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Music After Death

I recently won an award.  It was a complete surprise and I believe that I was nominated by several administrators and colleagues.  The award recognized me as an “Employee of Distinction” by an association for excellence long term care facilities.  I was obviously honored and completely surprised.  I was also, truthfully, feeling a bit perplexed.  

Approximately two months prior, I was working my typical Saturday when I heard the “code blue” alert sounding.  With less staff in-house on the weekends, I am trained to respond in an administrative capacity to see if assistance is needed (call 911, gather paperwork, direct traffic, etc.).  I obviously wondered who coded.  It was Rebekah, a nearly two-month-old infant who had a chromosomal abnormality that wasn’t really compatible with life.  (DNR/DNI’s in children and infants could be a subject for another post).  Our staff attempted resuscitation until the EMT’s came to take over.  Still no pulse.  We were pretty short staffed that day.  It had snowed and we had a lot of people call out.  Rather than send a nurse to accompany her to the hospital, I suddenly decided to go.

Off we went.  In the ED, I answered the usual barrage of questions. This wasn’t my first time.  I am always thankful it is me and not a parent.  I don’t know how parents answer all these questions.  The attending physician prepped me that they probably were not going to be successful in their resuscitation efforts.  I already knew this before we left our facility, so I wasn’t surprised.  When they finally exhausted their efforts, I came in to see her.  The room was typically full of supplies strewn about, random ED staff completing their counts and documentation, and two nurses attending to Rebekah.  I immediately went to the side of the gurney and asked to hold Rebekah.

As I said before, it was a Saturday.  Rebekah’s family is Orthodox Jewish and was not able to be reached until sundown that evening.  The state police were going to send someone to go to their house, but we did not know when that would happen.  So, for now, it was just Rebekah and I.  Instinctively, I picked her up and sat with her in my arms.  Her body was still warm.  Not even a minute later, I felt her breath leave her body and all remaining air was sent out into the world.  Now, we were alone.

Not even a month later, I attended a concurrent session given by music therapists Debbie Bates and Lauren DiMaio (2013) in which they discussed music therapy at the moment of death.  At the beginning of the session, the speakers asked participants what they would do if someone died during their music therapy session (while you were alone with them).  The majority of participants responded that they would complete the music experience.  Some responded with various procedural protocol that they are required to do.  However, overwhelmingly there was a sense that completion of the experience was paramount, regardless of the therapist’s belief system regarding the afterlife.  In some instances, participants cited that the completion was for themselves.  Others pondered if the spirit of the person was still lingering in the room.  Some participants discussed that they felt it was only “right” or what they would want if it were their family member.  So, I guess that’s where I found myself.  What would I do if this were my baby?  That was, and still is, a terrifying question to ask myself.  So, I started to sing.

This baby was already dead.  She probably died at our center.  My own beliefs about what happens after death have become so muddled.  I’m not sure if I believe that she was still hanging around in the room.  It didn’t seem to matter.  I just sang.  So, we rocked and sang as people came and went.  Eventually, we needed to move from the trauma room into a side room somewhere.  So, in one of the most bizarre yet memorable moments of my life, I carried Rebekah through the ED, past patients’ families commenting on what a cute baby I had, past nurses looking at me with sad eyes, into a secluded “pediatric” room….where we stayed for two more hours.

I placed Rebekah on the gurney two times to use the bathroom.  I stopped singing periodically to drink some water.  Once I started this process I didn’t know where to stop.  I am sure that I probably could have left.  Perhaps her parents were coming.  Perhaps that was what we were waiting for.  Finally a nurse came in and asked me if I was ready because they needed to take her to the morgue.  It seemed as though they thought it was me who needed the time with Rebekah to say goodbye!  No, her parents were not coming.  No one knew if they had been reached.  I stayed with the nurse as she wrapped up Rebekah, first gently tying her hands and feet together, affixing the identification tag and then laying her in the plastic.  I think the most difficult part of the day for me was seeing her being wrapped in the plastic like an object, another tag affixed to the top.

I left.  I walked out into the cool February air and breathed deeply, filling my lungs with as much fresh air as I could manage.  When I went back to work, I emailed the medical director.  I wanted someone who spoke to the parents to communicate that Rebekah was never left alone, and how our time together was spent.  By the time I came in on Tuesday, it appeared as though everyone knew.  Numerous administrators came up to me to hug and thank me, some teary-eyed.  It had become this week’s news.

