Lapis Magazine

Death & The Chalice of Repose by Therese Schroder-Sheker

Keys to a gracious death lie with the rediscovery of eleventh century music from the monasteries of France. Read how harpists in a modern hospital in Montana create a deathbed ritual of solace and beauty.

During the past three years, from late December 1992 to December 1995, a large and specialized team of musician-clinicians practising the art and science of prescriptive music has attended just under 850 death-bed vigils in every medical setting possible in Missoula, Montana. With voice and harp, they work in teams of two, position themselves on either side of the dying patient who is usually reclining in bed, and attentively work with musical deliveries that will support and facilitate the unbinding process that is central to a conscious, peaceful, or blessed death.

This palliative-medical work is a contemplative practice with clinical applications, and is called music-thanatology. The sole focus of the music-thanatology team is to lovingly attend the physical and spiritual needs of the dying with prescriptive music. The deliveries revolve around a highly nuanced body-systems phenomenology, in which the dynamic physiological changes in the patient's nervous, respiratory, circulatory, and metabolic systems are observed. Within those clinical observations in the death-bed vigil setting, the musician clinicians surround and anoint the dying patient with music that will support either heating or cooling, stimulating or soothing processes in the physical body. These concrete bodily experiences alter, color, or affect the emotional, mental, and spiritual dimensions in the individual. Unlike pharmacological dosages or protocols, no two prescriptive music deliveries can ever be the same, even if all the patients were dying of the same kind of disease. Prescriptive music is always delivered live, because it is attenuated to the changing state of the one who is dying, including their breathing and respiratory rates and patterns. This cannot be accommodated with previously recorded music, no matter how beautiful and substantial the repertoire or the artistry.

Simply put, we've never yet met a single dying person who hasn't had a profound bodily experience in meeting and preparing for their own death, no matter how ready or reticent they are to "let go". When all interventional medical procedures and routes have been exhausted, and the end of life requires palliative care, music-thanatology has proven itself as a singularly effective practice, for patients, for their loved ones, and even for the physicians and nurses who have been their providers. It is such intimate work that not everyone requests it, but approximately 18% of the entire dying population in this city are in fact served by this modality. At St. Patrick Hospital, music-thanatology is a standard component of supportive care, and is offered to anyone who requests it. The modality is not "pushed" on anyone who wants to be alone.

At one level, the work is a startlingly practical expression of a spiritual practice, one that can be lived by any committed musician-clinician, regardless of religious or non-religious personal identity. Each person has a body of meaning and values, and that is what is understood as spirituality in a medical setting, not our descriptions as humanists, Jews, Christians, Buddhists, or Muslims. The clinical practice involves interiority and presence-of-being at the deepest levels, along with an ever-increasing musical capacity. From this contemplative perspective of interiority, the work with the dying can be alternately described as musical sacramental midwifery. We say musical because the materia medica is actually created from the raw materials of tone, melody, harmony, pitch, duration, and timbre. (The materials become compound medicines, and, in that music is simultaneously physical and non-material, the medicine moves right at the threshold where "spirit" and "matter" intersect.) We say sacramental in the original sense of the Greek word mysterion; how and when each of us die (transitus) is always a mystery, and unique in each human autobiography, if we have the courage and love to be present to witness it. We say midwife because we understand death as part of the fullness of life, a movement that is sacred in human biography regardless of the particular personal story, and worthy of being met with the same attentive care that is involved in bringing new life into the human community. Additionally, for many patients, surviving loved ones, and clinicians, death is not an end, but a birth or transformation to another state or level. The intention of the music-thanatologist is simply and unconditionally to serve the patient's passage with prescriptive music, regardless of their beliefs, identities, or orientations. However, we know that a medical practice devoted exclusively to the needs of the dying requires a profound depth and commitment, not a mere technical fingertip or laryngeal proficiency. That is why the contemplative dimension of this work is so central: anything less spells "burn out" for the clinician within a very short time.

The historical inspiration for this work comes from the Western tradition of monastic medicine. Among many other courses, academic and contemplative, music-thanatologists do study the earliest Cluniac monastic-medical practices that were described in the eleventh century monastic customaries of Bernard and Odo. They also study the regular courses that would be expected in a biomedical model.

