My guest today is Tony Pederson, Certified Music-Thanatologist at Midwest Palliative and Hospice CareCenter.
JB: Welcome to OpEdNews, Tony. I'm willing to bet that most of our readers haven't the slightest idea what that is or what you do. I didn't either until quite recently. Can you give us an idea?
TP: Thanks for having me, Joan, and thanks for your interest in what I do. Music-thanatology refers to the application of music in end-of-life care, and really, specifically, music that is connected with the physiology of the patient, accommodating how a patient's body systems change moment by moment. The clearest example is connecting the pace of the music with the pace of a person's breathing, but then it gets increasingly nuanced from there. The tools of the music-thanatologist are harp and voice, but the point is - music for pain and symptom management, sometimes even when a person is actively dying.
JB: I know it can be very powerful. You came to my mother's home in February and played for her a few hours before she died. So, I guess that would constitute "actively dying". I was not there but my daughter, Yael, and Winne, our caregiver were. Yael reported that your playing was so peaceful, it made her want to take a nap. More significant, my mom opened her eyes and responded to the music. This was striking because, prior to that, she had not opened her eyes, eaten or drunk anything for several days. The report was that you approached my mother and gently took her pulse. Flesh this out a bit for us. How does it all work? How do you know what to play?
TP: Yes, in hospice, we generally consider "actively dying" to be the last 24-48 hours, and your mom was certainly in that zone. I do take some time to get a sense of what is going on in the body. Breath and pulse rates are very useful when thinking about rhythms and pacing, but if we look deeper at the breath, for instance, there is important information that can be gleaned from how much air they are moving, or how much work is involved to move that air. Is the person themselves thinking about the breath, or is it unconscious - on automatic pilot? What about tension in the body, or pain, or restlessness, or" well, the list goes on.
The idea is that there is a musical way of relating to any of those physical manifestations that we see. So what I do is put together a set of musical elements in response to what is going on in the body. I'm not playing familiar songs, I'm taking the raw elements of music, the building blocks - things like rhythm, meter, melody, harmony, dynamics, countermel.... well, the list goes on - and then I weave them together actively at the bedside, changing the tapestry as the patient's condition changes. At the same time, I'm not exactly improvising. The way I see it, the patient is improvising, and I am literally accompanying. The important thing here is that there is not really a recipe. Regular breaths don't necessarily required metered music - it's an option, but that decision has to be constantly revisited based on the responses to the music, the progress of a person's dying, family dynamics, the context of what has already happened in the room, and.... well, you guessed it. That list goes on, too.
JB: It sounds extremely creative and intuitive, actually. Do you get in the zone while you're doing this? It seems like you'd have to be very focused on all the various elements in order to hit just the right note, pun intended. How do you feel afterward and what makes for a successful outing? As you can see, I have a million questions.
TP: It is true that a large part of the training I went through was focused on expanding my capacity to be able to attend to many different aspects of a situation simultaneously, and I really appreciate the writings of psychologist Mihaly Csikszentmihalyi and his work on Flow States and Optimal Experience, but when he describes being "in the zone," it is often at the exclusion of any distraction. (For example, Olympic sprinters don't even hear the roar of the crowd until after they cross the finish line.) But what makes for a successful 'music vigil,' as we call it, is being fully attentive to all that is going on and then, further, being able to craft something musically that is appropriate, and hopefully beautiful. So creativity happens, but it is quite bound to the circumstance - reflecting it - in service to it.
Intuition is an entirely different story. At the bedside, I'm not guided by any innate knowing or inexplicable sense of things; I'm guided by the very practical, observable phenomena of breath, pulse, pain, tension, temperature, wakefulness, family dynamics, disease process, pharmacological effects, and so on. I think that what looks like intuition is most often just well-placed attention - recognizing the significance of even the most subtle shifts.
As for how I feel afterwards, it's an interesting question. I'm neither drained nor energized. There has been this process of taking in the situation and then pouring something back out into the music, but there is also a lot of talking with the family, explaining what I do and sharing my perspective on how the dying process is unfolding and what might lie ahead - and that's not something I understood when I got into this; that I would become extensively experienced in what dying looks like and how it manifests, and that I would become a reference for families facing great uncertainty and trying to navigate unfamiliar waters. But I'm trying to think of how to describe the feeling at the end of a music vigil. It's not 'satisfied,' because I'm always second-guessing and wondering what I could have done differently or better. There's gratitude, of course, that they would even let in this stranger with a harp at such an intimate time. People are often very appreciative, and remark on the beauty of the music, but because what I do is not really a 'performance,' that praise can be tricky to reconcile - it doesn't make sense to take credit for paying attention to what someone else is doing. Ultimately, the feeling I get is that I'm doing what I'm supposed to be doing.
Harps have unique musical properties and are well-suited for hospice and end of life work
(Image by Courtesy of Midwest CareCenter) Permission Details DMCA
JB: How did you decide to go into this, Tony? Before I learned that you had come to my mother's deathbed, I had never heard of music-thanatology. How did you? And what about it attracted you?
TP: It's one of those things that got in my way when I was heading a different direction. I was studying Religion, Philosophy, and Psychology, and had moved to Montana to attend the university there, and while I waited the nine months to qualify for cheaper tuition as a resident of the state, I ended up working with Alzheimer's patients in a local nursing home. One day, two harps came walking in the door of my locked unit. They were there to play for one of my patients as she lay dying. Now this little lady couldn't talk and was all curled up in a ball, tense and distressed. Medication, soothing speech and touch hadn't done much to help.
But after about 45 minutes, the people with the harps came out and I went in to check on her. What I found was that all her tension was gone; her brow was unfurrowed, her limbs were relaxed, her breaths were deep and easy. I went out and caught up with them as they packed the harps into carrying cases. I wanted to know what they had done, because, I told them, "there needs to be more of that in the world." They explained about music and the breath and the body, and how they were graduating from the School of Music-Thanatology, the only one of its kind in the world - and it just so happened to be in Missoula, Montana. It was a no-brainer for me from there.
The thing that really attracted me was seeing the effect that music could have on someone's physical situation. I'd always known that music can reach us cognitively, emotionally, even spiritually but the physical piece was a revelation for me.