Man, what are you doing here?

Note: This is the first post in an ongoing series about how music therapists began work in end-of-life and palliative care settings. It is our hope that the telling of these stories will promote new perspectives from the storyteller, new introspection for the listeners, and a shared understanding of the privilege that it is to be working in EOL and palliative care.  I’ve spent a good deal of time thinking about what to say in this post, and, subsequently, have  delayed getting the words down. I suppose I wasn’t sure where to start, maybe because my pull towards hospice was so natural and emergent I never really got a sense of the soil those roots grew from. An easy starting point would be my undergraduate practicum experiences in hospice as an undergraduate, or perhaps my experiences in grief following both personal and professional losses. Reflecting on these origins, however, I realized my starting point was not in any concrete moment or epiphany, but in my relationship with music, specifically the narratives and stories.  Each client brings with him or her a wealth of stories, and without fail they are the most poignant aspect of end-of-life work. These stories are explicitly expressed, implicitly shared, and inwardly coveted, but no matter their manifestation they inform and shape the therapeutic space. And what better medium to shape a story, to coax it out and actualize it through expression than through music? I’m admittedly biased in making such a statement, but music’s malleability to the context of the story’s telling is a unique human expression and experience. My first profound experience of stories in music came with the ownership of my first Walkman at 9 years old. I felt so adult owning a piece of art. I still remember every layout of the buttons, where the plastic alternated from smooth to textured, and how enamored I was with each line and curvature. For those of us who grew up with cassettes, was anything more satisfying than the easy push of the play button and its soft “snap” as it fixed into place and  got the gears moving, or the dull resistance of the stop button as if the Walkman itself hated to see the music stop for any reason? My aunt gave me my very first cassette tape to play in this new treasure: Billy Joel’s Greatest Hits. There are a number of reasons to potentially explain my quick fixation. The catchy melodies I naturally gravitated towards to me as a flautist, the Long Island kinship I shared with Joel like Jersians do with Springsteen, my first experience of “owning” and “controlling” music…each has some validity, but they all pale in comparison to the emotional connection I felt with each of the characters in those songs. I rooted for Anthony to save those pennies for someday. I waved goodbye to Brenda and Eddie. I rode the Greyhound to where ever it wanted to take me that night. And every time she asked for the truth, I expected her to believe me. These characters and more embodied a mosaic of personality and interpersonal relating I had not previously experienced. I was introduced to adult themes and concepts and empathized with them through each high and low, celebrating in their successes and commiserating with their losses. But no character resonated with me like the man offering song and cheer to the bar flies who rejected him with bread in his jar when he sat among them. As I got older, I recognized the multiple possible interpretations of that poignant verse in Piano Man, but as a bullied child at the time, those words cut through me and vibrated in deep places I had not previously ventured. I knew what it was like to sit in a common area looking for nothing more than a seat at the bar yet being turned away without reason or rationale. I knew what it meant to be exposed, to share a space with others but as floating islands connected only by flimsy bridges. Music took on a sacred role in my life from that point forward. I don’t listen to much music during the day because I don’t like to treat it frivolously; if I cannot find the time to groove with the rhythm or absorb the lyrics, I prefer to not cheapen the experience and potentially desensitize myself to an artist’s aesthetic before fully connecting with it. It’s why I failed as a performer. The pursuit of perfection flew in the face (for me) of the pursuit of imperfectly meaningful story telling. This is why, I believe, I work in end of life care. I’m not interested in applause or recognition when making music. All I ask for is a willing soul to make music with in silence or sound, passive intensity or active intentionality. To share in another’s journey and be offered the privilege to have even the smallest of roles or the briefest of footnotes in the final chapter of that individual’s story, and for them to have the same in my story. I’m overwhelmed sometimes with the honor of sharing in those final moments, to be present for the culmination of a life, no matter how short or long, leading to that singular moment of transition and transformation. It’s one I truly honor, and why I reject the notion that anybody is “called” to hospice. As hospice music therapists, none of us are necessary or required for another to die well; rather, we’re given the opportunity to be present and engage in just a handful of the millions of intimately human moment that individual has had to that point. It’s a pretty good crowd, and I’m glad to have any part in it.

2 thoughts on “Man, what are you doing here?”

  1. This piece is so beautiful, Noah! The vulnerability with which you approach your music is, I’m sure, a huge part of what makes it possible for others (patients) to share with you and relate with you so meaningfully. And, I can only assume, it must be a powerful combination in the clinical space with your passion for this field and your strong intellectual/theoretical grounding.

  2. I’ve been a Hospice Physician since 2005 and have run into more than a few minimally responsive but still agitated patients who couldn’t be calmed by benzos or opioids, but responded very well to Elvis Gospel (usually older women), Johnny Cash (usually older men), and classical music (all musicians). I’ll try Billy Joel next time. It’s a pretty good crowd here too.

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