The actual clinical inspiration for this work came through a thoroughly contemporary experience that occurred in a geriatric home more than two decades ago. I have been involved in the musical deathbed vigil in one way or another constantly since then, and during these two decades, it has grown into a full-scale, multi-institutional clinical practice and a graduate- level school now located within St. Patrick Hospital. People often ask about the first vigil, the one twenty years ago. It was only an hour or two, but it changed my entire life, and subsequently, the deaths of many others. The first nineteen years of this work evolved in Denver hospitals, with the gracious assistance and support of Regis University and the graduate school of theology at St. Thomas Seminary, but emerged as a palliative-medical national pilot program in the little university town of Missoula, Montana. The majority of our students enter the program as non-harpists and non-singers, and leave after having become truly musical. They are transformed, ready, and desiring to serve the needs of the dying in whole new ways. Here is the original story that drew them to us. It is one of intimacy, reverence, and beauty.

The First Vigil: Mystery and Awe

I have come to understand that the first time I was ever actually present and alone with someone who was in fact dying is also the first time that I ever really experienced silence, and an indescribably delicate kind of light. The man had emphysema; he was struggling, frightened, unable to breathe. No more mechanical ventilations, tracheotomies, or surgical procedures could resolve his disintegrated lungs. He could take no more in, could swallow no more, and, in his complete weariness, there was almost nothing he could return to the world. The room was filled with his fear and agony. I climbed into his hospital bed and propped myself behind him in midwifery position, my head and heart lined up behind his, my legs folded near his waist, and I held his frail body by the elbows and suspended his weight. At first I held us both in interior prayer, but soon began leaning down to his left ear and singing Gregorian chant in an almost inaudible pianissimo: The Kyrie from the Mass of the Angels, the Adoro te devote, the Ubi caritas, the Salve Regina.

He immediately nestled in my arms and began to breathe regularly, and we as a team, breathed together. It was as if the way in which sound anointed him now made up for the ways in which he had never been touched or returned touch while living the life of a man. The chants seemed to bring him balance, dissolving fears, and compensating for those issues still full of sting. How could they do anything less? These chants are the language of love. They carry the flaming power of hundreds of years and thousands of chanters who have sung these prayers before.

It seemed that the two of us were not alone in that room. Long after his heart ceased to beat, I was allowed to hold him. Almost twenty years later, the silence that replaced his struggle and that was present in his room has continued to penetrate the core of my life, birthing stages of hearing that even now flower at unexpected times and places.

When you are really peacefully present with someone whose time has come, all that matters is that they shine through the matrix. People ask if a midwife knows fear or sorrow: none of that exists if you are with the dying person. It's their time, not yours. Any burden or sorrow or wounds of your own disappear. You hold the person and keep vigil while they quietly, almost invisibly, shimmer an indescribable membrane of light. If there is no tenderness in the room, this film dissolves unnoticed. If a midwife is practicing inner emptiness, and is capable of profound stillness, she/he can guard this gossamer film for a moment or an hour. When a dying person's stillness fills an entire room, you can gently let go and lay them to rest. Then you thank them, again and again, for affirming what is so bright.

The mandatory practice of silence and inner emptiness creates a spiritual reservoir that teaches the importance of alternating sound with periods of silence. Hildegard of Bingen suggests that hearing is receiving, and as such, the reception of some rare experiences (one hears both sounds and souls) can cause the hardness of your heart to be shattered. When that kind of hearing has penetrated your center with a seemingly luminous wound, the place where you've been pierced can only be filled with an entirely new kind of love. This new radiance must be returned and sung continually, or you burn. This burning is a grace, and it is this kind of singing that anoints a dying person: it is audible warmth, and has the silver sound. This warmth helps someone slip from a body of pain into a birth canal.

It is clear that all work with death and dying is about the reception of spirit into matter, and the dissolution of matter into spirit. A conscious death changes everyone involved. The one singing vigil breathes in light, but the one who has just crossed the threshold becomes a source of luminosity. These transformative moments weave shining vestments for our living: we wear them when we celebrate. Together, the living and the dying form choirs of celebrants who bridge the two worlds by dissolving and creating themselves in the mystical body of Christ or the Rainbow body of Buddhism: in either case, the activity is a source of light for the universe.

Every death is exceptional, but it is the ability to hear and draw inspiration from the burning reservoir of silence that allows you to sing vigil for any person who asks you to come. You walk into the room, wondering: Can I put aside my baggage today? Can I be still? Can I make room to receive? Can I hear what they need? In the end, you thank them, again and again, for transforming you fully into your life of song.