Therapeutic Music Aims to Ease the Pain for the Seriously Ill
Tuesday, December 23, 2008
"Beautiful" is the word Cathy Maglaras uses to describe the first time she sat playing her harp to a man as he died. "People always ask, 'Isn't that depressing?' But no," she explains. "Actually I felt so honored to be there at such an intimate moment."
Maglaras is a therapeutic musician at Mercy Medical Center in Baltimore, one of the growing number of medical institutions integrating live music into patient care. She also serves as Baltimore area coordinator for the Music for Healing and Transition Program (MHTP), a national organization that certifies music practitioners to serve the dying and critically or chronically ill.
Not to be confused with music therapy, in which music is used to engage individuals or groups in pursuit of a specific treatment goal, therapeutic music is played live at the bedside of people facing physical, emotional or spiritual challenges, in the hope of creating a healing environment for them.
Maglaras had long been aware of the power of music. She grew up playing piano and violin, earned a music education degree from Towson University and became an orchestra teacher in Baltimore County. Then, five years ago, after reading that the harp possessed particular powers to reach across emotional divides, she rented a Celtic harp for a summer workshop at McDaniel College and discovered a new calling. She signed up for MHTP's program, which she completed in 2006.
"I used to have major stage fright," says Maglaras of her life as a performer, "because the focus was on me. What if I make a mistake? But therapeutic music is not a concert. . . . Now I'm focused on the other, what I'm giving. Am I uplifting my audience?"
The stars aligned to bring Maglaras to Mercy. While Maglaras was finishing her qualification requirements, Brenda Hannon of Mercy's pastoral care staff was in discussions with oncology surgeon Armando Sardi, director of the hospital's Institute for Cancer Care, who was looking for resources to uplift patients. With support from the Zanvyl and Isabelle Krieger Fund, they were able to invite Maglaras to practice at Mercy.
Maglaras plays twice a week, for patients recommended by the staff or sometimes on request, usually for 20 to 30 minutes each and from a mostly memorized repertoire.
Harps and More
People have used music to comfort the sick since ancient times. According to Carol Joy Loeb, a member of MHTP's board of directors, the current movement was pioneered 35 years ago, by concert harpist Therese Schroeder-Sheker, who developed a program now based in Oregon to serve the dying in hospitals and hospices. MHTP broadens that mission to help patients who are expected to recover.
A former registered nurse and opera singer, Loeb estimates that 80 percent of therapeutic musicians play the harp. But at an MHTP class at Mercy this year, the instruments being played included guitar, dulcimer, violin, piano, flute and cello. Loeb also knows practitioners who play Native American flute, double bass and French horn, as well as vocalists.
Loeb, who has practiced at Howard County General Hospital, stresses that the "live human touch" is essential and can't be matched by a CD or tape. "It's important for us to be able to watch the patient and react musically. We look at how they're breathing, at their facial muscles to see how relaxed they are, to know if we have to change the key, the rhythm, the melody."
She believes the music has an immediate impact: "You can see on the cardiac monitor the oxygen level creep its way up to 100 percent," she says, "because the music is relaxing them so that when they're breathing they're oxygenating their tissues better.
Loeb, who has played for comatose patients, says, "Sometimes you'll see a little facial relaxation or even a smile. Occasionally we've had comatose patients start to hum along."
'A Wonderful Tone'
"Hi," Maglaras says brightly to a frail, middle-aged, African American man with several visitors seated around his bed. "This isn't a performance, so you don't have to stay awake or clap. Please tell me to stop if you want me to stop." He nods, appearing uncertain.
After that brief introduction, Maglaras sets her harp a few feet from bedside, sits on a stool, places her hands on the strings and begins plucking a medieval-sounding melody. A visitor turns off the TV, and the patient leans back and closes his eyes as the music fills the room. He opens his eyes and gazes out the window. His eyelids droop, then close. His chin lowers gently onto his chest, his breathing growing deep and regular. His visitors also appear to have relaxed.
Suddenly, the patient's eyes open and he clears his throat, surprised that he'd been asleep. He turns to Maglaras. "That was so soothing," he says.
"A big part of my work is to see a patient's response to my music," Maglaras explains. "As he started to relax, I took the tempo slower. As he appeared to fall asleep, I played even more quietly. I improvised a little bit in there in between melodies. I knew it was time to stop when he shifted and I felt the energy change."
Elaine Nieberding, an oncology nurse at Mercy, says the music does more than help the individual patients. "Having music here provides a wonderful tone, not only for the patients -- some of whom are closer to the end stage of life than others, some of whom are more conscious than others -- but for the families and also for the staff. Hearing this music makes us all feel a healing presence."
For Babies, Too
"It's Cathy with the harp," Maglaras calls into a speaker and is admitted into the neonatal intensive care unit, a room with a nurses station in the middle and incubators and bassinets around the edge.
"I don't play for one particular baby," Maglaras says. "If I'm near one, I'll watch its responses. Sometimes a nurse will pick a baby up and sing or hum along."
Amid the beeps, ringing phones and staff chatter, Maglaras's harp creates a pervasive calm.
Amy Sheckels, a nurse, says, "Overall, [the music] makes things more even for the staff. . . . Especially today because we're busy, [the music] centers you and brings you back to not so task-oriented and makes you think a little bit more broadly."
Shanida Douglas of Baltimore, the mother of twins being treated in the unit, describes feeling soothed by the notes. The twins' father, Alex Ross, says: "It's a good atmosphere to feed the babies in. It feels good."
For neonatologist Susan Dulkerian, the music reinforces the findings of studies: "There's been good research on preemies that shows that loud noises and bright lights are not so good for babies in terms of their stress reactions, and their vital signs are different when there's a loud environment versus a soothing environment, whether it's a parent holding them or soothing music."
From the neonatal unit to the chemo floor, Maglaras's harp playing is gaining greater acceptance -- and creating deeper bonds with patients and staff. "Sometimes I'm bone-tired when I get here, " she says, but "there's something about that exchange that I just get energized by. Sometimes it's hard to leave."
Advocates for therapeutic music believe it will gradually play a greater role in conventional medicine.
"Not long ago acupuncture was like, if it helps, whatever," says Dan Collins, Mercy's media relations senior director. "But there are New England Journal of Medicine and JAMA studies that show it does make a difference, so now we have a medi-spa here that provides acupuncture for cancer patients. We are now starting to see clinical trials being done and research coming out that says, 'Yes, therapeutic music does make a difference.' "
"In my mind, I see therapeutic musicians on every floor of every hospital, nursing home and hospice in the country," says Loeb.