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November 5, 2004

Helping Patients Die a Good Death


By Anne Cassidy


He was a lonely old man, a combative patient facing death.  She was an undergraduate music student earning college money as an orderly in a nursing home. Their lives were about to intersect and change in a profound and mysterious way. 


Entering the room where the man lay frightened and dying, his last breaths rattling in his chest, the orderly, Therese Schroeder-Sheker, was moved to make this man's death a blessed one. She said his name, held him and sang the hymns "Ubi Caritas, "Salve Regina" and "The Mass of the Angels” in her clear soprano voice.  And then, Schroeder-Sheker recalls, "The desperate thrashing stopped. The death rattle quieted. This man who had a history of pushing everyone away actually trusted me, rested into me, and slowly, because of the quiet singing, we began to breathe together. When I walked home that night after he died, I understood his passage as a kind of birth." 


The four-octave harp that Therese Schroeder-Sheker plays at a CUA presentation is small enough to fit at a hospital bedside.

Since that first vigil at the bedside of a dying patient more than 30 years ago, Schroeder-Sheker — a musician, educator and CUA artist- and clinician-in-residence — has sung and played her harp at thousands of bedsides. She has pioneered the field of music-thanatology, the physical and spiritual care of the dying via “prescriptive music,” and through the Chalice of Repose Project she founded, has trained scores of other music-thanatologists who now work in the United States, Canada, the Netherlands, Israel and Japan. But she's never forgotten that first patient. "That moment of combined song and prayer now seems crucial. The music was not a form of distraction therapy," she says. "It had become a genuine medicine."


During her weeklong visit to campus last month, Schroeder-Sheker met with faculty and students at the Benjamin T. Rome School of Music, the National Catholic School of Social Service and the School of Nursing. At her Oct. 18 presentation to nursing students, Schroeder-Sheker described how she established a music-thanatology clinical practice in Missoula, Mont., and supervised it for 10 years. This work served more than 4,000 patients in two hospitals, four nursing homes, a hospice, several home health care agencies and many private homes. In 2002 Schroeder-Sheker moved the Chalice of Repose Project to Mount Angel, Ore., one hour south of Portland. She now practices and trains music-thanatologists there.
"I urge you to start small, to light a clear flame [of music] on even one floor of one wing of one hospital or hospice, or in a parish setting,” Schroeder-Sheker challenged the students. “If even a few doctors and nurses champion you, the program will spread like wildfire."


During the presentation, Schroeder-Sheker played her small four-octave harp and explained why she uses it instead of another instrument such as the flute.  The delivery of prescriptive music requires a polyphonic instrument that provides a full range of musical sounds to the patient. (“Polyphonic” means “many sounding” or “many voices.”) The harp is portable enough to fit into a small hospital room and it has the deep, resonant tones and low volume appropriate to the bedside. Finally, the sound created has to seem physically and emotionally non-invasive to the vulnerable patient; other instruments such as the French horn or bassoon make gorgeous music but the volume produced would be too great for the medical setting.


CUA nursing student Billie Tyler came to Schroeder-Sheker's presentation to thank her and tell her this story: When Tyler's close friend, Henry Arnold, was dying of cancer and wouldn't eat anything, he one day surprised Tyler by asking for a chili cheeseburger, fries and a strawberry shake. Tyler brought Arnold the food — which he gobbled — then asked him what had happened: Why was he so much better? Was he on a new medication? No, Arnold said, a woman had come to his bedside and played the harp. He had fallen into a deep, restful sleep. When he woke up the woman was gone and he was hungry for the first time in weeks. Tyler was convinced her friend was seeing things, but a hospital nurse confirmed that a very real woman, not an angel, had come to Arnold’s bedside and played for him. "The music took him to another place and that place was OK," Tyler said. 


"Music-thanatology is both an art and a science," Schroeder-Sheker explains. As a science it is a sub-specialty of palliative medicine that reduces both physiological pain and mental, emotional or spiritual suffering. An accomplished musician-clinician can decrease a patient's pulse and heart rate, stabilize breathing and change body temperature, says Schroeder-Sheker. These calming measures may help a patient fall into a deep, restorative sleep. As a pastoral art, music-thanatology does not seek to cure, entertain or distract, but to heal and to ease the interior suffering that can attend the end of life — both for the dying and their loved ones.


