most of my patients like hymns, and I often play what I call the Big 3:  “The Old Rugged Cross,” “In the Garden,” and “How Great Thou Art”. “Amazing Grace” isn’t part of the Big 3 because it’s in a class entirely by itself. It is by far my most requested song. “Jesus Loves Me” gets an honorable mention. There are other hymns I like to incorporate, lesser known than the Big 3, but still familiar: “Softly and Tenderly,” “Just a Closer Walk With Thee,” “What a Friend We Have in Jesus,” and “Sweet Hour of Prayer,” among many others.

When the patient has reached the very end of life, with literally hours or minutes left, and every breath calculated and delicate, these songs take on an almost unfathomable new meaning. Songs that might have been sung hundreds of times in church or at camp or revivals are now so potent when being sung to a loved one taking his or her last breaths. Consider these lyrics:

from The Old Rugged Cross:

To the Old Rugged Cross, I will ever be true
It’s shame and reproach gladly bear
Then He’ll call me someday to my home far away
Where His glory forever I’ll share

from Softly and Tenderly:

Come home, come home
Ye who are weary come home
Earnestly, tenderly, Jesus is calling
Calling, oh sinner, come home

from How Great Thou Art:

When Christ shall come, with shout of acclamation
And take me home, what joy shall fill my heart
Then I will bow with humble adoration
And there proclaim, “My God, how great Thou art.”

Anytime there are lyrics that talk about home it really hits you how relevant the song is. It’s a powerful message, so powerful that I have to be careful with these words. If the family or the patient isn’t ready or hasn’t accepted that death is coming, I could do real damage. I’ve been in situations where I held back from singing songs with these lyrics because I didn’t know what the reaction would be. It’s at times like those I have to rely on my intuition and empathy to make the right choices.

When I can sense that the patient is ready and the family has accepted the circumstances, I feel comfortable and led to sing these songs. I also like to sing a song called “Going Home.” The lyrics are simple, poetic, and usually comforting for the family.

Going Home

Going home, going home
I’m jus’ going home
Quiet like, some still day
I’m jus’ going home

It’s not far, just close by
Through an open door
Work all done, cares laid by
Going to fear no more

Mama’s there ‘specting me
Papa’s waiting, too
Lots of folk gathered there
All the friends I knew

Nothing lost, all’s gain
No more fret nor pain
No more stumbling on the way
No more longing for the day
Going to roam no more

Morning star lights the way
Restless dream all done
Shadows gone, break of day
Real life yes begun

There’s no break, aint no end
Jus’ a livin’ on
Wide awake with a smile
Going on and on
I’m a’goin home.

The other night my boyfriend and I were talking about heaven and all the descriptions it’s been given. I mentioned how I feel heaven is too glorious, too substantial to be up in the clouds like it’s always imagined. He said he likes to think of it how Tolkien described “the West” at the end of the Lord of the Rings trilogy:

“And the ship went out into the High Sea and passed into the West, until at last on a night of rain Frodo smelled a sweet fragrance on the air and heard the sound of singing that came over the water…the grey rain-curtain turned all to silver glass and was rolled back, and he beheld white shores and beyond them a far green country under a swift sunrise.”

I’ve occasionally used the song “Into the West,” from the LOTR movies, in my sessions, when I’ve felt it’s been appropriate. The imagery paints a beautiful picture and can be comforting for the patients.

Into the West

Lay down
Your sweet and weary head
Night is falling
You’ve come to journey’s end
Sleep now
And dream of the ones who came before
They are calling
From across the distant shore

Why do you weep?
What are these tears upon your face?
Soon you will see
All of your fears will pass away
Safe in my arms
You’re only sleeping

What can you see
On the horizon?
Why do the white gulls call?
Across the sea
A pale moon rises
The ships have come to carry you home

And all will turn
To silver glass
A light on the water
All souls pass

Hope fades
Into the world of night
Through shadows falling
Out of memory and time
Don’t say: We have come now to the end
White shores are calling
You and I will meet again

And you’ll be here in my arms
Just sleeping

What can you see
On the horizon?
Why do the white gulls call?
Across the sea
A pale moon rises
The ships have come to carry you home

And all will turn
To silver glass
A light on the water
Grey ships pass
Into the West

Finally, not a song (yet), but I came across a poem that is often used in hospice care and at funerals. I was probably drawn to it because it reminded me of the Tolkien words. The poem is called “Gone From My Sight” by Henry Van Dyke.

Gone From My Sight

I am standing upon the seashore. A ship, at my side,
spreads her white sails to the moving breeze and starts
for the blue ocean. She is an object of beauty and strength.
I stand and watch her until, at length, she hangs like a speck
of white cloud just where the sea and sky come to mingle with each other.

Then, someone at my side says, “There, she is gone”

Gone where?

