Music in Palliative Care: a personal view
Dr. Steve Mitchinson, MD
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How is music useful in Palliative Care? Now there is an interesting question. How about "Is music useful in palliative care?" What is its role? Is it appropriate? What sort of music? Who for? When and how, are patients able to hear or listen? Should there be lyrics or just instruments? So many questions. Such a powerful tool.
My name is Steve Mitchinson and I am a physician with a background in Family Practice, initially fifteen years in the UK and subsequently six years in Canada in Mission, BC. I am currently doing a Fellowship year in Palliative Medicine through UBC with a view to spending the rest of my career as a Palliative Physician. I am also a singer/ songwriter and worship leader having had a number of songs published. I’ve also recorded a couple of CDs in the last few years. The most recent project is entitled "Giver of life".
Having moved to Canada, it became clear to me that I was not only responsible for looking after patients in hospital at the end of their lives, but also that coming from a fully office based practice I had very little idea how to do this. This set me off on a journey to find some answers and some training which led me to the Victoria Hospice course in 2008 where I found something that resonated with my heart. Little did I know that I was embarking on a journey that was going to change the course of my career and begin to unite the two sides of my life-the Doctor and the Musician.
A little before this I remember talking with a patient, a man in his mid fifties who was losing a battle with stomach cancer. He had surgery and all had looked promising for a time but things had recurred and he was in hospital in the last stages of his illness. We had talked and as so often happens at this stage of life he was asking questions around existential and spiritual issues.
I remember stumbling around a bit for answers and thinking "I'll come back and we can talk some more." As I know now more clearly, this was a window in time and due to disease progression and medication there never was another really lucid moment for conversation. I remember thinking what if I could put into song what I would have wanted to say? Maybe I could have played it in his room or on headphones. He never did hear the song-but it did get written eventually.
According to the World Health Organization, palliative care is defined as care for the whole patient as well as the family and caregivers. It is about managing and controlling symptoms and caring for the physical, emotional, psychosocial and spiritual components of the ones suffering. This complex and challenging task not only requires a multi-disciplinary team to do it well; it also requires a wide variety of skills and tools. Music I believe has its part to play in this. Pain, in whatever form it comes, is what happens to the body. Suffering is what happens to the person. Music and song can bring great comfort to those at a time of great need, loss and suffering.
Interestingly, people don't argue with a song. They may not like the lyrics or even agree with them-but it generally doesn't start an argument. Sometimes they find themselves singing along anyway. Great melodies can stir your heart with powerful emotions and memories. Great songs and music have a way of getting "stuck in your head" in a way the written or spoken word never does. We all have a sound track to our lives and songs that punctuate the journey. It is amazing how patients with advanced dementia can remember and sing words to songs from that soundtrack. We are wired for sound and somehow it speaks a language to our hearts even when conventional language fails.
That first song became a number of songs and eventually a full CD. I wanted to try and write some songs that would not only bring comfort and hope, but also to help people realize that it's okay to ask questions. In fact why would we not have questions looking back over our lives and looking forward to somewhere we have never been before? Perhaps this has something to say to our concept of "existential suffering"- a search for answers in a life full of apparent mystery. I write my songs from a faith based perspective, as a Christian.
It seems to me that our death denying culture doesn't allow us the freedom to approach the end of our lives with confidence and preparation. In my experience it seems that our faith based communities don't always do much better. Maybe we don't have or haven't been given the language to frame the questions that inevitably come at end of life, or to have the conversations that would help. I believe that music has a significant role to play in giving freedom to our hearts and spirits to search and find comfort, hope and peace.
Music has a way of touching and releasing our emotions that goes beyond our abilities to communicate in more conventional ways. Somehow the resonant frequencies of our hearts can be touched by music. It expresses our times of joy and our deepest lament and all emotions in between. Lament, that feeling of grief and mourning, has been defined in a wonderful way by Kahlil Gibran. “When you are sorrowful, look into your heart and you shall see that you are weeping for that which has been your delight.”
There are clearly times for all types of songs, and times when melody alone is even better as we are not burdened with words that just confuse. I have found music to be immensely helpful in my practice of palliative care, and admittedly, a journey that I am only beginning to explore. I look forward to partnering with others, co-working and learning from those who have gone before.
About the author:
Dr. Steve Mitchinson, MD, trained as a medical doctor at Charing Cross and Westminster Medical School in London, England. He worked as a GP for fifteen years in the UK before moving to Mission, BC where he has been in practice for six years. Steve is currently working on a
Fellowship in Palliative Medicine at the University of British Columbia. He has also worked as a Worship Pastor and Worship Leader in the UK. Many of of songs have been published over the last fourteen years. He has 3 full length recordings: Arise 2004, War of love 2007, Giver of life 2012. In 2009, he won the CGMA worship song of the year "It's time for the reign of God" co-written with Brian Doerksen.
Dr. Mitchinson has begun the Grace Note Project whose mission is to help provide spiritual care and comfort for those at the end of their lives and those caring for them. The first album, Giver of Life is now available on itunes or through the website. For more information, or to contact Dr. Mitchinson, go to www.gracenoteproject.com.
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