Then, two months later, I found out about the award.  I couldn’t help but think that they were directly related.  It felt strange to be rewarded for something like this.  It still does.  This was one of the most intimate moments of my career, and perhaps my life.  Why do we do some of the things we do?  There was no goal in what happened, no evidence or fact.  There was only human instinct.

References:

Bates, D. & DiMaio, L. (2013). The last note: Music therapy at the moment of death.  Paper presented at the 6th annual Arts and Quality of Life Research Center conference, Temple University, Philadelphia, PA, March 1, 2013.

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12 thoughts on “Music After Death”

  1. What a beautiful story and a life changing opportunity. As a music therapist that has been present at many deaths, I know the emotions that go with it. Rebekah was truly lucky to have such great people caring for and a music therapist that never left her side.

  2. Kristen, your poignant story, so sensitively and thoughtfully written, captures so much of the essence of what I believe the be at the very core of the work we music therapists do. It is beyond the conditionality of “results” from our interventions; it is beyond the client’s conscious acknowledgement of the work; it is the aesthetic affirmation of the highest potentials of personhood, in our being-with our clients, in time which is always, already, therapy. A client’s humanity remains, even without a pulse, or brain activity…and what you did was to remain compassionately present to your client’s human identity, thereby affirming it, on behalf of your client, and of humanity itself. THAT is what we music therapists do. And it’s evidence-based, only the evidence is self-evident, implicit, and unconditional, contained and expressed within the act itself. You may not believe you deserve an award for that, but you do–and beyond the individual recognition, it’s a recognition on behalf of all who value the humanity that transcends a person’s physical and psychological components. Thank you for doing what you do.

    1. Brian, having gone over this experience numerous times in my head, I feel like I have pulled it apart and perhaps created somewhat of a piecemeal view for myself. The question of it being “music therapy” (as we have heard asked so many times in so many different contexts) continued to present itself. I did not doubt the value as a distinctly human experience. At the very least, there was value for me and for my perception of what humanity ought to be. In writing this piece, I had the experience of reconstructing what I had pulled apart in analysis. The act of writing held much more power for me than I had realized it would. I agree with everything you are saying. This was the evidence. In many ways, I work with the unknown all the time–we all do. If I ceased to be as a therapist simply because I could not observe all that is happening then I wouldn’t have any clients. The work needs to be based in potentials and possibilities–in the gray area (as I tell my interns). So, perhaps I was existing entirely in the “gray” area of the moment…no certainties or observable “evidence”. I somehow felt comfortable in that space. Thank you for helping to pull some of my thoughts together.

    1. Great question, Melinda. One thing I didn’t mention was that this was not my client. I found myself ill-prepared and wishing I knew what would have been important to the family in this moment. I improvised vocal melodies which were reminiscent of Hebrew and Yiddish melodies I had heard. The improvised melodies seemed to feel the most authentic to me.

  3. It is surprising that, as many of our clients have died (some unexpectedly and some not), I’ve only been present once. I think the thing I was, and am again, aware of and most struck by (in my own experience and as I read your story also) is the intimacy that goes along with making music together and with death. What makes you remarkable (as a person and as a therapist) is that you were able to fully engage in the intimacy of being with Rebekah in music and in death. So many people wouldn’t be able to tolerate that kind of intense (and beautiful) closeness. Thank you for sharing such a moving part of your music therapy journey.

    1. I am always struck by the intimacy of death. I agree that it is extremely intimate experience and I always feel honored to be present. In this circumstances (and others where the child has been alone), I feel even more honored to be a “stand-in” for the family. I think I was the most struck by this intimacy when people began reading and commenting on the blog. I suddenly felt exposed and wondered if I should have kept this story tucked away. It wasn’t so much that I was worried about my actions, but rather that (as you said), this was an extremely intimate moment that I shared with this child (or her spirit/body/memory/etc.). Was it ok to share it with others? In many ways, that was the challenge for me, not the decision to fully engage in the moment. Meghan wrote in her introductory post about doing this work because she can, because she is able to synthesize the moment for herself, the clients and families. I agree. I guess I do it because, for whatever reason, I can. Thanks for reading and taking the time to comment.

  4. It certainly is a struggle to balance the wish to share the profound ways our work is impactful while maintaining a respect for the intensely personal and vulnerable moments we co-experience with our clients (even when they aren’t officially our clients and, in this case, immediately after their death). When we do choose to share, though, it enriches the field by offering people, in general and music therapists in particular, a fuller understanding of what music therapy can be. It invites reflection and, I hope, a desire to engage in this work of being a music therapist in more difficult ways – ones that ask us to be with larger questions that don’t often have tidy answers.

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