"We speak about deathbed healing without curing, and experience it on a daily basis. There is often a release of emotion while we're playing," Schroeder-Sheker says. "I have seen so many broken families come together under crisis and, suddenly, the hospital bed becomes a sacred meeting ground, and genuine reconciliation and healing can and do occur."

Very Rev. David M. O'Connell, C.M., (right) presents Therese Schroeder-Sheker with an apolostic blessing from Pope John Paul II obtained through Father O'Connell's special request to the papal nuncio to the United States. Dean James Zabora, of the National Catholic School of Social Service (left), looks on.

Music-thanatologists work with patients who have six months or less to live, including those for whom death is imminent or who die during the session. "There are no limits on how many times a person can receive our service," Schroeder-Sheker explains. Sessions last approximately 45 minutes to an hour and may take place at home or in a hospice or hospital. Music-thanatologists often work in pairs. While they are usually paid by the hospital or hospice that has contracted their services, individuals may hire music-thanatologists on their own.


Schroeder-Sheker is a model for CUA music students since one of the music school’s stated goals is to expose students to new and imaginative musical careers.  Likewise, her visit to the nursing school gave students there a broader interpretation of healing.
"Caring for the dying forces one to confront one's own mortality and the mystery of suffering and pain," says Nalini Jairath, CUA's dean of nursing. "Our goal is to help patients 'die the good death.' Music-thanatology helps patients, nurses and families move toward this goal." 


CUA nursing student Ratana Charuwanno was so inspired by Schroeder-Sheker's Oct. 18 talk that she would like to bring the practice of music-thanatology to her native Thailand.  Knowledge of the harp is not a prerequisite to study music-thanatology, although a deep love of music is. “Students come from many different professions: nursing, social work, law, architecture. They bring with them a good deal of previously established discipline and wisdom, and they work very hard,” Schroeder-Sheker says.


While CUA hopes someday to collaborate with Schroeder-Sheker and establish a master’s degree program in music-thanatology, at this point the only way to become a certified music-thanatologist is through the Chalice of Repose Project. This involves at least two years of graduate study in music, medicine, liberal arts and theology, followed by a clinical internship, comprehensive exams and the completion of a professional paper. The coursework can be done through a distance-learning program (Web lectures and broadcasts) and the clinical internships can be served in several approved locations.


A medievalist and musicologist, Schroeder-Sheker became a lay oblate in the Benedictine order several years ago. She draws upon the history, repertoire and wisdom of monasticism in her dual careers as a clinician and as a concert and recording artist. The historical inspiration for music-thanatology is Benedictine Cluniac monastic medicine.  So Schroeder-Sheker was as comfortable speaking to students in music Professor Leo Nestor's sacred music seminar as she was visiting the course Theory and Models of Health Care taught by James Zabora, dean of the school of social service. The interdisciplinary nature of Schroeder-Sheker’s work and expertise has always required her to transcend departmental boundaries.


In addition to founding the field of music-thanatology, Schroeder-Sheker made her Carnegie Hall debut in 1980; has recorded CDs for Windham Hill, RCA, Celestial Harmonies and other labels; has composed extensively for harp, string quartets and a cappella chamber choral ensembles; has given concerts throughout the United States and Europe; and has written scholarly articles and a book called Transitus: A Blessed Death in the Modern World. She has been profiled on ABC News program "Nightline," "Dateline NBC" and on PBS and cable stations.


Although Schroeder-Sheker often travels and performs at other colleges and universities, she says she especially enjoys visiting CUA. This was her fifth visit (she has visited once a semester for the last five semesters) and she will be back again in March. "I've met such fabulous faculty members here, faculty members who really want to be here, who are very devoted to teaching and to what they can do for and with students in a values-centered atmosphere." For Schroeder-Sheker, "Catholic stands out like a shining light."


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