Lucile Wilson looked expectantly at Joe Goelz’s acoustic guitar as he strummed a few chords in her daughter’s Cutler Ridge living room.
“Would you like to start with Amazing Grace or I’ll Fly Away?” asked Goelz, a music therapist.
Wilson, 82, needed no prompting. “I’ll fly away, oh Lord,” she began to sing, her voice lifting along with her spirits.
Goelz runs a music therapy program for Seasons Hospice and Palliative Care of Southern Florida, serving people across Miami-Dade County. Most of his clients live at home or in nursing homes. Wilson, whom he began working with in August, was his third house visit of the day.
Since its first use to alleviate Post-Traumatic Stress Disorder in soldiers during Word War II, music therapy has helped improve the quality of life and the functioning of patients with a wide range of medical conditions. Goelz and his staff use it to help clients complete the tasks experts say are most important at the end of life: I love you. I forgive you. Please forgive me. Thank you. And goodbye.
“What Joe is doing is a form of music psychotherapy that’s very specialized,” said Shannon de l'Etoile, associate dean of graduate studies at the University of Miami’s Frost School of Music, where Goelz studied. Frost’s music therapy curriculum combines musicianship with a clinical understanding of how the brain processes musical experiences.
For the hospice setting, Goelz culls a repertoire of songs from events that occurred at different stages of his clients’ lives, their culture and the places they have lived. The music triggers primitive areas of the brain that remain intact even when dementia is present, he said.
“Lucile might not be able to describe a memory in words, but we know from science when the brain is lighting up. I play it, sing it, see if it means something, and go on to another song,” Goelz said.
His instrument of choice is an acoustic guitar because patients can feel its vibrations as well as hear it.
For Wilson, a devout Baptist from Abilene, Texas, hymns like I’ll Fly Away work as tools to talk about her life.
Just a few more weary days and then, t o a land where joy shall never end. I'll fly away.
Not all of his patients are ready to face the song’s message that the end is near. But Wilson’s faith made that conversation easier. “It emboldened me to ask, ‘Are you ready to go? Have you done and said everything?’ ”
Seasons’ national director of support services, Russell Hilliard, is a music therapist, too. In 2003, he researched cancer patients who received music therapy and found they fared better on a scale of physical, social and emotional indicators compared with those who didn’t receive the treatment.
“The closer patients came to the end of life, the more their quality of life improved,” Hilliard said.
Hilliard has worked with Italian matriarchs who set their recipes to music for their families and — in a non-musical form of therapy — with a 37-year-old parent who recorded himself reading a storybook for his 5-year-old daughter. Now she listens to her dad reading the bedtime story on the recording he left for her.
Another of Goelz’s patients has Lou Gehrig’s disease, but remains alert while her body is shutting down. Goelz said that when his team asked her questions, she was able to mouth responses that they later set to lyrics and music. The song will be a gift to the woman’s family when she is gone, he said.
Music therapy can also come into play when a patient or family member makes an end-of-life decision. If hospice is an option, the therapist might strum a guitar, providing a strong rhythm for the patient and family members to focus on as life support is removed. Breathing in sync with the guitar’s rhythm, the patient becomes calm and usually continues breathing unassisted, Goelz said.
I’ll Fly Away had tripped a deep response from Wilson during an earlier session. This time, Goelz found her more frail and withdrawn than he had ever seen her. “I knew when I walked in the room we wouldn’t be talking as much today,” he said.
“I’ve been feeling very bad. A cold in me,” said Wilson, the end of her sentence trailing off.
“You wanted to fly away?” Goelz asked.
Wilson nodded. “I’ll fly anywhere.”
“Where would you like to fly to right now?”
“The country,” she said.
Goelz launched into In the Garden — “I come to the garden alone, while the dew is still on the roses” — and Wilson joined in, cold and all.
Not every music therapist is cut out for hospice service. “It takes a level of maturity. People who make the choice aren’t just willing, they thrive on it,” de l'Etoile said.
Goelz finds the work rewarding. “When I saw her smile, that’s my payment. It’s not a job for me so much as a mission.”
While he fumbled for the next line, Wilson carried on by heart: “And the melody that he gave to me within my heart is ringing.”
“Want to do one more verse?” the therapist asked.
This story was written in partnership with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation