Finding a Language, Creating a Space

ComprehensiveMusicCASE Therapy OF and Palliative THEPalliative MONTH Care Care Program

Volume 3, No. 8 Andrea M. Scheve, MM, MT-BC August 2003

Case: Mrs. S is a 55-year-old woman who came to while they transferred her into her bed, and distract her UPMC from a nursing home with sepsis due to a stage IV from pain as she cleaned and re-packed her intra-abdominal decubitus ulcer. She previously had a below-the-knee abscesses. The MT kept the patient’s attention on the music amputation (BKA) which was also infected and required and relaxed and distracted the patient from any pain and debriedment. Mrs. S’s other medical issues included discomforts until the nursing staff had completed their hypotension, hypothyroidism, significant diabetes mellitus, tasks. This was an excellent use of MT services and end stage renal disease, coronary artery disease, morbid intuitive on the RN’s part considering she had no prior obesity, and previous placement of a pacemaker. Overall, experiences with MT. Mrs. S was in very poor condition. The following week Mrs. S was in dialysis on the The Palliative Care Team referred Mrs. S to Music Renal Unit when MT arrived. Mrs. S had requested Therapy (MT). Members of the Palliative Care Team specifically some of her favorite songs and she sang every identified needs that may be addressed through music word along with MT. She also liked keeping the beat by therapy such as a distraction from pain, increased coping tapping her hand on her chest. In the Renal Unit, curtains skills, increase in mood, increase in verbalizations about instead of walls separate patients, so everyone in the Unit illness and death, expression of feelings and emotions, could hear the music, and several patients and staff sang increased comfort, reduced anxiety and stress, sensory along. Towards the end of the session, other patients started stimulation, increased quality of life, increase in requesting songs as well, and the patient agreed to sing socialization, enhanced spirituality, and increased patient those songs to the Unit. Some patients commented how satisfaction. A member of the Palliative Care Team nice it was to have something structure their dialysis time interviewed the patient and found out she loves music, other than TV. The nursing staff was very receptive and especially country and gospel. commented how the patients usually keep to themselves but The first session of MT with Mrs. S was designed on that day they were all interacting. It was probably the to develop rapport with her. MT brought in several most social interaction Mrs. S had in a long time. different styles of country music and gospel songs to sing Discussion: There are many therapeutic applications of and play on guitar. Because Mrs. S had a severe infection music that may be utilized with hospice and palliative care resistant to antibiotics, MT took the proper precautions patients. Pain management is essential with this population necessary for entering the room and interacting with the and MT can be used as a distraction from pain, as a patient. Upon initial entrance in the patient’s room, the stimulus for comfort and relaxation, as a provider of smell of the dead tissue from the ulcers was almost sensory stimulation, as a means for mood-enhancement, as overwhelming. This is another issue the Palliative Care a mechanism for providing choice and control, as a means Team remedied by putting a fan and air fresheners in the for perceived time-compression, as an outlet for self- room. Mrs. S engaged in the first session of MT by singing expression, as a method for cognitive reframing, and as a and talking about her musical preferences with MT. Mrs. S vehicle for social support.1 Furthermore, music therapy is a even engaged in songwriting using familiar melodies and wonderful addition to the standard of care because it putting in new words. At the end of the session, Mrs. S was provides a basis for reminiscence and life review, a means very thankful to have participated in MT and was looking for relating to others, emotional comfort and relief from forward to the next session. anxiety, enjoyment, and a release in the last hours of life.2 One week later, MT entered Mrs. S’s room when she was returning from a procedure. The MT greeted the References: patient and inquired about her pain levels. Mrs. S replied 1. Dileo, C. (Ed.). (1999). Music therapy and medicine: “Yes, I’m in pain so let’s start singing so it’ll go away.” So Theoretical and clinical applications. Silver Spring, the music began. A RN entered the room during the first MD: American Music Therapy Association. song to test the patient’s blood sugar levels. Mrs. S kept her 2. Clair, A. A. (1996). Therapeutic uses of music with attention on the music and disregarded the finger prick. older adults. Baltimore: Health Professions Press. Shortly thereafter, another nurse entered the room and To contact Music Therapy please call (412) 647-6143 asked if MT could stay long enough to relax the patient

For further information please contact the Palliative Care Service at PUH/MUH, 647-7243, beeper 8511, Pain and Symptom Management Service, 647 –7243, beeper 8512, Shadyside Dept. of Medical Ethics and Palliative Care, 623-3008, beeper 263-9041, Perioperative/ Trauma Pain 647-7243, beeper 7246, UPCI Cancer Pain Service, beeper 644 –1724, Interventional Pain 784-4000, Magee Women’s Hospital, 641- 2108, beeper 917-9276, VA Palliative Care Program, 688-6178, beeper 296. For ethics consultations at UPMC Presbyterian-Montefiore, and Children’s call 647-5700 or pager 958-3844. With comments about “Case of the Month” call David Barnard at 647-5701.