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On Wings of Song: Music Therapy at the End of Life

Associate Professor and Director of Music Therapy East Carolina University School of Music Greenville, NC 27858

On Wings of Song: Music Therapy at the End of Life. Video/1999/43 min. Directed by Garry Beitel. Produced by Barry Lazar, Beitel/Lazar Productions, and the Society of Cultural Enterprises, Government of Quebec, and the Canadian Film and Video Tax Credit Program. Distributed by Filmakers, Inc., 124 East 40th Street, New York, NY 10016. 212-808-4980. Online: www.filmakers.com. E-mail: info{at}filmakers.com. Purchase $295, Rental $65.

If you have wondered how a music therapist uses the power of music in healing, then On Wings of Song, featuring the work of music therapist Deborah Salmon, is the video to see. Filmed in the Palliative Care Unit of Montreal's Royal Victoria Hospital, Salmon is seen wheeling her "MUSICART" into a patient's room, carrying the tools of her trade—flute, keyboard, guitar, music books, drums and percussion instruments of all kinds, CDs, and CD player. In a calm, quiet way, and with just a few moments of conversation, the therapist invites the patient to think about music in his life and the music that would be comforting in these moments together. In this and a half dozen other vignettes that follow, we then see the remarkable unfolding of music-making together—patients at the end of life, with little energy and medicated for pain, embracing drums, singing favorite songs, composing keyboard pieces, exploring the resonance of bells and claves, and remembering special times through music. The sounds in the room transform the ambience from loneliness and acquiescence to pleasure and purpose.

Interspersed with these scenes of music therapy in action, Salmon speaks directly to the viewer, describing the joys and challenges of such work. Her reflections touch on her observations of the dying process, her debt of gratitude to patients who permit the sharing of their final days, her understanding of the unique role of music in human experience, and music therapy assessment and treatment techniques. She is articulate (as well as bilingual in French and English), compassionate, and artful in conveying through word, gesture, tone, and touch her deep respect for each patient. The music she chooses—in terms of its style, the feelings it evokes, or its cultural perspective—always affirms the identity and wishes of her patients. This video absorbs the viewer completely in the relationships established between the patient and the music and among the people in the session, including family members and other health care staff. In various scenes the patients experience the tangible benefits of music therapy:

• A young Caribbean man, having shared his innermost feelings about loss and regret and the good feelings music brings him, plays calypso bongo and sings "Day-O" while the therapist plays guitar.
  
• A middle-aged woman and the therapist improvise a song together, the woman playing oriental cymbals while the therapist plays keyboard; the patient seems completely immersed in the beauty and serenity of the pentatonic music.
  
• A physician improvises a tune he calls the "Palliative Care Blues," while a young woman plays a conga drum and laughs audibly, despite having lost her voice.
  
• A woman with ALS, robbed of speech, with great dignity and control uses a straw in her mouth to direct the therapist to first play and then to write the notes on staff paper for an exquisite new composition for flute and piano; on another day that composition is performed in a formal recital with the therapist on flute, accompanied by a pianist. The pride and exultation on the composer's face are triumphant.
  
• A woman with her beloved dog on her bed writes new song lyrics to "One Day at a Time."
  
• A woman in pain listens to relaxing music while the therapist gives her a back massage; the therapist invites imagery of a place of safety, beauty, and well-being and lets the music take her to that "special place" now and any time she wishes.
  
• The therapist plays Bach's "Arioso" on flute, at the request of a patient for his wife and two grandchildren who are visiting.
  

Salmon describes several music therapy techniques used in medical and as well as palliative care. These include playing simple motives in rhythm with the breathing of a patient in coma to establish a supportive connection; playing the rocking rhythms of or 6/8 meter, as in lullabies, to enhance the comfort of physically rocking a patient; improvising descending melodies as a patient exhales to accompany the release of a sigh; and playing harmonic progressions in predictable patterns to support the patient's sense of security and his or her sense of "being held" by the music. Viewers will also enjoy seeing volunteer musicians provide background music for afternoon teas attended by patients and their visitors. A music therapist often will recruit talented volunteers. Although such volunteers do not provide therapy, they create an environment for social interaction and support that gives family members an opportunity to enjoy time together.

Salmon is no novice as a therapist (she has worked in the Palliative Care Unit since 1984), and her interpersonal skills and music skills are impressive. The ease with which she works alongside the other health care professionals, and the unique perspective music therapy brings, may encourage other hospital units and settings serving elderly residents to hire a music therapist. The American Music Therapy Association (AMTA) Web site (www.musictherapy.org) contains information about the training and credentials of qualified professionals, the role of music therapy in varied settings (e.g., gerontology, palliative care, mental health, substance abuse, medical/surgical/pain relief, rehabilitation, special education, and early intervention), and information on how to contact a music therapist in a specified city or state.

This video is an important addition to the profession of music therapy as well as all professions, advocacy and support groups, and regulatory bodies that are concerned with the care of individuals with rehabilitation or palliative care needs. It is appropriate for all training and educational purposes for students as well as professionals. The quality of sound and image, the editing, and the narrative flow of the video are superior. The video merits repeated viewings. On Wings of Song is a rare intimate glimpse into the thoughts, feelings, and concerns of people at the end of life and one professional's artful gift of music therapy. It brings to the viewer an intense awareness of the quality of life in the present moment and of the power of music to bring meaning and joy despite the ravages of age or illness.

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