Gone from my sight. That is all. She is just as large in mast,
hull and spar as she was when she left my side.
And, she is just as able to bear her load of living freight to her destined port.

Her diminished size is in me — not in her.
And, just at the moment when someone says, “There, she is gone,”
there are other eyes watching her coming, and other voices
ready to take up the glad shout, “Here she comes!”

And that is dying…

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Iowa

I wrote this on Sunday night and then realized the time synchronicity would be off because it’s being published on Monday morning. But I’m too tired to change it all, so get in your Delorean and read this on Sunday night.

I’m sitting in a hotel room outside of Des Moines, Iowa. Tomorrow I start my new job as a hospice music therapist. I feel like one of those people who travels for work, with my carry-on and eating dinner in the hotel restaurant alone with a glass of wine (it was a stressful drive in the snow).

How in the world did I get here? So much has happened in the last two weeks I get worn out just thinking about it. Two weeks ago my internship ended very well – it was such an amazing and rewarding experience. The next day our family had Thanksgiving dinner. The next day I drove 8 hours to visit friends in Virginia and Maryland for a week. It was a great time of catching up, sitting around watching TV, and growing important relationships. The following Saturday I drove back to Ohio and 10 minutes after arriving, helped load a U-haul full of all my stuff. Sunday was spent resting and seeing “Frozen” with my mom. Monday I left at 6 am for Iowa, and got there 11 hours later. A couple hours later my parents arrived with the trailer and we unloaded everything into my new (nice!) apartment. The rest of the week was spent at my brother’s house in Nebraska, what will become my second haven after my apartment. Yesterday I drove back to my place and spent the rest of the day organizing my stuff and putting things away. I also put up my Christmas decorations, which made me feel a lot better. Today, I tried out a new church, unpacked some more, did laundry, and took off for the hotel. And here I am, watching HIMYM in a hotel room with 2 queen sized beds for little old me.

Not gonna lie, I feel pretty alone. I’m trying to focus on all the positive stuff – a JOB, having my own kitchen, being close to my family in Nebraska. But this is hard. Really hard. I remember saying 2 years ago: all I ask is not to have to move to a new place all by myself again. … And now here I am. I guess God needs me in Iowa.

I never expected to end up here, that’s for sure! But, the people in my small town are nice, the cost of living is low, and I’m close to my dear family.

So, there’s my quick update! Hopefully I’ll get back to music therapy and Jesus posts soon!

Oh, and I technically graduate next Saturday. Yay student loan six month grace period!

– Sarah

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Itchy.

a post for myself, but feel free to join me for the ride

I’m in the itchy part of this season. The honeymoon phase of my internship passed a long time ago. It’s going like clockwork now and I’m thankful for that. It’s making me itchy. I’m done. I’m ready to go. I have to keep reminding myself that I haven’t fulfilled my internship requirements yet, I still have a lot to learn, I have a lot left to do, I must live in the present.

I’ve been zooming in and out of the future the past couple weeks, kind of like the new app animation on iOS7, which makes me a little motion sick, by the way. I’ve started applying for jobs. There have been a surprising amount of hospice music therapy job openings. Each application is followed by a thorough investigation into the agency’s website, a search on Google Maps for distance between the location and my parents’ homes, my brother in Nebraska, and the nearest big city, and then perusing for apartments to get a ballpark on cost of living.

And then I have to go back to the internship the next day.

I’m itchy too because I’m tired. I’m just tired. I’ve done the real world thing before. I remember being tired like this then. I think the energy spent thinking about the giant chasm of unknown future contributes to my fatigue. Funny thing is, I should be used to that part. The contents of my future seem to be revealed to me only 6 months at a time. The current interval is quickly coming to its end though…then what?

Why am I doing this again? Why am I putting myself through all this work and stress? I’m so tired.

Have you been there? I was at this place 3 1/2 years ago sitting on the beach next to the Sea of Galilee.

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Right here. This is exactly where I was when I looked at my life as I knew it. At the time I was running around crazy trying to do the adult thing. God had been slowing forming my calling in the empty spaces and nooks and afterthoughts. And it was upon the waters where Jesus told Peter to have faith that I felt God asking me to do the same. To upend my life and step out onto the water.

Since then, and after telling my “story” a bunch of times to different people who said I was “brave” and “courageous” and “faithful,” I would say to them I am “relieved” that I finally know my calling and have figured out why God gave me a brain so full of music nerdiness and a heart so empathetic I can’t see an old man alone at Panera without crying.

I digress. All that to say – yay God and yay callings and yay music therapy. But. Right now?

