By Isabelita Q. Boquiren, BCC
There are many definitions of music.
Music is said to be a spark of the divine,a universal language, the language of the soul, the language of angels, a second language to prayer. While all these statements have some truth to them, Plato’s assertion that “music and rhythm find their way into the secret places of the soul” speaks to me the most. It points to music as a form of communication that goes beyond words, reaches the depths of a person’s whole being, allows humans to touch their lived inner experiences, here and now, and to connect them to a memory, pleasant or painful, and therefore healing. In my mind, this is where music in spiritual care is most relevant and significant.
My previous experiences in hospice and now as a hospital chaplain provide powerful evidence-based truths in this regard. Music has not only reframed, but also influenced the way I practice spiritual care.
It has been years since my hospice chaplaincy, but I still cherish the nuanced intricacies of thanatology, when a certain type of music with a soothing cadence of notes was employed to lead the patient to relax into the threshold of heaven. Most times, when silence pervades the encounter with a critically ill or dying patient, music has the potential to become the familiar link to communication. The patient may send a message of acknowledgement of what he/she is able to hear through a handclasp, an eye blink, or sometimes a raised hand. Here the chaplain, through a combination of keen observation and the gift to interpret what is meaningful to the patient, spoken or unspoken, and with in-depth spiritual assessment, facilitates music as an easing into something native and familiar and a return to a place of emotional and spiritual comfort.
During a hospital assignment, Carlos stood out among the first patients I saw. The referral notes to the chaplain included feelings of isolation, sadness, occasional apathy, anxiety, and anger. The stated patient age was 25. I first knocked on the door and gained permission to enter. I found a 12-year-old-appearing gentleman sitting up in bed.
“Good morning Carlos,” I said, followed by a brief introduction. He responded: “You are right. That’s me, Carlos. People mistake me for a little boy. I suffer from one of the effects of having had cystic fibrosis since childhood. Please have a seat.” How polite and well-mannered, I thought, as I pulled my chair closer to the patient’s bed. In doing so, a small guitar leaning against the night table caught my eye. It was a bit larger than a ukulele and appeared to be constructed of fine wood. To open a conversation and as my way of beginning spiritual assessment, I shared with Carlos how intrigued I was with the guitar.
“Oh that,” he said, as he started to pull it up to his bed. “It was a gift to me by a friend before I left Puerto Rico. He had it customized to my size since big guitars would be too difficult for me to hold, considering how small I am.”
“How thoughtful of your friend,” I said, and just then he started to strum a musical intro quite familiar to me, “Malaguena.” I watched this patient’s facial expressions and the connection he had with every single note. Despite his frail, gaunt frame, he remained focused in the wonder of the here and now. I expressed my thanks and awe at the end of his guitar-playing.
“That is a special piece of music to me and my family. It speaks of who we are and where I came from. I wish they were all here.… Well, they are in many ways,” he said. He began to wipe away a tear and managed to recount his sacred story with meaning and courage — his journey from Puerto Rico to the mainland United States for medical treatment.
As I reflected on my day that evening, I was filled with an awareness of the power of music in spiritual care. I also more acutely realized the caring presence of the Spirit in every encounter with a patient, and as well, the interconnection music brings about in this work of healing. Music to Carlos was a way of connecting the deepest side of himself to his present lived experiences while in the hospital. It helped Carlos to express his nostalgia for family and home, loneliness, isolation, and suffering, all of which produced a gamut of emotions. It seemed to me that “Malaguena” and all the music in his soul opened a floodgate to allow the flow of deep emotional, spiritual, psychological issues that undoubtedly brought a sense of freedom to Carlos. Indeed, the Spirit “blows where it wills” and spiritual care for a patient depends on how I listen and pay attention to the clues and queues on when to allow music as an effective tool for the expression of the patient’s cultural, psychological, emotional and spiritual needs, struggles, and hopes.
Mrs. G came to the Geriatrics Center more than three years ago with a history of two major strokes that had left her with moderate dementia and a noticeable left-side paralysis. Every morning, Mrs. G arrived in the dining hall in a wheelchair with the help of patient technicians. She took her place at the group table. Her replies were a nod or a shake of the head, and when she liked something, she tapped the table with her good right hand. As a spiritual activity one rainy day, I sat down by the piano and randomly played musical runs that easily came to mind. Mrs. G began to tap the table. At tap 3 she indicated she wanted to go next to the piano. She watched me play at first and then began to run her right fingers on the keys.
On the second day, she did the same thing, only this time her runs were farther out than her normal reach on the keyboard. In the afternoon activity, she was taken to the piano and to everyone’s amazement played the chords to the opening of Beethoven’s Sonata No. 5. Mrs. G became much more animated in expression and in responses. She waved and seemed to smile a bit. She played the piano with her right hand more. We learned that Mrs. G was a concert pianist, and a deeply spiritual person before the onset of strokes. To Mrs. G, music was her emotional and spiritual source of strength and of hope, a connection and reminder that transported her to the depths of her being.
Mr. H suffered from a brain injury that had severely affected his speech pattern and his psychomotor functioning. When awake, he incessantly rocked and would repeat the last few syllables of any word he heard, only in an unintelligible fashion, followed by a loud burp or yell, just like someone with Tourette’s syndrome. Because of the loud yelling at the end, his family chose for him the farthest room down the hall in the skilled nursing facility. He was provided music CDs to listen to, but this proved ineffective as he displayed a dislike for listening longer than five minutes.
The nursing director approached the chaplain to see if there were spiritual tools or practices that could help alleviate his problems. At first I thought of brief meditative chants or prayers. How to transmit them to him so he could repeat them was a real challenge given his condition. The gift was in a five-hole Native American flute that typically offers what are called the “five healing notes,” each note with a tone that “reaches the depths of the five senses.” The flute was accessible and easy to carry. After a week of self -teaching, I ventured to engage Mr. H to see if he would listen. After the first notes, Mr. H became silently attentive. So I continued for 10 minutes more. His wife held his hand and was glad for the first time during his illness that he grasped hers tightly. Mrs. H asked that I play a little bit longer. The rocking, yelling and burping stopped.
The Native American flute now is put to good use now in the hospital setting. I find it helpful to carry it with me every day. Patients with chronic pain syndrome, anxiety, fear, emotional or spiritual crises claim they feel calmer, focused and transported to a healing inner quiet by listening to the musical notes of the flute.
Anita was the mother of three and grandmother of 10. She always loved the “Mañanitas,” a traditional Spanish-language song. As soon as breakfast was over, she would come to the piano and point to someone to sing the “Mañanitas” with her. This song holds special meaning in Latino cultures. It is an all-occasion song for significant events — birthdays, quinceañeras (15-year birthday celebrations), anniversaries, cursillos, illness, and death. Anita , with her dementia, managed to sing the songs in her native tongue, Spanish, although she was raised and grew up in the United States.
Music has a natural way of taking one back to what is familiar, and the mind has a way of recapturing what is stored in memory, such as the notes of a given song learned during formative years or in association with significant events, whether sorrowful or full of joy. It’s here that healing takes place and music finds Plato’s “secret places of the soul.”
Isabelita Q. Boquiren, a member of the NACC’s Editorial Advisory Panel, is chaplain and patient advocate at Carondelet Holy Cross Hospital in Nogales, AZ. Note: The names of patients in this article have been changed to protect their privacy.
