I take one of the surgical masks out of the box that is placed on a little table in front of Rebecca´s room, put the elastic straps behind my ears and fix the blue-white colored piece of fabric tight on my nasal bridge. During this extraordinary year with the Covid-19 pandemic, I have learned that this helps to prevent my glasses from getting fogged when I breathe, talk or sing. I knock at the door to Rebecca´s room. She was referred to the hospice the day before and my colleagues describe her in the team meeting as being very weak and tired. Rebecca has stopped eating and drinking and seems to having entered the final phase of her life.
Since 2014, I work as a music therapist at the hospice in western Norway. Once a week, I offer to play music for terminally ill people and their families, listen to their preferred music or sing familiar songs together. I work in a multi-disciplinary team with specialized nurses and physicians, a physiotherapist, a priest, a family therapist and a psychologist. People referred to the hospice are often in the final phase of their life and die during their stay. This means that I often see them only once in their dying process. Like in other hospices all over the world, we aim to practice person-centered holistic care here. That means neither hastening nor postponing death and dying, but affirming life. It means recognizing dying as a natural process – a part of life. And the hospice is a lively place; people are welcome 24/7, to gather to eat, celebrate and grieve together, to live their lives as fully as they might wish and with the best possible quality.
All these practices were turned upside down by the sanctions following the Covid 19-pandemic in spring 2020 during the first lockdown. The hospice was completely closed down for ten days. Eventually a few people were admitted to the hospice after this period. But life and care in the hospice was quite different from before. Visitor restrictions were introduced that allowed in exceptional cases that a terminally ill person could have one visitor, a close family member and always the same person, each day for a limited amount of time. When the hospice gradually opened again, we were talking about how to do music therapy – via zoom? With me sitting outside a person’s room? Or, being in the room but wearing a surgical mask, the requisite three meters distant, a maximum of 15 minutes. I decided to try the third option. As a music therapist, I did not necessarily have to be physically close in the way my colleagues from physiotherapy or nursing need to be. Even with the new constraints, being in the same room together felt right.
So, Rebecca and I meet during the second lockdown in winter 2020. My face and hands covered with a mask and gloves, I enter her room, taking with me a kantele, a small string instrument that can be easily sterilized after the session.
When I introduce music therapy to persons and their families at the hospice, the kantele is often my companion. It is both, a door-opener and an opportunity for here-and-now musicking. Once played, people often start to talk about music, and we find a song or piece that is meaningful to them and that we continue with.
Rebecca lies in her bed. A morning show is running on TV. I introduce myself and she looks at me and the instrument. Her reaction comes completely unexpected to me. She rises her body from the bed with such an energy, claps her hands and smiles. With a cheerful voice, she says that this is really a surprise! While I find a chair in three meters distance to her, Rebecca tells me that she has been writing some poems that she always wanted to make songs out of and that she used to play the piano, the trumpet and the guitar. She plays on an air guitar with big movements as if to prove that. She is really excited about the idea of music making, and at the same time expresses that she is quite tired and exhausted. We turn off the TV as Rebecca wants to hear the sound of the Kantele:
I begin with some sequences of arpeggiated tones and eventually find a little melody that I repeat. Rebecca closes her eyes and I can see that her breathing becomes steadier and deeper. She seems to relax and I almost get the sense that she has fallen asleep, but she opens her eyes and says that she likes the soft and delicate sound of the kantele. I ask her to tell me more about her poems and she tries to recall one of them. She smiles and I can hardly believe that this is the same person that has been introduced in the interdisciplinary team meeting earlier that day. She is frail and at the same time enjoys talking about her poems and music and seems to be right in the middle of it again. She asks me where I come from and if I want to sing a song from my home country.
I smile at her energy and her concern for me, weak as she is. I suggest an old song for advent that is known in both Germany and Norway: “Es ist ein Ros´ entsprungen” – “Det hev ei rose sprunga”. During the year I have become used to sing with the surgical mask and sing the first verse of the song in German and then in Norwegian. Rebecca closes her eyes and I see that she taps the rhythm of the melody with her right forefinger on the bed linen. She becomes slower and I adapt the tempo of my singing accordingly. Again, I feel that she has fallen asleep. But she opens her eyes and smiles. I say, that it would be lovely if we could meet again and take one of her poems and find a melody to it. She agrees and says that this needs to happen another day, as she felt quite tired now. Rebecca dies two days later.
I tell her nurse about the music therapy session, Rebecca´s energy, dedication and joy. And my nursing colleague responds: “You play on other strings with the people – both literally and metaphorically”.
I have been working at the hospice in this way now for nearly the entirety of this extraordinary year, and I realize that keeping a distance or a surgical mask are not hindrances for music therapy. To the contrary, we can build sounding bridges and musical bonds between us, keeping distance without being distant at all.
Care for Music 