I’m just so. tired. Sometimes I wonder about it all. Things about my life have been so transient, so un-grounded. When I moved to Winchester from DC I lost stuff – actual stuff (like my favorite underwear, true story) and relational stuff. I gained a lot of debt. When I moved to Ohio for my internship I had to leave my small delicate circle of friends I had carefully invested in while at school, and got even further away from the people I could always count on in DC. And I am so incredibly grateful to my family for being the emotional rock I’ve needed in this season. Even so…

I ache to settle, plant roots, to have a permanent address be permanent for more than 2 years. I long for the day when I can paint my apartment. Have regular stuff, like a regular grocery store, a regular bar, a regular church.

So I’m itchy. Before you counter my complaints with reassurance because you want to fix me, read my last post. Will you marinate with me on this? I have less than 2 months in my internship left. Pray that in that time I can secure a full-time job.

Please know I’ve grown so much in my faith during this. I talk to God all the time, usually giving him my crap (also in my last post) and so that’s why I don’t feel bad about writing a post like this. He can take it. He can take my feeling unsettled right now.

Thanks for listening, friend.

Validation

When a person gets older, they gradually, or in some cases instantly, lose control over certain things. Mobility, memory, independence, and decision making are just a few. Something else they lose which might not be obvious to many is the right to be heard. A man is admitted to hospice and the team does their job getting everything in order to care for this man the best way they know how. Often by this point, the family is already making most of the decisions. The patient may be in hospice care against his will. And many of our patients are stubborn, as we all are.

Everyone is bustling around and fussing over the patient and he is too tired or confused to put a fight so he just gives up and gives in. However, this isn’t usually the case. A majority of our patients are accepting of hospice care and appreciate all that we do. Others are so far gone in their dementia or Alzheimer’s they only have a vague notion that lots of people are taking care of them.

Whether the patient is docile or not, they will still go through a cornucopia of feelings throughout their dying journey. Family matters invariably may complicate things. Sometimes the family is healthy and coping well, getting along, and prepared for their loved one to die. Other times…I’ve seen denial, dysfunction, estrangement, insecurity, guilt, and simply poverty, significantly affect the experience of the patient.

It is in this context that I arrive for music therapy. The patient may be dealing with the new routine of nurse and aide visits, new medication, family members coming and going with their own emotions, and death waiting before them. They might have just had a bath, or a phone call, or a handful of pills, or a visit from a tearful son or daughter.

Upon being asked what song he would like to hear next, a patient of mine once said, “I don’t care what you sing, just don’t cry.”

I thought that was a very interesting statement. And this is where validation comes in. I could have said, “Oh, people are crying because they love you and are sad to see you sick,” or, “Sometimes people can’t help crying,” or, “Well, emotions are hard to control.” Or I could have ignored his statement. But none of these validate the patient.

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Validation

1. To declare or make legally valid.
2. To mark with an indication of official sanction.
3. To establish the soundness of; corroborate.

This third definition describes my use of validation in music therapy. To be clear (also I had look it up), corroborate means “to strengthen or support with other evidence; make more certain.” In this case, I corroborate with my patients by listening to and believing them.

Validation is the most common support I provide to my patients next to singing and playing songs. I said to the man, “You don’t like it when people cry?” He said, “No.” I said, “It’s hard to see people cry, isn’t it? Sometimes it might make you uncomfortable or you don’t know what to say. I can understand why you don’t want people to cry around you.” I can’t quite remember what he said after that, but I recall it was insightful and strengthened the rapport between us.

And then I sang a song. Probably “Ring of Fire” because he likes Johnny Cash.

Validation doesn’t come easily for me. I’m usually one of those people who is thinking of what I’m going to say while you’re talking. But in this internship I’ve learned to actually listen to people who are talking to me. It’s a lot less work because I don’t have to think of something witty to say or try to 1-up the person. Instead, I simply let them know they’ve been heard. It takes a lot of pressure off to be interesting, and the person appreciates the undivided attention. Charismatic people are experts at this, which is why we’re drawn to them.

Validation and music therapy naturally go together. Unlike the medical team in hospice, music therapists come to the patient to sit with them but not do anything to them. Music therapy is music, but it’s also talking. Partially because it’s a naturally social thing, and partially because music builds rapport and trust, and music will uniquely draw out conversation that may otherwise be suppressed or hidden behind barriers.

Two significant outcomes have resulted from my learning to validate. First, I’ve begun to validate my friends and family way more than I used to. The skill naturally spread into my whole life. I find myself talking less and listening more, and finding out more about the people I love.

Second, I’ve begun to validate myself. Part of this came from my therapist. Before, when I would have an emotion I didn’t like, I would be hard on myself and try to dismiss the feeling, which made me feel worse and like I was a terrible human being. Once I began validating my own feelings I gained a healthy confidence and respect for myself, and I didn’t feel like a weirdo all the time.

Now, when I experience an emotion, I acknowledge it instead of dismissing it. And in the times I’m really smart, I include God in the conversation. It usually goes something like this:

Me: God, I feel [emotion] because [of this situation], and….I don’t know what to do with it, so….here….I can’t – so….you.
God: Beloved, thank you for trusting me with this, let me take it from you and replace it with peace and a little clarity.

