In compassionate care through the end of life, treatments other than medicines can make a crucial difference. The human touch is one. Another can be music.
Guided by this, members of the Threshold Choir sit at the bedside of a dying person, singing a cappella, gently and tenderly — simple songs for someone who is “crossing the threshold.”
Before I encountered the Threshold Choir, I practiced family medicine in a small town in rural Oregon for more than 35 years, retiring in 2012. I was blessed to care for patients “from cradle to grave,” delivering babies and providing preventative and acute care to infants, toddlers, teens, and young and older adult clients. I loved my patients and my work. I learned early on that the most important things in primary care were listening and remembering that it was never “about” me. Patient autonomy is paramount, supplemented by professional integrity.
My family has always been very musical, and from an early age I sang in choirs in school and church. As the years passed, it was not unusual for me to be asked to sing at funerals of recently deceased patients, too. For me personally, listening to and participating in musical experiences has always been special, even therapeutic.
I was also blessed, early in my career, to have worked with a local oncologist who was forming something novel at that time and especially in our area – a hospice, a place that would care for dying people. Over the years, I taught classes about care through the end of life and became involved in educating my community and, ultimately, nationally. While traveling, many years ago, I had the pleasure of hearing a demonstration by a group of women who represented the Threshold Choir.
I was smitten. As a senior physician, I realize that there are very few panaceas in medicine. I believe that one of them is music, especially music that is tailored to the wishes of the listener. This concept of singing death lullabies to the dying resonated with me and also with my wife.
Left to right: Lynn Grube, the author’s wife; Melanie DeMore, who has composed many Threshold Choir songs, and the author
A few years later, we learned that a local Threshold Choir was forming in our area. More than twenty years ago, Kate Munger started a Threshold Choir in the San Francisco area, after her experience singing to a friend dying of AIDS. The organization has grown over the years to almost 200 choirs worldwide, with several thousand volunteer singers. A medical background is not necessary or, actually, common. Threshold choir members are of all ages and cultures. The only requirements are a commitment to tender harmony and gentle service.
The concept is simple. The music is written by choir members. The lyrics focus upon peace and grace and love and quiet and comfort, sacred but not religious. While a local choir may have many members, at the bedside there are only three or four, singing quietly, in three-part harmonies. Because the song is unfamiliar to the client and to family and friends, it reduces the concern that it will raise unwanted emotions or memories.
Many referrals for a Threshold Choir bedside sing come from hospice social workers or staff. The most important things to consider are, of course, the wishes of the dying person, their comfort, and their needs. Often family members, friends, and hospice staff comment that they were deeply affected by the experience as well. Since the singers bring their own stools, the trio can sing at the bedside in almost any location (hospital room, hospice house, assisted care facility, etc.). Most patients for whom we sing are enrolled in hospice and are at home. Every Threshold Choir chapter is made up of volunteers and thus there is never a fee.
My wife and I have been singing at the bedside now for more than four years. (Yes, the pandemic prevented this experience for many, many months, but Threshold Choirs around the nation were creative in the use of technologies such as iPads to provide songs for the dying in a virtual manner). Each of our experiences has been sacred and unique. Singing for an unresponsive patient, I did not notice that he was responding to our songs. However, it was clear to his wife and daughter, who were present along with the hospice nurse and two grandchildren, that he was calmed and eased by the music. They, of course, knew him best. As with so many volunteer experiences, I often feel that I have received much more than I gave as I drive home, reflecting upon the experience I just had.
Threshold Choir is growing. I hope that, in the future, it will be an integral part of hospice and end-of-life care. By listening to patients and what matters to them, we can offer comfort and accompany them on their journeys.
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