It’s amazing. It really is. And it works perfectly because God is really good with handling the stuff that doesn’t make sense. Guess who isn’t? Yah. And He gave us empathy and compassion and communication to validate each other so that we can support each other and grow through shared experiences.

So go forth and validate! Huzzah!

Two months in!

Today starts month 3, or week 9, of my internship. At the end of this month I will go through the mid-term evaluation, where my supervisors will watch my sessions for a week and thoroughly evaluate my music therapy. Yikes!

Things are starting to get into a routine now, if there is such a thing. What that really means is I’ve learned to start the week with a certain schedule and by the end of the week, that schedule has completely changed. That becomes the norm because, well, people die.

That sounds awful, I know, but it’s literally true (and I’m correctly using the word literally here). When I get word that a certain patient has died, I find myself responding in different ways. If the quality of life for the patient was really bad and they were ready and their caregivers were exhausted, then it’s a feeling of relief when you hear they’ve died. The spouse will finally get to sleep, the patient is no longer in pain. Sometimes the death is a shock, even though the patient is in hospice. I might have seen the patient one or two days before and they didn’t seem close to death. Sometimes a patient is admitted to hospice and they die within hours of being admitted.

Some patients are discharged, due to stability or even improvement. A lot of times it’s hard on the patient because we provided a good support system for them and now it will be gone, just like that. But Medicare won’t pay for someone to be in hospice if they don’t show signs of being terminal.

On a personal note, I just had a very quiet, peaceful weekend that was a long time coming. I hadn’t had a weekend where I slept in my bed the whole weekend since before my internship started. I’ve slept in tents, bunks, on couches, and in the camper. I actually slept in, which was only until 8. I can’t believe 8 is sleeping in for me. Last summer, getting up early was 9 or 10. Oh, how I needed this weekend.

My internship director is on vacation this week so I am on my own except for part of Wednesday and all of Thursday. Today I am singing a couple songs in a short memorial service for a nursing home employee who was killed in a car accident. Our bereavement team worked with the nursing home to plan everything. Pretty cool that we offer support to the community, beyond our patients.

Music update:
Still struggling to learn bar chords.
Still play most everything in G, but playing much more in D now!
I am learning A LOT of Gaither music. Oh my, you should see some of the YouTube videos.
I’m warming up to country. I actually just said that.

Happy Monday!

Camp Bearable

Last weekend I attended Camp Bearable as a “buddy.” Camp Bearable is a weekend-long overnight camp for children ages 6-Picture 117 who have lost a loved one. It was started by my hospice agency 13 years ago and is offered free of charge. Each camper is paired with an adult – a buddy – that is with them for the whole weekend. Activities in the camp included normal things like games, campfire, eating together, and crafts. Other activities were focused on helping these children deal with their loss, and simply to be there for the kids. Music therapy is one of the activities, which is how I was introduced to the camp in the first place. At the suggestion of my supervisor, I decided to volunteer the whole weekend as a buddy, instead of just coming in on Saturday afternoon to help lead the music therapy sessions.

I was paired with a girl who was very spunky and didn’t seem too sad…she had been at camp the year before and she was looking forward to the fried chicken. But at certain times during the weekend she became tearful, and a couple times she opened up to me about her loss. She was sad, angry, confused, frustrated, but also had good memories of the one she lost. Above all, she missed her loved one. A lot.

Most of the kids had lost either a parent or a grandparent. A few had lost siblings or aunts, uncles, or cousins. Some lost them to cancer, car accidents, other medical issues. Some lost them to suicide.

I am grateful and proud that my hospice agency offers this camp. The kids have a chance to say anything they want about their loss and they won’t be reprimanded or shushed or told they “shouldn’t say that.” We were taught to simply be there, listen, and validate their feelings. I found they were pretty resilient in their grief, compared to adults. They could easily go from being sad and crying to laughing with their friends and racing down the hallway to the cafeteria.

On the last day, when everyone was physically and emotionally exhausted of course, we did a balloon launch. Everyone (buddies included) wrote a note to their loved one and tied it to the ribbon. We went outside in silence and let the balloons go, watching them ascend, getting smaller and smaller until you couldn’t see them. It was quite an emotional release. I stood behind my girl with my hands on her shoulders. After a little while she turned around, put her arms around me, and tearfully said “I miss him so much.” I told her, “I know you do” and hugged her as tightly as I could. Her girlfriends, who were also crying, came over to comfort her and I found myself wrapping my arms around a group of 5 eleven year olds, with my girl’s arms still wrapped around me.

These kids hurt. Grief is hard because everyone wants to fix it. You can’t fix it. You just need to be there. And wrap your arms around the hurt. The love being poured out and the trust that is reciprocated will lessen the sting and loneliness.

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